Offer of mammography varies drastically between municipalities – 04/26/2023 – Health

Survey carried out by Sheet based on data from the SUS (Sistema Único de Saúde) shows that the offer of mammograms in the country varies drastically according to the region. The exam is essential for the early detection of breast cancer, the most common neoplasm among Brazilian women.

Between 2016 and 2021, Rio carried out 538,847 exams, a number short of the number needed to cover biennial screening among women aged 50 to 69 without signs of breast cancer —the city has more than 700,000 residents with this profile— and mammography diagnosis, indicated to evaluate suspicious changes at any age, in women and men.

Macapá is another capital with problems. The city carried out 16,962 tests through the SUS between 2016 and 2021, but it has more than 18,000 women in the screening range, according to the latest IBGE Census.

On the other hand, Cachoeirinha, in the metropolitan region of Porto Alegre, stands out for offering mammograms. The municipality of less than 12,000 women between 50 and 69 years old accumulates 92,876 tests carried out in six years, a higher number than that of capitals such as Florianópolis and Cuiabá.

“The reality of health in Brazil is very different. We have a system called the Unified Health System, but it is not unique. We have multiple SUS in different regions of Brazil or even in the same city”, says oncologist Laura Testa, member of the Breast Tumors Committee of the SBOC (Brazilian Society of Clinical Oncology).

Cachoeirinha resident, Andreia Ferreira, 44, is undergoing treatment for breast cancer. She noticed a bulge in her breast in April 2022, when doing a self-examination, and scheduled an appointment with a gynecologist at the center near her house. In two months, she completed all the exams and obtained the necessary reports to start the treatment. She has already undergone chemotherapy, surgery and will start radiotherapy.

“Sometimes, we are afraid that the SUS will rush to answer it, but the doctor sits down and talks, leaves it well explained. When I found out that I had to undergo the treatment, I had many doubts. I was confused, afraid and they passed security.”

Also in the city, Márcia Brasil, 41, regularly undergoes the examination since her silicone prosthesis ruptured. “Last time, the nurse who collected the pap smear already gave the request for the mammogram. I scheduled it at the outsourced company, I did it and in a few days I collected the result to take it back to the post”, narrates the micropigmentator.

Six years ago, she began offering free halo and nipple tattoos to women undergoing mastectomy and, through the NGO Amigas do Peito RS, she accompanies many women with breast cancer.

Today, in Cachoeirinha, users who go to the health center for a pap smear are invited to schedule a mammogram. In addition, events are organized on Saturdays in the city’s shopping center to schedule exams for those who cannot go to the units during the week.

Once scheduled, the exam is performed at the private clinic with which you have an agreement. “To offer the exam by the municipality, we would have to rent a place, equipment and make available a workforce that we don’t have in the staff”, says the municipal secretary of Health, Bianca Breier.

“We refer the patients, supervise the service and hold periodic meetings to check if there is a dammed demand”, he adds. If a biopsy is necessary, the patients are referred to the Hospital Padre Jeremias and, once the cancer is diagnosed, the treatment takes place in Porto Alegre.

“What we do in Cachoeirinha is to prevent mammography from falling into oblivion because we know that early detection of the disease is still the best medicine”, says Breier. In the last year, the municipality was 1 of the 10 in Rio Grande do Sul that stood out in breast cancer screening and received recognition from the state government.

The scenario is different at the other end of the country, in Macapá. There, the Secretary of Health, Erica Aymoré, says that the current management created a mammography service at the Specialty Center to increase the offer of the exam and opted for a free-demand system —women over 40 need only attend the unit, which is open from Monday to Friday, from 8am to 6pm—but demand is still low.

“We don’t have a queue. Our main job is not to manage queues, but to inform women of the importance of having a mammogram at the right time”, says Aymoré. The folder has sought to reinforce educational posts on social networks and strengthen the work of Family Health teams to provide guidance on the need for the exam.

The lack of awareness is also pointed out by the Undersecretary of Health of Rio de Janeiro, Renato Cony, as one of the factors to explain the numbers in the city. Other aspects are the lower coverage of primary care in the municipality in recent years, the fact that mammograms performed in the private sector —it is estimated that 25% of the eligible population uses health plans— are not accounted for by the SUS and the reduction in referrals in the pandemic .

According to the folder, the offer in the municipal network between 2016 and 2022 was 979,000 vacancies for the exam and the waiting time after scheduling is up to 28 days for screening cases and up to seven days for diagnostic mammography, but many patients make an appointment and don’t show up.

Another challenge, says Cony, is demand variation. In Pink October and November, requests for exams skyrocket, however, after this period, there is a drop in demand.

Laura Testa, from the SBOC (Brazilian Society of Clinical Oncology), says it is complex to devise a single answer to the problem. One way out, for example, would be to raise local demands and specific strategies, such as the purchase of a mammography device by a group of municipalities and its installation in a truck or offering mammography on boats in the case of riverside populations.

The important thing, says the oncologist, is to reach out to patients and achieve tracking of at least 85% of the target audience.

The next step, adds Maira Caleffi, head of the Mastology Service at Hospital Moinhos de Vento (RS) and president of Femama (Brazilian Federation of Philanthropic Institutions to Support Breast Health), is to help the patient evolve in the system. “There is no active search for symptomatic patients, there is no navigation.”

Caleffi says that, after the mammogram, many women find it difficult to perform the biopsy and pay for the exam, which affects the numbers of the municipalities and creates a false queue zero.

“The main problem is still the biopsy, an exam that not only tells whether it is cancer or not. Nowadays, in order to carry out the most assertive treatment, we need to know what type of cancer it is, what classification it is. Depending on the type, the patient need chemotherapy before surgery, for example.”

“If we have the possibility of curing 90% to 95% of cases in stage 1 and 2, as the literature shows, it is because of the right treatment, and the right treatment depends on being able to make the right diagnosis.”