Impacto de variáveis médicas e da organização laboratorial na qualidade do rastreamento do câncer do colo uterino no Brasil
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Data
2019-02-22
Autores
Salomé, Luciana Gusmão de Andrade Lima
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Universidade Estadual Paulista (Unesp)
Resumo
O câncer do colo uterino mantém altas taxas de incidência e mortalidade no Brasil, apesar do Programa Viva Mulher ter ampliado muito o acesso ao teste de Papanicolaou. O rastreamento desta neoplasia através do exame citológico foi responsável por redução significativa da sua ocorrência em países desenvolvidos, que monitoram a qualidade deste método em todos os passos que envolvem sua realização. Entretanto, essa realidade não é observada regularmente nos países em desenvolvimento. Partindo desta constatação, esse trabalho tem como foco as análises da visão do patologista brasileiro sobre o exame citológico e de critérios médicos necessários para melhorar a qualidade do rastreamento. Para tanto, foi realizado estudo descritivo observacional constituído por uma análise qualitativa reunindo entrevistas com patologistas, e pela aplicação de um questionário aos patologistas brasileiros, com perguntas sobre a estrutura de serviços que realizam exames citológicos no país. Os resultados evidenciaram claramente a preocupação deste profissional com seu afastamento do programa de rastreamento e com a necessidade de um controle de qualidade mais criterioso. Também foi observada uma crítica relação entre as falhas do rastreamento citológico, a atuação do patologista e a estrutura dos serviços responsáveis por este exame. Assim, o estudo identificou a imperativa necessidade de educação continuada dos profissionais responsáveis pelo exame citológico do colo uterino, além da implementação de um controle de qualidade externo amplo e criterioso.
The uterine cervix's cancer maintains high rates of incidence and mortality in Brazil, despite of the fact that the Programa Viva Mulher have expanded the access to the Papanicolaou’s test. The screening of this neoplasm by the cytological test was responsible for a significant reduction of events in developed countries, which have well stablished quality control systems. However, this reality cannot be seen in developing countries. Therefore, this study focuses on the analysis of the Brazilian pathologist's view of the cytological test and the medical criteria needed to improve the quality of screening. For this reason, a descriptive observational study was conducted, including a qualitative analysis with interviews with pathologists and the application of a questionnaire, about the structure of services that perform cytological examinations in the country. The results clearly showed the concern of this professional with your gradative removal from the screening program, and the need for a more careful quality control. A critical relationship was also observed between the failures of cytological screening, the performance of the pathologist and the structure of the services responsible for this exam. In this way, the study identified the imperative need for continued education of the professionals responsible for cervical cytological examination, in addition to the implementation of a comprehensive and judicious external quality control.
The uterine cervix's cancer maintains high rates of incidence and mortality in Brazil, despite of the fact that the Programa Viva Mulher have expanded the access to the Papanicolaou’s test. The screening of this neoplasm by the cytological test was responsible for a significant reduction of events in developed countries, which have well stablished quality control systems. However, this reality cannot be seen in developing countries. Therefore, this study focuses on the analysis of the Brazilian pathologist's view of the cytological test and the medical criteria needed to improve the quality of screening. For this reason, a descriptive observational study was conducted, including a qualitative analysis with interviews with pathologists and the application of a questionnaire, about the structure of services that perform cytological examinations in the country. The results clearly showed the concern of this professional with your gradative removal from the screening program, and the need for a more careful quality control. A critical relationship was also observed between the failures of cytological screening, the performance of the pathologist and the structure of the services responsible for this exam. In this way, the study identified the imperative need for continued education of the professionals responsible for cervical cytological examination, in addition to the implementation of a comprehensive and judicious external quality control.
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Câncer do colo uterino, rastreamento citológico, patologista, controle de qualidade, Uterine cervix cancer, cytological screening, pathologist, quality control