title: Treatment delays among women with breast cancer in a low socio-economic status region in Brazil.
abstract: Considering the inequalities and the areas of low socioeconomic status in Brazil, access to health services is a challenge and the delay between diagnosis and treatment represents an important factor of worse prognosis in patients with breast cancer. Herein, we describe the clinical and epidemiological profiles of women with breast cancer and evaluate their access to health services, as well as treatment delays, at a reference centre of the Cariri region, Ceará, Brazil.
  
  
  
  This is a retrospective study that included 473 women treated with breast cancer between 2009 and 2011 at the Oncology Centre of the Cariri.
  
  
  
  The majority of these patients were aged between 40 and 69 years old (65.7%), without a completed high school degree (89.2%). They were married (62.9%) and were already diagnosed but had not yet been subjected to any previous treatment (77.8%). It was observed that 91.8% were referred from the public health service, and treatment was paid for by the public health service in 92.9% of the cases. The patients whose source of referral was the public system waited longer between diagnosis and the treatment initiation (p = 0.031; Mann-Whitney's test), with a median waiting time of 71.5 days versus 39 days for those receiving referrals from private services. In addition, those with public referrals prior to diagnosis also experienced a longer waiting time between the first medical visit and treatment initiation (77 days vs. 37 days; p = 0.036; Mann-Whitney's test), with the waiting time for the biopsy being an important factor in this delay.
  
  
  
  Late diagnosis was often the result of inefficiency of the prevention policies coupled with difficulty accessing the public health network. It was commonly observed that, even after diagnosis, the patients needed to wait too long before entering the Oncology Service because of long waiting queues in the public health system.
authors.affiliation: Laboratory of Epidemiology and Data Analysis. School of Medicine of ABC, Santo André, SP, Brazil. naidhiasoares@hotmail.com.|Oncológica Brasil Ensino e Pesquisa., Belém, PA, Brazil. naidhiasoares@hotmail.com.
authors.forename: Naidhia
authors.initials: N
authors.lastname: Alves Soares Ferreira
authors.affiliation: Laboratory of Epidemiology and Data Analysis. School of Medicine of ABC, Santo André, SP, Brazil.|Laboratory of Design of Studies and Scientific Writing. School of Medicine of ABC, Santo André, SP, Brazil.
authors.forename: Sionara
authors.initials: S
authors.lastname: Melo Figueiredo de Carvalho
authors.affiliation: Laboratory of Design of Studies and Scientific Writing. School of Medicine of ABC, Santo André, SP, Brazil.
authors.forename: Vitor
authors.initials: V
authors.lastname: Engrácia Valenti
authors.affiliation: Oncológica Brasil Ensino e Pesquisa., Belém, PA, Brazil.
authors.forename: Italla Maria
authors.initials: IM
authors.lastname: Pinheiro Bezerra
authors.affiliation: Laboratory of Design of Studies and Scientific Writing. School of Medicine of ABC, Santo André, SP, Brazil.
authors.forename: Hermes
authors.initials: H
authors.lastname: Melo Teixeira Batista
authors.affiliation: Laboratory of Design of Studies and Scientific Writing. School of Medicine of ABC, Santo André, SP, Brazil.
authors.forename: Luiz Carlos
authors.initials: LC
authors.lastname: de Abreu
authors.affiliation: Public Health Department, School of Medicine of ABC, Santo André, SP, Brazil.
authors.forename: Leandro Luongo
authors.initials: LL
authors.lastname: Matos
authors.affiliation: Laboratory of Epidemiology and Data Analysis. School of Medicine of ABC, Santo André, SP, Brazil.|Oncológica Brasil Ensino e Pesquisa., Belém, PA, Brazil.
authors.forename: Fernando
authors.initials: F
authors.lastname: Adami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D001943:Breast Neoplasms / Q000145:classification / Q000453:epidemiology / Q000628:therapy*; D057210:Delayed Diagnosis / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D012923:Social Class; D013997:Time Factors
keywords: Breast neoplasms; Epidemiology; Hospital oncology service; Public policies; Unified health system