Banca de DEFESA: JULIANA DANTAS DE ARAÚJO SANTOS CAMARGO

Uma banca de DEFESA de DOUTORADO foi cadastrada pelo programa.
STUDENT : JULIANA DANTAS DE ARAÚJO SANTOS CAMARGO
DATE: 10/07/2026
TIME: 09:00
LOCAL: REMOTA
TITLE:

DIAGNOSIS, MORTALITY AND QUALITY OF INFORMATION ON BREAST CANCER IN BRAZIL: REGIONAL AND SOCIOECONOMIC INEQUALITIES

KEY WORDS:

Breast neoplasms; Mortality; Women's health; Health inequities; Socioeconomic inequalities; Health information quality.

PAGES: 146
BIG AREA: Ciências da Saúde
AREA: Medicina
SUMMARY:

Introduction: Breast cancer is the most frequently diagnosed malignancy among women in Brazil and one of the leading causes of cancer-related death in the female population. Its heterogeneous distribution reflects structural inequalities in healthcare access and health information quality, with underreporting of deaths and ill-defined causes disproportionately affecting the North and Northeast regions.

Objective: To analyze the diagnosis, mortality, and quality of information on breast cancer in Brazil, considering regional and socioeconomic inequalities, from 2000 to 2023.

Methods: This thesis integrates four complementary epidemiological studies. The first, a retrospective population-based study, assessed the impact of the COVID-19 pandemic on breast cancer diagnosis (12,597 cases; 2019–2020), using binary logistic regression to identify predictors of diagnostic delay. The three subsequent ecological studies analyzed breast cancer mortality across Brazil's 27 federative units (2000–2023) from three distinct analytical perspectives: spatial distribution, through Moran's autocorrelation and LISA; temporal trends, through Prais-Winsten regression with annual percent change estimation; and socioeconomic and healthcare access determinants, through Spearman correlations and AIC-based stepwise multiple linear regression. In all ecological studies, mortality data were subjected to a standardized correction protocol based on WHO and IBGE methodologies, comprising proportional redistribution of ill-defined causes of death, redistribution of incomplete cancer diagnoses, and demographic adjustment using correction factors derived from the 2024 IBGE female life tables. Mortality rates were age-standardized using the direct method with the WHO world standard population (2000–2025).

Results: The COVID-19 pandemic reduced breast cancer diagnoses by 50.2% and increased the mean time from first consultation to diagnostic confirmation from 28 to 36 days during the first six months. Diagnostic delay was associated with lower educational attainment, residence in the North, Northeast, or Midwest regions, and non-advanced clinical staging, with these inequalities further exacerbated during the pandemic. In the mortality studies, correction procedures increased the estimated number of deaths by 17.3% over 2000–2023 in the spatial analysis, with adjustments reaching 69.9% in the North and Northeast in the earliest years of the series and declining progressively over time. Trend analysis revealed a corrected national annual percent change of 0.28% (95% CI: 0.19–0.38), with significant increases in the North (0.73%), Northeast (0.82%), and Midwest (1.18%), a stationary pattern in the Southeast, and a decreasing trend in the South (−0.21%). LISA analysis identified persistent High-High mortality clusters in the Southeast and South and Low-Low clusters in the North and Northeast, with some cluster classifications modified after data correction. In the socioeconomic determinants analysis, the Municipal Human Development Index was the most consistent predictor of mortality, with corrected-data models showing greater explanatory power (R² = 59.5%) than uncorrected models (R² = 54.2%).

Conclusion: This study demonstrates that the true burden of breast cancer in Brazil is greater than official records indicate, particularly in the most vulnerable regions, and that regional and socioeconomic inequalities shape both access to diagnosis and mortality patterns. The pandemic amplified pre-existing diagnostic inequities. The systematic incorporation of mortality data correction procedures is essential for more accurate disease burden estimation and for planning more equitable breast cancer control policies.

COMMITTEE MEMBERS:
Presidente - 1199080 - ANA KATHERINE DA SILVEIRA GONCALVES DE OLIVEIRA
Externo à Instituição - JOSE MARIA SOARES JUNIOR - USP
Externa ao Programa - 2081758 - LUCIANA CONCEICAO DE LIMA - nullInterno - 2646619 - RODRIGO PEGADO DE ABREU FREITAS
Externa à Instituição - SOPHIE FRANÇOISE MAURICETTE DERCHAIN - UNICAMP