title: Outcomes of breast cancer in Brazil related to health care coverage: a retrospective cohort study.
abstract: BACKGROUND
  Breast cancer is the most common malignancy in women in Brazil. Differences between patients with public versus private healthcare coverage about general characteristics, disease presentation, treatment of primary tumors, and clinical outcomes have not been fully investigated.
  
  
  METHODS
  A national, retrospective cohort of 3,142 patients drawn from a representative sample of Brazilian medical centers was selected. Clinical and demographic data and type of healthcare coverage were retrieved by chart review. Groups were compared using the χ(2) test. The log-rank test was used for comparison of disease-free survival (DFS), postrelapse, and overall survival (OS). Multivariate Cox regression modeling with adjustment for patient characteristics and stage at diagnosis was performed. All P values are two sided.
  
  
  RESULTS
  Patients with public health coverage presented with more advanced disease at diagnosis (P < 0.001). DFS and OS for patients presenting with stage 0-II disease did not differ according to the type of healthcare coverage, whereas a significant difference in outcomes was seen for stage III-IV patients (P = 0.002 and P = 0.008, respectively). In a Cox multivariate analysis, no association was found for the type of health coverage with either DFS or OS, but there was an association for postrelapse survival (P < 0.001).
  
  
  CONCLUSIONS
  In Brazil, patients with breast cancer with public health coverage present with more advanced disease, and this possibly explains worse DFS and OS when compared with those with private coverage.
  
  
  CONCLUSIONS
  Earlier diagnosis and treatment of breast cancer could improve outcomes of women with public health coverage in Brazil.
authors.affiliation: Authors' Affiliations: Brazilian Breast Cancer Study Group (GBECAM); Federal University of Sao Paulo (UNIFESP), Sao Paulo, SP, Brazil; Hospital de Clínicas de Porto Alegre; PUCRS School of Medicine Porto Alegre, Porto Alegre, RS, Brazil; National Cancer Institute of Brazil (INCA), Rio de Janeiro, RJ, Brazil; Massachusetts General Hospital, Avon International Breast Cancer Program; and Massachusetts General Hospital Biostatistics Unit, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pedro E R
authors.initials: PE
authors.lastname: Liedke
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Finkelstein
authors.forename: Jackie
authors.initials: J
authors.lastname: Szymonifka
authors.forename: Carlos H
authors.initials: CH
authors.lastname: Barrios
authors.forename: Yanin
authors.initials: Y
authors.lastname: Chavarri-Guerra
authors.forename: José
authors.initials: J
authors.lastname: Bines
authors.forename: Cláudia
authors.initials: C
authors.lastname: Vasconcelos
authors.forename: Sérgio D
authors.initials: SD
authors.lastname: Simon
authors.forename: Paul E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology* / Q000473:pathology / Q000628:therapy*; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D017048:Health Care Costs; D054624:Health Status Disparities; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D017149:Private Sector; D017150:Public Sector; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult