Controle do câncer do colo do útero na atenção primária à saúde em países sul-americanos: revisão sistemática

OBJECTIVE. To describe cervical cancer (CC) prevention and control strategies in the primary care setting in South America. METHOD. Two review steps were performed: review of documents published in governmental websites in Argentina, Bolivia, Brazil, Chile, Colombia, Ecuador, Paraguay, Peru, Uruguay, and Venezuela; and systematic review of the literature available in LILACS, MEDLINE, Scopus, SciELO, and Science Direct databases. RESULTS. Twenty-one institutional documents (plans, practice guides, and national guidelines) and 25 journal articles were included. All countries had high CC morbidity and mortality rates. Screening in primary healthcare (PHC) was mostly opportunistic, although the institutional documents indicated an intention and strategies for early diagnosis and longitudinal follow-up of suspected and confirmed cases, preferably within the public healthcare system. All countries adopted a broad view of PHC, although the stage of PHC implementation was heterogeneous in different countries, with predominance of selective PHC. Access to screening was more difficult for women from rural or remote areas and for indigenous populations. The unavailability of PHC close to households/communities was an important barrier for CC screening. CONCLUSIONS. The fragmentation of healthcare systems and the selective provision of services are barriers for the prevention and control of CC in South America. Organized CC screening programs and active search for Papanicolaou testing in primary care are needed. Intercultural practices and intersectional public policies are essential to overcome the inequities in CC control in South American countries.