PERFIL EPIDEMIOLÓGICO DOS ÓBITOS POR CÂNCER DO COLO DO ÚTERO NO PARANÁ E O PROCESSO NO PROGRAMA NACIONAL DE CONTROLE

Abstract

Introduction: Cervical cancer is the fourth leading cause of death among women in Brazil, affecting women of working age. Despite the National Cervical Cancer Control Program, implemented by the Ministry of Health and provided through the Unified Health System, mortality remains high, indicating gaps in early detection and clinical follow-up. Objective: To characterize the care process of women who died from cervical cancer in the state of Paraná, Brazil, between 2014 and 2023, within the scope of the National Cervical Cancer Control Program, based on records from the Ministry of Health information systems. Methods: This study employed two complementary approaches: an ecological time-series investigation using records from the Mortality Information System of Paraná, and a retrospective analysis of cytopathological, colposcopic, and histopathological examinations recorded in the Cancer Information System. Sociodemographic variables, mortality rates by place of residence and place of death, projections through 2030, years of potential life lost, frequency of examinations, and clinical follow-up of precursor lesions and cancer were analyzed using descriptive statistics, chi-square tests, generalized linear models with Poisson distribution for temporal trends, and spatial analysis with mean rates and heat maps. Projections were performed using the Holt–Winters method, adopting a 5% significance level. Results: A total of 3,508 deaths were analyzed, predominantly among White women with low educational attainment and employment in repair and maintenance services. The highest mortality rates occurred among women aged over 65 years; however, a substantial number of deaths were observed among those aged 40–59 years, indicating a relevant socioeconomic impact, with a mean of 14.41 years of potential life lost. Higher mortality by place of residence was observed in the 9th Health Region, located in the tri-border area, indicating greater regional vulnerability, while higher mortality by place of death occurred in the 10th Health Region, possibly related to the greater availability of specialized health services. Temporal projections indicated a 27.69% increase in mortality by 2030, rising from 0.65 to 0.83 deaths per 100,000 women. Among 812 women analyzed in the Cancer Information System, 53.4% underwent only cytopathological examinations, 18.2% underwent colposcopic and histopathological examinations, and 28.4% completed the full diagnostic triad. Predominantly negative results were observed, with absence of squamocolumnar junction representation and screening indication. Inadequate clinical follow-up was identified in 25.8% of women with precursor lesions or cancer. The correlation between cytology and histology within the diagnostic triad reached 86.1%, highlighting the relevance of cytopathological examination, whereas isolated colposcopy showed low sensitivity.Conclusions: The study characterized the epidemiological profile, mortality rates, and care flow of women who died from cervical cancer in Paraná between 2014 and 2023. Weaknesses were identified in follow-up and screening stages within the National Cervical Cancer Control Program, indicating that, despite the reliability of cytopathological screening, the opportunistic model of the Unified Health System contributes to the persistence of high mortality rates in the state.