Addressing Breast Cancer Disparities in Brazil: A Roadmap for Innovative Strategies
Main Article Content
Abstract
Breast cancer (BC) is the most common malignant disease among women worldwide, with a rising incidence. It poses a significant burden in Latin America, where mortality rates have remained consistently high over recent decades, in contrast to some high-income countries (HICs), where these rates have decreased. The increase in survival rates has been driven by expanded screening coverage and advancements in the treatment of stage II, III, and metastatic breast cancer. Achieving similar improvements in low- and middle-income countries (LMICs) requires the incorporation of these strategies, which has been particularly challenging in resource-limited settings. In this narrative review, we have analyzed laws and ordinances launched by Brazilian government since the creation of its public health system in 1990. Alongside analysis of these governmental landmarks, we have pointed out the main published results regarding breast cancer staging distribution at diagnosis, strategies for timely diagnosis, screening coverage and barriers to treatment access in the last decades, aiming to understand the achievements by implemented public politics. Once, we have described the public health scenario in breast cancer, we have identified factors that represent bottlenecks to improve outcomes in breast cancer in Brazil and have proposed potential actions that might change this landscape. These actions could be centered on timely diagnosis and treatment beginning, attempt to widen access to new medicines, widen telehealth utilization since breast cancer detected abnormalities up to treatment and follow up after treatment conclusion. The authors have discussed how these actions could be implemented in Brazilian public health system, aiming to drive better outcomes.
Keywords:
breast cancer, cancer-care, access, Brazilian public health system, timely diagnosis, timely treatment initiation, supportive care, telehealth.
Article Details
How to Cite
RESENDE, Heloisa et al.
Addressing Breast Cancer Disparities in Brazil: A Roadmap for Innovative Strategies.
Medical Research Archives, [S.l.], v. 12, n. 10, oct. 2024.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/5846>. Date accessed: 22 dec. 2024.
doi: https://doi.org/10.18103/mra.v12i10.5846.
Section
Review Articles
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.
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2. Torres-Román JS, Ybaseta-Medina J, Loli-Guevara S, et al. Disparities in breast cancer mortality among Latin American women: trends and predictions for 2030. BMC Public Health. 2023;23(1):1449. doi:10.1186/s12889-023-16328-w.
3. Santos MO, Lima FCS, Martins LFL, et al. Estimativa de Incidência de Câncer no Brasil, 2023-2025. Revista Brasileira de Cancerologia. 2023;69(1): p.e-213700. doi.org/10.32635/2176-9745.RBC.2023v69n1.3700
4. Age-Standardized Rate (World) per 100 000, Incidence and Mortality, Both sexes, in 2022, Breast. Global Cancer Observatory. 2022. Accessed July 28, 2024. https://gco.iarc.fr/today/en/dataviz/bars?types=0_1.
5. Caswell-Jin JL, Sun LP, Munoz D, et al. Analysis of Breast Cancer Mortality in the US-1975 to 2019. JAMA. 2024;331(3):233-241.
doi:10.1001/jama.2023.25881.
6. Barrios C, Freitas-Junior R, Martins S, Bines J, Estevez-Diz MDP, Caleffi M. Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies. JCO Glob Oncol. 2021;7: 474-485. doi:10.1200/GO.20.00566.
7. Agência Nacional de Saúde ANS: General data beneficiaries of private health plans, by assistance coverage (Brazil: 2014-2024). GOV.BR. Published September 27, 2024. Accessed September 27, 2024. https://www.gov.br/ans/pt-br/acesso-a-informacao/perfil-do-setor/dados-gerais
8. 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(1019 5):345-356. doi:10.1016/S0140-6736(19)31243-7.
9. Padilha ARS. Ordinance 874 May 2013. Ministério da Saúde. Published May 16, 2013.
Accessed July 27, 2024. https://bvsms.saude.gov.br/bvs/saudelegis/gm/2013/prt0874_16_05_2013.html
10. Proposta da SBOC para garantir o efetivo acesso a antineoplásicos incorporados ao SUS. Sociedade Brasileira de Oncologia Clínica. Published May 25, 2023. Accessed July 27, 2024. https://sboc.org.br/images/pdf/075-Proposta-SBOC-Iniquidade-Pos-Conferencia.pdf
11. Resende H, Arai RJ, Barrios CH, et al. Improving access to cancer clinical research in Brazil: recent advances and new opportunities. Expert opinions from the 4th CURA meeting, São Paulo, 2023. Ecancermedicalscience. 2024;18:1698. doi:10.3332/ecancer.2024.1698.
12. Richards MA, Westcombe AM, Love SB, Littlejohns P, Ramirez AJ. Influence of delay on survival in patients with breast cancer: a systematic review. Lancet. 1999;353(9159):1119-1126. doi:10.1016/s0140-6736(99)02143-1.
13. Rivera-Franco MM, Leon-Rodriguez E. Delays in Breast Cancer Detection and Treatment in Developing Countries. Breast Cancer (Auckl). 2018;12:1178223417752677. doi:10.1177/1178223417752677.
14. Antonini M, Pinheiro DJPDC, 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.
15. Dos-Santos-Silva I, De Stavola BL, Renna NL Junior, et al. Ethnoracial and social trends in breast cancer staging at diagnosis in Brazil, 2001-14: a case only analysis. Lancet Glob Health. 2019; 7(6):e784-e797. doi:10.1016/S2214-109X(19)30151-2.
16. Simon SD, Bines J, Werutsky G, et al. Characteristics and prognosis of stage I-III breast cancer subtypes in Brazil: The AMAZONA retrospective cohort study. Breast. 2019;44:113-119. doi:10.1016/j.breast.2019.01.008.
17. 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.
18. Berry DA, Cronin KA, Plevritis SK, et al. Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med. 2005;353(17): 1784-1792. doi:10.1056/NEJMoa050518.
19. Duffy SW, Tabár L, Yen AM, et al. Mammography screening reduces rates of advanced and fatal breast cancers: Results in 549,091 women. Cancer. 2020;126(13):2971-2979. doi:10.1002/cncr.32859.
20. Duffy SW, Tabár L, Yen AM, et al. Beneficial Effect of Consecutive Screening Mammography Examinations on Mortality from Breast Cancer: A Prospective Study. Radiology. 2021;299(3):541-547. doi:10.1148/radiol.2021203935.
21. 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.
22. WHO. World health statistics 2019: monitoring health for the SDGs, sustainable development goals. WHO. Published May 21, 2019. Accessed July 27, 2024. https://www.who.int/publications/i/item/9789241565707
23. Resende H, Aguiar V, Jacob L, et al. The journey of breast cancer patient from self-perception of breast abnormalities to first cancer treatment- a sectional study in Sul Fluminense region-RJ-Brazil. Medical Research Archives. 2023;11(10). doi:10.18103/mra.v11i10.4577.
24. INCA. A situação do câncer de mama no Brasil: síntese de dados dos sistemas de informação. Instituto Nacional de Câncer. 2019. Published July 22, 2022. Accessed July 27, 2024.
https://www.inca.gov.br/publicacoes/livros/situacao-do-cancer-de-mama-no-brasil-sintese-de-dados-dos-sistemas-de-informacao
25. Bretas G, Renna NL, Bines J. Practical considerations for expediting breast cancer treatment in Brazil. Lancet Reg Health Am. 2021;2: 100028. doi:10.1016/j.lana.2021.100028.
26. Franzoi MA, Rosa DD, Zaffaroni F, et al. Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115). J Glob Oncol. 2019;5:1-10. doi:10.1200/JGO.19.00263.
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