Impact of educational level and travel burden on breast cancer stage at diagnosis in the state of Sao Paulo, Brazil.

ABSTRACT

We describe the characteristics of cases of breast cancer among women assisted at hospitals affiliated to the public health system in the state of São Paulo (Brazil), analysing the effects of level of education and travel burden to point of treatment. We conducted a retrospective analysis of invasive breast cancer among women diagnosed between 2000 and 2015. Data were extracted from the hospital-based cancer registries of Fundação Oncocentro de São Paulo-FOSP. The outcome was clinical stage at diagnosis (stage III-IV versus I-II). The explanatory variables were educational level and travel burden. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. Multiple imputations were used for missing educational level (31%). The study included 81,669 women with invasive breast cancer diagnosed between 2000 and 2015. The mean age of patients at diagnosis was 56.8 years (standard deviation 13.6 years). 38% of patients were at an advanced stage at diagnosis (stage III-IV). Women with lower levels of education and those who received cancer care in municipalities other than where they lived were more likely to be diagnosed at an advanced stage. In conclusion, promotion of breast cancer awareness and improving pathways to expedite breast cancer diagnosis and treatment could help identify breast tumors at earlier stages.