OBJECTIVES: Breast cancer diagnosis and treatment evolved a lot in the last two decades, with an increased importance to screening programs and introduction of hallmark novel treatment strategies. In this context, it is crucial to evaluate diagnosis patterns in and clinical characteristics changes through time. In Brazil, inequities in public and private healthcare settings exist in both diagnosis and treatment, therefore, we aim to evaluate diagnosis patterns disparities among both healthcare perspectives in São Paulo state, Brazil

METHODS: This is a descriptive analysis using real-world data from FOSP São Paulo state registry. We included all female breast cancer cases from 2000-2020 with healthcare coverage information available. We evaluated differences of demographic and clinical characteristics among public and private healthcare setting patients through the period

RESULTS: In the study period, we identified 88,532 eligible cases of breast cancer, of which 71,051 (80.2%) were from public and 17,481(19.8%) from private perspective. Patients mean age at diagnosis were 56.0y±13.5, 56.2y±13.4 and 55.1y±13.5 for overall, public and private, respectively. The proportion of diagnosis at metastatic stage was larger in public (10.6%) when compared to private setting (4.3%), and this proportion almost doubled through decades in both perspectives, from 6.7% in 2000-2010 to 11.5% in 2011-2020 in the public setting, and 2.4% to 4.7% in the private setting

CONCLUSIONS: Breast cancer inequities in diagnosis are huge among public and private settings in Brazil, which leads to important differences in the outcomes. In addition, an increase on the proportion of metastatic disease is notable in both settings, which reinforces the importance of awareness campaigns and screening.