Screen-detected breast cancer is associated with better prognosis and survival compared to self-detected/symptomatic cases in a Chilean cohort of female patients

• DOI: 10.1007/s10549-021-06317-1
• Publication Date: 2021-07-10T02:02:20Z
• Authors: Benjamin Walbaum; Klaus Puschel; Lidia Medina; Tomas Merino; Mauricio Camus; Dravna Razmilic; Maria Elena Navarro; Francisco Dominguez; Miguel Cordova-De...; Mauricio P. Pinto; Francisco Acevedo; César Sánchez
• Keywords: Stage; Receptor, ErbB-2; Chilean public health system; Subtype; 610; And overall survival; Breast Neoplasms; 613; Prognosis; 3. Good health; Cohort Studies; 03 medical and health sciences; Breast cancer; 0302 clinical medicine; Screening; Humans; Mass Screening; Female; Chile; Medicina y salud; Early Detection of Cancer; Mammography

The implementation of national breast cancer (BC) screening programs in Latin America has been rather inconsistent. Instead, most countries have opted for "opportunistic" mammogram screenings on the population at risk. Our study assessed and compared epidemiological, clinical factors, and survival rates associated with BC detected by screening (SDBC) or self-detected/symptomatic (non-SDBC) in Chilean female patients.Registry-based cohort study that included non-metastatic BC (stage I/II/III) patients diagnosed between 1993 and 2020, from a public hospital (PH) and a private university cancer center (PC). Epidemiological and clinical data were obtained from medical records.A total of 4559 patients were included. Most patients (55%; n = 2507) came from PH and were diagnosed by signs/symptoms (non-SDBC; n = 3132, 68.6%); these patients displayed poorer overall (OS) and invasive disease-free survival (iDFS) compared to SDBC. Importantly, the proportion of stage I and "luminal" BC (HR + /HER2 -) were significantly higher in SDBC vs. non-SDBC. Finally, using a stage/subset-stratified age/insurance-adjusted model, we found that non-SDBC cases are at a higher risk of death (HR:1.75; p < 0.001). In contrast, patients with PC health insurance have a lower risk of death (HR: 0.60; p < 0.001).We confirm previous studies that report better prognosis/survival on SDBC patients. This is probably due to a higher proportion of stage I and luminal-A cases versus non-SDBC. In turn, the survival benefit observed in patients with PC health insurance might be attributed to a larger proportion of SDBC. Our data support the implementation of a systematic BC screening program in Chile to improve patient prognosis and survival rates.