Tendência temporal da carga por câncer de mama em países da América

Abstract

In the field of Public Health, breast cancer stands out as a morbidity with both high incidence and high disease-specific mortality. Its incidence and mortality vary widely across countries, according to socioeconomic level. This study analyzed temporal trends in the burden of disease — measured by incidence, mortality, and DALYs (Disability-Adjusted Life Years) — in relation to Sociodemographic Indexes (SDIs), across different age groups (age-standardized, 15–49, 50–69, and ≥70 years), from 1990 to 2021, in countries of the Americas. In addition, it investigated breast cancer control policies in Brazil and Canada and examined disease trends between 1990 and 2021 based on incidence, mortality among women aged 50–69 years, and the mortality-to-incidence ratio. The sample included Canada, the United States, Argentina, Chile, Uruguay, Brazil, Colombia, Costa Rica, and Cuba, selected according to their SDI. The research design was a mixed ecological study of time series and geographical comparisons, using data from the Global Burden of Disease (GBD). For the analysis, the Joinpoint regression model was applied, as it can identify changes in temporal trends. The study identified differences in incidence, mortality, and DALYs from breast cancer among countries in the Americas, associated with sociodemographic profile and screening model, highlighting inequalities in access to diagnosis and treatment. In high-SDI countries (Canada and United States) with organized programs, such as Canada, consistent reductions in incidence and mortality rates were observed. In contrast, middle- and upper-middle-SDI countries (such as Brazil, Argentina, Chile, Colombia, Cuba, Costa Rica, and Uruguay) where opportunistic screening strategies predominate, showed rising incidence trends, stable or more modest declines in mortality, and higher DALY rates. Finally, it is recommended that future research deepen the analysis of the relationship between social determinants, access to screening, and health outcomes. Only evidence-based strategies will make it possible to advance in reducing the burden of breast cancer and to ensure fairer and more effective care for women in different contexts across the Americas.