Ethical issues surrounding breast cancer screening in Brazil

Abstract

Breast cancer (BC) is the most common type of cancer in Brazil; it was responsible for 15,593 deaths in 2015, and an estimated 59,700 new cases were diagnosed in 2018 (1). BC in Brazil has some peculiarities when compared to other countries; 35 to 41.1% of all cases are diagnosed among patients younger than 50 years old, and most of the operable cases are diagnosed in later stages (53.5% stage 2 and 23.2% stage 3) (2), despite the opportunistic mammographic screening program (MSP) supported by the national government. The screening model adopted in Brazil recommends a mammogram every two years for women between the ages of 50 and 69 (3). However, the frequent diagnosis of BC in women at younger ages in Brazil leads to the claim that over 40% of the women diagnosed with cancer were not eligible for the MSP to begin with. The late stage at diagnosis, on the other hand, leads to the hypothesis that the current screening program is either not effective or individuals do not have proper access to it. Additionally, BC mortality in Brazil has been increasing in the last decades (4). Together, these factors pose an ethical issue, as investing valuable resources in an ineffective program negatively impacts the whole society and, therefore, smarter resource allocation schemes should be implemented to address this issue. In this editorial, we will dispute, from a utilitarian approach, the usefulness of the current MSP recommendation in a country with great inequalities among its regions and will also discuss an alternative to breast cancer screening from a Rawlsian perspective.