The Contribution of the National Health System to Mammographic Screening in Brazil, 2010

Abstract

INTRODUCTION: In Brazil, access to mammography is provided through the National Health System (SUS), the Supplemental Health System, or is paid for directly by the patient. SUS is the official government system and was established to conform to the constitutional requirement that health is a right of all citizens and a duty of the state. In recent years SUS breast cancer control policies have advanced and government strategies for early detection have strengthened. However, evaluations are needed to monitor the effectiveness of these actions. OBJECTIVE: To describe the coverage of mammography in breast cancer screening conducted by the National Health System in Brazilian macro-regions and states in 2010. METHODS: An ecological study, where the estimate of coverage was the number of exams performed expressed as a percentage of the number of exams expected in the target population of women 50-69 years old. The exams performed refer to target population mammographic production data from the Outpatient Information System (CIS) of DATASUS. To calculate the expected number of exams for this population, the biennial screening recommendations of the National Cancer Institute (NCI) and an estimate of the female population based on the census of the Brazilian Institute of Geography and Statistics (IBGE) were used. RESULTS: The coverage estimate for SUS-performed mammographies in Brazil in 2010 was 19.1%. Broken down by macro region, the estimates were the following: North 8.5% (4.6 - 15.8), Northeast 13.2% (8.2 to 16.9), Center West 11.5% ( 6.4 to 16.6), Southeast 21.8% (12.2 - 25.9) and South 26.9% (23.3 to 29.3). The state of Santa Catarina had the broadest coverage with 26.9%, while Rondonia (4.6%) had the lowest. DISCUSSION: It is known that organized mammographic screening can reduce breast cancer mortality rates. This type of screening was implemented in Brazil by consensus only through the publication of the INCA - Breast Cancer Control - Consensus Document. Together with other government measures, this document demonstrates changes in strategies for the control and prevention of breast cancer in Brazil. However, a comparison of coverage indicators in relation to the population base eight years after the publication of the document shows that the involvement of SUS in mammography coverage in Brazil is still small. This may be due to the uneven distribution of mammographs and their limited operating capacity which are reflected in the estimated coverage levels by state. CONCLUSION: The results imply that the contribution of SUS to mammographic screening in Brazil is higher in both macro-regions and states with greater purchasing power to the detriment of those with less purchasing power.