Inequalities in Pap smear screening for cervical cancer in Brazil

• There are inequalities in Pap smear screening between Brazilian urban and rural areas
• North and Northeast region showed the highest prevalence of never-screened women
• Poorer, less educated, non-white skin color and younger women are less screened

ObjectiveTo examine the risk factors associated with never being screened for cervical cancer (CC) in Brazil.MethodsUsing the National Household Sample Survey 2008 (PNAD), we analyzed data from 102,108 Brazilian women ages 25–64 years. 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.ResultsThe 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 12 months.ConclusionSocioeconomic and demographic conditions lead to inequalities in access to Pap smear screening in Brazil. Public health policy addressing these risk groups is necessary.