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da Silva AG, Silva TPRD, Vasconcelos NMD, Santos FMD, Oliveira GDC, Malta DC. Time trend analysis and impacts of the COVID-19 pandemic on mammography and Papanicolaou test coverage in Brazilian state capitals. BMC Womens Health 2024; 24:436. [PMID: 39085895 PMCID: PMC11290149 DOI: 10.1186/s12905-024-03278-7] [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: 06/03/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Breast and cervical cancer are major public health issues globally. The reduction in incidence and mortality rates of these cancers is linked to effective prevention, early detection, and appropriate treatment measures. This study aims to analyze the temporal trends in the prevalence of mammography and Papanicolaou test coverage among women living in Brazilian state capitals between 2007 and 2023, and to compare the coverage of these tests before and during the Covid-19 pandemic. METHODS A time series study was conducted using data from the Surveillance System for Risk and Protective Factors for Chronic Diseases by Telephone Survey from 2007 to 2023. The variables analyzed included mammography and Papanicolaou test coverage according to education level, age group, race/skin color, regions, and Brazilian capitals. The Prais-Winsten regression model was used to analyze the time series, and Student's t-test was employed to compare the prevalence rates between 2019 and 2023. RESULTS Between 2007 and 2023, mammography coverage showed a stationary trend (71.1% in 2007 and 73.1% in 2023; p-value = 0.75) with a declining trend observed among women with 12 years or more of education (APC= -0.52% 95%CI -1.01%; -0.02%). Papanicolaou test coverage for all women aged between 25 and 64 exhibited a downward trend from 82% in 2007 to 76.8% in 2023 (APC= -0.45% 95%CI -0.76%; -0.13%). This decline was also noticed among those with 9 years or more of education; in the 25 to 44 age group; among women with white and mixed race; and in the Northeast, Central-West, Southeast, and South regions. When comparing coverage before and during Covid-19 pandemic, a reduction was noted for both tests. CONCLUSIONS Over the years, there has been stability in mammography coverage and a decline in Papanicolaou test. The COVID-19 pandemic negatively impacted the number of these tests carried out among women, highlighting the importance of actions aimed at increasing coverage, especially among the most vulnerable groups.
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Affiliation(s)
- Alanna Gomes da Silva
- School of Nursing, Graduate Program in Nursing, Department of Maternal-Child and Public Health Nursing, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, 30130-100, Minas Gerais, Brazil.
| | - Thales Philipe Rodrigues da Silva
- Women's Health Nursing Department, Paulista School of Nursing, Federal University of São Paulo (Unifesp), Rua Napoleão de Barros,754, Vila Clementino, São Paulo, 04023-062, Brazil
| | - Nádia Machado de Vasconcelos
- Graduate Program in Public Health at the Medical School, Federal University of Minas Gerais (UFMG), 190, Santa Efigênia, Belo Horizonte, 30130-100, Minas Gerais, Brazil
| | - Filipe Malta Dos Santos
- Faculty of Medical Sciences of Minas Gerais (CMMG), Alameda Ezequiel Dias, 275, Centro, Belo Horizonte, 30130-110, Minas Gerais, Brazil
| | - Greice de Campos Oliveira
- Sofia Feldman Hospital, Rua Antônio Bandeira 1060, Tupi, Belo Horizonte, 31844-130, Minas Gerais, Brazil
| | - Deborah Carvalho Malta
- School of Nursing, Graduate Program in Nursing, Department of Maternal-Child and Public Health Nursing, Federal University of Minas Gerais (UFMG), Avenida Professor Alfredo Balena, 190, Santa Efigênia, Belo Horizonte, 30130-100, Minas Gerais, Brazil
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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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Medina-Ranilla J, Espinoza-Pajuelo L, Mazzoni A, Roberti J, García-Elorrio E, Leslie HH, García PJ. A systematic review of population and patient perspectives and experiences as measured in Latin American and Caribbean surveys. Health Policy Plan 2023; 38:1225-1241. [PMID: 37803966 DOI: 10.1093/heapol/czad083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/20/2023] [Accepted: 09/11/2023] [Indexed: 10/08/2023] Open
Abstract
High-quality health systems must provide accessible, people-centred care to both improve health and maintain population trust in health services. Furthermore, accurate measurement of population perspectives is vital to hold health systems accountable and to inform improvement efforts. To describe the current state of such measures in Latin America and the Caribbean (LAC), we conducted a systematic review of facility and population-based assessments that included patient-reported experience and satisfaction measures. Five databases were searched for publications on quantitative surveys assessing healthcare quality in Spanish- or Portuguese-speaking LAC countries, focusing on the domains of processes of care and quality impacts. We included articles published since 2011 with a national sampling frame or inclusion of multiple subnational regions. We tabulated and described these articles, identifying, classifying and summarizing the items used to assess healthcare quality into the domains mentioned earlier. Of the 5584 publications reviewed, 58 articles met our inclusion criteria. Most studies were cross-sectional (95%), assessed all levels of healthcare (57%) and were secondary analyses of existing surveys (86%). The articles yielded 33 unique surveys spanning 12 LAC countries; only eight of them are regularly administered surveys. The most common quality domains assessed were satisfaction (in 33 out of 58 articles, 57%), evidence-based/effective care (34%), waiting times (33%), clear communication (33%) and ease of use (31%). Items and reported ratings varied widely among instruments used, time points and geographical settings. Assessment of patient-reported quality measures through population- and facility-based surveys is present but heterogeneous in LAC countries. Satisfaction was measured frequently, although its use in accountability or informing quality improvement is limited. Measurement of healthcare quality in LAC needs to be more systematic, regular, comprehensive and to be led collaboratively by researchers, governments and policymakers to enable comparison of results across countries and to effectively inform policy implementation.
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Affiliation(s)
- Jesús Medina-Ranilla
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Laura Espinoza-Pajuelo
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
| | - Agustina Mazzoni
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Javier Roberti
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Ezequiel García-Elorrio
- Health Care Quality and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS), Dr. Emilio Ravignani 2024, Buenos Aires C1414CPV, Argentina
| | - Hannah Hogan Leslie
- Division of Prevention Science, Department of Medicine, University of California, San Francisco, 550 16th St., Floor 4, San Francisco, CA 94143, United States
| | - Patricia Jannet García
- School of Public Health and Administration, Epidemiology, STD and HIV Unit, Cayetano Heredia University (UPCH), Honorio Delgado Av. 430, San Martín de Porres, Lima 150135, Peru
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Chávez-Penha R, Bustamante-Teixeira MT, Nogueira MC. Age-Period-Cohort Study of Breast Cancer Mortality in Brazil in State Capitals and in Non-Capital Municipalities from 1980 to 2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6505. [PMID: 37569045 PMCID: PMC10418483 DOI: 10.3390/ijerph20156505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/17/2023] [Accepted: 07/26/2023] [Indexed: 08/13/2023]
Abstract
Breast cancer was identified as the cancer with the highest mortality rate among women in Brazil. This study analyzed the effects of age, period and birth cohort on the breast cancer mortality rate for Brazilian women, comparing state capitals and non-capital municipalities. Population and deaths data were extracted from the Brazilian Unified Health System database for women aged 30 years or older, for the years between 1980 and 2019. The effects were analyzed using the age-period-cohort model. Age effect on breast cancer mortality is observed in the model through higher mortality rates at older ages. Period effect is similar in all regions in the form of a marked increase in the rate ratio (RR) in non-capital municipalities by period than in state capitals. The RR of birth cohorts in the state capitals remained stable (north, northeast and central-west regions) or decreased followed by an increase in the most recent cohorts (Brazil as a whole and the southeast and south regions). The RR for the other municipalities, however, showed a progressive increase in the cohorts for all regions. Policies and actions focused on breast cancer in women should consider these differences among Brazilian regions, state capitals and other municipalities.
