JCO global oncology · 2026
Disparities in 5-Year Overall Survival From Breast Cancer by Health Care Coverage in Brazil: Evidence From Patients in the Largest South American Registry-Based Study.
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Bines José, Lima Anne Dominique Nascimento, Silveira Iago Diogo, Correa Netto Nelson Francisco, de Oliveira Cintia S Kurokawa La Scala, Ziegelmann Patricia Klarmann
Аннотация
PURPOSE: Breast cancer is the most common cancer in women in Brazil. Despite universal coverage through the Unified Health System (Sistema Único de Saúde [SUS]), major inequities in access, timely diagnosis, and treatment persist when compared with the private sector. We assessed 5-year overall survival (OS) according to health care coverage to provide robust real-world evidence of survival inequities.
METHODS: This retrospective cohort study included 63,663 women with invasive breast cancer diagnosed between 2012 and 2019 using the largest South American hospital-based cancer registry (Registro Hospitalar de Câncer da Fundação Oncocentro de São Paulo). Survival probabilities were estimated using the Kaplan-Meier method, and differences across groups were tested with log-rank statistics. Cox proportional hazards models were applied to assess the association between health care coverage and mortality, adjusting for demographic, clinical, and treatment variables.
RESULTS: Patients in the public system (83%) were older, had lower educational attainment, were more often diagnosed with advanced-stage disease (41% v 21.0%), and were less likely to receive minimal standard treatment (75% v 81%). The 5-year OS rate was 66.2% in the SUS group and 79.7% in the private care group. After adjustment, patients with SUS faced a 53% higher risk of death (hazard ratio, 1.53 [95% CI, 1.44 to 1.63]).
CONCLUSION: Universal health coverage does not guarantee equitable outcomes. Disparities in the stage at diagnosis, treatment access, and social determinants translate into marked survival inequities. Our findings highlight the urgent need for system-level reforms and targeted investments in oncology capacity in Brazil and across the low- and middle-income countries.
METHODS: This retrospective cohort study included 63,663 women with invasive breast cancer diagnosed between 2012 and 2019 using the largest South American hospital-based cancer registry (Registro Hospitalar de Câncer da Fundação Oncocentro de São Paulo). Survival probabilities were estimated using the Kaplan-Meier method, and differences across groups were tested with log-rank statistics. Cox proportional hazards models were applied to assess the association between health care coverage and mortality, adjusting for demographic, clinical, and treatment variables.
RESULTS: Patients in the public system (83%) were older, had lower educational attainment, were more often diagnosed with advanced-stage disease (41% v 21.0%), and were less likely to receive minimal standard treatment (75% v 81%). The 5-year OS rate was 66.2% in the SUS group and 79.7% in the private care group. After adjustment, patients with SUS faced a 53% higher risk of death (hazard ratio, 1.53 [95% CI, 1.44 to 1.63]).
CONCLUSION: Universal health coverage does not guarantee equitable outcomes. Disparities in the stage at diagnosis, treatment access, and social determinants translate into marked survival inequities. Our findings highlight the urgent need for system-level reforms and targeted investments in oncology capacity in Brazil and across the low- and middle-income countries.