Retrato da Prevalência e Desigualdades na Participação em Rastreios Oncológicos de Base Populacional em Portugal

Autores

  • Carlota Quintal Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra; Centro de Estudos e Investigação em Saúde da Universidade de Coimbra (CEISUC). Coimbra.
  • Micaela Antunes Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal.

DOI:

https://doi.org/10.20344/amp.19443

Palavras-chave:

Detecção Precoce de Cancro, Factores Socioeconómicos, Neoplasias/diagnóstico, Neoplasias/prevenção e contolo, Portugal, Rastreio

Resumo

Introdução: Os rastreios reduzem a morbilidade e mortalidade associadas ao cancro. O objetivo deste estudo foi analisar os níveis de participação em rastreios oncológicos de base populacional em Portugal, e respetivas desigualdades.
Métodos: Os dados provêm do Inquérito Nacional de Saúde 2019. As variáveis utilizadas são: mamografia, citologia e a pesquisa de sangue oculto nas fezes. Calculámos prevalências e índices de concentração ao nível nacional e regional. Analisámos a participação ‘devida’ (idade/intervalo recomendados), ‘insuficiente’ (nunca ou em atraso), ‘excessiva’ (frequência superior à recomendada ou em idade não recomendada).
Resultados: A participação ‘devida’ atingiu 81,1%, 72% e 40%, enquanto a participação ‘insuficiente-nunca’ atingiu 3,4%, 15,7% e 39,9% para cancro da mama, cancro do colo do útero e cancro colorretal, respetivamente. A prevalência de participação ‘excessiva’ foi mais alta no cancro do colo do útero; relativamente ao cancro da mama, um terço das mulheres mais novas e um quarto das mulheres mais velhas fez mamografia. Este ‘excesso’ está concentrado nas mulheres com rendimento mais elevado. A participação ‘insuficiente-nunca’ está concentrada nos indivíduos com rendimentos mais baixos no cancro do colo do útero e nos rendimentos mais altos no colorretal. Acima da idade recomendada, 50% dos indivíduos nunca rastrearam para cancro colorretal e 41% das mulheres nunca o fizeram para cancro do colo do útero.
Conclusão: No rastreio do cancro da mama, no geral, a participação foi elevada e as desigualdades foram reduzidas. No cancro colorretal, a prioridade deve ser aumentar a participação no rastreio.

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Referências

World Health Organization. Globocan 2020. [cited 2022 Oct 05]. Available from: https://gco.iarc.fr/today/home.

Gini A, Jansen EE, Zielonke N, Meester RG, Senore C, Anttila A, et al. Impact of colorectal cancer screening on cancer-specific mortality in Europe: a systematic review. Eur J Cancer. 2020;127:224-35. DOI: https://doi.org/10.1016/j.ejca.2019.12.014

Basu P, Ponti A, Anttila A, Ronco G, Senore C, Vale DB, et al. Status of implementation and organization of cancer screening in the European Union Member States—summary results from the second European screening report. Int J Cancer. 2018;142:44-56. DOI: https://doi.org/10.1002/ijc.31043

Massat NJ, Dibden A, Parmar D, Cuzick J, Sasieni PD, Duffy SW. Impact of screening on breast cancer mortality: the UK program 20 years on. Cancer Epidemiol Biomarkers Prev. 2016;25:455-63. DOI: https://doi.org/10.1158/1055-9965.EPI-15-0803

von Karsa L, Ronc G, Ponti A, Malila N, Arbyn M, Segnan N, et al. Cancer screening in the European union: report on the implementation of the council recommendation on cancer screening – first report. Luxembourg: European Commission; 2008.

Direção-Geral da Saúde. Programa nacional para as doenças oncológicas. Avaliação e monitorização dos rastreios oncológicos organizados de base populacional. 2019/2020. Lisboa: DGS; 2021.

Tribunal de Contas. Auditoria ao acesso a cuidados de saúde oncológicos no SNS 2017-2020. Relatório N.11/2022, 2ª Secção. Lisboa: TC; 2022.

Serviço de Saúde da Região Autónoma da Madeira. Madeira inicia programa de rastreio de base populacional do cancro do colo do útero. 2022.

[cited 2022 Nov 08]. Available from: https://www.sesaram.pt/portal/o-sesaram/comunicacao/noticias/2503-madeira-inicia-programa-de-rastreio-de-basepopulacional-do-cancro-do-colo-do-utero.

