In early 2023 Brazil launched a national patient navigation programme for breast cancer, introducing a role that accompanies the person from the first suspicion of cancer through to treatment. A study published in Health Policy and Planning examines its effect on waiting times and on the cost of treatment within Brazil’s public health system.
What was already known
Delays between the diagnosis of breast cancer and the start of treatment undermine both the efficiency and the equity of universal health systems. Patient navigation programmes — professionals who coordinate appointments, tests and referrals — have been proposed precisely to improve that coordination and to facilitate timely access to treatment. Evidence on their cost, however, was scarce, particularly in middle-income countries.
What this work adds
The authors take advantage of the simultaneous nationwide rollout of the programme in January 2023 to estimate its causal effect. They use administrative microdata from the Sistema Único de Saúde covering January 2021 to June 2024 and compare women with breast cancer with women with gynaecological tumours, a comparison group that affects the same population and draws on similar hospital resources. The method is synthetic difference-in-differences, which reconstructs the counterfactual scenario without the reform.
Main results
Navigation cut by roughly ten days the time elapsed between diagnosis and the start of radiotherapy compared with the comparison group. By contrast, its effect on waiting times for surgery and for chemotherapy was limited. Radiotherapy costs rose by about 16.5%, an increase the authors interpret as a short-term expansion in service use, reflecting demand that had previously gone unmet. Effects varied across regions, with larger improvements in more developed areas.
What it means
The programme improved access to breast cancer treatment, but its effectiveness depended on the availability of healthcare resources in each territory. Put differently, coordinating a patient’s journey better achieves little if there is not enough capacity at the end of that journey. For patients, having a navigator can shorten waits, especially at the radiotherapy stage. For health managers, the initial rise in spending reflects previously unmet demand rather than waste, and waiting times should be measured by phase and by region.
A view from the breast unit
The interval between diagnosis and treatment is a classic quality indicator in any breast unit, and this work is a reminder that coordination and support roles have a measurable effect on it. It also stresses that the impact of such roles depends on the resources available: without radiotherapy or theatre capacity, improving the administrative pathway falls short.
Reference: Silva ARD, Postali FAS. The Brazilian breast cancer patient navigation program: impact on waiting times and treatment costs. Health Policy and Planning, 2026. https://doi.org/10.1093/heapol/czag105
