Difficult Access and Poor Productivity: Mammography Screening in Brazil

Abstract

Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic limitations and the geographical distribution and quality of the mammography machines. This study evaluated access to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions, states and the Federal District in 2016. The number of mammography machines required for breast cancer screening was calculated and compared to the number of machines available. The expected number of mammograms was compared with the actual number performed. Machines were georeferenced based on their location and the municipal seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed, representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60 km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion: These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the SUS is not associated with the number of machines available or with the geographical location of the equipment but rather with the insufficient number of mammograms performed.

Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006–2014

“…The authors discussed that this result could be partly explained by the mobile screening service provided by the National Cancer Screening Program that increases accessibility and compliance with the screening program [19]. Lower access to mammography screening, distance from health-care services, shorter working hours of health centers, and lower quality of equipment might be barriers to participate in BC screening in rural areas [35,36]. Age and marital status were not associated with participation in mammography screening, consistent with some studies [19,32], but not with other studies [20,24,25,37].…”

Ethical Concerns Regarding Breast Cancer Screening

“…In order to consider a screening program adequate, it must be acceptable, accessible, and sustainable, it must promote equity and it must be economically efficient to the target population [56]. As it has been demonstrated in this chapter, the Brazilian mammographic screening program is not accessible, since the coverage does not reach 30% of the target population [42]. This program is not sustainable either since there is a huge delay between the identification of an abnormal mammogram and the necessary biopsy to confirm the diagnostic.…”

“…This number is far from the 70% coverage recommended by the WHO, necessary to effectively reduce breast cancer-specific mortality [41]. Rodrigues et al also evaluated the number of mammogram machines available in the country, their geographical distribution and the total number of exams performed in 2016 [42]. In this study, it was demonstrated that Brazil has 4628 machines with a capacity of 14,279,654 exams per year.…”

Opportunistic mammography screening by the Brazilian Unified Health System in 2019

“…The first one involves remedying the low productivity of mammography machines available at SUS. In a recent study conducted by the Brazilian Breast Cancer Research Network, the extremely low productivity of the machines was observed, which shows that, in the country, there is no lack of mammography equipment, but rather of an efficient operation in all states, considering that the effectiveness ranged between 1% in the Federal District to 40% in the state of Bahia 14 . These numbers evidence the urgent need to reorganize several services related to SUS, which alone can promote a considerable improvement in mammography coverage for SUS users.…”