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Ferreira ADSS, Cintra JRD, Fayer VA, Nogueira MC, Júnior CB, Bustamante-Teixeira MT, Chaoubah A, Cintra AD, Simão CM, Guerra MR. Breast cancer survival and the health system in Brazil: an analysis of public and private healthcare. Front Oncol 2023; 13:927748. [PMID: 37305573 PMCID: PMC10248159 DOI: 10.3389/fonc.2023.927748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background The incidence of breast cancer is increasing globally; however, survival outcomes vary and are lower in developing countries. Methods We analyzed the 5- and 10-year survival rates for breast cancer according to the type of healthcare insurance (public vs. private) in a referral center for cancer care in the Brazilian southeast region. This hospital-based cohort study included 517 women diagnosed with invasive breast cancer between 2003 and 2005. The Kaplan-Meier method was used to estimate the probability of survival, and the Cox proportional hazards regression model was used to assess prognostic factors. Results The 5- and 10-year breast cancer survival rates were as follows: private healthcare service survival rate of 80.6% (95% CI 75.0-85.0) and 71.5% (95% CI 65.4-77.1), respectively, and public healthcare service survival rate of 68.5% (95% CI 62.5-73.8) and 58.5% (95% CI 52.1-64.4), respectively. The main factors associated with the worst prognosis were lymph node involvement in both healthcare services and tumor size >2 cm only in public health services. The use of hormone therapy (private) and radiotherapy (public) was associated with the best survival rates. Conclusions The survival discrepancies found between health services can be explained mainly by the difference in the stage of the disease at the time of diagnosis, indicating inequalities in access to the early detection of breast cancer.
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Affiliation(s)
- Adriana de Souza Sérgio Ferreira
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
| | - Jane Rocha Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
| | - Vívian Assis Fayer
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Mário Círio Nogueira
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | | | - Maria Teresa Bustamante-Teixeira
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Alfredo Chaoubah
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Arthur Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Caroline Montes Simão
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Maximiliano Ribeiro Guerra
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
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Justo AFO, Collaço RDC, Lescano CH, de Oliveira IP. Malignant neoplasm of breast in Brazilian women: A cross-sectional study from 2008 to 2019. J Natl Med Assoc 2023; 115:38-45. [PMID: 36577555 DOI: 10.1016/j.jnma.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/16/2022] [Accepted: 12/07/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Breast cancer is the most lethal malignancy for women worldwide. Developed countries, such as Portugal, Spain, and the United States, have declining mortality rates due to breast cancer; however, in developing countries, the epidemiological reports are scarce. In this context, the aims of this study are to describe and discuss the female breast cancer profile of hospitalization and mortality according to age and geographic region in Brazil from 2008 to 2019. METHODS Data were obtained from the National Health System Department of Informatics (DATASUS), maintained by the Brazilian Ministry of Health, which includes the registers of hospitalization and mortality by malignant neoplasm of breast (code C50, ICD-10). Proportional rates of hospitalization and deaths were estimated per 100,000 inhabitants according to respective subjects' age, region, and year of the occurrence. RESULTS From 2008 to 2019, 643,822 hospital admissions due to malignant neoplasm of breast were reported in Brazil, of which the South and Southeast regions were the most prevalent. Higher hospitalization rates were seen in subjects aged 50-79-years-old. Regarding mortality, 53,480 deaths by breast cancer were reported; similarly to hospitalization, the Southeast and South were the most affected regions. Mortality rates have increased over time in different magnitudes depending on subjects' age. CONCLUSION We have shown an increase in morbidity and mortality over time, which is dependent on patients' age and region. The results presented here may contribute to the ongoing discussion about the role and future perspectives of the Brazilian health care system, especially regarding to the strategies for the prevention, control, and treatment of breast cancer.
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Affiliation(s)
| | - Rita de Cássia Collaço
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Caroline Honaiser Lescano
- Department of Pharmacology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil
| | - Ivan Pires de Oliveira
- Institute of Agricultural Sciences, Federal University of Minas Gerais, Minas Gerais, Brazil
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Babatunde OA, Zahnd WE, Eberth JM, Lawson AB, Adams SA, Boakye EA, Jefferson MS, Allen CG, Pearce JL, Li H, Halbert CH. Association between Neighborhood Social Deprivation and Stage at Diagnosis among Breast Cancer Patients in South Carolina. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211824. [PMID: 34831579 PMCID: PMC8625868 DOI: 10.3390/ijerph182211824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 11/01/2021] [Accepted: 11/04/2021] [Indexed: 11/25/2022]
Abstract
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions-the social deprivation index (SDI). Data were analyzed using chi-square tests, Student's t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02-1.10), African American race (OR = 1.35, 95% CI: 1.29-1.41), and being unmarried (OR = 1.17, 95% CI: 1.13-1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
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Affiliation(s)
- Oluwole Adeyemi Babatunde
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Department of Psychiatry, Prisma Health, 109 Physicians Drive, Greer, SC 29650, USA
- Correspondence: ; Tel.: +1-803-477-1675
| | - Whitney E. Zahnd
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
| | - Jan M. Eberth
- Rural & Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, SC 29210, USA; (W.E.Z.); (J.M.E.)
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
| | - Andrew B. Lawson
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC 29208, USA;
- Cancer Survivorship Center, College of Nursing, University of South Carolina, Columbia, SC 29208, USA
| | - Eric Adjei Boakye
- Department of Population Science and Policy, School of Medicine, Southern Illinois University, Springfield, IL 62794, USA;
| | - Melanie S. Jefferson
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
| | - Caitlin G. Allen
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - John L. Pearce
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (A.B.L.); (C.G.A.); (J.L.P.)
| | - Hong Li
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
| | - Chanita Hughes Halbert
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA; (M.S.J.); (C.H.H.)
- Hollings Cancer Center, Medical University of South Carolina, Charleston, SC 29425, USA;
- Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA 90033, USA
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