Abstract PS5-12-07: Breast Cancer Treatment in Brazil: The Gap Between Incorporation and Real-World Access

Abstract Introduction: Breast cancer is the second most commonly diagnosed cancer worldwide, after lung cancer, and remains the leading cause ofcancer-related deaths among women globally (1). In Brazil, it is the most common cancer, with an estimated 66,280 new cases annually (2). Brazil has a universal healthcare system(SUS), which serves approximately 160 million people, or 75% of the population (3). Ensuring equitable access to breast cancer treatment within such a complex system is a significant challenge.The incorporation of new technologies into SUS is determined by the National Commission for the Incorporation of Technologies into the Unified Health System (Conitec), which conducts Health Technology Assessments (HTA) to decide on their adoption. Theoretically, once incorporated by Conitec, these technologies should be available to all patients cared for by SUS (4). However, Patient Advocacy Organizations frequently support patients who face barriers in accessing approved treatments. To strengthen advocacy efforts and generate evidence regarding the real-world availability of incorporated treatments, a cancer advocacy group in Brazil conducted a study to assess the accessibility of breast cancer medications incorporated by Conitec. Methods: The study focused on all medications incorporated by Conitec for breast cancer until September 2023, namely: trastuzumab and pertuzumab for HER-2 positive metastatic breast cancer (incorporated in 2018) (5), and abemaciclib, palbociclib, and ribociclib succinate for advanced or metastatic HR+ and HER2+ breast cancer (incorporated in 2021) (6). To investigate the availability of these treatments, the Brazilian Freedom of Information Law (7) was used, which allows citizens to request data from public institutions. Between September 2023 and January 2024, requests were made to 268 accredited public cancer centers, asking fortheir treatment protocols for five types of cancer (breast, prostate, colorectal, lung, and melanoma). This publication focuses on the responses related to breast cancer. Results: The total of 42 oncology centers submitted their breast cancer treatment protocols specifying the medications available. Each protocol was analyzed to determine the inclusion of the most recently incorporated Conitec-approved treatments. Of the protocols received, 42 (100%) listed trastuzumab; and 40 (95.2%) listed pertuzumab; but only 2 (4.8%) listed abemaciclib, palbociclib, and ribociclib succinate. The incorporation of trastuzumab and pertuzumab was accompanied by a centralized purchasing strategy by the Ministry of Health. The remaining medications listed were incorporated without a defined purchasing strategy. Conclusion: This study highlights significant disparities in the availability of breast cancer treatments within Brazil's public healthcare system. Despite their official incorporation, access to these medications remains inconsistent across hospitals. The higher presence of pertuzumab and trastuzumab in the protocols may indicate that the centralized purchasing strategy, implemented at the time of incorporation, ensures broader dissemination of Ministry of Health decisions across hospital protocols. Even with two medications being acquired through centralized purchasing, their availability for patients remains unequal. Moreover, the inclusion of a medication in a hospital's protocol does not guarantee its consistent availability or use, as factors such as stock shortages and implementation barriers may affect real patient access. The findings emphasize the need for improved mechanisms to ensure that the incorporation of new treatments translates into real-world access for patients. Strengthening monitoring and enforcement strategies is essential to bridge the gap between policy decisions and patient care. Citation Format: L. H. Barros, I. C. de Lima, P. S. Kindi, P. F. da silva, H. N. Esteves. Breast Cancer Treatment in Brazil: The Gap Between Incorporation and Real-World Access [abstract]. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS5-12-07.