Disparities in breast cancer screening, stage at diagnosis, and treatment in Brazil: A warning of the need to change public policies

BACKGROUND Breast cancer is the most prevalent form of cancer in Brazilian women, contributing significantly to cancer-related mortality, particularly when diagnosed at advanced stages. METHODS This ecological, temporal series study evaluated breast cancer screening coverage, clinical staging, and the time from diagnosis to treatment initiation in women of 40–49, 50–69 and \(\:\ge\:\)70 years of age in Brazil, its geographical regions, and states between 2013–2022. The data were extracted from databases of the Unified Health System (DATASUS). RESULTS There was a decreasing trend in screening coverage for the 40-49-year age group between 2013–2020 (APC= -10.79; p < 0.001), and stability in 2020–2022. Rates for the 50-69-year group remained stable, while coverage fell for women \(\:\ge\:\)70 years of age (APC= -6.27; p < 0.001) between 2013–2022. Cases of advanced stages at diagnosis tended to increase in all age groups: 40–49 (APC=1.71; p < 0.001), 50–69 (APC = 1.43; p < 0.001) and \(\:\ge\:\)70 years (APC = 1.82; p = 0.001). Breast cancer screening coverage was low for all the age groups and all geographical regions, with lower rates found for the 40–49 and \(\:\ge\:\)70-year age groups. The poorest coverage was in the regions north, northeast and midwest, revealing regional disparities. The proportion of cases diagnosed at advanced stages (III/IV) increased, particularly in 40–49 and \(\:\ge\:\)70-year age groups. Time from diagnosis to treatment initiation exceeded 60 days in >50% of cases in all age groups, with an increasing trend in women of 50–69 (APC = 1.27; p < 0.001) and \(\:\ge\:\)70 years of age (APC=1.83; p < 0.001). CONCLUSIONS This study highlights the urgent need for public policies to increase breast cancer screening coverage beyond the 50-69-year age group, and to guarantee equitable access to early diagnosis and timely treatment, particularly in less affluent areas. Dealing with these disparities is crucial to improving breast cancer outcomes in Brazil.