Trends in breast cancer surgery at Brazil's public health system.
OBJECTIVE
To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014.


METHODS
Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05.


RESULTS
Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014.


CONCLUSIONS
We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Ruffo
R
Freitas-Júnior
Centro de Oncologia do Paraná, Curitiba, Brazil.
Debora Melo
DM
Gagliato
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
João Wesley Cabral
JWC
Moura Filho
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Pollyana Alves
PA
Gouveia
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Rosemar Macedo Sousa
RMS
Rahal
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Régis Resende
RR
Paulinelli
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Luis Fernando Pádua
LFP
Oliveira
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Paola Ferreira
PF
Freitas
Clinical Hospital of the Federal University of Goias, Goiania, Brazil.
Edesio
E
Martins
Centro de Oncologia do Paraná, Curitiba, Brazil.|Positive University, Curitiba, Brazil.
Cicero
C
Urban
Santa Casa of Belo Horizonte, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil.
Clécio Ênio Murta
CÊM
Lucena
D001938:Brazil; D018427:Breast Implants / Q000639:trends; D001943:Breast Neoplasms / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000639:trends*; D008408:Mastectomy / Q000639:trends*; D015412:Mastectomy, Segmental / Q000639:trends*; D012189:Retrospective Studies; D013524:Surgical Flaps / Q000639:trends; D019472:Universal Health Insurance
breast cancer; breast conserving surgery; breast reconstruction; mastectomy