Ações no controle do câncer de mama : identificação das práticas na atenção primária por meio da usuária na região sudeste da cidade de São Paulo

• Ano de defesa: 2017
• Autor(a) principal: Marques, Carla Andreia Vilanova [UNIFESP]
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Breast neoplasm; Primary prevention; Mass screening; Health Evaluation; Neoplasia da mama; Atenção primária à saúde; Programas de rastreamento; Avaliação em saúde; São Paulo (SP)
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=5070490; http://repositorio.unifesp.br/handle/11600/50505

Objective: to analyze the early detection of breast cancer implementation and the associated factors, for primary health care (PHC) service users from southeast of São Paulo city, according to the Ministry of Health (MoH) guideline. Method: cross-sectional study approved by the Ethics and Research Committees (nº 13926013.3.1001.5505) and conducted from October to December of 2013. The cluster sample survey in two stages was performed, considering 50% of outcome frequency in the target group, 95% of the confidence level and deff of 2.9. In the first stage, 38 of the 90 PHC service has been selected in a simple random sample. In the second stage, the proportion of the target age (35-39, 40-49, 50-69) in the population from the selected PHC services, has been considered in the distribution of the 1.117 women surveyed. The user’s randomized systematic sample has been performed, taking in account the assistance routine in some selected PHC services. The research inclusion criteria for PHC services was been ≥ 3 years in the operation time, for the women, they should be between 35 to 69 years old and been attending in those selected PHC services for ≥ 3 years. The data were collected by trained interviewers, using a validated questionnaire with 83 questions regarding to socioeconomic characteristics, breast cancer risk factors and the actions for the early detection of breast cancer. There were missing data of 167 women resulting 950 in a final sample. The outcome variables analyzed were clinical breast examination (CBE) and mammography. The independent variables were sociodemographic data, risk factor and PHC services (Family Health Strategy, Traditional and Mixed). A descriptive analysis of all the variables has been performed and afterwards, the Pearson's Chi-square test and binary logistic regression were applied, assuming p≤0.05. For the analysis of compliance, the results obtained were compared to those recommended by the MoH. Results: the majority of 950 surveyed women was married, white, with 9 to 11 years of schooling, belonged to the C economic class and did not have health insurance. The preventive practice characteristic revealed a higher prevalence of achievement for women between 50-69 years old, married, white, who were not economically active, belonged to the C economic class, with a standard risk of breast cancer. The CBE frequency was 42.9% and the mammography was 58.5%, while compliance was 39.8% and 28.6%, respectively. Regarding the PHC service to the mammography, there was a higher frequency of this exam in the Traditional PHC service and lower in the FHS. There was a greater biennial coverage of this mammography in the target women with 50 to 69 years old in the Traditional PHC and lower in the Mixed PHC, the compliance of the governmental recommendation was higher in the FHS than in the Mixed and Traditional PHC. The associated factors with mammography were: age, family history of breast cancer assessment, to perform CBE and Pap Smear, to receive age guidance to start the mammography. The associated factors with the CBE were to receive age guidance to start this examination, to have mammography, to receive age guidance to start mammography and to perform a Pap Smear. Conclusion: the mammographic performance was more frequent than the CBE, however, the exams periodicity, target age group and the hereditary breast cancer risk factors has been little considered during the users assessment on PHC services, consequently the outcome show a low coverage and compliance of the government goals. The Traditional PHC offered more mammography, but, higher compliance of the recommendation has been achieved in the FHS. The adherence predictors to preventive practices were to receive age guidance of breast cancer exams and been performed gynecological exams.