Survey of public sector resources for breast cancer care in Argentina

VINIEGRA MARIA; PAOLINO MELISA; GONZALEZ PRIETO GUILLERMO; ARROSSI SILVINA

Chigago

Congreso; Global Summit on International Breast Health: Optimizing Healthcare Delivery; 2010

The Breast Health Global Initiative

BACKGROUND: Argentina¡¯s incidence and mortality rates are among the highest in Latin America (73.9 and 21.8 respectively). Mammography (Mx) coverage among women aged ¡Ý50 at national level is 46% with striking differences by provinces (PROVs) (range: 14-75%). In 2009 the Ministry of Health initiated a project to strengthen BC prevention programs. Its first phase (2009-2010) is a situational analysis in the 24 PROVs of the country regarding: a) the organizational framework of BC prevention activities; b) availability of Mx, oncology services and trained staff in public hospitals and c) screening (SCR) quality control procedures. The study was funded by the Pan American Health Organization (PAHO). METHODS: An ad-hoc questionnaire was sent to PROV heads of BC programs. In the case of PROVs lacking a formal program, questionnaires were sent to appointed Ministry of Health officers. A review of programmatic guidelines, program regulations and statistic reports was carried out. RESULTS: Data about program organization were obtained for 22 PROVs of which only 13 have formal programmatic frameworks. In all Mx is the recommended SCR test. Six PROVs also recommend clinical breast examination and 1 breast ultrasound. SCR is mainly opportunistic. The most recommended target age range is 40-70 and SCR interval is 1 year. Four PROVs recommend a target age range of 50-70 and a 2 year interval. The number of Mx devices per PROV varies greatly (range: 1-62). The density of Mx units ranges from 0.42 to 13.6 Mx units per 10000 targeted women, with 13 PROVs having ¡Ý1 per 10000.  Half of Mx units provide services ¡Ü5 hs per day. None reported having comprehensive quality control procedures. All PROVs provide diagnostic and surgical services for women having suspicious mammograms, although the reported time between SCR and definite treatment is highly variable (7 to 150 days). All PROVs provide free of charge antineoplastic drugs for women with public health insurance with a delay varying from 1 to 90 days; only 8 PROVs reported not having problems with the timely supply of drugs. Eight PROVs reported to have practice guidelines for cancer therapy although 7 were not available for review. Both radiation treatment and immunohistochemical testing have the lowest coverage with public services available only in 8 and 5 PROVs respectively; in the others the policy is to refer cases to the private sector or other PROVs. Only 2 PROVs have some kind of computerized information system. Most PROV programs lack data about number of performed procedures, results and follow up of cases. CONCLUSIONS:  This is the first situational analysis of BC care and control in Argentina. Our results suggest that most programs face organizational problems, subutilization of resources and the lack of quality control, monitoring and evaluation systems. These data reveal both strengths and weaknesses of the current programs and underscore the need of a central coordination to improve efficiency.