Abstract P6-11-11: Comparison of demographic, diagnostic, pathological, and treatment characteristics in Mexican women with breast cancer according to type of healthcare coverage
Authors: Martinez-Cannon Bertha A , Zertuche-Maldonado Tania , de la Rosa-Pacheco Sylvia , Cardona-Huerta Servado , Canavati-Marcos Mauricio , Gomez-Macias Gabriela S , Villarreal-Garza Cynthia 
Published: March 2020

Abstract
Background: Breast cancer (BC) represents the most frequent neoplasm and cause of cancer death in Mexican women. Previous studies have reported that BC patients with public healthcare coverage present with more advanced stage disease and worse clinical outcomes than those with private healthcare coverage. However, differences between BC patients with public versus private healthcare coverage regarding general characteristics, disease presentation, and treatment have not been investigated in Mexico.
Methods: A retrospective comparative analysis of women with BC diagnosed and treated at two hospitals by the same group of physicians with the same healthcare infrastructure, according to type healthcare coverage was done. Demographic, clinical, and treatment characteristics were retrieved from medical records. Groups were compared using the chi square test for qualitative variables and U Mann-Whitney and T-student for quantitative variables. A p value of &lt; 0.05 was considered statistically significant.
Results: A total of 268 women were included. Median age at diagnosis was 52.5 years. Comparisons of main demographic, diagnostic, pathological, and treatment characteristics by type of healthcare coverage are presented in Table 1. Women with public healthcare were more frequently diagnosed with self-detected tumors (82.6% vs. 47.9%, p &lt; 0.001) and with more locally advanced disease (51.3% vs. 23.3%, p = 0.026), whereas women with private healthcare presented with more early disease (64.4% vs. 42.6%, p = 0.026). Patients with public healthcare coverage have a significantly longer period of diagnostic and total delay. Globally, hormone receptor (HR) positive (HR+) / HER2 negative (HER2-) disease was the most prevalent molecular subtype (69.4%), with no difference among BC subtypes by type of coverage. More women with public healthcare coverage underwent initial systemic treatment (32.8% vs. 17.8%, p = 0.001), mastectomy (68.1% vs. 54.9%, p = 0.048), chemotherapy (79% vs. 43.8%, p &lt; 0.001), and adjuvant radiotherapy (68.7% vs. 53.5%, p = 0.02), probably related to more advanced disease. Women from both groups with HR+ and HER2 positive (HER2+) disease received hormonal therapy and HER2 targeted therapy equally.
Conclusion: In Mexico, patients with BC with public health coverage present with more advanced disease than those with private coverage, despite being similarly diagnosed and managed within the same healthcare framework. This is possibly explained by the higher rates of self-detected lesions vs. smaller screening-detected tumors and translates into superior rates of initial systemic treatment, mastectomy, chemotherapy use and adjuvant radiotherapy. Strategies to increase BC awareness, screening and early detection in the general population are urgently needed to promote timely diagnosis of BC in Mexican women with public healthcare coverage.
Table 1CharacteristicsPrivatePublicn = 73%n = 195%pPartnered (married, domestic partnership)5676.711156.00.003Unpartnered (single, divorced, widowed)1723.38443.1Homemaker4257.515780.50.001Unemployed11.421Employed3041.13618.5Self-detected3547.916182.6&lt;0.001BC screening3852.13417.4Diagnosis delay (months)0.46 (0-16.5)2.1 (0-59.6)&lt;0.001Total delay (months)1.22 (0.07-24.6)3.2 (0-59.89)&lt;0.001Treatment delay (months)0.62 (0-24.5)0.66 (0-36.9)0.183Clinical stage- In situ (0)68.284.10.026- Early (I, IIA)4764.48342.6- Locally advanced (IIB, IIIA-IIIC)1723.310051.3- Metastatic (IV)34.142.1Molecular subtype- RH- (in situ)22.710.50.568- HR+/HER2-5169.913569.2- HR+/HER2+45.5168.2- HR-/HER2+8112010.3- HR-/HER2-8112311.8Initial treatment- Local6082.212061.50.001- Systemic1317.88832.8Breast conserving surgery3245.16131.90.048Mastectomy3954.913068.1Axillary dissection2128.87940.50.121Sentinel lymph node466310855.4NA68.284.1Breast reconstruction3446.62412.3&lt;0.001Radiotherapy3953.413468.70.020Chemotherapy3243.815479&lt;0.001- Neoadjuvant1031.36944.80.199— Complete pathologic response3301927.50.029Anti-HER2 therapy (HER2+, n = 48)121003597.20.560Hormonal therapy (HR+, n = 206)5498.214797.40.7312
Citation Format: Bertha A Martinez-Cannon, Tania Zertuche-Maldonado, Sylvia de la Rosa-Pacheco, Servado Cardona-Huerta, Mauricio Canavati-Marcos, Gabriela S Gomez-Macias, Cynthia Villarreal-Garza. Comparison of demographic, diagnostic, pathological, and treatment characteristics in Mexican women with breast cancer according to type of healthcare coverage [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P6-11-11.