ABSTRACT:

Objective:

To describe the profile of patients who reported a medical diagnosis of cancer and describe the most prevalent types of cancer, according to selected variables.

Methods:

A descriptive study that used data from the National Survey of Health, 2013, to estimate prevalence and their values of confidence interval (95%CI).

Results:

Less than 2% of adults reported a medical diagnosis of cancer, with most reported by women, people over 60, among whites, residents in the village and residents of South Prostate cancer was the most reported among men and breast among women. The lowest average age of first diagnosis was identified for cervical cancer (35.4 years; 95%CI 30.3 - 40.6) and the highest for prostate (65.7 years; 95%CI 64.2 - 67.0).

Conclusion:

The findings of this study are important for the planning of health services and access, as they show differences mainly regional.

Keywords:
Neoplasms; Chronic disease; Health surveys; Epidemiological surveillance; Prevalence; Brazil.

INTRODUCTION

Cancers may be caused by different risk factors and their role in its etiology is currently well known. It is a disease of multiple causes, such as environmental, cultural, socioeconomic factors, life style and customs, with focus on: smoking and eating habits, genetic factors and the aging process itself¹1. Peto J. Cancer epidemiology in the last century and the next decade. Nature 2001; 411: 390-95. ²2. Jemal A, Center MM, DeSantis C, Ward EM. Global patterns of cancer incidence and mortality rates and trends. Cancer Epidemiol Biomarkers Prev 2010; 19(8): 1893-907. ³3. Bray F, Jemal A, Grey N, Ferlay J, Forman D. Global cancer transitions according to the Human Development Index (2008-2030): a population-based study. Lancet Oncol 2012; 13: 790-801.. Tumors have grown worldwide and are the second cause of death in most countries⁴4. Hoyert DL, Xu JQ. Deaths: preliminary data for 2011. Natl Vital Stat Rep 2012; 61(6): 1-52. Disponível em: Disponível em: http://www.cdc.gov/nchs/data/nvsr/nvsr61/nvsr61_06.pdf . (Acessado em 15 de março de 2015).
http://www.cdc.gov/nchs/data/nvsr/nvsr61... . In developed countries it is expected that soon cancers Will surpass cardiovascular diseases⁵5. World Health Organization. Global status report on noncommunicable diseases 2010. Geneva: World Health Organization; 2011. p. 176..

In Brazil, in 2011, cancer was responsible for 16.4% of deaths, being the second cause of mortality⁶6. Carvalho MD, Moura L, Prado RR, Escalante JC, Schmidt MI, Duncan BB. Mortalidade por doenças crônicas não transmissíveis no Brasil e suas regiões, 2000 a 2011. Epidemiol Serv Saúde 2014; 23(4): 599-608.. Besides that, for some kinds of cancer, the mortality trend follow a pattern similar to the one observed in developed countries⁷7. Azevedo e Silva G, Gamarra CJ, Valente JG. Tendência da mortalidade por câncer nas capitais e interior do Brasil entre 1980 e 2006. Rev Saúde Pública 2011; 45: 1009-18.. The hospitalization data of the Unified Health System (Sistema Único de Saúde - SUS) show that tumors were the third cause for hospitalization in the period from 2002 to 2012⁸8. Malta DC, Prestes IV, Oliveira JCG, Moura L, Nunes ML, Oliveira MM, et al. Morbidade hospitalar e ambulatorial em Doenças Crônicas não Transmissíveis no Sistema Único de Saúde - DCNT. In: Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde (org.). Saúde Brasil 2012: uma análise da situação de saúde e dos 40 anos do Programa Nacional de Imunizações. Brasília: Ministério da Saúde; 2012. p. 243-71..

According to the cancer estimates for the country, based on the Population-Based Cancer Registries (Registros de Câncer de Base Populacional - RCBP) of the country and the Mortality Information System (Sistema de Informação sobre Mortalidade - SIM), were estimated, for 2014, approximately 576 thousand new cases of cancer, excluding the non-melanoma skin cancer (182 thousand new cases)⁹9. Instituto Nacional de Câncer. Coordenação de Prevenção e Vigilância. Estimativa 2014: Incidência de Câncer no Brasil. Rio de Janeiro: INCA; 2014., which shows the burden of the disease in the morbidity and mortality profile of the country. Cancer requires great demand of investment in prevention and assistance policies, especially when considering the long exposure period to environmental and individuals risk factors, in addition to populational aging¹⁰10. Harford JB, Edwards BK, Nandakumar A, Ndom P, Capocaccia R, Coleman MP, ICCC-3; Session A Group. Cancer control-planning and monitoring population-based systems. Tumori 2009; 95: 568-78..

