Educational, racial, and geographic inequalities in breast cancer screening and diagnosis among Brazilian women

This study aimed to describe educational, racial, and geographic inequalities in breast cancer screening and diagnosis among Brazilian women using data from the 2019 Brazilian National Health Survey. The sample included women aged 50 to 69 years. The outcomes were breast cancer diagnosis, mammography screening, and clinical breast examination (CBE), with skin color, area of residence, and educational level as equity stratifiers. Simple and complex measures of inequality were applied, including the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). Inequality measures indicated that access to mammography referrals, screening, and CBE was higher among White women, urban residents, and those with higher education levels. Women with higher education who identified as White (2.6%), Brown (3.4%), or lived in urban areas (3.1%) had a higher prevalence of breast cancer diagnosis compared to Black women (2.3%) and rural residents (1.9%) with the same education level. These findings suggest that breast cancer screening and diagnosis disproportionately benefit White, highly educated, and urban-dwelling women. The results underscore the need for equitable screening programs, awareness campaigns, and public health policies targeting structurally disadvantaged groups to reduce persistent disparities in breast cancer outcomes.