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Affiliation(s)
- Rodrigo Chávez-Penha
- Post-Graduation Program in Collective Health, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Minas Gerais, Brazil;
| | | | - Mário Círio Nogueira
- Post-Graduation Program in Collective Health, Faculty of Medicine, Federal University of Juiz de Fora, Juiz de Fora 36036-900, Minas Gerais, Brazil;
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Ferreira ADSS, Cintra JRD, Fayer VA, Nogueira MC, Júnior CB, Bustamante-Teixeira MT, Chaoubah A, Cintra AD, Simão CM, Guerra MR. Breast cancer survival and the health system in Brazil: an analysis of public and private healthcare. Front Oncol 2023; 13:927748. [PMID: 37305573 PMCID: PMC10248159 DOI: 10.3389/fonc.2023.927748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background The incidence of breast cancer is increasing globally; however, survival outcomes vary and are lower in developing countries. Methods We analyzed the 5- and 10-year survival rates for breast cancer according to the type of healthcare insurance (public vs. private) in a referral center for cancer care in the Brazilian southeast region. This hospital-based cohort study included 517 women diagnosed with invasive breast cancer between 2003 and 2005. The Kaplan-Meier method was used to estimate the probability of survival, and the Cox proportional hazards regression model was used to assess prognostic factors. Results The 5- and 10-year breast cancer survival rates were as follows: private healthcare service survival rate of 80.6% (95% CI 75.0-85.0) and 71.5% (95% CI 65.4-77.1), respectively, and public healthcare service survival rate of 68.5% (95% CI 62.5-73.8) and 58.5% (95% CI 52.1-64.4), respectively. The main factors associated with the worst prognosis were lymph node involvement in both healthcare services and tumor size >2 cm only in public health services. The use of hormone therapy (private) and radiotherapy (public) was associated with the best survival rates. Conclusions The survival discrepancies found between health services can be explained mainly by the difference in the stage of the disease at the time of diagnosis, indicating inequalities in access to the early detection of breast cancer.
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Affiliation(s)
- Adriana de Souza Sérgio Ferreira
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
| | - Jane Rocha Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
| | - Vívian Assis Fayer
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Mário Círio Nogueira
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | | | - Maria Teresa Bustamante-Teixeira
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Alfredo Chaoubah
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Arthur Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Caroline Montes Simão
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Maximiliano Ribeiro Guerra
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
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Saes-Silva E, Vieira YP, Viero VDSF, Rocha JQS, Saes MDO. [Trend of inequalities in the performance of mammography in Brazilian capitals in the last ten years]. CIENCIA & SAUDE COLETIVA 2023; 28:397-404. [PMID: 36651395 DOI: 10.1590/1413-81232023282.07742022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 07/26/2022] [Indexed: 01/18/2023] Open
Abstract
The objective was to verify the trend of inequality in the realization of mammography exam according to the possession of health insurance plan and schooling from data from the period 2011 to 2020 of VIGITEL. Population-based study with data from the Surveillance System of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL) between 2011 and 2020. Outcome: mammography exam in the last 2 years in women aged 50 to 69 years. The magnitude of inequalities of outcome in relation to exposures (health insurance plan and education) was estimated using two indices: inequality slope index (SII) and concentration index (CIX). The prevalence of mammography exam (2011-2020) increased from 74,4% to 78,0%, with a stable trend. The prevalence of those with health insurance plan were 85,7% and 86,4%, and without 63.4% and 71.2%, with an increasing trend. According to education, women with 0-8 years of schooling the prevalence increased from 68,2% to 72,6%, 9-11 years from 80,4% to 80,0% (decreasing trend), 12 years or more 88,0% to 86,6% (decreasing trend). As for the absolute (SII) and relative (CIX) inequality indices of schooling and health insurance plan show that there is a decrease in inequality over the last 10 years.
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Affiliation(s)
- Elizabet Saes-Silva
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Yohana Pereira Vieira
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Vanise Dos Santos Ferreira Viero
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Juliana Quadros Santos Rocha
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
| | - Mirelle de Oliveira Saes
- Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal do Rio Grande. R. Visconde de Paranaguá 102. 96203-900 Rio Grande RS Brasil.
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Justo AFO, Collaço RDC, Lescano CH, de Oliveira IP. Malignant neoplasm of breast in Brazilian women: A cross-sectional study from 2008 to 2019. J Natl Med Assoc 2023; 115:38-45. [PMID: 36577555 DOI: 10.1016/j.jnma.2022.12.003] [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: 07/12/2022] [Revised: 09/16/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Breast cancer is the most lethal malignancy for women worldwide. Developed countries, such as Portugal, Spain, and the United States, have declining mortality rates due to breast cancer; however, in developing countries, the epidemiological reports are scarce. In this context, the aims of this study are to describe and discuss the female breast cancer profile of hospitalization and mortality according to age and geographic region in Brazil from 2008 to 2019. METHODS Data were obtained from the National Health System Department of Informatics (DATASUS), maintained by the Brazilian Ministry of Health, which includes the registers of hospitalization and mortality by malignant neoplasm of breast (code C50, ICD-10). Proportional rates of hospitalization and deaths were estimated per 100,000 inhabitants according to respective subjects' age, region, and year of the occurrence. RESULTS From 2008 to 2019, 643,822 hospital admissions due to malignant neoplasm of breast were reported in Brazil, of which the South and Southeast regions were the most prevalent. Higher hospitalization rates were seen in subjects aged 50-79-years-old. Regarding mortality, 53,480 deaths by breast cancer were reported; similarly to hospitalization, the Southeast and South were the most affected regions. Mortality rates have increased over time in different magnitudes depending on subjects' age. CONCLUSION We have shown an increase in morbidity and mortality over time, which is dependent on patients' age and region. The results presented here may contribute to the ongoing discussion about the role and future perspectives of the Brazilian health care system, especially regarding to the strategies for the prevention, control, and treatment of breast cancer.
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Affiliation(s)
| | - Rita de Cássia Collaço
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Caroline Honaiser Lescano
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Pires de Oliveira
- Institute of Agricultural Sciences, Federal University of Minas Gerais, Minas Gerais, Brazil
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Determinants of Lack of Access to Treatment for Women Diagnosed with Breast Cancer in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137635. [PMID: 35805293 PMCID: PMC9266036 DOI: 10.3390/ijerph19137635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/13/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Abstract
Access to timely treatment is essential for the probability of the cure and reduction of severe breast cancer cases. In Brazil, legislation states that cancer treatment must start within 60 days of diagnosis. This study analyzed the factors associated with lack of access to breast cancer treatment in women with a confirmed diagnosis inserted in the health system. We collected secondary data from Brazilian women with a diagnosis and without treatment from January to December 2019 through the Cancer Hospital Registers developed by the National Cancer Institute. Our findings indicate that most women (60.11%) are diagnosed with stage II cancer but are without treatment. Most of them are aged 18–70 years, non-white race/color, have a low educational level and are from the Southeast Brazilian region. In addition, social inequalities are determinant in women’s lack of access to breast cancer treatment.
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Castro CPD, Sala DCP, Rosa TEDC, Tanaka OY. Atenção ao câncer de mama a partir da suspeita na atenção primária à saúde nos municípios de São Paulo e Campinas, Brasil. CIENCIA & SAUDE COLETIVA 2022; 27:459-470. [DOI: 10.1590/1413-81232022272.42012020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 11/25/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Buscou-se identificar fatores que interferem na suspeita do câncer de mama (CM) pela atenção primária à saúde (APS) que impulsionam o encaminhamento para a atenção especializada (AE) nos municípios de São Paulo e Campinas. Foram entrevistadas 664 mulheres (353 paulistanas e 311 campineiras) diagnosticadas com CM, encaminhadas para AE pela APS. Utilizou-se a análise de regressão logística multinível para a identificação das associações entre a suspeita do CM pela APS, variáveis socioeconômicas e atenção ao câncer. Mostraram associação significativa: nível superior de escolaridade (RC = 0,59; IC 95% = 0,35-0,98); pagamento de consulta médica para atendimento relacionado ao câncer (RC = 0,59; IC 95% = 0,36-0,96), continuou atendimento na APS após início do tratamento na AE (RC = 0,62; IC 95% = 0,41-0,95); mama examinada na APS (ECM) antes do encaminhamento para a AE (RC = 1,61; IC 95% = 1,10-2,34) e primeira mamografia solicitada na APS (RC = 2,81; IC 95% = 1,95-4,00). A solicitação da mamografia e o ECM são ações que têm sido incorporadas na APS para a detecção precoce do CM nos municípios. Continuar o atendimento na APS e melhores condições socioeconômicas, como ter nível superior de escolaridade e capacidade de pagar por atendimento, reduzem a chance da suspeita.
