Población objetivo del tamizaje de cáncer cervicouterino en el sistema público de atención chileno y su relación con la cobertura de PAP. Implicancias en políticas de salud y asignación de recursos públicos

Abstract

Pap smear coverage in Chile has gradually decreased in the last years, from 67% to 59%, making it necessary to determine the causes of this decline. Aim: To analyze the relationship between the characteristics of the cervical cancer screening target population in the public health care system and the percentage of PAP coverage. Material and Methods: This study was carried out in women aged between 25 and 64 years, belonging to a public health care system and registered in any of the eight primary healthcare centers of a Metropolitan Santiago low income community. The analysis considered information from the recruitment database (n = 6,058) and interviewed women database (n = 1,042). Results: In 52% of cases there were difficulties in recruiting women, mainly due to wrong addresses. Among contacted women, 4.1% had a hysterectomy or had cervical cancer and 1.4% were dead. When analyzing the variable “adherence to cervical cancer screening” in the interviewed women, 76.8% reported to comply with the ministerial guidelines. From that group, 20.5% reported to attend screening at the private health care system. Seventy seven percent of women who had timely screening visits, reported attending screening periodically every 3 years or less. Conclusions: Pap smear coverage must be analyzed considering the different factors that affect it. Among the latter, the exclusion of some women from the target population and performing the screening in private clinics stand out.