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Against delayed diagnosis of cancer in SUS, new law stipulates 30 days for exams



RIO – It was the result of a blood test that lit the
yellow sign
in the life of retired Pedro da Silva, 68 years old. THE
PSA
, protein that, when high, indicates
prostate cancer
, was above the indicated. Still, it needed a
tomography
for confirmation. The test, however, was only performed
six months later
.

The case of the resident of Volta Redonda illustrates a common scenario in the country:
the urgency is missing
appropriate in cases of the disease, which leads to
diagnostics
with
tumors already in advanced stages
– like
attests report of the Court of Auditors of the Union
(
TCU
) released in September.

– It took too long to take the exam. Only when I got to Inca did the thing go – Silva says, in the Volta Redonda city bus that takes patients from Sul Fluminense city to the hospital in the Cruz Vermelha square, in downtown Rio.

According to the TCU study, 80% of lung, thyroid, stomach and oral cavity cancers are diagnosed at more advanced stages. Already the disease in the colon, rectum, cervix, breast and prostate also have a level of 50% in delayed diagnoses.

Since 2013, according to the study, only 6% of people are diagnosed in the first stage of the disease. This is the same level found since 2013. According to the Inca estimate presented by TCU, whose study considers data from 2017 in 14 states of the country, 420,000 people will have cancer between 2018 and 2019.

Last week, the Senate passed a law that requires the Unified Health System (SUS) to do, within 30 days, tests that confirm cancer, after the patient has gone through a medical consultation that raises suspicion of the disease. The text went to President Jair Bolsonaro's sanction or veto.

If approved, the change will be included in the law that stipulates the beginning of treatment by SUS within 60 days from the diagnosis of cancer.

Electronic queue

In the public health system, the responsibility for the disease confirmation test lies with the municipalities. After diagnosis, the municipal network directs the patient to the higher complexity networks, the state or federal.

The organization of exams is done through a kind of electronic queue. In the city of Rio, for example, the Regulation System (Sisreg) points out that all 108 women with the highest degree of urgency will have to wait for a breast ultrasound – one of the exams for diagnosing cancer on the spot – for at least one. at least two months. The first in line at this time, for example, entered the system in February last year.

The Rio de Janeiro Municipal Health Department said that breast ultrasound “is not the screening test or diagnosis of cancer, but the mammogram”, which has “more than enough to meet the demand of the city”. It also says that you need to evaluate each case of ultrasound to explain the delay.

Sandra Gioia, vice president of the Brazilian Mastology Society of Rio de Janeiro, says, however, that breast ultrasound is important for diagnosing cancer when mammography fails to confirm the result.

– What we want is early detection. Then the mammogram is indispensable and the ultrasound may be necessary – said the doctor.

Network without structure

The TCU study attests that the diagnosis of cancer in the country is not being made in a timely manner. And it reveals a high percentage of patients diagnosed with the disease “stage IV and V” – that is, the two most advanced of the five that exist.

– A patient with a suspicious lump, for example, cannot enter a normal queue. There has to be special, urgent treatment – argues Gioia. "We get patients with large, bloody lumps, swollen arms." These are symptoms of delayed tests leading to diagnosis.

The TCU study also highlights that the network of exams offered by SUS is not sufficiently structured to enable patients with suspected cancer to receive the correct diagnosis at the appropriate time.

The regulation of access to health care in the country, according to the TCU, has “deficiencies in the organization, management and prioritization of access through care flows within the SUS”.

The Ministry of Health said that in eight years, doubled federal resources for cancer treatments in the public health system, from $ 2.2 billion in 2010 to $ 4.4 billion in 2018.

"The (TCU) audit portrays a sample of only the eight most prevalent cancers, which does not represent the national scenario."

According to the folder, Brazil has 309 hospitals qualified to offer care to cancer patients.

Commitment

President of the Brazilian Federation of Philanthropic Breast Support Institutions (Femama), Dr. Maira Caleffi said she had personally met with Vice President Hamilton Mourão and secured a commitment from him that the law passed in the Senate, which guarantees a health screening. Confirmation of the disease within 30 days when there is a suspicion of cancer, will be sanctioned still in October Rose.

Femama, made up of 71 institutions spread over 18 states, in addition to the Federal District, was responsible for formulating the law.

– I was with the vice-president, Hamilton Mourão, and handed over the (sanction) letter on Friday. He personally pledged to sanction the law later this month, either through the president or as interim president (Bolsonaro is traveling in Asia), – says Caleffi.

The doctor also said that she would meet the Chief Minister of the House, Onyx Lorenzoni, to deliver the same document.

Senate approval, she said, took everyone by surprise by the budgetary challenge. The agenda is the subject of criticism from sectors of the public administration, since there is no sign of extra money – as occurred in the 60-day law.

"We'd do an act of approval, but thank God it happened." The next step is to fight for funding. For the law to be put into practice, it is 180 days from the sanction. We have to work on a joint so that there is funding and not the same thing that happened with the 60-day law. To date, there has been no extra funding to fund it.

For Caleffi, everyone is against cancer and dialogue should be the basis of the debate.

– As we begin to be able to demand and charge the 60-day law, passed in 2012, we begin to see a dam. Patients were stopped before diagnosis because if the disease were diagnosed, the state would have to treat – claims.

(Collaborated Johanns Eller)


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