Análise do tempo entre a detecção e o diagnóstico do câncer de mama no Sistema Único de Saúde entre 2008 e 2014

Abstract

Introduction: Breast cancer is a type of cancer in which 99% of the victims are women. Among the more than 100 known cancers, breast cancer is the most common in among women. The number of confirmed cases in Brazil now exceeds 180 cases per day. The chances of cure decrease as the disease progress. Studies indicate that diagnosis in Brazil is confirmed when the tumor is already at an advanced stage, which is associated with higher mortality. Law 13,896/2019 has established time limit for the completion of the diagnosis when cancer-related changes are detected. However, there are still many challenges in implementing this law. Regardless of the public policy aimed at reducing the time between detection and diagnosis, it must start with an understanding of the time currently spent, from which targets can be set. Since the recent period was and is heavily influenced by the COVID-19 pandemic, an analysis of the period between 2008 and 2014 can provide insight into the reality of the time that elapses between the detection and diagnosis of breast cancer in Brazil. Objective: To analyze the time between breast cancer detection and diagnosis in women with diagnoses registered in the Brazilian Unified Health System between 2008 and 2014 and to identify factors that may be associated with this time. Methods: Data were extracted from the "National Cancer Database," a national population-based cohort constructed by record linkage techniques and aggregates data from the Unified Health System´s the main Information Systems and contains all records of patients who underwent cancer treatment in the Unified Health System between 2000 and 2015. The eligible population consisted of women who had a positive diagnosis of breast cancer registered in the Unified Health System between January 1, 2008, and December 31, 2014. The time interval between detection by imaging examination (mammography or ultrasound) and diagnosis was analyzed. The time interval between detection and diagnosis was stratified by sociodemographic variables, staging, and occurrence of breast cancer-related deaths. The results obtained were presented in tables and graphs with median values and interquartile ranges (Q1, Q3). Results: The initial population size was 204,305 women. The main reasons for exclusion were that they had not undergone any examination en route to breast cancer diagnosis by SUS: 125,480 women (61.42%), and having only a record of biopsy examination at SUS: 9,224 women (4.51%). After exclusions, data from 65,555 women (32.07%) were investigated. In the analyzed period, the median time between detection and diagnosis of breast cancer by ultrasound or mammography was 132 days (Q1= 61; Q3= 294), and only 24% of women managed to complete the diagnosis within 60 days. The majority of the population consisted of white women (59%), aged between 40 and 59 years, but Black and Indigenous women had the highest mortality rates: black (17%) and Indigenous (35%). 75.5% of women had stage ≥ 2 tumors. Women with stage 3 and 4 tumors had the shortest time intervals to reach the diagnosis. The same situation occurred in relation to women who died due to breast cancer. This is one of the largest populations ever analyzed in Brazil for this purpose. The results presented contribute to improving the monitoring of early breast cancer detection and diagnosis interventions, as they identify the weaknesses in the care pathway and highlight the challenge faced by the managers of the Unified Health System in implementing the diagnosis within 30 (thirty) days, as established in Law 13,896/2019, which came into force in April 2020.