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.
Bines et al. (Thu,) studied this question.