# Inequalities in mammograms and cervical biopsies provision in the public and private sectors of the Brazilian healthcare system and the availability of gynecology and obstetrics specialists

## TL;DR

The study finds large disparities in access to mammograms and cervical biopsies between Brazil's public and private healthcare sectors, affecting cancer diagnosis and health equity.

## Contribution

The study quantifies regional and sectoral disparities in gynecological services and specialist availability in Brazil.

## Key findings

- Private health insurance plans performed three times more mammograms per 100,000 women than the public sector.
- Specialist availability strongly correlates with the number of mammograms and cervical biopsies performed.
- Regional disparities are most severe in the North and Northeast of Brazil.

## Abstract

•Gynecologist and obstetrician availability in Brazil shows significant inequalities.•Mammography and cervical biopsy service provision shows significant inequalities.•These inequalities exist across regions and between the public and private sectors.•The inequalities create barriers to breast and cervical cancer diagnosis.•The inequalities lead to increased health inequities in North and Northeast Brazil.

Gynecologist and obstetrician availability in Brazil shows significant inequalities.

Mammography and cervical biopsy service provision shows significant inequalities.

These inequalities exist across regions and between the public and private sectors.

The inequalities create barriers to breast and cervical cancer diagnosis.

The inequalities lead to increased health inequities in North and Northeast Brazil.

This study aimed to evaluate the provision of mammograms and cervical biopsies in Brazil’s public and private healthcare sectors and the availability of gynecologists and obstetricians.

This ecological study included specialists in gynecology and obstetrics, as well as data on mammograms and cervical biopsy procedures performed in 2024 through the Brazilian Unified Health System (SUS) and private health insurance plans. For each state, ratios of specialist availability and the rate of procedures per 100,000 women were calculated. Sensitivity analysis was performed to calculate the ratio of procedures in women of different age groups, and Spearman’s correlation coefficient was used to assess the association between specialist availability and the rate of procedures performed.

In 2024, health insurance plans performed 15,510.88 mammograms per 100,000 women, almost triple the SUS rate (5,733.93). The private sector performed 426.28 cervical biopsies per 100,000 women, while the public sector conducted only 85.24. The total provision of mammograms varied from 12,691.29 per 100,000 women in São Paulo to 2,702.91 in Pará. For cervical biopsies, the provision ranged from 348.94 per 100,000 women in São Paulo to 21.18 in Roraima. Correlation analysis showed a positive association between specialist availability and procedure volume (mammograms: r = 0.74; biopsies: r = 0.39; p < 0.001), which remained consistent after sensitivity analysis.

Separate indicators for procedure provision and specialist availability effectively identified regional disparities. These findings can guide policymakers in reducing inequalities in access to early breast and cervical cancer diagnosis.