Evaluation of Quality Indices after Measures Promoted by External Monitoring of the Quality of Cervical Cytopathology Exams Performed by SUS in Espírito Santo
DOI:
https://doi.org/10.32635/2176-9745.RBC.2025v71n1.4858Keywords:
Uterine Cervical Neoplasms/prevention & control, Cervix Uteri/cytology, Quality Assurance, Health Care, Preventive Health ServicesAbstract
Introduction: In recent decades, despite efforts by the Ministry of Health to expand access to screening programs and monitor the quality of cytopathological exams, morbidity and mortality rates from cervical cancer in Brazil have remained high. The persistence of these rates suggests flaws in the programs, probably due to low population coverage, failures in monitoring, and errors in the process of collecting and interpreting tests. To improve the prevention and screening of cervical cancer in Espírito Santo, the External Quality Monitoring Unit (UMEQ/Lacen-ES) implemented, in 2023, actions in partnership with laboratories that provide services to the SUS. Objective: To evaluate the impact of these actions on the quality of cytopathological exams. Method: The study compared quality indicators of exams obtained through SISCAN from 2023 to the previous five years, as well as evaluating the indicators of each provider between the years 2022 and 2023. Results: Significant improvements were observed, such as increased diagnoses of precursor lesions and a more adequate proportion of diagnoses, reflecting greater effectiveness in preventing cervical cancer in the state. Furthermore, there was an improvement in the quality standards of laboratories throughout the period. Conclusion: The actions implemented by UMEQ/Lacen-ES will contribute to improving the tracking and prevention of the disease, although it is necessary to continue investing in new technologies and the application of protocols to ensure agility and safety in the treatment of patients.
Downloads
References
Singh D, Vignat J, Lorenzoni V, et al. Global estimates of incidence and mortality of cercical cancer in 2020: a baseline analysis of the WHO Global Cervical Cancer Elimination Iniciative. Lancet Glob Health. 2023;111:197-206. doi: https://doi.org/10.1016/s2214-109x(22)00501-0 DOI: https://doi.org/10.1016/S2214-109X(22)00501-0
Sung H, Ferlay J, Siegel RC, et al. Global Cancer Statistics 2020: globocan worldwide incidence and mortality estimates for 36 cancers in 185 countries. CA Cancer J Clin. 2021;71(3):209-49. doi: https://doi.org/10.3322/caac.21660 DOI: https://doi.org/10.3322/caac.21660
Instituto Nacional de Câncer. Dados e números sobre câncer do colo do útero – relatório anual 2023. Rio de Janeiro: INCA; 2023.
Tallon B, Monteiro D, Soares L, et al. Tendência da mortalidade por câncer de colo no Brasil em 5 anos (2012-2016). Saúde debate. 2020;44(125):362-71. doi: https://doi.org/10.1590/0103-1104202012506 DOI: https://doi.org/10.1590/0103-1104202012506
Alliance for Cervical Cancer Prevention. Planning and implementing cervical cancer prevention and control programs: a manual for managers. Seattle: ACCP; 2004.
Torres-Roman JS, Ronceros-Cardenas L, Valcarel B, et al. Cervical câncer mortality among young women in Latin America and the Caribbean: trend analysis from 1997 to 2030. BMC Public Health. 2022;22:113. doi: https://doi.org/10.1186/s12889-021-12413-0 DOI: https://doi.org/10.1186/s12889-021-12413-0
Atlas On-line de Mortalidade [Internet]. Rio de Janeiro: Instituto Nacional de Câncer José Alencar Gomes da Silva; c1996-2014. [acesso 2024 maio 24]. Disponível em: https://www.inca.gov.br/MortalidadeWeb/pages/Modelo06/consultar.xhtml#panelResultado
Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes brasileiras para o rastreamento do câncer do colo do útero. 2 ed. Rio de Janeiro: INCA; 2016.
