Prevenção do Câncer do Colo do Útero em um Município do Maranhão: Análise Epidemiológica e Avaliação das Barreiras e do Conhecimento em Comunidades Quilombolas

Abstract

Cervical cancer (CC) is a serious public health problem, a slow and progressive process involving reversible changes in the cervical epithelium associated with infection by the human papillomavirus (HPV). Prevention is challenging in vulnerable populations, such as quilombola communities, which face structural inequalities and specific sociocultural barriers. This research aimed to analyze CCU prevention in the municipality of Codó - MA, using a dual approach: a municipal epidemiological analysis and an in-depth study on knowledge and barriers in quilombola communities. To this end, we employed a mixed-methods methodology, combining a descriptive and retrospective epidemiological study, based on data from the Cancer Information System (SISCAN) referring to the period from 2018 to 2023, with a quantitative-qualitative field study that integrated surveys and participant observation with women from the Santo Antônio dos Pretos Quilombo. This study aimed to analyze CCU prevention in Codó, Maranhão (Brazil), by integrating a municipal epidemiological analysis with an in-depth assessment of knowledge and access barriers in Quilombola communities. The epidemiological study, based on 14,993 tests, revealed inefficient coverage, peaking at 12% in 2019 in the target population (25 to 64 years old), well below the 80% target recommended by the World Health Organization. The majority of tests (99.87%) were for initial screening and not for follow-up. Additionally, a study with 33 women from quilombola communities identified critical barriers explaining this low adherence: 33.3% were unaware of the cause of sexually transmitted infections (STIs), 36.4% did not know the symptoms of HPV, and 50% of those who did not undergo preventive testing did so because they did not feel ill, highlighting a perception of health focused on disease. Although 75.8% had undergone some preventive examination in their lives, only 27.3% do so regularly, and 42.4% had never spoken to a professional about HPV or ISTs. Statistical analysis revealed a strong correlation between age group and multiparity (χ²= 17.849; p= 0.0013), reflecting historically limited access to family planning. The barriers identified were structural (distance of 47 km and absence of local services), sociocultural (exhausting work routine, such as breaking babaçu coconuts, and difficulty in communication), and informational (inadequate technical language). The majority of women (75.8%) were farmworkers with an income of less than R$ 1,000/month, reflecting overlapping vulnerabilities. It is concluded that the low adherence to cervical cancer screening transcends the availability of the examination, being influenced by structural inequalities and deep sociocultural barriers that disproportionately affect quilombola women. The results reinforce the urgent need for intersectoral, territorially-based, and culturally sensitive public policies to promote health equity and strengthen the autonomy of quilombola women in cervical cancer prevention.