Hospital Moinhos de Vento (HMV), Tiradentes Street, 333 - 2nd floor, Porto Alegre, RS, 90035-001, Brazil.
Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil.
Breast Cancer Res Treat. 2020 Oct;183(3):749-757. doi: 10.1007/s10549-020-05831-y. Epub 2020 Jul 29.
In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients' characteristics at diagnosis and their association with health insurance type.
This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured.
A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II-III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001).
Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.
在巴西，现有的癌症登记处数量和质量都存在不足，因此，关于乳腺癌（BC）患者的社会人口学、临床病理特征、治疗模式和结局的信息知之甚少。我们开展了 AMAZONA III/GBECAM 0115 研究，在此分析中，我们描述了患者诊断时的特征及其与健康保险类型的关系。
这是一项在巴西 23 个地点开展的前瞻性队列研究，纳入了 2016 年 1 月至 2018 年 3 月期间新诊断为浸润性 BC 的女性患者。为了比较医疗保健保险类型，我们将在巴西公共卫生系统下接受治疗的患者视为公共保险患者，将有私人保险或自费治疗的患者视为私人保险患者。
共纳入 2950 例患者。中位诊断年龄为 53.9 岁；63.1%的患者为公共保险。大多数患者（68.6%）为 II-III 期乳腺癌和导管癌组织学（80.9%）。最常见的乳腺癌亚型是 luminal A 样（48.0%），其次是 luminal B-HER2 阳性样（17.0%）和三阴性（15.6%）。luminal A 在私人保险中更为常见（53.7% vs. 44.2%，p < 0.0001），而 luminal B-HER2 阳性（19.2% vs. 14.2%，p = 0.0012）和 HER2 阳性（8.8% vs. 5.1%，p = 0.0009）在公共卫生系统覆盖的患者中更为常见。仅有 34%的患者通过筛查检查确诊。与公共保险患者相比，私人保险患者更常被诊断为 I 期疾病；公共保险患者更常被诊断为 III 期疾病（33.5% vs. 14.7%；p 值 < 0.0001）。与私人保险患者相比，公共保险患者更多地因症状而被诊断为乳腺癌（74.2% vs. 25.8%；p 值 < 0.0001）。
与私人保险患者相比，公共健康保险覆盖的患者被诊断为症状性疾病、晚期疾病和侵袭性更强的亚型。
