Document prepared by the Brazilian College of Radiology and Diagnostic Imaging, in partnership with SBM, SBOC, Febrasgo and Femama, proves the benefits of screening before the age of 50 and after the age of 70
Women under 50 and over 70 must have guaranteed access to breast cancer screening tests through the health insurance network in the country. This is the main conclusion of a technical report sent on Wednesday (26) to the National Supplementary Health Agency (ANS) in response to the agency's request for information from medical entities that monitor the issue.
The document prepared by the Brazilian College of Radiology and Diagnostic Imaging (CBR), through its National Mammography Commission (CNM), provides a thorough analysis of the negative impact of a possible restriction on this service and highlights the benefits of extending it to the population in these age groups. The text is also signed by the Brazilian Society of Mastology (SBM), the Brazilian Society of Clinical Oncology (SBOC) and the Brazilian Federation of Gynecology and Obstetrics Associations (Febrasgo), and has the endorsement of the Brazilian Federation of Philanthropic Institutions for Breast Health Support (Femama).
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The position is part of the discussion promoted by ANS through a public consultation that proposes the inclusion of proactive measures in health plans for screening breast cancer in women aged 50 to 69, with mammograms every two years. Experts and medical entities believe that the Agency's initiative opens the way for health insurance companies to limit access to these exams for this population.
Early detection – In the assessment of the text signed by the CBR and other entities, among the advantages of breast cancer screening in the general population highlighted in the work, which is now under analysis by the ANS, are the early detection of tumors, which reduces the chances of extensive surgical treatments, including mastectomy, and the need for chemotherapy.
Furthermore, early diagnosis generates a better quality of life for women who have had the disease, reduces the costs of complex oncological treatments and, above all, stimulates a reduction in mortality caused by the disease in women aged between 40 and 74. To reach this conclusion, the CBR analyzed dozens of studies published in some of the world's leading scientific journals.
The incidence of breast cancer has increased worldwide in recent decades, with a growth rate of 0.5% per year. Despite this global increase, significant disparities persist between regions with different socioeconomic levels. A study that evaluated data from 185 countries showed that the incidence ranged from 25 cases per 100,000 women in low- and middle-income countries (including regions of Africa and East Asia) to more than 85 cases per 100,000 women in high-income countries (such as those located in North America, Europe and Australia).
In Brazil, for the three-year period from 2023 to 2025, it is estimated that 73,610 new cases of breast cancer will occur per year. This corresponds to an estimated risk of 66.54 new cases for every 100,000 women. These numbers place breast cancer as the most common cancer among women in all Brazilian regions, according to data from the National Cancer Institute (INCA), which reveal that the geographic distribution of this disease in the country reveals significant heterogeneity. The highest incidence is present in the Southeast (84.46 per 100,000 women), followed by the South (71.44 per 100,000), Central-West (57.28 per 100,000), Northeast (52.20 per 100,000) and North (24.99 per 100,000).
Risk factors – In the document, the CBR points out that this regional variability can be attributed to a combination of factors, such as differences in population structure, levels of exposure to known risk factors (family history, genetic factors, lifestyle habits, among others) and access to health services, including screening and early diagnosis programs. In addition, the data reveal that the age distribution of breast cancer in Brazil is different compared to developed countries.
In Brazil, there is a higher prevalence of tumors in premenopausal women under the age of 50, as revealed by a series of studies analyzed by the CBR. The multicenter Amazona I study, which represented several Brazilian regions, demonstrated that 12% of the tumors occurred before the age of 40, 32% between the ages of 40 and 50, and 56% over the age of 50. In the United States, 4% of the cancer cases occurred before the age of 40, 13% between the ages of 40 and 49, and 83% over the age of 50.
This difference is also observed in other developing countries. According to Beatriz Maranhão, from the CBR Mammography Commission, one of the possible explanations “would be the particularities in the age pyramids, which would have an older shape in developed countries (wider top, due to the number of elderly people) and a younger shape in developing countries (broad base, due to the number of young people)”.
Currently, Brazil's population pyramid is considered adult, with a median age of 35 and a tendency towards aging, with a greater concentration of women between the ages of 20 and 59. "This demographic scenario demonstrates the importance of specific health strategies for these age groups, ensuring access to quality screening at an early stage," says CBR president Rubens Chojniak.
Young patients – The technical report also points out that in Brazil, as in other parts of the world, there is an increase in tumors in young patients, under 40 years of age, generally more aggressive and with larger size at diagnosis. The CBR shows that a study with patients treated for breast cancer between 2009 and 2020 showed an increase in the proportion of cases of the disease in the subgroup under 40 years of age, rising from 7.9% of cases in 2009 to 21.8% in 2020.
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Another study highlighted the prevalence of breast cancer with more aggressive subtypes and a higher risk of advanced and metastatic cancer in this subgroup (under 40 years of age). For the president of the National Mammography Commission, Ivie Braga de Paula, “these findings raise concerns about the need to reconsider primary and secondary prevention strategies in this group of young women, ensuring them access to screening exams through health plans and the public health care network.”
The CBR also warns in its technical report that breast cancer mortality in Brazil represents a significant challenge for public health and requires a detailed analysis, considering demographic and socioeconomic factors and the health policies implemented in the country. In 2022 alone, there were more than 19,000 deaths attributed to breast cancer, which is equivalent to a rate of 12.3 deaths per 100,000 women.
The technical report also highlights the difference in time for access to diagnosis based on clinical suspicion. In the case of private patients, this interval is, on average, 31.7 days. For care provided by health plans, it is 68.9 days and rises to 93.4 days in the Unified Health System (SUS). “It may seem like a short period of time on the calendar, but the impact can be devastating, reducing the chances of a cure and allowing tumors to be diagnosed many times at a more advanced stage in Brazil, when compared to countries with established screening programs,” recalled Hélio Braga, vice president of the CBR.
International comparison – When analyzing data by age group, the disparities are more pronounced in an international comparison. According to epidemiological surveillance data, 22% of breast cancer deaths in Brazil occur before the age of 50 and 34% after the age of 70, demonstrating the impact of this disease on these age groups. In countries with a very high development index, less than 10% of deaths occur in women under the age of 50. In Western Europe, this rate was up to 7.1%.
“Many factors may be responsible for the difficulty in reducing mortality in Brazil: the lack of an organized screening program for the entire country; the exclusion of important subgroups of women, aged between 40-49 and over 69, from screening recommendations by the public system; the low quality of exams observed in mammography quality certification programs; delays in scheduling appointments, performing exams, releasing results, and accessing surgical, radiotherapy and chemotherapy treatment,” says Rubens Chojniak.
According to the president of the CBR, with this technical report, medical entities are aligning arguments to halt an initiative that could have serious consequences for breast cancer prevention and control programs in Brazil. In the document, the Brazilian College of Radiology and Diagnostic Imaging and other medical entities reiterate that access to early diagnosis is a right of all Brazilian women.
“We hope that the ANS will look into the subsidies presented. This is a delicate matter that should be treated impartially. It should be taken into account that any savings for the plans due to restricted access could result in much higher expenses in the medium and long term due to treatments for cancer cases diagnosed late. Women’s lives and health are priceless and should be protected, seeking early diagnosis for a problem like breast cancer,” concluded the president of the CBR.