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

BMC Cancer

Débora Balabram¹  Cassio M Turra²  Helenice Gobbi¹ 

[1] Breast Pathology Laboratory, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil

[2] Department of Demography, Center for Development and Regional Planning, (Cedeplar), Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil

关键词: Cohort study;    Brazil;    Neoplasm staging;    Survival analysis;    Breast neoplasms;   

Others  :  1079557
DOI  :  10.1186/1471-2407-13-434

 received in 2013-03-20, accepted in 2013-09-19,  发布年份 2013

【 摘 要 】

Background

Breast 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.

Methods

A 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.

Results

A 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.

Conclusions

Five-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.

【 授权许可】

   
2013 Balabram et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Harford JB: Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all. Lancet Oncol 2011, 12:306-312.
• [2]Brasil M da S, Instituto Nacional de Câncer: Estimativa, Incidência De Câncer No Brasil. Rio de Janeiro: Ministério da Saúde 2012, 2011:118.
• [3]Atlas de Mortalidade por Câncer http://mortalidade.inca.gov.br/Mortalidade/ webcite
• [4]Coleman MP, Quaresma M, Berrino F, Lutz J-M, De Angelis R, Capocaccia R, Baili P, Rachet B, Gatta G, Hakulinen T, Micheli A, Sant M, Weir HK, Elwood JM, Tsukuma H, Koifman S, Silva GA E, Francisci S, Santaquilani M, Verdecchia A, Storm HH, Young JL: Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol 2008, 9:730-56.
• [5]Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A: AJCC Cancer Staging Manual. 7th edition. New York: Springer; 2009:648.
• [6]Brito C, Portela MC, de Vasconcellos MTL: Survival of breast cancer women in the state of Rio de Janeiro, Southeastern Brazil. Rev Saude Publica 2009, 43:481-9.
• [7]Yu XQ: Socioeconomic disparities in breast cancer survival: relation to stage at diagnosis, treatment and race. BMC Cancer 2009, 9:364.
• [8]Woods LM, Rachet B, Coleman MP: Origins of socio-economic inequalities in cancer survival: a review. Ann Oncol 2006, 17:5-19.
• [9]Smith ER, Adams SA, Das IP, Bottai M, Fulton J, Hebert JR: Breast cancer survival among economically disadvantaged women: the influences of delayed diagnosis and treatment on mortality. Cancer Epidemiol Biomarkers Prev 2008, 17:2882-90.
• [10]Lee BL, Liedke PE, Barrios CH, Simon SD, Finkelstein DM, Goss PE: Breast cancer in Brazil: present status and future goals. Lancet Oncol 2012, 13:e95-e102.
• [11]Paim J, Travassos C, Almeida C, Bahia L, Macinko J: The Brazilian health system: history, advances, and challenges. Lancet 2011, 377:1778-97.
• [12]Schneider IJC, D’Orsi E: Five-year survival and prognostic factors in women with breast cancer in Santa Catarina State, Brazil. Cad Saude Publica 2009, 25:1285-96.
• [13]Ayala ALM: Survival of women with breast cancer, of a city in the south of Brazil. Rev Bras Enferm 2012, 65:566-70.
• [14]Cintra JRD, Guerra MR, Bustamante-Teixeira MT: Non-metastatic breast cancer specific-survival of patients after treatment with adjuvant chemotherapy. Rev Assoc Med Bras 2008, 54:339-46.
• [15]Guerra MR, Mendonça GAES, Bustamante-Teixeira MT, Cintra JRD, de Carvalho LM, de Magalhães LMPV: Five-year survival and prognostic factors in a cohort of breast cancer patients treated in Juiz de Fora, Minas Gerais State, Brazil. Cad Saude Publica 2009, 25:2455-66.
• [16]De Moraes AB, Zanini RR, Turchiello MS, Riboldi J, De Medeiros LR: Survival study of breast cancer patients treated at the hospital of the Federal University in Santa Maria, Rio Grande do Sul, Brazil. Cad Saude Publica 2006, 22:2219-28.
• [17]Howlader N, Ries LAG, Mariotto AB, Reichman ME, Ruhl J, Cronin KA: Improved estimates of cancer-specific survival rates from population-based data. J Natl Cancer Inst 2010, 102:1584-98.
• [18]Balabram D, Araújo FB, Porto SS, Rodrigues JS, Sousa AS, Siqueira AL, Gobbi H: Changes in mastectomy rates at a Brazilian public hospital over 20 years (1989 to 2008). Sao Paulo Med J 2012, 130:360-6.
• [19]Sistema Nacional de Vigilância em Saúde - Relatório de Situação - Minas Gerais http://portal.saude.gov.br/portal/arquivos/pdf/003_mg_relatorio_de_situacao.pdf webcite
