Technical, social, and economic characteristics of mammography screening in Goiás: ecological study after the implementation of a mammography quality control program
DOI:
https://doi.org/10.29289/2594539420250022Keywords:
breast neoplasms, early diagnosis, mass screening, mammography, delivery of health careAbstract
Objective: The aim of this study was to evaluate technical, social, and economic aspects characterizing opportunistic breast cancer screening in a state in central Brazil. Methods: A survey was conducted to quantify the number of mammography machines and evaluate the imaging technology, the geographical distribution of the scanners, the number of mammograms performed at each center, the cost of the exams, and sources of payment. Data from this study were compared with data from a similar study conducted in 2008. Results: In Goiás, 164 mammography units were operational, with 66 (40%) serving the Sistema Único de Saúde (SUS). Approximately 400,896 scans were performed in 2019, averaging 204 scans/month (ranging from 5 to 1,000), at a cost of R$ 41,931,120.00. Screening coverage was 31.2%, with 6.4% of these scans being performed within the SUS. No correlation was found between the municipal Human Development Index (HDI) and mammography coverage in the health regions (HRs) (p=0.10). Compared with the 2008 results, the percentage of computed radiography systems increased from 24.3% to 86.7%, and digital radiography was introduced (7.3%). Conclusion: In 2019, breast cancer screening coverage in Goiás reached 31.1%, with 6.4% of scans being conducted within the SUS. The geographic distribution of mammography units is heterogeneous, and productivity is low. Compared to 2008, availability increased, and the standard of the equipment improved.
Downloads
References
1. World Health Organization. Early detection. Cancer control: knowledge into action: WHO guide for effective programmes; module 3 [Internet]. Geneva: WHO Press; 2007 [cited September 12, 2025]. Available at: http://www.who.int/cancer/modules/en/.
2. Dibden A, Offman J, Duffy SW, Gabe R. Worldwide review and meta-analysis of cohort studies measuring the effect of mammography screening programmes on incidence-based breast cancer mortality. Cancers. 2020;12(4):976. https://doi.org/10.3390/cancers12040976
3. Smith RA, Duffy SW, Gabe R, Tabar L, Yen AMF, Chen THH. The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am. 2004;42(5):793-806. https://doi.org/10.1016/j.rcl.2004.06.014
4. Giaquinto AN, Sung H, Newman LA, Freedman RA, Smith RA, Star J, et al. Breast cancer statistics 2024. CA Cancer J Clin. 2024;74(6):477-95. https://doi.org/10.3322/caac.21863
5. Brasil. Instituto Nacional de Câncer. Estimativa 2023: incidência de câncer no Brasil [Internet]. Rio de Janeiro: Instituto Nacional de Câncer; 2022 [cited September 11, 2025]. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document//estimativa-2023.pdf.
6. Urban LABD, Chala LF, Bauab SP, Schaefer MB, Santos RP, Maranhão NMA, et al. Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations. Radiol Bras. 2017;50(4):244-9. https://doi.org/10.1590/0100-3984.2017-0069
7. Migowski A, Silva GAE, Dias MBK, Diz MPE, Sant’Anna DR, Nadanovsky P. Guidelines for early detection of breast cancer in Brazil. II - New national recommendations, main evidence, and controversies. Cad Saúde Pública. 2018;34(6):e00074817. https://doi.org/10.1590/0102-311X00074817
8. Brasil. Ministério da Saúde. Legislation No. 11,664, of April 29, 2008. Diário Oficial da União. 2008;Section 1.
9. Castro MC, Massuda A, Almeida G, Menezes-Filho NA, Andrade MV, Noronha KVMS, et al. Brazil's unified health system: the first 30 years and prospects for the future. Lancet. 2019;394(10195):345-6. https://doi.org/10.1016/S0140-6736(19)31243-7
10. Brasil. Ministério da Saúde. Secretaria Executiva. Sistema Único de Saúde (SUS): instrumentos de gestão em saúde. Brasília: Ministério da Saúde; 2002.
