Transitioning from opportunistic to organized cancer screening programs: the experience of the state of São Paulo

Abstract

Cancer screening consists of early detection or precancerous lesions in an asymptomatic population and aims to reduce mortality from the disease. Screening programs can be organized or opportunistic. The first model is characterized by centralized actions for calling the target population of defined age groups, systematic strategies for recall, diagnostic investigation, treatment and follow-up of individuals with abnormal screening tests, quality assurance in all stages involved in the line of care and permanent updating of the database resulting from this process. In the opportunistic model, screening tests are made available upon user request or casually during routine visits to the health services. Organized programs have been more cost-effective. In low- and middle-income countries, insufficient health services and lack of resources make it difficult to implement screening programs as part of public health policies. A recommended option would be to introduce pilot programs with regional coverage before scaling up to a national scale. In the Brazilian context, screening programs for cervical and breast cancer have been conducted for many years on an opportunistic basis; however, there is evidence that they do not achieve the expected results. In São Paulo, trend analysis of mortality rates for cervical cancer shows a decrease between 2000 and 2015, followed by stability until 2019. For breast cancer, between 2000 and 2008 a decline in mortality rates was observed, followed by stability until 2015 and a subsequent rise until 2019. Such interruptions in the trends of falling mortality and high percentages of diagnosis in advanced stages (data from hospital based cancer registries) imply attention and celerity of effective actions to control these diseases. In São Paulo, the proposal to structure organized screening programs for uterine cervix and breast tumors seeks to face one of the great challenges of the Unified Health System (SUS), where 61% of the population depends exclusively on SUS for access to health services. This is the context of the general research proposal presented by the CCD ConeCta-SP, which will be hosted by the Oncocentro Foundation of São Paulo (FOSP), with the objective of applying effective methods for cancer prevention and control. The proposal of this implementation research is to establish resolutive screening programs in the state of São Paulo. The postdoctoral fellow will develop activities related to the introduction of organized screening programs in the state of São Paulo - subprojects 1 and 2 of Axis 1.