Breast cancer screening in Primary Health Care in Brazil: a systematic review

Sala, Danila Cristina Paquier; Okuno, Meiry Fernanda Pinto; Taminato, Monica; Castro, Cristiane Pereira de; Louvison, Marília Cristina Prado; Tanaka, Oswaldo Yoshimi

doi:10.1590/0034-7167-2020-0995

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Revista Brasileira de Enfermagem

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Sumário

REVIEW • Rev. Bras. Enferm. 74 (3) • 2021 • https://doi.org/10.1590/0034-7167-2020-0995 copy

Breast cancer screening in Primary Health Care in Brazil: a systematic review

Cribado del cáncer de mama en la Atención Primaria de Salud en Brasil: una revisión sistemática

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objectives:

to analyze care strategies for breast cancer screening in Primary Health Care in Brazil.

Methods:

this is a systematic review following the Cochrane Collaboration recommendations.

Results:

among 355 manuscripts, five were eligible. The patient navigation program by Community Health Agent stood out with the best result, among the strategies: flexibility of goals considering viability; community engagement; team training; active search of the target population by Community Health Agent; request for mammography by physicians; actions integrated to women’s health; monitoring of mammography results, absent users, and population coverage by physician and nurse; and assessment of criteria for requesting screening mammography by means of an information system. The population coverage rate in the program ranged from 23% to 88%.

Conclusions:

Primary Health Care in Brazil presents devices with potential to induce the production of care for breast cancer screening.

Descriptors:
Mass Screening; Breast Neoplasms; Primary Health Care; Public Policy; Brazil

Indicator	Concept	Brazil parameters, INCA^* * INCA - Brazilian National Cancer Institute; MMG - mammography; BI-RADS - Breast Imaging-Reporting and Data System.	Canada parameters
Participation rate or coverage of the screening program	Percentage of women in specific age group who performed the screening, in a given place and period, in relation to the total target population.	70% in the age group from 50 to 69 years, MMG^* * INCA - Brazilian National Cancer Institute; MMG - mammography; BI-RADS - Breast Imaging-Reporting and Data System. biennial.	≥70% in the age group 50 to 69 years; MMG^* * INCA - Brazilian National Cancer Institute; MMG - mammography; BI-RADS - Breast Imaging-Reporting and Data System. in 30 months.
Detection rate	Number of invasive breast cancer cases detected every 1,000 screening tests.	Undefined.	>5 per 1,000 initial screenings; >3 per 1,000 screening subsequent - invasive cancer (no in situ).
Proportion of altered results in screening MMGs	Percentage of altered exams in the screening program.	Undefined parameter of MMGs with BI-RADS^* * INCA - Brazilian National Cancer Institute; MMG - mammography; BI-RADS - Breast Imaging-Reporting and Data System. 0.4 and 5.	<10% in initial screening; <5% in subsequent screenings.
Percentage according to tumor extension	Percentage of tumor detection in screening the size of invasive tumors with size ≤15mm of the largest diameter determined by the best evidence (pathology, radiology, and clinic).	Undefined.	50 to 69 years old: >50% detection of invasive tumors by screening with ≤15mm.
Program support	Adherence/retention rate is the estimated percentage of the target population that returns to screening within the estimated period.	Undefined.	≥75% in the 50-67 age group in the 1st screening; ≥90% in subsequent years.

