Educational, Racial, and Geographic Inequalities in Breast Cancer Screening and Diagnosis among Brazilian Women

BACKGROUND: Breast cancer screening and timely diagnosis are essential for reducing mortality and improving outcomes. However, access to preventive services and early detection remains uneven across social groups, particularly in low- and middle-income countries such as Brazil. This study aimed to describe educational, racial, and geographic inequalities in breast cancer screening and diagnosis among Brazilian women using data from the 2019 Brazilian National Health Survey. METHODS: The sample included women aged 50 to 69 years. The outcomes were breast cancer diagnosis and screening, including mammography and clinical breast examination (CBE). Skin color, area of residence, and educational level were used as equity stratifiers. Simple and complex measures of inequality were applied, including the Slope Index of Inequality (SII) and the Relative Index of Inequality (RII). RESULTS: White women, urban residents, and those with higher education levels had greater access to mammography referrals, screening, and CBE. Among women with the same education level, the prevalence of breast cancer diagnosis was higher among White women (2.6%) and Brown women (3.4%) than among Black women (2.3%). Likewise, urban residents had a higher prevalence of breast cancer diagnosis (3.1%) than rural residents (1.9%).These findings indicate that breast cancer screening and diagnosis disproportionately benefit White, highly educated, and urban-dwelling women. CONCLUSION: Educational, racial, and geographic inequalities persist in breast cancer screening and diagnosis in Brazil, even among women with similar levels of education. These results highlight the need for equitable screening programs, awareness strategies, and public health policies targeting structurally disadvantaged groups to reduce disparities in breast cancer outcomes.