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publications for full evaluation. At this stage, we excluded
21 articles, seven related to mortality, five presenting post-
-treatment Brazilian Unified Health System (SUS, in the
Portuguese acronym) data, three presenting global aspects
related to different types of cancer, and six for different
reasons (breast changes, social support to cancer, costs in
the private system, ethics, cervical cancer and stage of di-
agnosis). Aiming at a better understanding of the barriers
related to the health system in Brazil, 30 publications re-
mained in the study, and these were the basis of our bib-
liographic review. The data are summarized in Figure 1.
The data are mostly qualitative. We chose to present grouped
results according to the subject presented (Table 2).
CAAE Study No. 56123516.1.0000.5505, approved
by the Research Ethics Committee of Unifesp under
No. 0650/2016 on June 1, 2016.
R
esults
With 30 articles selected according to PICTOS,
4-6,8-34
we
attempted to create groups according to contexts, namely:
TABLE 1
Summary of the findings observed according to PICOTS.
Proposal
Inclusion
P/ Population Breast cancer in Brazil
Breast cancer in Brazil; dependence to the SUS
I/ Intervention Mammography
Health management
Mammography; screening
Health management
C/ Comparison Factors related to the Health System Mammography machine: population-based coverage, availability, quality; management;
type of screening
O/ Outcome Results found
Experience in screening, vulnerable populations, diagnostic flow, clinical stage at diagnosis,
treatment and mortality
T/ Time
Any
Any
S/ Study type Any
Any
TABLE 2
Main results summarized.
PICO
Summary of findings
Goal
Mammography 50-69 years, bi-annually
P/ Population
SUS system population dependent on governmental actions
Subgroup without MMG: absence of health plan, non-white, low income
Patients over the age of 40 who never underwent MMG
Distance from place of residence to treatment greater than 150 km
I/ Intervention
SUS Screening type
Mammography control done by the SISMAMA
MMG usually diagnostic
Opportunistic screening through collective action to meet demand
Organized screening does not exist
Organized screening being implemented at a single center in the country
C/ Comparison
Comparison
Inadequate mammography coverage
Inadequate biannual recall
Unsatisfactory quality of mammography in the SUS
O/ Outcome
Result
Difficulty in patient flow, from diagnosis to treatment
Diagnosis in symptomatic phase
Advanced clinical stage of cancer at diagnosis negatively influencing survival
Mortality: Private < well-structured public < regular public services
Gradual improvement in the supply of MMG and outcomes related to cancer staging, with no defined indicators
Increased incidence and increased mortality: Midwest, North and Northeast regions
Increased incidence and decrease in mortality: South and Southeast
MMG: mammography.