SISMAMA—Implementation of an information system for breast cancer early detection programs in Brazil

Abstract

As national health systems seek to apply breast cancer screening recommendations to an entire population of women (within target age ranges for which there is evidence that screening reduces mortality), the volume of screening tests and resulting diagnostic investigations arising from abnormal test results-and the cost associated with them-will grow dramatically. Population-based early detection (screening) programs will need information systems and management tools to help these programs. This report describes Brazil's highly decentralized health care system and then describes in greater detail how the development and implementation of an information system for Brazil's nationwide breast cancer early detection program was carried out with input from various stakeholders. Challenges encountered in the implementation are shared. Preliminary findings from the first 1.5 million mammograms are presented to demonstrate the kind of provocative management information such a system can yield in a relatively short period of time. The potential of such information systems for improving efficiency, efficacy and cost-effectiveness of early detection programs is emphasized.

Acesso à detecção precoce do câncer de mama no Sistema Único de Saúde: uma análise a partir dos dados do Sistema de Informações em Saúde

“…No SISMAMA, subsistema do SIA instalado nos serviços públicos ou nos prestadores contratados pelo SUS e nas Coordenações de Saúde da Mulher das secretarias estaduais e municipais de saúde, são registrados os dados de solicitação e resultados de exames de mamografia, citopatoló-gicos e anatomopatológicos de mama (biópsia e peça cirúrgica) 12 .…”

“…Em 2009, foi implantado o Sistema de Informação para o Controle do Câncer de Mama (SISMAMA) 11 , para padronização da coleta de dados sobre o rastreamento, o diagnóstico e o tratamento do câncer da mama em todo o país e permitir a avaliação das ações de controle da doença 12,13 .…”

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

“…The mean time between presentation of symptoms and diagnosis is 72-185 days, which leads to high rates of advanced stage diagnosis, with 37.0% in stage III and IV, different from that observed in the private sector, where this rate is 16.2%. 8 Regarding health management 11,12 and information systems for the support of health management, 13,14 four articles were selected. Assessing the origin-destination flow of outpatient visits and hospitalizations related to breast cancer, we observed that the treatment is generally performed in large cities and in reference centers, and patients travel distances greater than 150 km from their city source.…”

“…12 The SISMAMA system showed promising results with 50% of the examinations performed in the age group 50-69 years and about 66% of mammography reports were performed in a period inferior to 30 days. 13 National coverage is low, including 32% of women in the 50-59 age group and 25% in the 60-69 age group, though this actually depends on the age group of the macro-region. In general, the coverage of women in the 50-59 age group is higher in the Southern and Southeastern states, and lower in the North and Northeast.…”

“…32 Logistical and technological limitation leads to delayed examinations and diagnosis, 8 with low population coverage, 32,43 seen in our study population, and is one of the main barriers related to the health system, as presented in the results section. The SISMAMA system is an important auxiliary tool for health management, 13 but there is much to be done. There is a need for evaluation of populations vulnerable to mammography, 3,5,17,18 as well as strategies to improve their access.…”