Breast cancer: in SUS, delay in diagnosis reduces the cure rate to less than 30%

O early diagnosis and treatment changed the image of breast cancer, which ceased to be a death sentence. But he remains the tumor that most kills women in Brazil and the second most frequent – ​​second only to non-melanoma skin cancer🇧🇷 Estimates for 2016, still unconfirmed, were 57,960 new cases and 14,388 deaths. Unfortunately, to the greater detriment of the poor woman, to whom attention comes last. Inequality in access to medical care and examinations produces a striking difference: while in private services 90% of malignant nodules are detected in early stages, when the chances of cure reach 95%, in the public system 60% of patients receive the news with the disease already advancing. For them, the chances of getting rid of the tumor do not reach 30%.

O nodule size may also be indicative of this sad reality. Where there are good research resources, finding very small tumors becomes easier. Doctor Antônio Luiz Frasson, president of the Brazilian Society of Mastology, mentions the Albert Einstein Hospital, in São Paulo. “There, the average diameter of the identified tumors is equivalent to that of the best centers in Europe and the United States, 1.5 centimeters”, he says. In the public system, half of the tumors are discovered when they reach 5 centimeters. The conclusion was reached by researchers from the Pontifical Catholic University of Rio Grande do Sul (PUC-RS).

The main factor responsible for this problem is the delay in making the differential diagnosis, according to mastologist Maira Caleffi, volunteer president of the Brazilian Federation of Philanthropic Institutions to Support Breast Health (Femama). “Women can mammography, but the bottleneck appears later, at the time of the biopsy, which will allow confirming whether the nodule is benign or malignant.” According to the doctor, they have to wait in a long line or run to a private laboratory. “For that, they will have to spend from 500 to a thousand reais”, she says.

There is a bill in the National Congress to stipulate the time until the final diagnosis around 30 days after going to the doctor – as is the case with the treatment of all types of cancer. The law determines that the therapeutic stage should be initiated within 60 days after the positive result of the biopsy. “If approved, the new measure will reduce late diagnosis, mortality and health care costs. breast cancer”, says Maira, who heads the Mastology Service at Hospital Moinhos de Vento, in Porto Alegre.

In the SUS, drugs arrive later

The delay in including state-of-the-art medicines in the Unified Health System (SUS) also contributes to mortality. In August, Femama celebrated the incorporation of a drug that is part of a new class of drugs called targeted therapy.

Trastuzumab has been used worldwide for 15 years in patients with a specific and aggressive type of breast cancer, HER2 positive🇧🇷 “On the list of the World Health Organization, this drug is part of the basic therapeutic options for combating the disease”, explains Maira. “But, in Brazil, it was only available in the public system for initial tumors. It was sad,” she says.

As most arrive at SUS with advanced disease, this medication could not be used. Only chemotherapeutic agents were adopted, which are older and less effective. “I co-authored an article showing that this procedure caused 800 deaths from breast cancer in two years”, she comments. Published on August 2, the ordinance that determines the inclusion of trastuzumab provides for a period of six months for public hospitals to start offering it to patients with metastatic cancer🇧🇷 Thus, access to the drug will only be possible from February 2018.

GOOD NEWS

• A genetic evaluation of tumor cells allows distinguishing the type of cancer, predicting the occurrence of secondary tumors and planning treatment. It is already carried out in the public service.

• Simplified magnetic resonance imaging for cancer screening in young people is fast, with less contrast and will make diagnosis easier. Not yet available in the country.

• The time to apply radiotherapy, which destroys tumor cells, was reduced from five weeks to three in the initial stage. Already present in public service.

• Blood tests to detect fragments of the tumor’s DNA can already detect the return of the cancer. Can be
made only in the private service.

• A immunotherapy against the triple negative, aggressive and resistant tumor, was proposed in June at the meeting of the American Society of Clinical Oncology, which brought together 40,000 specialists in Chicago, in the United States. The idea is to stimulate the immune system to react to the tumor. Can be associated with chemotherapy🇧🇷 Among the targeted therapies discussed at the event, the drug olaparib, promising in cases of advanced breast cancer. Approved this year in Brazil against ovarian cancer, it can be included in the fight against breast tumors. But it is not yet available in public service. At the congress, it was also revealed that pregnancy after a breast tumor does not favor the return of the disease – scientists have already proven that it even has a protective effect.