ANALYSIS OF MORTALITY FROM BREAST CANCER IN THE STATE OF MINAS
GERAIS: AN ANALYSIS OF THE HOSPITAL INFORMATION SYSTEM OF THE
UNIFIED HEALTH SYSTEM IN THE PERIOD FROM 2008 TO 2016
Análise de internações e mortalidade por neoplasia de mama em Minas Gerais: análise de dados
do sistema de informações hospitalares do sistema único de saúde no período de 2008 a 2016
Camila Teles Gonçalves1
Jaqueline Teixeira Teles Gonçalves1,2,3 Luís Gustavo Soares Rodrigues1 Patrícia Alves Paiva3 Karina Andrade de Prince2
Abstract: Objective: To analyze the information of the Hospital Information System of the Unified Health
System about the number of hospitalizations and deaths for breast cancer in women in Minas Gerais, in
the period from 2008 to 2016, regarding epidemiological variables (age, color, and character of service and
number of hospitalizations). Methods: retrospective study, research, cross, descriptive and quantitative
character. The universe of research data of the Hospital Information System of the Unified Health System
concerning the rate of hospitalizations for breast cancer in Minas Gerais, in the period from January 2008
to December 2016. Results: during this period were 52,180 hospitalizations were registered having an
increase in the period studied. As for the character of care, it was found prevalence of elective care (50.6%).
The predominance of the private service scheme (85.6%), with the largest number of deaths in the age
group from 50 to 59 years. As for the color/race, 43.8% declared themselves mixed race. Conclusion: in
Minas Gerais, the number of hospitalizations and deaths for breast cancer has increased significantly each
year, being more common in the age group from 40 to 59 years, with worse prognosis after 80 years, being
the largest private sector body responsible for hospitalizations and expenditures of these patients, and they
occur predominantly in the central region of the State.
Keywords: Breast cancer; Epidemiological profile; Morbidity and mortality; Public health.
________________
Corresponding author: Camila Teles Gonçalves. E-mail: camilatelesg@hotmail.com
1 Faculdades Unidas do Norte de Minas.
2 Faculdades Integradas Pitágoras de Montes Claros. 3 Universidade Estadual de Montes Claros.
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Resumo: Objetivo: analisar as informações do Sistema de Informações Hospitalares do Sistema Único
de Saúde sobre o número de internações e óbitos por neoplasia de mama em mulheres em Minas Gerais,
no período de 2008 a 2016, referentes às variáveis epidemiológicas (idade, cor, regime e caráter de
atendimento e número de internações). Metodologia: estudo de investigação, retrospectivo, transversal,
de caráter descritivo e quantitativo. O universo da pesquisa são os dados do Sistema de Informações
Hospitalares do Sistema Único de Saúde referente à taxa de internações e o número de óbitos por câncer de
mama em Minas Gerais, no período de janeiro de 2008 a dezembro de 2016. Resultados: Registraram-se
nesse período 52.180 casos de internações com aumento crescente no período estudado. Quanto ao caráter
de atendimento, verificou-se prevalência de atendimentos eletivos (50,6%). O predomínio do regime de
atendimento foi o privado (85,6%), com maior número de óbitos no grupo etário de 50 a 59 anos. Quanto à
cor/raça autorreferida, 43,8% declararam-se pardas. Conclusão: em Minas Gerais, o número de internações
e óbitos por câncer de mama tem aumentado expressivamente a cada ano, sendo mais frequente na faixa
etária dos 40 aos 59 anos, com pior prognóstico após os 80 anos, sendo o setor privado o maior órgão
responsável pelas internações e gastos desses pacientes, e estas ocorrem predominantemente na região
central do Estado.
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INTRODUCTION
The breast cancer presents high prevalence
and mortality throughout the world, representing
a serious public health problem. Regarding the
incidence, the National Institute of Cancer (INCA),
estimated 57,120 new cases of this neoplasm to the
year 2014.
1According to the Ministry of Health, it is
the neoplasm that kills the most and affects the
female population. It remains as the second type of
cancer most often in the world and the first among
women. In Brazil, due to the difficult access to
early diagnosis, the mortality due to breast cancer
remains high and growing, since the detection of
the disease is performed in an advanced stage.
2In addition to age, previous history or family
history of breast cancer or ovarian cancer, biopsies
of the breast and the presence of mutation in the
genes and several other risk factors have been raised.
However, there are specific practical measures
of primary prevention of breast cancer for the
population.
3Observational studies have suggested
that the prevention of smoking, alcoholism,
obesity, sedentary lifestyle and encouragement to
breastfeeding reduces the risk of breast cancer.
1It is assumed that the increase in incidence
is due to a greater improvement in the diagnosis
of cancer, and changes in the reproductive history
and life style of women around the world.
4It is
noticed that risk factors such as the aging of the
population, the anticipation of menarche, reduction
in the number of pregnancies and in the duration of
breastfeeding, use of contraceptives and hormone
replacement therapy, increased sedentary lifestyle
and obesity, changing eating habits and increased
alcohol consumption by women.
