Avaliação do programa de rastreamento mamográfico oportunístico realizado pelo Sistema Único de Saúde, no município de Goiânia, em 2010: desempenho dos centros de diagnóstico e indicadores para monitoramento de resultados

• Autor(a) principal: Rodrigues, Danielle Cristina Netto
• Data de Publicação: 2012
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Repositório Institucional da UFG
• Texto Completo: http://repositorio.bc.ufg.br/tede/handle/tde/2981
• topic: Câncer de Mama; Programas de Rastreamento; Mamografia; Sistemas de Informação; Serviços de Saúde; Breast Cancer; Screening Programs; Mammography; Information Systems; Health Services; CIENCIAS DA SAUDE

Introduction: Among governmental measures in support of strategies to control and prevent breast cancer in Brazil, the implementation of the Breast Cancer Control Information System (SISMAMA) has made it possible for Single Health System (SUS) managers to identify users and diagnostic centers and provide data to the National Mammmogram Quality Program (PNQM) as a way of guaranteeing adequate tracking and establishing indicators for monitoring mammography results in each region of the country. Objective: To evaluate the opportunistic mammographic screening program carried out by the Single Health System in the municipality of Goiânia en 2010 in regard to the performance of diagnostic centers and indicators for monitoring results. Method: This was an ecological study in which the results of mammograms performed by SUS on the female population of Goiânia from January to December, 2010 and reported by diagnostic centers to SISMAMA were analyzed. The data were collected from the “export data” file of the state coordination module and the variables studied were analyzed in the two articles produced on the basis of this study. In Article 1, the variables studied were test production by diagnostic center, monthly test volume, tests by clinical indication, screening tests by age group and screening tests by diagnostic conclusion using BIRADS® categories (0,1,2,3,4 and 5). To evaluate the conformity of the diagnostic centers, an arbitrary variation limit of ± 30% of the relative frequency of all diagnostic centers in each BIRADS® category was established. Those centers found to be within this limit were considered to be in conformity. Centers with the same conformity percentage were considered to have the same performance. For Article 2 the variables were mammography distribution by age group, diagnostic conclusion, earlier mammograms and those indicated for biopsy. The following indicators for monitoring the results for the 50- 69 year age group were calculated: participation (coverage) rate, test rate by BIRADS® category (1,2,3,4 and 5), recall rate (BIRADS® 0), percentage of positive mammograms (BIRADS® 0, 4 and 5) and the biopsy indication rate (BIRADS® 4 and 5). Results: In Artlcle 1, of the 31,454 tests carried out on women residing in Goiânia, 8,268 (26.3%) were reported by the proprietary SUS diagnostic center network and 23,186 by the accredited network. Test distribution by age group and type of network shows that 43.3% of tests were carried out on women in the 40-49 year age bracket and 44.8% on women from 50 to 69 years old. Diagnostic conclusion performance was uneven among the diagnostic centers for BIRADS® categories 1,2,3,4 and 5 as well as for BIRADS® category 0 in comparison with the other categories, with p<0.001. In Article 2, for the 50-69 year age bracket, the biennial screening coverage estimate was 25.2% and the mammography ratio for 2010 was 0.14. The indicators for monitoring the results of the SUS opportunistic mammography screening program were the following: the recall rate was 9.6% (BIRADS® 0) and the normal test rate (BIRADS® 1 and 2) was 86.1% while the percentage of positive mammograms (BIRADS® 0, 4 and 5) was 10.9% and the biopsy indication rate was 1.3% (BIRADS® 4 and 5). Conclusion: An analysis of the results makes it possible to construct the first opportunistic mammography screening indicators for Goiânia. These will serve as parameters for monitoring early breast cancer detection measures. MMG services’ unequal diagnostic conclusion performance points to the necessity of implementing result auditing in screening programs to monitor the quality of mammographic test interpretation.