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The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115)

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

In Brazil, the available cancer registries are deficient in number and quality and, hence, little information is known regarding sociodemographic, clinicopathological characteristics, treatment patterns, and outcomes of breast cancer (BC) patients. We performed the AMAZONA III/ GBECAM 0115 study and in this analysis, we describe patients’ characteristics at diagnosis and their association with health insurance type.

Methods

This is a prospective cohort study developed in 23 sites in Brazil including women with newly diagnosed invasive BC from January 2016 to March 2018. In order to compare healthcare insurance type, we considered patients who were treated under the Brazilian public health system as publicly insured, and women who had private insurance or paid for their treatment as privately insured.

Results

A total of 2950 patients were included in the study. Median age at diagnosis was 53.9 years; 63.1% were publicly insured. The majority of patients (68.6%) had stage II–III breast cancer and ductal carcinoma histology (80.9%). The most common breast cancer subtype was luminal A-like (48.0%) followed by luminal B-HER2 positive-like (17.0%) and triple-negative (15.6%). Luminal A was more frequent in private (53.7% vs. 44.2%, p < .0001) than public, whereas Luminal B HER2-positive (19.2% vs. 14.2%, p = 0.0012) and HER2-positive (8.8% vs. 5.1%, p = 0.0009) were more common in patients with public health system coverage. Only 34% of patients were diagnosed by screening exams. Privately insured patients were more frequently diagnosed with stage I disease when compared to publicly insured patients; publicly insured patients had more stage III (33.5% vs. 14.7%; p-value < 0.0001) disease than privately insured ones. Breast cancer was detected by symptoms more frequently in publicly than in privately insured patients (74.2% vs 25.8%, respectively; p-value < 0.0001).

Conclusions

Patients with public health coverage were diagnosed with symptomatic disease, later stages and more aggressive subtypes when compared to privately insured patients.

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Abbreviations

BC:

Breast cancer

ER:

Estrogen receptor

HER2:

Human epidermal growth factor receptor 2

LMIC:

Low to middle-income countries

PR:

Progesterone receptor

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Acknowledgements

We would like to thank the patients, the research teams, and investigators for the dedication to this study. We acknowledge Instituto Avon, Itaú Seguros, and Grupo Bamaq for the financial support under the PRONON (Ministry of Health, Brazil) program and SAS Institute Inc. for providing license-free access to SAS®.

Funding

This study was funded by a Grant from Programa Nacional de Apoio à Atenção Oncológica (PRONON) of the Brazilian Health Ministry (No. 25000.173.901/2013–73).

Author information

Authors and Affiliations

  1. Hospital Moinhos de Vento (HMV), Tiradentes Street, 333 – 2nd floor, Porto Alegre, RS, 90035-001, Brazil

    Daniela Dornelles Rosa, Alessandra Morelle & Maira Caleffi

  2. Instituto Nacional do Câncer (INCA), Rio de Janeiro, Brazil

    José Bines

  3. Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil

    Gustavo Werutsky, Carlos Henrique Barrios, Facundo Zaffaroni & Rafaela Gomes de Jesus

