Breast cancer screening in Brazil. Barriers related to the health system

Abstract

Objective: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. Method: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. Results: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. Conclusion: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

Difficult Access and Poor Productivity: Mammography Screening in Brazil

“…Therefore, only 29% of the target population was able to access mammography, while another 9,899,410 exams failed to be carried out despite the existence of the necessary equipment. The lack of human resources and, in many cases, a lack of the consumables required for breast screening to be adequately performed are additional factors that hamper productivity (Brasil, 1990;Lima-Costa & Matos, 2007;Toledo et al, 2016;Vieira et al, 2017).…”

“…Several factors may hamper access to mammography in a given geographical region, including socioeconomic inequalities and the geographical distribution and quality of the equipment (Lima-Costa and Matos, 2007;Vieira et al, 2017). In developing countries, the problem is compounded by the fact that human resources are limited, as are the consumables required for the equipment to function adequately, ultimately affecting productivity (Sopelete and Biscarde, 2013;Toledo et al, 2016;Vieira et al, 2017).…”

Avaliação do acesso em mamografias no Brasil e indicadores socioeconômicos: um estudo espacial

“…In addition, the exams availability is lower in the North and Northeast due to the number of non-white people, the low educational level, low income and lack of health insurance. There are also barriers to the access to the services in these regions, such as the low number of professionals and mammography equipment (20) .…”

Barriers to mammography screening in a riverine population of the Brazilian Amazon

“…Despite debates regarding mammography screening, it is still considered the best method for secondary prevention and early detection 1 . In Brazil due to economic and logistic limitations, mammography screening is not a reality 2 …”