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Silva ARD, Nicolella AC, Pazello ET. [Analysis of the effect of mammography allocation on women's health indicators]. CAD SAUDE PUBLICA 2024; 40:e00220122. [PMID: 39082499 PMCID: PMC11290823 DOI: 10.1590/0102-311xpt220122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 08/02/2024] Open
Abstract
The early detection of breast cancer enables more effective forms of treatment. However, widespread access to its main screening tool, mammography, remains a challenge for the Brazilian public health system. This study aimed to analyze the effect of allocating mammography equipment on women's health indicators. In 2013, of the 4,557 municipalities that lacked the equipment, 260 received it up to 2019. The main hypothesis of this study suggests that receiving the mammography device would show a heterogeneous effect between locations and that such receival would depend on observable (propensity score matching) and non-observable variables (fixed effects model). Results indicate that the Brazilian municipalities that had mammography equipment in use from 2014 onward increased their number of exams without short-term effects to diagnoses and deaths due to malignant breast neoplasia. In addition to equipment, a more complex structure involving other factors (such as access to consultations, qualified professionals, waiting time, etc.) is important to improve women's health indicators in the analyzed municipalities.
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Affiliation(s)
- Alana Ramos da Silva
- Faculdade de Economia, Administração e Contabilidade de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Alexandre Chibebe Nicolella
- Faculdade de Economia, Administração e Contabilidade de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
| | - Elaine Toldo Pazello
- Faculdade de Economia, Administração e Contabilidade de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, Brasil
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Dias MBK, Assis MD, Santos ROMD, Ribeiro CM, Migowski A, Tomazelli JG. [Adequacy of provision of procedures for early detection of breast cancer in the Brazilian Unified National Health System: a cross-sectional study conducted in Brazil and its regions, 2019]. CAD SAUDE PUBLICA 2024; 40:e00139723. [PMID: 38775611 PMCID: PMC11111169 DOI: 10.1590/0102-311xpt139723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/13/2023] [Accepted: 11/28/2023] [Indexed: 05/24/2024] Open
Abstract
Early detection is a major strategy in breast cancer control and, for this reason, it is important to ensure access to investigation of suspected cases for care continuity and timely treatment. This study aimed to estimate the need for procedures of breast cancer early detection and assess their adequacy for providing care to screened and symptomatic women in the Brazilian Unified National Health System (SUS) in 2019. A descriptive cross-sectional study was conducted to analyze the provision of tests for breast cancer early detection, comparing the estimated need with the procedures performed in the SUS. Parameters provided by the Brazilian National Cancer Institute were used to estimate the population and the need for early detection tests. The number of procedures performed in 2019 was obtained from the Outpatient Information System of the SUS. A deficit in screening mammograms was observed in the country (-45.1%), ranging from -31.4% in the South Region to -70.5 % in the North Region. If this test was offered to the target population, the deficit in the country would reduce to -14.8% and there would be an oversupply in the South Region (6.2%). Diagnostic investigation procedures varied between the regions, with higher deficits in coarse needle biopsy (-90.8%) and breast lump biopsy/excision (-80.6%) observed in the Central-West Region, and the highest deficit in anatomopathological exams in the North Region (-88.5%). The comparison between the production and need for procedures of breast cancer early detection in Brazil and its regions identified deficits and inadequacies that must be better understood and addressed at the state and municipal levels.
