908 – Survival implications of non-organized breast cancer screening in a brazilian tertiary women’s health center: a retrospective cohort study of 1,517 patients

Abstract

Introduction/Justification: Breast cancer is the most common malignancy among Brazilian women, and advancedstage diagnosis remains frequent, partly due to limited access to organized screening and timely treatment. Although
screening is nationally recommended, implementation is largely opportunistic, and its prognostic impact in real-world
public settings warrants quantification beyond conventional survival estimates. Prognostic outcomes were compared
between clinically detected and opportunistically screened breast cancers to quantify the impact of clinical stage on survival and disease-free survival expectancy
Methods: Retrospective cohort of 1,517 women with unilateral, invasive, nonmetastatic breast cancer who underwent
surgery at a tertiary public hospital in Brazil (2012–2016). Patients were classified as symptomatic (clinically detected) or
asymptomatic (opportunistically screen-detected). Clinicopathological characteristics, treatments, and outcomes were
compared using Chi-square, Fisher’s exact, and Kruskal-Wallis tests. Overall survival and disease-free survival were analyzed using Kaplan-Meier estimates and Cox regression. Years of Life Lost (YLL) and Years of Disease-Free Life Lost (YDFL)
were derived from Weibull survival models using stage I as the reference.
Results: Most patients were symptomatic at diagnosis (69.5%), and 94.3% presented with palpable tumors. Compared
with asymptomatic cases, symptomatic women were younger, had more advanced clinical stage and more aggressive
tumor features, and underwent mastectomy and neoadjuvant chemotherapy (p<0.001) more frequently. YLL and YDFL
increased progressively with advancing stage, exceeding 15 years in stage III.
Conclusion: In this public Brazilian cohort, opportunistic screening detected a minority of cases, while symptomatic presentation predominated and was associated with more advanced-stage and intensive treatment. Advanced-stage disease
translated into substantial loss of lifetime and disease-free years, reinforcing the prognostic value of early-stage detection.
Ethics: Research Ethics Committee Approval (CAAE 84450518.9.0000.5404).