Epidemiology of breast cancer screening in Brazil: coverage, resource distribution, and inconclusive mammography in 2022

Keywords

breast cancer screening - epidemiology - inconclusive mammography

Introduction: Breast cancer accounts for 24.5% of all new cases of cancer in women and 15.5% of all cancer-related mortality annually among Brazilian women. As a strategy for early diagnosis, improving treatment outcomes and mortality, the Ministry of Health recommends annual mammographic screening for women aged 50 to 69 years, through the Unified Health System.

Objectives: To evaluate mammographic coverage in the target population by the Brazilian states in 2022; the availability of mammography machines and the distribution of radiologists; the percentage of BIRADS 0 mammograms and tumors smaller than 2 cm.

Methods: An analysis of public data related to the number of mammograms, lesion sizes, and BIRADS results was conducted using SISMAMA; the number of radiologists was obtained from the Brazilian College of Radiology; the number of women aged 50 to 69 years was sourced from the 2022 Census (IBGE), along with the coverage of private health plans from ANS. The target population considered patients without health insurance and within the established age range for screening.

Results: There are 22.360.526 women aged 50-69 years in Brazil, the majority residing in the southeast region, with those lacking health insurance concentrated in the north region. Mammographic coverage of the target population varied between 2% (Amapá) and 22% (Paraná). The northern and northeastern regions have the lowest number of radiologists, with 80% located in the capitals in 10 states. Mammography machines are also less concentrated in the northeastern and northern states. The percentage of inconclusive examinations, tolerable up to 12% (Breast Cancer Surveillance Consortium), was exceeded in states across all Brazilian regions, except for the southern region. Lesions larger than 2 cm were prevalent in half of the states, distributed across all regions of the country.

Conclusion: Mammographic coverage by SUS for its population is insufficient. The availability of radiologists remains concentrated in capitals and in the Southeast and South states, revealing a clear inequality in the distribution of mammography machines. The rate of inconclusive examinations above the recommended threshold is high in the country. This study demonstrates that integrated database analysis allows for a more precise detailing of the mammographic screening situation by state, aiding in the planning of targeted measures to improve national diagnostic outcomes and, consequently, breast cancer treatment.

Corresponding author: Gabriel Costa de Santana (e-mail: [e-mail]).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
06 May 2025