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

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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.

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Most cited references 24

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Screening for breast cancer with mammography

Peter C. Gøtzsche, Karsten Juhl Jørgensen (2013)

A variety of estimates of the benefits and harms of mammographic screening for breast cancer have been published and national policies vary. To assess the effect of screening for breast cancer with mammography on mortality and morbidity. We searched PubMed (22 November 2012) and the World Health Organization's International Clinical Trials Registry Platform (22 November 2012). Randomised trials comparing mammographic screening with no mammographic screening. Two authors independently extracted data. Study authors were contacted for additional information. Eight eligible trials were identified. We excluded a trial because the randomisation had failed to produce comparable groups.The eligible trials included 600,000 women in the analyses in the age range 39 to 74 years. Three trials with adequate randomisation did not show a statistically significant reduction in breast cancer mortality at 13 years (relative risk (RR) 0.90, 95% confidence interval (CI) 0.79 to 1.02); four trials with suboptimal randomisation showed a significant reduction in breast cancer mortality with an RR of 0.75 (95% CI 0.67 to 0.83). The RR for all seven trials combined was 0.81 (95% CI 0.74 to 0.87). We found that breast cancer mortality was an unreliable outcome that was biased in favour of screening, mainly because of differential misclassification of cause of death. The trials with adequate randomisation did not find an effect of screening on total cancer mortality, including breast cancer, after 10 years (RR 1.02, 95% CI 0.95 to 1.10) or on all-cause mortality after 13 years (RR 0.99, 95% CI 0.95 to 1.03).Total numbers of lumpectomies and mastectomies were significantly larger in the screened groups (RR 1.31, 95% CI 1.22 to 1.42), as were number of mastectomies (RR 1.20, 95% CI 1.08 to 1.32). The use of radiotherapy was similarly increased whereas there was no difference in the use of chemotherapy (data available in only two trials). If we assume that screening reduces breast cancer mortality by 15% and that overdiagnosis and overtreatment is at 30%, it means that for every 2000 women invited for screening throughout 10 years, one will avoid dying of breast cancer and 10 healthy women, who would not have been diagnosed if there had not been screening, will be treated unnecessarily. Furthermore, more than 200 women will experience important psychological distress including anxiety and uncertainty for years because of false positive findings. To help ensure that the women are fully informed before they decide whether or not to attend screening, we have written an evidence-based leaflet for lay people that is available in several languages on www.cochrane.dk. Because of substantial advances in treatment and greater breast cancer awareness since the trials were carried out, it is likely that the absolute effect of screening today is smaller than in the trials. Recent observational studies show more overdiagnosis than in the trials and very little or no reduction in the incidence of advanced cancers with screening.

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Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.

Andrew D. A. C. Smith, Craig W. Duffy, Helena Fohlin … (2011)

To estimate the long-term (29-year) effect of mammographic screening on breast cancer mortality in terms of both relative and absolute effects. This study was carried out under the auspices of the Swedish National Board of Health and Welfare. The board determined that, because randomization was at a community level and was to invitation to screening, informed verbal consent could be given by the participants when they attended the screening examination. A total of 133 065 women aged 40-74 years residing in two Swedish counties were randomized into a group invited to mammographic screening and a control group receiving usual care. Case status and cause of death were determined by the local trial end point committees and, independently, by an external committee. Mortality analysis was performed by using negative binomial regression. There was a highly significant reduction in breast cancer mortality in women invited to screening according to both local end point committee data (relative risk [RR] = 0.69; 95% confidence interval: 0.56, 0.84; P < .0001) and consensus data (RR = 0.73; 95% confidence interval: 0.59, 0.89; P = .002). At 29 years of follow-up, the number of women needed to undergo screening for 7 years to prevent one breast cancer death was 414 according to local data and 519 according to consensus data. Most prevented breast cancer deaths would have occurred (in the absence of screening) after the first 10 years of follow-up. Invitation to mammographic screening results in a highly significant decrease in breast cancer-specific mortality. Evaluation of the full impact of screening, in particular estimates of absolute benefit and number needed to screen, requires follow-up times exceeding 20 years because the observed number of breast cancer deaths prevented increases with increasing time of follow-up.

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Breast cancer in Brazil: present status and future goals.

Brittany Lee, Pedro Liedke, Carlos Barrios … (2012)

Breast cancer is the most common cancer in women worldwide and 70% of breast cancer deaths occur in women from low-income and middle-income countries. Latin America has about 115,000 new cases of disease every year, with about 50,000 arising in Brazil. We examined the present status of breast cancer in Brazil as an example of the health effects of geographical, ethnic, and socioeconomic diversities on delivery of care. Our goal was to identify deficiencies that could be responsible for disparities in survival from breast cancer. We searched the English and Portuguese published work and reviewed national databases and Brazilian publications. Although the availability of publications specific to Brazil is low in general, we identified several factors that could account for disparities: delays in diagnosis due to low cancer awareness and implementation of mammography screening, unknown quality of surgery, and restricted access to radiotherapy and modern systemic therapies. Copyright © 2012 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Danielle Cristina Netto Rodrigues:

ORCID: http://orcid.org/0000-0002-6044-0003

+55 (62) 3991-6012 , +55 (62) 99925-6630 , daniellepsinetto@yahoo.com.br

Journal

Journal ID (nlm-ta): BMC Public Health

Journal ID (iso-abbrev): BMC Public Health

Title: BMC Public Health

Publisher: BioMed Central (London )

ISSN (Electronic): 1471-2458

Publication date (Electronic): 18 July 2019

Publication date PMC-release: 18 July 2019

Publication date Collection: 2019

Volume: 19

Electronic Location Identifier: 959

Affiliations

[1 ]ISNI 0000 0001 2192 5801, GRID grid.411195.9, Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), , School of Medicine, Federal University of Goiás, ; Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás 74605-020 Brazil

[2 ]GRID grid.419166.d, Brazilian Breast Cancer Research Network, Division of Quality Control in Ionizing Radiation, , National Cancer Institute (INCA), ; Rio de Janeiro, RJ Brazil

[3 ]Brazilian Breast Cancer Research Network, Faculdade Unida de Campinas, Goiânia, Goiás Brazil

Author information

Danielle Cristina Netto Rodrigues http://orcid.org/0000-0002-6044-0003

Article

Publisher ID: 7278

DOI: 10.1186/s12889-019-7278-z

PMC ID: 6637648

PubMed ID: 31319826

SO-VID: 800e0209-4b58-414d-b97b-c758f7992d5b

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 18 July 2018

Date accepted : 3 July 2019

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ScienceOpen disciplines: Public health

Keywords: breast cancer,screening programs,mammography,healthcare coverage,brazilian national health service

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ScienceOpen disciplines: Public health

Keywords: breast cancer, screening programs, mammography, healthcare coverage, brazilian national health service

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

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Karger: Oncology

Most cited references 24

Screening for breast cancer with mammography

Swedish two-county trial: impact of mammographic screening on breast cancer mortality during 3 decades.

Breast cancer in Brazil: present status and future goals.

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