Amidst the coronavirus pandemic, the number of procedures for diagnostic purposes carried out in the SUS fell 20% in 2020. There were 785 million exams last year, compared to 982 million in 2019, according to data from the Ministry of Outpatient Information System. Health.
The number is the lowest since 2012, when the public network reached 784 million diagnostic procedures. In eight years, it is the first time that the volume of exams is below 800 million.
Among the main explanations for the fall are the postponement of routine exams by people who preferred to remain isolated and the temporary suspension of elective (non-urgent) care by health units overloaded by the demand for care provided by Covid-19.
The delay in carrying out the tests worries doctors, who already observe later diagnoses of diseases such as cancer — for which early detection is crucial to increase the chances of a cure.
“We have been receiving patients with a more advanced stage of the tumor. Many people have postponed exams such as mammography, colonoscopy and gynecological and prostate preventive exams for more than a year. A delay of six to eight months in diagnosis can already make a difference to progression of the disease”, reports Alexandre Ferreira Oliveira, president of the Brazilian Society of Oncology Surgery and head of the oncology service at the Federal University of Juiz de Fora.
Data from the Ministry of Health, available on the Datasus portal, show, in fact, a significant drop in screening tests for the main types of tumor.
In the case of Pap smears, a gynecological test that detects lesions prior to cervical cancer, the reduction reached 66.9% in the analyzed period. As for mammography, the decrease was 20.8%. The PSA dosage test, which helps in the diagnosis of prostate cancer, had a drop of 26.9%.
At least three British studies released last year have already pointed to a possible increase in cancer mortality associated with the pandemic.
In the most recent, published in November in the journal The British Medical Journal, the authors estimated up to 17.9 thousand extra deaths of cancer patients in one year. This includes deaths that would have been avoided were it not for factors such as late diagnosis or interruption of treatments or follow-ups.
Other diseases, such as cardiovascular ones, can also have their conditions aggravated by the lack of specialized monitoring.
According to Evandro Tinoco Mesquita, coordinator of the Heart University of the Brazilian Society of Cardiology, tests and fundamental procedures for the detection and monitoring of heart diseases, such as catheterization, scintigraphy and exercise testing, had an important reduction.
Datasus data confirms the expert’s perception. The number of cardiac catheterizations performed in adults dropped 26% in 2020 from the previous year.
Myocardial (cardiac muscle) scintigraphy had a 25% drop. On the other hand, the stress/exercise tests decreased even more — 38%.
“If we lately detect an infarction or decompensation of heart failure, this poses a risk to the patient. We must be careful to maintain the treatment of cardiometabolic diseases, such as hypertension, diabetes and the insufficiency itself”, highlights Mesquita, who is also a professor of the UFF (Universidade Federal Fluminense).
The doctor also points out that, at the beginning of the pandemic, the Brazilian Society of Cardiology even carried out a survey showing an increase in deaths from cardiovascular causes occurring at home.
The main hypothesis for the phenomenon is that even patients with symptoms of these problems were avoiding going to the doctor or an emergency room for fear of becoming infected with the coronavirus.
Experts point out that, even with a still high number of Covid-19 cases in the country, consultations and exams should no longer be interrupted or postponed.
Today, most medical centers have separate care flows for patients without the virus and follow health protocols to minimize the risk of contagion.
Main screening and preventive exams
Mammography — used in the diagnosis of breast cancer, should be performed by women aged 50 to 69, every two years, as recommended by the Ministry of Health.
Some scientific societies, however, advocate that the procedure be performed after the age of 40, especially if there is a family history of the disease.
PSA exam and digital rectal exam — help in the diagnosis of prostate cancer. Should be done by men aged 50 years or older, or from 45 years old when the patient has risk factors such as family history or obesity.
Colonoscopy — the procedure can detect bowel cancer or premalignant lesions that, if treated, do not progress. The exam must be done after the age of 50 and repeated every 3 or 5 years, as per medical evaluation.
For individuals with a family history of the disease, the first colonoscopy needs to be done ten years before the age at which the relative presented the tumor.
Pap smear — it can identify cervical cancer precursor lesions and should be done in women who have already had sex from the age of 20 (the exact age requires a conversation with the doctor).
Other ratings — In addition to screening tests for cancer, it is important to see a doctor periodically to assess the need for tests that signal other health problems.
Among the most requested are blood count, echocardiogram, exercise test and electrocardiogram.