Clinical Characteristics and Outcome of Treatment of Brazilian Women with Breast Cancer Treated at Public and Private Institutions – The AMAZONE Project of the Brazilian Breast Cancer Study Group (GBECAM).
Authors: Simon S. , Bines J. , Barrios C. , Nunes J. , Gomes E. , Pacheco F. , Santana Gomes A. , Segalla J. , Crocamo-Costa S. , Gimenes D. , van Eyll B. , Queiroz G. , Borges G. , Dal Lago L. , Vasconcellos C. 
Published: December 2010

Abstract
Introduction: With close to 50,000 new cases/year, breast cancer is the most common cancer among Brazilian women. There are few data regarding the clinical presentation, treatment and outcome of this population.Methods: The Brazilian Breast Cancer Study Group (GBECAM) collected data from 28 cancer centers distributed throughout the country on 1-) clinical characteristics, 2-) type of treatment received and 3-) survival curves of 4,912 Brazilian women presenting with breast cancer and treated at public (Pu), and private (Pr) institutions in the years 2001(N=2,198) and 2006 (N=2,714).Results: 1-) Mean age at diagnosis was 59.3 (median=58), with 25.4% below age 50. Stage 0 was seen in 2.8%, Stage I in 20.2%, Stage II in 46.8%, Stage III in 24.6% and Stage IV in 5.5%. Clinical Stage III+IV was seen in 36.9% of pts in Pu, and only 16.2% in Pr institutions. Hormone Receptors were positive in 69.9% of pts; HER2 was overexpressed/amplified in 20.3%; 19.1% of the cases were triple-negative. 2-) Neoadjuvant chemotherapy (CT) was done in 26.5% of cases in Pu and only 11% of Pr pts. Breast-conserving surgery was performed in 40.9% of Pu and 51.7% of Pr pts. Sentinel node biopsy was done in 15.9% of Pu and 25.9% of Pr pts. Adjuvant therapy was done in 88.2% of the cases. Adjuvant CMF was done in 31.4% of Pu and 15.8% of Pr pts; anthracycline plus taxane was used in 9.2% of Pu and 23.5% of Pr pts. In the cohort of 2006, adjuvant trastuzumab was given to 56.2% of Pr but only 6.6% of Pu pts. Adjuvant hormonal therapy consisted of tamoxifen (TAM) in 86.6%, aromatase inhibitors (AI) in 6.3% and sequential Tam/AI in 6.6% of pts. Adjuvant radiotherapy was given to 76% of the cases. 3-) Survival was studied for all patients of the 2001 cohort. Disease-free survival (DFS) at 5 years was 78% for Pr vs 72% for Pu institutions. Overal survival (OS) at 5 years was 97% in Pr vs 88% in Pu institutions. When analyzed by stage, there was no apparent difference when pts with stage I or II were treated in Pr or Pu institutions. In stage III, however, DFS was 61% in Pr vs 47% in Pu institutions. OS in Stage III disease was 95% for Pr vs 65% in Pu institutions.Outcomes in Public vs. Private Institutions PUBLICPRIVATENeoadjuvant CT26.5%11%Adjuvant CMF31.4%15.8%Taxane/Anthra9.2%23.5%DFS72%78%DFS - Stage III47%61%OS88 %97%OS - Stage III65%95%Cohort of 2001 (N=2,198)Conclusions: Our data suggest that pts with breast cancer in Brazil present with more advanced stages in Pu institutions. These pts are more likely to receive neoadjuvant CT and undergo total mastectomy. These pts receive more CMF and less anthracycline/taxane combinations as adjuvant CT. Patients with Stage III disease treated in Pu institutions have inferior DFS and OS compared to similar pts treated in Pr institutions.
Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3082.