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Affiliation(s)
| | | | | | | | - Arn Migowski
- Instituto Nacional de Câncer, Rio de Janeiro, Brasil
- Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
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da Silva AR, Scorzafave LGDS. Inequality by Skin Color in Breast Cancer Screening in Brazil: a Differences-in-Differences Analysis of the COVID-19 Pandemic. J Racial Ethn Health Disparities 2024:10.1007/s40615-024-01908-2. [PMID: 38228863 DOI: 10.1007/s40615-024-01908-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 12/28/2023] [Accepted: 01/04/2024] [Indexed: 01/18/2024]
Abstract
Breast cancer is the second most common cancer type and the first in mortality among Brazilian women. Mammograms are one of the main early diagnosis strategies. National breast cancer screening coverage is still low. Brazil's low screening coverage is due to high mammography access inequality. Skin color defines healthcare access differences. Our article explores the natural event of the COVID-19 pandemic to analyze differences in screening rates between two racial groups of women through the application of the differences in differences (DiD) estimator. The results indicate that BBI women (Black, Brown, and Indigenous Brazilian) have lower screening rates than WY women (White and Yellow) and that the pandemic reduced the difference between these two groups due to the lower number of mammograms performed by WY women. It is believed that the information channel can explain much of this result. The BA population, wealthier and more educated, may have had additional information about COVID-19 and its consequences, as well as an increased likelihood of working remotely and practicing social distance. Structural racism causes many social indicators to be correlated with inequality of access to mammography and negatively impacts health conditions for BBI women. Public policies are necessary for equal access to breast cancer screening for the most vulnerable women.
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Affiliation(s)
- Alana Ramos da Silva
- Faculty of Economics, Administration and Accounting of Ribeirão Preto, University of São Paulo (FEA-RP/USP), Ribeirão Preto, SP, Brazil.
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Renna Junior NL, Azevedo E Silva GD. Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996-2012. Cancer Epidemiol 2023; 85:102394. [PMID: 37419053 DOI: 10.1016/j.canep.2023.102394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 07/09/2023]
Abstract
INTRODUCTION The association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available. OBJECTIVES The objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR). METHODS Using population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards. RESULTS 28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years) OBJECTIVES: Study the impact of socioeconomic factors on cancer survival in two Brazilian capitals. METHODS Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines. RESULTS 28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%. CONCLUSION The results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s.
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Baquero OS, Rebolledo EAS, Ribeiro AG, Bermudi PMM, Pellini ACG, Failla MA, Aguiar BSD, Diniz CSG, Chiaravalloti Neto F. Pink October and mammograms: when health communication misses the target. CAD SAUDE PUBLICA 2021; 37:e00149620. [PMID: 34816950 DOI: 10.1590/0102-311x00149620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/04/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.
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Affiliation(s)
- Oswaldo Santos Baquero
- Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil.,Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Alessandra Cristina Guedes Pellini
- Coordenação de Epidemiologia e Informação, Secretaria Municipal de Saúde de São Paulo, São Paulo, Brasil.,Universidade Nove de Julho, São Paulo, Brasil
| | | | - Breno Souza de Aguiar
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Coordenação de Epidemiologia e Informação, Secretaria Municipal de Saúde de São Paulo, São Paulo, Brasil
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Viacava F, Porto SM, Carvalho CDC, Bellido JG. Health inequalities by region and social group based on data from household surveys (Brazil, 1998-2013). CIENCIA & SAUDE COLETIVA 2019; 24:2745-2760. [PMID: 31340291 DOI: 10.1590/1413-81232018247.15812017] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 12/15/2017] [Indexed: 11/21/2022] Open
Abstract
This article discusses trends in health inequalities and access to health services across the regions of Brazil using data from household surveys conducted between 1998 and 2013. Social inequality was measured based on the ratio between the extremes of years of schooling considering two age groups (18 to 59 years and 60 years and over). The findings show a decline in health status and increase in prevalence of diabetes and hypertension in both age groups, which may be related to the expansion of primary healthcare. The findings regarding the percentage of people who had had a medical appointment in the last 12 months show that low levels of inequalities persist despite a general improvement in access. Despite an increase in the percentage of people with up to 3 years of schooling who had had a dental appointment in the last year, significant inequalities persist. The percentage of people who reported being admitted to hospital in the last 12 months was greater among people with up to 3 years of schooling throughout the study period. The hospitalization rate decreased in both age groups across almost all regions. The proportion of women aged between 50 and 69 years with up to 3 years of schooling who had had a mammogram increased, leading to a decrease in inequality. The findings show the need to ensure the continuity of household surveys to monitor inequalities in access to health care services by region and social group.
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Affiliation(s)
- Francisco Viacava
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | | | - Carolina de Campos Carvalho
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
| | - Jaime Gregório Bellido
- Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fiocruz. Av. Brasil 4365, Manguinhos. 21040-900 Rio de Janeiro RJ Brasil.
