A detecção precoce do câncer de mama no Brasil

Abstract

Background: The diagnosis of breast cancer, from rst medical visit until treatment initiation, requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately nanced diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. Methods: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals among patient groups. Results: If diagnostic mammography was nanced privately and covered by private health insurance, the likelihood of a delay of >90 days between the rst medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06-4.36; p= 0.033) and 4.44-fold (95%CI: 1.58-12.46; p= 0.004), respectively. The median time between the rst medical visit and the diagnostic result and between the rst medical visit and the initiation of treatment was, respectively, 56.0 and 116.5 days. For these time intervals, 54 (34.8%) and 114 (64.8%) patients had a delay of >90 days for diagnostic results and the initiation of treatment, respectively. For patients in the FAP and HNL who had a delay of >90 days, the median time between the rst medical visit and the diagnostic results was 180 and 158 days, respectively (p= 0.032). If the clinic-histopathological exam was outsourced (FAP) and publicly or privately nanced, the median delay between diagnostic mammography and the diagnostic result was 65.0 or 29.0 days, respectively, compared to 53.0 days in the integrated (HNL) publicly nanced system (p < 0.050). The median time between the rst medical visit and the diagnostic results of all patients who were supported by NGOs, who nanced their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p < 0.050). Conclusions: Patients who used privately nanced health services had shorter delays. Compared to outsourcing, the integration of the publicly nanced clinic-histopathological exam diminished the delay. The support of patients by NGOs accelerated patient ow. which also include the two largest urban centres of the country, namely, São Paulo and Rio de Janeiro, the incidence has stabilized over the last ten years [3, 4]. In contrast, in the Northeast region, the incidence of breast cancer has increased between 2005 and 2018 from 27.23 to 63.98 new cases per 100,000 women [3, 4]. The diagnosis and treatment of breast cancer is complex and requires a series of diagnostic and therapeutic procedures. These successive diagnostic and therapeutic steps require time and can lead to delays in the time to treatment initiation (TTI). Long waiting times for diagnostic procedures, poor disease management, access barriers and a high number of se...

Detecção Precoce Do Câncer De Mama: Como Atuam Os Enfermeiros Da Atenção Primária À Saúde?

“…Como a detecção precoce do câncer de mama na atenção básica ainda não é bem estruturada, o ECM poderia servir de estratégia, a partir da capacitação dos profissionais da saúde e adequação de uma rede com recursos para atender de forma imediata aos casos que necessitassem de investigação diagnóstica. 20 Ressaltase que o Maranhão é o Estado com maior número de casos de lesões identificadas na mamografia que são palpáveis. Dessa forma, capacitação dos profissionais de saúde, principalmente na Atenção Básica, e orientação às mulheres sobre a patologia, bem como facilitar o acesso aos exames diagnósticos é fundamental para o controle do câncer de mama.…”

Association between primary care coverage and breast cancer mortality in Brazil

“…Early diagnosis of breast cancer is determined by the triad: i) knowledge of the population regarding signs and symptoms; ii) professional qualification for diagnosis; and iii) the capacity of the health system to offer services to confirm the diagnosis and support the diagnosed cases[ 4 ].…”

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment

“…Similar, in the present study, the median time between the diagnostic result of the anatomic-pathological exam and treatment initiation at public referral centres was 56.0 days, but in 35 (44.3%) out of 79 cases, it exceeded the obligatory 60 days guaranteed by the public health care system. According to previous Brazilian studies, long waiting times for specialized medical consultations and diagnostic exams were among the main problems in cancer treatment by public health care providers (Gebrim, 2016;Ferreira et al, 2017). These long waiting times can often be the result of a lack of specialized services: Cavalcanti et al, (2012) for example, reported waiting times of up to 30 days for specialized services after detection of first symptoms.…”

“…Other earlier studies performed in the states of Rio de Janeiro and Minas Gerais reported median and mean waiting times of 6.5 and >6 months, respectively, between the first medical consultation and diagnostic confirmation (Rezende et al, 2009;Soares et al, 2012). Furthermore, there were no guidelines for referrals or requests for subsidiary exams by health professional (Gebrim, 2016;Ferreira et al, 2017). Authors of a previous study that focused on the time interval between screening mammography and treatment initiation of patients in São Paulo identified missing coordination of patient flow and social assistance of patients as organizational problems and principal reasons for SD (Trufelli et al, 2008).…”