Sociodemographic and Clinicopathologic Characteristics of Patients With Invasive Breast Cancer in Latin America: The LATINA Breast Cohort (LACOG 0615/MO39485).
TL;DR
A substantial proportion of BC cases in LATAM are diagnosed symptomatically and at advanced stages, and late-stage presentation is associated with sociodemographic characteristics and type of health care coverage.
Abstract
Purpose
Breast cancer (BC) is the most common malignancy in women and a leading cause of cancer-related mortality in Latin America (LATAM). This region is characterized by marked disparities in incidence, mortality, and care delivery, yet these differences have not been systematically examined.
Methods
The LATINA study is a multinational, prospective cohort design to characterize BC in LATAM, enrolling patients 18 years and older with newly diagnosed BC across 10 countries. Data collection occurred at baseline and every 6 months for up to 5 years postenrollment. Multivariable logistic regression was used to identify associations between advanced-stage diagnosis and the detection method. Causal mediation analysis evaluated whether the detection method mediated the association between the type of health care coverage (public v private) and the stage at diagnosis.
Results
Among 3,275 patients, 72.1% received care in public health systems and 41.8% were 50 years and younger. Overall, 40.5% presented at an advanced stage (III or IV). The most common molecular subtypes were luminal A (41.3%) and human epidermal growth factor receptor 2 (HER2)-positive (22.9%). Most patients were diagnosed based on symptoms (60.3%). Symptom-detected disease was more frequent among patients in the public health system (68.3% v 59.6% private; P < .001). In multivariable analyses, younger age (≤40 years), public health care coverage, symptom-detected disease, and HER2 overexpression were independently associated with advanced-stage presentation. Younger age, Black or African American/Brown race, public health care coverage, lower educational attainment, unemployment, unmarried status, and triple-negative disease were associated with symptom-detected diagnosis.
Conclusion
A substantial proportion of BC cases in LATAM are diagnosed symptomatically and at advanced stages. Late-stage presentation is associated with sociodemographic characteristics and type of health care coverage. Strategies that expand screening programs and strengthen early diagnosis will be essential to improve early detection and reduce disparities in BC outcomes across LATAM.