Main Article Content
Breast cancer is the most common female neoplasm in Brazil accounting for 73.610 new cases a year. The organization of public health system is a critical point to provide diagnosis and treatment for these patients, considering that 75% of the population is covered by public health system (Sistema Único de Saúde, SUS). Waiting time for diagnosis procedures and treatment has been used to evaluate accessibility to the health system and can guide governmental strategies to improve them. A retrospective study was conducted by assessing medical records of all patients registered at a High Complexity Oncology Assistance Unit (Unidade de Alta Complexidade em Oncologia, UNACON). The patients registered in the period from October 2021 to September 2022 were included. The medical report was used to collect epidemiological, clinicopathologic data, and main waiting times for diagnosis procedures and treatment. There were registered 143 patients, mean age was 57.6 years (SD±12,6). Symptoms detected cancer was the majority with 112 patients (86,8%). Median waiting times: 1-from breast abnormalities self-perception to first image exam was 60 days; 2-waiting time from the exam to core biopsy was 41,5 days; 3-waiting time from the biopsy to report liberation of biopsy was 11.0 days; 4-waiting time from biopsy report to first visit at oncologic care unit was 31.0 days; 4-waiting time from the oncologic care unit first visit to first treatment was 55.0 days; 5-waiting time from the breast biopsy to treatment beginning was 97.0 days. Our study demonstrates long waiting time from diagnosis to first treatment (above 60 days as established by Brazilian law) and long waiting time spending with each step of journey from the breast abnormalities self-detected to treatment beginning. Integration among basic, secondary and high complexity units, and clear strategies to guide patients with self-detected symptoms are points to be target.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Instituto Nacional de Câncer. Estatísticas de câncer. INCA. Published 2022. Accessed August 2, 2023. https://www.gov.br/inca/pt-br/assuntos/cancer/numeros/
3. Mujar NMM, Dahlui M, Emran NA, et al. Breast Cancer Care Timeliness Framework: A Quality Framework for Cancer Control. JCO Glob Oncol. 2022; 8:e2100250. doi:10.1200/ GO.21.00250.
4. Rivera-Franco MM, Leon-Rodriguez E. Delays in Breast Cancer Detection and Treatment in Developing Countries. Breast Cancer (Auckl). 2018; 12:1-5. doi: 10.1177/ 1178223417752677.
5. National Cancer Registry Department. Malaysian Study on Cancer Survival (MySCan). Ministry of Health. Published 2018. Accessed October 5, 2023. https://www.moh.gov.my/moh/resources/Penerbitan/Laporan/Umum/Malaysian_Study_on_Cancer_Survival_MySCan_2018.pdf
6. Porter P. "Westernizing" women's risks? Breast cancer in lower-income countries. N Engl J Med. 2008; 358(3):213-6. doi: 10.1056/ NEJMp0708307.
7. Instituto Nacional de Câncer. A situação do câncer de mama no Brasil: Síntese de dados dos Sistemas de Informação. INCA. Published 2019. Accessed August 2, 2023. https://www.inca.gov.br/publicacoes/livros/situacao-do-cancer-de-mama-no-brasil-sintese-de-dados-dos-sistemas-de-informacao
8. Rosa DD, Bines J, Werutsky G, et al. The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115). Breast Cancer Res Treat. 2020; 183(3):749-757. doi:10.1007/S10549-020-05831-Y
9. Walters S, Maringe C, Butler J, et al. Breast cancer survival and stage at diagnosis in Australia, Canada, Denmark, Norway, Sweden and the UK, 2000-2007: a population-based study. Br J Cancer. 2013; 108(5):1195-1208. doi:10.1038/BJC.2013.6
10. Yip CH. Downstaging is more important than screening for asymptomatic breast cancer. Lancet Glob Health. 2019; 7(6):e690-e691. doi:10.1016/S2214-109X(19)30190-1
11. Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. Lancet Glob Health. 2018; 6(8):e885-e893. doi:10.1016/S2214-109X(18)30257-2
12. Goss PE, Lee BL, Badovinac-Crnjevic T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol. 2013; 14(5):391-436. doi:10.1016/S1470-2045(13)7 0048-2
13. Sankaranarayanan R, Ramadas K, Thara S, et al. Clinical breast examination: preliminary results from a cluster randomized controlled trial in India. J Natl Cancer Inst. 2011; 103(19):1476-1480. doi:10.1093/jnci/djr304