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Ramos ACV, Alves LS, Berra TZ, Popolin MP, Arcoverde MAM, Campoy LT, Martoreli JF, Lapão LV, Palha PF, Arcêncio RA. [Family Health Strategy, private health care, and inequalities in access to mammography in BrazilEstrategia de Salud Familiar, salud suplementaria y desigualdad en el acceso a la mamografía en Brasil]. Rev Panam Salud Publica 2018; 42:e166. [PMID: 31093194 PMCID: PMC6398316 DOI: 10.26633/rpsp.2018.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 08/15/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To evaluate the association between access to mammography and coverage by private health insurance or by the public healthcare system through the Family Health Strategy (FHS). METHOD An ecological study was performed with data obtained from the Unified Health System Data Processing Department (DATASUS). Time trends were analyzed using the Prais-Winsten method, having the Brazilian federal units as units of analysis. Multiple linear regression was used to investigate the relationship between the dependent variable - women aged 50 to 69 years who never had a mammogram - and the independent variables (coverage by the FHS or private health care and socioeconomic aspects). RESULTS Acre was the only Brazilian state for which an increasing growth trend in private health care was not observed. Roraima, Tocantins, Maranhão, Piauí, Rio Grande do Norte, and Paraíba showed a stable trend for FHS coverage, whereas all other federal units had increasing coverage. A significant association was observed between never having had a mammogram at 50 to 69 years of age and the variables mean per capita income and FHS and private health care coverage (R2 = 0.77; P < 0.001). CONCLUSION Unequal access to mammography is a reality in Brazil. Both private health care and the FHS have contributed to improve health care accessibility for Brazilian women.
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Affiliation(s)
- Antônio Carlos Vieira Ramos
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil,Correspondência: Antônio Carlos Vieira Ramos,
| | - Luana Seles Alves
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Thaís Zamboni Berra
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Marcela Paschoal Popolin
- Universidade Federal de Mato Grosso (UFMT), Instituto de Ciências da Saúde, Campus de Sinop, Sinop, (MT), Brasil
| | - Marcos Augusto Moraes Arcoverde
- Universidade Estadual do Oeste do Paraná (UNIOESTE), Campus de Foz do Iguaçu, Centro de Educação, Letras e Saúde, Foz do Iguaçu (PR), Brasil
| | - Laura Terenciani Campoy
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - José Francisco Martoreli
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
| | - Luís Velez Lapão
- Universidade Nova de Lisboa, Instituto de Higiene e Medicina Tropical, Lisboa, Portugal
| | - Pedro Fredemir Palha
- Universidade de São Paulo (USP), Escola de Enfermagem de Ribeirão Preto, Ribeirão Preto (SP), Brasil
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Silva MTAD, Silva Júnior VBD, Mangueira JDO, Gurgel Junior GD, Leal EMM. Distribution of mammograms and mammography offering in relation to the parametric care of the Public Health Care System in Pernambuco. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2018. [DOI: 10.1590/1806-93042018000300009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Objective: to describe the distribution of available mammograms in the Sistema Único de Saúde (SUS) (Public Health Care System) and the mammography offering were carried out by this system, throughout the health regions in Pernambuco State, and compared them with the parametric care recommended by the Ministry of Health. Methods: this is a descriptive cross-sectional study that used secondary mammograms data in December 2016 by the Cadastro Nacional de Estabelecimentos de Saúde (National Registy on Health Establishments); and about mammography performed at SUS in 2016 by the Sistema de Informação Ambulatorial (Ambulatory Information System). The parametric care document No. 1.631/2015 was used as a comparability standard in relation to the distribution of the equipment and the mammography offering. Results: Pernambuco State presented approximately the double amount of mammograms and mammography was performed about 46% below the recommended parameter used in this study. All the health regions presented sufficient quantity of mammograms. However, the use of the installed capacity was less than 50% in all the health regions in the state. Conclusions: this study shows the need for a better use of the installed capacity for mammograms in Pernambuco State taken by the insufficient mammography offering and the poor distribution of the equipment in its territory.
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