Abstract P4-10-16: Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US
Authors: Ramalho S , Dória MT , Natal RA , Conz L , Cabello V , Pavanello M , Cabello C , Mano MS , Linck RD , Batista LS , Pedro EP , Bines J , de Paula BH , Zucca-Matthes G , Ellis MJ , Podany E , Debord L , Makawita S , Stewart K , NematiShafaee M , Bondy ML 
Published: February 2018

Abstract
Background: Delays in diagnosis and treatment is associated with recurrence. Access to medical care in public health systems (PHS) may vary across Southwest Brazil and Houston, Texas. Objective: To evaluate disparities in breast cancer (BC) diagnosis and treatment between public services in southwest Brazil and at a public safety net hospital in Houston, Texas. Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at thefour hospitals in Brazil and two health centers in US were included. All statistical analyses was performed in R studio, and p&lt;0.05 was considered significant. Results: 967 women from PHS were included: 778 from Brazil and 189 from US. Recurrence rates were not significantly different (15.9% vs. 9.5%, p=0.233)
Table 1. Clinical and demographic characteristics of the patientsCharacteristicsBrazil (%), n=778US (%), n=189pDiscovery of BC By patient443 (56.9)87 (46) Routine exam82 (10.5)5 (2.7) Screening mammography207 (26.6)63 (33.4) Other46 (6)34 (17.9)&lt;0.001Initial treatment Surgery587 (75.4)100 (52.9) Neo-adjuvant chemotherapy176 (22.6)48 (25.4) Neo-adjuvant hormone therapy9 (1.1)14 (7.4) Unknown6 (0.9)27 (14.3)&lt;0.001Clinical Stage I234 (30.1)59 (31.2) II289 (36.8)56 (29.7) III239 (30.7)32 (16.9) Unknown19 (2.4)42 (22.2)0.027IHQ Subtype HR+/HER2 -467 (60)94 (49.7) HR+/HER2+91 (11.7)17 (9) HR-/HER2+66 (8.5)10 (5.3) Triple negative123 (15.8)26 (13.8) Unknown31 (4)42 (22.2)0.853Symptoms Yes492 (63.2)99 (52.4) No248 (31.9)58 (30.7) Unknown38 (4.9)32 (16.9)0.410Recurence No599 (77)120 (63.5) Yes124 (15.9)18 (9.5) Unknown55 (7.1)51 (27.0)0.233
. Considering the interval in weeks: symptoms to diagnosis, diagnosis to first systemic therapy and diagnosis to radiotherapy were longer in Brazil PHS patients (24.4 vs. 22.8; 18.9 vs. 16.1 and 51.8 vs. 47.8 p&lt;0.001).
Table 2. Delay disparities in public health system between Brazil and US BrazilUSpSymptoms to diagnosis Number of patients473102 Time (weeks)24.4 (0.5-102.6)22.8 (0.1-124.8)&lt;0.001Diagnosis to first treatment Number of patients546117 Time (weeks)10.8 (1.9-31.7)12.2 (3.1-26.4)&lt;0.001Diagnosis to first systemic treatment Number of patients45967 Time (weeks)18.9 (2.4-45.6)16.1 (3.3-38.6)&lt;0.001Diagnosis to surgical treatment Number of patients541116 Time (weeks)16.4 (3.1-43.1)19.2 (4.5-51.2)&lt;0.001Diagnosis to radiotherapy Number of patients41352 Time (weeks)51.8 (19.4-89.7)47.8 (14.9-84.8)&lt;0.001
However, considering the interval in weeks: diagnosis to first treatment (either surgery or neoadjuvant chemotherapy) and diagnosis to surgical treatment were shorter in Brazil PHS patients (10.8 vs. 12.2 and 16.4 vs. 19.2, p&lt;0.001). When considering surgery as initial treatment, treatment in Brazil PHS and stage III disease at diagnosis were associated with worse prognosis (HR: 1.91, 95%CI: 1.38 – 1.99, padj=0.015; HR 1.44, 95%CI:1.11-1.87, padj=0.006). Conclusions: There were significant disparities between Brazil and US PHS. Women in Brazil PHS presented higher rates of advanced clinical stages at diagnosis and diagnosis by routine exam, while US PHS present higher rates of diagnosis by screening mammography. When considering surgery as initial treatment, Houston PHS women had a better prognosis.
Citation Format: Ramalho S, Dória MT, Natal RA, Conz L, Cabello V, Pavanello M, Cabello C, Mano MS, Linck RD, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, NematiShafaee M, Bondy ML. Impact of delay in breast cancer diagnosis and treatment in public health according to nationality: Brazil vs US [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 P4-10-16.