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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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Barrios C, Freitas-Junior R, Martins S, Bines J, Del Pilar Estevez-Diz M, Caleffi M. Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies. JCO Glob Oncol 2021; 7:474-485. [PMID: 33822641 PMCID: PMC8081546 DOI: 10.1200/go.20.00566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to treatment of advanced metastatic breast cancer (mBC) in Brazil, specifically for patients in the public health care system, arguably those with the least access to innovation. MATERIALS AND METHODS A selected panel of Brazilian experts in BC were provided with a series of relevant questions to address in a multiday conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to new drugs in cancer care in Brazil. Moreover, in creating these recommendations and framework, the authors strive to address the most important barriers and impediments for technology incorporation. A feasible and specific multidisciplinary process is proposed, which is based on the collective participation of all involved stakeholders. CONCLUSION Given the current benefits and likely future developments, there is a great need to expand treatments for mBC not only in Brazil but also in most other countries in the world where access issues remain an unresolved demand. Adapting the current framework is essential for accomplishing this goal. The recommendations in this review can serve as a framework for adoption of new technologies in countries with limited resources.
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Affiliation(s)
- Carlos Barrios
- Grupo Oncoclínicas, Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Ruffo Freitas-Junior
- CORA, Advanced Center for Diagnosis of Breast Diseases, Federal University of Goias, Goiânia, Brazil
- Araujo Jorge Hospital of Associação de Combate ao Câncer em Goiás, Goiânia, Brazil
| | - Sandro Martins
- Medical Oncology Unit, University Hospital of Brasília/EBSERH, Brasília, Brazil
| | - Jose Bines
- Clínica São Vicente, Rio de Janeiro, Brazil
| | - Maria Del Pilar Estevez-Diz
- Instituto do Câncer do Estado de São Paulo/Faculdade de Medicina da Universidade de São Paulo, Onco Star Rede D'Or, São Paulo, Brazil
| | - Maira Caleffi
- Hospital Moinhos de Vento, Femama, Porto Alegre, Brazil
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Silva JDDE, de Oliveira RR, da Silva MT, Carvalho MDDB, Pedroso RB, Pelloso SM. Breast Cancer Mortality in Young Women in Brazil. Front Oncol 2021; 10:569933. [PMID: 33585192 PMCID: PMC7874105 DOI: 10.3389/fonc.2020.569933] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 12/07/2020] [Indexed: 11/29/2022] Open
Abstract
Objective Malignant breast cancer is the leading cause of death by cancer in young women. The study aimed to determine if breast cancer mortality among young women has increased between the period from 1996 to 2017 in Brazil. Methods A time-series analysis of breast cancer mortality rate in young women (20–39 years old) was carried out. Mortality data, from 1996 to 2017, were collected from the Mortality Information System of the Health Ministry, and demographic data, from the Brazilian Institute of Geography and Statistics. Trends in mortality were performed by Joinpoint Regression, the spatial distribution of the mortality rate was done with the QGIZ Software version 2.18, and Spearman’s correlation coefficient was used to correlate the mortality rates with the Human Development Index. Results There was an increase in breast cancer mortality rates in young women in the majority of Brazilian states, with an upward trend in all regions. The correlation with the Municipal Human Development Index, income, and education had a significant impact on the mortality rate for women from 30–39 years old in both time frames evaluated and for women from 20–29 years old, only from 1996 to 2000. Conclusion The data obtained in the study, showed that even though the breast cancer mortality rate of young women is lower than women over 40 years old, it has been increasing in all regions of Brazil, mostly for women from 30–39 years old, suggesting that this group should be included in screening programs.