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Pitcairn CFM, Laverty AA, Chan JJL, Oyebode O, Mrejen M, Pescarini JM, Machado DB, Hone TV. Inequalities in the prevalence of major depressive disorder in Brazilian slum populations: a cross-sectional analysis. Epidemiol Psychiatr Sci 2021; 30:e66. [PMID: 34670640 PMCID: PMC8546499 DOI: 10.1017/s204579602100055x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
AIMS The mental health of slum residents is under-researched globally, and depression is a significant source of worldwide morbidity. Brazil's large slum-dwelling population is often considered part of a general urban-poor demographic. This study aims to identify the prevalence and distribution of depression in Brazil and compare mental health inequalities between slum and non-slum populations. METHODS Data were obtained from Brazil's 2019 National Health Survey. Slum residence was defined based on the UN-Habitat definition for slums and estimated from survey responses. Doctor-diagnosed depression, Patient Health Questionnaire (PHQ-9)-screened depression and presence of undiagnosed depression (PHQ-9-screened depression in the absence of a doctor's diagnosis) were analysed as primary outcomes, alongside depressive symptom severity as a secondary outcome. Prevalence estimates for all outcomes were calculated. Multivariable logistic regression models were used to investigate the association of socioeconomic characteristics, including slum residence, with primary outcomes. Depressive symptom severity was analysed using generalised ordinal logistic regression. RESULTS Nationally, the prevalence of doctor diagnosed, PHQ-9 screened and undiagnosed depression were 9.9% (95% confidence interval (CI): 9.5-10.3), 10.8% (95% CI: 10.4-11.2) and 6.9% (95% CI: 6.6-7.2), respectively. Slum residents exhibited lower levels of doctor-diagnosed depression than non-slum urban residents (8.6%; 95% CI: 7.9-9.3 v. 10.7%; 95% CI: 10.2-11.2), while reporting similar levels of PHQ-9-screened depression (11.3%; 95% CI: 10.4-12.1 v. 11.3%; 95% CI: 10.8-11.8). In adjusted regression models, slum residence was associated with a lower likelihood of doctor diagnosed (adjusted odds ratio (adjusted OR): 0.87; 95% CI: 0.77-0.97) and PHQ-9-screened depression (adjusted OR: 0.87; 95% CI: 0.78-0.97). Slum residents showed a greater likelihood of reporting less severe depressive symptoms. There were significant ethnic/racial disparities in the likelihood of reporting doctor-diagnosed depression. Black individuals were less likely to report doctor-diagnosed depression (adjusted OR: 0.66; 95% CI: 0.57-0.75) than white individuals. A similar pattern was observed in Mixed Black (adjusted OR: 0.72; 95% CI: 0.66-0.79) and other (adjusted OR: 0.63; 95% CI: 0.45-0.88) ethnic/racial groups. Slum residents self-reporting a diagnosis of one or more chronic non-communicable diseases had greater odds of exhibiting all three primary depression outcomes. CONCLUSIONS Substantial inequalities characterise the distribution of depression in Brazil including in slum settings. People living in slums may have lower diagnosed rates of depression than non-slum urban residents. Understanding the mechanisms behind the discrepancy in depression diagnosis between slum and non-slum populations is important to inform health policy in Brazil, including in addressing potential gaps in access to mental healthcare.
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Affiliation(s)
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
| | | | | | - Matías Mrejen
- São Paulo School of Business Administration, Fundação Getulio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Julia M. Pescarini
- Centro de Integração de Dados e Conhecimentos para Saúde (Cidacs), Fundação Oswaldo Cruz, Salvador, Brazil
- Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, London, UK
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Salvador, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Thomas V. Hone
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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11
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Fatores associados à realização de mamografia de acordo com dois critérios. SCIENTIA MEDICA 2021. [DOI: 10.15448/1980-6108.2021.1.38014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objetivo: objetivou-se comparar as prevalências e os fatores associados à realização de mamografia de acordo com dois critérios em vigência no Brasil.Métodos: estudo transversal, de base populacional, com mulheres entre 40 e 74 anos de Rio Grande, RS, Brasil. A cobertura de mamografia foi avaliada: 1) rastreamento anual para mulheres entre 40 e 74 anos; 2) rastreamento bienal para mulheres entre 50 e 69 anos. Os dados foram analisados por regressão de Poisson.Resultados: participaram do estudo 413 (critério 1) e 246 (critério 2) mulheres. A cobertura de mamografia pelo critério 1 foi de 49,4% (IC95% 43,8 a 55,0), oscilando de um quarto para as que não consultaram um médico no último ano até dois terços para aquelas com maior escolaridade. Segundo o critério 2, a cobertura foi de 65,5% (IC95% 59,2 a 71,7), indo de um terço entre as que não consultaram um médico no último ano a três quartos entre as obesas.Conclusões: a cobertura de mamografia diferiu conforme o critério empregado. Maior nível socioeconômico e ter consultado com médico no último ano foram os fatores mais associados, independentemente do critério.
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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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Teixeira LADS, Araújo Neto LA. Still Controversial: Early Detection and Screening for Breast Cancer in Brazil, 1950-2010s. MEDICAL HISTORY 2020; 64:52-70. [PMID: 31933502 PMCID: PMC6945208 DOI: 10.1017/mdh.2019.76] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
Mammographic screening for breast cancer is a widely used public health approach, but is constantly a subject of controversy. Medical and historical research on this topic has been mainly conducted in Western Europe and North America. In Brazil, screening mammography has been an open topic of discussion and a challenge for health care and public health since the 1970s. Effectively, Brazilian public health agencies never implemented a nationwide population-based screening programme for breast cancer, despite the pressures of many specific groups such as advocacy associations and the implementation of local programmes. This article examines the complex process of incorporating mammography as a diagnostic tool and the debates towards implementing screening programmes in Brazil. We argue that debates about screening for breast malignancies, especially those conducted in the late twentieth and early twenty-first centuries, took place in a context of change and uncertainty in the Brazilian health field. These discussions were strongly affected both by tensions between the public and the private health care sectors during the formative period of a new Brazilian health system, and by the growing role of civil society actors. Our study investigates these tensions and their consequences. We use several medical sources that discussed the topic in Brazil, mainly specialised leading oncology journals published between 1950 and 2017, medical congress reports for the same period, books and theses, institutional documents and oral testimonies of health professionals, patients and associations collected in the framework of the 'The History of Cancer' project from the Oswaldo Cruz Foundation and Brazilian National Cancer Institute.
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Affiliation(s)
- Luiz Antonio da Silva Teixeira
- Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
- Praia do Flamengo Avenue, 82, apt. 805/ Rio de Janeiro, Brazil. Email address for correspondence:
| | - Luiz Alves Araújo Neto
- National Cancer Institute Jose Alencar Gomes da Silva (INCA), Rio de Janeiro, Brazil
- Present affiliation: Oswaldo Cruz Foundation (FIOCRUZ), Rio de Janeiro, Brazil
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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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15
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Rech RS, Hugo FN, Schmidt JG, Goulart BNGD, Hilgert JB. Speech-language therapy offer and primary health care in Brazil: an analysis based on socioeconomic development. Codas 2019; 31:e20180083. [PMID: 30758397 DOI: 10.1590/2317-1782/20182018083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To describe the presence of speech-language therapists (SLT) in the primary health care (PHC) in Brazil and its association with socioeconomic inequalities. METHODS Cross-sectional study with 17,157 PHC services in all Brazilian states. Based on the NASF External Assessment Questionnaire sub-item "speech-language therapist", which was used to answer the question "What NASF professionals support your PHC service?", in addition to contextual data (regional population, number of registered SLP, speech therapy college courses, city HDI and Gini Index). RESULTS From all the PHC services supported by NASF, 50.8% (8713/17,157) has SLPs as part of the team. Brazil's Southeast region has the higher prevalence of SLP at the team (57.4%; 5,575). South Region has the lower prevalence (28.9%; 625). The presence of SLP support is directly proportional to HDI stratum and Gini Index (average and high). CONCLUSION There is an important limitation of public care to treat communication and swallowing disorders in Brazil.
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Affiliation(s)
- Rafaela Soares Rech
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brasil
| | - Fernando Neves Hugo
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brasil
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16
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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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17
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Pinto JA, Pinillos L, Villarreal-Garza C, Morante Z, Villarán MV, Mejía G, Caglevic C, Aguilar A, Fajardo W, Usuga F, Carrasco M, Rebaza P, Posada AM, Tirado-Hurtado I, Flores C, Vallejos CS. Barriers in Latin America for the management of locally advanced breast cancer. Ecancermedicalscience 2019; 13:897. [PMID: 30792814 PMCID: PMC6372299 DOI: 10.3332/ecancer.2019.897] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Indexed: 01/21/2023] Open
Abstract
Breast cancer (BC) is a highly prevalent malignancy in Latin American women, most cases being diagnosed at locally advanced or metastatic stages when options for cancer care are limited. Despite its label as a public health problem in the region, Latin American BC patients face several barriers in accessing standard of care treatment when compared with patients from developed countries. In this review, we analyse the landscape of the four main identified barriers in the region: i) high burden of locally advanced/advanced BC; ii) inadequate access to medical resources; iii) deficient access to specialised cancer care and iv) insufficient BC research in Latin America. Unfortunately, these barriers represent the main factors associated with the BC poor outcomes seen in the region. Targeted actions should be conducted independently by each country and as a region to overcome these limitations and create an enhanced model of BC care.
