Análise da incidência e acesso ao diagnóstico e tratamento do câncer de mama na região Nordeste do Brasil (2014-2023)

Abstract

Breast cancer represents a serious public health issue in Brazil, particularly in the Northeast region. Despite advances in diagnostic and treatment technologies, the region is still marked by a late and unequal process of demographic and epidemiological transition, presenting a concerning scenario regarding cancer mortality among the female population. Within the scientific literature, there is still a knowledge gap concerning the trend of breast cancer incidence across the different microregions of the Northeast. Therefore, this study aims to analyze breast cancer incidence rates among women in the Northeast region from 2014 to 2023. This is an observational, retrospective study using secondary data with a quantitative approach. Data on histological and cytological breast examinations, mammograms, and breast cancer diagnoses in the Northeast region of Brazil were utilized. Information was obtained through SISCAN and the Oncology Panel. The analyzed population included all women from the Northeast region who underwent screening and diagnostic examinations for breast cancer, recorded between 2014 and 2023. The sample consisted of data from patients who underwent histological, cytological, and mammographic examinations, as well as those diagnosed with breast cancer during the same period. The data were organized and tabulated in a Microsoft Excel spreadsheet, enabling statistical analysis using the open-source R software. To assess trends, the segmented linear regression technique was applied using the Joinpoint software, which specializes in temporal trend analyses. The data obtained show a growing trend in the crude incidence rate for diagnostic and screening examinations aimed at the early detection of breast cancer among women in the Northeast from 2014 to 2023. A total of 117,413 histological examinations were performed, with Pernambuco leading (40,608 examinations), and 66,755 cytological examinations, with Bahia at the forefront (32,643 examinations). Mammograms showed an annual growth of 8.997%, with Piauí presenting the highest increase (AAPC of 95.53%). The most affected age group was 40-59 years, particularly women aged 50-59 (1,026 cases in 2014 → 4,400 in 2023). Chemotherapy showed a significant increase (2,074 cases in 2014 → 9,977 in 2023), while surgery showed a reduction (AAPC -15.29%). Staging showed growth in all stages, especially in the early (Category 1: 373 cases in 2014 → 1,638 in 2023) and metastatic stages (Category 4: 211 cases in 2014 → 993 in 2023). Treatment delays were a challenge, with Bahia recording the highest number of patients experiencing delays greater than 60 days (5,243 cases in 2023). Starting from 2018, a significant reduction in waiting times was observed (AAPC -36.61% for delays longer than 1 year), although during the 2020 pandemic, there was a temporary peak in delays (1,777 cases between 121-300 days). It is concluded that, despite advances in detection and treatment, public policies are necessary to improve the efficiency of screening and to reduce delays in diagnosis and the initiation of treatment.