Abstract P5-13-11: Impact of public health insurance “Seguro Popular” on breast cancer recurrence at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City

Abstract

Abstract Introduction. Public health insurance called Seguro Popular (SP) for breast cancer treatment (BCT) was instituted in Mexico in 2007. Our third level center was enrolled until 2011. SP covers systemic BCT (WHO 20th model list essential medicines). The aims were: 1) Describe frequency and type of breast cancer recurrence (BCR), 2) compare which factors were contributing to recurrence of breast cancer patients (pts) before and after the implementation of SP. Methods. Pts with diagnosis of breast cancer (BC) from 2004 to 2018 were analyzed and pts with BCR whom primary tumor (PBC) was treated and followed at INCMNSZ were recruited. They were divided into two groups according to access to SP: pts without Seguro Popular (non-SP) and, pts with SP. Xi-square, non-parametric tests and Kaplan-Meier curves (log-rank test) were used. Logistic regression was done for multivariate analysis. A p-value <0.05 was considered significant. Results. Between 2004 and 2018, 929 pts with BC were diagnosed; 438 non-SP and 473 SP. Ninety-one (9.7%) had a BCR (loco-regional or distant) during this period. Median follow-up was 125 months. The BCR proportion was higher within non-SP than in SP (74 (16.8%) vs 17 (3.5%) pts) (p=<0.05). Median age at diagnosis was higher in non-SP (p=0.028). Distant relapses were higher in non-SP than in SP (44 (59.4%) vs 8 (47%) pts). St Gallen 2017 Luminal A/B subtypes were most common in non-SP compared to SP where Basal-like subtype was higher (p=0.048). Luminal-A subtype had the best survival among non-SP compared to SP in which HER2 non-luminal had the higher survival (p<0.001). Conclusions. Experience with SP at our center shows promising results in the improvement of BCR. Access to adequate systemic management (hormone-blocking and HER2 targeted therapy) has a positive impact on recurrence, disease-free survival, and cancer-specific global survival. A longer follow-up time is required in the SP group (prospective cohort) to confirm these findings, especially in luminal tumors with late recurrence risk. Efforts should be made in the Mexican public health system to secure basic and continuous access to BCT. Citation Format: Mejía-Fernández L, Medina-Franco H, Armengol-Alonso A. Impact of public health insurance “Seguro Popular” on breast cancer recurrence at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-11.