Inequality in breast cancer care in a Brazilian capital city: A comparative analysis of narratives

Abstract

Introduction: Breast cancer is the leading cause of death by cancer in women in Brazil. Timely access to treatment is a priority for health policy in the country. However, indicators of the disease are not equally distributed between women. Poverty and low levels of schooling associate with late diagnosis, worse prognosis and lower survival. Objective: To investigate differences between women from different socio-demographic profiles in the breast cancer care trajectory in Belo Horizonte, Brazil. Method: This is a hermeneutic study through narrative analysis. The selection of the participants was based on data from hospital records of four public and private oncology services in Belo Horizonte, Brazil, according to the following variables: Age, levels of schooling, and treatment cost source (Proxy of income): In-depth interviews were performed with 35 women characterized in three profiles: Profile 1 (n = 7), age range 51-69 years, schooling ≥15 years and private treatment cost; Profile 2 (n = 13), age range 35-58 years, schooling = 11 years and predominantly public treatment costing; Profile 3 (n = 15), age range 43-79 years, schooling ≤ 8 years and public treatment cost. Results: The analysis of the narratives allowed the identification of three main themes (preventive care and first signs/symptoms; search for care and diagnosis of cancer; treatment and perceptions about care received) that highlighted differences between the trajectories, with prejudice to women with characteristics of greater vulnerability (Profile 3). Conclusion: Although in Brazil the attention to women with breast cancer is guided by principles of equality and equity of care, it is necessary to develop mechanisms to prevent discriminatory practices and that guarantee equality of access to diagnosis and treatment.