1192 – Impact of the COVID-19 pandemic on mammographic screening of breast cancer in the Unified Health System of Brazil: a national epidemiological study with a specific focus on Goiás and racial inequality

Abstract

Introduction: Breast cancer remains the leading cause of death from malignant neoplasms among women in Brazil, with
mammography recognized as the gold standard method for population screening. In the context of the COVID-19 pandemic, a substantial reduction in the coverage of this examination was observed, attributed to the redirection of resources
in the public health system. This scenario disproportionately impacted vulnerable groups, especially Black women, compromising early diagnosis and, consequently, clinical outcomes.
Methodology: A systematic review conducted in accordance with the PRISMA guidelines. The search was performed via
the PubMed database, using the descriptors “breast cancer”, “mammography”, “Brazil” and “COVID-19”, applying filters
for studies published in the last five years, involving humans and the female population. Fourteen studies were included.
The PICO strategy included women eligible for mammographic screening in the Brazilian Unified Health System (SUS)
in Goiás, exposed to the pandemic period, compared to the pre-pandemic timeframe, stratified by race. The outcomes
included the volume of mammograms performed, screening coverage, mortality, and racial inequalities, complemented
by secondary data from DATASUS and INCA.
Results: In the state of Goiás, a significant reduction in the number of mammograms was observed between 2019 and
2020, with a decrease from 31,041 to 15,710 exams in white women and from 4,980 to 2,547 in black women. Although the
proportional reductions were similar, black women maintained less absolute access to screening, highlighting the persistence of structural inequities. Furthermore, an increase was observed in the proportion of diagnoses at advanced stages,
as well as an increase in mortality, estimated at 12.74 per 100,000 women.
Conclusion: The reorganization of health services during the COVID-19 pandemic negatively impacted breast cancer
screening, exacerbating racial inequalities in access to early diagnosis and clinical management, particularly among
Black women in the state of Goiás.
Ethics: Public data.