Ten-year survival and prognostic factors for breast cancer in the southeast region of Brazil

Fayer, Vívian Assis; Guerra, Maximiliano Ribeiro; Cintra, Jane Rocha Duarte; Bustamante-Teixeira, Maria Teresa

doi:10.1590/1980-5497201600040007

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ORIGINAL ARTICLES • Rev. bras. epidemiol. 19 (04) • Oct-Dec 2016 • https://doi.org/10.1590/1980-5497201600040007 copy

Ten-year survival and prognostic factors for breast cancer in the southeast region of Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT:

Introduction:

Breast cancer is an important public health issue in many parts of the world. Thus, it shows relevant incidence and is considered one of the main causes of death from cancer among women.

Objective:

To analyze ten-year survival and prognostic factors in women with invasive breast cancer.

Methods:

The cohort was composed of 195 women assisted in an oncology referral center in the municipality of Juiz de Fora, state of Minas Gerais, Brazil, who were diagnosed with the disease in 2000 and 2001. Sociodemographic, tumoral, health service, and treatment-related characteristics were analyzed. The Kaplan-Meier method was used to estimate the survival functions and the Cox model of proportional hazards for the evaluation of prognostic factors.

Results:

The ten-year survival after diagnosis was of 56.3%. The major independent prognostic factors associated with increased risk of death were tumor size > 2.0 cm (hazard ratio - HR = 1.9; confidence interval - 95%CI 1.0 - 3.2) and presence of compromised lymph nodes (HR = 3.7; 95%CI 2.1 - 5.9).

Conclusion:

These findings reinforce the need of adopting actions that ensure access of the target population to the recommended diagnostic and therapeutic modalities, thus contributing to achieve earlier diagnosis and better survival rates.

Keywords:
Breast neoplasms; Survival analysis; Prognosis; Indicators; Brazil; Epidemiology

Characteristics	Cases (n)^#	%	Under-10 years (%)	95%CI	p-value*
Total of cases	195	100.0	56.3	48.3 - 63.5	p-value*
Color of skin
White	145	79.7	57.7	48.5 - 65.7	0.37
Not white	37	20.3	44.9	27.1 - 61.3	0.37
Age at diagnosis (years)
< 40	17	8.7	57.0	26.5 - 78.8	0.16
40 - 49	43	22.1	66.1	49.4 - 79.5
50 - 59	44	22.6	51.1	33.9 - 65.8
60 - 69	46	23.6	65.6	47.1 - 79.0
≥ 70	45	23.1	42.9	27.9 - 57.0
Size of the tumor (cm)
≤ 2.0	66	34.9	68.6	54.5 - 79.2	0.01
> 2.0	123	65.1	49.0	38.9 - 58.3	0.01
Lymph nodes involvement
Negative	102	55.4	74.1	63.1 - 82.3	< 0.001
Positive	82	44.6	36.6	27.2 - 49.9	< 0.001
Staging
I	45	23.4	75.1	57.1 - 86.3	< 0.001
II	101	52.6	63.0	51.7 - 72.4
III	39	20.3	26.3	12.9 - 41.8
IV	7	3.6	14.3	0.71 - 46.5
Estrogen receptor
Negative	37	25.3	53.0	34.9 - 68.2	0.24
Positive	109	74.7	61.0	50.3 - 70.4	0.24
Progesterone receptor
Negative	44	30.3	57.7	40.7 - 71.4	0.50
Positive	101	69.7	59.7	48.4 - 69.3	0.50
HER2
Negative	73	57.5	64.2	50.8 - 74.8	0.27
Positive	54	42.5	55.1	39.8 - 68.1	0.27
Service type
Public	110	56.4	46.9	36.5 - 56.6	0.01
Private	85	43.6	68.9	56.6 - 78.4	0.01
Health insurance
No	97	50	47.9	36.5 - 58.3	0.02
Yes	97	50	65.0	53.6 - 74.3	0.02
Time elapse between diagnosis and surgery (weeks)
≤ 4	166	86	55.8	47.2 - 63.6	0.80
> 4	27	14	61.3	36.8 - 78.7	0.80
Type of surgery
Conservative	98	53.6	71.1	59.2 - 80.1	< 0.001
Radical	85	46.4	45.1	33.8 - 55.7	< 0.001
Tumor markers
Absent	46	24	44.0	27.8 - 59.1	0.08
Present	146	76	59.3	50.0 - 67.4	0.08
Chemotherapy
Did not use	120	61.5	54.3	44.0 - 63.4	0.36
Used	75	38.5	59.7	46.5 - 70.6	0.36
Hormone therapy
Did not use	116	59.5	57.1	46.7 - 66.3	0.70
Used	79	40.5	54.9	42.2 - 66.0	0.70
Radiotherapy
Did not use	79	40.5	56.9	44.5 - 67.6	0.54
Used	116	59.5	56.4	45.8 - 65.6	0.54

Characteristics	Unadjusted HR	95%CI	Adjusted HR*	95%CI	p-value
Lymph nodes involvement
Negative	1	2.2 - 6.2	1	2.1 - 5.9	< 0.001
Positive	3.7	2.2 - 6.2	3.5	2.1 - 5.9	< 0.001
Size of the tumor (cm)
≤ 2.0	1	1.1 - 3.3	1	1.0 - 3.2	0.04
> 2.0	1.9	1.1 - 3.3	1.8	1.0 - 3.2	0.04
Health plan
No	1	0.4 - 0.9	1	0.4 - 0.9	0.04
Yes	0.6	0.4 - 0.9	0.6	0.4 - 0.9	0.04

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[1] Corresponding author: Vívian Assis Fayer. Universidade Federal de Juiz de Fora. Programa de Pós-Graduação em Saúde Coletiva. Rua José Lourenço Kelmer, s/n.º, Campus Universitário, São Pedro, CEP: 36036-900, Juiz de Fora, MG, Brasil. E-mail: vivifayer@gmail.com