IMPACT OF MAMMOGRAPHIC SCREENING GUIDELINES AT AGES 40 AND 50: AN ANALYSIS OF BI-RADS 4–6 FINDINGS IN PARANÁ, BRAZIL

Abstract

Introduction: Breast cancer is one of the most prevalent malignancies among the female population in Brazil, and its early diagnosis is directly associated with a better prognosis and increased chances of cure. However, discrepancies among screening guidelines recommended by different medical organizations raise questions about the ideal age to initiate mammographic screening. Objective: This study aimed to evaluate the impact of different screening guidelines on early disease detection and mortality, in order to compare the risks associated with late diagnosis, as well as to analyze the costs and burden on the Brazilian healthcare system. Methodology: The research was conducted through the analysis of data obtained from the Department of Information and Informatics of the Brazilian Unified Health System (DATASUS), using data from the Cancer Information System (SISCAN). It included mammographic exams for diagnostic investigation performed in the state of Paraná between 2015 and 2025, in women aged 40 to 74 years from the target population, with no prior mammogram recorded and with the presence of signs and symptoms suggestive of breast cancer prior to the examination (papillary lesion, spontaneous nipple discharge, palpable mass, thickening, and axillary or supraclavicular lymph nodes). The study was supported by a literature review based on articles published in indexed platforms such as SciELO, PubMed, and scientific journals, with emphasis on the recommendations of the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO), the Ministry of Health, and the National Cancer Institute (INCA). Results: A total of 10,410 examinations were analyzed, of which 228 presented findings classified as BI-RADS 4–6. Approximately 63% of these cases occurred in women outside the age range recommended by the Ministry of Health (50–69 years), indicating that a significant proportion of suspicious lesions would not be covered by current screening guidelines. Conclusion: From an economic perspective, early diagnosis proved to be more advantageous, as the treatment of advanced-stage neoplasms tends to be significantly more costly, representing a better alternative in the medium and long term. These findings highlight the importance of revising national screening guidelines, considering regional epidemiological evidence, in order to support public health policies better aligned with Brazil’s reality and the sustainability of the healthcare system.