Fatores associados à mortalidade por câncer de mama e do colo do útero no município de São Paulo: uma análise comparativa ecológica

Objectives: To identify intra-urban spatial variability in mortality from breast and cervical cancer and possible associated factors. To analyze temporal patterns of trend and seasonality in the performance of screening tests for cervical and breast cancer, according to age group, administrative management, and in municipal establishments, Health Care level. Methods: Between 2009 and 2016, 10,124 deaths were recorded from breast cancer and 2,116 deaths from cervical cancer in women aged 20 years and over living in the city of São Paulo. The records were geocoded by home address and aggregated according to the coverage areas of the municipal UBS. Spatial modeling was carried out in a Bayesian context, using the INLA (Integrated Nested Laplace Approximations) approach to verify the association of deaths from both cancers with social, demographic, economic, educational and health care indicators. Time series analysis of cervical-vaginal / microflora cytopathological exams and bilateral mammography for screening performed on women aged 20 years and over living in the city of São Paulo between 2010 and 2019 was developed. Generalized linear models were adjusted, with negative binomial response, the ratio of procedures according to the reference month, year and age group. To calculate the relative risk (RR) and the percentage change (%) in relation to October (MPC) and annual (APC) time, we used segmented regression techniques and indicator variables for the period. Results: The general rate of geocoding was 99.4%. Mortalities due to breast cancer and cervical cancer showed inverse spatial patterns in the city of São Paulo. Some variables were associated with breast cancer mortality: commuting time between one and two hours to work (RR 0.97; 95% CI 0.93:1.00); proportion of women responsible for the household (RR 0.97; 95% CI 0.94:0.99) and proportion of breast cancer deaths that occurred in private establishments (RR 1.04; 95% CI 1.00:1.07). Cervical cancer mortality was associated with: commuting time between half an hour and an hour to work (RR 0.92; 95% CI 0.87:0.98); per capita household income up to 3.0 minimum wages (RR 1.27; 95% CI 1.18:1.37) and ratio of children under one year old to the female population aged 15 to 49 years (RR 1.09; 95% CI % 1.01:1.18). The ratio of cervical-vaginal / microflora cytopathological examinations estimated in the population without a health plan is high, with a drop from 2013. There was an increase in screening by mammography in the recommended age group; however, the proportion of this procedure in women under 50 is still high. The screening for cervical and breast cancer did not show seasonality in relation to October. Conclusion: This study allowed to test the association between different indicators in the areas covered by Primary Health Care and the intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo. In addition to analyzing the temporal trend and seasonality related to October of cervical and breast cancer screening, as well as highlighting the differences in the request for these tests according to the administrative management and the Health Care level, in order to collaborate with the prevention of these cancers.