11. Lima LD, Queiroz LFN, Machado CV, Viana ALD. [Decentralization and regionalization: dynamics and conditioning factors for the implementation of the Health Pact in Brazil]. Ciênc Saúde Coletiva. 2012;17(7):1903-14. https://doi.org/10.1590/S1413-81232012000700030
12. Lima LD, Viana ALA, Machado CV, Albuquerque MV, Oliveira RG, Iozzi FL, et al. [Regionalization and access to healthcare in Brazilian states: historical and political-institutional conditioning factors]. Ciênc Saúde Coletiva. 2012;17(11):2881-92. https://doi.org/10.1590/S1413-81232012001100005
13. Rodrigues DCN, Freitas-Junior R, Rahal RMS, Correa RS, Peixoto JE, Ribeiro NV, et al. Difficult access and poor productivity: mammography screening in Brazil. Asian Pac J Cancer Prev. 2019;20(6):1857-64. https://doi.org/10.31557/APJCP.2019.20.6.1857
14. Rodrigues DCN, Freitas-Junior R, Rahal RMS, Correa RS, Gouveia PA, Peixoto JE, et al. Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017. BMC Public Health. 2019;19(1):959. https://doi.org/10.1186/s12889-019-7278-z
15. Corrêa RS, Freitas-Junior R, Peixoto JE, Rodrigues DCN, Lemos MEF, Marins LAP, et al. [Estimated mammogram coverage in Goiás State, Brazil]. Cad Saúde Pública. 2011;27(9):1757-67. https://doi.org/10.1590/S0102-311X2011000900009
16. Instituto Brasileiro de Geografia e Estatística. Resolução Nº PR-02, de 21 de junho de 2016. Aprova os valores de áreas territoriais do Brasil, Estados e Municípios. Diário Oficial da União [Internet]. 2016 [cited September 12, 2025];Seção 1(118):87. Available at: https://cidades.ibge.gov.br/brasil/go/panorama.
17. Secretaria de Estado da Saúde de Goiás. Governo do Estado de Goiás. Programas, Projetos, Ações, Atividades. Mapa da Saúde – Indicadores de Saúde [Internet]. Goiás: Secretaria de Estado da Saúde de Goiás [cited May 3, 2020]. Available at: http://mapadasaude.saude.go.gov.br/#l=pt;v=map3
18. Brasil. Ministério da Saúde. Departamento de Informática do SUS – DATASUS. Sistema de Informações Ambulatoriais do SUS (SIA/SUS) [Internet]. Brasília, DF: Ministério da Saúde; 2016 [cited September 12, 2025]. Available at: https://datasus.saude.gov.br/acesso-a-informacao/producao-ambulatorial-sia-sus.
19. Programa das Nações Unidas para o Desenvolvimento – PNUD. Atlas do Desenvolvimento Humano no Brasil. Consulta. Espacialidade. Indicadores [Internet]. PNUD [cited September 12, 2025]. Available at: http://atlasbrasil.org.br/2013/pt/consulta/
20. Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Diretrizes para a detecção precoce do câncer de mama no Brasil. Rio de Janeiro: Instituto Nacional de Câncer José Alencar Gomes da Silva; 2015.
21. Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva. Divisão de Detecção Precoce e Apoio à Organização de Rede Coordenação de Prevenção e Vigilância. Nota Técnica: revisão do parâmetro para cálculo da capacidade de produção do mamógrafo simples [Internet]. Rio de Janeiro: Instituto Nacional de Câncer José Alencar Gomes da Silva; 2015 [cited September 12, 2025]. Available at: https://www.inca.gov.br/sites/ufu.sti.inca.local/files//media/document/nota-revisao-capacidade-dos-mamografos-2015_0.pdf
22. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 1.631 de 1 de outubro de 2015. Aprova critérios e parâmetros para o planejamento e programação de ações e serviços de saúde no âmbito do SUS. Diário Oficial da União. 2015;Seção 1(189):38.
23. Brasil. Ministério da Saúde. Conselho Nacional de Saúde. Resolução 466 de 12 de dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União. 2013;Seção 1(59):59.
