Verduzco-Aguirre Haydee, Favorito Fernanda Mallucelli, Ynoe de Moraes Fabio, Marta Gustavo, Tagle Camila, Henrique Dos Anjos Carlos, Mattar André, Wilson Brooke E
Department of Oncology, Queen's University, Kingston, ON, Canada.
Division of Cancer Care and Epidemiology, Sinclair Cancer Research Institute, Kingston, Canada.
Lancet Reg Health Am. 2025 May 7;47:101115. doi: 10.1016/j.lana.2025.101115. eCollection 2025 Jul.
Over half of new breast cancer cases occur in low- and middle-income countries, with disparities in survival outcomes due to late-stage diagnoses, healthcare access gaps, and biological differences. This retrospective cohort study examined trends in survival, stage distribution, and treatment utilization for breast cancer in Brazil, an upper middle-income country.
Patients newly diagnosed with invasive breast cancer between 2000 and 2019 were identified from São Paulo's Oncocenter Foundation registry. Data on demographics, diagnosis stage, diagnosis-to-treatment intervals, and treatments received were analyzed in 5-year blocks. Median overall survival was estimated using the Kaplan-Meier method. Actual treatment utilization was compared to model-based estimates of optimal utilization derived from the National Comprehensive Cancer Network Guidelines' Enhanced and Maximal Resource Modules.
We included 125,005 patients, with a median age at diagnosis of 55 years (interquartile range 46-75); 99.4% (n = 124,218) were female. The proportion with early disease remained stable over time (61.7% in 2000-2004, 62.4% 2015-2019). Median overall survival increased from 10.7 years (2000-2004) to 11.7 years (2010-2014); median survival for 2015-2019 was not reached. Median overall survival was 20.8, 15.1, 6.8, and 2.0 years for stages I-IV, respectively. Median diagnosis-to-treatment interval more than doubled over time. From 2000 to 2004 to 2015-2019, chemotherapy use decreased from 71.5% to 68.9%; radiotherapy use decreased from 64.0% to 56.5%, and surgery utilization decreased from 80.3% to 74.8%; endocrine therapy use varied between 54% and 62%. Gaps between observed and model-based estimates of treatment utilization were seen across all stages.
Overall survival in patients with breast cancer in São Paulo has improved over time. However, significant treatment gaps and increasing diagnosis-to-treatment intervals suggest systemic barriers to optimal care delivery.
No funding received.
超过一半的新发乳腺癌病例发生在低收入和中等收入国家，由于晚期诊断、医疗服务可及性差距以及生物学差异，生存结果存在差异。这项回顾性队列研究调查了巴西（一个中高收入国家）乳腺癌患者的生存趋势、分期分布和治疗利用情况。
从圣保罗肿瘤中心基金会登记处识别出2000年至2019年间新诊断为浸润性乳腺癌的患者。对人口统计学、诊断分期、诊断至治疗间隔以及接受的治疗等数据按5年时间段进行分析。采用Kaplan-Meier方法估计总体生存中位数。将实际治疗利用率与基于国家综合癌症网络指南的强化和最大资源模块得出的最佳利用率模型估计值进行比较。
我们纳入了125,005名患者，诊断时的中位年龄为55岁（四分位间距46 - 75岁）；99.4%（n = 124,218）为女性。早期疾病患者的比例随时间保持稳定（2000 - 2004年为61.7%，2015 - 2019年为62.4%）。总体生存中位数从10.7年（2000 - 2004年）增加到11.7年（2010 - 2014年）；2015 - 2019年的生存中位数未达到。I - IV期的总体生存中位数分别为20.8年、15.1年、6.8年和2.0年。诊断至治疗间隔的中位数随时间增加了一倍多。从2000 - 2004年到2015 - 2019年，化疗使用率从71.5%降至68.9%；放疗使用率从64.0%降至56.5%，手术使用率从80.3%降至74.8%；内分泌治疗使用率在54%至62%之间波动。在所有分期中，观察到的治疗利用率与基于模型的估计值之间均存在差距。
圣保罗乳腺癌患者的总体生存情况随时间有所改善。然而，显著的治疗差距以及不断增加的诊断至治疗间隔表明在提供最佳护理方面存在系统性障碍。
未获得资金。
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