Breast cancer screening in Brazil: an assessment of supply and use of Brazilian National Health System health care network for the period 2010-2012*

Tomazelli, Jeane Glaucia; Silva, Gulnar Azevedo e

doi:10.5123/S1679-49742017000400004

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Epidemiologia e Serviços de Saúde

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 26 (4) • Oct-Dec 2017 • https://doi.org/10.5123/S1679-49742017000400004 copy

Breast cancer screening in Brazil: an assessment of supply and use of Brazilian National Health System health care network for the period 2010-2012^* * This article is part of the doctoral thesis 'Evaluation of early detection of breast cancer in Brazil: an analysis based on health information systems', defended by the author Jeane Glaucia Tomazelli, at the Institute of Social Medicine of the State University of Rio de Janeiro, presented in 2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

OBJECTIVE:

to assess the supply and use of procedures for early detection, diagnosis and surgeries of breast cancer in the Brazilian National Health System (SUS).

METHODS:

descriptive study using data from SUS Ambulatory Care and Hospital Information Systems, and from the National Register of Health Care Facilities; the indicators of supply and use of these services in Brazil and its macroregions for 2010-2012 were calculated.

RESULTS:

the ratio mammography equipment and female population/100 thousand remained stable (1.5), ranging from 1.0 in the North region to 2.0 in the South; the ratio mammograms and female population/100 thousand increased in all macroregions; there was a low proportion of diagnostic procedures when compared to the estimates (biopsy, 11.5%; core biopsy, 16.6% in women aged 50-69 years); the installed capacity decreased, however the production increased, and the supply (3,995,627) was below the necessary to cover 70% (7,785,415).

CONCLUSION:

there are inequalities in supply and use of the procedures in the Brazilian regions, and the access to diagnosis is worrisome.

Keywords:
Breast Neoplasms; Early Detection of Cancer; Health Services; Indicators of Health Services

Structure		Brazil		North		Northeast		Southeast		South		Midwest
Structure		N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)
Equipament	Mammography equipment ^a
	2010	1,443	1.5	73	0.9	315	1.2	668	1.6	274	2.0	113	1.6
	2011	1,566	1.6	85	1.1	351	1.3	695	1.7	305	2.2	131	1.8
	2012 ^a	1,526	1.5	78	1.0	339	1.2	698	1.7	288	2.0	123	1.7
	Conventional ultrasound
	2010	3,306	3.4	310	3.9	1,251	4.6	1,088	2.6	432	3.1	226	3.2
	2011	3,673	3.7	350	4.4	1,355	4.9	1,214	2.9	504	3.6	255	3.5
	2012	3,952	4.0	369	4.6	1,458	5.3	1,317	3.1	526	3.7	281	3.9
Human Resources	Mammogram/ultrasound										3.7	281
	2010	36,648	37.6	2,128	27.1	8,480	31.2	17,222	41.7	5,638	40.4	3,181	44.9
	2011	35,959	36.6	2,074	26.0	8,024	29.3	17,204	41.4	5,599	39.9	3,057	42.6
	2012	36,223	36.6	2,074	25.6	8,239	29.9	17,253	41.2	5,681	40.2	2,977	41.0
	Fine needle aspiration
	2010	169,647	174.3	8,163	103.9	33,541	123.4	82,642	200.2	32,272	231.3	123,029	184.1
	2011	167,148	170.3	8,021	100.6	31,607	115.4	82,409	198.1	32,345	230.4	12,765	178.0
	2012	170,054	171.8	8,111	100.2	32,546	117.9	83,528	199.3	33,351	236.1	12,518	172.4
	Core biopsy/ Surgical biopsy										236.1	12,518
	2010	67,979	69.8	3,558	45.3	14,780	54.4	32,443	78.6	11,662	83.6	5,536	78.2
	2011	66,725	68.0	3,425	43.0	13,862	50.6	32,332	77.7	11,730	83.5	5,376	75.0
	2012	66,650	67.3	3,390	41.9	13,990	50.7	32,208	76.9	11,872	84.0	5,189	71.5
	Breast surgeries
	2010	175,585	180.4	7,862	100.0	34,581	127.3	86,270	208.9	33,375	239.2	13,496	190.7
	2011	173,459	176.7	8,204	102.9	32,631	119.1	85,942	206.6	33,449	238.2	13,233	184.5
	2012	176,356	178.2	8,294	102.4	33,595	121.7	87,034	207.7	34,472	244.0	12,961	178.5

