Sobrevida e fatores prognósticos para o câncer de mama em Juiz de Fora, Minas Gerais, na coorte diagnosticada entre 1998 e 2000

• Autor(a) principal: Guerra, Maximiliano Ribeiro
• Data de Publicação: 2007
• Tipo de documento: Tese
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/4630
• topic: Breast cancer; Survival analysis; Prognosis; Health services coverage; Public health; Câncer da mama; Análise de sobrevida; Prognóstico; Cobertura de serviços de saúde; Saúde pública; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA::EPIDEMIOLOGIA

This study aimed to evaluate the breast cancer survival and prognostic factors mainly concerning health service-related variables. A total of 782 women with invasive disease, who had undergone curative surgery, were analysed. All of them received surgical treatment and/or complementary therapy in the city of Juiz de Fora, State of Minas Gerais, Brazil, and were diagnosed between 1998 and 2000. The cases were recruited from all local oncology services, and followed up through medical records, the Mortality Information System (SIM), contact by phone and the National Identification Number (CPF) investigation. Main variables studied included skin color, age at diagnosis, tumour size, lymph node involvement, disease stage, city of residence, health service-related variables, and others. Survival functions were calculated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. In the first article, the 5-year disease-specific survival was 80.9%, and tumour size and lymph node involvement were the main prognostic factors independently associated to disease-specific survival in the study population (HR=1.99, IC95%: 1.27-3.10 and HR=3.92, IC95%: 2.49-6.16, respectively). In the second article, when considered the health service-related variables, a worst survival was observed among women assisted in public health services in spite of bordering significance (p=0.05), and among women without private health coverage, despite not significant (p=0.1). Non-adjusted survival functions stratified by the health service nature identified a lower survival among non This study aimed to evaluate the breast cancer survival and prognostic factors mainly concerning health service-related variables. A total of 782 women with invasive disease, who had undergone curative surgery, were analysed. All of them received surgical treatment and/or complementary therapy in the city of Juiz de Fora, State of Minas Gerais, Brazil, and were diagnosed between 1998 and 2000. The cases were recruited from all local oncology services, and followed up through medical records, the Mortality Information System (SIM), contact by phone and the National Identification Number (CPF) investigation. Main variables studied included skin color, age at diagnosis, tumour size, lymph node involvement, disease stage, city of residence, health service-related variables, and others. Survival functions were calculated by the Kaplan-Meier method, and multivariate analysis was performed by the Cox proportional hazard model. In the first article, the 5-year disease-specific survival was 80.9%, and tumour size and lymph node involvement were the main prognostic factors independently associated to disease-specific survival in the study population (HR=1.99, IC95%: 1.27-3.10 and HR=3.92, IC95%: 2.49-6.16, respectively). In the second article, when considered the health service-related variables, a worst survival was observed among women assisted in public health services in spite of bordering significance (p=0.05), and among women without private health coverage, despite not significant (p=0.1). Non-adjusted survival functions stratified by the health service nature identified a lower survival among non white women and among cases with no nodes, or less than 10 nodes examined, both just in public service in spite of marginal significance (p=0.09 and p=0.07, respectively). In multivariate analysis the higher death risk observed among women who did not undergo hormonal therapy was detected only in cases assisted in the public service (HR=1.56; IC95%: 1.01-2.41) independently on tumour size and axillary node status. These results suggest social disparities and inequalities in primary and secondary disease prevention in the studied region with disadvantage to public service. The necessity of improving the disease information was emphasized, as well as earlier diagnosis and treatment. The importance of working with available oncology services data in our country was enhanced making it possible for the identification of the assisted patients profile and disease survival, and offering information to the local health government to establish preventive strategies for disease control in the studied population.