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Affiliation(s)
- Joseph A Pinto
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Luis Pinillos
- Departamento de Radioterapia, Oncosalud-AUNA, Lima 15036, Peru
| | - Cynthia Villarreal-Garza
- Departamento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City 14080, Mexico
| | - Zaida Morante
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru.,Departamento de Oncología Médica, Instituto Nacional de Enfermedades Neoplásicas, Lima 15038, Peru
| | - Manuel V Villarán
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Gerson Mejía
- Departamento de Oncología Médica, Hospital Clínico Viedma, Cochabamba 00725, Bolivia
| | - Christian Caglevic
- Medical Oncology Department, Clinica Alemana, Santiago 5951, Chile.,Facultad de Medicina Clínica Alemana, Universidad del Desarrollo, Santiago 700, Chile
| | - Alfredo Aguilar
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
| | - Williams Fajardo
- Departamento de Medicina Especializada, Hospital Nacional Dos de Mayo, Lima 15003, Peru
| | - Franz Usuga
- Grupo de Radioterapia Oncológica, Instituto Nacional de Cancerología, Bogotá 9-85, Colombia
| | - Marcia Carrasco
- Departamento de Oncología, Hospital Santa Rosa, Lima 95405, Peru.,Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Ana M Posada
- Unidad de la Mama, Oncosalud-AUNA, Lima 15036, Peru
| | | | - Claudio Flores
- Unidad de Investigación Básica y Traslacional, Oncosalud-AUNA, Lima 15036, Peru
| | - Carlos S Vallejos
- Departamento de Medicina Oncológica, Oncosalud-AUNA, Lima 15036, Peru
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Nogueira MC, Fayer VA, Corrêa CSL, Guerra MR, Stavola BD, dos-Santos-Silva I, Bustamante-Teixeira MT, Silva GAE. Inequities in access to mammographic screening in Brazil. CAD SAUDE PUBLICA 2019; 35:e00099817. [DOI: 10.1590/0102-311x00099817] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Accepted: 02/06/2019] [Indexed: 12/24/2022] Open
Abstract
Abstract: Our objectives with this study were to describe the spatial distribution of mammographic screening coverage across small geographical areas (micro-regions) in Brazil, and to analyze whether the observed differences were associated with spatial inequities in socioeconomic conditions, provision of health care, and healthcare services utilization. We performed an area-based ecological study on mammographic screening coverage in the period of 2010-2011 regarding socioeconomic and healthcare variables. The units of analysis were the 438 health micro-regions in Brazil. Spatial regression models were used to study these relationships. There was marked variability in mammographic coverage across micro-regions (median = 21.6%; interquartile range: 8.1%-37.9%). Multivariable analyses identified high household income inequality, low number of radiologists/100,000 inhabitants, low number of mammography machines/10,000 inhabitants, and low number of mammograms performed by each machine as independent correlates of poor mammographic coverage at the micro-region level. There was evidence of strong spatial dependence of these associations, with changes in one micro-region affecting neighboring micro-regions, and also of geographical heterogeneities. There were substantial inequities in access to mammographic screening across micro-regions in Brazil, in 2010-2011, with coverage being higher in those with smaller wealth inequities and better access to health care.
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Barbosa YC, Oliveira AGC, Rabêlo PPC, Silva FDS, Santos AMD. Fatores associados à não realização de mamografia: Pesquisa Nacional de Saúde, 2013. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2019; 22:e190069. [DOI: 10.1590/1980-549720190069] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Accepted: 10/05/2018] [Indexed: 11/22/2022] Open
Abstract
RESUMO: Introdução: O acesso à mamografia, principal exame de detecção precoce do câncer de mama, não é igualitário entre as mulheres brasileiras. Objetivou-se analisar os fatores associados à não realização desse exame num período inferior a dois anos no Brasil e por macrorregião, considerando-se características sociodemográficas, condições de saúde, hábitos de vida e uso dos serviços de saúde. Método: Estudo transversal que utilizou dados da Pesquisa Nacional de Saúde (PNS). A amostra consiste de 10.571 mulheres (≥ 40 anos) residentes em todas as regiões brasileiras. Modelo de regressão de Poisson com abordagem hierarquizada foi utilizado para estimar razões de prevalência. Resultados: As características associadas à não realização de mamografia foram: idade ≥ 60 anos, baixa escolaridade, viver sem companheiro, avaliar negativamente o próprio estado de saúde, possuir alguma doença crônica, não praticar exercício físico, não realizar o exame clínico da mama até um ano, ou o exame de Papanicolaou até três anos, não ter consultado com médico no último ano, não possuir plano de saúde, sentir-se discriminada por profissional de saúde e ter cadastro em uma unidade de saúde da família. Variáveis sociodemográficas se sobressaíram no Norte e Nordeste; e nas outras regiões, condições de saúde e hábitos de vida. Conclusão: Variáveis relacionadas ao uso dos serviços de saúde tiveram destaque na não realização da mamografia. Ações que reduzam a desigualdade no acesso ao exame devem ser adotadas em cada macrorregião do Brasil.
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Buranello MC, Meirelles MCCC, Walsh IAPD, Pereira GDA, Castro SSD. Breast cancer screening practice and associated factors: Women's Health Survey in Uberaba MG Brazil, 2014. CIENCIA & SAUDE COLETIVA 2018; 23:2661-2670. [PMID: 30137135 DOI: 10.1590/1413-81232018238.14762016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 08/25/2016] [Indexed: 11/21/2022] Open
Abstract
This study aimed to characterize women's socioeconomic and epidemiological profile in Uberaba according to the breast cancer screening practice and identify associated factors with this practice. This is a cross-sectional research part of the Women's Health Survey in Uberaba (MG). Data was collected by home interview, referring to socioeconomic and epidemiological issues and breast cancer screening practice, from a sample of 1,520 women above 20 years of age. After processing the data, we performed statistical analysis with measures of association by the Chi-square test, bivariate and multivariate Poisson regression, with a significance level of 5%. The results showed a profile of breast cancer screening practice with white women (66%), high schooling and per capita income, in common-law marriage (67,5%), non-heads of households (64,4%) and non-smokers (64,6%). Factors associated with higher practice were the age groups 40-49 and 50-69 years (PR = 0.7 and 0.64), per capita income higher than one minimum wage (PR = 1.17) and public or health plan mammography coverage (PR = 1.98 and 1.94). We can conclude that factors associated with breast cancer screening practice have been identified in the studied sample.
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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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Bezerra IC, da Silva RM, Oliveira CP, Brasil CCP, Vasconcelos MGF, Vilela Mamede M, de oliveira MTP. Mastectomized women's perception of breast cancer early detection. PLoS One 2018; 13:e0206405. [PMID: 30403717 PMCID: PMC6221333 DOI: 10.1371/journal.pone.0206405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 10/14/2018] [Indexed: 12/03/2022] Open
Abstract
Background A third of new cases of breast cancer could be detected early, which would prevent more serious consequences, such as mastectomy and death. Access to the subjectivity of mastectomized patients becomes relevant to elucidate failures in early detection of breast cancer and thus improve the cancer care network. Given that, the present study aimed to identify mastectomized women’s perception of the quality of care provided by the cancer care network for the early detection and diagnosis of breast cancer. Methods Qualitative study carried out at a public outpatient cancer center in the city of Fortaleza, Ceará, Northeastern Brazil, to analyze the perceptions of 26 women who had undergone mastectomy after breast cancer based on Symbolic Interactionism. Results The thematic analysis showed how women (re)structure their lives in the face of the structural and social aspects of coping with breast. Two essential themes emerged: “Contradictions regarding access to primary health care services and obstacles to the organization of SUS formal care network services” and “The informal and private health care network increase quality care coverage”. Conclusions The absence of effective measures in Primary Health Care and patients’ ‘pilgrimage’ in the formal health care network have delayed early detection breast cancer.
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Affiliation(s)
- Indara Cavalcante Bezerra
- Programa de Pós Graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
- * E-mail:
| | | | | | | | | | - Marli Vilela Mamede
- Departamento de Enfermagem, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
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Migowski A, Dias MBK, Nadanovsky P, Silva GAE, Sant'Ana DR, Stein AT. Guidelines for early detection of breast cancer in Brazil. III - Challenges for implementation. CAD SAUDE PUBLICA 2018; 34:e00046317. [PMID: 29952397 DOI: 10.1590/0102-311x00046317] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Accepted: 02/23/2018] [Indexed: 12/22/2022] Open
Abstract
The objective of the current article is to present the main challenges for the implementation of the new recommendations for early detection of breast cancer in Brazil, and to reflect on the barriers and the strategies to overcome them. The implementation of evidence-based guidelines is a global challenge, and traditional strategies based only on disseminating their recommendations have proven insufficient for changing prevailing clinical practice. A major challenge for adherence to the new guidelines for early detection of breast cancer in Brazil is the current pattern in the use of mammographic screening in the country, which very often includes young women and a short interval between tests. Such practice, harmful to the population's health, is reinforced by the logic of defensive medicine and the dissemination of erroneous information that overestimates the benefits of screening and underestimates or even omits its harms. In addition, there is a lack of policies and measures focused on early diagnosis of symptomatic cases. To overcome these barriers, changes in the regulation of care, financing, and implementation of shared decision-making in primary care are essential. Audit and feedback, academic detailing, and the incorporation of decision aids are some of the strategies that can facilitate implementation of the new recommendations.
