CONVERSATIONAL DIGITAL MEDICAL SCREENING THROUGH A FREE MESSAGING APP AS POTENTIAL NEW TOOL TO AVOID BC LATE DIAGNOSIS AT BRAZILIAN PUBLIC HEALTH SERVICE

Introduction: Breast Cancer (BC) delay diagnosis is a national health problem and retrospective analysis suggested that most Brazilian women wait at least 120-160 days from first red flag to BC pathological confirmation. Efficient reference to secondary and tertiary BC specialized unity is crucial to avoid late diagnosis and improve BC patients (pts) survival.Objective: To evaluate the effectiveness of a free chat-based solution, equipped with a bot, combined with humans, as a possible pathway to optimize access to breast cancer specialists in the Brazilian public health system. Method: We elaborate high-risk questions related to breast symptoms and BIRADS radiological classification to serve as BC virtual screening as part of an university extension program. Within 24 hours of a chat initiation, medical students supervised by BC specialists, evaluate and decide if pts needed a structured multidisciplinary presencial consultant or only online orientation. Prospective data were collected from chatbot and medical consultant according to data protection law. Results: A total of 94 pts contacted through triage. All were female and the median age was 48 years. More than a half (n=48 ; 51%) of women attended by the virtual triage were diagnosed with BC and subsequently received active oncology treatment. Of those 48 pts, 85.4% (n=41) reported a nodule on self-examination and 66.7% (n=32) had a medical confirmed palpable nodule and 20.83% (n=10) had malignant axillary lymph nodes in the medical consultant. Regarding breast imaging exams, 45.8% (n=22) and 29.1% (n=14) of pts never had a mammogram and breast ultrasound, respectively, before our triage. The median interval between BC high-risk features and virtual triage first contact and first virtual contact to presential medical consultant were 202 and 8 days, respectively. As for the conduct, 39.6% (n=19) pts did core biopsy in our tertiary service, 14.5% (n=7) pts needed additional diagnostic radiological tests and only 18.75% (n=9) did not need any additional exam or procedure and only received adequate information. Conclusion: We developed a promising and efficient digital screening solution that was able to identify in more than 80% of cases potential high-risk BC pts that needed specialized mastology or oncology consultants and diagnosed BC in 51% of screened pts. Virtual triage is accessible to the population and has great innovative potential to avoid late diagnosis and improve BC pts access and journey.