Centro de Oncologia dos Açores. Relatório de atividades 2021. [cited 2022 Nov 08]. Available from: https://portal.azores.gov.pt/documents/37454/deb301cf-e881-3390-9175-ed4777b7ff11.

Portugal. Despacho n.º 8254/2017. Diário da República, II Série, n.º 183 (2017/09/21). p.20788-9.

Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, et al. Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates. BMC Public Health. 2018;18:1236. DOI: https://doi.org/10.1186/s12889-018-6155-5

Palència L, Espelt A, Rodríguez-Sanz M, Puigpinós R, Pons-Vigués M, Pasarín MI, et al. Socio-economic inequalities in breast and cervical cancer screening practices in Europe: influence of the type of screening program. Int J Epidemiol. 2010;39:757-65. DOI: https://doi.org/10.1093/ije/dyq003

World Health Organization. Everybody’s business: strengthening health systems to improve health outcomes: WHO’s framework for action. Geneva: WHO; 2007.

World Health Organization. The world health report 2000: health systems: improving performance. Geneva: WHO; 2000.

Burton-Jeangros C, Cullati S, Manor O, Courvoisier DS, Bouchardy C, Guessous I. Cervical cancer screening in Switzerland: cross-sectional trends (1992–2012) in social inequalities. Eur J Public Health. 2017;27:167-73. DOI: https://doi.org/10.1093/eurpub/ckw113

Willems B, Bracke P. Education gradient in cancer screening participation: a consistent phenomenon across Europe? Int J Public Health. 2018;63:93-103. DOI: https://doi.org/10.1007/s00038-017-1045-7

Mahumud RA, Keramat SA, Ormsby GM, Sultana M, Rawal LB, Alam K. et al. Wealth-related inequalities of women’s knowledge of cervical cancer screening and service utilisation in 18 resource-constrained countries: evidence from a pooled decomposition analysis. Int J Equity Health. 2020;19:42. DOI: https://doi.org/10.1186/s12939-020-01159-7

De Prez V, Jolidon V, Willems B, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer (over) screening in Belgium and Switzerland: trends and social inequalities. Eur J Public Health. 2020;30:552-57. DOI: https://doi.org/10.1093/eurpub/ckaa041

Jolidon V, De Prez V, Willems B, Bracke P, Cullati S, Burton-Jeangros C. Never and under cervical cancer screening in Switzerland and Belgium: trends and inequalities. BMC Public Health. 2020;20:1517. DOI: https://doi.org/10.1186/s12889-020-09619-z

Arbyn M, Rebolj M, De Kok IM, Fender M, Becker N, O’Reilly M, et al. The challenges of organising cervical screening programmes in the 15 old member states of the European Union. Eur J Cancer. 2009;45:2671–8. DOI: https://doi.org/10.1016/j.ejca.2009.07.016

Willems B, Bracke P. The impact of regional screening policies on the diffusion of cancer screening participation in Belgium: time trends in educational inequalities in Flanders and Wallonia. BMC Health Serv. Res. 2018;18:943. DOI: https://doi.org/10.1186/s12913-018-3746-x

Instituto Nacional de Estatística. Inquérito Nacional de Saúde 2019. 2020. [cited 2022 Nov 07]. Available from: https://www.ine.pt/xportal/xmain?xpid=INE&xpgid=ine_destaques&DESTAQUESdest_boui=414434213&DESTAQUESmodo=2.

Eurostat. Glossary: Equivalised disposable income. 2021. [cited 2023 Mar 29]. Available from: https://ec.europa.eu/eurostat/statistics-explained/index.php?title=Glossary:Equivalised_disposable_income.

Quintal C, Antunes M. Mirror, mirror on the wall, when are inequalities higher, after all? Analysis of breast and cervical cancer screening in 30 European countries. Soc Sci Med. 2022;312:115371. DOI: https://doi.org/10.1016/j.socscimed.2022.115371

Devaux M. Income-related inequalities and inequities in health care services utilisation in 18 selected OECD countries. Eur J Health Econ. 2015;16:21-33. DOI: https://doi.org/10.1007/s10198-013-0546-4

Mullachery P, Silver D, Macinko J. Changes in health care inequity in Brazil between 2008 and 2013. Int J Equity Health. 2016;15:140. DOI: https://doi.org/10.1186/s12939-016-0431-8

San Sebastián M, Mosquera PA, Ng N, Gustafsson PE. Health care on equal terms? Assessing horizontal equity in health care use in Northern Sweden. Eur J Public Health. 2017;27:637-43. DOI: https://doi.org/10.1093/eurpub/ckx031

Quintal C, Antunes M. Equidade na utilização de consultas médicas em Portugal: na saúde e na doença, na riqueza e na pobreza?, Acta Med Port. 2020;33:93-100. DOI: https://doi.org/10.20344/amp.12278

The Organization for Economic Cooperation and Development. Health for everyone? In: Social Inequalities in Health and Health Systems, OECD Health Policy Studies. Paris: OECD Publishing; 2019.