Procedure	Brazil		North		Northeast		Southeast		South		Midwest
Procedure	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)	N	Ratio (per 100,000)
Mammograms
2010	3,077,658	3,161.5	68,092	866.4	568,934	2,093.8	1,590,669	3,852.6	791,741	5,230.9	120,222	1,968.5
2011	3,565,929	3,653.6	81,700	1,021.6	705,894	2,577.3	1,858,234	4,466.8	811,230	5,778.2	127,871	1,783.0
2012	3,995,627	4,036.7	94,134	1,162.6	895,791	3,246.0	2,011,637	4,800.8	847,115	5,996.9	146,950	2,023.5
Breast ultrasound
2010	845,949	869.0	38,880	494.7	292,018	1,074.7	370,803	898.1	103,962	745.2	40,286	569.2
2011	992,999	1,011.5	46,196	579.4	325,682	1,189.1	452,879	1,088.6	124,443	886.4	43,799	610.2
2012	1,018,331	1,028.8	47,162	582.5	325,699	1,180.2	461,444	1,101.2	131,955	934.1	52,071	717.0
Fine needle aspiration
2010	24,180	24.8	1,146	14.6	5,756	20.5	12,013	29.1	3,180	22.8	2,265	32.0
2011	25,971	26.5	1,029	12.9	7,545	27.5	11,310	27.2	4,024	28.7	2,063	28.8
2012	26,939	27.2	1,031	13.2	7,916	28.7	11,434	27.8	3,875	27.4	2,439	33.6
Core biopsy
2010	8,694	8.9	274	3.5	2,163	8.0	4,234	10.3	1,758	12.6	265	3.7
2011	13,322	13.6	292	3.7	3,071	11.2	7,002	16.8	2,469	17.6	488	6.8
2012	13,510	13.6	323	4.0	3,259	11.8	6,537	16.5	2,404	17.0	587	8.1
Surgical biopsy
2010	5,696	5.9	167	2.1	2,114	7.8	2,636	6.4	737	5.3	42	0.6
2011	5,063	5.2	212	2.7	1,947	7.1	2,142	5.1	696	5.0	66	0.9
2012	5,644	5.7	157	1.9	2,116	7.7	1,993	4.9	1,229	8.7	89	1.2
Breast surgeries non-exclusive to specialized units					2,116	7.7	1,993	4.9	1,229	8.7	89	1.2
2010	29,522	30.3	1,551	19.7	7,978	29.4	12,291	29.8	5,298	38.0	2,404	34.0
2011	27,953	28.5	1,390	17.4	7,866	28.7	11,907	28.6	4,408	31.4	2,382	33.2
2012	28,172	28.5	1,187	14.7	7,976	29.9	12,256	29.2	4,421	31.3	2,332	32.1
Breast surgeries exclusive to specialized units (oncological)										31.3	2,332	32.1
2010	10,275	10.6	370	4.7	2,597	9.6	4,937	12.0	1,821	13.1	550	7.8
2011	9,387	9.6	384	4.8	2,337	8.5	4,388	10.5	1,729	12.3	549	7.7
2012	10,410	10.5	329	4.1	2,126	7.7	5,479	13.1	1,877	13.3	599	8.2