Azevedo e Silva G, Damascena GN, Ribeiro CM, et al. Exame de papanicolaou no brasil: análise da pesquisa nacional de saúde em 2013 e 2019. Rev de Saúde Publica. 2023;57:55. doi: https://doi.org/10.11606/s1518-8787.2023057004798 DOI: https://doi.org/10.11606/s1518-8787.2023057004798
Tsuchiya CT, Lawrence T, Klen MS, et al. O câncer de colo do útero no Brasil: uma retrospectiva sobre as políticas públicas voltadas à saúde da mulher. J Bras Econ Saúde. 2017;9(1):137-47. doi: https://doi.org/10.21115/JBES.v9.n1.p137-47 DOI: https://doi.org/10.21115/JBES.v9.n1.p137-47
Dias MB, Alcântara LL, Girianelli VR, et al. Rastreamento do câncer do colo do útero em mulheres de 25 a 64 anos: indicadores do primeiro exame citopatológico informado no Siscolo, 2007-2013. Rev Bras Cancerol. 2022;68(1):e-111520. doi: https://doi.org/10.32635/2176-9745.RBC.2022v68n1.1520 DOI: https://doi.org/10.32635/2176-9745.RBC.2022v68n1.1520
Ribeiro CM, Dias MB, Pla MAS, et al. Parâmetros para a programação de procedimentos da linha de cuidado do câncer do colo do útero no Brasil. Cad Saúde Pública. 2019;35(6):e00183118. doi: https://doi.org/10.1590/0102-311X00183118 DOI: https://doi.org/10.1590/0102-311x00183118
World Health Organization. World Health Organization guideline for screening and treatment of cervical pre-cancer lesions for cervical cancer prevention [Internet]. 2 ed. Geneva: World Health Organization; 2021. [acesso 2024 jun 3]. Disponível em: https://www.who.int/publications/i/item/9789240030824
Ministério da Saúde (BR). Nota técnica n°5/2020-DESF/SAPS/MS. Indicadores de Pagamento por Desempenho do Programa Previne Brasil (2020). Sistema Eletrônico de Informações (SEI), Brasília, DF. 2020 jan 31. [Acesso 2024 jun 3]. Disponível em: https://www.gov.br/saude/pt-br/composicao/saps/publicacoes/notas-tecnicas/nota-tecnica-no-5-2020-desf-saps-ms/view
Tribunal de Contas do Estado do Espírito Santo. Relatório final auditoria operacional câncer de colo de útero – Processo 06598/2022-1 [Internet]. Vitória: TCEES; 2024. [Acesso 2024 dez 16]. Disponível em: https://www.tcees.tc.br/wp-content/uploads/2023/03/RelatoriodeAuditoria-Cancer-de-colo-de-utero.pdf
Silva GA, Jardim BC, Ferreira V M, et al. Mortalidade por câncer nas capitais e no interior do Brasil: uma análise de quatro décadas. Rev saúde pública. 2020;54:126. doi: https://doi.org/10.11606/s1518-8787.2020054002255 DOI: https://doi.org/10.11606/s1518-8787.2020054002255
Instituto Nacional de Câncer José de Alencar Gomes da Silva. Manual de gestão da qualidade para laboratórios de citopatologia. 2 ed. Rio de Janeiro: INCA; 2016.
SISCAN: Sistema de Informação do Câncer [Internet]. Brasília, DF: DATASUS; 2024. [Acesso 2024 maio 13]. Disponível em: http://tabnet.datasus.gov.br/cgi/dhdat.exe?SISCAN/cito_colo_atendes.def
Marques JPH, Costa LB, Souza e Pinto, AP, et al. Células glandulares atípicas e câncer de colo uterino: revisão sistemática. Rev Assoc Med Bras. 2011;57(2):234-8. doi: https://doi.org/10.1590/S0104-42302011000200024 DOI: https://doi.org/10.1590/S0104-42302011000200024
Hammoud MM, Haefner HK, Michael CW, et al. Atypical glandular cells of undetermined significance. Histologic findings and proposed management. J Reprod Med. 2002;47(4):266-70.
