The negative impact of the COVID-19 pandemic on breast cancer tackle in Brazil's public and private healthcare system: time series study between 2014 and 2022

The COVID-19 pandemic has overwhelmed the healthcare systems of many countries and negatively impacted the care of other diseases. To evaluate the trend of screening mammograms, oncological breast surgeries, and breast cancer hospitalizations in Brazil's public and private healthcare system between 2014 and 2022. This ecological time series study uses the inflection point regression model and semester percentage change (SPC). We use the open-access dataset of the different healthcare systems in Brazil. We analyzed the trend of the variables in the pre-pandemic and the effect of the pandemic on the total time series. In 2020, compared to 2019, the decrease in screening mammograms, oncological breast surgeries, and breast cancer hospitalization was - 41.44%, -23.13%, and - 10.52% (public health system) and - 29.49%, -18.96%, and - 15.35% (private healthcare system). In the public healthcare system, the pandemic has enhanced the decreasing trend of mammograms (SPC - 1.6% before and - 3.4% after), has reverted the stationary trend of oncological breast surgeries to decreasing (SPC - 1.0%), has slowed the increasing trend of breast cancer hospitalization (SPC 1.8% before and 0.9% after). In the private healthcare system, the pandemic has reverted the stationary trend of mammograms to decreasing (SPC - 1.0%), has slowed the increasing trend of breast cancer surgeries (SPC 2.3% before and 0.8% after), has reverted the growing trend of breast cancer hospitalization (SPC 3.9%) to stationary. During the COVID-19 pandemic, there was an increase in inequalities between healthcare systems, especially in breast cancer screening.