1.5In women with an ever smaller number of
children and at later time n life, it is noted that a
term pregnancy decreases by 25% the risk of breast
cancer, and multiparous women have half the risk
of nulliparous women. Also, patients who got
pregnant before 20 years of age is 35% less risk
than the patients who gave birth after 35 years.
5In
addition, it is justified to analyze the mortality due
to breast cancer, since the knowledge can inform
and strengthen actions of prevention and diagnosis.
Therefore, this paper aimed to analyze the
information of the Hospital Information System of
the Unified Health System (SIH/SUS) about the
number of hospitalizations and deaths for breast
cancer in women in Minas Gerais, in the period
from 2008 to 2016, regarding epidemiological
variables (age, color, and character of service and
number of hospitalizations).
METHODOLOGIES
This is a retrospective, cross-sectional,
descriptive, quantitative-like study. It had as universe
research data from the Hospital Information System
of the Unified Health System (SIH/SUS) Regarding
hospitalizations due to malignant neoplasm of
breast cancer in women from Minas Gerais, in
the period from January 2008 to December 2016,
accessed via the electronic portal
http://tabnet.
datasus.gov.br/
, between the months of January
and March of 2017. The variables evaluated were:
number of hospitalizations, age, color/race; deaths,
expenses, mortality rate, scheme and character of
the attendances. Excel software 12.0 (Office 2007)
was used for management and analysis of data.
Because it is a database of public domain, it was not
necessary to submit the project to the committee on
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63
ethics in research involving humans.
RESULTS
The analysis of SIH/SUS, in the period from January 2008 to December 2016, in Minas Gerais
state-MG, allowed us to identify the occurrence of 52,180 cases of hospitalizations for malignant neoplasm
of breast cancer in women. There was an increasing and significant number of cases between the evaluated
period (2008 to 2016) ranging from 4,139 to 7,789 which is equivalent to an increase of 88.18% (Figure 1).
Analyzing the demographic data, it was found a predominance of admissions aged 50 to 59 years
14,435 (27.6%) and 40 to 49 years 12,743 (24.4%). As to the self-reported color/race, 22,853 (43.8%)
claimed to be of color/race brown and 17,630 (33.78%) white.
As regards the character of care, whether elective or urgent, it was found prevalence of visits 26,416
elective cases (50.6%). The urgency services added 25,764 cases (49,3%). As for the service regime -private
or public, 85.6% occurred in private institutions 44,680 and only 14.3% of the total, being 7,500 cases in
public institutions. The other results are exhibited in table 1.
Figure 1 - Number of hospitalizations due to the breast malignant neoplasia in women
from Minas Gerais, 2008 to 2016.
Table 1 - Sociodemographic and clinical data of hospitalized patients due to
breast malignant neoplasia, Minas Gerais, 2008 a 2016.
Variables
n
%
Age range
0 to 9
10
0.02
10 to 19
406
0.78
In the representation of hospitalizations for breast malignant neoplasm by macroregion of Minas
Gerais, there was a predominance in central macro-region of the state with 20,882 hospitalizations (40%),
and due to this, leads us to the idea that this region holds the reference centers in oncology. The southeast
region appears in second place with 11,832 (22.6%). The other regions had lower rates, possibly because they
are represented by smaller municipalities. The mortality rate of the disease is greater in the macroregions
with a smaller number of cases of hospitalizations, as Jequitinhonha (50) and Mid-Southern (12) (Figure 2).
Continuação da table 1.
Variables
n
%
30 to 39
5355
10.26
40 to 49
12743
24.42
50 to 59
14435
27.66
60 to 69
10355
19.84
≥ 70
7588
14.54
Color/race
White
17630
33.78
Black
3498
6.70
Brown
22853
43.80
Yellow
421
0.80
Indian
37
0.07
No information
7741
14.83
Care character
Elective
26416
50.62
Emergency
25764
49.38
Regime
Public
7500
14.37
Private
44680
85.63
Public
Expenditures
9,624,236.23
12.36
Private
68,213,768.56
87.64
Figure 2 - Number of Hospitalizations and mortality rate due to malignant neoplasm of
breast cancer according to the macroregions of Minas Gerais, 2008 to 2016.
Analysis of mortality from breast cancer in the state of Minas Gerais: an analysis of the hospital information system of the unified health system in the period from 2008 to 2016
GONÇALVES, C. T.; GONÇALVES, J. T. T.; RODRIGUES, L. G. S.; PAIVA, P. A.; PRINCE, K. A. ISSN 2236-5257
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Regarding the notifications of deaths of patients with this neoplasm, 52,180 cases of hospitalization,
3,827 died which represents 7.3%, cases, with an average of 425 in the period assessed (Figure 3).
The rate of average mortality of this disease was 7.36% cases for each thousand hospitalizations,
ranging from 6.58% to 8.38% (Figure 3).
