Background: Breast cancer incidence is increasing. The survival rate varies and is longer in high-income countries.\r\nIn Brazil, lower-income populations rely on the Unified Public Health System (Sistema �šnico de Saude, SUS) for\r\nbreast cancer care. The goal of our study is to evaluate the survival of patients with operable breast cancer stages\r\nI-III at a Brazilian public hospital that treats mostly patients from the SUS.\r\nMethods: A cohort study of patients who underwent surgery for breast cancer treatment at the Clinical Hospital of\r\nthe Federal University of Minas Gerais from 2001 to 2008 was performed, with a population of 897 cases.\r\nInformation on tumor pathology and staging, as well as patientsâ�� age and type of health coverage (SUS or private\r\nsystem) was collected. A probabilistic record linkage was performed with the database of the Mortality Information\r\nSystem to identify patients who died by December 31th, 2011. The basic cause of death was retrieved, and breast\r\ncancer-specific survival rates were estimated with the Kaplan-Meier method. The Cox proportional hazards model\r\nwas used for univariate and multivariate analysis of factors related to survival.\r\nResults: A total of 282 deaths occurred during the studyâ��s period, 228 of them due to breast cancer. Five-year\r\nbreast cancer-specific survival rates were 95.5% for stage I, 85.1% for stage II and 62.1% for stage III disease. Patients\r\nfrom the SUS had higher stages at diagnosis (42% was in stage III, and from the private system only 17.6% was in\r\nthis stage), and in the univariate but not multivariate analysis, being treated by the SUS was associated with shorter\r\nsurvival (hazard ratio, HR = 2.22, 95% CI 1.24-3.98). In the multivariate analysis, larger tumor size, higher histologic\r\ngrade, higher number of positive nodes and age older than 70 years were associated with a shorter breast cancerspecific\r\nsurvival.\r\nConclusions: Five-year breast cancer survival was comparable to other Brazilian cohorts. Patients treated by the\r\nSUS, rather than by the private system, had shorter survival times, mostly due to higher initial stage of the disease.
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