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Affiliation(s)
- Arn Migowski
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil.,Instituto Nacional de Cardiologia, Rio de Janeiro, Brasil
| | | | - Paulo Nadanovsky
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil.,Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
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Borges ZDS, Wehrmeister FC, Gomes AP, Gonçalves H. Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2017; 19:1-13. [PMID: 27167644 DOI: 10.1590/1980-5497201600010001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Accepted: 09/18/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence and associated factors of doing clinical breast examinations (CBE) and mammogram (MMG) in the Southern and Northeast Brazilian regions, focusing on some social inequalities. METHODS This is a cross-sectional study using data from the 2008 National Household Sampling Survey (PNAD). We evaluated the prevalence of CBE during the last year and of the MMG in the last two years, which were analyzed based on demographic (age, skin color, and marital status) and socioeconomic (income and schooling) variables. Gross and adjusted prevalence ratios were obtained using Poisson regression models. All analyses were stratified by region. RESULTS The sample comprised 27,718 women aged 40 to 69 years. Less than a half of the women followed the recommendation of annual CBE performance in both the regions. The MMG prevalence during the last two years was 58.6 and 45.5% for the Southern and Northeast regions, respectively. More than a quarter of the women had never had a MMG (26.5% in the Southern and 40.6% in the Northeast regions). Not having performed both examinations was almost two times higher in the Northeast region (29.7%) when compared with the Southern (15.9%). The risk for not having performed both examinations was greater among nonwhite women, aged 60 to 69 years, with lower schooling level and family income. CONCLUSION Important inequalities were seen between the Southern and Northeast regions for CBE and MMG. Health public policies should prioritize the most vulnerable groups to reduce these inequalities.
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Souza CIDA, Araújo DS, Teles DADF, Carvalho SGLD, Cavalcante KWM, Rabelo WL, Alves CNR, Fonseca AJD. Factors related to non-adherence to mammography in a city of the Brazilian Amazonian area: A population-based study. Rev Assoc Med Bras (1992) 2017; 63:35-42. [PMID: 28225871 DOI: 10.1590/1806-9282.63.01.35] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2016] [Accepted: 04/01/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the prevalence of mammography use and factors related to non-adherence in Boa Vista, capital of Roraima, Brazil. METHOD A cross sectional study, quantitative analysis, based on household survey was performed between June and August 2013, using a face-to-face interview with a pre-tested form. Target population was women between 40 and 69 years. The sample size target was 240 participants, and the sampling method was random cluster sampling. The study was approved by the Institutional Review Board of Federal University of Roraima. RESULTS 241 women were included without refusals. The prevalence of non-use of mammography in the past two years was 55.6% (95CI 49.1-61.9). In univariate analysis, the risk factors for non-adherence to mammography were having low educational level, family income below three minimum wages, receiving government assistance, not having consulted with a doctor and no health insurance. In multivariate analysis, only low educational level and receiving government assistance remained as risk factors. Medical consultation or health worker visiting were protective factors. CONCLUSION Adherence to mammography is unsatisfactory in Boa Vista, Roraima, and has a predominantly opportunistic character. Low educational level is confirmed as an independent risk factor, but belonging to a family that receives government assistance can be interpreted as a social marker of families and/or areas lacking of government intervention to increase access to breast cancer control programs.
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Affiliation(s)
| | - Daniela Souza Araújo
- Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, Brazil
| | | | | | | | - Wendell Lima Rabelo
- Centro de Ciências da Saúde, Universidade Federal de Roraima, Boa Vista, RR, Brazil
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Bittencourt L, Scarinci IC. Training Community Health Workers to promote breast cancer screening in Brazil. Health Promot Int 2017; 34:95-101. [DOI: 10.1093/heapro/dax058] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lorna Bittencourt
- University of Alabama at Birmingham, Division of Preventive Medicine, 1720 2nd Ave. S, MT 609, Birmingham, AL, USA
| | - Isabel C Scarinci
- University of Alabama at Birmingham, Division of Preventive Medicine, 1720 2nd Ave. S, MT 609, Birmingham, AL, USA
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Rodrigues JD, Cruz MS, Paixão AN. [An analysis of breast cancer prevention in Brazil]. CIENCIA & SAUDE COLETIVA 2017; 20:3163-76. [PMID: 26465858 DOI: 10.1590/1413-812320152010.20822014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 04/18/2015] [Indexed: 03/25/2024] Open
Abstract
This research sets out to study the interrelationship between breast cancer prevention and the socioeconomic, demographic, behavioral, regional and health factors in determining the temporal frequency of tests for prevention by performing mammograms and breast exams in Brazil. Based on the information of the health supplement of the National Sampling Survey of Domiciles of 2008, a sample that includes only women over age 40 was created. To achieve the desired goal, the estimate of the ordered logit model is used to establish partial proportional odds, which revealed the main results as follows. Women with a good socioeconomic status, living in the more developed regions of the country, family structure including children, making a good self-assessment of health and having been diagnosed with some type of cancer in the past. This is the profile of women who are best at preventing breast cancer, both in relation to the demand for mammograms and to a greater demand for breast exam performed by a doctor or a nurse. The results also point to the fact that the majority of those interviewed had either had the tests in question within the previous year, or had never been exposed to such procedures.
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Affiliation(s)
- Juliana Dantas Rodrigues
- Departamento de Economia, Centro de Ciências Sociais Aplicadas, Universidade Federal da Paraíba, João Pessoa, PB, Brasil,
| | - Mércia Santos Cruz
- Departamento de Economia, Centro de Ciências Sociais Aplicadas, Universidade Federal da Paraíba, João Pessoa, PB, Brasil,
| | - Adriano Nascimento Paixão
- Departamento de Economia, Centro de Ciências Sociais Aplicadas, Universidade Federal da Paraíba, João Pessoa, PB, Brasil,
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Sousa KDM, Oliveira WIFD, Alves EA, Gama ZADS. Factors associated with access to physical rehabilitation for victims of traffic accidents. Rev Saude Publica 2017; 51:54. [PMID: 28658365 PMCID: PMC5493366 DOI: 10.1590/s1518-8787.2017051006429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 05/26/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE Evaluate the level of access to physical rehabilitation for survivors of traffic accidents and the associated factors. METHODS A cross-sectional study performed in Natal, Northeastern Brazil, through a telephone survey of 155 victims of traffic accidents admitted to an emergency hospital between January and August of 2013, with a diagnosis of fracture, traumatic brain injury or amputation. Participants were identified in the database of the reference hospital for care of traffic accident victims. We calculated point estimates and confidence interval (95%CI) for the frequency of subjects who had access, in addition to multivariate analysis (logistic regression) between access (dependent variable) and sociodemographic, clinical, and assistance variables. RESULTS Among the 155 respondents, the majority were adolescents and adults between 15–29 years of age (47.7%), men (82.6%), education up to high school (92.3%), income of up to two minimum wages (78.0%) and bikers (75.5%). Although 85.8% of traffic accident survivors reported the need for physical rehabilitation, there was little access (51.6%; 95%CI 43.7–59.4) and a delay to start the physical rehabilitation (average = 67 days). We classified factors associated with access to physical rehabilitation as: (i) unmodifiable individuals in the short term – family income greater than two minimum wages (OR = 3.7), informal worker (OR = 0.11) or unemployed (OR = 0.15) and possession of a private health care plan (OR = 0.07); and (ii) assistance modifiable by service management – written referral for physical rehabilitation (OR = 27.5) and perceived need of physical rehabilitation (OR = 10). CONCLUSIONS This study found a low and slow access to physical rehabilitation for individuals potentially in need. The associated factors were the organizational processes of health care (health information and referral) and social determinants (income, occupation and private health care plan).