14. Anderson BO, Bevers TB, Carlson RW. Clinical Breast Examination and Breast Cancer Screening Guideline. JAMA. 2016; 315(13):1403-1404. doi:10.1001/jama.2016. 0686
15. Kardinah D, Anderson BO, Duggan C, Ali IA, Thomas DB. Short report: Limited effectiveness of screening mammography in addition to clinical breast examination by trained nurse midwives in rural Jakarta, Indonesia. Int J Cancer. 2014; 134(5):1250-1255. doi:10.1002/ijc.28442
16. Bretas G, Renna NL, Bines J. Practical considerations for expediting breast cancer treatment in Brazil. Lancet regional health Americas. 2021;2. doi:10.1016/J.LANA.2021. 100028
17. Duggan C, Dvaladze A, Rositch AF, et al. The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation: Methods and overview. Cancer. 2020;126 Suppl 10(Suppl 10):2339-2352. doi:10.1002/cncr.32891
18. Castro MC, Massuda A, Almeida G, et al. Brazil's unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345-356. doi:10.1016/ S0140-6736(19)31243-7
19. Gadelha MIP. A Assistência Oncológica e os 30 Anos do Sistema Único de Saúde. Rev. Bras. Cancerol. 2018; 64(2): 237-45. https://doi.org/10.32635/21769745.RBC.2018v64n2.83
20. Serra J. Portaria nº 3.535, de 2 de setembro de 1998. Ministério da Saúde. Published 1998. Accessed August 2, 2023. https://bvsms.saude.gov.br/bvs/saudelegis/gm/1998/prt3535_02_09_1998_revog.html
21. Instituto Nacional de Câncer. Onde tratar pelo SUS. INCA. Published 2022. Accessed August 2, 2023. https://www.gov.br/inca/pt-br/assuntos/cancer/tratamento/onde-tratar-pelo-sus
22. Temporão JG. PORTARIA No 741, DE 19 DE DEZEMBRO DE 2005. Ministério da Saúde. Published 2005. Accessed August 2, 2023. https://bvsms.saude.gov.br/bvs/saudelegis/sas/2005/prt0741_19_12_2005.html
23. Agência Nacional de Saúde Suplementar. Dados Gerais. Ministério da Saúde. Published 2018. Accessed August 2, 2023. https://www.gov.br/ans/pt-br/acesso-a-informacao/perfil-do-setor/dados-gerais
24. Instituto Nacional de Câncer. Diretrizes para a detecção precoce do câncer de mama no Brasil. INCA. Published 2015. Accessed August 2, 2023. https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil
25. Instituto Nacional de Câncer. Mamografias no SUS. INCA. Published 2022. Accessed July 13, 2022. https://www.gov.br/inca/pt-br/assuntos/gestor-e-profissional-de-saude/controle-do-cancer-de-mama/dados-e-numeros/mamografias-no-sus
26. Antonini M, Pinheiro DJP da C, Salerno GRF, et al. Does Pink October really impact breast cancer screening? Public Health Pract (Oxf). 2022; 4:100316. doi:10.1016/J.PUHIP. 2022.100316
27. Marchi AA, Gurgel MSC. Adherence to the opportunistic mammography screening in public and private health systems. Rev Bras Ginecol Obstet. 2010; 32(4):191-197. doi:10. 1590/S0100-72032010000400007
28. World Health Organization. Guide to cancer early diagnosis. WHO. Published 2017. Accessed August 2, 2023. https://apps.who.int/iris/handle/10665/254500
29. Oeffinger KC, Fontham ETH, Etzioni R, et al. Breast Cancer Screening for Women at Average Risk: 2015 Guideline Update From the American Cancer Society. JAMA. 2015; 314(15):1599-1614. doi:10.1001/JAMA.2015. 12783
30. Bonita R, Beaglehole R, Kjellström T. Epidemiologia Básica 2ª edição. Organização Mundial de Saúde; 2008.
31. Romanoff A, Constant TH, Johnson KM, et al. Association of Previous Clinical Breast Examination with Reduced Delays and Earlier-Stage Breast Cancer Diagnosis Among Women in Peru. JAMA Oncol. 2017; 3(11):1563-1567. doi:10.1001/JAMAONCOL. 2017.1023
32. Ferreira NAS, Schoueri JHM, Sorpreso ICE, Adami F, Figueiredo FWDS. Waiting Time between Breast Cancer Diagnosis and Treatment in Brazilian Women: An Analysis of Cases from 1998 to 2012. Int J Environ Res Public Health. 2020; 17(11):1-10. doi:10.3390/ IJERPH17114030
33. Rousseff D, Cardozo JE, Padilha ARS. LEI No 12.732, DE 22 DE NOVEMBRO DE 2012. Presidência da República. Published 2012. Accessed August 2, 2023. http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12732.htm
34. Barrios C, de Lima Lopes G, Yusof MM, Rubagumya F, Rutkowski P, Sengar M. Barriers in access to oncology drugs - a global crisis. Nat Rev Clin Oncol. 2023; 20(1):7-15. doi:10.1038/S41571-022-00700-7
35. Nogueira-Rodrigues A, Rosa DD, Suzuki DA, et al. Breast and gynecologic cancers as a Brazilian health priority. Rev Assoc Med Bras. 2023; 69 (suppl 1): e2023S120. doi:10. 1590/1806-9282.2023S120