Around 1/3 of mammograms in Campinas are performed on women under 50 years of age. This was confirmed by a study carried out by a group of oncologists from Hospital da Mulher – Caism, in partnership with the city's City Hall. Because of this, experts are evaluating the impact of screening on the general population, but also on younger women, to see who benefits from it, reveals Diama Vale, gynecologist at Caism and one of those responsible for the project “Population-based assessment of screening, diagnosis and death from breast cancer among women in the city of Campinas, depending on age”.
The ongoing research refers to the 125 mammograms carried out between 2010 and 2014, evaluating their performance and epidemiological data, says Diama. The aim, she informs, is to evaluate the effectiveness of breast screening in the city's population, with the interest of improving disease control strategies locally. This project was motivated by the idea of identifying breast cancer early, especially in middle-aged women, between 50 and 69 years old, for whom mammography screening could bring the best results.
To evaluate the screening performance, the Unicamp team is researching the information made available by the Computerized System of the Municipality of Campinas, the Ministry of Health and the São Paulo Hospital Base Cancer Registry (provided by the Oncocentro de São Paulo Foundation - Fosp).
According to the doctor, screening involves a mammogram exam and, according to the cancer classification (the staging – which helps to determine the extent of the disease so that the treatment is even more effective), the woman is advised on the next steps. . If the mammogram is normal, she will only undergo another exam in two years. If it shows changes (nodules or calcifications), you will undergo further tests, complemented by ultrasound or biopsy. A fragment of the breast tissue is then removed for evaluation by the pathologist, in order to investigate changes in the cells.
In the State of São Paulo, more or less 2/3 of breast cancer cases are diagnosed in early stages (0, I or II). This result is comparable to those obtained in developed countries, which manage to control cancer well in their populations.
The reduction in the staging of breast cancer in the State, when diagnosed between 2000 and 2015, most likely occurred thanks to the increase in the number of mammograms. In 2000, the most common stage for diagnosis was stage IIA. In relation to 2015, the most common diagnosis was stage I. The staging for breast cancer ranges from 0 to IV, with IV being the worst.
Population base
The Unicamp group is now evaluating cases of death in the city from breast cancer in the last two decades (from 1996 to 2015). During this period, around 1.800 women died from breast cancer, reports the professor. Regarding the diagnosis of new cases, data from the Campinas Population-Based Cancer Registry is being researched, which shows an average of 500 new cases (which come from women) per year in the city.
The survival of women diagnosed with breast cancer between 2010 and 2012 is also being evaluated, with the expectation of also analyzing the year 2013. “We are investigating which women diagnosed are still alive and which have already died. We will calculate the time it took from diagnosis to death to calculate the risk of this patient dying, according to the clinical confirmation of the disease”, she explains.
Regarding the performance evaluation of the screening program, the professor points out that this is an audit evaluation of the health service in which it was concluded that mammographic exams, carried out annually by the City Hall, are sufficient to guarantee biannual coverage of half of the population with aged between 50 and 69 years.
In the doctor's opinion, 50% may seem like an insignificant number for the city's potential, but she highlights that, in developed countries, this coverage is around 60%. “Therefore, Campinas City Hall has a good installed capacity to provide tests to its population, however coverage of the target population can still be considered low”, she explains.
Another aspect addressed in the study was related to the performance of mammography in women under 50 years of age. It was considered “bad”, because there is a high prevalence of tests that require additional evaluation and are considered inconclusive, generating costs for the system and causing unnecessary anxiety to the patient.
In the case of a biopsy recommended for women under 50, the risk of this lesion being a false positive (unnecessary biopsy) is also greater than in women over 50, according to the doctor.
The performance of mammography, he comments, is related to the characteristics of the breast. The exam is less accurate in younger women, largely because the breast tissue tends to be denser and reduces the sensitivity of the mammogram to detect breast lumps.
Furthermore, screening can diagnose cases of breast cancer in women who would never have problems related to this disease, which are the so-called “indolent” cancer cases. This one This type of tumor will evolve very slowly and will not pose a risk to the woman. It is precisely because This is why this exam becomes more recommended for women over 50 years of age, when there is evidence that screening actually brings benefits to these women's lives.
Advance
Diama points out that mammography is indicated for women under 50 years of age only when she would possibly have an increased risk of breast cancer. In general, they are patients with genetic alterations who are rarely able to undergo genetic testing in the public service. This assessment ends up being carried out through clinical history involving first-degree relatives affected under the age of 50 and other factors such as the presence of atypical proliferative pathologies.
Women with a positive family history in a first-degree relative are considered to be at high risk, as long as that diagnosis was made under the age of 50 or with a family history of at least one first-degree relative diagnosed with bilateral breast cancer or ovarian cancer. , in any age group. Women diagnosed with a proliferative breast lesion with atypia or carcinoma are also at high risk. in situ or those patients with a family history of male breast cancer.
“We believe that this study can be extrapolated to other states, as it would provide a good portrait of what is happening in Brazil. We know that mammography can help with strategies for organizing a screening program to improve cancer control and this, in terms of health policy, is very relevant”, considers the professor.
She comments that Caism currently has the main oncology reference service in the Metropolitan Region of Campinas. Other hospitals that offer care are Hospital and Maternity Celso Pierro and the Mario Gatti Municipal Hospital.
In Diama's opinion, this project generates many gains because the municipality has a long history of evaluating its health system data, has a computerization system and has well-established health surveillance. “We hope that these results will help other municipalities to carry out similar assessments, using our data and opting for the best strategies for cancer control in their region”, he highlights.
