Open Access Highly Accessed Study protocol

A model to optimize public health care and downstage breast cancer in limited-resource populations in southern Brazil. (Porto Alegre Breast Health Intervention Cohort)

Maira Caleffi19*, Rodrigo A Ribeiro1, Dakir L Duarte Filho1, Patrícia Ashton-Prolla234, Ademar J Bedin1, Giovana P Skonieski1, Juliana M Zignani1, Juliana Giacomazzi5, Luciane R Franco16, Márcia Graudenz15, Paula Pohlmann7, Jefferson G Fernandes1, Philip Kivitz8 and Bernardete Weber1

Author Affiliations

1 Associação Hospitalar Moinhos de Vento, Porto Alegre, Brazil

2 Department of Genetics, Universidade Federal do Rio Grande do Sul, Brazil

3 Hospital de Clínicas de Porto Alegre, Brazil

4 Post-Graduate Program in Genetics and Molecular Biology, Universidade Federal do Rio Grande do Sul, Brazil

5 Post-Graduate Course in Medicine, Universidade Federal do Rio Grande do Sul, Brazil

6 Secretaria Municipal de Saúde, Porto Alegre, Brazil

7 Vanderbilt University, Nashville, USA

8 Stanford University, San Francisco, USA

9 Rua Ramiro Barcelos 910, 11º andar, CEP 90035-001, Porto Alegre, RS, Brazil

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BMC Public Health 2009, 9:83  doi:10.1186/1471-2458-9-83

Published: 13 March 2009



Breast cancer (BC) is a major public health problem, with rising incidence in many regions of the globe. Although mortality has recently dropped in developed countries, death rates are still increasing in some developing countries, as seen in Brazil. Among the reasons for this phenomenon are the lack of structured screening programs, a long waiting period between diagnosis and treatment, and lack of access to health services for a large proportion of the Brazilian population.

Methods and design

Since 2004, an intervention study in a cohort of women in Southern Brazil, denominated Porto Alegre Breast Health Intervention Cohort, is being conducted in order to test the effectiveness and cost-effectiveness of a model for BC early detection and treatment. In this study, over 4,000 women from underserved communities aged 40 to 69 years are being screened annually with mammography and clinical breast examination performed by a multidisciplinary team, which also involves nutritional counseling and genetic cancer risk assessment. Risk factors for BC development are also being evaluated. Active search of participants by lay community health workers is one of the major features of our program. The accrual of new participants was concluded in 2006 and the study will last for 10 years. The main goal of the study is to demonstrate significant downstaging of BC in an underserved population through proper screening, attaining a higher rate of early-stage BC diagnoses than usually seen in women diagnosed in the Brazilian Public Health System. Preliminary results show a very high BC incidence in this population (117 cases per 100,000 women per year), despite a low prevalence of classical risk factors.


This study will allow us to test a model of BC early diagnosis and treatment and evaluate its cost-effectiveness in a developing country where the mortality associated with this disease is very high. Also, it might contribute to the evaluation of risk factors in a population with a different ethnic background from that studied in developed countries. If our model is proven effective, it may be replicated in other parts of the globe where BC is also a major public health problem.