Disparities in breast cancer screening for the Brazilian Unified Health System (SUS): A warning of the need to change public policies.

Abstract

1528 Background: Breast cancer is the most prevalent form of cancer in Brazilian women, contributing significantly to cancer-related mortality, particularly when diagnosed at advanced stages. Public policies of the Ministry of Health have been not changed for the last 2 decades. Methods: This ecological, temporal series study evaluated breast cancer screening coverage, clinical staging, and the time from diagnosis to treatment initiation in women of 40-49, 50-69 and 70 years of age in Brazil as a whole, its geographical regions, and states between 2013 and 2022. The data were extracted from databases of the Unified Health System (DATASUS). Results: There was a decreasing trend in screening coverage for the 40-49-year age group between 2013 and 2020 (APC = -10.79; p < 0.001), followed by stability in 2020-2022. Rates for the 50-69-year group remained stable, while coverage fell for women 70 years of age (APC = -6.27; p < 0.001) between 2013 and 2022. Cases of advanced stages at diagnosis tended to increase in all age groups: 40-49 (APC = 1.71; p < 0.001), 50-69 (APC = 1.43; p < 0.001) and 70 years (APC = 1.82; p = 0.001). Breast cancer screening coverage was low for all the age groups and all geographical regions, with lower rates found for the 40-49 and 70-year age groups. The poorest coverage was in the north, northeast and Midwestof the country, revealing regional disparities. The proportion of cases diagnosed at advanced stages (III/IV) increased,particularly in younger women (40-49 years) and the elderly (70 years). Time from diagnosis to treatment initiationexceeded 60 days in > 50% of cases in all age groups, with an increasing trend in women of 50-69 (APC = 1.27; p < 0.001) and 70 years of age (APC = 1.83; p < 0.001). Conclusions: This study highlightsthe urgent need for public policies to increase breast cancer screening coverage beyond the 50-69-year age group, and to guarantee equitable access to early diagnosis and timely treatment, particularly in less affluent areas. Dealing with these disparities is crucial to improving breast cancer outcomes in Brazil.