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Authors
Abstract(s)
O cancro do colo do útero representa um grave problema de saúde pública mundial. Afeta
anualmente mais de 500.000 mulheres em todo o mundo, sendo a quarta causa de morte
por cancro nas mulheres. A redução da mortalidade observada nos últimos anos, em países
de elevados recursos, reflete o impacto dos programas de rastreio, com aumento das taxas
de cobertura, bem como das taxas de adesão, pela maior consciencialização das mulheres.
Virtualmente, todos os casos de cancro do colo do útero são atribuíveis à infeção pelo vírus
do papiloma humano (HPV). A prevenção deste cancro assenta em duas estratégias: a
prevenção primária, através a vacinação contra o HPV e a prevenção secundária, com o
rastreio, o qual permite a deteção e tratamento de lesões pré-cancerosas ou cancerosas
iniciais.
O método de rastreio tradicional tem por base a realização de citologia e a sua utilização em
programas de rastreio organizado levou a uma redução de 70-80% na incidência e
mortalidade por cancro do colo do útero. No entanto, este método apresenta algumas
limitações, das quais se destacam a fraca reprodutibilidade, a baixa sensibilidade
(especialmente na população vacinada) e a baixa acuidade na deteção de lesões glandulares.
O teste de HPV é mais reprodutível que a citologia e apresenta elevada sensibilidade na
deteção de lesões precursoras do cancro do colo do útero, com elevado valor preditivo
negativo.
Até recentemente, em Portugal, o rastreio de base populacional deste cancro apresentava
diferentes modalidades conforme a região, que incluíam maioritariamente a citologia
(convencional ou em meio líquido). Em 2017 foi decretado um programa nacional de
rastreio do cancro do colo do útero, com base no teste primário de HPV em mulheres com
mais de 25 anos, que se encontra atualmente em fase de implementação.
Pretende-se, com este trabalho, fazer uma revisão bibliográfica dos métodos de rastreio de
cancro do colo do útero, desenvolvendo uma abordagem comparativa no sentido de
clarificar as razões da mudança de paradigma observada nos últimos anos.
Cervical cancer represents a serious public health problem worldwide. Each year, it affects more than 500,000 women worldwide, being the fourth leading cause of cancer death in women. The reduction in mortality observed in the past years in high income countries reflects the impact of screening programs, with increasing coverage rates, as well as the increase in adherence rates, due to the greater awareness of women. Virtually all cases of cervical cancer are attributable to infection by human papilloma virus (HPV). Prevention of this cancer is based on two strategies: primary prevention, through vaccination against HPV and secondary prevention with screening, which allows the detection and treatment of precancerous or cancerous lesions. The traditional screening method is based on cytology that when used in organized screening programs led to a reduction of 70-80% in the incidence and mortality from cervical cancer. However, this method has some limitations, which include poor reproducibility, low sensitivity (especially in vaccinated population) and low accuracy in detecting glandular lesions. The HPV test is more reproducible than cytology and has high sensitivity in detecting precursor lesions of cervical cancer, with a high negative predictive value. In Portugal, until recently, population-based screening had different modalities depending on the region, which mostly included cytology (conventional or liquid-based). In 2017 a national cervical cancer screening program was decreed using the HPV test as primary screening method in women over 25 years old, which is currently being implemented. The aim of this work is to make a bibliographic review of cervical cancer screening methods, developing a comparative approach in order to clarify the reasons for the paradigm shift observed in the last years.
Cervical cancer represents a serious public health problem worldwide. Each year, it affects more than 500,000 women worldwide, being the fourth leading cause of cancer death in women. The reduction in mortality observed in the past years in high income countries reflects the impact of screening programs, with increasing coverage rates, as well as the increase in adherence rates, due to the greater awareness of women. Virtually all cases of cervical cancer are attributable to infection by human papilloma virus (HPV). Prevention of this cancer is based on two strategies: primary prevention, through vaccination against HPV and secondary prevention with screening, which allows the detection and treatment of precancerous or cancerous lesions. The traditional screening method is based on cytology that when used in organized screening programs led to a reduction of 70-80% in the incidence and mortality from cervical cancer. However, this method has some limitations, which include poor reproducibility, low sensitivity (especially in vaccinated population) and low accuracy in detecting glandular lesions. The HPV test is more reproducible than cytology and has high sensitivity in detecting precursor lesions of cervical cancer, with a high negative predictive value. In Portugal, until recently, population-based screening had different modalities depending on the region, which mostly included cytology (conventional or liquid-based). In 2017 a national cervical cancer screening program was decreed using the HPV test as primary screening method in women over 25 years old, which is currently being implemented. The aim of this work is to make a bibliographic review of cervical cancer screening methods, developing a comparative approach in order to clarify the reasons for the paradigm shift observed in the last years.
Description
Keywords
Cancro do Colo do Útero Citologia Hpv Rastreio Teste de Hpv