title: Regional and social inequalities in the performance of Pap test and screening mammography and their correlation with lifestyle: Brazilian national health survey, 2013.
abstract: Mass population screening for the early detection of cervical and breast cancer has been shown to be a safe and effective strategy worldwide and has reduced the incidence and mortality rates of these diseases. The aim of this study is to analyse the reach of screening tests for cervical and breast cancer according to sociodemographic variables and to analyse their correlation with a healthy lifestyle.
  
  
  
  We have analysed data collected from 31.845 women aged 18 and over, who were interviewed for the Brazilian National Health Survey, a nationwide household inquiry, which took place between August 2013 and February 2014. The Pap tests performed in the last 3 years in women aged between 25 and 64 and screening mammogram performed in the last 2 years in women aged between 50 and 69 were considered adequate. We identified habits that constitute a healthy lifestyle, such as the consumption of five or more daily servings of fruits and vegetables, 30 min or more of leisurely physical activity and not smoking.
  
  
  
  We observed that the Pap test (78.8 %) was more widespread than the screening mammogram (54.5 %), with significant geographical and social differences concerning access to health care. Access for such screening was higher for women living in more developed regions (Southeast and South), who were white-skinned, better educated, living with a partner and, especially, who were covered by private health insurance. Those who underwent the tests according to established protocols also had a healthy lifestyle, which corroborates the healthy behaviour pattern of damage prevention.
  
  
  
  Despite the progress made, social disparity still defines access to screening tests for cervical and breast cancer, with women covered by private health insurance tending to benefit the most. It is necessary to reduce social and regional inequalities and ensure a more uniform provision and access to the tests, especially for socially disadvantaged women, in order to reduce the incidence and mortality rate resulting from the aforementioned diseases.
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. marizatheme@hotmail.com.|Escola Nacional de Saúde Pública Sérgio Arouca-ENSP/FIOCRUZ, Rua Leopoldo Bulhões 1480 sala 813, Manguinhos, 20041-210, RJ, Brazil. marizatheme@hotmail.com.
authors.forename: Mariza Miranda
authors.initials: MM
authors.lastname: Theme Filha
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Maria do Carmo
authors.initials: MD
authors.lastname: Leal
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Elaine Fernandes Viellas de
authors.initials: EF
authors.lastname: Oliveira
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Ana Paula
authors.initials: AP
authors.lastname: Esteves-Pereira
authors.affiliation: Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
authors.forename: Silvana Granado Nogueira da
authors.initials: SG
authors.lastname: Gama
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001938:Brazil; D001943:Breast Neoplasms / Q000175:diagnosis; D055088:Early Detection of Cancer / Q000379:methods; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006306:Health Surveys; D006801:Humans; D007348:Insurance, Health; D008019:Life Style; D008327:Mammography; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D065006:Papanicolaou Test; D012111:Residence Characteristics; D012923:Social Class; D012959:Socioeconomic Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis; D055815:Young Adult
keywords: Breast cancer screening; Cervical cancer screening; Health self-assessment; Lifestyle; Mammogram