MD Sandra Gioia, an Inca mastologist and Coordinator of the Mastology Service of the Hospital San Francisco in Providencia de Deus, in Usina, started on March 2014 an Organized Breast Cancer Screening Program. Scientific Advisor of the Laço Rosa Foundation.
Exactly five years ago, after reading the books The Emperor of All Males by Siddhartha Mukherjee and All Over Love by Henrique Prata, I began to question my performance as a specialist. There are incredible books in which much is said about breast cancer and how the course of history has been modified by men and women brave enough to fight for control of this disease and save thousands of lives.
And began my journey beyond the "Castle of Knowledge". Coming out of my comfort zone, I can understand better the complex Brazilian health system and the multiple barriers faced by women to obtain breast cancer care. I was able to understand why, year after year, I receive patients with locally advanced tumors (6 out of 10) in the Health Unic System.
Cancer is a global public health problem. Its incidence has grown 20% in the last decade. By 2018, according to estimates provided by the National Cancer Institute (INCA), the main cancer incident in women is the breast, with more than 59,000 new cases expected to correspond to 29.5% of female cancers. The second tumor with the highest incidence in women is the colon and rectum, which corresponds to 9.4%, followed by cervical cancer, 8.1%. Of these new cases, more than half will be advanced cases, which decreases the possibility of treatment with intent to cure. Breast cancer is a disease that has a cure but needs to be diagnosed early and have immediate treatment. A Datafolha survey conducted for the ONG Laço Rosa Foundation shows that, on average, women with breast cancer expect up to 4.4 months to get the diagnosis of the disease, 3.5 months between diagnosis and initiation of treatment. For this reason the need for the development of actions by the public and private sector for the early diagnosis aiming at the reduction of mortality.
Despite the high frequency of the tumor, there is not a wide structure that allows the women assisted by the SUS, the guarantee of a decent service, focused not only on the treatment, but on prevention and early diagnosis. Only 18 women out of 100 do screening mammograms in Rio de Janeiro. This number is lower than that recommended by the World Health Organization (WHO) - 70 women out of 100. In countries that have implemented effective screening programs with coverage of the target population, quality of the tests and adequate treatment, health costs are lower and mortality from breast cancer is decreasing, which justifies adopting it as a public health policy.
An Organized Breast Cancer Screening Program was initiated in March 2014 with the support of the Federal Hospital of Andaraí and the Maria Augusta Estrella Health Post. The pilot project launched in the Community of Andaraí, titled 'Mama's Club: Beautiful Woman Inside and Out', entered into a partnership with the Renaissance Club in October 2014, remaining until today. In the program are included asymptomatic women, from 50 to 69 years, the most incident age group, and women under 50 who have a family history for breast cancer. These women are guided in meetings, which took place in the Renaissance Club, regarding risk factors and breast care. The clinical examination of the breasts and the mammography are performed with day and time marked in Hospital of the Andaraí that has mammary radiology, equipped with digital mammography and mammographic ultrasound. If a suspicious change is diagnosed or if malignancy is confirmed, the patients will be properly assisted to perform the treatment in Reference Hospital.
From 2014 to 2016, 200 women from the Andaraí Complex were registered, who did not have at this time a Family Health Strategy. In this population, 50% of women never had their breasts examined by a doctor or had mammography before; 80% are hypertensive; 50% diabetic; 5% of families are considered to be at high risk for breast cancer; no woman had previously received information about women's health in general or about lifestyle changes to reduce the risk of chronic diseases, such as cancer. The Clube da Mama - Beautiful Woman Inside and Out, is an innovative project that aims at the early detection of breast cancer in the communities of Rio de Janeiro, but also aims at Empowering Women in these localities to transform lives.
In the search for knowledge and expansion of the Breast Club, I had the opportunity to meet in 2016 the Breast Cancer Navigation Program at Massachusetts General Hospital (MGH), Boston / USA, with support from the Avon Foundation. This program, co-ordinated by Dr. Paul Goss, a renowned clinical oncologist, Harvard professor and founder of the Global Cancer Institute, aims to break the barriers that prevent the early diagnosis of breast cancer and timely treatment in low and middle income countries.
The Breast Club is now, with experienced supporters in the cause against breast cancer, the Laco Rosa Foundation and the Avon Institute, a Program: User Education, Training of Primary Health Care of Health Professionals and Patient Navigation. It is an intervention project aimed at eliminating barriers and proposing strategies to ensure that at least 70% of women recruited in the Andaraí Community carry out organized screening and may propose considerations for incorporating the program into health policy makers and those who help them in Rio de Janeiro.
In March, were registered over 150 women in the Clube da Mama and in partnership with the Clinic Family Odaléa Firmo Dutra and their Family Health Teams, Municipal and State Health, the program is intended to address the target population for organized screening of breast cancer with about 3,000 women in this region in 2018.
Breast cancer control is a duty of the Society and the State. Together we can improve access to breast cancer care in the health system by eliminating the institutional, socioeconomic and personal barriers that prevent the early diagnosis and timely treatment of this disease. Together we can save lives.
By Sandra Gioia, mastologist unformed with the current scenario of breast cancer in Rio de Janeiro and Brazil.