Strategies for cervical cancer screening in the scope of the Brazilian unified national health system

Abstract

Cervical cancer (CC) is the third most diagnosed malignancy among women in Latin America. CC control focuses on prevention methods: primary prevention is carried out to prevent Human Papillomavirus (HPV) infections, such as vaccination, while secondary prevention methods aim to detect and treat cervical premalignant lesions. In addition, cytology is used for triage, and many countries, including Brazil, still use it for this purpose. However, this method has significant limitations, such as low sensitivity and poor reproducibility. Some molecular assays are relevant, such as HPV testing. In this pilot study, a micro-costing analysis was done to compare cytology and HPV testing for cervical cancer screening in the Brazilian Unified Health System. For this assessment, a cross-sectional study was performed involving 500 women aged 18–55 years old without cervical precancer or cancer. The participants underwent cervical cytology and HPV testing. The overall prevalence of HPV infection was 25.2%. Among these HPV-infected women, 13.6% presented normal or inflammatory, cytology and were HPV positive by molecular assay. Most of these patients were infected with high-risk-HPV 16 and 18 and were asymptomatic. Oncotic cytology was the most cost-effective in the comparison between these two screening strategies. However, the molecular assay had a higher sensitivity and specificity when compared with cytology. HPV testing, despite the higher costs, may still be economically advantageous for CC control programs as it could reduce the cost of CC treatment in the public health system. In conclusion, although HPV testing is currently more expensive than cytology assay, its use would still be justified as it can reduce the economic and social impact due to cases not detected by cytology.