Clinical impact of the Mexican healthcare system "Seguro Popular" on breast cancer survival.
Bibliographic record
Abstract
6569 Background: Breast cancer (BC) is one of the leading issues in public health in low and middle-income countries. In Mexico, access to healthcare is fragmented according to the patient´s employment and not by its needs; IMSS and ISSTE (Social Security) provide access to prepaid medicine to those under the formal sector of the economy, leaving up to 50 million Mexicans without access to a prepaid scheme. In 2003, the Seguro Popular (SP) was created in order to bring universal access to prepaid medicine in Mexico, and in 2007 expanded its coverage for BC. Methods: Retrospective and comparative study. The primary endpoint was to determine the impact on survival of SP on BC. Records were obtained from the electronic database of the Hospital Universitario “Dr. José Eleuterio González”. We included patients with invasive BC stage I-IV. Patients with any other kind of healthcare schemes other than SP, patients who underwent treatment outside our institution, and those with a follow up no greater than 3 months were excluded. 104 patients from the period prior the implementation of the SP (2000-2007) met the criteria for evaluation; thereafter we randomly selected a second cohort with the same size from the period after the implementation of the SP (2008-2013). Results: Median age at diagnosis was 48 and 51 years, respectively, for the periods before and after the implementation of SP. Distribution by clinical stage (Non-SP vs SP): CS I, 4.8 vs 10%, CS II, 31 vs 44%, CS III, 52 vs 38%, and CS IV, 10 vs 6.7%. Molecular subtypes distribution (Non-SP vs SP): Luminal, 61 vs 62%, HER2 Positive (IHC+++/FISH+) 17 vs 22%, TNBC, 21 vs 18%, unknown 6.7 vs 5.7%. Regarding survival, we observed a statistically significant difference on progression-free survival and overall survival favoring the SP cohort; PFS at 5 years, 54 vs 81% (p = < 0.0001) and OS at 5-year, 72 vs 86% (p = 0.01). Conclusions: We present evidence that the Mexican healthcare scheme SP, created to bring medical access to those patients without prepaid health protection, provides a significant clinical benefit on survival (PFS and OS) in women with breast cancer.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.003 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".