Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units

Abstract

BackgroundBreast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU) and a fixed unit (FU) in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area.MethodsBased on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p < 0.05.ResultsOverall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54%) in the MU). This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p < 0.001) or 40 to 49 years (p < 0.001). No difference was observed between women aged 40 to 49 years and those aged 50 to 59 years (p = 0.164). The proportion of tumors in the early (EC 0 and EC I) and advanced (CS III and CS IV) stages of development were 43.4% and 15.8%, respectively.ConclusionsPreliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

“…Therefore, this region experienced a transition from the diagnostic mammography stage, in which mammograms were often performed in symptomatic patients while the demand for diagnostic exams was suppressed, to a large-scale mammography screening. In the years before this project, the incidence of early tumors (clinical staging 0 + I) in this region was 14.5%; this rate increased to 43.2% among the women who adhered to the project, reflecting a prior deficiency in access to mammography screening [9].…”

“…However, there is no organized screening program, and only isolated studies were conducted [8]. A regional pilot screening program was initiated in the countryside of São Paulo State, in which mammography screening was implemented at the population level [8,9].…”

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

“…However, there are some well-organized, although isolated, screening programs in the country, such as the one run by the Cancer Hospital of Barretos, in the state of São Paulo, which employs mobile units outfitted with mammography equipment in order to carry out active surveillance of the target population (41,42) .…”

“…Factors such as cultural differences, socioeconomic differences, geographical location, and limited information on the part of the population can also impede access to health care services, thus increasing disparity (41,45) . The low rates of mammography coverage found in the present study underscore the need to research the geographic distribution of the mammography equipment available via the SUS and the influence that it can have on access to the test (16,42) .…”

Associated factors with mammographic changes in women undergoing breast cancer screening

“…The Haikel et al (19) study about a screening based program in mammography reported strategies on adherence and better optimization in breast cancer detection using this initiative. For these authors, administrators of public health institutions must be always encouraged to adhere to population level program, which might consequently increase participation of these women.…”