Brazil and major regions	Year	Average number of mammography equipment available at SUS	Total production of screening mammograms	Estimated production capacity^a	Number of mammograms required^b	Ratio between mammograms and target population^c
Brazil	2010	1,443	3,077,658	7,314,567	7,666,360	0.20
	2011	1,566	3,584,929	7,938,054	7,726,687	0.23
	2012	1,526	3,995,627	7,735,294	7,785,415	0.27
North	2010	73	68,092	370,037	428,328	0.08
	2011	85	81,700	430,865	434,103	0.09
	2012	78	94,134	395,382	440,223	0.12
Northeast	2010	315	568,934	1,596,735	1,909,175	0.14
	2011	351	705,894	1,779,219	1,923,626	0.17
	2012	339	895,791	1,718,391	1,937,528	0.24
Southeast	2010	668	1,590,669	3,386,092	3,582,772	0.22
	2011	695	1,858,234	3,522,955	3,609,099	0.26
	2012	698	2,011,637	3,538,162	3,634,509	0.29
South	2010	274	729,741	1,388,906	1,237,129	0.29
	2011	305	811,230	1,546,045	1,244,535	0.33
	2012	288	847,115	1,459,872	1,251,706	0.35
Midwest	2010	113	120,122	572,797	508,956	0.12
	2011	131	127,871	664,039	515,324	0.13
	2012	123	146,950	623,487	521,448	0.15

Procedure	Years	Brazil		North		Northeast		Southeast		South		Midwest
Procedure	Years	40-49 %	50-69 %	40-49 %	50-69 %	40-49 %	50-69 %	40-49 %	50-69 %	40-49 %	50-69 %	40-49 %	50-69 %
Breast ultrasound	2010	336.8	258.2	601.7	392.8	586.9	434.1	288.3	243.0	186.1	151.3	391.2	274.3
	2011	339.5	263.8	571.1	403.9	529.8	400.5	303.3	252.5	197.8	163.8	413.6	286.5
	2012	312.7	251.0	434.6	330.5	440.2	322.0	283.7	245.4	196.8	169.6	435.7	312.9
Fine needle aspiration	2010	131.4	100.3	290.2	97.2	197.2	97.0	115.4	113.8	59.9	60.5	300.0	183.9
	2011	125.5	87.6	202.5	93.0	195.3	135.6	100.5	79.2	84.0	60.0	249.6	140.1
	2012	116.9	78.2	161.6	90.7	176.4	88.5	91.8	74.7	79.5	59.5	238.7	164.5
Core biopsy	2010	13.7	14.3	19.7	17.4	18.0	17.2	12.5	13.9	13.0	12.9	9.1	11.9
	2011	18.8	18.9	15.7	13.6	21.1	21.4	19.7	19.4	14.8	16.1	19.9	18.1
	2012	16.0	16.6	12.4	15.4	17.7	16.2	16.1	17.5	13.4	14.6	22.4	19.0
Surgical biopsy	2010	14.3	17.3	27.9	21.3	27.5	18.8	12.1	19.6	8.0	12.4	6.2	8.0
	2011	13.3	9.3	29.2	16.9	23.1	12.5	11.2	8.6	8.0	8.1	6.2	7.5
	2012	11.7	11.5	10.3	9.7	19.8	11.2	9.7	7.1	8.8	23.9	5.8	5.1

Secretaria de Vigilância em Saúde e Ambiente - Ministério da Saúde do Brasil SRTVN Quadra 701, Via W5 Norte, Lote D, Edifício P0700, CEP: 70719-040, +55 61 3315-3464, Fax: +55 61 3315-3464 - Brasília - DF - Brazil
E-mail: ress.svs@gmail.com

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[1] Correspondence: Jeane Glaucia Tomazelli - Instituto Nacional de Câncer José Alencar Gomes da Silva, Divisão de Detecção Precoce e Apoio à Organização de Rede, Rua Marquês de Pombal, No. 125, 7º andar, Centro, Rio de Janeiro-RJ, Brasil. CEP: 22230-240. E-mail: jtomazelli@inca.gov.br