Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units

RLH, TBS and ALF made substantial contributions to the conception and design of the article, the acquisition, analysis and interpretation of the data, and drafting of the article. ECM, JSCM and NB made substantial contributions to the conception and design of the study.Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU) and a fixed unit (FU) in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area. Methods: Based on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p < 0.05. Results: Overall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54%) in the MU). This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p < 0.001) or 40 to 49 years (p < 0.001). No difference was observed between women aged 40 to 49 years and those aged 50 to 59 years (p = 0.164). The proportion of tumors in the early (EC 0 and EC I) and advanced (CS III and CS IV) stages of development were 43.4% and 15.8%, respectively. Conclusions: Preliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation

Costs and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America, and Asia.

Contains fulltext : 51056.pdf (publisher's version ) (Closed access)We estimated the costs and health effects of treating stage I, II, III, and IV breast cancer individually, of treating all stages, and of introducing an extensive cancer control program (treating all stages plus early stage diagnosis) in three epidemiologically different world regions--Africa, North America, and Asia. We developed a mathematical simulation model of breast cancer using the stage distribution and case fatality rates in the presence and absence of treatment as predictors of survival. Outcome measures were life-years adjusted for disability (DALYs), costs (in 2000 U.S. dollars) of treatment and follow-up, and cost-effectiveness ratios (CERs; in dollars per DALY averted). Sensitivity analyses were performed to determine the robustness of the results. Treating patients with stage I breast cancer resulted in 23.41, 12.25, and 19.25 DALYs averted per patient in Africa, North America, and Asia, respectively. The corresponding average CERs compared with no intervention were 78 U.S. dollars , 1,960 U.S. dollars, and 62 U.S. dollars per DALY averted. The number of DALYs averted per patient decreased with stage; the value was lowest for stage IV treatment (0.18-0.19), with average CERs of 4,986 U.S. dollars in Africa, 70,380 U.S. dollars in North America, and 3,510 U.S. dollars per DALY averted in Asia. An extensive breast cancer program resulted in 16.14, 12.91, and 12.58 DALYs averted per patient and average CERs of 75 U.S. dollars, 915 U.S. dollars, and 75 U.S. dollars per DALY averted. Outcomes were most sensitive to case fatality rates for untreated patients, but varying model assumptions did not change the conclusions. These findings suggest that treating stage I disease and introducing an extensive breast cancer program are the most cost-effective breast cancer interventions