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The Brazilian health system can be divided in public and private sectors. In the public sector, insurance is provided by the state to all Brazilian citizens (municipal, state and federal levels). The private sector is comprised of the private health insurance area, with various schemes of health plans or with out-of-pocket expenses. This study proposed to evaluate the breast cancer population characteristics, treatments according to public and private health care systems. 

This retrospective cohort had included patients diagnosed with invasive breast cancer, with health insurance information, between January 2000 and June 2020, from Fundação Oncocentro de Sao Paulo database. Descriptive analysis with fisher and x² test. Overall survival (OS) was evaluated using Kaplan-Meier model with log-rank test and Cox proportional regression analysis.

A total of 65543 patients were included. The distribution by age was the same for public and private systems. Table 1 describes all characteristics of cohort. The majority of patients was diagnosed on stage I and II (77.8%) in private system. Otherwise, at public system, it was found more advanced stage disease. (67.8% in II and III stage). Patients with metastatic tumor were more common in public system (11.1% versus 5.3%). Treatment with surgery and, at least, two types of adjuvant therapy, as trimodal therapy was the same in both groups (46,6% private versus 46.2% public). Kaplan-Meyer plot shows 5- and 10-years OS differences in all stages (Figure 1). 10-year OS in stage I, II, III and IV in private and public system were, respectively, 81,6 versus 77.5%, 74 versus 63.3%, 55.6% versus 39.6% and 7.6 versus 6.4%. In the multivariable analyses, the significant independent predictors for OS were private system, age at diagnosis, high level education, trimodal therapy and stage.

Public practice, older patients, less intensive treatment, and lower educational level were associated with worse survival outcomes in Brazilian breast cancer patients.