Mortalidade, sobrevida e fatores associados em mulheres portadoras de neoplasia maligna de mama

• Ano de defesa: 2023
• Autor(a) principal: Queiroz, Daiane de
• Tipo de documento: Tese
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal da Paraíba; Brasil; Ciências Exatas e da Saúde; Programa de Pós-Graduação em Modelos de Decisão e Saúde; UFPB
• Palavras-chave em Português: Câncer de mama; Neoplasia de mama; Análise de sobrevida; Mortalidade - Câncer; Breast cancer; Breast neoplasia; Survival analysis; Mortality - Cancer; CNPQ::CIENCIAS DA SAUDE::SAUDE COLETIVA
• Link de acesso: https://repositorio.ufpb.br/jspui/handle/123456789/31387

Introduction: Breast cancer is one of the main public health problems in various regions of the world. It has the highest incidence and prevalence for both developed and underdeveloped countries, being considered a barrier to increasing global life expectancy. Objective: To assess the behavior of mortality, survival, and associated factors in women diagnosed with breast cancer. Method: To achieve the different objectives, the work was structured in various scenarios: 1) For the analysis of time series and temporal trends in breast cancer mortality in Brazil, data from 2009 to 2019 were used, considering income strata of municipalities and age groups; 2) For national comparisons on the influence of socioeconomic, demographic, and health factors on breast cancer, records from 2009, 2014, and 2019 were observed using the Sistema de Informação sobre Mortalidade (SIM, Mortality Information System) as a source of information for mortality in Brazilian states and associated socioeconomic and health factors; 3) For survival analysis, a review study was conducted, evaluating data from the Hospital Cancer Registry (RHC) of hospitals in the State of Paraíba, considering cases from 2010 onwards, with the follow-up outcome being patient death recorded in the SIM. 4) Using RHC data, factors related to advanced stage breast cancer were evaluated. The research was approved by the research ethics committees of the Universidade Federal da Paraíba (UFPB) and the University Hospital Alcides Carneiro of the Universidade Federal de Campina Grande - HUAC/UFCG. Results: The population classified in the high-income stratum in Brazil has a higher mortality rate, but the highest growth in the mortality rate was among women in the low-income stratum. When considering income stratification by states, we observe patterns of similarities within specific groups. Considering the influence of socioeconomic, demographic, and health factors on breast cancer, we observed a positive association in the variables average salary and health team/10,000 inhabitants. Considering the data from the RHC of Paraíba hospitals, 6,121 registered women from the year 2010 onward were analyzed. The variables that showed differences in Kaplan-Meier curves were age, education level, marital status, referral source, clinical staging, undergoing radiotherapy, chemotherapy, or hormone therapy treatment, and the macroregion of residence. In the multivariate analysis, age, education level, marital status, clinical staging, surgery as the first treatment received at the hospital, radiotherapy as the first treatment received at the hospital, chemotherapy as the first treatment received at the hospital, hormone therapy as the first treatment received at the hospital, other types of treatment received at the hospital, and the health macroregion of residence were identified as important independent prognostic factors. Considering the analysis of the clinical staging of women registered in the RHC, we observed a prevalence of advanced breast cancer diagnosis, noted in 43.24% (95% CI: 41.62 – 44.87). For the Poisson regression model, the predictor variables for advanced staging were age, family history of breast cancer, referral source, women referred without diagnosis and treatment, and women with invasive/infiltrating ductal carcinoma histological type. Conclusion: The changes in society over space and time influence the patterns of breast cancer mortality and survival, leading to the need for assessments of regionalized epidemiological indicators and their related factors. This is essential for evaluating screening strategies for this issue.