Time trend on breast cancer mortality: How are we allocating physicians to deal with the disease in men and women in Brazil?

Abstract

e22532 Background: Female breast cancer (FBC) is a well-known public health issue worldwide. However, male breast cancer (MBC) is a rare condition, which might be overlooked by public health authorities and clinicians alike. Methods: Ecological study conducted with secondary data from 2008-2020 to examine the relationship between the amount of doctors per inhabitant on FBC and MBC mortality in Brazil and its federative regions. All data were gathered from Brazil’s public health system. For each cancer, mortality was analyzed by age and standardized by the World Health Organization’s population. The number of physicians was obtained from the Unified Health System and was calculated as the rate per 100,000 inhabitants. Linear regression was performed using stepwise selection/backward elimination. Results: Despite not reaching statistical significance, the total amount of physicians that work in the Unified Health System (UHS) was positively associated with MBC mortality (β 0.00003, IC95% -5,77 x 10-6; 0.00007, p = 0.097), whereas there was a clear trend on FBC mortality reduction over the years (β -0.157, IC95% -0.2355;, p < 0.001) and with higher number of gynecologists (β -0.0400, IC95% -0.577; -0.2236, p < 0.001). Also, FBC mortality rates were positively associated with higher availability of physicians in general (β 0.0088, IC95% 0.0079; 0.0098, p < 0.001) in the UHS. Conclusions: Trends on FBC and MBC mortality rates differ in Brazil. Whereas higher mortality was associated with a greater amount of doctors per inhabitant, perhaps due to more diagnosis, trends on lower mortality rates were found only for FBC – in those cases, it was associated with more gynecologists available. For both neoplasms, there was no association between mortality rates and the amount of clinical oncologists nor primary care physicians available in the country. [Table: see text]