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Affiliation(s)
- Kelienny de Meneses Sousa
- Programa de Pós-Graduação em Saúde Coletiva. Universidade Federal do Rio Grande do Norte. Natal, RN, Brasil
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Silva GAE, de Souza-Júnior PRB, Damacena GN, Szwarcwald CL. Early detection of breast cancer in Brazil: data from the National Health Survey, 2013. Rev Saude Publica 2017; 51:14s. [PMID: 28591356 PMCID: PMC5676402 DOI: 10.1590/s1518-8787.2017051000191] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 09/06/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To analyze whether the actions of early detection of breast cancer, initiated with the medical request for mammography, differ between users of the Brazilian Unified Health System (SUS) and those who have private health insurance. METHODS From the data collected in the National Health Survey, we estimated the proportions of women who had medical request for mammography according to presence or absence of private health insurance. For assessing the factors related to having mammography medical request, we estimated crude and adjusted odds ratios and respective 95%CI by logistic regression. We also analyzed the main reasons reported for not having performed mammography after medical request, as well as the time between examination and result. RESULTS Of the women interviewed, 66.7% had a medical request for mammography (59.4% among SUS users and 83.9% among those with private health insurance). Having private health insurance, higher education level, and being white were positively associated with having the medical request. Only 5.4% (95%CI 4.8-6.0) of women who received medical request failed to perform mammography - 7.6% were SUS users and 1.7% had health insurance. The most reported reasons for not being able to perform the examination were: not thinking it was necessary; having the test scheduled, but not yet performed; and not being able to schedule it. More than 70% of women received the result with less than one month from its execution. CONCLUSIONS The barriers to access a medical request for mammographic screening for breast cancer are higher among women who depend exclusively on SUS.
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Affiliation(s)
- Gulnar Azevedo e Silva
- Departamento de Epidemiologia. Instituto de Medicina Social. Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil
| | - Paulo Roberto Borges de Souza-Júnior
- Laboratório de Informações em Saúde. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Giseli Nogueira Damacena
- Laboratório de Informações em Saúde. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
| | - Célia Landmann Szwarcwald
- Laboratório de Informações em Saúde. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
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Barbosa PA, Cesca RG, Pacífico TED, Leite ICG. Quality of life in women with breast cancer, after surgical intervention, in a city in the zona da mata region in Minas Gerais, Brazil. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2017. [DOI: 10.1590/1806-93042017000200010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Objectives: To evaluate health-related quality of life (HRQoL) in women with breast cancer, after surgical intervention, attended at the regional Oncology Referral Hospital in Juiz de Fora (MG). Methods: 121 women were evaluated and the European Organization for Research and Treatment of Cancer, Breast Cancer-Specific Quality of Life Questionnaire (EORTC QLC 30 BR23) was applied. After the descriptive analysis, a multiple linear regression model was created. The SPSS 14 was used to build the database and to conduct the analysis. Results: the mean values of the EORTC QLC 30 BR23 showed a tendency for good HRQoL, thus, the functional scale showed the most impairment with the worst mean scores observed. There was statistical significance among the symptoms scale and obese women who underwent adjuvant radiotherapy and those who had a greater number of dissected lymph nodes. The subjective perceptions influenced all the EORTC QLC 30 BR23domains. Conclusions: after controlling the variable by functional hand, and time of surgery, the BMI variables, breast reconstruction, heavy feeling in the arm, range of motion (ROM) reduction of the shoulder, and the tight shirt-sleeve sensation proven capable of explaining HRQoL. HRQoL appears to be relatively good, but negatively influenced by subjective perceptions, in addition to treatment factors.
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Horta RL, Andersen CS, Pinto RO, Horta BL, Oliveira-Campos M, Andreazzi MARD, Malta DC. Health promotion in school environment in Brazil. Rev Saude Publica 2017; 51:27. [PMID: 28380209 PMCID: PMC5575721 DOI: 10.1590/s1518-8787.2017051006709] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/07/2016] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Evaluate the school environments to which ninth-year students are exposed in Brazil and in the five regions of the country according to health promotion guidelines. METHODS Cross-sectional study from 2012, with a representative sample of Brazil and its macroregions. We interviewed ninth-year schoolchildren and managers of public and private schools. We proposed a score of health promotion in the school environment (EPSAE) and estimated the distribution of school members according to this score. Crude and adjusted odds ratios (OR) were used, by ordinal regression, to determine the schoolchildren and schools with higher scores, according to the independent variables. RESULTS A student is more likely to attend a school with a higher EPSAE in the South (OR = 2.80; 95%CI 2.67–2.93) if the school is private (OR = 4.52; 95%CI 4.25–4.81) and located in a state capital, as well as if the student is 15 years of age or older, has a paid job, or has parents with higher education. CONCLUSIONS The inequalities among the country’s regions and schools are significant, demonstrating the need for resources and actions that promote greater equity.
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Affiliation(s)
- Rogério Lessa Horta
- Programa de Pós-Graduação em Saúde Coletiva. Unidade de Pesquisa e Pós-Graduação. Universidade do Vale do Rio dos Sinos. São Leopoldo, RS, Brasil
| | - Cristine Scattolin Andersen
- Núcleo de Saúde e Segurança do Trabalho. Gestão de Pessoas. Instituto Federal de Educação, Ciência e Tecnologia. Farroupilha, RS, Brasil
| | - Raquel Oliveira Pinto
- Hospital Escola. Universidade Federal de Pelotas. Empresa Brasileira de Serviços Hospitalares. Pelotas, RS, Brasil
| | - Bernardo Lessa Horta
- Programa de Pós-Graduação em Epidemiologia. Faculdade de Medicina. Universidade Federal de Pelotas. Pelotas, RS, Brasil
| | - Maryane Oliveira-Campos
- Departamento de Ciências Básicas e da Saúde. Universidade Federal dos Vales do Jequitinhonha e Mucuri. Diamantina, MG, Brasil
| | - Marco Antonio Ratzsch de Andreazzi
- Coordenação de População e Indicadores Sociais. Diretoria de Pesquisa. Instituto Brasileiro de Geografia e Estatística. Rio de Janeiro, RJ, Brasil
| | - Deborah Carvalho Malta
- Departamento de Vigilância de Doenças e Agravos Não Transmissíveis e Promoção da Saúde. Secretaria de Vigilância em Saúde. Ministério da Saúde. Brasília, DF, Brasil.,Departamento de Enfermagem Materno Infantil e Saúde Pública. Escola de Enfermagem. Universidade Federal de Minas Gerais. Belo Horizonte, MG, Brasil
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Theme Filha MM, Leal MDC, Oliveira EFVD, Esteves-Pereira AP, Gama SGND. Regional and social inequalities in the performance of Pap test and screening mammography and their correlation with lifestyle: Brazilian national health survey, 2013. Int J Equity Health 2016; 15:136. [PMID: 27852313 PMCID: PMC5112710 DOI: 10.1186/s12939-016-0430-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 09/01/2016] [Indexed: 11/13/2022] Open
Abstract
Background Mass population screening for the early detection of cervical and breast cancer has been shown to be a safe and effective strategy worldwide and has reduced the incidence and mortality rates of these diseases. The aim of this study is to analyse the reach of screening tests for cervical and breast cancer according to sociodemographic variables and to analyse their correlation with a healthy lifestyle. Methods We have analysed data collected from 31.845 women aged 18 and over, who were interviewed for the Brazilian National Health Survey, a nationwide household inquiry, which took place between August 2013 and February 2014. The Pap tests performed in the last 3 years in women aged between 25 and 64 and screening mammogram performed in the last 2 years in women aged between 50 and 69 were considered adequate. We identified habits that constitute a healthy lifestyle, such as the consumption of five or more daily servings of fruits and vegetables, 30 min or more of leisurely physical activity and not smoking. Results We observed that the Pap test (78.8 %) was more widespread than the screening mammogram (54.5 %), with significant geographical and social differences concerning access to health care. Access for such screening was higher for women living in more developed regions (Southeast and South), who were white-skinned, better educated, living with a partner and, especially, who were covered by private health insurance. Those who underwent the tests according to established protocols also had a healthy lifestyle, which corroborates the healthy behaviour pattern of damage prevention. Conclusion Despite the progress made, social disparity still defines access to screening tests for cervical and breast cancer, with women covered by private health insurance tending to benefit the most. It is necessary to reduce social and regional inequalities and ensure a more uniform provision and access to the tests, especially for socially disadvantaged women, in order to reduce the incidence and mortality rate resulting from the aforementioned diseases.
