Contribution of the Unified Health Care System to mammography screening in Brazil, 2013

Abstract

ObjectiveTo estimate the coverage of opportunistic mammography screening performed via the Brazilian Sistema Único de Saúde (SUS, Unified Health Care System), at the state and regional level, in 2013.Materials and MethodsThis was an ecological study in which coverage was estimated by determining the ratio between the number of mammograms performed and the expected number of mammograms among the population of females between 50 and 69 years of age. The number of mammograms performed in the target population was obtained from the Outpatient Database of the Information Technology Department of the SUS. To calculate the expected number of mammograms, we considered 58.9% of the target population, the proportion that would be expected on the basis of the recommendations of the Brazilian National Cancer Institute.ResultsIn 2013, the estimated national coverage of mammography screening via the SUS was 24.8%. The mammography rate ranged from 12.0% in the northern region to 31.3% in the southern region. When stratified by state, coverage was lowest in the state of Pará and highest in the state of Santa Catarina (7.5% and 35.7%, respectively).ConclusionThe coverage of mammography screening performed via the SUS is low. There is a significant disparity among the Brazilian states (including the Federal District of Brasília) and among regions, being higher in the south/southeast and lower in the north/northeast.

Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study

“…In this study, we highlight the difference in survival between the patients who received the diagnosis through screening programs (84%) and those diagnosed on physical examination (76%) 1 . The divergences found between the European study and this series are possibly due to the absence of a population screening program for breast cancer and inadequate mammography coverage in Brazil 18,19 .…”

“…Despite the methodological differences, we observed an increase in survival from one series to the other, corresponding to 57%, 65.4% and 72.1%, respectively. This increase was possibly related to improvements in local screening and diagnosis of breast cancer [16][17][18] , which led to a reduction in advanced cases and an increase in initial cases 14,19 . The inclusion of new targeted drugs and therapies should also have contributed to this outcome improvement 20,21 .…”

The impact of mammography screening on the surgical treatment of breast cancer

“…4 Finally, the difficulties in accessing health care services found in some regions of Brazil 5,6 should be emphasized, as well as the absence of an effective population-based screening program. 7,8 In 2013, the nationwide estimated mammography coverage within the public health care system was only 24.8%, ranging from 7.5% to 35.7% in the different states in the country. 8 The barriers to mammography screening in Brazil include the limited access of the population to information and to health care services, the geographical distribution of mammography machines that tend to be concentrated in the major cities, the inadequate quality of mammography in some centers, and the delay in treatment following a diagnosis of breast cancer.…”

Breast Cancer Screening: Updated Recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations

“…1,2 In Brazil, despite all efforts, an increase in both breast cancer incidence and mortality rates has been noticed. [3][4][5] One peculiarity of breast cancer in Brazil and in other developing countries is that its incidence among women aged 40-50 years is proportionally higher than that reported in developed countries. [6][7][8] Programs that aim at standardizing breast cancer screening guidelines -as well as educating the population regarding the importance of such tests -should be promoted.…”