Difficult Access and Poor Productivity: Mammography Screening in Brazil

Document Type: Research Articles

Authors

1 Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.

2 Brazilian Network for Breast Research, Service for Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil.

3 Institute of Social and Environmental Studies (IESA), Federal University of Goiás, Goiânia, Goiás, Brazil.

4 School of Civil and Environmental Engineering, Federal University of Goiás, Goiânia, Goiás, Brazil.

Abstract

Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic
limitations and the geographical distribution and quality of the mammography machines. This study evaluated access
to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of
mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study
evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions,
states and the Federal District in 2016. The number of mammography machines required for breast cancer
screening was calculated and compared to the number of machines available. The expected number of mammograms was
compared with the actual number performed. Machines were georeferenced based on their location and the municipal
seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for
a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use
and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the
number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of
machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed,
representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60
km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion:
These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the
SUS is not associated with the number of machines available or with the geographical location of the equipment but
rather with the insufficient number of mammograms performed.

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