Diagnóstico de câncer de mama em estado avançado no Brasil: análise de dados dos registros hospitalares de câncer (2000-2012)

Renna Junior, Nelson Luiz; Silva, Gulnar de Azevedo e

doi:10.1055/s-0038-1624580

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Brasil

Revista Brasileira de Ginecologia e Obstetrícia

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Sumário

Original Article • Rev. Bras. Ginecol. Obstet. 40 (03) • Mar 2018 • https://doi.org/10.1055/s-0038-1624580 copiar

Diagnóstico de câncer de mama em estado avançado no Brasil: análise de dados dos registros hospitalares de câncer (2000-2012)

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Objetivo

Analisar a tendência temporal e os fatores relacionados ao diagnóstico do câncer de mama em estágio avançado no Brasil entre 2000 e 2012.

Métodos

Foi feito estudo de tendência temporal e de coorte retrospectiva e com dados do registro hospitalar de câncer. A análise de tendência temporal foi feita usando o modelo de regressão joinpoint. A chance de apresentação em estágio avançado foi estimada pelo modelo de regressão logística multinomial.

Resultados

Um total de 170.757 casos foram analisados. O tempo médio entre o diagnóstico e o início do tratamento foi de 43 dias (variação: 0-182 dias). O percentual de casos com estadiamento avançado ao diagnóstico diminuiu de 2000 a 2002, com uma variação percentual anual (VPA) de -6,6% (intervalo de confiança de 95% [IC95%] -7,6-5,5%); esse percentual aumentou entre 2002 e 2009, com um VPA de 1,1% (IC95%: 0,9- 1,3%), e se manteve estável de 2009 a 2012. Mulheres com ensino superior (comparadas a analfabetas) apresentaram chance menor de terem doença avançada ao diagnóstico (razão de chances [OP]: 0,32; IC95%: 0,29-0,35). As chances foram maiores entre mulheres pardas (OR: 1,30; IC95%: 1,21-1,41) e negras (OR: 1,63; IC95%: 1,47-1,82) em comparação com as brancas. Mulheres tratadas nas regiões Norte (OR: 1,23; IC95%: 1,04-1,45) e Centro-oeste (OR: 1,61; IC95%: 1,34-1,94) apresentaram maior chance de terem doença avançada ao diagnóstico quando comparadas com as tratadas na região Sul. Outros fatores positivamente associados ao estadiamento no momento do diagnóstico foram: idade, tipo histológico e estado civil.

Conclusão

O acesso ao diagnóstico de câncer de mama é desigual no Brasil, e mulheres com nível socioeconômico mais baixo têm uma probabilidade maior de ter uma doença avançada ao diagnóstico.

Palavras-Chave:
neoplasias da mama; serviços de saúde da mulher; registros de doenças; acesso aos serviços de saúde; oncologia

Level of schooling	n (%)
No formal education	12,037 (6.8)
Primary education (incomplete)	50,476 (28.5)
Primary education (complete)	23,433 (13.2)
Secondary education	24,144 (13.6)
College (higher education)	12,296 (6.9)
Missing information	54,849 (30.9)
Region of the institution	n (%)
Midwest	2,802 (1.6)
Northeast	29,547 (17.3)
North	4,433 (2.6)
Southeast	106,711 (62.5)
South	27,264 (15.9)
Region of birth	n (%)
Midwest	2,401 (1.5)
Northeast	41,358 (26.0)
North	4,250 (2.7)
Southeast	83,861 (52.7)
South	25,838 (16.2)
Another country	1,361 (0.9)
Region of birth differs from region of institution	n (%)
No	124,237 (72.8)
Yes	33,471 (19.6)
Missing information	13,049 (7.6)
Smoking	n (%)
Former	2,486 (2.5)
Never	47,196 (48.1)
Current	16,927 (17.2)
Missing information	31,595 (32.2)
Alcoholism	n (%)
Former	723 (0.7)
Never	51,768 (52.7)
Current	8,802 (8.9)
Missing information	36,911 (37.6)
Marital status	n (%)
Single	20,155 (20.5)
Married	46,716 (47.6)
Civil union	341 (0.3)
Divorced	6,396 (6.5)
Widow	14,516 (14.8)
Missing information	10,080 (10.3)
Race/skin color	n (%)
Asian	665 (0.7)
White	49,825 (50.7)
Indigenous	86 (0.1)
Brown	32,801 (33.4)
Black	6,477 (6.6)
Missing information	8,350 (8.5)

Treatment accomplishment	n (%)
Complete treatment	147,375 (86.3)
Incomplete treatment	5,211 (3.0)
Missing information	18,171 (10.6)
Status at the end of treatment	n (%)
Without evidence of disease	31,107 (18.2)
Partial remission	5,481 (3.2)
Stable disease	25,653 (15.0)
Disease in progression	6,793 (3.9)
End-of-life care	989 (0.6)
Death	4,535 (2.6)
Not applicable	2,500 (1.5)
Missing information	93,699 (54.9)
Diagnosis and treatment at admission	n (%)
Diagnosis stabilized, treatment initiated	30,911 (18.1)
Diagnosis stabilized, no treatment	58,219 (34.0)
Without diagnosis and treatment	78,791 (46.1)
Missing information	431 (0.2)
Histological type	n (%)
Adenocarcinoma	3,049 (1.8)
Ductal differentiation	143,261 (84.0)
Lobular differentiation	15,013 (8.8)
Epithelial without any other specifications	4,860 (2.8)
Squamous	1,130 (0.6)
Medullary	1,106 (0.6)
Mucinous	2,078 (1.2)
Mucoepidermoid	14 (0.01)
Invasive neoplasm without any other specifications	246 (0.1)
Stage	n (%)
I	32,942 (19.3)
II	70,268 (41.1)
III	51,636 (30.2)
IV	15,911 (9.3)

