Outcomes of breast cancer in Brazil related to health care coverage: a retrospective cohort study
Menée au Brésil auprès d'une cohorte de 3 142 patientes atteintes d'un cancer du sein, cette étude rétrospective analyse leur survie en lien avec la couverture de santé dont elles bénéficient
Background : Breast cancer is the most common malignancy in women in Brazil. Differences between patients with public versus private health care coverage regarding general characteristics, disease presentation, treatment of primary tumors, and clinical outcomes have not been fully investigated. Methods : A national, retrospective cohort of 3 142 patients drawn from a representative sample of Brazilian medical centers was selected. Clinical and demographic data and type of health care coverage were retrieved by chart review. Groups were compared using the Chi-square test. The log-rank test was used for comparison of disease-free survival, post-relapse and overall survival. Multivariate Cox regression modeling with adjustment for patient characteristics and stage at diagnosis was performed. All p-values are two sided. Results : Patients with public health coverage presented with more advanced disease at diagnosis (p<0.001). Disease-free survival and overall survival for patients presenting with stage 0-II disease did not differ according to type of health care coverage while a significant difference in outcomes was seen for stage III-IV patients (p=0.002 and p=0.008, respectively). In a Cox multivariate analysis, no association was found for type of health coverage with either disease-free survival or overall survival, but there was an association for post-relapse survival (p<0.001). Conclusion : In Brazil breast cancer patients with public health coverage present with more advanced disease and this possibly explains worse disease free and overall survival when compared to those with private coverage. Impact Earlier diagnosis and treatment of breast cancer could improve outcomes of women with public health coverage in Brazil.