Screening and diagnosis of breast cancer in older women in Brazil: Why should recommendations be reconsidered?

Abstract

Objective: Breast cancer is considered one of the current challenges of population aging. Nevertheless, there is disagreement about screening in older women over 70 years of age due to the lack of prospective, controlled, and randomized studies that include women in this group. The aim of this study was to evaluate Brazilian data on mammography screening
and staging of breast cancer in women over 70 years. Methodology: This was an ecological time series study. Information
on screening and staging of breast cancer in the Unified Health System (SUS) in women over 70 years of age was analyzed
and compared with the group aged 50–69 years in Brazil and its five regions from 2013 to 2019. The secondary database
was compiled with information from the Outpatient Information System of the Informatics Department of the SUS, the
Oncology Brazil Panel, the Brazilian Institute of Geography and Statistics, the Supplementary Health the Supplemental
Health Agency, and the Online Mortality Atlas. Trends in rates of mammography screening and clinical staging of breast
cancer were analyzed. Results: In the regression analysis, a more significant decline in follow-up was observed in the
70+-year-old group, with an APC of –3.5 (p<0.001), compared with the 50- to 69-year-old group APC – 2.2 (p=0.010). There
was a trend toward an increase in the advanced stage, but it was more pronounced in the 70+-year-old group. Clinical
staging analysis revealed a higher incidence of stages III and IV in the elderly population (44.3%) compared with the
50–69-year-old group (40.8%; p<0.001). Conclusion: Considering the aging of the Brazilian population and the heterogeneity of the functional and cognitive status of older women, mammography screening in the group over 70 years of age in
SUS needs to be better discussed in the context of public policy implementation.