Cancer: rate of tumors discovered late grows – 07/12/2023 – Health

The delay in detecting cancer and starting treatment has led to an increase in the rate of tumors diagnosed in more advanced stages, according to data from the Ministry of Health compiled by a new panel at the Instituto Oncoguia.

In 13 years, the high was nine percentage points. In 2008, 53% of patients had locally advanced or advanced tumors when they started chemo and/or radiotherapy. In 2021, the second year of the Covid-19 pandemic, the rate was 62%. In the previous year, 61% and, in 2019, 59%.

Nurse Vanessa Cavalcante Miranda Beu, 42, is part of these statistics. In July 2020, she was diagnosed with colorectal cancer, a tumor that has been increasing among younger people.

“I felt a lot of back pain, gas, but I thought it was overwork because of the pandemic, 12 hours standing in the ICU. I had no pain or bleeding,” he says. The diagnosis came after an intestinal obstruction.

After the surgery, in which 27 cm of the large intestine were removed, she underwent chemotherapy and went back to work. At the time, the tests showed some suspicious spots in the lung, which were later confirmed to be metastases. Currently, Vanessa undergoes chemotherapy sessions every 15 days.

“The physical part is very tired on chemotherapy days, it leaves me a little down. But the head is fine because I’ve always been in therapy and learned to deal with the disease.”

Data show that the pandemic had a major impact on cancer care and may be one of the factors for the increase in late diagnosis and the worst prognosis of the disease.

In 2020, there was a 37.4% reduction in the number of biopsies, 50% of cytopathological tests, 48% of mammograms and 14.6% of oncological surgeries, compared to 2019.

Among the tumors discovered in more advanced stages are those of the penis, lung and liver (in 88% of cases, on average, the diagnosis is late). At the other end, among those that are diagnosed earlier, are skin (29.8%), eyes (30.8%) and bladder (37.5%).

Cure rates are highest when the disease is restricted to one organ (early stage), drop slightly when it is in the organ and regional lymph nodes (locally advanced), and get much worse when it has already spread to other organs (advanced).

In the distribution by gender, men are the ones with the latest diagnoses: 67.2% start treatments with more advanced tumors, against 59.4% of women. The institute’s survey was based only on records that had information on cancer staging.

According to psychologist Luciana Holtz, president-founder of Oncoguia, there was a deterioration in the quality of filling in this data. In 2008, 9.6% of patient records did not have this information. In 2021, that number was 11.9%. “This shows how much we still need to advance in the correct reporting of data so that we have analyzes that are ever closer to reality.”

For her, some of the problems that hinder the early diagnosis of cancer already existed before the pandemic and continue to persist, such as the time-consuming access to biopsies to confirm the cancer.

Data from Oncoguia show, for example, that 44.5% of patients with breast cancer started treatment after 60 days, which goes against a 2013 law that established that the first oncological treatment in the SUS must start within a maximum period of 60 days after the pathological report.

More than half of them (55%) need to travel to other cities for treatment. “If it’s chemotherapy, at least every 21 days. If it’s radio, it’s every day. It has a big impact on life, on the family, on financial issues”, says Luciana.

For oncological surgeon Ricardo Antunes, president of the Brazilian Society of Cancerology, the lack of health education, prevention and information about cancer also leads to late diagnoses because people, in general, take time to realize that there is something wrong with them.

“But it is clear that we lack access to public health and this has been getting worse. Until the patient arrives, has her evaluation, diagnosis and adequate treatment, it takes six months to a year. During this period, the tumor does not wait, he advances.”

Misinformation about the disease also affects the medical profession, especially recently graduated general practitioners, according to him. “There is a lack of oncology chairs in medical faculties. And much of what exists out there is well below what is desired.”

Luciana, from Oncoguia, also defends an oncology policy that prioritizes early diagnosis, has clear investment targets, with measurement of results, and that tackles health inequities.

Another survey carried out by the institute, in partnership with Datafavela (Instituto Locomotiva) shows that 7 out of 10 people living in favelas in Brazil report difficulties in preventing and diagnosing cancer, including delays in consultations and exams in the SUS.

Fernando Maia, coordinator of the Ministry of Health’s national cancer prevention and control policy, says that the federal government is in the process of diagnosing the oncological situation in the country so that, by the end of the year, it can propose a series of actions.

“We know that there is a serious problem in the care of people with cancer. There are several fundamental actions, such as the qualification of primary health care professionals to better identify suspected cases of cancer and refer them to the specialized level, in a timely manner. “

Other planned actions, according to him, are better structuring of existing screening programs, such as breast and cervical cancer, and the incorporation of new ones, such as colorectal cancer.

“International studies demonstrate that [o tumor colorretal] it is a traceable cancer, which has an impact on mortality when diagnosed early, but Brazil has never structured a program about this.”

The goal is to ensure timely access to cancer diagnostic confirmation services. In the case of an intestinal tumor, performing a colonoscopy and a biopsy, for example.

“These are areas that were left in the background in the SUS. There are places where people even manage to take the exam in the indicated time, but the report takes 30 to 60 days. There is no way”, says Maia.

The coordinator also draws attention to the gaps in care. “We have huge health regions where people need to travel 400, 500 km to have cancer care. This is unacceptable.”

One strategy studied is the use of digital technologies, such as telediagnosis and remote clinical discussions of complex cases.

Between 2009 and 2021, there was a 32% jump in new cancer patients treated, from 156,000 to 206,000, according to the Oncoguia survey. Spending on chemotherapy also rose: from BRL 1.8 billion in 2017 to BRL 2.5 billion in 2022, according to the ministry.

“The growth is closely related to the new medications incorporated, but we don’t know, for example, what impact this has on patient survival in relation to the old medications. We need to better qualify these indicators and make them transparent.”