Social disparities in survival of women with breast cancer in Espírito Santo, Brazil

Keywords

breast neoplasms - Kaplan-Meier estimate - survival analysis - disparities

Introduction: In Brazil, sociodemographic factors play an important role in breast cancer survival, such as stage, age at diagnosis, time from diagnosis to treatment, race, and socioeconomic status. Breast cancer survival analyses can demonstrate the effectiveness of public health policies, equity in resource distribution, and the impact of predictive factors on survival. Therefore, assessing breast cancer survival can help establish criteria for objective assessment of patient prognosis and can contribute to improving cancer prevention and control strategies.

Objective: To investigate the association between sociodemographic factors and survival of women diagnosed with breast cancer in all hospitals that make up the Oncology Care Network of the state of Espírito Santo.

Methods: Observational, hospital-based retrospective cohort study, covering databases extracted from the Hospital Cancer Registries and the Mortality Information System of Espírito Santo, composed of 12,096 patients with breast cancer. Cases were divided into death from breast cancer, death from other causes, and 5-year survival. For 5-year survival, the Kaplan-Meier and LogRank methods were used, in addition, the Cox proportional hazard model for specific cause of death was used in the multivariate analysis.

Results: The hospital cohort revealed that 8,184 (67.66%) of the women survived to the end of treatment, 2,947 (24.28%) died of breast cancer, and 9,075 (8.06%) died of other causes. Overall specific survival was 82% at 5 years. Multivariate analysis revealed that race is a risk factor for breast cancer-specific death, with black women having a 60% higher risk of breast cancer-specific mortality than white women (HR=1.601; 95% CI: 1.303-1.967; p<0.001). Similarly, marital status was also a risk factor for specific death, with single women having a 31% higher risk of breast cancer-specific mortality than married women (HR=1.314; 95% CI: 1.188-1.454; p<0.001).

Conclusion: There is a social disparity in 5-year breast cancer survival, mediated mainly by age at diagnosis, race/color, marital status, and level of education. These findings point to the need to expand the coverage and quality of the breast cancer screening program and facilitate access to early diagnosis and treatment, with a view to reducing health disparities and inequities.

Corresponding author: Luís Carlos Lopes-Júnior (e-mail: [e-mail]).

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
06 May 2025