  4. Centro Regional Integrado de Oncologia (CRIO), Fortaleza, Brazil

    Eduardo Cronemberger

  5. Hospital Araújo Jorge, Goiás, Brazil

    Geraldo Silva Queiroz

  6. A.C. Camargo Cancer Center, São Paulo, Brazil

    Vladmir C. Cordeiro de Lima

  7. Universidade Federal de Goiás, Goiânia, Brazil

    Ruffo Freitas-Júnior

  8. Hospital do Câncer de Londrina, Londrina, Brazil

    José d’Oliveira Couto

  9. Liga Norte Riograndense, Natal, Brazil

    Karla Emerenciano

  10. Hospital Jardim Amalia, Volta Redonda, Brazil

    Heloísa Resende

  11. Oncoclínica RJ, Rio de Janeiro, Brazil

    Susane Crocamo

  12. Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caixas do Sul, Brazil

    Tomás Reinert

  13. Instituto do Câncer Dr Arnaldo, São Paulo, Brazil

    Brigitte Van Eyil

  14. Centro de Pesquisas Oncológicas (CEPON), Florianópolis, Brazil

    Yeni Nerón

  15. Clínica AMO, Salvador, Brazil

    Vanessa Dybal & Carlos Sampaio Filho

  16. Instituto do Câncer Hospital São Vicente, Passo Fundo, Brazil

    Nicolas Lazaretti & Giovana Zerwes Vacaro

  17. Universidade de Caxias do Sul, Caxias do Sul, Brazil

    Rita de Cassia Costamilan

  18. Instituo Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil

    Diocésio Alves Pinto de Andrade

  19. Núcleo Oncológico da Bahia/ Oncoclínicas, Lauro de Freitas, Brazil

    Clarissa Mathias

  20. Clínica de Neoplasias Litoral, Itajaí, Brazil

    Giuliano Borges

  21. Hospital Sírio-Libanês, São Paulo, Brazil

    Max S. Mano

  22. Hospital Israelita Albert Einstein, São Paulo, Brazil

    Sergio Daniel Simon

Authors
  1. Daniela Dornelles Rosa
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  2. José Bines
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  3. Gustavo Werutsky
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  4. Carlos Henrique Barrios
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  5. Eduardo Cronemberger
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  6. Geraldo Silva Queiroz
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  7. Vladmir C. Cordeiro de Lima
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  8. Ruffo Freitas-Júnior
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  9. José d’Oliveira Couto
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  10. Karla Emerenciano
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  11. Heloísa Resende
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  12. Susane Crocamo
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  13. Tomás Reinert
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  14. Brigitte Van Eyil
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  15. Yeni Nerón
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  16. Vanessa Dybal
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  17. Nicolas Lazaretti
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  18. Rita de Cassia Costamilan
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  19. Diocésio Alves Pinto de Andrade
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  20. Clarissa Mathias
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  21. Giovana Zerwes Vacaro
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  22. Giuliano Borges
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  23. Alessandra Morelle
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  24. Maira Caleffi
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  25. Carlos Sampaio Filho
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  26. Max S. Mano
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  27. Facundo Zaffaroni
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  28. Rafaela Gomes de Jesus
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  29. Sergio Daniel Simon
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Corresponding author

Correspondence to Daniela Dornelles Rosa.

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Conflict of interest

DDR is a consultant for: Roche, Novartis, AstraZeneca, Lilly, GSK, Sanofi, Libbs, Eisai, Pfizer, MSD, Dr Reddy’s. Research funding is obtained from Amgen, Roche, GSK, L’Òreal. Expert testimony for: Roche, Novartis, Pfizer, AstraZeneca, Lilly, MSD. Travel, Accommodations, Expenses: Roche, Novartis, Lilly, Amgen. HR: speaker honorarium from Company Libbs Farmaceutica. CHB: Stock and Other Ownership Interests: Biomarker, MedSIR, Tummi Honoraria: Novartis, Genentech, Pfizer, GlaxoSmithKline, Sanofi, Boehringer Ingelheim, Eisai. Consulting or Advisory Role: Boehringer Ingelheim, Genentech, Novartis, GlaxoSmithKline, Eisai, Pfizer, AstraZeneca, Libbs, MSD Oncology, United Medical. Research Funding: Pfizer, Novartis, Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Genentech, Eli Lilly, Sanofi, Taiho Pharmaceutical, Mylan, Merrimack, Merck, AbbVie, Astellas Pharma, Biomarin, Bristol-Myers Squibb, Daiichi Sankyo, Abraxis BioScience, AB Science, Asana Biosciences, Medivation, Exelixis, ImClone Systems, LEO Pharma, Millennium, Janssen, Atlantis Clinica, INC Research, Halozyme, Covance, Celgene, inVentiv Health. Travel, Accommodations, Expenses: Genentech, Novartis, Pfizer, BMS Brazil, AstraZeneca, MSD Oncology. TR received research funding from AstraZeneca and speaker honoraria from AstraZeneca, Lilly, Novartis, Pfizer and PierreFabre. CSF: Advisory Board Chair—Clinica AMO, Advisory Board Member—Indivumed (based in Hamburg-Germany), Multiple affiliations: ASCO, SBOC. MSM: Honoraria for speaker and advisory board engagements: Roche, Novartis, Astrazeneca, Pfizer, Eisai, Genomic Health, Lilly, Oncologia Brasil, Amgen, DASA/GeneOne, Educational support (Roche, Pfizer), Principal and sub investigator of clinical trials from Novartis, Roche, Lilly, Pfizer. Stock Ownership: Biotoscana, Hypera, Fleury. JB, GW, EC, GSQ, VCCL, RFJ, JOC, KE, SC, BVE, YN, VD, NL, RCC, DAPA, CM, GZV, GB, AM, MC, FZ, RJG, and SDS declare that they have no conflicts of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

All study subjects provided written informed consent before entering the study.

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Rosa, D.D., Bines, J., Werutsky, G. et al. The impact of sociodemographic factors and health insurance coverage in the diagnosis and clinicopathological characteristics of breast cancer in Brazil: AMAZONA III study (GBECAM 0115). Breast Cancer Res Treat 183, 749–757 (2020). https://doi.org/10.1007/s10549-020-05831-y

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  • DOI: https://doi.org/10.1007/s10549-020-05831-y

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