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Affiliation(s)
| | | | - Mariana Teixeira da Silva
- Health Sciences Department, Graduate Program in Health Science, State University of Maringá, Maringá, Brazil
| | | | - Raissa Bocchi Pedroso
- Health Sciences Department, Graduate Program in Health Science, State University of Maringá, Maringá, Brazil
| | - Sandra Marisa Pelloso
- Health Sciences Department, Graduate Program in Health Science, State University of Maringá, Maringá, Brazil.,Health Sciences Department, Graduate Program in Nursing, State University of Maringá, Maringá, Brazil
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Moreira CB, Dahinten VS, Howard AF, Fernandes AFC. The Revised Champion's Health Belief Model Scale: Predictive Validity Among Brazilian Women. SAGE Open Nurs 2021; 6:2377960820940551. [PMID: 33415294 PMCID: PMC7774489 DOI: 10.1177/2377960820940551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 05/26/2020] [Accepted: 06/13/2020] [Indexed: 11/25/2022] Open
Abstract
Mammography screening is provided free of charge for the recommended target
population in Brazil but participation rates have remained low, and breast
cancer mortality has continued to increase. Thus, it is important to
identify factors that are associated with poor participation in mammography
screening so that service providers can target health promotion messages and
screening programs more effectively. Objective: To evaluate the
predictive validity of the Revised Champion’s Health Belief Model scale
(RCHBMS) for identifying women at high risk of not adhering to national
guidelines for mammography screening in Brazil. Methods: We
used a longitudinal survey design with a 1-year follow-up data from 194
women living in northeastern Brazil, in the city of Fortaleza, Ceará,
participants completed the RCHBMS at baseline, and mammography uptake was
measured 1 year later. Hierarchical logistic regression was used to
determine the predictive validity of the RCHBMS for identifying women who
had not adhered to recommendations for mammography screening, after
accounting for the women’s sociodemographic and clinical characteristics.
The sensitivity and specificity of various cut-off points were calculated to
determine the optimal cut-off point for identifying women at high risk of
not adhering to mammography screening guidelines. Results: Two
subscales of the RCHBMS uniquely predicted nonadherence: susceptibility and
barriers, along with race and family history of cancer. The total scale
score (with barriers reverse coded) was also highly predictive. For our
sample, using only the RCHBMS with a cutoff of ≤ 3.67 (out of a total
possible range of 1–5) yielded a high sensitivity and specificity for
predicting nonadherence. Conclusion: Study findings support the
validity and clinical utility of the RCHBM for identifying women at risk of
not adhering to national guidelines for mammography screening in Brazil.
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Moreira CB, Dahinten VS, Howard AF, Fernandes AFC, Schirmer J. Factors related to mammography adherence among women in Brazil: A scoping review. Nurs Open 2020; 8:2035-2049. [PMID: 34388860 PMCID: PMC8363398 DOI: 10.1002/nop2.706] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/30/2020] [Accepted: 11/04/2020] [Indexed: 01/24/2023] Open
Abstract
AIM To explore and synthesize the literature on factors related to mammography screening adherence among women in Brazil. DESIGN A scoping review. METHODS We searched 11 databases for studies published between 2006-January 2020. All identified articles were screened, and data were extracted from eligible studies. We used the UK Government Social Research Service weight of evidence appraisal tool to appraise the quality of the included study. RESULTS From a total of 1,384 identified articles, 22 were retained. All included studies used quantitative, non-experimental methods and all but two studies used cross-sectional data. Quality of evidence varied across studies. We identified 41 factors that were investigated across the set of studies. Demographic and socio-economic factors were the most commonly investigated, with older age, urban residence, living in the southeast of Brazil, higher level of education, higher income and private health insurance most consistently associated with mammography adherence.
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Affiliation(s)
- Camila Brasil Moreira
- School of Nursing, Federal University of São Paulo, São Paulo, Brazil.,School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - V Susan Dahinten
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - A Fuchsia Howard
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | | | - Janine Schirmer
- School of Nursing, Federal University of São Paulo, São Paulo, Brazil
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Nuche-Berenguer B, Sakellariou D. Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review. PLoS One 2019; 14:e0225667. [PMID: 31765426 PMCID: PMC6876872 DOI: 10.1371/journal.pone.0225667] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.
