Work

Impact of Chile’s Explicit Health Guarantees Policy on breast cancer mortality: an interrupted time series analysis (1990–2024)

Year: 2026

Type: article

Abstract: Background: Breast cancer mortality in Chile has shown divergent trends over recent decades, with declining age-adjusted rates alongside increasing crude mortality driven by population aging. In 2005, Chile incorporated breast cancer into the Explicit Health Guarantees Regime (AUGE/GES), ensuring universal access, timeliness, quality standards, and financial protection across the continuum of care. Whether this policy produced an independent, detectable impact on population-level breast cancer mortality remains uncertain. Methods: We conducted an interrupted time series (ITS) analysis of female breast cancer mortality in Chile from 1990 to 2024. Annual death counts were obtained from national vital statistics and modeled using negative binomial regression with population offsets. Age-standardized mortality rates were calculated using the 2017 Chilean population as the reference. ITS models estimated changes in level and slope associated with two intervention points: the consolidation of the National Breast Cancer Program in 1995 and the implementation of AUGE/GES in 2005. Analyses were performed for the total female population and by age group. Results: While the absolute number of deaths and crude mortality rates increased over time, age-standardized breast cancer mortality declined steadily throughout the study period. A significant change in trend was observed after 1995, consistent with the early programmatic organization of breast cancer services. In contrast, no additional statistically significant change in level or slope was detected after 2005 at the population level or among women aged ≥40/≥50 years. Age-stratified analyses revealed a more pronounced post-2005 decline among women aged 65-69 and ≥80 years, suggesting age- and cohort-specific effects. Conclusions: Breast cancer mortality risk in Chile has declined primarily due to long-term secular trends and early programmatic strengthening, while population aging has driven increasing crude mortality. The AUGE/GES reform has consolidated access and financial protection, with heterogeneous benefits in older cohorts, but without generating a detectable additional inflection in national mortality trends. Further mortality reductions will require integrated, equity-oriented strategies emphasizing organized screening, timely diagnosis, and high-quality treatment across the life course.

Source: Frontiers in Oncology

DOI: 10.3389/fonc.2026.1801070

Authors: Matilde Maddaleno Herrera, Christian García-Calavaro, Felipe Elorrieta, Angélica Verdugo Sobral, Ignacio Toledo-Ordóñez

Institution: Universidad de Santiago de Chile

Language: English

Topic: Global Cancer Incidence and Screening

Subfield: Oncology

Field: Medicine

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: gold

Estimated APC paid: $3,801