24. Corrêa RS, Freitas-Junior R, Peixoto JE, Rodrigues DCN, Lemos MEF, Dias CM, et al. Effectiveness of a quality control program in mammography for the Brazilian National Health System. Rev Saúde Pública. 2012;46(5):769-76. https://doi.org/10.1590/s0034-89102012000500002
25. Brasil. Instituto Brasileiro de Geografia e Estatística. Diretoria de Pesquisas. Coordenação de População e Indicadores Sociais. Gerência de Estudos e Análises da Dinâmica Demográfica. Projeção da população do brasil e unidades da federação por sexo e idade para o período 2000–2030 [Internet]. Brasil: Instituto Brasileiro de Geografia e Estatística [cited September 12, 2025]. Available at: http://www.ibge.gov.br/home/estatística/população
26. Autier P, Ait Ouakrim D. Determinants of the number of mammography units in 31 countries with significant mammography screening. Br J Cancer. 2008;99(7):1185-90. https://doi.org/10.1038/sj.bjc.6604657
27. Gonçalves R, Soares-Jr JM, Baracat EC, Filassi JR. Ethical issues surrounding breast cancer screening in Brazil. Clinics. 2019;74:e1573. https://doi.org/10.6061/clinics/2019/e1573
28. Vieira RADC, Formenton A, Bertolini SR. Breast cancer screening in Brazil. Barriers related to the health system. Rev Assoc Med Bras. 2017;63(5):466-74. https://doi.org/10.1590/1806-9282.63.05.466
29. Silva TB, Mauad EC, Carvalho AL, Jacobs LA, Shulman LN. Difficulties in implementing an organized screening program for breast cancer in Brazil with emphasis on diagnostic methods. Rural Remote Health. 2013;13(2):2321.
30. Sandoval JL, Himsl R, Theler JM, Gaspoz J-M, Joost S, Guessous I. Spatial distribution of mammography adherence in a Swiss urban population and its association with socioeconomic status. Cancer Med. 2018;7(12):6299-307. https://doi.org/10.1002/cam4.1829
31. Tolêdo SRS, Almeida NAM, Souza MR, Minamisava R, Freitas Júnior R. Care flow of breast cancer patients in the public health care network. Rev Eletr Enf. 2016;18:e1201. https://doi.org/10.5216/ree.v18.39147
32. Freitas-Junior R, Rodrigues DCN, Corrêa RS, Peixoto JE, Oliveira HVCG, Rahal RMS. Contribution of the Unified Health Care System to mammography screening in Brazil, 2013. Radiol Bras. 2016;49(5):305-10. https://doi.org/10.1590/0100-3984.2014.0129
33. Quintanilha LF, Souza LN, Sanches D, Demarco RS, Fukutani KF. The impact of cancer campaigns in Brazil: a Google Trends analysis. Ecancermedicalscience. 2019;13:963. https://doi.org/10.3332/ecancer.2019.963
34. Gonzaga CMR, Freitas-Junior R, Curado MP, Sousa A-LL, Souza-Neto J-A, Souza MR. Temporal trends in female breast cancer mortality in Brazil and correlations with social inequalities: ecological time-series study. BMC Public Health. 2015;15:96. https://doi.org/10.1186/s12889-015-1445-7
35. Nederend J, Duijm LE, Louwman MW, Coebergh JW, Roumen RMH, Lohle PN, et al. Impact of the transition from screen-film to digital screening mammography on interval cancer characteristics and treatment: a population based study from the Netherlands. Eur J Cancer. 2014;50(1):31-9. https://doi.org/10.1016/j.ejca.2013.09.018
36. Sankatsing VDV, Fracheboud J, de Munck L, Broeders MJM, van Ravesteyn NT, Heijnsdijk EAM, et al. Detection and interval cancer rates during the transition from screen-film to digital mammography in population-based screening. BMC Cancer. 2018;18(1):256. https://doi.org/10.1186/s12885-018-4122-2
37. Rodrigues TB, Stavola B, Bustamante-Teixeira MT, Guerra MR, Nogueira MC, Fayer VA, et al. [Mammographic over-screening: evaluation based on probabilistic linkage of records databases from the Breast Cancer Information System (SISMAMA)]. Cad Saúde Pública. 2019;35(1):e00049718. https://doi.org/10.1590/0102-311x00049718
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Rosangela da Silveira Corrêa, Ruffo Freitas-Junior, Danielle Cristina Netto Rodrigues, João Emílio Peixoto, Suzana Alves Bastos, Rodrigo Massakatsu Nishiharu Tanaka, Lucy Aparecida Parreira Marins, Leonardo Ribeiro Soares
This work is licensed under a Creative Commons Attribution 4.0 International License.