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Affiliation(s)
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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Cabral ALLV, Giatti L, Martínez-Hernáez Á, Cherchiglia ML. Inequality in breast cancer care in a Brazilian capital city: a comparative analysis of narratives. Int J Equity Health 2019; 18:88. [PMID: 31196095 PMCID: PMC6567470 DOI: 10.1186/s12939-019-0989-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 05/21/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction Breast cancer is the leading cause of death by cancer in women in Brazil. Timely access to treatment is a priority for health policy in the country. However, indicators of the disease are not equally distributed between women. Poverty and low levels of schooling associate with late diagnosis, worse prognosis and lower survival. Objective To investigate differences between women from different socio-demographic profiles in the breast cancer care trajectory in Belo Horizonte, Brazil. Method This is a hermeneutic study through narrative analysis. The selection of the participants was based on data from hospital records of four public and private oncology services in Belo Horizonte, Brazil, according to the following variables: age, levels of schooling, and treatment cost source (Proxy of income): In-depth interviews were performed with 35 women characterized in three profiles: Profile 1 (n = 7), age range 51–69 years, schooling ≥15 years and private treatment cost; Profile 2 (n = 13), age range 35–58 years, schooling = 11 years and predominantly public treatment costing; Profile 3 (n = 15), age range 43–79 years, schooling ≤ 8 years and public treatment cost. Results The analysis of the narratives allowed the identification of three main themes (preventive care and first signs/symptoms; search for care and diagnosis of cancer; treatment and perceptions about care received) that highlighted differences between the trajectories, with prejudice to women with characteristics of greater vulnerability (Profile 3). Conclusion Although in Brazil the attention to women with breast cancer is guided by principles of equality and equity of care, it is necessary to develop mechanisms to prevent discriminatory practices and that guarantee equality of access to diagnosis and treatment.
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Affiliation(s)
- Ana Lúcia Lobo Vianna Cabral
- Graduate Public Health Program, Medical School, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, Brazil.
| | - Luana Giatti
- Department of Preventive and Social Medicine, Medical School. UFMG, Belo Horizonte, Brazil
| | - Ángel Martínez-Hernáez
- Departament d'Antropologia, Filosofia e Treball Social. Medical Anthropology Research Center. Universitat Rovira I Virgili, Tarragona, Spain
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da Cunha GN, Vianna CMDM, Mosegui GBG, da Silva MPR, Jardim FN. [Breast cancer screening: modeling improvement of access using mobile mammography unitsSeguimiento del cáncer de mama: modelo de mejora del acceso con el uso de mamógrafos móviles]. Rev Panam Salud Publica 2019; 43:e19. [PMID: 31093243 PMCID: PMC6459392 DOI: 10.26633/rpsp.2019.19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/27/2018] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the impact of combined use of fixed and mobile mammography units to rationalize the management of breast cancer screening programs and increase population coverage. METHODS An observational study was performed using agents-based modeling. The model was used to simulate breast cancer screening coverage in a specific region in the state of Rio de Janeiro (região serrana) where 22 fixed mammography units are installed. The number and distribution of fixed and mobile units, as well as the required number of daily exams, were estimated considering a population coverage of 100% and 60% in the region for the 2015-2016 biennium. RESULTS For the two-year period, a 60% population coverage could be reached with eight mammography units (five fixed and three mobile). Considering a scenario in which 100% of the eligible population would undergo screening, 11 units would be required (seven fixed and four mobile units). The actual coverage in the region for the 2015-2016 biennium was 36.4%, with 22 mammography units performing four exams daily. CONCLUSIONS The present simulation showed that it would be possible to reduce by half the number of mammography units in the region, ensuring 100% coverage. Adding more mobile units would facilitate access by the population from cities without installed mammography units and from rural areas.
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Affiliation(s)
- Gerson Nunes da Cunha
- Faculdade de Tecnologia do Estado do Rio de JaneiroFaculdade de Tecnologia do Estado do Rio de JaneiroPetrópolisRJBrasilFaculdade de Tecnologia do Estado do Rio de Janeiro, Petrópolis (RJ), Brasil.
| | - Cid Manso de Mello Vianna
- Instituto de Medicina SocialInstituto de Medicina SocialUniversidade do Estado do Rio de Janeiro (UERJ)Rio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Rio de Janeiro (RJ), Brasil.
| | - Gabriela Bittencourt Gonzalez Mosegui
- Instituto de Saúde ColetivaInstituto de Saúde ColetivaUniversidade Federal Fluminense (UFF)Rio de JaneiroRJBrasilUniversidade Federal Fluminense (UFF), Instituto de Saúde Coletiva, Rio de Janeiro (RJ), Brasil.
| | - Marcus Paulo Rodrigues da Silva
- Instituto de Medicina SocialInstituto de Medicina SocialUniversidade do Estado do Rio de Janeiro (UERJ)Rio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Rio de Janeiro (RJ), Brasil.
| | - Fernando Nagib Jardim
- Instituto de Medicina SocialInstituto de Medicina SocialUniversidade do Estado do Rio de Janeiro (UERJ)Rio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro (UERJ), Instituto de Medicina Social, Rio de Janeiro (RJ), Brasil.
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