It was already expected that the coronavirus pandemic would undermine the prevention and treatment of other diseases. The doctors simply did not imagine that this consequence would come as quickly as it did with the breast cancer.
A study by the Brazilian Society of Mastology (SBM), published in the International Journal of Public Health (IJPH), indicates an increase of approximately 26% in severe cases of the disease in Brazil during the Covid-19 crisis.
To arrive at this number, the researchers compared data from two periods: between 2013 and 2019 and between 2020 and 2021, the hardest stage of living with the coronavirus.
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This increase refers to tumors in the stages III and IV. They are those that are more than five centimeters or that are already in metastasis (that is, they have reached other organs).
“In these phases, the chance of a cure is very small,” laments breast specialist Ruffo Freitas-Junior, special advisor to SBM and one of the survey authors.
The rise in cases was expected about five years from now, but researchers were surprised by a steep increase even in the midst of the pandemic.
One of the reasons for this situation is the reduction in the number of mammograms. To get an idea, when comparing 2019 to 2020, the drop was 40%. The following year, 2021, the situation even improved a bit, but there was nothing to celebrate. Compared to 2019, the exam performance rate was still 18% smaller.
The information refers to women between 50 and 69 years, the age range of increased risk of this type of cancerwho must carry out this examination periodically, every two years.
Fear of diagnosis has already turned some women away from the doctor’s office, and fear of contracting Covid-19 has only made the scenario worse.
“This happened mainly in 2020, when there was no vaccine yet, and posts and hospitals were dangerous places to be at that time,” recalls Freitas-Junior.
Inequality and slowness in the SUS
The study also unraveled the situation according to the Brazilian regions and showed that the situation worsens in areas where the health care structure is more precarious.
The region Midwest is the one with the most severe cases (21%), and the Norte comes in second place (17%). Regarding the regions southeast Es On they have fewer occurrences of advanced tumors, with 11% and 6%, respectively.
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Another study, published at the beginning of the year, shows that women who have access to health insurance and private clinics were also affected by this reality, but to a lesser extent.
According to Cristiano Resende, an oncologist from the Oncoclínicas Group and one of the authors of this other investigation, after the pandemic there was a 4.2% increase in the diagnosis of metastatic cancer (stage IV) among these patients. The discovery of the disease in early stages (stages I and II) decreased by 4.8%.
“We are going through the ‘sinking of the Titanic syndrome’, the one in which the first class has the best chance of being saved”, assesses Freitas-Junior, citing the accident of the ship in which the most privileged passengers were previously rescued.
What to do to improve this scenario?
Prevention and early diagnosis are the two most crucial aspects to protect women against breast cancer.
According to Resende, there is no shortage of mammography machines throughout Brazil. The challenge is in what happens before and after.
“In general, the woman goes to a health center and, if there is suspicion, the examination is requested. Although this step is quick, the patient will need a second visit just to schedule the mammogram”, reports the SBM doctor.
On average, 36 days pass from the first consultation to diagnosis. After finding the tumor, there is still a biopsy to be done and you return to the doctor until the actual treatment arrives.
The wait between the detection of the tumor and the start of treatment is approximately 174 days. These data are from the Panorama of Breast Cancer Care in the SUS report, with data from 2015 to 2020.
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“Imagine that most women are able to notice the bulge at home. When they sought help and started the treatment, the tumor had already doubled”, highlights Freitas-Junior.
The doctor says that some initiatives are already being studied to change this story. “SUS agents usually measure blood pressure and check other health parameters during consultations. There is a project in Goiás that plans to train employees to include breast analysis in this routine”, exemplifies the SBM doctor.
With a more integrated system, these agents can even generate the mammography order, skipping some steps in the process.
It should be noted that the 60-day Law, published in 2012, establishes that it is the right of the person with cancer to start care within that period.
A problem in Brazil and in the world
Breast cancer is the most incident type of tumor among women in Brazil (apart from skin cancer, the most common). The National Institute of Cancerology (Inca) forecasts 73,610 new cases of the disease by the end of 2023.
The drama is the same all over the world. According to the World Health Organization (WHO), breast cancer overtook lung cancer in 2021 and became a the most common type of disease on the planet. Again: skin tumors, which are more frequent and benign, are not included in this account.
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In 2020, more than 2 million cases were registered, or 11.7% of the total. A more recent study predicts that by 2040, the annual incidence of breast cancer will increase by 40% (there will be more than 3 million new cases) and there will be 50% more deaths (about 1 million). The study was published in the journal At my mom.
prevention
Healthy lifestyle habits guide the prevention of many diseases, and breast cancer is no different.
“About 10% of the population may have genes that increase the risk of developing the tumor, but lifestyle counts more than this family inheritance,” says Freitas-Junior.
To get an idea, maintaining a healthy diet and practicing physical exercise helps reduce the risk by 25%, according to the doctor.
It is still essential to take care of your body weight and avoid smoking and alcoholic beverages.
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