Impact of Chile’s Explicit Health Guarantees Policy on breast cancer mortality: an interrupted time series analysis (1990–2024)
4 affiliations
- 1Public Health Center Program, Faculty of Medical Sciences, University of Santiago of Chile
- 2Departamento de Planificación y Control de Gestión, Servicio de Salud Metropolitano Oriente
- 3Department of Mathematics and Computer Science, Faculty of Sciences, University of Santiago of Chile
- 4Health Division, Corporación de Educación, Salud y Atención de Menores de Conchalí (CORESAM)
Abstract
Background: Breast cancer mortality in Chile has shown divergent trends over recent decades, with declining age-adjusted rates alongside increasing crude mortality driven by population aging. In 2005, Chile incorporated breast cancer into the Explicit Health Guarantees Regime (AUGE/GES), ensuring universal access, timeliness, quality standards, and financial protection across the continuum of care. Whether this policy produced an independent, detectable impact on population-level breast cancer mortality remains uncertain.
Methods: We conducted an interrupted time series (ITS) analysis of female breast cancer mortality in Chile from 1990 to 2024. Annual death counts were obtained from national vital statistics and modeled using negative binomial regression with population offsets. Age-standardized mortality rates were calculated using the 2017 Chilean population as the reference. ITS models estimated changes in level and slope associated with two intervention points: the consolidation of the National Breast Cancer Program in 1995 and the implementation of AUGE/GES in 2005. Analyses were performed for the total female population and by age group.
Results: While the absolute number of deaths and crude mortality rates increased over time, age-standardized breast cancer mortality declined steadily throughout the study period. A significant change in trend was observed after 1995, consistent with the early programmatic organization of breast cancer services. In contrast, no additional statistically significant change in level or slope was detected after 2005 at the population level or among women aged ≥40/≥50 years. Age-stratified analyses revealed a more pronounced post-2005 decline among women aged 65–69 and ≥80 years, suggesting age- and cohort-specific effects.
Conclusions: Breast cancer mortality risk in Chile has declined primarily due to long-term secular trends and early programmatic strengthening, while population aging has driven increasing crude mortality. The AUGE/GES reform has consolidated access and financial protection, with heterogeneous benefits in older cohorts, but without generating a detectable additional inflection in national mortality trends. Further mortality reductions will require integrated, equity-oriented strategies emphasizing organized screening, timely diagnosis, and high-quality treatment across the life course.
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BibTeX
@article{herrera2026impact,
title = {{Impact of Chile’s Explicit Health Guarantees Policy on breast cancer mortality: an interrupted time series analysis (1990–2024)}},
author = {Matilde Maddaleno Herrera and Christian García-Calavaro and Felipe Elorrieta and Angélica Verdugo Sobral and Ignacio Toledo-Ordóñez},
journal = {Frontiers in Oncology},
year = {2026},
month = oct,
doi = {10.3389/fonc.2026.1801070},
url = {https://www.frontiersin.org/articles/10.3389/fonc.2026.1801070/full},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Impact of Chile’s Explicit Health Guarantees Policy on breast cancer mortality: an interrupted time series analysis (1990–2024)
AU - Matilde Maddaleno Herrera
AU - Christian García-Calavaro
AU - Felipe Elorrieta
AU - Angélica Verdugo Sobral
AU - Ignacio Toledo-Ordóñez
PY - 2026
DA - 2026/10/13
JO - Frontiers in Oncology
DO - 10.3389/fonc.2026.1801070
UR - https://www.frontiersin.org/articles/10.3389/fonc.2026.1801070/full
AB - Background: Breast cancer mortality in Chile has shown divergent trends over recent decades, with declining age-adjusted rates alongside increasing crude mortality driven by population aging. In 2005, Chile incorporated breast cancer into the Explicit Health Guarantees Regime (AUGE/GES), ensuring universal access, timeliness, quality standards, and financial protection across the continuum of care. Whether this policy produced an independent, detectable impact on population-level breast cancer mortality remains uncertain. Methods: We conducted an interrupted time series (ITS) analysis of female breast cancer mortality in Chile from 1990 to 2024. Annual death counts were obtained from national vital statistics and modeled using negative binomial regression with population offsets. Age-standardized mortality rates were calculated using the 2017 Chilean population as the reference. ITS models estimated changes in level and slope associated with two intervention points: the consolidation of the National Breast Cancer Program in 1995 and the implementation of AUGE/GES in 2005. Analyses were performed for the total female population and by age group. Results: While the absolute number of deaths and crude mortality rates increased over time, age-standardized breast cancer mortality declined steadily throughout the study period. A significant change in trend was observed after 1995, consistent with the early programmatic organization of breast cancer services. In contrast, no additional statistically significant change in level or slope was detected after 2005 at the population level or among women aged ≥40/≥50 years. Age-stratified analyses revealed a more pronounced post-2005 decline among women aged 65–69 and ≥80 years, suggesting age- and cohort-specific effects. Conclusions: Breast cancer mortality risk in Chile has declined primarily due to long-term secular trends and early programmatic strengthening, while population aging has driven increasing crude mortality. The AUGE/GES reform has consolidated access and financial protection, with heterogeneous benefits in older cohorts, but without generating a detectable additional inflection in national mortality trends. Further mortality reductions will require integrated, equity-oriented strategies emphasizing organized screening, timely diagnosis, and high-quality treatment across the life course.
SN - 2234-943X
ER -