Disparities in breast cancer screening, stage at diagnosis, and treatment in Brazil: a warning of the need to change public policies.

BACKGROUND: Breast cancer (BC) is the most prevalent form of cancer in Brazilian women, contributing significantly to cancer-related mortality, particularly when diagnosed at advanced stages. METHODS: This ecological, temporal series study evaluated breast cancer mammography screening rate, clinical staging, and the time from diagnosis to treatment initiation in women of 40–49, 50–69 and [Formula: see text]70 years of age in Brazil, its geographical regions, and states between 2013 and 2022. The data were extracted from databases of the Unified Health System (DATASUS). RESULTS: There was a decreasing trend in mammography screening rate for the 40-49-year age group between 2013 and 2020 (Annual Percentual Change- APC= -10.79; p < 0.001), and stability in 2020–2022. Rates for the 50-69-year group remained stable, while fell for women [Formula: see text]70 years of age (APC= -6.27; p < 0.001) between 2013 and 2022. Cases of advanced stages at diagnosis tended to increase in all age groups: 40–49 (APC=1.71; p < 0.001), 50–69 (APC = 1.43; p < 0.001) and [Formula: see text]70 years (APC = 1.82; p = 0.001). The mammography screening rate was low for all the age groups and all geographical regions, with lower rates found for the 40–49 and [Formula: see text]70-year age groups. The poorest screening rates were seen in the regions North, Northeast and Midwest, revealing regional disparities. The proportion of cases diagnosed at advanced stages (III/IV) increased, particularly in 40–49 and [Formula: see text]70-year age groups. Time from diagnosis to treatment initiation exceeded 60 days in >50% of cases in all age groups, with an increasing trend in women of 50–69 (APC = 1.27; p < 0.001) and [Formula: see text]70 years of age (APC=1.83; p < 0.001). CONCLUSIONS: This study highlights the urgent need for public policies to increase BC mammography screening rate beyond the 50-69-year age group, and to guarantee equitable access to early diagnosis and timely treatment, particularly in less affluent areas. Dealing with these disparities is crucial to improving BC outcomes in Brazil, positively influencing clinical stage at diagnosis, treatment efficacy, and ultimately, survival and mortality.