Survival implications of non-organized breast cancer screening in a Brazilian tertiary women’s health center: a retrospective cohort study of 1517 patients
- 1State University of Campinas
- 2Federal University of Rio Grande do Norte
Abstract
Breast cancer (BC) is the most prevalent malignancy among Brazilian women. Advanced-stage diagnosis remains frequent, largely due to limited access to screening and treatment. Despite national recommendations for organised screening, implementation remains opportunistic. This study compared prognostic outcomes between clinically detected and opportunistically screened breast cancers and estimated Years of Life Lost (YLL) and Years of Disease-Free Life Lost (YDFL) to quantify the impact of clinical stage on survival and disease-free survival expectancy. A retrospective cohort of 1,517 women with unilateral, invasive, non-metastatic BC who underwent surgery at a tertiary public hospital in Brazil between 2012 and 2016 was analysed. Patients were classified as symptomatic (diagnosed based on clinical signs and symptoms) or asymptomatic (diagnosed through screening). Clinicopathological features, treatments, and outcomes were compared using the Chi-square, Fisher’s exact, and Kruskal–Wallis tests. Survival was analysed using Kaplan–Meier estimates and Cox regression models. YLL and YDFL were derived from Weibull survival models, using stage I patients as the reference. Most patients (69.5%) were symptomatic at diagnosis, with palpable tumours in 94.3%. Compared with asymptomatic cases, symptomatic women were younger and presented with more advanced stages, and aggressive tumours. They more frequently underwent mastectomy and neoadjuvant chemotherapy (p < 0.001). Both YLL and YDFL increased progressively with advancing clinical stage, reaching over 15 years in stage III. The predominance of advanced-stage diagnoses may reflect limitations in the current implementation of opportunistic screening, although this interpretation should be considered in light of potential screening-related biases. Advanced disease was associated with substantial loss of lifetime and disease-free years, reinforcing the prognostic value of early-stage detection.
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BibTeX
@article{almeida2026survival,
title = {{Survival implications of non-organized breast cancer screening in a Brazilian tertiary women’s health center: a retrospective cohort study of 1517 patients}},
author = {Natalie Rios Almeida and Fabricio Palermo Brenelli and Maria Beatriz de Paula Leite Kraft and Nicoli Serquiz de Azevedo and Cesar Cabello and Renato Zocchio Torresan and Cassio Cardoso‑Filho and Giuliano Mendes Duarte and Julia Yoriko Shinzato and Luis Otávio Zanatta Sarian and Luiz Carlos Zeferino},
journal = {BMC Cancer},
year = {2026},
month = jul,
doi = {10.1186/s12885-026-16626-7},
url = {https://doi.org/10.1186/s12885-026-16626-7},
note = {CC BY},
}
RIS
TY - JOUR
TI - Survival implications of non-organized breast cancer screening in a Brazilian tertiary women’s health center: a retrospective cohort study of 1517 patients
AU - Natalie Rios Almeida
AU - Fabricio Palermo Brenelli
AU - Maria Beatriz de Paula Leite Kraft
AU - Nicoli Serquiz de Azevedo
AU - Cesar Cabello
AU - Renato Zocchio Torresan
AU - Cassio Cardoso‑Filho
AU - Giuliano Mendes Duarte
AU - Julia Yoriko Shinzato
AU - Luis Otávio Zanatta Sarian
AU - Luiz Carlos Zeferino
PY - 2026
DA - 2026/07/01
JO - BMC Cancer
DO - 10.1186/s12885-026-16626-7
UR - https://doi.org/10.1186/s12885-026-16626-7
AB - Breast cancer (BC) is the most prevalent malignancy among Brazilian women. Advanced-stage diagnosis remains frequent, largely due to limited access to screening and treatment. Despite national recommendations for organised screening, implementation remains opportunistic. This study compared prognostic outcomes between clinically detected and opportunistically screened breast cancers and estimated Years of Life Lost (YLL) and Years of Disease-Free Life Lost (YDFL) to quantify the impact of clinical stage on survival and disease-free survival expectancy. A retrospective cohort of 1,517 women with unilateral, invasive, non-metastatic BC who underwent surgery at a tertiary public hospital in Brazil between 2012 and 2016 was analysed. Patients were classified as symptomatic (diagnosed based on clinical signs and symptoms) or asymptomatic (diagnosed through screening). Clinicopathological features, treatments, and outcomes were compared using the Chi-square, Fisher’s exact, and Kruskal–Wallis tests. Survival was analysed using Kaplan–Meier estimates and Cox regression models. YLL and YDFL were derived from Weibull survival models, using stage I patients as the reference. Most patients (69.5%) were symptomatic at diagnosis, with palpable tumours in 94.3%. Compared with asymptomatic cases, symptomatic women were younger and presented with more advanced stages, and aggressive tumours. They more frequently underwent mastectomy and neoadjuvant chemotherapy (p < 0.001). Both YLL and YDFL increased progressively with advancing clinical stage, reaching over 15 years in stage III. The predominance of advanced-stage diagnoses may reflect limitations in the current implementation of opportunistic screening, although this interpretation should be considered in light of potential screening-related biases. Advanced disease was associated with substantial loss of lifetime and disease-free years, reinforcing the prognostic value of early-stage detection.
SN - 1471-2407
ER -