Regional Disparities and Temporal Trends in Mammography Screening in Brazil From 2014 to 2024: A Nationwide Ecological Study

PURPOSE Breast cancer remains the most common cancer among women worldwide and a major cause of cancer-related mortality, particularly in low- and middle-income countries (LMICs), where barriers to early detection persist. Mammography screening plays a critical role in reducing breast cancer mortality through early diagnosis and timely treatment. This study aimed to evaluate temporal trends and regional disparities in mammography screening rates in Brazil between 2014 and 2024. METHODS A nationwide retrospective ecological study was conducted using publicly available data from the Brazilian Health Informatics Department (DATASUS/SISCAN). Screening mammograms performed in women aged 50–69 years were analyzed according to year and geographic region. Female population estimates for the same age group were obtained from the Brazilian Institute of Geography and Statistics (IBGE). Mammography screening rates were calculated per 100,000 women. Temporal trends and regional differences in screening rates were descriptively analyzed. RESULTS A total of 18,365,466 screening mammograms were performed in Brazil during the study period. National screening rates increased from 5,687.7 per 100,000 women in 2014 to 9,188.6 in 2019. In 2020, a marked reduction was observed, with rates declining to 5,425.6 per 100,000 women, representing an approximate 41% decrease compared with the previous year. Progressive recovery was observed after 2020, reaching 9,928.3 per 100,000 women in 2024. Persistent regional disparities were identified throughout the study period. The South region consistently demonstrated the highest screening rates, peaking at 13,510.9 per 100,000 women in 2023, while the North region presented the lowest rates across nearly all years analyzed. The Northeast region showed substantial growth in screening rates over time. CONCLUSION Despite overall expansion in mammography screening in Brazil over the last decade, significant regional inequalities remain. The COVID-19 pandemic was associated with substantial disruption in breast cancer screening nationwide, potentially contributing to delays in diagnosis and treatment. These findings highlight the need for equitable public health strategies to strengthen breast cancer screening access and improve cancer control in underserved populations within LMIC settings.