Difficult Access and Poor Productivity: Mammography Screening in Brazil

Abstract

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