A model to optimize health care assistance for women with breast cancer: The Núcleo Mama Porto Alegre Project

Abstract

e17526 Background: The promptness of breast cancer (BC) diagnosis and treatment is cornerstone in reducing the disease's mortality. In Brazil, the main problem to achieve this is lack of access to the insufficient referral centers, which in turn are not used to perform early diagnosis and treatment. To address this problem in our city, we created the Núcleo Mama Porto Alegre (NMPOA) model, through a partnership among the private, public and third sectors. The cohort is composed by 9,218 women, of which 4,500 are in the 40–69 age group and have annual clinical examination and mammography (MMG) at NMPOA, and the remainder (<40 and >=70) have clinical follow-up at primary care facilities. All clinical visits, exams and treatment are conducted in the NMPOA center. Our aim is to demonstrate the effectiveness of a model for underserved population to shorten the time between 1st medical appointment and the start of BC treatment. Methods: We analyzed all BC cases diagnosed up to now. We evaluated 3 time periods of the patient's care: median time (MT) between the medical appointment and MMG, MT between MMG and biopsy, and MT between biopsy and the first treatment as indicated: definitive surgery, neoadjuvant chemo- or hormone therapy. Results: 48 cases were evaluated. Clinical staging were the following: stage 0: 16.6%; I: 37.5%; IIA: 18.8%; IIB: 12.5%; IIIA: 10.4%; and IV: 4.1%. MT between the first visit and MMG was 0 days; between MMG and biopsy, 3 days; and between biopsy and first treatment, 23 days. Conclusions: Our model shows much faster results than the usual delay time in Brazil (4–6 months between first visit and treatment). A nationwide BC screening program in Brazil must be implemented with efficient infrastructure and well trained personnel in order to rapid investigate breast lesions, assuring quick access to treatment and therefore diminishing BC mortality. No significant financial relationships to disclose.