Transition from an opportunistic breast cancer screening program to an organized program in the state of São Paulo

• Grant number: 22/15539-1
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• Start date: February 01, 2023
• End date: January 31, 2027
• Field of knowledge: Health Sciences - Collective Health - Public Health
• Principal Investigator: Victor Wünsch Filho
• Grantee: Alice Barros Câmara
• Host Institution: Fundação Oncocentro de São Paulo (FOSP). Secretaria da Saúde (São Paulo - Estado). São Paulo , SP, Brazil
• Associated research grant: 21/11794-4 - Cancer Control in the state of São Paulo (ConeCta-SP): from knowledge to action, AP.CCD
• Associated scholarship(s): 25/05545-2 - Assessment of performance and sustainability of the organized breast cancer screening program implemented in São Paulo, BE.EP.PD

Abstract

Cancer screening consists of the early detection of precancerous lesions in an asymptomatic population and aims to reduce mortality from the disease. Screening programs can be organized or opportunistic. The first model is characterized by centralized actions to call the target population of defined age groups, systematic recall strategies, diagnostic investigation, treatment and follow-up of individuals with altered screening tests, quality assurance in all stages involved in the line of care and permanent updating of the database resulting from this process. In the opportunistic model, screening tests are made available upon user request or casually during routine visits to health services. Organized programs have shown better cost-effectiveness. In low- and middle-income countries, insufficient health services and lack of resources make it difficult to implement screening programs as part of public health policies. A recommended option would be to introduce pilot programs with regional coverage before scaling up to a national scale. In the Brazilian context, the screening program for breast cancer has been conducted for many years on an opportunistic basis, however, there is evidence that it does not achieve the expected result. In São Paulo, trend analysis of breast cancer mortality rates showed that between 2000 and 2008 there was a decline in mortality rates, followed by stability until 2015 and later increase until 2019. The interruption in the downward trend in mortality and high percentages of diagnoses in advanced stages, as shown by data from hospital cancer records, constitute facts that imply attention and speed of effective actions to control this disease. In this context, the general research proposal presented by CCD ConeCta-SP, which will be hosted by the Oncocentro Foundation of São Paulo (FOSP), is inserted, with the objective of applying effective methods in the prevention and control of cancer. In this Project, the proposal to structure organized screening programs for uterine cervix (subproject 1) and breast (subproject 2) cancer in São Paulo seeks to face one of the great challenges of the Unified Health System (SUS), where 61% of the population depends exclusively on the SUS for access to health services. In this postdoctoral program the candidate will contribute with the implementation research proposal related to subproject 2 - establishment of a resolutive screening program in the state of São Paulo for breast cancer.