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
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2012-06-27
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Universidade Federal de Goiás
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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.
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RODRIGUES, Danielle Cristina Netto. 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. 2012. 98 f. Dissertação (Mestrado em Ciências da Saúde (FM)) - Universidade Federal de Goiás, Goiânia. 2012.