Study reveals inequalities in access to breast cancer treatment
A study carried out by the Cancer Foundation reveals inequalities found by women in accessing breast cancer treatment, both in public and private hospitals. Based on data from the Brazilian Hospital Cancer Records (RHC) made available by the Ministry of Health and consolidated by the National Cancer Institute (Inca), the survey covers a period of 13 years, between 2006 and 2018. Its conclusions were released today (15), in Rio de Janeiro.
The records show that the origin of the woman's referral to the hospital for the treatment of breast cancer is classified as SUS (Unified Health System) and not SUS. In general, the records have a delay of about two years from the calendar year, said epidemiologist biologist at the Cancer Foundation Rejane Reis, one of those responsible for the study.
According to the epidemiologist Alfredo Scaff, medical consultant at the Cancer Foundation, the variables related to the staging of breast cancer at diagnosis, the time between diagnosis and treatment, and the patients' education level were analyzed. “Thus, we show that the time between diagnosis and the start of treatment is far from ideal for the two studied groups. Even so, patients who came through the SUS took longer than patients referred by the private sector.” About 34% of SUS patients started treatment before 60 days, against 48% in the private sector.
There's no telling why this is, Scaff said. The hypothesis is that, when looking for the SUS hospital for treatment, new tests are often requested. "And anyone who has any resources can do the exams privately and then start treatment, such as surgery or chemotherapy, faster, more opportunely."
For Scaff, the process of accessing treatment is not opportune and, as a likely consequence, the survival of patients of SUS origin should be lower. “When the origin is via health insurance, or private, the diagnosis ends up being faster. It is the iniquity that endures."
Stadiums
The stage, or stage, of cancer is a classification of the degree of involvement of the disease in the patient. Smaller stages, such as 0 or 1, indicate early localized disease, while larger ones, such as 3 and 4, indicate advanced, metastatic disease. Metastasis is when cancer spreads to other organs in the body.
According to the study, SUS patients come to treatment at more advanced stages than patients from the private sector. “This difference is such that only 19% of SUS patients reach treatment in initial stages 0 or 1, against 31% of non-SUS patients,” Scaff said.
Ideally, most cases arrive at early stages (0 and 1) because, in this way, treatment is more effective, prognosis is much better and survival is much longer, with better results, said Rejane Reis.
"What is clear is that the time between the suspected diagnosis and the start of treatment is crucial: it is related to the worsening of the disease and, consequently, to the necessary treatment. The longer the time, the more aggressive the treatment; cancer is a time-dependent disease”, added Scaff.
education
In of education, Alfredo Scaff pointed out a significant difference. Among women referred by the SUS, 51% do not have complete primary education, against 29% of patients who come for treatment in a private way. “These differences highlight the inequity of timely access to breast cancer treatment. Patients referred for treatment in SUS hospitals, from private health services, have higher education, start treatment more quickly and at earlier stages, compared to patients diagnosed and referred by SUS”.
Scaff said that the correction of these disparities requires the organization of the SUS Network for early diagnosis. For him, it is also essential to implement a navigation system that speeds up care for these women diagnosed with cancer. Such a system would accompany the patient from diagnosis, helping to speed up care, considering the stage of the disease, preventing delays, bureaucracy and lack of guidance.
The executive director of the Cancer Foundation, oncological surgeon Luiz Augusto Maltoni, highlighted that women with less access to studies are among those who come most from the SUS Network. "It is the portrait of unequal health, with differentiated access, which reinforces the need for massive social investment in education and health and actions linked to these two areas."
Text translated using artificial intelligence.
