Breast cancer in Brazil: Screening program and surgical approach

Background: Screening mammography for breast cancer (BC) is a current strategy that reduces the mortality of BC by up to 30 %. Although mastectomy has been an important component of treatment for decades, conservative surgery (lumpectomy) has become the gold-standard approach for most cases, yet it depends on early detection of the BC. Methods: This was an epidemiological study performed through DATASUS (2010-2018). We evaluated the temporal trend of screening mammograms, deaths from BC, and surgical procedures at national, regional and state levels. Statistical analysis was performed on VassarStat (R)-Website for Statistical Computation (Vassar College, New York, USA) and the R-software (R Foundation, v.4.0.3). Results: During 2010-2018 there were 67,392 oncological mastectomies and 48,567 lumpectomies in Brazil's health system. Mastectomies decreased in the Northeast (-3.67 % +/- 0.43 per year) and in Bahia state (-3.58 % +/- 0.24 per year). Lumpectomies increased in Brazil (median 2.19 (-9.6 to 20.96)), the Northeast (median -12.07 (-25.8 to 9.43)) and Bahia (median 0.16 (-29.1 to 1.9)). Also, screening mammograms increased in Brazil (3.29 % +/- 0.43), the Northeast (6.36 % +/- 0.49) and Bahia (5.51 % +/- 0.31), with 35,317,728 exams during this period. Deaths from BC increased annually in Brazil (+4.13 % +/- 0.86), the Northeast (+4.76 % +/- 1.45) and Bahia (+5.65 % +/- 0.83). Conclusion: The number of mammograms related to the screening program increased in the years 2010-2018 in Brazil. Furthermore, we identified an increase in lumpectomies as opposed to mastectomies, and this approach is associated with a reduction in hospitalization days by almost a half, which in turn might result in a cost decrease and probably an earlier return to work.