Background Breast cancer (BC) is the most prevalent form of cancer in Brazilian women, contributing significantly to cancer-related mortality, particularly when diagnosed at advanced stages. Methods This ecological, temporal series study evaluated breast cancer mammography screening rate, clinical staging, and the time from diagnosis to treatment initiation in women of 40–49, 50–69 and <InlineEquation ID="IEq1"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70 years of age in Brazil, its geographical regions, and states between 2013 and 2022. The data were extracted from databases of the Unified Health System (DATASUS). Results There was a decreasing trend in mammography screening rate for the 40-49-year age group between 2013 and 2020 (Annual Percentual Change- APC= -10.79; p < 0.001), and stability in 2020–2022. Rates for the 50-69-year group remained stable, while fell for women <InlineEquation ID="IEq2"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70 years of age (APC= -6.27; p < 0.001) between 2013 and 2022. Cases of advanced stages at diagnosis tended to increase in all age groups: 40–49 (APC=1.71; p < 0.001), 50–69 (APC = 1.43; p < 0.001) and <InlineEquation ID="IEq3"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70 years (APC = 1.82; p = 0.001). The mammography screening rate was low for all the age groups and all geographical regions, with lower rates found for the 40–49 and <InlineEquation ID="IEq4"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70-year age groups. The poorest screening rates were seen in the regions North, Northeast and Midwest, revealing regional disparities. The proportion of cases diagnosed at advanced stages (III/IV) increased, particularly in 40–49 and <InlineEquation ID="IEq5"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70-year age groups. Time from diagnosis to treatment initiation exceeded 60 days in >50% of cases in all age groups, with an increasing trend in women of 50–69 (APC = 1.27; p < 0.001) and <InlineEquation ID="IEq6"> <EquationSource Format="TEX">\(\:\ge\:\)</EquationSource> </InlineEquation>70 years of age (APC=1.83; p < 0.001). Conclusions This study highlights the urgent need for public policies to increase BC mammography screening rate beyond the 50-69-year age group, and to guarantee equitable access to early diagnosis and timely treatment, particularly in less affluent areas. Dealing with these disparities is crucial to improving BC outcomes in Brazil, positively influencing clinical stage at diagnosis, treatment efficacy, and ultimately, survival and mortality.

Disparities in breast cancer screening, stage at diagnosis, and treatment in Brazil: a warning of the need to change public policies

期刊论文
出版模式：

开放获取
发表日期：

2026年3月10日

查看全文

Ruffo Freitas-Junior,
Aline Ferreira Bandeira de Melo Rocha,
Leonardo Ribeiro Soares,
Glalber Luiz da Rocha Ferreira

摘要

Background

Breast cancer (BC) is the most prevalent form of cancer in Brazilian women, contributing significantly to cancer-related mortality, particularly when diagnosed at advanced stages.

Methods

This ecological, temporal series study evaluated breast cancer mammography screening rate, clinical staging, and the time from diagnosis to treatment initiation in women of 40–49, 50–69 and \(\:\ge\:\) 70 years of age in Brazil, its geographical regions, and states between 2013 and 2022. The data were extracted from databases of the Unified Health System (DATASUS).

Results

There was a decreasing trend in mammography screening rate for the 40-49-year age group between 2013 and 2020 (Annual Percentual Change- APC= -10.79; p < 0.001), and stability in 2020–2022. Rates for the 50-69-year group remained stable, while fell for women \(\:\ge\:\) 70 years of age (APC= -6.27; p < 0.001) between 2013 and 2022. Cases of advanced stages at diagnosis tended to increase in all age groups: 40–49 (APC=1.71; p < 0.001), 50–69 (APC = 1.43; p < 0.001) and \(\:\ge\:\) 70 years (APC = 1.82; p = 0.001). The mammography screening rate was low for all the age groups and all geographical regions, with lower rates found for the 40–49 and \(\:\ge\:\) 70-year age groups. The poorest screening rates were seen in the regions North, Northeast and Midwest, revealing regional disparities. The proportion of cases diagnosed at advanced stages (III/IV) increased, particularly in 40–49 and \(\:\ge\:\) 70-year age groups. Time from diagnosis to treatment initiation exceeded 60 days in >50% of cases in all age groups, with an increasing trend in women of 50–69 (APC = 1.27; p < 0.001) and \(\:\ge\:\) 70 years of age (APC=1.83; p < 0.001).

Conclusions

This study highlights the urgent need for public policies to increase BC mammography screening rate beyond the 50-69-year age group, and to guarantee equitable access to early diagnosis and timely treatment, particularly in less affluent areas. Dealing with these disparities is crucial to improving BC outcomes in Brazil, positively influencing clinical stage at diagnosis, treatment efficacy, and ultimately, survival and mortality.