title: Historical Analysis of the Brazilian Cervical Cancer Screening Program from 2006 to 2013: A Time for Reflection.
abstract: BACKGROUND
  The Cervical Cancer Database of the Brazilian National Health Service (SISCOLO) contains information regarding all cervical cytological tests and, if properly explored, can be used as a tool for monitoring and managing the cervical cancer screening program. The aim of this study was to perform a historical analysis of the cervical cancer screening program in Brazil from 2006 to 2013.
  
  
  METHODS
  The data necessary to calculate quality indicators were obtained from the SISCOLO, a Brazilian health system tool. Joinpoint analysis was used to calculate the annual percentage change.
  
  
  RESULTS
  We observed important trends showing decreased rates of low-grade squamous intraepithelial lesions (LSIL) and high-grade squamous intraepithelial lesions (HSIL) and an increased rate of rejected exams from 2009 to 2013. The index of positivity was maintained at levels below those indicated by international standards; very low frequencies of unsatisfactory cases were observed over the study period, which partially contradicts the low rate of positive cases. The number of positive cytological diagnoses was below that expected, considering that developed countries with low frequencies of cervical cancer detect more lesions annually.
  
  
  CONCLUSIONS
  The evolution of indicators from 2006 to 2013 suggests that actions must be taken to improve the effectiveness of cervical cancer control in Brazil.
authors.affiliation: Graduate Program of Oncology, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Barretos School of Health Sciences Dr. Paulo Prata - FACISB, Barretos, São Paulo, Brazil.
authors.forename: Ricardo Filipe Alves
authors.initials: RF
authors.lastname: Costa
authors.affiliation: Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil; Laboratory of Medical Investigation (LIM 14), Faculty of Medicine, São Paulo University, FMUSP, São Paulo, Brazil; Life and Health Sciences Research Institute, ICVS, School of Health Sciences, Minho University, Braga, Portugal; ICVS/3B's - PT Government Associate Laboratory, Braga/Guimarães, Portugal.
authors.forename: Adhemar
authors.initials: A
authors.lastname: Longatto-Filho
authors.affiliation: Barretos School of Health Sciences Dr. Paulo Prata - FACISB, Barretos, São Paulo, Brazil; Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
authors.forename: Céline
authors.initials: C
authors.lastname: Pinheiro
authors.affiliation: School of Medical Sciences, Women's Hospital CAISM, Unicamp, Campinas, São Paulo, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: Zeferino
authors.affiliation: Research and Teaching Institute, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.
authors.forename: José Humberto
authors.initials: JH
authors.lastname: Fregnani
mesh_terms: D000328:Adult; D001938:Brazil; D055088:Early Detection of Cancer / Q000266:history* / Q000592:standards; D005260:Female; D049674:History, 21st Century; D006801:Humans; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears