Inequality of access to breast reconstruction in Brazil: An ecological study.

Abstract

e13742 Background: Breast reconstruction (BR) is an important step in breast cancer treatment, and several authors have reported disparities in its access across different populations. Brazil has a universal public healthcare system, and 25% of the population has access to a private system through healthcare insurance. In this study, we conducted an ecological analysis to identify national and regional discrepancies in access to breast reconstruction in Brazil, from both private and public perspectives. Methods: The number of mastectomies, breast conserving surgeries (BCS), and BR performed between 2015 and 2022 in the private and public health care systems was obtained from publicly available registries and was used to determine each procedure's incidence, according to the covered population of each system. A regression analysis was applied to estimate the differences in relative risks of having access to the surgery in the public and private. Results: In 8-year, 400,566 mastectomies or BCS and 267,781 BRs were performed on a population of over 100 million women. 58.8% of all BRs performed were under the private perspective. The risk of undergoing a BR procedure relative to the risk of undergoing a BCS or a mastectomy varied from 1.05 to 1.35 in the private perspective, whereas from the public perspective, it varied between 0.24 and 0.4 (Table 1). Overall, a woman who underwent a breast oncological procedure was 3 to 5 times more likely to undergo a BR if she was covered by private health care insurance. Conclusions: Our data suggests that in low resources constrained healthcare systems, women that survive breast cancer have limited access to BR, and there is an important disparity in access to BR between people who has access to private insurance and who don’t in Brazil. Risk of receiving a BR procedure relative to the risk of receiving a breast oncological procedure, according to year and system of coverage. Year Private Public 2015 1,12 0,24 2016 1,05 0,25 2017 1,11 0,33 2018 1,12 0,37 2019 1,21 0,37 2020 1,20 0,36 2021 1,30 0,41 2022 1,35 0,40