Avaliação das ações de detecção precoce do câncer de mama no Brasil: uma análise com base nos sistemas de informação em saúde.

Abstract

This research aims to evaluate the actions for early detections of breast cancer in the care network of SUS (Public Health system), analyzing the offer and usage of health services in Brazil and regions and tracing the trajectory of women screened in the city of Rio de Janeiro. The thesis is presented in three articles which comprehend (i) the evaluation of the offer and usage of the services related to early detection of breast cancer in Brazil; (ii) the description of the used methodology to correlate the data from the database of the information system on health (SIS) to evaluate the group of women whose mammography exams are suspicious or highly suspicious of malignancy and (iii) the trajectory analysis. As database sources, the following SIS were used: Information system for Cancer Control (SISMAMA), ambulatory information system (SIA: BPA-I e APAC), hospital information system (SIH) and the mortality information system (SIM). It was calculated the equipment offer and human resources indicators and the informed production of the procedures related to the early detection of breast cancer for Brazil and regions. Based on the parameters for screnning programming, the informed production of the procedures related to the early detection of breast cancer was compared with the estimated one from the performed screnning mammography exams. A methodology of relations was used between the databases of the city of Rio de Janeiro, and from the results of the exams of women screnned with suspicious or highly suspicious lesions of malignancy, the group was then evaluated.The results point out increase on the use of the procedures and the coverage, despite the reduction on the capacity of offering mammography for screening, and being these still inferior to the expected parameters; identified the relationship strategies which allow higher identification of true pairs between the SIS and through the formed cohort pointed out possible difficulty in accessing diagnostic investigation, errors concerning mammography request and higher detection of cases for BI-RADS® 5 results and in palpable lesions; the average time for treatment was longer than 6 months, even for the women with mammography exams requested by specialized hospitals which presented 4 times better chances of being treated before and to repeat the mammography has associated to a longer waiting time for treatment. Thus, it is concluded that there is discrepancy between the offer and usage of the procedures for the early detection of breast cancer on SUS, that the relationship techniques of the databases allowed analyzing the trajectory of women who were screnned with suspicious or high suspicious lesions of breast cancer. For the studied cohort in the city of Rio de Janeiro, the average time between the altered mammography and the treatment was considered long compared to other countries, if even longer with the exam were requested by the basic health network. These findings suggest necessity of a greater organization of the offer by the health assisting network and qualification of human resources to perform adequately the actions of breast cancer control.