Mammography Coverage in Brazil and the Presidential Elections: Is There Anything to Celebrate?

Abstract

Brazil is currently experiencing a blow to democracy, 1 with political polarization between the right and the left in the presidential elections. Added to this are the inequalities and negligence resulting from the long-term mismanagement of government resources and compounded by the COVID-19 pandemic. Consequently, we question whether breast cancer screening coverage changed under the different presidents and political ideologies: Lula and Dilma (left), Temer (center) and Bolsonaro (right). Therefore, we evaluated breast cancer screening coverage within the public health care system in women age 50-69 years, the target population for screening according to the Brazilian Ministry of Health guidelines. 2 Data from 2020 and 2021 were excluded to eliminate the effect of the pandemic on the analysis. The mean rates of breast cancer screening coverage 3 were calculated and divided by the number of years during which each president governed. Rates ranged from 20.7% during Lula's presidency to 30.0% when Dilma and Temer were in power and then falling to 28.1% during Bolsonaro's current presidency (P = .20). Therefore, breast cancer screening coverage is clearly low irrespective of who is governing the country and well below the 70% recommended by the WHO 4 (Fig 1). Lack of government investment to increase breast cancer screening coverage is extremely concerning, since breast cancer represents 30.3% of all new cases of cancer diagnosed in women in Brazil. In 2020, 88,492 new breast cancer cases were registered, and 122,690 deaths occurred, with breast cancer being the principal cause of death from cancer in Brazilian women. 5 Notwithstanding, the Federal Government published numerous laws on the control of breast cancer between 2007 and 2020, 6 64% of which were issued during Dilma's first term of presidency. This initiative may partially justify the increase in breast cancer screening coverage seen in subsequent years, although other factors could also have been involved..6% 30.0% 30.0% 28.1% FIG 1. Breast cancer screening coverage (%) in Brazil in women age 50-69 years, clients of the public health care system, according to the president in power at the time.