Mulheres com câncer de mama em Belo Horizonte: perfil, trajetória e narrativas sobre o cuidado

Abstract

Introduction: Cancer is the archetype of human impotence before death. Breast cancer is the most common among women and the leading cause of cancer death in Brazilian women with 28,828 deaths in 2014 and incidence of 2016 estimated in 56.2 / 100,000 women. High mortality is attributed to delayed diagnosis and treatment. Objectives: To know the profile and trajectory of attention to female breast cancer in Belo Horizonte, from prevention to treatment. Methods: Theoretical essay on social and political history of women's health care and perceived contradictions; Cross-sectional study with hospital-based data through cluster analysis to delineate, describe and analyze profiles of women in the treatment of breast cancer in public and private units in Belo Horizonte from 2010 to 2013 and verify association with intervals between diagnosis and treatment Regardless of staging of the disease; Interpretative analysis of narratives of women from Belo Horizonte, different sociodemographic profiles, attention to breast cancer, from preventive to treatment. Results: Women who need the most public health services (SUS) are the ones that find the greatest difficulties in care (article 1); Five profiles were identified: A (white color, schooling> 15 years, private network treatment); B (white color, schooling = 11 years, SUS treatment); C and D (brown color, schooling = 11 years and <8 years respectively, SUS treatment); E (black color, schooling <8 years, SUS treatment). The B, C, D and E profiles were associated with longer diagnostic / treatment intervals regardless of the stage of the cancer at diagnosis, and E presented a 37 greater chance of> 91 days (OR: 37.26, 95% CI: 11, 91-116,56). Even after overcoming access barriers, women with social vulnerability profiles were more likely to wait for treatment (Article 2). Narratives have shown that differences in breast cancer care among women of different profiles are related to social inequalities that result in damages to women of greater vulnerability, such as: asymmetrical relationships with professionals and health services; negligent and discriminatory care to SUS users in the accredited network; Deprivations in the course of treatment; Precarious work links, hindering the search for preventive care and provoking insecurity after treatment (Article 3). Conclusion: There is evidence that social inequalities are related to inequalities occurring in breast cancer care in Belo Horizonte, affecting women with characteristics of social vulnerability. Studies on the subject should support the formulation of policies and strategies that address the care needs of women from different social groups, from prevention to post-treatment of breast cancer, so that social inequalities do not result in inequalities of attention.