Conselho Nacional de Saúde (BR). Resolução n° 510, de 7 de abril de 2016. Dispõe sobre as normas aplicáveis a pesquisas em Ciências Humanas e Sociais cujos procedimentos metodológicos envolvam a utilização de dados diretamente obtidos com os participantes ou de informações identificáveis ou que possam acarretar riscos maiores do que os existentes na vida cotidiana, na forma definida nesta Resolução [Internet]. Diário Oficial da União, Brasília, DF. 2016 maio 24 [acesso 2024 abr 7]; Seção 1:44. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/cns/2016/res0510_07_04_2016.html
Baasland I, Vie GA, Romundstad PR, et al. Cervical cancer mortality in Norway according to screening attendance and age. Acta Obstet Gynecol Scand. 2022;101:952-9. doi: https://doi.org/10.1111/aogs.14402 DOI: https://doi.org/10.1111/aogs.14402
Cardoso Filho LI, Tavares SBN, Siqueira MLB, et al. Internal quality control indicators in cervical cytopathology of a university laboratory. Cytopathology. 2018;29(4):355-60. doi: https://doi.org/10.1111/cyt.12571 DOI: https://doi.org/10.1111/cyt.12571
Rocha VSO, Malfacini SS, Gomes AM, et al. External quality monitoring of the cervical cytopathological exams in the Rio de Janeiro City. Rev Bras Ginecol Obstet. 2018;40:338-46. doi: https://doi.org/10.1055/s-0038-1657755 DOI: https://doi.org/10.1055/s-0038-1657755
Tobias AHG, Amaral RG, Diniz EM, et al. Quality indicators of cervical cytopathology tests in the public service in Minas Gerais, Brazil. Rev Bras Ginecol Obstet. 2016;38(2):65-70. doi: https://doi.org/10.1055/s-0035-1571175 DOI: https://doi.org/10.1055/s-0035-1571175
Ázara CZS, Manrique EJC, Tavares SBN, et al. Internal quality control indicators of cervical cytopathology exams performed in laboratories monitored by the External Quality Control Laboratory. Rev Bras de Ginecol Obstet. 2014;36(9):398-403. doi: https://doi.org/10.1590/so100-720320140004996 DOI: https://doi.org/10.1590/SO100-720320140004996
Silva EGA, Lima DM, Meira BS, et al. Rastreamento do câncer de colo do útero na Bahia: avaliação da cobertura, adesão, adequabilidade e positividade das citopatologias realizadas entre 2017 e 2021. RBAC. 2023;55(2):123-35. doi: https://doi.org/10.21877/2448-3877.202300059 DOI: https://doi.org/10.21877/2448-3877.202300059
Santos MJS, Ribeiro AA. Estratégias utilizadas para melhorar a qualidade dos exames citopatológicos. Rev Bras Cancerol. 2020;66(1):e-05104. doi: https://doi.org/10.32635/2176-9745.RBC.2020v66n1.104 DOI: https://doi.org/10.32635/2176-9745.RBC.2020v66n1.104
Dias LM, Montagner MI. O efeito da pandemia de COVID-19 na coleta de material de colo do útero para exame citopatológico no Brasil. TEMPUS. 2023;17(4):169-89. doi: https://doi.org/10.18569/tempus.v17i4.3157 DOI: https://doi.org/10.18569/tempus.v17i4.3157
Turkiewicz M, Plewka J, Santos MA, et al. Os impactos da qualidade nos exames citopatológicos do colo do útero, numa cidade de tríplice fronteira, na pandemia de COVID-19. RSD. 2022;11(6):e52411629428. doi: https://doi.org/10.33448/rsd-v11i6.29428 DOI: https://doi.org/10.33448/rsd-v11i6.29428
Ribeiro CM, Correa FM, Migowski A. Short-term effects of the COVID-19 pandemic on cancer screening, diagnosis and treatment procedures in Brazil: a descriptive study, 2019-2020. Epidemiol Serv Saude. 2022;31(1):e2021405. doi: https://doi.org/10.1590/s1679-49742022000100010 DOI: https://doi.org/10.1590/s1679-49742022000100010
Corrêa FM, Migowski A, Almeida LM, et al. Cervical cancer screening, treatment and prophylaxis in Brazil: current and future perspectives for cervical cancer elimination. Front Med (Lausanne). 2022;9:945621. doi: https://doi.org/10.3389/fmed.2022.945621 DOI: https://doi.org/10.3389/fmed.2022.945621
Published
How to Cite
Issue
Section
License
Os direitos morais e intelectuais dos artigos pertencem aos respectivos autores, que concedem à RBC o direito de publicação.
This work is licensed under a Creative Commons Attribution 4.0 International License.
