Sobrevida por câncer de mama segundo serviço de assistência público ou privado: análise de coorte hospitalar de município do sudeste brasileiro

Abstract

This study aimed to evaluate breast cancer survival at five and ten years, according to the type of health care service in women who were diagnosed with breast cancer between 2003-2005 and assisted in Juiz de Fora / MG. From the cohort study carried out with 518 women diagnosed with invasive breast cancer between 2003 and 2005, it was applied the Kaplan Meier method to estimate the probability of survival and the Cox proportional hazards regression model to assess prognostic factors. Five and ten-year breast cancer survival were, respectively: 80.6% (CI95% 75.0-85.0) and 71.5% (CI95% 65.4-77.1) in private health care service; and 68.5% (CI95% 62.5-73.8) and 58.5% (CI95% 52.1-64.4) in public health care service. The main factors associated with the worst prognosis were the presence of lymph node involvement in both health care services and tumor size >2 cm only in public health service. The use of hormone therapy in the private service was associated with best survival such as the use of radiotherapy in the public service was associated with better survival. The results indicate inequalities in the access to early detection of the disease, such as the high percentage of advanced staging at diagnosis among women treated in the public service. On the other hand, most women started treatment within thirty days after the diagnosis was confirmed, with no differences between the services. The findings reinforce the important role played by the registries of health services, which subsidize the production of relevant data for the monitoring and evaluation of cancer care, as well as allowing the identification of the adversities that blocks the development of better practices in the health service to reach integral care of patients.