In the editions of 2003 and 2008 of the National Household Sample Survey (Pesquisa Nacional de Amostra Domiciliar - PNAD) were estimated prevalences of cancer of 0.40 and 0.56%, respectively, considering that in the edition of 2008 the prevalence of cancer among men was 0.51%, and among women of 0.61%¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68..

Considering the burden of this disease for the country, in 2013, the National Health Survey (NHS), in the module for chronic diseases, issues related to cancer were investigated, with the objective of knowing the prevalence of people who live or lived with the disease in the country. Thus, the objective of this work was to describe the profile of patients who reported medical diagnosis for cancer and to describe the most prevalent types of cancer, according to the selected variables.

METHODS

This was a cross-sectional study which used data from the NHS of 2013, carried out by the Brazilian Institute of Geography and Statistics (Instituto Brasileiro de Geografia e Estatística - IBGE), in partnership with the Ministry of Health (MS). The population of the study consisted of adults living in private households in Brazil.

The parameters used to the sample calculation takes into account the main indicators studied on people with characteristics of interest, to be representative of Brazil, of the 5 regions and the 27 federation units. A conglomerate sample in three stages was carried out. In the first stage the census sectors in a simples random form from a Master Sample of the Integrated System of Household Surveys of IBGE. In the second stage there were the households by simple random sampling using the National Address List for Statistical Purposes of IBGE. And finally, in the third stage, a resident aged 18 years old or more was selected by equiprobability¹³13. Szwarcwald CL, Malta DC, Pereira CA, Vieira MLFP, Conde WL, Souza Júnior PRB, et al. Pesquisa Nacional de Saúde no Brasil: concepção e metodologia de aplicação. Ciênc Saúde Coletiva 2014; 19(2): 333-42. ¹⁴14. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde, 2013. Rio de Janeiro: IBGE; 2014..

The final sample consisted of 64,348 households, conducting 60,202 interviews. In order to represent Brazilian adults, the samples was considered taking into account the sampling weight for each selection stage. For more methodological details, see the NHS¹⁴14. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde, 2013. Rio de Janeiro: IBGE; 2014..

The IBGE coordinated the field work, the interviews were carried out using the PDAs (Personal Digital Assistance), handheld computers. The module about chronic diseases was answered by the adult themselves through the random selection program of the PDA, as mentioned above. The interviews were scheduled on the dates and times more convenient for the informants, predicting two or more visits in each household¹⁴14. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional de Saúde, 2013. Rio de Janeiro: IBGE; 2014..

Cancer prevalences were analyzed using the following variables and the respective question in the questionnaire:

The calculation was carried out for the prevalence of categorical variables and their respective values in the confidence interval of 95% (95%CI) according to gender, race/color, place of residence; the mean age and the 95%CI of the diagnosis were estimated by location. The data were analyzed using the statistical package Stata .

The NHS project was approved by the Research Ethics Committee, of the National Health Council, under endorsement No. 328.159, of June 26th 2013, in June 2013.

RESULTS

The NHS pointed out that 1.8% (1.6 - 2.0) of the adults reported having been diagnosed with cancer at some point in their lives. Despite this report being higher among women (1.9%; 1.8 - 2.3), there was no difference between genders. The prevalence of the ones who reported the diagnosis was lower within the age range from 18 to 29 years of age (0.3%; 0.1 - 0.6) and from 30 to 59 years of age (1.3%; 1.1 - 1.5), reaching 7.7% (5.9 - 9.4) among people who were older than 75 years of age; 3.0% (2.2 - 3.8) of the ones who completed their college degree reported the diagnosis; however, no differences of diagnosis were observed among people with different levels of instruction. The prevalence of medical diagnosis of cancer was higher among people who were self-declared race/color Caucasian/White (2.6%; 2.3 - 3.0). Considering the place of residence, the highest prevalences were observed in the urban area (1.9%; 1.7 - 2.2) and among the residents of the South region (3.2%; 2.6 - 3.8) (Table 1).

As for the type of cancer diagnosed, the prostate cancer was the most often reported one among men (36.9%; 29.5 - 45.0), and the breast cancer was the most often reported one among women (23.0%; 18.8 - 27.8) (Figure 1).

