Fatores associados à não realização de mamografia: Pesquisa Nacional de Saúde, 2013

Abstract

RESUMO: Introdução: O acesso à mamografia, principal exame de detecção precoce do câncer de mama, não é igualitário entre as mulheres brasileiras. Objetivou-se analisar os fatores associados à não realização desse exame num período inferior a dois anos no Brasil e por macrorregião, considerando-se características sociodemográficas, condições de saúde, hábitos de vida e uso dos serviços de saúde. Método: Estudo transversal que utilizou dados da Pesquisa Nacional de Saúde (PNS). A amostra consiste de 10.571 mulheres (≥ 40 anos) residentes em todas as regiões brasileiras. Modelo de regressão de Poisson com abordagem hierarquizada foi utilizado para estimar razões de prevalência. Resultados: As características associadas à não realização de mamografia foram: idade ≥ 60 anos, baixa escolaridade, viver sem companheiro, avaliar negativamente o próprio estado de saúde, possuir alguma doença crônica, não praticar exercício físico, não realizar o exame clínico da mama até um ano, ou o exame de Papanicolaou até três anos, não ter consultado com médico no último ano, não possuir plano de saúde, sentir-se discriminada por profissional de saúde e ter cadastro em uma unidade de saúde da família. Variáveis sociodemográficas se sobressaíram no Norte e Nordeste; e nas outras regiões, condições de saúde e hábitos de vida. Conclusão: Variáveis relacionadas ao uso dos serviços de saúde tiveram destaque na não realização da mamografia. Ações que reduzam a desigualdade no acesso ao exame devem ser adotadas em cada macrorregião do Brasil.

Association of mammography with sociodemographic and care factors in residents of Belo Horizonte, MG, Brazil

“…Therefore, expanding access to medical appointments can positively impact early detection of breast cancer. In the same direction, we found that the Pap smear test, an indicator of gynecological consultation, was significantly associated with the performance of mammography in both age groups, suggesting that the actions to prevent cervical and breast cancer, coordinated by basic care and usually treated together, as part of preventive health care 16,26 , represent a line of comprehensive care for women.…”

“…Another aspect reported was the possibility of surveillance bias, which represents the tendency to look more carefully for an outcome in one of the comparisons groups 25 , as well as the finding that the medical appointments were associated with mammography exam less than two years before the interview in both age groups. Previous studies indicate that this variable can be an important predictor for the performance of mammography, but it can also be considered one of the first barriers faced for the examination [14][15][16][17] , as the lack of periodic medical appointments may indicate difficulty in accessing the health service and/or lack of self-health care in general 26 . Women who had not seen a physician less than a year before study have one-third of the chance of undergoing mammography when compared to women who had seen a physician less than a year before survey 14,15 .…”

“…Some studies have shown that individuals with private health coverage use health services more frequently when compared to those who use only the public health system 16,17,27 . In addition, having health insurance coverage is an important factor for better access to mammography reported in the literature 26 . Thus, it is plausible to infer that having a private health insurance may have contributed to the performance of mammography among the participants of our study, since health insurance users use health services more frequently, have more contact with health professionals, and are more commonly referred to exams, in addition to higher availability of mammography devices in the private sector 28 .Although no significant association was found between the use of BHU and the performance of mammography in both age groups, when relating this variable to affiliation with a private health insurance in the group that had undergone mammography less than two years before the interview, most women who frequently used BHU did not have a private health insurance and, among those who never attended BHU, most had one.…”

Roda De Conversa: Diálogos Sobre O Empoderamento Da Mulher Na Escolha Do Método Contraceptivo

“…No Brasil é associado há elevada mortalidade, fato que pode ser compreendido pelas dificuldades de acesso diagnóstico e tratamento em tempo hábil, estima-se que cerca de 80% das mulheres sejam diagnosticadas em estágio avançado, muitas delas com baixa renda, escolaridade precoce e que dependem do Sistema Único de Saúde (SUS) para garantir sua saúde (LIEDKE et al, 2014;SILVA et al, 2013;BARBOSA et al, 2019).…”

Health Iniquity, Unhealthy Behavior, and Coverage of Mammography in Brazil

“…Studies show social inequalities in access to breast cancer screening (8)(9)(10)(11)(12)(13)(14) . Black and brown (pardo) women (8) , with a low level of education (8,(10)(11)13) , who were single or living without a partner (8,10,15,16) , who smoked (8) and did not have health insurance (12)(13)(14) had mammographies less often. Additionally, studies with small samples (8,12) have shown that unhealthy behaviors, such as insufficient physical activity level and low intake of fruits and vegetables, may be associated with non-adherence to mammography screening.…”