Compliance with Brazilian Law 12.732: assessing breast cancer treatment delays across different therapeutic modalities (2017-2022)

Abstract

Introduction: Breast cancer (BC) is the most common cancer among women in Brazil and worldwide, followed by non-melanoma skin cancer. Law No. 12,732, of November 22, 2012, stipulates that cancer treatment should begin within 60 days of the anatomopathological diagnosis. However, the time to start treatment is still variable in Brazil. Methods: A cross-sectional observational ecological study was conducted using data on breast cancer in Brazil between 2017 and 2022, obtained from the DATASUS-SISCAN database. Patients with a diagnosis of breast cancer (ICD C50), the federative unit (UF) of residence, and the treatment modality were considered. Five-time intervals were defined for the start of treatment. The χ² and Z tests of two proportions were used, considering a 95% confidence interval (p<0.05). Results: Of the 243,277 evaluated cases, the highest frequency of patients was in the interval of more than 120 days to start treatment (25.5%). Surgery as a modality had a predominance of treatment initiation within 30 days in Brazil and in all regions, with the Northeast and South presenting 63.3% and 66.9% of patients starting treatment within 30 days, respectively. The chemotherapy modality had a greater distribution of patients in the interval of 31 to 60 days in the Northeast (26.1%) and in the South (26.3%), with the remaining regions predominantly showing intervals of more than 120 days. For radiation therapy, the predominance of treatment was after 120 days from diagnosis in all segments. Conclusion: Most patients waited more than 120 days to start breast cancer treatment. Surgical treatment had the shortest waiting time, while radiation therapy showed the longest intervals. For chemotherapy, the time until initiation was variable. In the trend analysis, a decrease in the time to start treatment was evident.