Acesso ao exame papanicolau entre mulheres negras comparada a outras raças/etnias: uma revisão sistemática com metanálise

Abstract

Introduction: Pap smears test are among the most effective measures for screening for cervical cancer. Its widespread use of cytological screening derives from its ease, cost-effectiveness and ability to identify premalignant diseases. Studies show that among racial minorities there is an increase in mortality from cervical cancer, due to disparities in screening, ranging from difficulty in accessing the service to basic health information. Objective: to identify the prevalence of access to Pap smears among black women compared to other races/ethnicities in a systematic review and to identify the magnitude of this association in a meta-analysis. Methodology: The protocol for this review is registered on the PROSPERO platform under number CRD42021251764. Searches were performed in PubMed, Web of Science, Lilacs, Scopus, Cinahl databases, in addition to Google Scholar and Open Grey, using the Mesh terms “ethnic groups”, “race factors”, “papanicolaou test”, “prevalence”, “papanicolaou smear”,“Transversal studies”. For eligibility, cross-sectional studies that showed women's access to the Pap smear were included. Study quality and risk of bias were analyzed using the Joanna Briggs Critical Appraisal Checklist for Analytical Cross-Sectional Studies instrument. The extracted data were tabulated and analyzed qualitatively and quantitatively through metaanalysis (Review Manager). The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) was used as a writing guide. Results: The review resulted in 29 crosssectional studies that analyzed the prevalence of access to the Pap smear based on the race/ethnicity criterion. The prevalence of access among blacks ranged from 10.3% to 90.60% and among whites ranged from 14% to 89.47%. Among Asian women, it ranged from 2.56% to 76.3% and among Hispanics it ranged from 21.8% to 92.3%. Regarding race, the greatest chances of having Pap smears was associated with white women OR=2.49 (95%CI 1.12-4.54) when compared to black women (Johnson et al., 2020). For ethnicity, one chance was associated with Hispanic women with OR= 2.08 (95% CI 1.96-2.21) when they were not higher as black and white Hispanics. The results of the meta-analysis show that access to the Pap smear is lower among black women when compared to white women (OR=0.61; 95% CI 0.43-0.86). However, when compared to other ethnicities (except white), there was no significant difference (OR=1.39; 95% CI 0.82-2.35). Final considerations: Race is still an important factor in determining access to the Pap smear. The results showed disparities in the prevalence of access when comparing black women with other ethnicities. The difficulty of access, coupled with the lack of knowledge about the need to perform the exam and the lack of guidance for its execution, represent a risk for non-adherence to the preventive program.