Breast cancer screening program for risk groups: facts and perspectives

a cross-sectional study with 950 female users of 38 public Primary Health Care services in São Paulo, between October and December 2013. According to UHS criteria, participants were grouped into high risk and standard risk, and frequency, association (p≤0.05), and screening compliance were measured.

Results:

6.7% had high risk and 93.3% standard risk, respectively; in these groups, the frequency and compliance of clinical breast examination were 40.3% and 37.1%, and 43.5% and 43.0% (frequency p=0.631, compliance p=0.290). Mammograms were 67.7% and 35.5% for participants at high risk, and 57.4% and 25.4% for those at standard risk (frequency p=0.090, compliance p=0.000).

Conclusions:

in the groups, attendance and conformity of the clinical breast exam were similar; for mammography, it was higher in those at high risk, with assertiveness lower than the 70% set in UHS.

Descriptors:
Breast Neoplasms; Risk Assessment; Primary Prevention; Mass Screening; Process and Outcome Evaluation in Health Care

Target audience	Recomended action
35 years or older with high risk	Annual clinical breast exam and annual mammography
40 to 49 years old with standard risk	Annual clinical breast exam
50 to 69 years old with standard risk	Annual clinical breast examination and biennial mammography

Age group	Type of cancer	Laterality	Age	Kinship
35-39 years (n = 09)	» Breast » Breast	» Unilateral » Bilateral	» < 50 years » > 50 years	» Mother » Mother	(n = 02) (n = 01)
35-39 years (n = 09)	» Ovary			» Mother » Sister » Daughter	(n = 04) (n = 01) (n = 01)
40-49 years (n = 29)	» Breast » Breast » Breast	» Unilateral » Non specific » Bilateral	» < 50 years » Non specific » < 50 years	» Mother Sister Homem Mother Sister	(n = 03) (n = 10) (n = 01) (n = 01) (n = 01)
40-49 years (n = 29)	» Ovary			» Mother » Sister	(n = 08) (n = 05)
50-69 years (n = 24)	» Breast » Breast » Breast	» Unilateral » Bilateral » Bilateral	» < 50 years » < 50 years » < 50 years	» Mother » Sister » Daughter » Mother » Sister » Mother	(n = 03) (n = 05) (n = 02) (n = 01) (n = 02) (n = 01)
50-69 years (n = 24)	» Ovary			» Mother » Sister » Daughter	(n = 05) (n = 04) (n = 01)

Sociodemographic profile	Risk				p value
	High		Standard
	n (62)	%	n (863)	%
Age group (in years)
35 to 39	9	14,5	175	20,3	0,181^†
40 to 49	29	46,8	306	35,5
50 to 69	24	38,7	382	44,2
Total	62	100,0	863	100,0
Lives with a partner
Yes	36	58,1	510	59,1	0,873^†
No	26	41,9	353	40,9
Total	62	100,0	863	100,0
Race
White	32	51,6	375	43,5	0,211^†
Non-white	30	48,4	488	56,5
Total	62	100,0	863	100,0
Years of study
0 to 3	11	17,7	202	23,4	0,722^†
4 to 7	18	29,0	235	27,2
8 to 10	11	17,7	124	14,4
11 or more	22	35,5	301	34,9
Total	62	100,0	862^* * Loss; †Pearson’s chi-square statistical test; ‡National Business Association’s Brazil Economic Classification Criterion, 2014.	100,0
Economic class^‡
A+B	11	17,7	202	23,4	0,244^†
C	45	72,6	535	62,0
D+E	6	9,7	126	14,6
Total	62	100,0	863	100,0

Actions for early detection of breast cancer performed	Risk				p value
	High		Standard		p value
Clinical breast examination	n (62)	%	n (863)	%
Done in public service	25	40,3	375	43,5	0,631^†
Not done in public service	37	59,7	488	56,5
Total	62	100,0	863	100,0
Reason for breast examination in public service	n (25)	%	n (375)	%
Screening and other reason	13	52,0	305	82,0	0,000^†
Breast alteration	5	20,0	50	13,4
Case of cancer in a relative	7	28,0	17	4,6
Total	25	100,0	372^* * Loss; †Pearson’s chi-square statistical test.	100,0
Mammography	n (62)	%	n (863)	%
Done in public service	42	67,7	495	57,4	0,090^†
Not done in public service	9	14,5	235	27,2
Done through the complementary system	11	17,7	133	15,6
Total	62	100,0	863	100,0
Reason for mammography in public service	n (42)	%	n (495)	%
Screening and other reason	19	45,2	424	86,7	0,000^†
Breast alteration	17	40,5	16	3,3
Case of cancer in a relative	6	14,3	49	10,0
Total	42	100,0	489^* * Loss; †Pearson’s chi-square statistical test.	100,0
Mammography periodicity in public service	n (42)	%	n (495)	%
≤ 1 year	29	70,7	307	64,6	0,715^†
Biennial	7	17,1	104	21,9
> biennium	5	12,2	64	13,5
Total	42	100,0	495	100,0

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[1] EDITOR IN CHIEF: Antonio José de Almeida Filho

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