The mean age of the first cancer diagnosis was 51.9 years of age. The lowest mean age was observed for cervical cancer (35.4 years of age), and the highest, for prostate cancer (65.7 years of age). When comparing the mean ages, it was verified that there was no difference for lung, intestine, stomach, skin and other cancers, nor between men and women, for neither kind of cancer evaluated (Table 2).

When analyzing the types of cancer by region of residence, it was observed that, in the Northern region, the highest proportion was cervical cancer, while in the Southeastern region it was the breast cancer. For the Northeastern, Southern and Mid-Western regions, the highest proportions observed were the ones for breast cancer and others. The stratified analysis by gender showed that the prostate cancer had the highest proportion among men living in the Mid-Western, Northern and Southeastern regions. Among women, it was observed the highest proportion of breast cancer in the Southeastern and Northeastern regions, and cervical cancer in the Northern region (Table 3).

DISCUSSION

This survey showed that less than 2% of the adults reported medical diagnosis for cancer at some point in their lives, more often among women, people over 60 years of age, with complete college degree, among the ones self-declared White/Caucasian, among the residents of urban areas and residents of the Southern region. The prostate cancer was the most reported one among men; among women, breast cancer was the most prevalent one. The mean age for the first diagnosis was lower for cervical cancer and higher for prostate cancer. Among men, the prostrate cancer was the most reported one in the Mid-Western, Northern and Southeastern regions; among women, in the Southeastern and Northeastern, the breast cancer, as well as the cervical cancer, were the most reported ones.

The prevalence found in this study was higher than the one found in researches using data from the PNAD from 2003 to 2008, being 0.40 and 0.56, respectively¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68..

In this work, the diagnosis of cancer was most often reported by women, as well as in other studies¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68.. It is noteworthy that women tend to report their morbidities more than men, as well as more often seeking for health care, and consequently having timely diagnosis and treament¹⁵15. Gomes R. Sexualidade Masculina, Gênero e Saúde. Rio de Janeiro: Fiocruz; 2008. ¹⁶16. Figueiredo WS, Schraiber LB. Concepções de gênero de homens usuários e profissionais de saúde de serviços de atenção primária e os possíveis impactos na saúde da população masculina, São Paulo, Brasil. Ciênc Saude Coletiva. 2011; 16(Supl. 1): 935-44..

It was verified, also, most reports of diagnosis with the increasing age, corroborating the results from other studies¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68.; besides that, such finding is what would be expected according to the natural story of most cancers. Similar findings were also verified in other Brazilian surveys¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68. ¹⁷17. Guerra MR, Gallo CVM, Mendonça GAS. Risco de câncer no Brasil: tendências e estudos epidemiológicos mais recentes. Rev Bras Cancerol 2005; 51(3): 227-34. ¹⁸18. Almeida MF, Barata RB, Monteiro CV, Silva ZP. Prevalência de doenças crônicas auto-referidas e utilização de serviços de saúde, PNAD/1998, Brasil. Ciênc Saúde Coletiva 2002; 7(4): 743-56.. It is noteworthy that the significant increase of cancer prevalence with the growing age, once that, with the aging of the Brazilian population, the chronic diseases began representing an expressive and increasing demand for health services¹⁸18. Almeida MF, Barata RB, Monteiro CV, Silva ZP. Prevalência de doenças crônicas auto-referidas e utilização de serviços de saúde, PNAD/1998, Brasil. Ciênc Saúde Coletiva 2002; 7(4): 743-56..

The data found follow the cancer epidemiology in Brazil, in which it is observed higher incidence of prostate and breast cancers⁹9. Instituto Nacional de Câncer. Coordenação de Prevenção e Vigilância. Estimativa 2014: Incidência de Câncer no Brasil. Rio de Janeiro: INCA; 2014.. It is also observed that most people had their diagnosis after they were 60 years of age, which is expected for most malignant tumors¹⁹19. Veras R, Lima-Costa MF. Epidemiologia do Envelhecimento. In: Almeida Filho N, Barreto ML. Epidemiologia & Saúde. Rio de Janeiro: Guanabara Koogan; 2011. p. 427-37..

