Access to diagnosis and treatment creates an unequal scenario in the fight against cancer in the country


When it comes to cancer, each region of Brazil has a path to follow for the country to reach the goal of, by 2030, reducing premature mortality by 33% —of people aged 30 to 69 years. Among the local barriers are access to tests and the provision of treatments.

Data published in the scientific journal Frontiers in Oncology and released on Thursday (2) at an event at the headquarters of Inca (National Cancer Institute), in Rio de Janeiro, show that while in the Southeast there is a prediction of a 14.5% reduction considering all forms of cancer among men, in the North the projection is for an increase of 1.1%, when comparing the data from 2011 to 2015 and the projections from 2026 to 2030. Among women, the numbers are respectively -5, 5% and 3.2%.

“There is still a very large disparity”, evaluated Marianna Cancela, a researcher at Inca and one of the authors of the work.

Member of the board of directors of the UICC (International Union for Cancer Control), Ana Cristina Pinho Mendes Pereira said that several issues can contribute to disparities, such as socioeconomic status, place of residence (urban or rural, for example), gender and age of the patient. She also mentioned that people with physical or mental disabilities and members of minority groups may encounter more barriers in treatment.

“These difficulties need to be noted and considered, with the presentation of differentiated proposals”, stated the deputy general director of Inca, Liz Maria de Almeida, during the event.

Held in reference to World Cancer Day (February 4), the meeting highlighted Brazil’s position in the face of the objective proposed by the UN (United Nations) of, by 2030, countries reducing premature mortality from non-communicable diseases by one third. transmissible through prevention and treatment, and promote mental health and well-being.

From current perspectives, only lung cancer will be able to approach the goal, with a 28% reduction at the national level. The result, in this case, is a reflection of long-term government tobacco control efforts.

Premature mortality from colorectal cancer, on the other hand, is expected to rise by 10.2% among men and 8.5% among women. The regional breakdown shows that the variation ranges from 4.5% in the Southeast to 52% in the North (men) and from 0.3% in the South to 37.7% in the Northeast (women).

The participants also drew attention to the maintenance of high rates of cervical cancer, which can be eradicated with the HPV vaccine and the pap smear, and breast cancer.

In the latter, the forecast is for a growth of 0.1% in premature mortality in the country, with a reduction of 4% in the Southeast and an increase of 1.0% in the South, 4.0% in the Midwest, 7.3% in the Northeast and 25.6% in the North.

“Your city, the place where you live cannot determine whether you will live or die from cancer”, criticized Maira Caleffi, head of the Mastology Service at Hospital Moinhos de Vento (RS) and president of Femama (Brazilian Federation of Philanthropic Institutions of Support for Breast Health), this Friday (3).

Also a member of the UICC, she said that there is an effort to raise awareness about the problem of inequality in the fight against cancer and to show that the answer to the problem needs to take into account each context.

In the North region, for example, where there is great difficulty in getting around, it is possible to invest in boats with health professionals and equipment for carrying out tests. Another way to deal with the issue of displacement, preventing people from having to travel, is to establish partnerships with private clinics, where there is often idle equipment.

“Currently, we cannot perform the surgery without a biopsy and without knowing the type of tumor, and the wait for that exam is one of the big bottlenecks”, he exemplifies. Still regarding waiting, she pointed out the importance of patient navigation, with guidance and support from prevention to the end of treatment.

The way in which each region has been recovering from the pandemic also has repercussions, since many services have been dammed up. In the case of the pap smear, for example, data from the Umane Primary Health Care Observatory indicate that, in 2019, 84% of women had taken the exam less than two years ago. In 2021, the rate dropped to 77.6%.

Another point is the adoption of the same protocols in all locations. “It is not possible for each professional to have a conduct, we need to optimize resources”, said Caleffi.

Regionalizing the installation of Cacons (High Complexity Oncology Assistance Center) and intensive radiotherapy, in turn, are ways of moving towards truly universal access to treatment, as they allow for shorter trips and stays.

Finally, experts agree that it is necessary to unite voices and efforts, since cancer is everyone’s problem.

“Often, the woman cannot go for the test because there is no one to look after the children or she cannot miss work, for example. Have you ever asked the people who work with you when the last time they took tests? can you help? We need everyone’s effort,” said Caleffi.

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