title: Inequalities in Pap smear screening for cervical cancer in Brazil.
abstract: OBJECTIVE
  To examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil.
  
  
  METHODS
  Using the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25-64years. The patients were analyzed as having been or never having been screened with a Pap smear (Yes/No). Age-adjusted prevalence of never-screening was analyzed using a Chi-squared test. Crude and adjusted models using Poisson regression were performed.
  
  
  RESULTS
  The prevalence of never-screened women for CC was 12.9%, 11.5% and 22.2% in Brazil in general, urban and rural areas, respectively. The Brazilian region with the highest prevalence of never-screening was the North (17.4%, 14.7% and 27.3% in general, urban and rural areas, respectively). The factors associated with a higher risk for never being screened were the following: poverty, younger age, lower educational level, non-white skin color, a greater number of children, no supplemental health insurance and not having visited a doctor in the past 12months.
  
  
  CONCLUSIONS
  Socioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.
authors.affiliation: Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil. Electronic address: jeovanymm@yahoo.es.
authors.forename: Jeovany
authors.initials: J
authors.lastname: Martínez-Mesa
authors.forename: Gustavo
authors.initials: G
authors.lastname: Werutsky
authors.forename: Raquel Barth
authors.initials: RB
authors.lastname: Campani
authors.forename: Fernando César
authors.initials: FC
authors.lastname: Wehrmeister
authors.forename: Carlos Henrique
authors.initials: CH
authors.lastname: Barrios
mesh_terms: D000328:Adult; D000367:Age Factors; D001938:Brazil / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D004522:Educational Status; D005260:Female; D019538:Health Care Surveys; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D065006:Papanicolaou Test / Q000706:statistics & numerical data*; D011203:Poverty / Q000706:statistics & numerical data; D044469:Racial Groups / Q000706:statistics & numerical data; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D014505:Urban Population / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*
keywords: Cancer screening; Epidemiology; Health inequities; Papanicolau smear; Tumor virus infection; Uterine cervical neoplasm