An exception to this finding was verified for the diagnosis of cervical cancer which showed a mean age of 35 years old. This, besides being a characteristic observed in poor countries, it is compatible with the natural story of the disease, in which women infected by the human papillomavirus (HPV) close to their sexual initiation have greater probability to early ²⁰20. Bosch FX, Lorincz A, Muñoz N, Meijer CJ, Shah KV. The causal relation between human papillomavirus and cervical cancer. J Clin Pathol 2002; 55(4): 244-65.. Te control actions for cervical cancer in Brazil which began in the late 1990s²¹21. Instituto Nacional de Câncer. Viva Mulher. Câncer do Colo do Útero: Informações Técnico-Gerenciais e Ações Desenvolvidas. Rio de Janeiro: INCA 2002. broadened the preventive gynecological exam²²22. Meira KC, Azevedo e Silva G, Silva CMF, Valente JG. Age-period-cohort effect on mortality from cervical cancer. Rev Saúde Pública 2013; 47: 274-82., which may be measured by the high coverages informed in previous researches²³23. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Vigitel Brasil 2013: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde 2014. ²⁴24. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios. Um panorama da saúde no Brasil. Acesso e utilização de serviços, condições de saúde e fatores de risco e proteção à saúde 2008: Brasil/IBGE, Coordenação de Trabalho e Rendimento. Rio de Janeiro: IBGE 2010 . It is also pointed out the introduction of the HPV vaccine for teenagers in 2013, which may, in the future, change the picture of infections by this virus²⁵25. Borsatto AZ, Vidal MLB, Rocha RCNP. Vacina contra o HPV e a prevenção do Câncer do Colo do Útero: subsídios para a prática. Rev Bras Cancerol 2011; 57(1): 67-74.. Besides the early performing of the exam, in order to obtain a reduction on the incidence and in mortality it is necessary that all women who had results changes in screening have their treatment in a timely manner²⁶26. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Atenção Básica. Rastreamento. Brasília: Ministério da Saúde 2010. ²⁷27. Azevedo e Silva G, Bustamante-Teixeira MT, Tomazelli JG, Aquino E, Santos Silva I. Acesso à detecção precoce do câncer de mama no Sistema Único de Saúde brasileiro: uma análise a partir dos dados do Sistema de Informações de Saúde. Cad Saúde Pública 2014; 30(7): 1537-50..

Another interesting fact is the high prevalence of people diagnosed in the Southern region (3.2; 2.6 - 3.8), even higher to the one registered in the Southeastern region (2.1; 1.7 - 2.5). These two regions are the ones with the highest socioeconomic level in the country, the most populated ones, with higher numbers of available health care, and therefore higher option for diagnosis, and with greater elderly population, which results in higher prevalences of cancer²⁴24. Instituto Brasileiro de Geografia e Estatística. Pesquisa Nacional por Amostra de Domicílios. Um panorama da saúde no Brasil. Acesso e utilização de serviços, condições de saúde e fatores de risco e proteção à saúde 2008: Brasil/IBGE, Coordenação de Trabalho e Rendimento. Rio de Janeiro: IBGE 2010 .

Unlike the results found in this study, in which the prevalence, when analyzed by school education, Did not show significant differences between the people with higher or lower education, other studies pointed out higher frequencies in the segments of low education levels, revealing social inequality in the presence of chronic diseases¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68.. It should be mentioned that, as the prevalence measured in the NHS is defined by medical diagnosis, it only considers people Who had Access to specialized services, which allows residents of urban areas to have higher chances of being diagnosed²⁸28. Azevedo e Silva G, Gamarra CJ, Girianelli, Valente JG. Tendência da mortalidade por câncer nas capitais e interior do Brasil entre 1980 e 2006. Rev Saúde Pública 2011; 45: 1009-18.. This finding was also observed in the study using data from the PNAD of 2003¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26..

The presence of reported morbidity is strongly dependent of the pattern of Access to health services and diagnostic procedures. Having been informed by a health Professional about having a given clinical condition or being submitted to a drug treatment for the control of a disease implies having had Access to the services, which is differentiated regionally and socially. Thus, an increase on the prevalence of a morbid condition may be a positive indicator of Access to the services (with broadening of the Access to the diagnostic and/or reduction of mortality), if accompanied by the absence of incidence growth¹¹11. Barros MBA, Cesar CLG, Candira L, Torre GD. Desigualdades sociais na prevalência de doenças crônicas no Brasil, PNAD-2003. Ciênc Saúde Coletiva 2006; 11(4): 911-26. ¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68..

