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.
Highlights
IntroductionThe survival rate varies and is longer in high-income countries
A small proportion of our patients were followed over a 10-year period (45 patients, 5%); among those in stage I, 10-year survival rate was 91.2%, 69.8% for stage II, and 43% for stage III patients
The study by Ayala [13] described 5-year survival rates of 97% for stage I, 88% for stage II, and 51% for stage III in patients treated in the SUS, considering patients diagnosed at a similar period to the one of our study (2000–2009)
Summary
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 incidence is increasing, especially in low and middle-income countries [1]. Socioeconomic status is known to be an intervening factor, mostly because of lower frequencies of patients undergoing interval screening, treatment’s delay and smaller availability of modalities of treatment, such as chemo, hormone, and radiotherapy, among the less affluent populations [6,7,8,9]. In Brazil, most of the population does not have private health insurance, and relies on the Unified Public Health System (Sistema Único de Saúde, SUS) for care, which provides patients with screening, diagnosis, and breast cancer treatment [10,11]. In 2008, only 26% of the Brazilian population had private health insurance [11]
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