Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017

Abstract

Background In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. Methods This ecological study analyzed data on breast cancer screening within the SUS for women aged 50–69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. Results Around 19 million mammograms were performed in 50–69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 ( p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of − 0.4% ( p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. Conclusion Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.

Opportunistic mammography screening by the Brazilian Unified Health System in 2019

“…Concerning the mammography coverage, the year 2019 reflects what happened in the previous years, from 2012 to 2017 9 , when there was no increase in mammography coverage in the female population aged 50 to 69 years who use the SUS services. This probably reflects a political issue, with greater emphasis on the economic and financial situation in which Brazil was immersed in the period under analysis.…”

“…In a recent study conducted by the Rede Brasileira de Pesquisa em Câncer de Mama [Brazilian Breast Cancer Research Network], following the recommendations of the Brazilian Ministry of Health, according to which women aged between 50 and 69 years must undergo a biennial mammography examination, it was observed that the rate of mammography coverage by the Brazilian Unified Health System (SUS) in this population increased from 14.4% in 2008 to 24.4% in 2012 and, since then, mammography coverage has been stabilized, accounting for 24.2% in 2017 9 .…”

Ethical Concerns Regarding Breast Cancer Screening

“…A broader study by Rodrigues et al evaluated retrospective data regarding mammograms between 2008 and 2016 in the public health system [40]. Around nineteen million mammograms were performed in this period with an increase in coverage of 14.5% annually between 2008 and 2012 followed by a stable period between 2012 and 2017.…”

Desigualdades regionais e sociais na realização de mamografia e exame citopatológico nas capitais brasileiras em 2019: estudo transversal

“…1,2 Apesar de uma alta proporção de mulheres afirmarem realizar exames de rastreamento de câncer de colo uterino e de mama, observa-se menor cobertura entre aquelas com maior vulnerabilidade social, principalmente nas regiões mais pobres do país. [3][4][5][6] Este problema parece estar relacionado a dificuldades no acesso a esses exames, [7][8][9][10] além de determinantes sociais, como baixa escolaridade, 4,5,11 raça/cor da pele preta e parda 11,12 e utilização do setor público de saúde. 11 As desigualdades regionais e sociais na cobertura da realização dos exames preventivos de mamografia e citopatológicos tornam-se ainda mais preocupantes diante da constatação de que, no ano de 2020, mais de 80 mil mulheres foram acometidas por câncer de mama ou de colo do útero no Brasil, respectivamente o primeiro e o terceiro tipos de câncer mais frequentes no sexo feminino no país.…”