TY - JOUR
T1 - A model to optimize public health care and downstage breast cancer in limited-resource populations in southern Brazil. (Porto Alegre Breast Health Intervention Cohort)
AU - Caleffi, Maira
AU - Ribeiro, Rodrigo A.
AU - Filho, Dakir L.Duarte
AU - Ashton-Prolla, Patrícia
AU - Bedin, Ademar J.
AU - Skonieski, Giovana P.
AU - Zignani, Juliana M.
AU - Giacomazzi, Juliana
AU - Franco, Luciane R.
AU - Graudenz, Márcia
AU - Pohlmann, Paula
AU - Fernandes, Jefferson G.
AU - Kivitz, Philip
AU - Weber, Bernardete
N1 - Funding Information:
Finally, we would like to thank the institutions that provide funding for the project. Funding for the main project is supported by the Associação Hos-pitalar Moinhos de Vento social responsibility budget. This includes financing for all clinical visits, exams, surgical treatment and project administration. The genetics study was funded mainly by a grant from Susan G Komen for the Cure (POP0403033). Additional financial support was received from CAPES, CNPq, FAPERGS and FIPE-HCPA (four public funding agencies from Brazil), all achieved through grant applications.
PY - 2009
Y1 - 2009
N2 - Background. Breast cancer (BC) is a major public health problem, with rising incidence in many regions of the globe. Although mortality has recently dropped in developed countries, death rates are still increasing in some developing countries, as seen in Brazil. Among the reasons for this phenomenon are the lack of structured screening programs, a long waiting period between diagnosis and treatment, and lack of access to health services for a large proportion of the Brazilian population. Methods and design. Since 2004, an intervention study in a cohort of women in Southern Brazil, denominated Porto Alegre Breast Health Intervention Cohort, is being conducted in order to test the effectiveness and cost-effectiveness of a model for BC early detection and treatment. In this study, over 4,000 women from underserved communities aged 40 to 69 years are being screened annually with mammography and clinical breast examination performed by a multidisciplinary team, which also involves nutritional counseling and genetic cancer risk assessment. Risk factors for BC development are also being evaluated. Active search of participants by lay community health workers is one of the major features of our program. The accrual of new participants was concluded in 2006 and the study will last for 10 years. The main goal of the study is to demonstrate significant downstaging of BC in an underserved population through proper screening, attaining a higher rate of early-stage BC diagnoses than usually seen in women diagnosed in the Brazilian Public Health System. Preliminary results show a very high BC incidence in this population (117 cases per 100,000 women per year), despite a low prevalence of classical risk factors. Discussion. This study will allow us to test a model of BC early diagnosis and treatment and evaluate its cost-effectiveness in a developing country where the mortality associated with this disease is very high. Also, it might contribute to the evaluation of risk factors in a population with a different ethnic background from that studied in developed countries. If our model is proven effective, it may be replicated in other parts of the globe where BC is also a major public health problem.
AB - Background. Breast cancer (BC) is a major public health problem, with rising incidence in many regions of the globe. Although mortality has recently dropped in developed countries, death rates are still increasing in some developing countries, as seen in Brazil. Among the reasons for this phenomenon are the lack of structured screening programs, a long waiting period between diagnosis and treatment, and lack of access to health services for a large proportion of the Brazilian population. Methods and design. Since 2004, an intervention study in a cohort of women in Southern Brazil, denominated Porto Alegre Breast Health Intervention Cohort, is being conducted in order to test the effectiveness and cost-effectiveness of a model for BC early detection and treatment. In this study, over 4,000 women from underserved communities aged 40 to 69 years are being screened annually with mammography and clinical breast examination performed by a multidisciplinary team, which also involves nutritional counseling and genetic cancer risk assessment. Risk factors for BC development are also being evaluated. Active search of participants by lay community health workers is one of the major features of our program. The accrual of new participants was concluded in 2006 and the study will last for 10 years. The main goal of the study is to demonstrate significant downstaging of BC in an underserved population through proper screening, attaining a higher rate of early-stage BC diagnoses than usually seen in women diagnosed in the Brazilian Public Health System. Preliminary results show a very high BC incidence in this population (117 cases per 100,000 women per year), despite a low prevalence of classical risk factors. Discussion. This study will allow us to test a model of BC early diagnosis and treatment and evaluate its cost-effectiveness in a developing country where the mortality associated with this disease is very high. Also, it might contribute to the evaluation of risk factors in a population with a different ethnic background from that studied in developed countries. If our model is proven effective, it may be replicated in other parts of the globe where BC is also a major public health problem.
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U2 - 10.1186/1471-2458-9-83
DO - 10.1186/1471-2458-9-83
M3 - Article
C2 - 19284670
AN - SCOPUS:64649107077
SN - 1471-2458
VL - 9
JO - BMC public health
JF - BMC public health
M1 - 83
ER -