Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.
Divisão de Pesquisa Populacional, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer, Ministério da Saúde, Rio de Janeiro, Brazil.
Lancet Glob Health. 2024 Feb;12(2):e292-e305. doi: 10.1016/S2214-109X(23)00521-1.
Breast cancer is a public health priority in Brazil and ensuring equity in health care is one of the cancer control plan goals. Our aim was to present the first assessment on the influence of race or skin colour on breast cancer survival at the national level.
In this nationwide cohort study, data on women who initiated treatment for breast cancer in the public health-care system (Sistema Unico de Saúde), Brazil, were assembled through record linkage of administrative and mortality information systems. The administrative information systems were the Outpatient Information System (data from high complexity procedure authorisations) and the Hospital Information System (data from hospitalisation authorisations). We included women aged 19 years or older who started treatment between Jan 1, 2008, and Nov 30, 2010; self-identified as having White, Black, or Brown race or skin colour; had tumour stage I-IV; and were treated with chemotherapy or radiotherapy, or both. Patients were followed up until Dec 31, 2015. Patients with only hormone therapy records or who underwent only surgery were excluded. The Kaplan-Meier method was used to estimate crude overall survival for race or skin colour by time since treatment initiation, and Cox regression to estimate all-cause mortality hazard ratios (HRs) before and after adjustment for other covariates.
We identified 59 811 women treated for stage I-IV breast cancer. 37 318 (62·4%) women identified themselves as White, 18 779 (31·4%) as Brown, and 3714 (6·2%) as Black. 5-year overall survival probability was higher for White women (74% [95% CI 73-74]) than Black women (64% [62-65]; p<0·0001). In adjusted regression models stratified by the absence of hormone therapy, Black women had a 24% (HR 1·24 [95% CI 1·16-1·34]; p<0·0001) higher risk of all-cause death than White women, and in the presence of hormone therapy Black women had a 25% (1·25 [1·14-1·38]; p<0·0001) higher risk of all-cause death than White women.
Black skin colour was identified as a statistically significant risk marker for lower 5-year survival probability and higher risk of all-cause death among women treated for breast cancer by the Sistema Unico de Saúde. Actions to understand and mitigate this unfair difference in health results are urgently needed.
Conselho Nacional de Desenvolvimento Científico e Tecnológico and Coordenação de Aperfeiçoamento de Pessoal de Nível Superior and Pró-Reitoria de Pesquisa da Universidade Federal de Minas Gerais.
乳腺癌是巴西的一个公共卫生重点，确保医疗保健公平是癌症控制计划的目标之一。我们的目的是在国家层面上首次评估种族或肤色对乳腺癌生存的影响。
在这项全国性的队列研究中，通过对巴西公共医疗保健系统（Sistema Unico de Saúde）中接受乳腺癌治疗的女性的行政和死亡率信息系统进行记录链接，收集了有关女性的数据。行政信息系统包括门诊信息系统（高复杂度程序授权数据）和医院信息系统（住院授权数据）。我们纳入了年龄在 19 岁及以上、自认为是白种人、黑种人或棕种人、患有 I-IV 期肿瘤、接受化疗或放疗或两者兼有的女性。患者接受治疗的起始时间为 2008 年 1 月 1 日至 2010 年 11 月 30 日。患者被随访至 2015 年 12 月 31 日。仅记录激素治疗或仅接受手术的患者被排除在外。使用 Kaplan-Meier 方法估计种族或肤色的粗总生存概率，根据其他协变量调整后使用 Cox 回归估计全因死亡率风险比（HRs）。
我们共确定了 59811 名接受 I-IV 期乳腺癌治疗的女性。37318 名（62.4%）女性自认为是白人，18779 名（31.4%）是棕色人种，3714 名（6.2%）是黑人。白人女性的 5 年总生存率（74% [95%CI 73-74]）高于黑人女性（64% [62-65]；p<0.0001）。在按是否接受激素治疗分层的调整后回归模型中，黑人女性的全因死亡风险比白人女性高 24%（HR 1.24 [95%CI 1.16-1.34]；p<0.0001），而在接受激素治疗的情况下，黑人女性的全因死亡风险比白人女性高 25%（1.25 [1.14-1.38]；p<0.0001）。
在接受 Sistema Unico de Saúde 治疗的乳腺癌女性中，黑皮肤被确定为 5 年生存率较低和全因死亡风险较高的统计学显著风险标志物。迫切需要采取行动来了解和减轻这种不公平的健康差异。
巴西国家科学技术发展理事会、高级人员培训协调委员会和米纳斯吉拉斯联邦大学研究副校长办公室。
