Mammographic Screening in the Brazilian Unified Health System.

Abstract

Breast cancer is the leading cause of cancer-related death among Brazilian women. Understanding the regional disparities in mammographic screening coverage is essential for improving early detection strategies. The purpose of this study was to analyze mammographic screening coverage and proportion of BI-RADS 0 results across Brazilian states and regions. This cross-sectional study analyzed mammographic screening data from the Unified Health System (SUS) for 2022. The primary outcomes and measures were mammographic SUS coverage rates and proportion of Breast Imaging Reporting and Data System (BI-RADS) 0 results. Secondary outcomes included the number of mammography devices per state, proportion of municipalities with equipment, and distribution of radiologists both in absolute numbers and relative concentrations in the capital cities. Women age 50-69 years in 2022 without private health services were studied. Mammographic coverage was defined as the proportion of women in the target population (age 50-69 years without private insurance) who underwent screening mammography in 2022 and the proportion of BI-RADS 0 results, defined as examinations classified as inconclusive. This study analyzed data from over 22 million women age 50-69 years. The annual mammographic screening coverage across the country was low, ranging from 1.3% to 15.9%. A high proportion of BI-RADS 0 results were observed in 44% of the states. Although mammography devices are unequally distributed, coverage remains low even in regions with a high concentration of services. This suggests the influence of other factors, such as accessibility barriers, insufficient screening education, and a lack of active surveillance within the target population. Mammographic screening coverage in Brazil is insufficient and unevenly distributed. The high rates of BI-RADS 0 suggest significant quality concerns. Addressing these disparities is crucial for the effective early detection of breast cancer.