- Mariana Alvim -marianaalvim
- BBC News Brazil in Sao Paulo
Among the various diseases affected by the prevention and treatment of the coronavirus pandemic, it is the most common type of cancer in new cases and deaths of women in Brazil, after non-melanoma skin cancer: breast cancer.
One of the most important early detection measures for the disease is mammography for women between the ages of 50 and 69 years, who have been directly affected by the epidemic, as shown by upload Published in April in Revista de Saúde Pública.
The number of mammograms performed on the public network in this age group decreased by 42% in 2020 compared to the previous year, dropping from 1,948,471 in 2019 to 1,126,688 in the year the epidemic began.
The difference of 800,000 tests not performed last year should mean nearly 4,000 undiagnosed breast cancer cases in 2020, taking into account estimates of the disease detection rate on digital mammograms (an average of 5 cases detected per 1,000 scans) .
“This represents a potential burden of disease over the next few years,” says the study, signed by mammologist Jordana Besa.
The author also used information from DATASUS to break down numbers by state and month. Although there are some regional differences, the volume of mammograms taken in 2020 has decreased in most parts of the country, indicating that it is a widespread problem.
“In January (the number of mammograms taken in the country) it started reasonably well, then in April it started to decrease very drastically. The decline was eased in October, with the Pink October campaign, but it did not reach the level Before “Pandemic, Pisa Details”, she graduated from the University of São Paulo Medical School, a member of the Brazilian Society of Archeology (SBM) and a doctor at Rede D’or São Luiz in São Paulo.
The Ministry of Health recommends that women between the ages of 50 and 69 undergo a so-called mammogram, which is a routine examination even without symptoms, every two years. Representative of the ministry, the National Cancer Institute (INCA) explained to BBC News Brazil that even in the event of a pandemic, mammograms have not been suspended and must continue to be performed, in line with care such as wearing a mask and social distancing.
Although the agency and the people interviewed highlight the importance of maintaining this routine, Jordana Besa says that’s not what actually happens.
“We practically see that the patients have really disappeared. In the office, they come back to refresh the exams and say they are late,” says the mammologist and author of the paper, praising the existence and availability of DATASUS information.
PESA notes that the survey only includes data from the public network, but there may have also been a decline in the private network. For this reason and other factors, an estimate of 4,000 undiagnosed cases in 2020 is a conservative estimate.
Previous data, not included in the study, shows that in the first three months of 2021, the monthly number of mammograms was lower than it was in 2020 and 2019.
When requesting a mammogram, the doctor must complete a short questionnaire, and answer for example: “Does the patient have any breast lumps?”
If you answer yes, it means that the doctor found a lump in the breast that could be either benign or malignant, and a mammogram is one of the tests that will help verify this.
Jordana Besa says that such cases require extra attention – and health care – because the rate of cancer detection is higher when nodules are present.
In her survey, she also collected a number of mammograms taken in 2019 and 2020 in which the presence of nodules according to their medical arrangement was confirmed.
The size of your mammograms decreased from 137,570 in 2019 to 89,408 in 2020.
In other words, tens of thousands of women with detected nodules stopped having mammograms in the first year of the epidemic.
“There are nearly 50,000 women with palpable nodules missing,” says the doctor. “Where are these women who haven’t had a mammogram? It’s really worrisome.”
While there are women who have stopped performing mammograms due to this epidemic, there are those who have tried diligently and faced long-term problems in accessing this test, which were exacerbated by the crisis caused by the Corona virus.
One Report A 2019 year from the Brazilian College of Radiology and Diagnostic Imaging (CBR) showed that the rate of mammography SUS was 1.3 per 100,000 population; In the private network, 6.16.
Today, the Ministry of Health guidelines do not speak of an ideal number, but do take into account various variables and local characteristics. However, as a limitation, the 2002 decree set a minimum of 0.42 devices per 100,000 inhabitants.
According to the CBR report, it is common for public hospitals to have difficulties maintaining devices, and there is also a shortage of professionals qualified to use them.
Local Severina Maria, 55, based in Niterói (RJ), says that since October 2019 she has been trying to get a mammogram through the public network, through the Unified Health System (SUS). In addition to her biennial routine, she also needs to undergo screening as a follow-up, as a nodule was found in her breast five years ago.
