Abstract P6-08-25: Outcome of breast cancer patients treated in the private health care in Brazil
Authors: Boukai A , Gonçalves AC , Andrade PM , Carvalho N , Almeida T , Lemos F , Padoan M , Teich NS , Araujo LH 
Published: February 2018

Abstract
Background
Developing countries like Brazil often present a dichotomous health care system, where patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutics procedures. Herein, we present the first report of a comprehensive study to assess real-world data in breast cancer patients treated in the private health care in Brazil.
Methods
This is a prospective study of breast cancer patients treated in a private health care institution, comprising six unities in Rio de Janeiro and surroundings. Eligible patients were at least 18 years old and had a histology-proven diagnosis of breast cancer between July 2012 and November 2016. For this analysis, only female patients with an invasive component were included. Patients with prior malignancies and those who initiated therapy in other institutions were excluded. Patients or relatives were contacted by telephone to ensure that all information was annotated. Data quality was certified by regular monitoring. This study was approved by the local Research Ethics Committee.
Results
One thousand three hundred and ninety patients were enrolled. One hundred sixty were excluded in this analysis, 11 due to male gender and 151 with exclusively in situ carcinoma. The report comprises 1230 female patients, predominantly diagnosed in early (79.0% stages I-II) or locally advanced (16.1% stage III) stages. One thousand thirty-three (84.0%) patients had hormone receptor (HR)-positive tumors, and 185 (15.0%) were HER2 positive. One hundred twenty-six (10.2%) cases were triple negative. The primary tumor was resected in 89.0% of times, most often through breast-conserving surgery (55.1%). Axillary lymph nodes were assessed in 83.4% of cases, and 32.0% required complete axillary dissection. Chemotherapy was used in 61.3% of cases, and radiation therapy in 59.6%. Patients with locally advanced disease received more aggressive therapy than patients with early stage (higher rates of mastectomy, axillary dissection and chemotherapy use). After a median follow up of 22.5 months (95% CI, 21.09-23.90), 54 (4.4%) deaths were reported. The estimated 2-year overall survival (OS) was 95.3%. 2-year OS was significantly longer among patients with stages I-II (97.9% and 97.5%, respectively) than in stages III and IV (89.4% and 69.5%, respectively) (p&lt;0.01). HER2/HR status (p&lt;0.01) and tumor grade (p=0.05) were also correlated to OS in the overall cohort, however triple-negative cases were only prognostic in stage III. Age (p=0.10), menopausal status (p=0.74), and histological subtype (p=0.55) were not correlated to OS.
Conclusion
To our knowledge, this is the most comprehensive and best-annotated study in breast cancer patients treated in the private health care in Brazil. More oncological interventions were used in advanced stages, reflecting international recommendations, but also a need to pursue early diagnoses, where outcome is optimal despite less aggressive therapy. Outcomes are favorably similar to the current literature from developed countries in all stages. The data provided helps comprehending the current scenario of breast cancer presentation and treatment in Brazil, and may serve as a foundation to guide resource allocation in the years to come.
Citation Format: Boukai A, Gonçalves AC, Andrade PM, Carvalho N, Almeida T, Lemos F, Padoan M, Teich NS, Araujo LH. Outcome of breast cancer patients treated in the private health care in Brazil [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-08-25.