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Affiliation(s)
- Mariza Miranda Theme Filha
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil. .,Escola Nacional de Saúde Pública Sérgio Arouca-ENSP/FIOCRUZ, Rua Leopoldo Bulhões 1480 sala 813, Manguinhos, 20041-210, RJ, Brazil.
| | - Maria do Carmo Leal
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Elaine Fernandes Viellas de Oliveira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Ana Paula Esteves-Pereira
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Silvana Granado Nogueira da Gama
- Department of Epidemiology and Quantitative Methods in Health, Sérgio Arouca National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
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Melo ECP, de Oliveira EXG, Chor D, Carvalho MS, Pinheiro RS. Inequalities in socioeconomic status and race and the odds of undergoing a mammogram in Brazil. Int J Equity Health 2016; 15:144. [PMID: 27628786 PMCID: PMC5024478 DOI: 10.1186/s12939-016-0435-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/05/2016] [Indexed: 12/05/2022] Open
Abstract
Background Access to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies. Methods This study analyzed data from the 2008 PNAD - Brazilian National Household Sample Survey (11.607 million women 40 years of age or older), on having had at least one mammogram over life for women 40 years of age or older in each of Brazil’s nine Metropolitan Regions (MR), according to socioeconomic position. The effects of income, schooling, health insurance and race in the different regions were investigated using multivariate logistical regression for each region individually, and for all MRs combined. The age-adjusted odds of a woman having had a mammogram according to race and stratified by two income strata (and two schooling strata) were also analyzed. Results Having a higher income increases four to seven times a woman’s odds of having had at least one mammogram in all MRs except Curitiba. For schooling, the gradient, though less steep, is favorable to women with more years of study. Having health insurance increases two to three times the odds in all MRs. Multivariate analysis did not show differences due to race (except for the Fortaleza MR), but the stratified analysis by income and schooling shows effects of race in most MRs, with greater differences for women with higher socioeconomic status. Conclusions This study confirms that income and schooling, as well as having health insurance, are still important determinants of inequality in health service use in Brazil. Additionally, race also contributes to the odds of having had a mammogram. The point is not to isolate the effect of each factor, but to evaluate how their interrelations may exacerbate differences, generating patterns of cumulative adversity, a theme that is still little explored in Brazil. This is much more important when we consider that race has only recently started be included in analyses of health outcomes in Brazil.
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Affiliation(s)
- Enirtes Caetano Prates Melo
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil. .,Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | | | - Dóra Chor
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Marilia Sá Carvalho
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
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Xavier DR, Oliveira RADD, Matos VPD, Viacava F, Carvalho CDC. Cobertura de mamografias, alocação e uso de equipamentos nas Regiões de Saúde. SAÚDE EM DEBATE 2016. [DOI: 10.1590/0103-1104201611002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O rastreamento por intermédio da mamografia é o principal meio de detecção da neoplasia maligna da mama. Considera-se relevante compreender como este tem se dado nas Regiões de Saúde brasileiras, unidade espacial fundamental na atual política de saúde. A análise de indicadores relacionados à cobertura de mamografia das mulheres de 40 a 69 anos, número, distribuição e grau de utilização dos mamógrafos demonstra grandes problemas, que não podem ser simplesmente atribuídos à falta de equipamentos. Destaca-se também a diversidade de situações das Regiões de Saúde e das unidades da federação, caracterizada especialmente pelas melhores condições no Sul e Sudeste e piores nas outras regiões.
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Freitas AGQ, Weller M. Patient delays and system delays in breast cancer treatment in developed and developing countries. CIENCIA & SAUDE COLETIVA 2015; 20:3177-89. [DOI: 10.1590/1413-812320152010.19692014] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Accepted: 01/31/2015] [Indexed: 01/12/2023] Open
Abstract
AbstractDelays in treating breast cancer have been associated with a more advanced stage of the disease and a decrease in patient survival rates. The scope of this integrative review was to analyze the main causal factors and types of patient and system delays. The underlying causal factors of delays were compared among studies conducted in developing and developed countries. Of the 53 studies selected, 24 were carried out in developing countries and 29 in developed countries, respectively. Non-attribution of symptoms to cancer, fear of the disease and treatment and low educational level were the most frequent causes of patient delay. Less comprehensive health insurance coverage, older/younger age and false negative diagnosis tests were the three most common causal factors of system delay. The effects of factors such as age were not decisive per se and depended mainly on the social and cultural context. Some factors caused both patient delay and system delay. Studies conducted in developing countries identified more causal factors of patient delay and had a stronger focus on patient delay or the combination of both. Studies conducted in developed countries had a stronger focus on aspects of system delay during treatment and guidance of breast cancer patients in the health care system.
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Schneider IJC, Corseuil MW, Boing AF, d'Orsi E. Knowledge about mammography and associated factors: population surveys with female adults and elderly. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2015; 16:930-42. [PMID: 24896598 DOI: 10.1590/s1415-790x2013000400013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 06/05/2013] [Indexed: 11/22/2022] Open
Abstract
The purpose of this paper is to describe the knowledge about mammography and to identify associated factors in female adults and elderly. Data were obtained from two population surveys, one with female adults and another with elderly women from Florianópolis (SC) in 2009 - 2010. A descriptive analysis of the variables was carried out, the appropriate mean of responses about mammography was estimated and crude and adjusted Poisson regression was conducted to identify associated factors. Among adults, 23.1% answered all of the questions appropriately and the appropriate average responses was 7.2 (95%CI 7.1 - 7.3) in a total of 9. In the adjusted model, older age, higher education and income were associated with knowledge about mammography. For the elderly, 15.3% answered all questions appropriately and the average of appropriate responses was 6.4 (95%CI 5.2 - 6.5) and the factors associated with knowledge about mammography in the adjusted model were younger age groups, increased education and income, and identification of mammography as the main diagnostic method for breast cancer. Information about mammography can neither be transmitted in a clear way nor be easily understood; there are also demographic and socioeconomic differences concerning the knowledge about the exam.
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Affiliation(s)
| | | | | | - Eleonora d'Orsi
- Universidade Federal de Santa Catarina, Florianopolis, SC, Brazil
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Abrahão KDS, Bergmann A, Aguiar SSD, Thuler LCS. Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women. Maturitas 2015; 82:365-70. [PMID: 26358931 DOI: 10.1016/j.maturitas.2015.07.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/23/2015] [Accepted: 07/24/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION We conclude that future interventions should focus on these high risk groups.
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Affiliation(s)
| | - Anke Bergmann
- Brazilian National Cancer Institute (INCA) and University Center Augusto Motta (UNISUAM), Rio de Janeiro, Brazil.
| | | | - Luiz Claudio Santos Thuler
- Brazilian National Cancer Institute (INCA) and Federal University of Rio de Janeiro State (UNIRIO), Rio de Janeiro, Brazil.
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Sadovsky ADID, Poton WL, Reis-Santos B, Barcelos MRB, Silva ICMD. Índice de Desenvolvimento Humano e prevenção secundária de câncer de mama e colo do útero: um estudo ecológico. CAD SAUDE PUBLICA 2015; 31:1539-50. [DOI: 10.1590/0102-311x00073014] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 01/09/2015] [Indexed: 11/22/2022] Open
Abstract
Estudo ecológico que analisou a proporção da realização de mamografia e do exame de Papanicolaou e a associação destes com o Índice de Desenvolvimento Humano (IDH), nas 26 capitais brasileiras e Distrito Federal, em 2011, com dados do VIGITEL. A proporção de mamografia em algum momento da vida esteve acima de 70% para todas as capitais estudadas. Entretanto, poucas capitais atingiram a meta de 80% para o Papanicolaou, tanto para a realização em algum momento da vida como nos últimos três anos. Houve forte correlação positiva entre IDH e as proporções desses exames (r = 0,52 e 0,66 para realização de mamografia em algum momento da vida e nos últimos dois anos e r = 0,66 e 0,71 para realização do Papanicolaou em algum momento da vida e nos últimos três anos, respectivamente). A razão de prevalência de mamografia nos últimos dois anos foi 1,06 (IC95%: 1,01-1,10) e para o Papanicolaou nos últimos três anos foi 1,07 (IC95%: 1,04-1,10). A promoção de políticas públicas que incentivem o desenvolvimento socioeconômico das cidades brasileiras favoreceria o aumento da cobertura desses exames.
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Girianelli VR, Gamarra CJ, Azevedo e Silva G. Disparities in cervical and breast cancer mortality in Brazil. Rev Saude Publica 2015; 48:459-67. [PMID: 25119941 PMCID: PMC4203079 DOI: 10.1590/s0034-8910.2014048005214] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 02/26/2014] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson's correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment.
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Affiliation(s)
- Vania Reis Girianelli
- Plataforma de Pesquisa Clínica, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brasil
| | - Carmen Justina Gamarra
- Instituto Latino-americano de Ciências da Vida e da Natureza, Universidade Federal da Integração Latino-americana, Foz do Iguaçu, PR, Brasil
| | - Gulnar Azevedo e Silva
- Departamento de Epidemiologia, Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brasil
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Medeiros GC, Bergmann A, Aguiar SSD, Thuler LCS. Análise dos determinantes que influenciam o tempo para o início do tratamento de mulheres com câncer de mama no Brasil. CAD SAUDE PUBLICA 2015. [DOI: 10.1590/0102-311x00048514] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Este estudo teve como objetivo analisar o intervalo de tempo entre o diagnóstico e o início do tratamento do câncer de mama em mulheres e seus determinantes. Foi realizado um estudo de coorte retrospectiva com 137.593 mulheres diagnosticadas em 239 unidades hospitalares do Brasil entre 2000 a 2011. Em 63,1% dos casos, o intervalo entre o diagnóstico e o tratamento foi de até 60 dias. No país, as mulheres mais suscetíveis ao atraso foram não brancas (OR = 1,18; IC95%: 1,13-1,23), sem companheiro (OR = 1,05; IC95%: 1,01-1,09), com menos de oito anos de estudo (OR = 1,13; IC95%: 1,08-1,18), com doença em estadiamento inicial (OR = 1,27; IC95%: 1,22-1,32), tratadas de 2006 a 2011 (OR = 1,54; IC95%: 1,47-1,60) e provenientes do sistema público de saúde (OR = 1,19; IC95%: 1,13-1,25). Na análise estratificada foi observada a variabilidade dos fatores entre as regiões do Brasil. A identificação de fatores associados à demora no início do tratamento poderá possibilitar a elaboração de propostas de intervenções destinadas a grupos populacionais específicos.