Nearly two years ago, Severina heard in the family doctor’s office in Enginho de Mato that the device was broken and also that the streak of the women in front of her was too big, and they couldn’t decide when to take an exam.
“With the epidemic, it got worse, because they focus more on the Coronavirus. But it was never easy to schedule a mammogram. It was always difficult. I only managed to get a mammogram through SUS once, in 2018, it was The rest says the housekeeper, who said she sought help from family members to pay for private consultations and exams, but now faces unemployment and an even more difficult financial situation.
In a memo, the City of Niteroi ensured that “there is no pent-up mammography request in the city,” as there are two mammograms and an accredited clinic for the public to attend. In response to a question from BBC News Brazil about what could explain the patient’s difficulty, the city council’s press office said she would investigate her situation in particular, but did not respond until this report was published.
In Belem (PA), student and IT specialist Victor Arcango, 30, has been trying since November 2020 to schedule a mammogram for his 59-year-old mother. That month, a doctor submitted a request for an examination with a warning: “Urgent”.
Victor does not know the reason for the urgency, since he was not in counseling, but for reasons related to his mother’s health, he was the one receiving medical care for her in recent months. In the basic health unit (UBS) where they are being examined, the mammogram was broken for a while and then the responsible doctor was absent due to outside requests related to the epidemic.
Today, the breast photographer and the doctor are back, but now Victor and his mother are facing a bureaucratic problem, trying to organize registration for Medicare due to the change of address.
The college student asks, “What we feel is frustration. It is a very important and urgent test, and we have not been able to do it for six or seven months. How is the mind?” “There aren’t a lot of people working in this position, because they focus on serving covid. The information is not the same. It doesn’t mean that there shouldn’t be that focus with covid, but we are frustrated with the problems it can deal with faster.”
BBC News Brasil was unable to contact, by email or phone, the UBS that Victor mentioned, nor his press office.
On the one hand, Dr. Arn Migowski, head of the department of early detection and support for the INCA network organization, says that in Brazil there is also a problem of wasting mammograms – those that are done annually and ahead of life, both in the public network as in the private sector.
“Even before the epidemic, and now more than ever, one should avoid being ruled out of necessities. Based on what we have analyzed so far, with past data, this pattern has not changed in the pandemic: The number of mammograms has definitely decreased, but The distribution of inappropriate measures has not changed. It is a mistake, as there is no evidence of benefits, “says the NIMS doctor.
He notes that the recommendation is mammograms for women between the ages of 50 and 69, as well as help with suspected cases.
“In symptomatic cases, people should not fail to seek counseling, as in cases of nodules, whose prognosis is usually worse.”
Jordana Pesa adds that estimating thousands of undetected cases in the epidemic becomes even more alarming when looking at bottlenecks in the later stages of treatment – that is, after a pandemic, not only can the disease streak be prevented, but also more advanced, where well, which is really a problem in Country.
“Unfortunately, about a third (of cases) have been diagnosed with a lymph node that can actually be observed in Brazil,” explains the breast specialist.
“There are many other barriers to overcome (besides mammography). There is time between the person presenting the concrete nodule and the biopsy procedure; there is time between performing the biopsy examination and performing the surgery; and the time between having the surgery and starting the chemo,” the pathologist lists The breast.
One a study The post in 2019, for example, showed that out of 4,912 breast cancer patients treated in 28 institutions across Brazil in 2001 and 2006, 23.3% were diagnosed with stage 1 patients; 53.5% are already in the second stage; And 23.2% in the third stage.
Although differences in data collection and presentation hinder comparison with other countries, the prevalence of late diagnoses is far from limited to Brazil.
In general, later diagnoses mean more invasive treatments and fewer chances of survival. For these and other reasons, traceability is very important.
“Making a late diagnosis ends up generating more costs for the system, because we can do less invasive treatment. It is this problem that generates one economic expense after another, because a palpable lymph node, for example, needs chemotherapy, needs radiotherapy and Another study has already shown that despite all the limitations, staying in Brazil is still very good when the diagnosis is early, above 90%. So it is worth sticking to it. ”
According to INCA, the Ministry of Health published in December 2020a Concierge and concierge services Set a budget of R $ 150 million for states to strengthen cancer prevention and control during the coronavirus pandemic, including the breast pandemic. The agency also said that workshops were held with state managers in early 2021 to advise them on early detection in the health crisis caused by the Coronavirus.
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