O’Donnell O, van Doorslaer E, Wagstaff A, Lindelow M. Analyzing Health equity using survey data: a guide to techniques and their implementation. Washington, DC: The World Bank; 2008. DOI: https://doi.org/10.1596/978-0-8213-6933-3

O’Donnell O, O’Neill S, Van Ourti T, Walsh B. Conindex: estimation of concentration indices. Stata J. 2016;16:112-38. DOI: https://doi.org/10.1177/1536867X1601600112

Khan H, Shaaban N, Peleteiro B. Faecal occult blood test and colonoscopy use in Portugal: results from the National Health Survey 2014. J Med Screen. 2020;27:171-85. DOI: https://doi.org/10.1177/0969141319891456

Dourado F, Carreira H, Lunet N. Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey. Eur J Public Health. 2013;23:386-92. DOI: https://doi.org/10.1093/eurpub/cks103

Chkotua S, Peleteiro B. Peer reviewed: mammography use in Portugal: national health survey 2014. Prev Chronic Dis. 2017;14:e100. DOI: https://doi.org/10.5888/pcd14.170054

Oliveira M, Peleteiro B, Lunet N. Cytology use for cervical cancer screening in Portugal: results from the 2005/2006 National Health Survey. Eur J Public Health. 2014;24:253-8. DOI: https://doi.org/10.1093/eurpub/ckt077

Rukhadze L, Lunet N, Peleteiro B. Cervical cytology use in Portugal: results from the National Health Survey 2014. J Obstet Gynaecol Res. 2019:45:1286-95. DOI: https://doi.org/10.1111/jog.13974

Bartley SJ, Benard V, Tai E, Rockwell T, Kenney K, Richardson LC. Are uninsured women in a national screening program having longer intervals between cervical cancer screening tests? Prev Med. 2020;135:106078. DOI: https://doi.org/10.1016/j.ypmed.2020.106078

Regional Health Administration of Algarve. Activity report 2018. [cited 2023 Mar 29]. Available from: https://www.arsalgarve.min-saude.pt/wp-content/uploads/sites/2/2019/09/Relatorio_de-_Atividades_2018_ARS_Algarve_homologado.pdf.

Howard M, Agarwal G, Lytwyn A. Accuracy of self-reports of pap and mammography screening compared to medical record: a meta-analysis. Cancer Causes Control. 2009;20:1. DOI: https://doi.org/10.1007/s10552-008-9228-4

Aranda E, Franck JE, Ringa V, Sassenou J, Coeuret-Pellicer M, Rigal L, et al. Social inequalities in participation in cancer screening: does the mode of data collection matter? The CONSTANCES cohort. Eur J Publ Health. 2021;31:602-8. DOI: https://doi.org/10.1093/eurpub/ckab055

Brown RF, Muller TR, Olsen A. Australian women’s cervical cancer screening attendance as a function of screening barriers and facilitators. Soc Sci Med. 2019;220:396-402. DOI: https://doi.org/10.1016/j.socscimed.2018.11.038

Vaccarella S, Lortet-Tieulent J, Saracci R, Conway DI, Straif K, Wild CP. Reducing social inequalities in cancer: evidence and priorities for research, vol. 168. IARC Scientific Publications. Lyon: IARC; 2019.

Monteiro H, Tavares F, Reis J, Ferreira G, Campos MJ, Costa S, et al. Colorectal screening program in northern Portugal: first findings. Acta Med Port. 2022;35:164-9. DOI: https://doi.org/10.20344/amp.15904

Publicado

2023-06-19

Como Citar

1.
Quintal C, Antunes M. Retrato da Prevalência e Desigualdades na Participação em Rastreios Oncológicos de Base Populacional em Portugal. Acta Med Port [Internet]. 19 de Junho de 2023 [citado 22 de Novembro de 2024];36(9):577-8. Disponível em: https://actamedicaportuguesa.com/revista/index.php/amp/article/view/19443

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