Survival of patients with operable breast cancer (Stages I-III) at a Brazilian public hospital - a closer look into cause-specific mortality

Abstract

BackgroundBreast cancer incidence is increasing. The survival rate varies and is longer in high-income countries. In Brazil, lower-income populations rely on the Unified Public Health System (Sistema Único de Saude, SUS) for breast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages I-III at a Brazilian public hospital that treats mostly patients from the SUS.MethodsA cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of the Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases. Information on tumor pathology and staging, as well as patients’ age and type of health coverage (SUS or private system) was collected. A probabilistic record linkage was performed with the database of the Mortality Information System to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast cancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model was used for univariate and multivariate analysis of factors related to survival.ResultsA total of 282 deaths occurred during the study’s period, 228 of them due to breast cancer. Five-year breast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients from the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in this stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter survival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic grade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancer-specific survival.ConclusionsFive-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the SUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.

Características clínico-patológicas e estadiamento ao diagnóstico de pacientes com câncer de mama em um centro de saúde do interior de Minas Gerais

“…Comparando estes dados com o estudo de Macchetti 19 , realizado no interior do estado de São Paulo, detectamos em nossa amostra um achado de 58,4 % de tumores in situ ou invasivos de até 2 cm contra apenas 22,1% no estudo citado 19 . Diferentemente dos dados aqui encontrados, outro estudo brasileiro, realizado em um hospital universitário de Minas Gerais, encontrou 42% dos casos em estadio III 20 . A maioria das pacientes (67% dos casos) teve seu diagnóstico de câncer de mama realizado na presença de lesão clínica palpá-vel, fato este que necessariamente influenciará no prognóstico, na radicalidade cirúrgica, no tratamento adjuvante e nos custos que a terapêutica implicará.…”

Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study

“…The age of the patient at diagnosis, tumor size, number of lymph nodes involved, degree of tumor differentiation, molecular subtype and clinical staging are the main parameters used to evaluate survival and play a fundamental role in the therapeutic planning of this neoplasia [10][11][12] .…”

Apresentação

“…No entanto, a dificuldade de acesso e a demora de atendimento, que chega a atingir até 230 dias para o início do tratamento após o diagnóstico da doença na rede pública (Barros, Uemura, & Macedo, 2013;da Rosa & Radünz, 2013) ainda representam barreiras para um manejo oncológico eficaz (Balabram, Turra, & Gobbi, 2013).…”