Temporal Trends in Mammography Examinations in Brazil from 2013 to 2023
DOI:
https://doi.org/10.29289/2594539420250041Keywords:
prevalence, mammography, preventive medicine, early detection of cancer, breast neoplasmsAbstract
Introduction: Breast cancer is the most common cancer among Brazilian women and a leading cause of death in the 30–59 age group. Due to its high incidence and mortality rates, mammography is a key strategy for early detection and mortality reduction. This study aimed to analyze the time trend of mammography exams conducted in Brazil between 2013 and 2023, considering age group, region, clinical indication, prior mammogram frequency, type of screening, and Breast Imaging Reporting and Data System (BI-RADS®) categories. Methods: This ecological time-series study used secondary data from the Cancer Information System (SISCAN, Sistema de Informação de Câncer). Mammograms performed on women aged ≥30 years from 2013 to 2023 were included. Variables analyzed were age group, region, clinical indication (screening or diagnostic), prior exam history, type of screening (target population, high risk, treated patient), and BI-RADS® classification. Time trend analysis was conducted using the Joinpoint Regression Program, version 5.0.2, applying annual percentage change and average annual percentage change, with 95% confidence intervals and a significance level of p<0.05. Results: A total of 25,713,333 mammograms were performed, with a 33.92% increase overall. Of these, 97.8% were for screening purposes. The 65–69 age group had the highest growth with average annual percentage change of 3.63%. Prior exam frequency rose to 72.85%. BI-RADS 2 (49.92%) and 1 (35.37%) were the most prevalent. Diagnostic exams rose from 2013 to 2020 (5.94%) and declined from 2020 to 2023 (-12.75%). Conclusion: Mammography use increased in Brazil over the decade, with greater adherence among target populations, improved follow-up, and persistent regional and age disparities.
Downloads
References
1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. https://doi.org/10.3322/caac.21492
2. National Cancer Institute José Alencar Gomes da Silva (INCA). How does cancer arise? [Internet]. Rio de Janeiro: INCA; 2022 [cited 2024 Jul 13]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/como-surge-o-cancer.
3. National Cancer Institute José Alencar Gomes da Silva (INCA). What is cancer? [Internet]. Rio de Janeiro: INCA; 2022 [cited 2024 Jul 13]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/o-que-e-cancer.
4. National Cancer Institute José Alencar Gomes da Silva (INCA). Population-based cancer registries [Internet]. Rio de Janeiro: INCA; 2022 [cited 2024 Jul 13]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/numeros/registros/base-populacional.
5. Gobbi H. Classification of tumours of the breast: an update based on the new 2012 World Health Organization Classification. J Bras Patol Med Lab. 2012;48(6):463-74. https://doi.org/10.1590/S1676-24442012000600013
6. National Cancer Institute José Alencar Gomes da Silva (INCA). Estimate 2023: Cancer incidence in Brazil [Internet]. Rio de Janeiro: INCA; 2022 [cited 2024 Jul 13]. Available from: https://www.gov.br/inca/pt-br/assuntos/cancer/numeros/estimativa.
7. National Cancer Institute José Alencar Gomes da Silva (INCA). Atlas of cancer mortality [Internet]. Rio de Janeiro: INCA; 2021 [cited 2024 Jul 13]. Available from: https://www.inca.gov.br/app/mortalidade.
8. Ministry of Health (BR). Ordinance No. 779, of December 31, 2008. Defines SISMAMA as the official information system for breast cancer screening and diagnostic confirmation procedures [Internet]. Diário Oficial da União; 2009 Jan 2 [cited 2024 Jul 13];Section 1:38. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2008/prt0779_31_12_2008.html.
9. National Cancer Institute José Alencar Gomes da Silva (INCA). Monitoring actions for cervical and breast cancer control. Bol Inf Detecção Precoce [Internet]. 2020 [cited 2024 Sep 29];11(1):1-4. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/informativo_numero1_2020.pdf.
10. Alcântara LLM, Ribeiro ALR, Pinheiro RS, Silva ZP, Oliveira EXG. Temporal trend of mammography coverage in the Unified Health System, Brazil, 2010-2019. Epidemiol Serv Saude. 2022;31(3):e2022007.
11. Wolf AB, Brem RF. Decreased mammography utilization in the United States: Why and how can we reverse the trend? AJR Am J Roentgenol. 2009;192(2):400-2. https://doi.org/10.2214/AJR.08.1873
12. Breen N, Cronin KA, Meissner HI, Taplin SH, Tangka FK, Tiro JA, et al. Reported drop in mammography: is this cause for concern? Cancer. 2007;109(12):2405-9. https://doi.org/10.1002/cncr.22723
13. Trivedi AN, Rakowski W, Ayanian JZ. Effect of cost sharing on screening mammography in Medicare health plans. N Engl J Med. 2008;358(4):375-83. https://doi.org/10.1056/NEJMsa070929
14. Ribeiro CM, Correa FM, Migowski A. Short-term effects of the COVID-19 pandemic on screening, diagnostic, and treatment procedures for cancer in Brazil: descriptive study, 2019-2020. Epidemiol Serv Saude. 2022;31(1):e2021405. https://doi.org/10.1590/S1679-49742022000100010
15. Silva PA, Vianna PVC, Barja PR. Breast cancer screening mammography by SUS in the Metropolitan Region of Vale do Paraíba and North Coast: trend and social characteristics of women undergoing the exam 2010 and 2014. Rev Univap. 2016;22(41):45-60. https://doi.org/10.18066/revistaunivap.v22i41.394
16. Brazil. Ministry of Health. Strategic action plan to tackle non-communicable diseases (NCDs) in Brazil 2011–2022 [Internet]. Brasília: Ministry of Health; 2011 [cited 2024 Dec 10]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/plano_acoes_enfrent_dcnt_2011.pdf.
