Análise da estratégia de rastreio do câncer do colo do útero por autocoleta e teste rápido para HPV em mulheres ribeirinhas do município de Coari/AM

Abstract

According to the International Agency for Research on Cancer (IARC), cervical cancer is the fourth most common cause of cancer among women worldwide. The relation of HPV with cervical cancer is already well established. The Amazon region is the world's region with the highest proportion of cervical cancer rate. Prevention of cervical cancer (CC) in Brazil, as in many other countries, is based on cytological examinations using the Papanicolaou method. However, screening for cervical cancer is a critical health service, which is often unavailable to women in resource-poor countries. The ability to collect samples by self-collection would be a welcome alternative, allowing part of the population to be covered, who does not have access to prevention programs or tends to avoid them due to fear of embarrassing exams, thus increasing coverage rates in the state of Amazonas.This study aims to analyze the screening strategy for cervical cancer by self-collection and a rapid test for HPV, among women living in riverfront populations in Coari / Amazonas (Brazil). This is a cross-sectional study of 412 women from such populations from Coari from August 2014 to February 2015, whose sample was obtained in their homes by using self-collection devices (brush Rovers® Evalyn®). The samples were processed using the rapid test Onco ™ E6 (Arbor Vita Corporation, stroke), followed by the test for DNA of HPV by PCR in house, targeting the L1 region of the virus and genotyping by PapilloCheck® (Greiner Bio-One, Germany). Women who screened positive for one of the test were submitted to a colposcopic evaluation, and to a histopathological exam when necessary. Informed consent was requested and a confidential and anonymous questionnaire was distributed with questions regarding socio-economic issues, clinical and behavioral questions, as well as concerning the acceptance of self-collection. For the analysis of categorical variables, we used the absolute and relative frequency and for numerical variables we used the mean ± ds, for the association of variables with HPV infections, we used the chi-square test de Pearson ( ᵡ2) and/or Fisher's exact test, using Epi info, version 7.0 software. All 412 women provided independent samples. The self-collection with Rovers® Evalyn® brush was a tool accepted by 97.8 % of the women interviewed and was considered easy by 95.4 % of the participants. The possibility of using self-collection together with the Onco E6 ™ rapid test in remote areas of difficult access would be a good alternative to increasing screening coverage in the state of Amazonas. The prevalence of the HPV infection was 18.7 %, and most common genotypes found by the technique of Papillocheck® were HPV 51 (1.94 % ), HPV 16 (1.7%) , HPV 53 (1.2%) and HPV 18 (1%). There were also detected 9 histopathological changes (5 cases of CIN I, 2 CINIII, 2 invasive carcinomas).