The Clinical and Economic Epidemiology of Breast Cancer in Brazil from 2016 to 2022: A Real-World Evidence Study of 295,000 Outpatients in Public System

OBJECTIVES: Malignant breast cancer is the most incident cancer in Brazilian women. This study aims to investigate the epidemiological aspects and costs of breast cancer in Brazilian national public health(SUS), exploring the disease staging, demographics of the affected population and treatment characteristics.

METHODS: We collected data of outpatient events from the public secondary data system DATASUS(SIASUS-AQ), from 2016 to 2022. The population collected is diagnosed with breast cancer selected by ICD-10 C50. We then evaluated Costs distribution, Usage, Menopausal Status (considered as positive:age≥55, negative:age≤54), Year of First Treatment, Treatment Type for outpatients with early(stages 0/1/2) and advanced(stages 3/4) disease.

RESULTS: The database holds 12,479,043 registries from 295,233 outpatients between 2016-22, of which 50% had early disease at diagnosis, from those 59% were stage 2. Among outpatients with advanced disease, 72% were stage 3. Both contexts of early and advanced disease, had a greater presence of postmenopausal diagnosis, 59% and 52% respectively. The total reimbursement cost was 4.05bi Reais(R$) in treatment, the median general treatment length was 2.18 years, while per outpatient, we observed an average value of R$9,953 per treatment journey. In 2016,the total of reimbursement treatment was R$482mi and in 2022 was R$662mi, observing a mean increase by 5,4% and 42,176 new cases yearly. The dispensation for Hormone Therapy represented a mean reimbursement cost of R$103(n=9,923,288) and Chemotherapy at a cost of R$1,185(n=2,555,755).

CONCLUSIONS: The data presents trends regarding outpatients treated in SUS. Regarding stage distribution, and treatment costs, we described high prevalence and expenditure in advanced disease than initial disease, which highlights the need for strategies that accelerate early diagnosis. Considering Brazil as a country of continental proportions, this cross-sectional study presents valuable information, describing economic and demographic characteristics from this population. Future works will address more treatment features, access to treatment and economic impact.