ABC | Volume 113, Nº3, September 2019

Original Article Figueiredo et al. Rheumatic fever: a disease without color Arq Bras Cardiol. 2019; 113(3):345-354 on November 17, starting its activities in Brazil in 2008. Despite the support of several non-governmental entities, the movement, especially regarding its aspect related to prostate cancer, is repudiated by the Ministry of Health of Brazil and the National Cancer Institute due to the lack of scientific indications for the screening. 37 Pink October's history dates back to the last decade of the 20 th century. In 1997, entities from the cities of Yuba and Lodi in the United States began effectively celebrating and promoting actions aimed at breast cancer prevention, called Pink October. All actions were and are directed towards the prevention and early diagnosis. From 1989-2015 (most recent data available), breast cancer mortality decreased by 39 percent (preventing more than 320,000 deaths). 38 The first initiative seen in Brazil in relation to the Pink October, was carried out in 2002, and is currently disseminated throughout the country, where there is the involvement of the health teams and the population. 12 The campaign against rheumatic heart disease needs a strong political will, driven by the awareness and effort of health professionals. The principles that underlie the control of this disease in high-income countries might not apply to developing countries. Where health care finances are very scarce and health is often provided by non-governmental organizations (NGOs), rheumatic heart disease might not be perceived as a priority. 39 Three successful approaches originating from Central America and the Caribbean, in different economic and political contexts, showed the efficiency of combined strategies consisting of education and primary and secondary prophylaxis. 31 Some initiatives in this sense have already been taken in Brazil, such as the PROVAR (Rheumatic Valvular Diseases Screening Program) program, being the first large-scale echocardiographic screening program in Brazil, using echocardiography to estimate the prevalence of latent RHD in asymptomatic children between 5 and 18 years of age attending public schools in the underserved areas of cities such as Belo Horizonte, Montes Claros and Bocaiúva, in the Brazilian state of Minas Gerais. 40 Conclusion The analysis of mortality rate trends in Brazil by ARF and RHD are alarming. At the advent of the new millennium, we know little about our real situation due to the lack of a more complete database aimed at this condition. The existing disease load may represent only the tip of the iceberg, since the analyzed data may be underestimated. On a large scale, preferably, national surveys and clinical studies should be conducted to determine the different aspects of RF and RHD in Brazil. The information added by this research would thus help to encourage the real need to formulate national policies to address this public health problem more efficiently in the future. Moreover - why not give a color to rheumatic fever? Author contributions Conception and design of the research, Statistical analysis and Critical revision of the manuscript for intellectual content: Figueiredo ET, Azevedo L, Rezende ML; Acquisition of data: Figueiredo ET, Alves CG; Analysis and interpretation of the data: Figueiredo ET, Azevedo L, Rezende ML, Alves CG; Writing of the manuscript: Figueiredo ET, Azevedo L, Rezende ML, Alves CG. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding There were no external funding sources for this study. Study Association This study is not associatedwith any thesis or dissertationwork. Ethics approval and consent to participate This article does not contain any studies with human participants or animals performed by any of the authors. 1. Braga, ALL, Achutti AC, Ramos AIO, Weksler C, Mota CCC, Santos CCL, et al. Diretrizes Brasileiras para o Diagnóstico, Tratamento e Prevenção da Febre Reumática. 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