Uncovering Surgical Dynamics and Trends in Early Breast Cancer Stage at Diagnosis: Key Insights From a Two-Decade Argentine Database Analysis.

Abstract

Breast cancer remains a major public health challenge worldwide, and understanding the trends and changes in breast cancer diagnosis and treatment over time is crucial for improving patient outcomes and guiding public health strategies. The Argentine Society of Mastology has maintained a comprehensive Breast Cancer Registry that provides valuable data for analyzing these trends. This retrospective analysis of the Breast Cancer Registry database evaluated changes in stages at the time of surgery, patterns of surgical care, and factors associated with higher stage diagnoses in patients with breast cancer in Argentina from January 2000 to December 2019. Overall, 13,239 patients met the inclusion criteria. Significant differences were observed in the axillary procedure performed, with sentinel lymph node biopsy increasing from 14.9% (2000-2004) to 69.5% (2015-2019; <i>P</i> < .001). A higher proportion of in situ carcinoma was detected in the last 5-year period compared with the first (11.3% <i>v</i> 9.4%; <i>P</i> = .01) and fewer patients were stage III (17.1% <i>v</i> 14.2%). In multivariate analysis, postmenopausal status (odds ratio [OR], 0.72 [95% CI, 0.64 to 0.80]; <i>P</i> < .001), health coverage (social health insurance OR, 0.53 [95% CI, 0.46 to 0.61]; <i>P</i> < .001 and private insurance OR, 0.36 [95% CI, 0.31 to 0.42]; <i>P</i> < .001), tumor grade (grade 3 OR, 2.97 [95% CI, 2.54 to 3.47]; <i>P</i> < .001), and phenotype (hormone receptor-positive [HR+]/human epidermal growth factor receptor 2 [HER2]+ OR, 1.36 [95% CI, 1.10 to 1.70]; <i>P</i> = .005; HR-/HER2+ OR, 2.14 [95% CI, 1.62 to 2.83]; <i>P</i> < .001; HR-/HER2- OR, 1.40 [95% CI, 1.19 to 1.66]; <i>P</i> < .001) were associated with the risk of diagnosis at stages II-III. Significant advances in the patterns of surgical care were identified. Numerous clinical and pathologic factors correlated with higher stage at diagnosis. However, multivariate analysis failed to show a noteworthy reduction in stage at diagnosis. This observation underscores the imperative to persistently strive to improve breast cancer care in Argentina.