17. Khan-Gates JA, Ersek JL, Eberth JM, Adams SA, Pruitt SL. Geographic access to mammography and its relationship to breast cancer screening and stage at diagnosis: a systematic review. Womens Health Issues. 2015;25(5):482-93. https://doi.org/10.1016/j.whi.2015.05.010
18. National Cancer Institute José Alencar Gomes da Silva (INCA). Guidelines for early detection of breast cancer in Brazil [Internet]. Rio de Janeiro: INCA; 2015 [cited 2024 Jul 13]. Available from: https://www.inca.gov.br/sites/ufu.sti.inca.local/files/media/document/diretrizes_deteccao_precoce_cancer_mama_brasil.pdf.
19. Malta DC, Jorge AO. Trend analysis of Pap smear and mammography in Brazilian capitals. Rev Cien Cult. 2014;66(1):25-9. https://doi.org/10.21800/S0009-67252014000100012
20. Moreira APL, Malta DC, Carvalho AT. Mammography trend and associated factors in women from 50 to 69 years. Cad Saúde Colet. 2023;31(3):e31030594. https://doi.org/10.1590/1414-462X202331030594
21. Silva RP, Gigante DP, Amorim MHC, Leite FMC. Factors associated with mammography in primary health care users in Vitória, Espírito Santo. Epidemiol Serv Saude. 2019;28(1):e2018048. https://doi.org/10.5123/S1679-49742019000100010
22. Urban LABD, Chala LF, Paula IB, Bauab SP, Schaefer MB, Oliveira ALK, et al. Recommendations for breast cancer screening in Brazil, from the Brazilian College of Radiology, the Brazilian Society of Mastology, and the Brazilian Federation of Gynecology and Obstetrics Associations. Femina. 2023;51(7):390-9.
23. Tomazelli J, Migowski A, Ribeiro CM, Assis M, Abreu DMX, Azevedo e Silva G. Evaluation of monitoring indicators for breast cancer screening in women treated by the Unified Health System, Brazil, 2018–2019: descriptive study. Epidemiol Serv Saude. 2023;32:e2022567.
24. Lehman CD, Arao RF, Sprague BL, Lee JM, Buist DSM, Kerlikowske K, et al. National performance benchmarks for modern screening digital mammography: update from the Breast Cancer Surveillance Consortium. Radiology. 2017;283(1):49-58. https://doi.org/10.1148/radiol.2016161174
25. Badan GM, Roveda Junior D, Ferreira CAP, Noronha Junior OA. Comprehensive internal audit of the mammography service in a breast imaging reference institution. Radiol Bras. 2014;47(2):74-8. https://doi.org/10.1590/S0100-39842014000200007.
26. National Cancer Institute José Alencar Gomes da Silva (INCA). Guidelines for early detection of breast cancer in Brazil. Rio de Janeiro: INCA; 2015 [cited 2024 Jul 23]. Available from: https://www.inca.gov.br/publicacoes/livros/diretrizes-para-deteccao-precoce-do-cancer-de-mama-no-brasil.
27. Ministry of Health (BR). Ordinance No. 126, of February 24, 2014. Amends the SUS Table of Procedures, Medications, Orthotics, Prosthetics, and Special Materials [Internet]. Diário Oficial da União; 2014 Feb 25 [cited 2024 Jul 23]. Available from: https://bvsms.saude.gov.br/bvs/saudelegis/sas/2014/prt0126_24_02_2014.html.
28. Brazilian Society of Mastology – São Paulo Regional. Guideline manual: breast cancer in elderly women [Internet]. São Paulo: SBM; 2021 [cited on 2024 Jul 25]. Available from: https://pt.scribd.com/document/630780383/cancer-de-mama-em-idosas-manual-de-diretrizes-pdf.
29. Xavier DR, Oliveira RAD, Matos VP, Viacava F, Carvalho CC. Mammograms coverage, allocation and use of equipment in the Health Regions. Saude Debate. 2016;40(110):20-35. https://doi.org/10.1590/0103-1104201611002
30. Oliveira EXG, Pinheiro RS, Melo ECP, Carvalho MS. Socioeconomic and geographic constraints to access mammography in Brazil, 2003–2008. Cien Saúde Colet. 2011;16(9):3649-64. https://doi.org/10.1590/S1413-81232011001000002
31. Borges ZS, Wehrmeister FC, Gomes AP, Gonçalves H. Clinical breast examination and mammography: inequalities in Southern and Northeast Brazilian regions. Rev Bras Epidemiol. 2016;19(1):1-13. https://doi.org/10.1590/1980-5497201600010001
32. Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Access to cancer care: mapping hospital admissions and high-complexity outpatient care flows. The case of breast cancer. Cad Saúde Publica. 2011;27(2):317-26. https://doi.org/10.1590/S0102-311X2011000200013
33. Nunes A, Santos JRS, Barata RB, Vianna SM. Measuring health inequalities in Brazil: a monitoring proposal. Brasília: Pan American Health Organization; 2001.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Victor Quarentei Ciaccio, Letícia Enedina do Nascimento Torquato, Franciele Cascaes da Silva
This work is licensed under a Creative Commons Attribution 4.0 International License.