Variables	Localized disease - OR (95%CI)	Advanced disease - OR (95%CI)
Age (years)
< 30	1	1
30–34	0.98 (0.85–1.15)	0.78 (0.63–0.97)
35–39	0.80 (0.70–0.93)	0.64 (0.52–0.78)
40–44	0.66 (0.57–0.75)	0.44 (0.36–0.53)
45–49	0.55 (0.48–0.63)	0.39 (0.32–0.47)
50–54	0.51 (0.44–0.58)	0.38 (0.32–0.47)
55–59	0.46 (0.40–0.53)	0.36 (0.30–0.44)
60–64	0.40 (0.35–0.46)	0.34 (0.28–0.41)
65–69	0.38 (0.33–0.43)	0.32 (0.26–0.39)
≥ 70	0.41 (0.36–0.47)	0.34 (0.28–0.42)
Level of schooling
No formal education (illiterate)	1	1
Primary education (incomplete)	0.67 (0.64–0.70)	0.65 (0.60–0.70)
Primary education (complete)	0.56 (0.54––0.60)	0.51 (0.46–0.55)
Secondary education	0.45 (0.43––0.48)	0.41 (0.38–0.45)
College (higher education)	0.34 (0.32––0.36)	0.32 (0.29–0.35)
Region of the institution
South	1	1
Midwest	1.69 (1.50–1.90)	1.88 (1.58–2.23)
Northeast	1.64 (1.57–1.72)	1.06 (0.98–1.15)
North	1.81 (1.68–1.96)	1.31 (1.15–1.49)
Southeast	1.10 (1.06–1.14)	1.11 (1.04–1.18)
State of birth
Same as the institution	1	1
Different from the institution	1.12 (1.09–1.16)	1.15 (1.09–1.21)
Histology
Ductal differentiation	1	1
Lobular differentiation	0.94 (0.90–0.98)	1.01 (0.93–1.08)
Other	0.71 (0.68–0.75)	1.16 (1.08–1.25)
Year of diagnosis
2000–2005	1	1
2006–2012	0.98 (0.96–1.01)	0.88 (0.85–0.92)

Variables	Localized disease - OR (95%CI)	Advanced disease - OR (95%CI)
Age
< 30	1	1
30–34	0.93 (0.76–1.15)	0.64 (0.47–0.86)
35–39	0.79 (0.65–0.96)	0.61 (0.46–0.80)
40–44	0.66 (0.55–0.80)	0.42 (0.32–0.55)
45–49	0.56 (0.46–0.67)	0.38 (0.30–0.50)
50–54	0.53 (0.44–0.63)	0.39 (0.30–0.50)
55–59	0.46 (0.38–0.55)	0.36 (0.27–0.47)
60–64	0.42 (0.35–0.51)	0.34 (0.26–0.45)
65–69	0.39 (0.32–0.48)	0.33 (0.25–0.43)
≥ 70	0.38 (0.32–0.46)	0.31 (0.24–0.41)
Level of schooling
No formal education (illiterate)	1	1
Primary education (incomplete)	0.67 (0.63–0.71)	0.65 (0.59–0.72)
Primary education (complete)	0.62 (0.57–0.66)	0.60 (0.54–0.67)
Secondary education	0.46 (0.43–0.50)	0.43 (0.38–0.48)
College (higher education)	0.38 (0.35–0.42)	0.32 (0.28–0.37)
Region of the institution
South	1	1
Midwest	1.48 (1.31–1.68)	1.61 (1.34–1.94)
Northeast	1.36 (1.28–1.44)	0.77 (0.70–0.85)
North	1.82 (1.64–2.01)	1.23 (1.04–1.45)
Southeast	1.17 (1.12–1.23)	1.03 (0.95–1.11)
State of birth
Same as the institution	1	1
Different from the institution	1.06 (1.01–1.11)	1.06 (0.99–1.15)
Histology
Ductal differentiation	1	1
Lobular differentiation	0.96 (0.90–1.02)	0.89 (0.80–0.99)
Other	0.81 (0.76–0.87)	1.19 (1.07–1.33)
Year of diagnosis
2000–2005	1	1
2006–2012	0.89 (0.86–0.92)	0.77 (0.72–0.82)
Race/skin color
White	1	1
Asian	1.16 (0.96–1.41)	1.24 (0.88–1.75)
Indigenous	0.94 (0.52–1.69)	1.25 (0.50–3.15)
Brown	1.16 (1.11–1.21)	1.30 (1.21–1.41)
Black	1.46 (1.36–1.57)	1.63 (1.47–1.82)
Marital status
Married	1	1
Divorced	1.05 (0.98–1.12)	0.97 (0.86–1.09)
Single	1.24 (1.19–1.30)	1.46 (1.35–1.56)
Widow	1.17 (1.11–1.23)	1.16 (1.07–1.28)

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[1] Address for correspondence Nelson Luiz Renna Junior, MD, MSc, Instituto deMedicina Social, Universidade do Estado do Rio de Janeiro, Rua São Francisco Xavier 524, bloco E, 7° andar, Maracanã, Rio de Janeiro, RJ, 20550-900, Brazil (e-mail: nelsonrenna@gmail.com).