Abstract

JERI, Alice  and  MONTEIRO, Ana Bessa. Cervical cancer screening in homosexual patients: what is the evidence?. Rev Port Med Geral Fam [online]. 2018, vol.34, n.6, pp.377-383. ISSN 2182-5173.  https://doi.org/10.32385/rpmgf.v34i6.12036.

Objective: To review the evidence on the relevance of cervical cancer screening on healthy patients engaged in homosexual behavior, taking into account the risk of developing this pathology within this population. Data sources: MEDLINE database, National Guideline Clearinghouse, National Institute for Health and Care Excellence, Canadian Medical Association Practice Guidelines Infobase, Cochrane Library, Bandolier, DARE and Trip Database. Revision methods: Evidence based review of relevant scientific papers, published within the past five years (from 01/10/2011 to 30/09/2015), in English, Spanish and Portuguese. Combinations of the following MESH words were used: ‘female homosexuality’, ‘mass screening’, ‘diagnosis’, ‘uterine cervical neoplasms’ and ‘papillomaviridae’, and also the term ‘cervical cancer’. The Strength of Recommendation Taxonomy of the American Family Physician was used to evaluate the Levels of Evidence (LE) and the Strength of Recommendation (SR). Results: The search returned 88 papers, six of which met the inclusion: five clinical guidelines (one with SR A, two with SR B and two with SR C) and one prospective cohort study (LE 3). International guidelines present some limitations and inconsistencies regarding the indication of screening homosexual women, but the majority recommends their inclusion. The cohort study found abnormal results in Pap and human papillomavirus (HPV) in women who have sex with women, placing them at risk of developing cervical cancer. Conclusions: Women engaged in homosexual behavior may be at risk of being infected by HPV and developing cervical cancer, and should therefore be included in population-based screening, with the same frequency than other women (SR B). Nonetheless, further studies are needed to reinforce this evidence. Given the lower awareness of this group on the benefits of screening, we suggest the implementation of specific educational measures in order to increase their adherence. We also suggest reviewing national guidelines so as to clarify the indication of screening in this population.

Keywords : Mass screening; Diagnosis; Uterine cervical neoplasms; Female homosexuality; Sexual behavior.

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