Effectiveness of cytology-based cervical cancer screening in the Colombian health system

Introduction. Despite the implementation of cytological screening since 1991, cervical cancer continuous to be the leading cause of cancer mortality among Colombian women. Objectives. The effectiveness of cytology-based cervical cancer screening was subjected to review in the context of the Colombian health system. Materials and methods. A case-control study was done. Invasive cervical cancer cases between 25-69 years were recruited and histopathological confirmation was required. Controls without invasive cancer were matched by age and neighborhood. Cases and controls were recruited in four Colombian provinces representing different settings for cervical cancer control with respect to program performance and mortality rates. The cases were randomly selected from the pathology in each province (year 2005). A survey of risk factors and cytology history in the previous 72 months was conducted. Results. Fifty cases and 50 controls in each department were enrolled for a total of 400 subjects. The average age was 48.4 years, illiteracy 12.5%, and persons without health insurance 13.8%.The average number of Pap-smears was higher among controls (p<0.01). Cases with a Papsmear in the previous 36 months was nearly half (49.5%). Oral contraceptives and the lack of cytology were associated with invasive cervical cancer. Conclusions. Cytology-based screening continued to be effective for early detection of cervical cancer in Colombia but its effectiveness was determined by quality of Pap-smears rather than by screening coverage. Governmental guidelines need to be revisited. Case-control studies provided a useful tool for evaluation of the screening program.