title: Prognosis in women with breast cancer and private extra insurance coverage.
abstract: BACKGROUND
  Many women covered by the Spanish public health system also have an extra private insurance policy for gynecological examinations and routine annual mammography. We retrospectively analyzed the long-term survival rates in these patients when diagnosed with breast cancer.
  
  
  METHODS
  We analyzed the survival and prognostic factors in patients diagnosed with breast cancer who were referred to a medical oncology unit for multidisciplinary treatment covered by private health insurance.
  
  
  RESULTS
  Between 1994 and 2009, a total of 434 patients with breast tumor were analyzed: 33 in situ and 401 infiltrating. Among the infiltrating carcinomas, 38 were stage IV and 363 were stage I, II, or III. With a median follow-up of 62 months, the 5-year global survival rate was 91%: 97% for stage I, 94% for stage II, and 77% for stage III tumors. In the patients diagnosed by routine mammography, the 5-year survival rate was 96%, compared with 86% in those consulting their gynecologist after breast self-examination or for other symptoms (p=0.0159). Seventy-four percent were treated conservatively and experienced better survival than the 26% who underwent mastectomy (p=0.0024). Patients with disease with positive hormone receptors had a better survival rate (p=0.0264); hormone receptor status was the only independent prognostic factor in the Cox multivariate analysis. Postmenopausal patients who received adjuvant tamoxifen plus exemestane had a better prognosis than those who received tamoxifen alone (p=0.0203).
  
  
  CONCLUSIONS
  Long-term survival rate was high in breast cancer patients with extra private insurance coverage. This is probably because disease was diagnosed at an early stage.
authors.affiliation: Department of Clinical Oncology, Faculty of Medicine, University of Barcelona, Barcelona, Spain. jjgrau@clinic.ub.es
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Grau
authors.forename: Gabriel
authors.initials: G
authors.lastname: Zanon
authors.forename: Carlos
authors.initials: C
authors.lastname: Caso
authors.forename: Xavier
authors.initials: X
authors.lastname: Gonzalez
authors.forename: Araceli
authors.initials: A
authors.lastname: Rodriguez
authors.forename: Miguel
authors.initials: M
authors.lastname: Caballero
authors.forename: Albert
authors.initials: A
authors.lastname: Biete
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019458:Insurance Coverage; D008207:Lymphatic Metastasis; D008327:Mammography; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate