Late-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)

Renna Junior, Nelson Luiz; Silva, Gulnar de Azevedo e

doi:10.1055/s-0038-1624580

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 40 (03) • Mar 2018 • https://doi.org/10.1055/s-0038-1624580 copy

Late-Stage Diagnosis of Breast Cancer in Brazil: Analysis of Data from Hospital-Based Cancer Registries (2000-2012)

Diagnóstico de câncer de mama em estado avançado no Brasil: análise de dados dos registros hospitalares de câncer (2000-2012)

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To analyze the time trend and the factors regarding the diagnosis of latestage breast cancer in Brazil from 2000 to 2012.

Methods

We conducted a retrospective cohort study using data from hospital-based cancer registries. Joinpoint regression was used to analyze the time trends of stage at diagnosis. The risk of late-stage presentation was estimated using multinomial logistic regression.

Results

A total of 170,757 cases were analyzed. The median time from diagnosis to treatment was of 43 days (range: 0-182 days). The percentage of cases with late-stage diagnosis decreased from2000 to 2002, with an annual percent change (APC) of -6.6%(95%confidence interval [95%CI]: -7.6--5.5%); it increased from 2002 until 2009, with an APC of 1.1% (95% CI: 0.9-1.3%), and remained stable up to 2012.Women with college education (compared with illiterate women) had less chance of having a late-stage diagnosis (odds ratio [OR]: 0.32; 95%CI: 0.29-0.35). The odds were greater among brown women (OR: 1.30; 95%CI: 1.21-1.41) and black women (OR: 1.63; 95%CI: 1.47-1.82), compared with white women. The odds were also higher for women treated in facilities located and in the Northern region of Brazil (OR: 1.23; 95%CI: 1.04-1.45) and in the Midwest (OR: 1.61;95%CI: 1.34-1.94), compared with those treated in the southern region of the country. Age, histological type, and marital status were some of the other factors that were positively related to staging at the diagnosis.

Conclusion

Access to diagnosis of breast cancer is uneven in Brazil, and women with lower socioeconomic status present a greater probability of having an advanced stage at diagnosis.

Keywords:
breast neoplasms; women’s health service; disease registries; health services accessibility; oncology

Level of schooling	n (%)
No formal education	12,037 (6.8)
Primary education (incomplete)	50,476 (28.5)
Primary education (complete)	23,433 (13.2)
Secondary education	24,144 (13.6)
College (higher education)	12,296 (6.9)
Missing information	54,849 (30.9)
Region of the institution	n (%)
Midwest	2,802 (1.6)
Northeast	29,547 (17.3)
North	4,433 (2.6)
Southeast	106,711 (62.5)
South	27,264 (15.9)
Region of birth	n (%)
Midwest	2,401 (1.5)
Northeast	41,358 (26.0)
North	4,250 (2.7)
Southeast	83,861 (52.7)
South	25,838 (16.2)
Another country	1,361 (0.9)
Region of birth differs from region of institution	n (%)
No	124,237 (72.8)
Yes	33,471 (19.6)
Missing information	13,049 (7.6)
Smoking	n (%)
Former	2,486 (2.5)
Never	47,196 (48.1)
Current	16,927 (17.2)
Missing information	31,595 (32.2)
Alcoholism	n (%)
Former	723 (0.7)
Never	51,768 (52.7)
Current	8,802 (8.9)
Missing information	36,911 (37.6)
Marital status	n (%)
Single	20,155 (20.5)
Married	46,716 (47.6)
Civil union	341 (0.3)
Divorced	6,396 (6.5)
Widow	14,516 (14.8)
Missing information	10,080 (10.3)
Race/skin color	n (%)
Asian	665 (0.7)
White	49,825 (50.7)
Indigenous	86 (0.1)
Brown	32,801 (33.4)
Black	6,477 (6.6)
Missing information	8,350 (8.5)

Treatment accomplishment	n (%)
Complete treatment	147,375 (86.3)
Incomplete treatment	5,211 (3.0)
Missing information	18,171 (10.6)
Status at the end of treatment	n (%)
Without evidence of disease	31,107 (18.2)
Partial remission	5,481 (3.2)
Stable disease	25,653 (15.0)
Disease in progression	6,793 (3.9)
End-of-life care	989 (0.6)
Death	4,535 (2.6)
Not applicable	2,500 (1.5)
Missing information	93,699 (54.9)
Diagnosis and treatment at admission	n (%)
Diagnosis stabilized, treatment initiated	30,911 (18.1)
Diagnosis stabilized, no treatment	58,219 (34.0)
Without diagnosis and treatment	78,791 (46.1)
Missing information	431 (0.2)
Histological type	n (%)
Adenocarcinoma	3,049 (1.8)
Ductal differentiation	143,261 (84.0)
Lobular differentiation	15,013 (8.8)
Epithelial without any other specifications	4,860 (2.8)
Squamous	1,130 (0.6)
Medullary	1,106 (0.6)
Mucinous	2,078 (1.2)
Mucoepidermoid	14 (0.01)
Invasive neoplasm without any other specifications	246 (0.1)
Stage	n (%)
I	32,942 (19.3)
II	70,268 (41.1)
III	51,636 (30.2)
IV	15,911 (9.3)

Variables	Localized disease - OR (95%CI)	Advanced disease - OR (95%CI)
Age (years)
< 30	1	1
30–34	0.98 (0.85–1.15)	0.78 (0.63–0.97)
35–39	0.80 (0.70–0.93)	0.64 (0.52–0.78)
40–44	0.66 (0.57–0.75)	0.44 (0.36–0.53)
45–49	0.55 (0.48–0.63)	0.39 (0.32–0.47)
50–54	0.51 (0.44–0.58)	0.38 (0.32–0.47)
55–59	0.46 (0.40–0.53)	0.36 (0.30–0.44)
60–64	0.40 (0.35–0.46)	0.34 (0.28–0.41)
65–69	0.38 (0.33–0.43)	0.32 (0.26–0.39)
≥ 70	0.41 (0.36–0.47)	0.34 (0.28–0.42)
Level of schooling
No formal education (illiterate)	1	1
Primary education (incomplete)	0.67 (0.64–0.70)	0.65 (0.60–0.70)
Primary education (complete)	0.56 (0.54––0.60)	0.51 (0.46–0.55)
Secondary education	0.45 (0.43––0.48)	0.41 (0.38–0.45)
College (higher education)	0.34 (0.32––0.36)	0.32 (0.29–0.35)
Region of the institution
South	1	1
Midwest	1.69 (1.50–1.90)	1.88 (1.58–2.23)
Northeast	1.64 (1.57–1.72)	1.06 (0.98–1.15)
North	1.81 (1.68–1.96)	1.31 (1.15–1.49)
Southeast	1.10 (1.06–1.14)	1.11 (1.04–1.18)
State of birth
Same as the institution	1	1
Different from the institution	1.12 (1.09–1.16)	1.15 (1.09–1.21)
Histology
Ductal differentiation	1	1
Lobular differentiation	0.94 (0.90–0.98)	1.01 (0.93–1.08)
Other	0.71 (0.68–0.75)	1.16 (1.08–1.25)
Year of diagnosis
2000–2005	1	1
2006–2012	0.98 (0.96–1.01)	0.88 (0.85–0.92)

Variables	Localized disease - OR (95%CI)	Advanced disease - OR (95%CI)
Age
< 30	1	1
30–34	0.93 (0.76–1.15)	0.64 (0.47–0.86)
35–39	0.79 (0.65–0.96)	0.61 (0.46–0.80)
40–44	0.66 (0.55–0.80)	0.42 (0.32–0.55)
45–49	0.56 (0.46–0.67)	0.38 (0.30–0.50)
50–54	0.53 (0.44–0.63)	0.39 (0.30–0.50)
55–59	0.46 (0.38–0.55)	0.36 (0.27–0.47)
60–64	0.42 (0.35–0.51)	0.34 (0.26–0.45)
65–69	0.39 (0.32–0.48)	0.33 (0.25–0.43)
≥ 70	0.38 (0.32–0.46)	0.31 (0.24–0.41)
Level of schooling
No formal education (illiterate)	1	1
Primary education (incomplete)	0.67 (0.63–0.71)	0.65 (0.59–0.72)
Primary education (complete)	0.62 (0.57–0.66)	0.60 (0.54–0.67)
Secondary education	0.46 (0.43–0.50)	0.43 (0.38–0.48)
College (higher education)	0.38 (0.35–0.42)	0.32 (0.28–0.37)
Region of the institution
South	1	1
Midwest	1.48 (1.31–1.68)	1.61 (1.34–1.94)
Northeast	1.36 (1.28–1.44)	0.77 (0.70–0.85)
North	1.82 (1.64–2.01)	1.23 (1.04–1.45)
Southeast	1.17 (1.12–1.23)	1.03 (0.95–1.11)
State of birth
Same as the institution	1	1
Different from the institution	1.06 (1.01–1.11)	1.06 (0.99–1.15)
Histology
Ductal differentiation	1	1
Lobular differentiation	0.96 (0.90–1.02)	0.89 (0.80–0.99)
Other	0.81 (0.76–0.87)	1.19 (1.07–1.33)
Year of diagnosis
2000–2005	1	1
2006–2012	0.89 (0.86–0.92)	0.77 (0.72–0.82)
Race/skin color
White	1	1
Asian	1.16 (0.96–1.41)	1.24 (0.88–1.75)
Indigenous	0.94 (0.52–1.69)	1.25 (0.50–3.15)
Brown	1.16 (1.11–1.21)	1.30 (1.21–1.41)
Black	1.46 (1.36–1.57)	1.63 (1.47–1.82)
Marital status
Married	1	1
Divorced	1.05 (0.98–1.12)	0.97 (0.86–1.09)
Single	1.24 (1.19–1.30)	1.46 (1.35–1.56)
Widow	1.17 (1.11–1.23)	1.16 (1.07–1.28)

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[1] Address for correspondence Nelson Luiz Renna Junior, MD, MSc, Instituto deMedicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, bloco E, 7° andar, Maracanã, Rio de Janeiro, RJ, 20550-900, Brazil (e-mail: nelsonrenna@gmail.com).