Persistent Regional Inequalities and Unequal Post-Pandemic Recovery in Breast Cancer Screening in Brazil: A Nationwide DATASUS Analysis Among Women Age 50-69 Years (2015-2024)

PURPOSE Breast cancer is the leading cause of cancer-related death among women in Brazil, where access to screening remains heterogeneous across regions. This study analyzed temporal trends and regional inequalities in mammography utilization among women aged 50-69 years between 2015 and 2024, emphasizing the impact of the COVID-19 pandemic. METHODS A retrospective ecological study was conducted using secondary data from DATASUS/SIA-SUS. Mammograms performed in women aged 50-69 years between 2015 and 2024 were analyzed according to region and year. Variables included absolute number of mammograms, proportional regional participation, and temporal differences before and after the COVID-19 pandemic. For 2024 proportional analyses, utilization rates per 1,000 women were estimated using regional demographic estimates from IBGE adjusted according to the proportion of women aged 50-69 years identified in the 2022 Brazilian Census. Temporal trends were evaluated using linear regression. RESULTS A total of 17,584,413 mammograms were performed during the study period. National screening volume increased from 1,201,047 examinations in 2015 to 1,966,136 in 2019 (+63.7%), followed by a marked decline in 2020 (1,191,775 procedures; –39.4%). Recovery patterns were regionally heterogeneous. The North demonstrated the largest relative recovery after the pandemic-related decline, with a 64.1% increase between 2021 and 2024, whereas the South showed slower recovery (+26.7%) and remained close to pre-pandemic levels. The Southeast accounted for the highest absolute number of examinations (38.0%). However, substantial regional disparities persisted after adjustment for the target female population. In 2024, the Northeast (125.5/1,000 women) and South (124.0/1,000 women) presented the highest utilization rates, whereas the North showed the lowest nationwide (72.8/1,000 women), approximately 42% lower than the best-performing regions. Significant annual increases were observed in the North, Northeast, and Southeast regions. CONCLUSION Breast cancer screening in Brazil remains marked by regional inequalities and unequal post-pandemic recovery. Disparities, particularly in Northern Brazil, suggest inequities in access to preventive oncology services beyond demographic variation alone. These findings highlight the need to expand equitable mammography capacity in underserved regions of Brazil and other low- and middle-income countries.