Diego Wallace Nascimento

University of Sao Paulo, Brazil

Title: Mapping delays in breast cancer care during COVID-19: Lessons from the Brazilian Public Health System (SUS)

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Biography

Breast Surgeon – Hospital das Clínicas, Faculty of Medicine, University of São Paulo (HC-FMUSP)

Dr. Diego Wallace Nascimento holds a Medical Degree from Centro Universitário Lusíada (2016), Brazil. He completed his General Surgery residency at Pontifícia Universidade Católica de São Paulo (2020) and Breast Surgery (Mastology) residency at Hospital das Clínicas, University of São Paulo (2022). Currently, he is specializing in Oncoplastic Breast Surgery at Universitat Autònoma de Barcelona (2025).

He is an instructor for the Advanced Trauma Life Support (ATLS) course by the American College of Surgeons (ACS). Dr. Nascimento has scientific publications in breast surgery, obstetrics, urology, cardiology, and general surgery.

His main interests include breast oncology, oncoplastic surgery, breast imaging, women’s health, and quality of life

Abstract

In March 2020, the World Health Organization (WHO) classified COVID-19 as a global pandemic, leading health systems around the world to shift financial and structural resources to curb the virus's spread.1 In Brazil, the Unified Health System swiftly reorganized to meet the demands of COVID-19, leading to significant disruptions to public health policies related to cancer screening,2 treatment, and follow-up, particularly for breast cancer.

These disruptions have had a direct impact on patient outcomes, contributing to an increase in the diagnosis of advanced-stage breast cancer, as reported by various health organizations.3–6 Delays in screening, treatment, and follow-up are expected to negatively affect long-term outcomes, including overall and disease-free survival, while also increasing the cost of care for the public healthcare system.

Despite the growing need for timely interventions, Brazil's oncology data systems present substantial limitations in tracking the patient journey from initial screening to definitive treatment within the SUS. The lack of integrated and comprehensive data hinders strategic planning and impedes the development of effective emergency policy responses.

To address this gap, the Ministry of Health developed PAINEL-Oncology, a data management tool integrated with DATASUS.7,8 This tool links multiple information systems within the SUS, including:

• SIA (Outpatient Information System).

• BPA-I (Individualized Outpatient Production Bulletin).

• APAC (Authorization for High-Complexity Procedures).

• SIH (Hospital Information System).

These databases are linked to the National Health Card (CNS) and the ICD-10 codes. Since 2019, the PAINEL-Oncology platform has integrated retrospective data from the Cancer Information System – Breast and Cervical Cancer (SISCAN), covering records dating back to 2013.

The integration enabled by PAINEL facilitates nationwide surveillance of breast cancer cases and allows for the evaluation of the time interval between diagnosis and initiation of treatment. Treatment start times are categorized as ? 30 days, 31–60 days, and > 60 days. Unfortunately, a substantial proportion of patients commence therapy more than 60 days after diagnosis, underscoring the systemic delays prevalent across many locations.

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