Baylor College of Medicine, Houston, TX, USA.
Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Oncologist. 2022 May 6;27(5):344-351. doi: 10.1093/oncolo/oyac050.
Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes.
We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp's Women's Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death.
One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death.
Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes.
Access to timely screening and diagnosis of breast cancer are priorities in these populations.
在人口稠密的得克萨斯州哈里斯县和巴西东南部，使用安全网医院的乳腺癌患者的预后较差。目前尚不清楚治疗延迟是否导致了这些结果。
我们对 2009 年 1 月 1 日至 2011 年 12 月 31 日期间在得克萨斯州哈里斯卫生系统和巴西坎皮纳斯大学妇女医院、巴雷托斯医院和巴西国家癌症研究所诊断为非转移性乳腺癌的患者进行了回顾性队列分析。我们使用 Cox 比例风险回归来评估治疗时间与复发风险（ROR）或死亡的关系。
共纳入 1191 例患者。巴西女性更常被诊断为 III 期疾病（32.3%比 21.1%的得克萨斯州；P=0.002）。两个地区的大多数患者均为症状性疾病（巴西为 63%，得克萨斯州为 59%）。诊断后 5 年内复发率相似，分别为 21%和 23%。从诊断到首次治疗的中位时间定义为系统治疗（化疗或内分泌治疗）或手术，两者相当，分别为 9.9 周和 9.4 周。治疗延迟与 ROR 或死亡增加无关。诊断时分期较高与 ROR 和死亡增加均相关。
两个地区从症状出现到治疗的时间都相当长。治疗延迟并未影响结局。
及时筛查和诊断乳腺癌是这些人群的重点。
