“…In addition to advanced staging, other factors also directly influence prognosis, such as individual characteristics, molecular and tumoral aspects, health services use and time until diagnosis or treatment initiation (Balabram et al, 2013;Caplan, 2014;Richards et al, 1999). However, the true impact of this delay has been reported as inconsistent among studies, due to the diversity of individual patient characteristics, geographic variations and differentiated health policies (Rezende, Koch, Figueiredo, & Thuler, 2009;Unger-Saldaña, 2014;Unger-Saldaña & Infante-Castañeda, 2009;Medeiros, Bergmann, Aguiar, & Thuler, 2015). In Brazil, about 70% of all cases are diagnosed in clinical stages II and III, while the chance of advanced stage at diagnosis is significantly higher among public health services users when compared to private service users (Balabram et al, 2013;Medeiros et al, 2015).…”