Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage

Abstract

Objective: To compare the sociodemographic, diagnostic, clinical, and treatment-related characteristics and outcomes of patients with breast cancer in two hospitals in Mexico according to type of healthcare coverage. Methods: A retrospective cohort study of women with breast cancer according to public or private healthcare coverage in two hospitals was done. Patients were treated by the same group of physicians and healthcare infrastructure. Groups were compared using the chi-square test for categorical variables, Mann–Whitney U-test and Student’s t-test for quantitative variables, and Kaplan–Meier estimator and log-rank test for time dependent outcomes (including recurrence-free and overall survival). A value of p < 0.05 was considered statistically significant. Results: A total of 282 women were included. Mean age at diagnosis was 52 years. Women with public healthcare coverage were diagnosed more frequently with self-detected tumors (82.8% vs 47.9%, p < 0.001) and advanced clinical stage (III and IV) (31.1% vs 17.8%, p = 0.014). More women with public healthcare insurance underwent initial systemic treatment (41.1% vs 17.8%, p < 0.001) and mastectomy (70.1% vs 54.9%, p = 0.020), and received more chemotherapy (79.4% vs 43.8%, p < 0.001) and adjuvant radiotherapy (68.9% vs 53.4%, p = 0.017). Overall, no differences were found in survival outcomes according to healthcare coverage. Trends suggesting worse recurrence-free and overall survival were observed in patients with public coverage at 3 years follow-up in stage III (85.7% vs 67.3% and 100% vs 84.6%, respectively) and triple negative disease (83.3% vs 74.5% and 100% vs 74.1%, respectively). Conclusion: Strategies to promote preventive medicine, diagnostic mammograms, and prompt diagnosis of breast cancer in Mexican women with public health coverage are needed. Access to the main treatment modalities by Seguro Popular and good quality care by an experienced group of physicians likely explains the similar outcomes between patients with private and public healthcare coverage. However, trends suggesting worse survival for patients with public medical coverage with stage III and triple-negative disease should encourage close follow-up.

Survival Outcomes of Patients With Breast Cancer in a Mexican Population

“…To our knowledge, this cohort is the largest to be analyzed in a single institution of the IMSS and in Mexico. The age of diagnosis worldwide is 63 years; however, mean reported age in the Mexican series is 52 years, 6 , 14 , 15 and similar results are shown in our cohort, with 53 years. The data on clinical stage at diagnosis were consistent with data reported in other Mexican papers.…”

“…In all cases, they were higher than those in the US population 17 and other developed countries, where most of the population are diagnosed in early stages. The proportion of patients diagnosed with metastatic disease was 7.3%, which is not different from that reported in other publications, 6 , 9 , 14 , 15 although higher than that reported in patients treated in private settings. 17 The distribution of breast cancer subtypes is consistent with that reported worldwide.…”

Adipocytokines and Insulin Resistance: Their Role as Benign Breast Disease and Breast Cancer Risk Factors in a High-Prevalence Overweight-Obesity Group of Women over 40 Years Old

“…The frequency of overweight-obese and thin women found in our report is consistent with results reported by the National Health and Nutrition Survey in 2018 [17], with reported rates of overweight-obesity from 74.4% in women > 20 years to 88.1%, 84%, and 83.3% in women in their 40s, 50s, and 60s. These findings highlight two critical public health issues: The burden of overweight obesity [17] and the prevalence of breast cancer [1], the most common cancer in women in some geographic areas.…”

“…Worldwide, breast cancer is a complex phenomenon characterized by coincident factors such as (1) a high prevalence, incidence, and mortality [1,2]; (2) the country-specific conditions, including deficiency in screening programs and limited access to treatment in some geographic areas [3]; and (3) the metabolic disturbances related to the high prevalence of overweight-obesity around the world, associated with hyperinsulinism, insulin resistance, metabolic syndrome [4], and adipocytokines altered levels [5]. Fortunately, those conditions are considered modifiable risk factors [6].…”

Descriptive analysis of histological types in women undergoing post mastectomy breast reconstruction

“…6 In addition to risk factors in women, institutional factors have also been described, such as: low coverage of screening mammograms, barriers to timely diagnosis, limited access to standard treatment, and suboptimal quality of health services, which predominate in the population with public health coverage. 7 Breast reconstruction consists of recovering the volume lost after the mastectomy, either immediately in the same resection surgery or later. This reconstruction has developed greatly in recent decades and has benefited from all the successive contributions of plastic and reconstructive surgery: prostheses, expanders, and flaps (pedicled or microsurgical).…”