Factors associated with abnormal PAP Smears in a health center X – Costa Rica, 2009 Leandra Abarca...
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Transcript of Factors associated with abnormal PAP Smears in a health center X – Costa Rica, 2009 Leandra Abarca...
Factors associated with abnormal PAP Smears in a health center X – Costa Rica, 2009
Leandra Abarca 1 , Julia Freer1, Maricela Salas2
1,MD, MsC, FETP, Caja Costarricense de Seguro Social, 2, MD, MsC, Caja Costarricense del Seguro Social
Background
Incidence Rate Mortality Rate
1, Skin
44,5 1, Breast 13,4
2, Breast 40,1 2, Stomach 8,7
3, Cervical 17,4 3, Colorectal
5,5
4, Stomach 16,9 4, Cervical 4,9
5, Colorectal
9, 8 5, Lung 3,2
• Cervical cancer is among the leading causes of cancer in women globally
• In Costa Rica it is among the top five causes *
* INEC: Incidence and Mortality Rate / 100 000 Hab- 2007
Background (II)
• Early detection of premalignant or malignant cells through PAP smears improves prognosis
• The PAP smears is part of the national screening guidelines, but the coverage in some areas of health is low
Cervical Cancer Screening in Costa Rica Social Security
Sexually active women
· PAP Smears· General physician
· PAP Smears· Colposcopy· Gynecologist· Oncologist
CommunityFirst and second level health care
Third level health care
• The medical care is public (CCSS) in 90% and a percentage of private medical establishments
Geographical location of health center X , Costa Rica
• Located in the heart of the capital
• Population:94,145 ( 47,958 women)
• This center heath sees an urban population
• Very good accessibility to health services
• Do not perform colposcopy
Objective
• Identify demographic and clinical factors associated with abnormal Pap Smears in this center during 2009 to improve prevention and control strategies
Methods
• Study Design: We conducted a health center-based case control study• Data collection instruments: Questionnaire administered through personal
interviews Questions included sociodemographic, medical
history, sexual behavior and alcohol and tobacco use
Methods (II) • Case definition: Case: was defined as any woman seeking care in a
health center during 2009, having abnormal PAP smear
We defined abnormal as PAP smear positive for either cells of undetermined significance (ASCUS), mild, moderate or severe dysplasia
• Control: was defined women seen at the same health
centers in 2009 and having normal PAP smears
Methods (III)
• Sampling Selection : Simple random sampling• Data analysis: Proportions, odds ratios 95% Confidence
Intervals (CI) were calculated for associations between potential risk factors and abnormal PAP smears
• Software used : Epiinfo 3,3,2 & Stata 10,1
General characteristics as a group, Health Center, Costa Rica 2009
Case Control Frequency Frequency n % n % Age group Less than 35 years 20 32 51 3735 years and older 42 68 86 63 Civil Status Married 29 39 58 43Single 16 26 34 25Free Union 12 19 23 17Divorced 5 8 11 8Widow 5 8 10 7
Frequency of PAP smears every 2 years 47 75 113 82 Family history of cervical cancer 7 11 11 8 Tobaco use 30 48 39 29 Alcohol 22 36 37 27
Case Control Frequency Frequency n % n %
Onset of sexual activity before 18 years old 40 65 71 52after 19 years old 22 35 66 48 Number of sexual parthers > 3 sexual partners 36 58 37 27< 3 sexual parthers 26 42 100 73
Contraceptive Methods Hormonal contraception 25 44 44 32
Non-hormonal contraception 37 60 56 41
General characteristics as a group, Health Center, Costa Rica 2009 (II)
Analysis of factors associated abnormal PAP smears health center X, Costa Rica, 2009
95%CI OR IL SL Age group >35 years old 1,25 0,63 2,47 Frequency of PAP smears every 2 years 0,6 0,3 0,92 Family history of cervical cancer 1,45 0,5 3,95 Tobaco use 2,4 1,21 4,60 Vaginal delivery 1,78 0,81 3,94 Onset of sexual activity before 18 years old 1,95 1,04 3,85 Number of sexual parthers > 3 sexual partners 2,10 1,1 3,97 Contraceptive Methods Hormonal contraception 1,6 0,9 3,1
Discussion
• Similarity between our results and those in the literature as onset of sexual activity before age 18 and having a history of > 3 sexual partners
• Smoking is considered a factor associated with abnormal Pap Smears
Discussion (II)
• PAP smears every 2 years would help early detection of precancerous lesions
• Delaying first age of sex or reducing # of partners may help to reduce risk of abnormal Pap in the future
Limitations
• Our study was limited by the failure to follow-up colposcopy results for final diagnosis
• No determination of HPV in all the health social security
• Population studied is not representative of all the population in Costa Rica
Recommendations
• Dissemination of the results to local and central health authorities to generate intervention strategies
• Improve strategies for not smoking in the population of the area studied
• Doing this nationwide study, to be more representative and thus create or strengthen health care policy
Actions
• Workshop development and reproductive health in schools in the area
• Inclusion in the National Survey of Risk Factors for Noncommunicable Diseases questions about risk factors associated with Cervical Cancer, representing all the population