Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais

Abstract

The study's objectives were to investigate the association between race/color and 10-year survival in women with breast cancer and the role of staging as mediator. This was a hospital cohort with 481 women with invasive breast cancer diagnosed from 2003 to 2005. Comparisons were made between white and black women as to sociodemographic characteristics and staging, using the chi-square test, and 10-year survival, using Kaplan-Meier and Cox regression methods. For the race/color variable, direct and indirect effects were estimated, mediated by staging, with adjustment for the socioeconomic status of the woman's area of residence and age, using the potential responses (counterfactual) model and Cox multiple regression. Black women living in low-income census tracts were more likely to use the public health care system and to be diagnosed at more advanced stages. Breast cancer-specific 10-year survival was 64.3% (95%CI: 60.0; 68.9), with a significant difference between whites (69.5%; 95%CI: 64.8; 74.6) and blacks (44; 95%CI: 35.2%; 55.1). In the multivariate models adjusted for income and age, black women had worse prognosis (HR = 2.09; 95%CI: 1.76; 2.51), and the proportion mediated by staging was 40% (95%CI: 37; 42). There is racial disparity in 10-year breast cancer survival in Brazilian women, mediated mainly by more advanced staging at diagnosis in black women. This highlights the need to expand both the coverage and the quality of breast cancer screening and to facilitate access to early diagnosis and treatment in order to reduce racial inequality.

Inequalities in the burden of female breast cancer in Brazil, 1990–2017

“…The long-term survival of women with breast cancer has been increasing in Brazil, although it still shows lower rates than in higher-income countries. This increase in survival has been attributed to improvements in breast cancer treatment, and also to the increase in mammographic screening [30]. However, a study that analyzed data from hospital-based cancer registries in Brazil did not show a reduction in the late stage of breast cancer, even with the implementation of the screening national program in 2004 [31].…”

Prevalência e fatores associados ao diagnóstico de câncer de mama em estágio avançado

“…Tal fato decorre das iniquidades raciais em saúde, ligadas ao risco de adoecer e de morrer 30 . Desigualdades em indicadores de saúde, juntamente com outros indicadores de posição social, como educação e renda, evidenciam a raça/cor de pele como um determinante social da pior saúde da população negra em comparação à branca 31 . Portanto, o estudo em questão parece corroborar essa afirmativa, uma vez que a raça/cor de pele preta e parda se mostrou associada ao diagnóstico de câncer de mama em estágio avançado.…”

Qualidade de Vida de Mulheres Negras com Câncer de Mama: Uma Revisão de Literatura

“…É válido comentar que o diagnóstico tardio das mulheres afro-americanas, mencionado por Bradley e Wilk (2014), converge com o que já foi observado no contexto brasileiro, aonde se percebe uma tendência em que mulheres negras recebem o diagnóstico de câncer de mama em estadiamento mais avançado (Nogueira et al, 2018;Renna Junior & Silva, 2018). É preciso relembrar que quanto mais avançado for o estadiamento do câncer, maior será a agressividade do tratamento, o que poderá acarretar prejuízos para o exercício ocupacional (Paiva & Cesse, 2015).…”