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Affiliation(s)
| | - Anke Bergmann
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brasil
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Azevedo E Silva G, Bustamante-Teixeira MT, Aquino EML, Tomazelli JG, Dos-Santos-Silva I. [Access to early breast cancer diagnosis in the Brazilian Unified National Health System: an analysis of data from the Health Information System]. CAD SAUDE PUBLICA 2015; 30:1537-50. [PMID: 25166949 DOI: 10.1590/0102-311x00156513] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 01/09/2014] [Indexed: 11/21/2022] Open
Abstract
The recent reduction in breast cancer mortality in high-income countries resulted from improvements in early detection and treatment. Breast cancer is the most common cancer in Brazilian women. Since 2004, the government has recommended annual clinical breast examination for women aged ≥ 40 years and biannual mammograms for those aged 50-69. This article investigates the degree of implementation of these guidelines using data from the Brazilian Unified National Health System for 2010 according to major geographic region and age group. The findings showed low national mammogram coverage in the target population (32% in the 50-59-year group; 25% from 60 to 69 years). The percentage of women with abnormal radiological findings who underwent biopsy was also low (27% for 50-59 years; 63% for 60-69 years). The number of breast cancer surgeries exceeded the number of cases detected by mammography but was well below the estimated number of incident breast cancer cases in 2010. There are striking regional inequalities in access to early detection and surgery, being the lowest access in the North Region and the highest in the South Region.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | | | - Estela M L Aquino
- Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brasil
| | | | - Isabel Dos-Santos-Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, U.K
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Schneider IJC, Giehl MWC, Boing AF, d'Orsi E. [Mammogram screening for breast cancer and associated factors in the South of Brazil: a based-population survey]. CAD SAUDE PUBLICA 2014; 30:1987-97. [PMID: 25317527 DOI: 10.1590/0102-311x00162313] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 02/17/2014] [Indexed: 11/22/2022] Open
Abstract
The purpose of this study was to identify factors associated with annual mammogram screening in women 40 to 69 years of age in Florianópolis, Santa Catarina State, Brazil. Data were obtained from two population studies with independent samples, one with adult women and the other with elderly women, in 2009-2010. Prevalence rates for annual mammogram screening were estimated by crude and adjusted Poisson regression. Overall prevalence of annual mammograms in adult women was 43.5% (95%CI: 38.8-48.2) and was higher in women with private health insurance. In elderly women, prevalence was 38.3% (95%CI: 34.0-42.6), with the following associated factors: marital status (married/with partner), schooling (> 5 years), and highest income quartile. Mammogram screening should be independent of socioeconomic status and age in order to reduce mortality from breast cancer.
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Lages RB, Oliveira GDP, Simeão Filho VM, Nogueira FM, Teles JBM, Vieira SC. Inequalities associated with lack of mammography in Teresina-Piauí-Brazil, 2010-2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 15:737-47. [PMID: 23515770 DOI: 10.1590/s1415-790x2012000400006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 05/23/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Randomized studies have shown that screening for breast cancer with mammography reduces the breast cancer mortality. However there are signs of a great inequality in access to mammography in Brazil. OBJECTIVES To analyze the percentage of women who did not undergo mammography according to socioeconomic and demographic variables in women aged from 40 to 69 years in Teresina, Piauí State, Brazil. METHODS This was a cross-sectional population-based study in women aged 40-69 years in Teresina-Piauí in 2010/2011. The sampling was randomly conducted in five stages. The data were processed by SPSS 19.0 and it was performed univariate and multivariate analysis. RESULTS Among 433 women who answered the questionnaire, 75,3% had a mammography and 17,2% of these women had not a mammography over the last two years. The lack of breast cancer screening was associated with non-white skin color (p = 0,030), never being married (p = 0,041), low levels of education (p = 0,010), low family income (p < 0,001), smoking (p = 0,006), having no private health insurance (p < 0,001). The Unified National Health System (SUS) performed 56,3% of reported mammograms. CONCLUSION About 24.7% of women in the sample never had a mammography. According to the findings, the lack of breast cancer screening is associated with social and racial inequalities.
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Garcia-Subirats I, Vargas I, Mogollón-Pérez AS, De Paepe P, da Silva MRF, Unger JP, Borrell C, Vázquez ML. Inequities in access to health care in different health systems: a study in municipalities of central Colombia and north-eastern Brazil. Int J Equity Health 2014; 13:10. [PMID: 24479581 PMCID: PMC3917695 DOI: 10.1186/1475-9276-13-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 01/24/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health system reforms are undertaken with the aim of improving equity of access to health care. Their impact is generally analyzed based on health care utilization, without distinguishing between levels of care. This study aims to analyze inequities in access to the continuum of care in municipalities of Brazil and Colombia. METHODS A cross-sectional study was conducted based on a survey of a multistage probability sample of people who had had at least one health problem in the prior three months (2,163 in Colombia and 2,167 in Brazil). The outcome variables were dichotomous variables on the utilization of curative and preventive services. The main independent variables were income, being the holder of a private health plan and, in Colombia, type of insurance scheme of the General System of Social Security in Health (SGSSS). For each country, the prevalence of the outcome variables was calculated overall and stratified by levels of per capita income, SGSSS insurance schemes and private health plan. Prevalence ratios were computed by means of Poisson regression models with robust variance, controlling for health care need. RESULTS There are inequities in favor of individuals of a higher socioeconomic status: in Colombia, in the three different care levels (primary, outpatient secondary and emergency care) and preventive activities; and in Brazil, in the use of outpatient secondary care services and preventive activities, whilst lower-income individuals make greater use of the primary care services. In both countries, inequity in the use of outpatient secondary care is more pronounced than in the other care levels. Income in both countries, insurance scheme enrollment in Colombia and holding a private health plan in Brazil all contribute to the presence of inequities in utilization. CONCLUSIONS Twenty years after the introduction of reforms implemented to improve equity in access to health care, inequities, defined in terms of unequal use for equal need, are still present in both countries. The design of the health systems appears to determine access to the health services: two insurance schemes in Colombia with different benefits packages and a segmented system in Brazil, with a significant private component.
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Affiliation(s)
- Irene Garcia-Subirats
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Avenida Tibidabo, 21, Barcelona 08022, Spain.
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Balabram D, Turra CM, Gobbi H. Survival of patients with operable breast cancer (Stages I-III) at a Brazilian public hospital--a closer look into cause-specific mortality. BMC Cancer 2013; 13:434. [PMID: 24063763 PMCID: PMC3849091 DOI: 10.1186/1471-2407-13-434] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2013] [Accepted: 09/19/2013] [Indexed: 12/02/2022] Open
Abstract
Background Breast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS. Methods A cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival. Results A total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival. Conclusions Five-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.
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Affiliation(s)
- Débora Balabram
- Breast Pathology Laboratory, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil.
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Senicato C, Barros MBDA. Social inequality in health among women in Campinas, São Paulo State, Brazil. CAD SAUDE PUBLICA 2012; 28:1903-14. [PMID: 23090170 DOI: 10.1590/s0102-311x2012001000009] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Accepted: 04/17/2012] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to assess social inequalities in health status and use of health services according to level of schooling in women. This was a cross-sectional population-based study with a sample of 508 women from 20 to 59 years of age living in Campinas, São Paulo State, Brazil (ISA-Camp 2008). Women with less schooling showed higher prevalence of hypertension, circulatory problems, headache, dizziness, obesity, common mental disorders, worse self-rated health, use of dental prosthesis, and visual impairment, but lower prevalence for use of eyeglasses. There were no differences between the two schooling strata in prevalence of medical visits in the previous two weeks, use of medicines in the three previous days, Pap smear, breast self-examination, clinical breast examination, hospitalizations and surgeries in the previous year, and rubella vaccination any time in life. The only significant differences were in use of dental services and mammograms. The results show social inequalities in various health indicators and equity in access to various components of the health services.
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Affiliation(s)
- Caroline Senicato
- Faculdade de Ciências Médicas, Universidade Estadual de Campinas, Rua Tessália Vieira de Camargo 126, Campinas, SP, Brazil.
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