Factors associated with the proportion of abnormal results in screening mammograms: ecological study

Sverzut, Tatiana do Valle Lovato; Cunha, Inara Pereira da; Cortellazi, Karine Laura; Ambrosano, Gláucia Maria Bovi; Pecorari, Vanessa Gallego Arias

doi:10.1590/1983-1447.2023.20220155.en

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Original Article • Rev. Gaúcha Enferm. 44 • 2023 • https://doi.org/10.1590/1983-1447.2023.20220155.en copy

Factors associated with the proportion of abnormal results in screening mammograms: ecological study

Factores asociados a la proporción de resultados alterados en mamografías de tamizaje: estudio ecológico

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the factors associated with the proportion of abnormal results in screening mammograms.

Methods:

Ecological study, with data from DATASUS/SISCAN, Atlas Brasil do Desenvolvimento Humano, Fundação SEADE, and Sistema e-Gestor, from 2016 to 2019, of women aged 50 to 69 years in the 645 municipalities of São Paulo (Brazil). Independent variables were associated with the outcome: proportion of unsatisfactory coverage of abnormal test results (Breast Imaging Reporting and Data System - BI-RADS® 0, 4 and 5 proportion >10% of tests performed). Multiple Poisson regression was used.

Results:

Higher proportion of screening mammography (PR=1.20; 95%CI: 1.00;1.45), higher percentage of poor (PR=1.20; 95%CI: 1.07;1.36), low (PR=1.57; 95%CI: 1.38;1.78) and medium coverage of the Family Health Strategy (ESF) (PR=1.30; 95%CI: 1.09;1.52) were associated to the outcome.

Conclusion:

Socioeconomic and FHS coverage factors mediate the proportion of mammograms with abnormal results in public health services. Therefore, they are important aspects in the fight against breast cancer.

Keywords:
Breast neoplasms; Mammography; Diagnostic techniques and procedures; Health policy; Ecological studies

Variable	Categorization	Year
Variable	Categorization	2016	2017	2018	2019
Proportion of abnormal results in screening mammograms de (abnormal call rate)	Satisfactory (<10%)	401 (62.2%)	384 (59.5%)	347 (53.8%)	363 (56.3%)
	Not satisfactory (>10%)	244 (37.8%)	261 (40.5%)	298 (46.2%)	282 (43.7%)
PMMG	Below average	133(20.6%)	106 (16.4%)	111 (17.2%)	101 (15.7%)
	Average	106 (16.4%)	90 (14.0%)	101 (15.7%)	96 (14.9%)
	Above average	406 (63.0%)	449 (69.6%)	433 (67.1%)	448 (69.5%)
MHDI	Very low	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
	Low	0 (0.0%)	0 (0.0%)	0 (0.0%)	0 (0.0%)
	Medium	62 (9.6%)	62 (9.6%)	62 (9.6%)	62 (9.6%)
	High	559 (86.7%)	559 (86.7%)	559 (86.7%)	559 (86.7%)
	Very high	24 (3.7%)	24 (3.7%)	24 (3.7%)	24 (3.7%)
PEP	≤Median (1.07)	324 (50.2%)	324 (50.2%)	324 (50.2%)	324 (50.2%)
PEP	>Median	321 (49.8%)	321 (49.8%)	321 (49.8%)	321 (49.8%)
Percentage of Poor	≤Median (4.75)	323 (50.1%)	323 (50.1%)	323 (50.1%)	323 (50.1%)
Percentage of Poor	>Median	322 (49.9%)	322 (49.9%)	322 (49.9%)	322 (49.9%)
Percentage of Vulnerable	≤Median (18.68)	323(50.1%)	323 (50.1%)	323 (50.1%)	323 (50.1%)
Percentage of Vulnerable	>Median	322 (49.9%)	322 (49.9%)	322 (49.9%)	322 (49.9%)
GDP	≤Median (26537.35)	323 (50.1%)	323 (50.1%)	323 (50.1%)	323 (50.1%)
GDP	>Median	322 (49.9%)	322 (49.9%)	322 (49.9%)	322 (49.9%)
Population size	Up to 24.999	426 (66.0%)	425 (65.9%)	423 (65.6%)	422 (65.4%)
	From 25.000 to 99.999	144 (22.3%)	145 (22.5%)	145 (22.5%)	145 (22.5%)
	Greater than 100.000	75 (11.6%)	75 (11.6%)	77 (11.9%)	78 (12.1%)
ESF	Low Coverage	211 (32.7%)	207(32.1%)	205 (31.8%)	212 (32.9%)
	Medium Coverage	113 (17.5%)	113 (17.5%)	114 (17.7%)	104 (23.4%)
	High Coverage	321 (49.8%)	325 (50.4%)	326 (50.5%)	329 (51.0%)
AB	Low Coverage	95 (14.7%)	89 (13.8%)	94 (14.6%)	100 (15.5%)
	Medium Coverage	137(21.2%)	137 (21.2%)	129 (20.0%)	122 (18.9%)
	High Coverage	413 (64.0%)	419 (65.0%)	422 (65.4%)	423 (65.6%)

Variable	Category	Crude PR (CI95%)	p-value	Adjusted PR (CI95%)	p-value
Year	2016	Ref		Ref	0.3023
	2017	1.07(0.96-1.20)	0.2375	1.06(0.95-1.19)	0.0009
	2018	1.22(1.09-1.37)	0.0007	1.21(1.08-1.36)	0.0193
	2019	1.16(1.03-1.29)	0.0123	1.14(1.02-1.28)	0.3023
PMMG	Below average	Ref		Ref
	Average	1.28(1.05-1.54)	0.0134	1.20(1.00-1.45)	0.0500
	Above average	1.29(1.10-1.52)	0.0015	1.27(1.08-1.49)	0.0029
MHDI	Very low	-		-	-
	Low	-
	Medium	Ref
	High	1.19(0.97-1.47)	0.0992
	Very high	1.50(1.05-2.12)	0.0240
PEP	≤Median (1.07)	Ref
PEP	>Median	1.10(0.97-1.24)	0.1486		-
Percentage of Poor	≤Median (4.75)	Ref		Ref
Percentage of Poor	>Median	1.14(1.01-1.29)	0.0417	1.20(1.07-1.36)	0.0024
Percentage of Vulnerable	≤Median (18.68)	Ref
Percentage of Vulnerable	>Median	1.04(0.91-1.17)	0.5890
GDP	≤Median (26537.35)	Ref
GDP	>Median	1.19(1.06-1.35)	0.0043	-	-
Population size	Up to24.999	Ref
	From 25.000to99.999	1.42(1.23-1.63)	<0.0001	-	-
	Greater than 100.000	1.37(1.14-1.65)	0.0006
ESF	Low Coverage	1.54(1.35-1.75)	<0.0001	1.57(1.38-1.78)	<0.0001
	Medium Coverage	1.29(1.10-1.51)	0.0016	1.30(1.09-1.52)	0.0012
	High Coverage	Ref		Ref
AB	Low Coverage	1.36(1.16-1.58)	0.0001	-	-
	Median Coverage	1.52(1.34-1.73)
	High Coverage	Ref

Universidade Federal do Rio Grande do Sul. Escola de Enfermagem Rua São Manoel, 963 -Campus da Saúde , 90.620-110 - Porto Alegre - RS - Brasil, Fone: (55 51) 3308-5242 / Fax: (55 51) 3308-5436 - Porto Alegre - RS - Brazil
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[1] Corresponding author:
Inara Pereira da Cunha E-mail: inara-pereira@hotmail.com