Cervical cancer in Brazil: a retrospective on public policies for women’s health

Abstract

Cervical cancer is the third most frequent neoplasm among Brazilian women, with a mortality rate of more than 5/100 thousand women, despite having a good prognosis when diagnosed in the early stages. In Brazil, public policies for cervical cancer have been developed since the 1970s and have included several screening programs that have been able to increase access to the Papanicolaou test, with a stable coverage level in recent years, around 83%. In 2014, the anti-HPV vaccine was included in the National Vaccination Calendar. The most recent Strategic Action Plan has targets to increase coverage of cytopathological examination and treatment of all women with precursor lesions. Two other initiatives were created: the Qualification Program of Gynecologists for Secondary Care for Women with Cytologic Alterations Related to Intraepithelial Lesions and Cervical Cancer, and the formalization of the Collaborative Network for the Prevention of Cervical Cancer. Even with constant progress of these measures, more than 70% of Brazilian women are diagnosed in advanced stages of the disease, which negatively impacts the prognosis. The analysis of treatment protocols aimed at public health shows lag in relation to international and national scenario recommended by medical societies, especially in the treatment of late stage disease. Despite the advances in the dissemination of preventive measures and the scope of extensive screening coverage, cervical cancer remains a major health problem in the country.