The recognition of the disease by the individual depends on the perception degree of signs and symptoms, the Access to medical services and to diagnostic tests, besides the type and the quality of the guidance obtained by health professionals¹²12. Barros MBA, Francisco PMSB, Zanchetta LM, Chester LGC. Tendências das desigualdades sociais e demográficas na prevalência de doenças crônicas no Brasil, PNAD: 2003- 2008. Ciênc Saúde Coletiva 2011; 16(9): 3755-68.. In the case of cancer, in addition to awareness, having Access to diagnosis and treatment means having had referral to specialized services with complementary tests and specialized treatment, which requires the services to have resoluteness in Oncology.

The limitations of this study refer to the formulation of the matters studied: the issue on cancer diagnosis does not allow distinction between people Who were diagnosed with cancer and the ones Who have it at the moment, which may overestimate the prevalence; and in this study it was higher than the ones found by the PNAD of 2003 and 2008, as mentioned before. As for the matter of types of cancer there is a category called "other cancers" and it had great proportions, however, it is not possible to stratify them, due to the way the issue was built.

As for the percentages of this study, they do not represent the incidence of cancer or the mortality rates, but the prevalent cases instead, i.e., the percentage of individuals Who survived after the diagnosis. Among the ones Who survived cancer, it is expected a higher percentage among individuals with diagnosis of tumors with better prognostic, such as breast cancer (among women), and the prostate one (among men) and intestine cancer (for both genders). On the other hand, it is expected lower prevalence of people diagnosed with high mortality cancer, such as lung cancer, since survivors are, probably, the ones Who had early detection of very early tumors, before they metastasized, increasing the possibility of cure. This number is low since that, for lung cancer, there is no recommendation of radiographic screening and the therapeutic possibilities for initial cases are still limited.

Thus, the prevalences found regard tumor reported, i.e., the competition between prevalent cancers with better prognostic, as observed for the colorectal cancer in the Southern and Southeastern regions, and, consequently, lower prevalence of other types of cancer, such as lung cancer in the Southern region.

In 2011, with the launch of the Strategic Plano f Action for Fighting Non-Communicable Chronic Diseases in Brazil (Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil )²⁹29. Brasil. Ministério da Saúde. Plano de ações estratégicas para o enfrentamento das doenças crônicas não transmissíveis (DCNT) no Brasil, 2011-2022. Brasília: Ministério da Saúde 2011. and the National Policy for Prevention and Control of Cancer in the Primary Health Care Network for People with Chronic Diseases in SUS (Política Nacional para a Prevenção e Controle do Câncer na Rede de Atenção à Saúde das Pessoas com Doenças Crônicas no âmbito do SUS )³⁰30. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 874, de 16 de maio de 2013. Institui a Política Nacional para a Prevenção e Controle do Câncer na Rede de Atenção à Saúde das Pessoas com Doenças Crônicas no âmbito do Sistema Único de Saúde (SUS).; Brasília: Ministério da Saúde 2013., several measured were adopted in order to reduce mortality and morbidity caused by breast and cervical cancer, established by the Brazilian Guidelines for Screening of Cervical Cancer (Diretrizes Brasileiras para o Rastreamento do Câncer de Colo de Útero ), containing clinical procedures For the appropriate care of women identified as possible carriers of precursor lesions of cervical cancer, broadened the screening age range, including women from 25 to 64 years of age, and determined guidelines for a greater Access to the Pap test, resulting in an increase of tests carried out. It was also created the National Program of Cytopathology Quality (Programa Nacional de Qualidade em Citopatologia ), with the measures for qualification of large cytopathology laboratories, and there is an ongoing structuring of 20 services of diagnosis confirmation and treatment of the precursor lesions of cervical cancer³¹31. Malta DC, Silva Junior JB. Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil após três anos de implantação, 2011-2013. Epidemiol Serv Saúde 2014; 23(3): 389-98. ³²32. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 189, de 31 de janeiro de 2014: Institui o Serviço de Referência para Diagnóstico e Tratamento de Lesões Precursoras do Câncer do Colo de Útero (SRC), o Serviço de Referência para Diagnóstico de Câncer de Mama (SDM) e os respectivos incentivos financeiros de custeio e de investimento para a sua implantação.; Brasília: Ministério da Saúde 2014. ³³33. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 176, de 29 de janeiro de 2014. Altera dispositivos à Portaria nº 3.388/GM/MS, de 30 de dezembro de 2013, que redefine a Qualificação Nacional em Citopatologia na prevenção do câncer do colo do útero (Qualicito) no âmbito da Rede de Atenção à Saúde das Pessoas com Doenças Crônicas. Brasília: Ministério da Saúde 2014..

