Prevalence and social inequalities in the use of cancer screening tests in Campinas, Brazil (ISACamp 2014/15).

Abstract

Objective: To analyze the prevalence of early detection tests for cervical, breast, prostate, and colorectal cancers in the population of Campinas, São Paulo and the presence of social inequalities in access.

Methods: Population-based cross-sectional study using data from ISACamp 2014/15. Dependent variables were the performance of Pap smear, mammogram, prostate-specific antigen (PSA), fecal occult blood test (FOBT) and colonoscopy/sigmoidoscopy within the age ranges recommended by national guidelines. Independent variables included sex, age, schooling, income, race/skin color, and private health insurance. Prevalence and prevalence ratio adjusted for sex and age were estimated using Poisson regression. Analyses were performed using Stata 14, considering sampling weights.

Results: The prevalence of mammography (77.7%) and Pap smear (87.8%) met the targets set by the Brazilian Ministry of Health, while FOBT (22.3%) and colonoscopy/sigmoidoscopy (21.5%) showed low coverage. PSA testing in the previous three years was reported by 55.2% of eligible men. Higher prevalence of test performance was observed among individuals with higher schooling and income levels and those with private health insurance. Inequalities varied by type of test. For instance, individuals with private health insurance had 11 and 162% higher prevalence of Pap test and colonoscopy/sigmoidoscopy, respectively, compared to those without insurance. Racial inequality was observed only for mammography.

Conclusion: The results indicate high coverage and lower inequalities for Pap and mammography, and low coverage with significant disparities for FOBT and colonoscopy/sigmoidoscopy. Findings highlight the need to monitor coverage and to implement public policies aimed at reducing inequities in access to cancer screening.