Cancer epidemiology · 2026
Inequalities in breast cancer early detection, timeliness of care and survival in Colombia.
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Valbuena-Garcia Ana Maria, Piñeros Marion, Vaccarella Salvatore, Acuña Lizbeth, de Vries Esther
Аннотация
PURPOSE: Despite universal health care coverage, Colombia remains among the most unequal countries worldwide, with disparities in cancer care. We evaluated inequities in breast cancer care across stage at diagnosis, timeliness of care, and survival by region, insurance scheme, and ethnicity.
METHODS: Longitudinal study including all adult women with primary invasive breast cancer diagnosed between 2021 and 2023, reported to the Colombian administrative cancer registry. Inequities were assessed between regions of residence, ethnicity, and health insurance schemes. Outcomes included stage at diagnosis, diagnostic delay (>60 days), treatment delay (>30 days), and overall survival. Survival was estimated using Kaplan-Meier methods, with group comparisons by log-rank tests. Crude hazard ratios for death were estimated using Cox model stratified by stage at diagnosis. Absolute and relative measures quantified inequalities.
RESULTS: 63.3% of the 31,476 included cases were affiliated with the contributory insurance scheme. Localized-stage diagnosis was more frequent in the contributory than in the subsidized scheme (49.2% vs 33.8%). Median time to diagnosis was shorter in the contributory versus the subsidized scheme (25 vs 35 days). 2-year OS was lower in the subsidized than in the contributory scheme (86.0% vs 92.5%). Survival was poorer for locally advanced and metastatic disease, with additional disadvantages among Indigenous women and residents of the Amazonian region. Inequities were most pronounced by insurance scheme.
CONCLUSIONS: Substantial inequities in breast cancer care persist in Colombia. Indigenous and Black women, and those in the subsidized scheme experience later-stage diagnosis and lower survival, reflecting ongoing barriers to timely and equitable access to cancer care despite universal health coverage.
METHODS: Longitudinal study including all adult women with primary invasive breast cancer diagnosed between 2021 and 2023, reported to the Colombian administrative cancer registry. Inequities were assessed between regions of residence, ethnicity, and health insurance schemes. Outcomes included stage at diagnosis, diagnostic delay (>60 days), treatment delay (>30 days), and overall survival. Survival was estimated using Kaplan-Meier methods, with group comparisons by log-rank tests. Crude hazard ratios for death were estimated using Cox model stratified by stage at diagnosis. Absolute and relative measures quantified inequalities.
RESULTS: 63.3% of the 31,476 included cases were affiliated with the contributory insurance scheme. Localized-stage diagnosis was more frequent in the contributory than in the subsidized scheme (49.2% vs 33.8%). Median time to diagnosis was shorter in the contributory versus the subsidized scheme (25 vs 35 days). 2-year OS was lower in the subsidized than in the contributory scheme (86.0% vs 92.5%). Survival was poorer for locally advanced and metastatic disease, with additional disadvantages among Indigenous women and residents of the Amazonian region. Inequities were most pronounced by insurance scheme.
CONCLUSIONS: Substantial inequities in breast cancer care persist in Colombia. Indigenous and Black women, and those in the subsidized scheme experience later-stage diagnosis and lower survival, reflecting ongoing barriers to timely and equitable access to cancer care despite universal health coverage.