Authors, year	Objective	Method/Level of evidence	Population/Participants	Strategies	Indicators	Results
Barreto ALSB, Mendes MFM, Thuler LCS. 2012⁽²⁴24 Barreto ASB, Mendes MFM, Thuler LCS. Avaliação de uma estratégia para ampliar a adesão ao rastreamento do câncer de mama no Nordeste brasileiro. Rev Bras Ginecol Obstet. 2012;34(2):86-91. https://doi.org/10.1590/S0100-72032012000200008 https://doi.org/10.1590/S0100-7203201200... ⁾	Assess the actions of a program entitled Um Beijo Pela Vida, developed in a municipality in northeastern Brazil, aiming to expand the treatment of breast cancer screening in women registered by FHS.	Cross-sectional description/4	3,608 women	Active search for women eligible for CHW^* * CHW - Community Health Worker; QualiAB - Primary Care Monitoring and Assessment System; PHC - Primary Health Care. . Team training and qualification.	MMG coverage of target population screening (50 to 69 years old).	56.7%
Haikel Jr RL, Mauad EC, Silva TB, Mattos JSC, Chala LF, Longatto-Filho A, et al. 2012⁽²⁵25 Haikel RL, Mauad EC, Silva TB, Mattos JC, Chala LF, Longatto-Filho A, et al. Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units. BMC Womens Health. 2012;12(1):32. https://doi.org/10.1186/1472-6874-12-32 https://doi.org/10.1186/1472-6874-12-32... ⁾	Assess the results of the first 2 years of an MMG program implemented with mobile and immovable mammographic unit in rural region of the state of São Paulo, Brazil.	Cross-sectional description/4	17,964 MMGs	Invitation of the eligible population made by CHW^* * CHW - Community Health Worker; QualiAB - Primary Care Monitoring and Assessment System; PHC - Primary Health Care. (active search) and by physicians. Team training and qualification.	Detection rate (50-59 years old) (60-69 years old).	3.4/1,000 6.7/1,000
Nasser MA, Nemes MIB, Andrade MC, Prado RR, Castanheira ERL. 2017⁽²⁶26 Nasser MA, Nemes MIB, Andrade MC, Prado RR, Castanheira ERL. Avaliação na atenção primária paulista: ações incipientes em saúde sexual e reprodutiva. Rev Saude Publica. 2017;51:77. https://doi.org/10.11606/s1518-8787.2017051006711 https://doi.org/10.11606/s1518-8787.2017... ⁾	Assess the performance in sexual and reproductive health of PHC services of the Brazilian Unified Health System (Sistema Único de Saúde), in the state of São Paulo.	Evaluative study/4	2,735 PHC services^* * CHW - Community Health Worker; QualiAB - Primary Care Monitoring and Assessment System; PHC - Primary Health Care. .	Assessment of the screening MMG request criteria for age group (50 and 69 years old), asymptomatic, repeating at biennial intervals, information system - QualiAB Program^* * CHW - Community Health Worker; QualiAB - Primary Care Monitoring and Assessment System; PHC - Primary Health Care. .	Adequacy to the criteria of MMG request.	11.8%
Romero LS, Shimocomaqui GB, Medeiros ABR. Piauí. 2017⁽²⁷27 Romero LS, Shimocomaqui GB, Medeiros ABR. Intervenção na prevenção e controle de câncer de colo uterino e mama numa unidade básica de saúde do nordeste do Brasil. Rev Bras Med Fam Com. 2017;12(39):1-9. https://doi.org/10.5712/rbmfc12(39)1356. https://doi.org/10.5712/rbmfc12(39)1356... ⁾	Report the experience carried out at the São Miguel II Basic Health Unit, Miguel Alves, Piauí, focusing on the prevention and control of cervical and breast cancers.	Experience report/5	1 PHC service.	Community engagement.	Screening MMG request to target population (50 to 69 years old).	88.1%
				MMG request by physician.
				Monitoring of the results of MMG, missing users and coverage of the population by physician and nurse.
				Integrated actions to women's health (prevention of breast, cervical cancer and risk factor assessment).	MMG coverage of target population screening (50 to 69 years old).	23%
				Team training and qualification.
				Flexibility of goals considering viability.
Gioia S, Brigagão L, Torres C, Lima A, Medeiros M. 2019⁽²⁸28 Gioia S, Brigagão L, Torres C, Lima A, Medeiros M. The implementation of patient navigation to improve mammography coverage and access to breast cancer care in rio de janeiro. Mastol. 2019;29(4):186-92. https://doi.org/10.29289/25945394201920190006 https://doi.org/10.29289/259453942019201... ⁾	Establish the viability of patients' navigation program in a community in the city of Rio de Janeiro; identify barriers to mammographic screening; mammographic coverage of 70% of women recruited between 50 and 69 years old.	Quantitative qualitative/4	497 women.	CHW^* * CHW - Community Health Worker; QualiAB - Primary Care Monitoring and Assessment System; PHC - Primary Health Care. patient navigation program.	MMG coverage of target population screening (50 to 69 years old).
		Quantitative qualitative/4	497 women.		User satisfaction.	100%

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
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[1] Corresponding author: Danila Cristina Paquier Sala. E-mail: danilapaquiersala@gmail.com

P (problem)	Breast cancer.
I (intervention)	Care strategies for mammographic screening for breast cancer in PHC in Brazil.
C (comparison)	Not applicable.
O (outcomes)	Program coverage, adherence to the program, disease detection rate, proportion of altered results in screening MMGs, percentage according to tumor extension, among other indicators, assessed in the female population aged 50 to 69 years.
S (study design)	Comprehensive designs.