In relation to the prevention and control action for breast cancer, a reference service was created for the diagnosis of breast cancer, which has invested in order to expand the mobile mammography service and the structuring of 50 mammary diagnostic services³¹31. Malta DC, Silva Junior JB. Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil após três anos de implantação, 2011-2013. Epidemiol Serv Saúde 2014; 23(3): 389-98. ³²32. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 189, de 31 de janeiro de 2014: Institui o Serviço de Referência para Diagnóstico e Tratamento de Lesões Precursoras do Câncer do Colo de Útero (SRC), o Serviço de Referência para Diagnóstico de Câncer de Mama (SDM) e os respectivos incentivos financeiros de custeio e de investimento para a sua implantação.; Brasília: Ministério da Saúde 2014.. There was an increase of offers For mammography exams and the results of the Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Inquiry (Vigilância de Fatores de Risco e Proteção para Doenças Crônicas por Inquérito Telefônico - Vigitel) showed expansion in mammography coverage in the capitals, from 71.1%, in 2007, to 78.0%, in 2013²³23. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Vigitel Brasil 2013: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: Ministério da Saúde 2014.. In the Radiotherapy Expansion Plan in SUS (Plano de Expansão da Radioterapia no SUS ) is expected the creation of radiotherapy services in 48 hospitals and expansion of 32 existing services, totaling the acquisition of 80 radiotherapy equipments by the MS (Linear Accelerator), in addition to remodeling of hospitals³¹31. Malta DC, Silva Junior JB. Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil após três anos de implantação, 2011-2013. Epidemiol Serv Saúde 2014; 23(3): 389-98. ³⁴34. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 931, de 10 de maio de 2012. Institui o Plano de Expansão da Radioterapia no Sistema Único de Saúde (SUS).; Brasília: Ministério da Saúde 2012..

The vaccine against Hepatitis B is part of the vaccination calendar of children, adolescents and adults and is available in vaccine centers of SUS, which expanded the offer of vaccines for the age range from 30 to 49 years old. Besides that, every newborn must have their first dose right after birth, preferably within the first 12 hours of life. If the mother has hepatitis B, the newborn, in addition to the vaccine, should receive immunoglobulin against hepatitis B within the first 12 hours of life. The HPV vaccine is offered to pre-teenagers between 11 and 13 years of age in the Primary Care Units (unidades básicas de saúde - UBSs) and also in public and private schools, in coordination with the health units of each region. In 2015, teenagers between 9 and 11 years of age Will be vaccinated³¹31. Malta DC, Silva Junior JB. Plano de Ações Estratégicas para o Enfrentamento das Doenças Crônicas Não Transmissíveis no Brasil após três anos de implantação, 2011-2013. Epidemiol Serv Saúde 2014; 23(3): 389-98.. It is expected, with those action, to improve in prevention, treatment and survival of patients with cancer in the country and Who converge with the enforcement of the Law ensuring the beginning of the cancer treatment within 60 days after the diagnosis³⁵35. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 1220 de 03 de junho de 2014. Altera o art. 3º da Portaria nº 876/GM/MS, de 16 de maio de 2013, que dispõe sobre a aplicação da Lei nº 12.732, de 22 de novembro de 2012, que versa a respeito do primeiro tratamento do paciente com neoplasia maligna comprovada, no âmbito do Sistema Único de Saúde (SUS). Brasília: Ministério da Saúde 2014..

CONCLUSION

The findings of this study are important for the planning of health services and their Access, since they show differences, specially regional ones. These may be, also, a reflex of how the health services were previously organized. Nowadays, it is expected that, with the investments in the health área, especially regarding the reorganization of services, such as the building of a line of care for patients with cancer³⁰30. Brasil. Ministério da Saúde. Gabinete do Ministro. Portaria nº 874, de 16 de maio de 2013. Institui a Política Nacional para a Prevenção e Controle do Câncer na Rede de Atenção à Saúde das Pessoas com Doenças Crônicas no âmbito do Sistema Único de Saúde (SUS).; Brasília: Ministério da Saúde 2013., may, in addition to helping with Law enforcement for the treatment of cancer to also, in the future, have an impact on the natural story of the disease, especially in the pathogenic period of cancer, allowing the early diagnosis and treatment and, thus, as a result, provide greater survival time for patients Who were diagnosed with cancer.

References

Publication Dates

History