Comparing the number of deaths with the mortality rate per year, it was found that the number was
greater in the year 2016 and 2015 (n = 575/15,02%; n = 481/12,56%) respectively, however, the highest
mortality rate occurred in the year of 2011 (8.38%) and 2012 (7.95%) (Figure 3).
According to age range, it becomes clear
that the number of deaths is higher in groups from
50 to 59 years (n = 1077/ 28.14%) and 60 to 69 (n
= 801 / 20.9%), however, the mortality rate is more
expressive in the age of 19 years (14.29%), and in
those over 80 years (12.66%) (Figure 4).
According to the expenses relating
to hospitalizations due to breast malignant
neoplasm, it is noticed a total expenditure of R$
77,838.004.7, being 87.6% of the the same invested
Figure 3 - Number of deaths and mortality rate due to malignant neoplasm of breast cancer
according to the macroregions of Minas Gerais, 2008 to 2016.
in private institutions, which corresponds to R$
68,213.768.56, which is the reflection of the greater
number of admissions in these institutions.
As to the average length of stay of patients
according to the service regime, it was found that
this is higher in public regime (4.3 days), in relation
to the private regime (3.6 days). However, the
average spending is higher in the private system (R$
1,526,72), in relation to the public (R$ 1,283.23).
DISCUSSION
In the period from January 2008 to December
2016 there were 52,180 cases of hospitalizations
for breast malignant neoplasia in women in the
state of Minas Gerais. There was an increasing and
significant number of cases between the evaluated
period (2008 to 2016) ranging from 4,139 to 7,789
which is equivalent to an increase of 88.1%.
The most affected age group was between
50 to 59 years (27.6%) similar to the result found in
a study carried out at a university hospital.
6Research carried out with women diagnosed
with breast cancer, indexed in hospital records of
Cancer (RHC) found a prevalence of the disease
in the age range of 50 to 69 years.
7Whereas in
the Federal District, the most affected age group
was between 40-49 years. Studies show that the
appearance is more common from the age of 40
years.
8It is known that the more advanced age is a
risk factor for this type of cancer.
In this study, the number of deaths was
higher in groups from 50 to 59 years, a result
similar to another study evaluating mortality from
breast cancer in a medium-sized city .
9As the mortality rate, this was more
expressive in the age lower than 19 years (14.2), and
in those over 80 years (12.6). Brazil is a country of
great geographical variations, with different rates
of mortality from breast cancer in each region, with
higher prevalence in the Southeast region (64.7%).
7Women are the most affected by this
neoplasm, and the brown race is in the first place,
unlike other studies that showed an increased
frequency in white women.
6,7,10,11The largest number of white women with
breast cancer can be associated to the fact that
50% of the population over 20 years of age is
composed of white women.
12Brazil is a country
of great demographic area and with racial diversity
that can justify the differences in clinical outcomes
associated with breast cancer and it may influence
morbidity demonstrating the relevance to research
this variable.
13Analysis of mortality from breast cancer in the state of Minas Gerais: an analysis of the hospital information system of the unified health system in the period from 2008 to 2016
GONÇALVES, C. T.; GONÇALVES, J. T. T.; RODRIGUES, L. G. S.; PAIVA, P. A.; PRINCE, K. A. ISSN 2236-5257
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According to hospitalization regime, in
this research, it was realized that the private system
had a greater predilection, probably due to the
greater access to forms of diagnosis and treatment.
Research conducted in São Paulo revealed that the
treatment in private institutions, the start time of
the adjuvant chemotherapy and radiotherapy were
lower when compared to the public..
14The expenses related to the admissions for
this neoplasm in this study was high, being 87.64%
of this invested in private institutions, reflecting
the increased number of admissions in these
institutions. The assistance in the area of Oncology
is among the most expensive in the medical area,
as a result of high value of diagnostic tests and
anticancer drugs.
15,16CONCLUSION
With this study it is concluded that the
number of hospitalizations and deaths due
to malignant breast neoplasia has increased
substantially each year in the state of Minas Gerais,
being more common in the age ranges from 40 to
59 years. However, the mortality rate is higher after
80 years due to a worse prognosis, as determined
by the secondary complications in this age group.
The private sector is the largest organ responsible
for hospitalizations and costs of these patients, and
these occur predominantly in the central region of
the state of Minas Gerais.
Thus, it is clear the need of knowledge of
the profile of hospitalizations and deaths by breast
malignant neoplasia among women from Minas
Gerais, in order to strengthen the implementation
of public policies aimed at the prevention of this
neoplasia considering aspects of demographic,
epidemiological, racial and cultural distribution,
thereby reducing the morbidity and mortality due
to the disease in the state.
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Analysis of mortality from breast cancer in the state of Minas Gerais: an analysis of the hospital information system of the unified health system in the period from 2008 to 2016
GONÇALVES, C. T.; GONÇALVES, J. T. T.; RODRIGUES, L. G. S.; PAIVA, P. A.; PRINCE, K. A. ISSN 2236-5257
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