• [20]Camargo KR, Coeli CM: Reclink: an application for database linkage implementing the probabilistic record linkage method. Cad Saude Publica 2000, 16:439-47.
• [21]WHO International Classification of Diseases (ICD) http://www.who.int/classifications/icd/en/ webcite
• [22]Paes NA: Quality of death statistics by unknown causes in Brazilian states. Rev Saude Publica 2007, 41:436-45.
• [23]Dignam JJ, Huang L, Ries L, Reichman M, Mariotto A, Feuer E: Estimating breast cancer-specific and other-cause mortality in clinical trial and population-based cancer registry cohorts. Cancer 2009, 115:5272-83.
• [24]Menke CH, Pohlmann PR, Backes A, Cericatto R, Oliveira M, Bittelbrunn A, Schwartsmann G: Tumor size as a surrogate end point for the detection of early breast cancer: a 30-year (1972–2002), single-center experience in southern Brazil. Breast J 2007, 13:448-56.
• [25]Macià F, Porta M, Murta-Nascimento C, Servitja S, Guxens M, Burón A, Tusquets I, Albanell J, Castells X: Factors affecting 5- and 10-year survival of women with breast cancer: an analysis based on a public general hospital in Barcelona. Cancer Epidemiol 2012, 36:554-9.
• [26]Schonberg MA, Marcantonio ER, Ngo L, Li D, Silliman RA, McCarthy EP: Causes of death and relative survival of older women after a breast cancer diagnosis. J Clin Oncol 2011, 29:1570-7.
• [27]Eaker S, Halmin M, Bellocco R, Bergkvist L, Ahlgren J, Holmberg L, Lambe M: Social differences in breast cancer survival in relation to patient management within a National Health Care System (Sweden). Int J Cancer 2009, 124:180-7.
• [28]Publicada lei que dá prazo para tratamento do câncer http://portalsaude.saude.gov.br/portalsaude/noticia/8324/893/publicada-lei-que-da-prazo-para-tratamento-do-cancer.html webcite
• [29]Passman LJ, Farias AM, Tomazelli JG, De Abreu DM, Dias MB, De Assis M, De Almeida PF, Da Silva RC, Santini LA: SISMAMA–implementation of an information system for breast cancer early detection programs in Brazil. Breast 2011, 20(Suppl 2):S35-9.
• [30]Sociedade Brasileira de Mastologia: Recomendações da X Reunião Nacional de Consenso - Rastreamento do câncer de mama na mulher Brasileira X Reunião Nacional de Consenso 2008, 9. http://www.sbmastologia.com.br/downloads/reuniao_de_consenso_2008.pdf webcite
• [31]Marchi AA, Gurgel MS: Adherence to the opportunistic mammography screening in public and private health systems. Rev Bras Ginecol Obstet 2010, 32:191-197.
• [32]Lima-Costa MF, Matos DL: Prevalence and factors associated with mammograms in the 50-69-year age group: a study based on the Brazilian National Household Sample Survey (PNAD-2003). Cad Saude Publica 2007, 23:1665-1673.
• [33]De Oliveira EXG, Pinheiro RS, Melo ECP, Carvalho MS: Socioeconomic and geographic constraints to access mammography in Brasil, 2003–2008. Cien Saude Colet 2011, 16:3649-64.
• [34]Novaes Cde O, Mattos IE: Prevalence of non-utilization of mammography and associated factors in elderly women. Cad Saude Publica 2009, 25(Suppl 2):S310-20.
• [35]Schonberg MA, Marcantonio ER, Li D, Silliman RA, Ngo L, McCarthy EP: Breast cancer among the oldest old: tumor characteristics, treatment choices, and survival. J Clin Oncol 2010, 28:2038-45.
• [36]Yood MU, Owusu C, Buist DSM, Geiger AM, Field TS, Thwin SS, Lash TL, Prout MN, Wei F, Quinn VP, Frost FJ, Silliman RA: Mortality impact of less-than-standard therapy in older breast cancer patients. J Am Coll Surg 2008, 206:66-75.
• [37]Colzani E, Liljegren A, Johansson ALV, Adolfsson J, Hellborg H, Hall PFL, Czene K: Prognosis of patients with breast cancer: causes of death and effects of time since diagnosis, age, and tumor characteristics. J Clin Oncol 2011, 29:4014-21.
• [38]Du XL, Fox EE, Lai D: Competing causes of death for women with breast cancer and change over time from 1975 to 2003. Am J Clin Oncol 2008, 31:105-16.
• [39]Dutra MC, Rezende MA, de Andrade VP, Soares FA, Ribeiro MV, de Paula EC, Gobbi H: Immunophenotype and evolution of breast carcinomas: a comparison between very young and postmenopausal women. Rev Bras Ginecol Obstet 2009, 31:54-60.
• [40]Riihimäki M, Thomsen H, Brandt A, Sundquist J, Hemminki K: Death causes in breast cancer patients. Ann Oncol 2012, 23:604-10.
• [41]German RR, Fink AK, Heron M, Stewart SL, Johnson CJ, Finch JL, Yin D: The accuracy of cancer mortality statistics based on death certificates in the United States. Cancer Epidemiol 2011, 35:126-31.