Background
Theoretical framework
Methods
Country | Total Population (thousands) | Health coverage(a)
| Health systems type(a)
| National health expenditure as a % of GDP | Physicians per 10,000 pop. | |||
---|---|---|---|---|---|---|---|---|
Public | Social security | Private | Public | Private | ||||
Argentina | 41,119 | 30.2 % | 60.8 % | 9 % | Fragmented | 6.2 | 3.2 | Not available |
Brasil | 198,361 | 75 % | 0 % | 25 % | Unified | 3.1 | 4.1 | 15.1 |
Colombia | 47,551 | Contributory regime: 39.7 % | Without insurance 4.3 % | Segmented and articulated | 3.5 | 1.5 | 16.5 | |
Subsidized regime: 51.4 % | ||||||||
Special regimes: 4.6 % | ||||||||
Mexico | 116,147 | 36.6 %(b)
| 36.8 %(b)
| 0.44 %(b) and without insurance 25.43 % | Segmented, not articulated | 3.0 | 3.1 | 22 |
Venezuela (Boliviarian Republic of) | 29,891 | Not available | 17.5 %(c)
| 11.7 %(c) without insurance 68 % | Segmented, not articulated | Not available | 2.4 | Not available |
Type of informant | Mexico | Colombia | Venezuela | Brazil | Argentina | Total |
---|---|---|---|---|---|---|
Public sector | 7 | 5 | 3 | 3 | 5 | 23 |
Civil society organization | 3 | 5 | 8 | 3 | 3 | 22 |
Professional society | 0a
| 1 | 3 | 3 | 1 | 8 |
Other stakeholder | 4 | 2 | 4 | 1 | 1 | 12 |
Total | 14 | 13 | 18 | 10 | 10 | 65 |
Data source | Mexico | Colombia | Venezuela | Brazil | Argentina |
---|---|---|---|---|---|
Women’s health program | Yes | Yes | Yes | Yes | Yes |
Sexual and reproductive health program | Yes | Yes | Yes | Yes | Yes |
Breast cancer policies | Yes | Yes | No | Yes | Yes |
Breast cancer care/control programs | Yes | No | Yes | Yes | Yes |
Breast cancer treatment consensus | Yes | Yes | No | Yes | Yes |
Breast cancer statistics (from national or regional surveys) | Yes | Yes | Yes | Yes | Yes |
Breast cancer statistics (from continuous information system) | Yes | No | No | Yes | No |
Results
Country | Breast cancer epidemiology (Estimated incidence and mortality per 100,000 women 2008)a
| Specific breast cancer policy | Early detection strategy | Civil society and civic participation | Information system |
---|---|---|---|---|---|
Mexico | Incidence: 27.2 | Yes. Supported by a program with defined objectives and goals. | Organized opportunistic mammography screening program for women 40–69 years old. | High level of participation in the areas of education, research, service provision and lobbying but atomized. | Yes. SICAM PRO-MAMA is a routine data collection system. |
Mortality: 10.1 | |||||
Colombia | Incidence:31.2 | No. Recently approved a cancer care law. National Cancer Institute is involved in policy. | Opportunistic mammography screening for both contributory and subsidized regimens. Not fully organized. Annual mammography starting at 49 years of age, except for symptomatic cases and the related risks. | High level of participation in the areas of education, research, service provision and lobbying but atomized. | No. Indicators produced through national surveys [35]. |
Mortality: 10.0 | |||||
Venezuela | Incidence: 42.5 | Not. The Ministry of Health has an under-funded sub-program for breast cancer control. | Sub-program with indications for opportunistic mammography screening carried out differently in each state. Starting age of mammography 35 years and for women with known risk factors at low age. | Low level of participation in program and policy definition. Active participation in educational activities and support for women with breast cancer. | Yes. Data collection is problematic and not all stakeholders are aware of its existence. |
Mortality: 13.7 | |||||
Brazil | Incidence:42.3 | Yes. Supported by a program with defined objectives and goals. | Organized opportunistic mammography screening program for women 35 years and older and for women with known risk factors less than 35 years old. | High level of organized participation. Assigned seats in state and municipal health councils. | Yes. SISMAMA is a routine information collection system. |
Mortality: 12.3 | |||||
Argentina | Incidence: 74.0 | Not at the national level. Some provinces have well developed policies. | No national screening program due to decentralized health system structure. In generally annual mammography starting from 49 years of age, except for symptomatic cases and the | Low level of participation in program and policy definition. Active participation in service provision. | No. Measured through national studies. |
Mortality: 20.1 |
a) Definition of policy to confront breast cancer
“Up to now, the government has said very little (about breast cancer policy).Plans were initiated and quickly disappeared. The current expectation is that the (new) National Cancer Institute could provide an assessment to understand the situation and see what we can do. (Argentina 4)
b) Early detection strategy
“In the year 2009, the updating process of the Breast Cancer Official Norm started. This process engaged into the discussion of lowering the age of the start of screening mammography down to 40 years, based on the existence of new epidemiological evidence that stated that breast cancer in Mexico was appearing at younger ages. In these discussion the main participants were the government, the academia and civil society organizations”(Mexico 5)
“There is an enormous gap in the timely detection of breast cancer due to the fragmentation of the health care system in two insurance modalities: the contributory and the subsidized. The first one has defined that it should reach 20 % of mammographic screening of its target population while the second has not established any goal at all” (Colombia 5)
c) Civil society and citizen’s participation
“In 2002 conversations started to define a breast cancer policy. Once the analysis was completed in 2003, the ministry of health called upon the civil society and decision makers to debate about cancer policy” (Brazil 3)
d) Information systems
“Cancer registries have faced serious difficulties to have available enough human, material and financial resources to guarantee their continuous operation. These difficulties have affected the continuity of recordings, affecting quality and coverage targets” (Venezuela 3)
“What the Institute of Cancer should do is to put together all registries (..) available throughout the country. We have registries in various provinces even in (small) localities such as Venados Blancos.”(Argentina 4).