A Review of Breast Cancer Care and Outcomes in Latin America

Abstract

This review presents an overview of breast cancer care, burden, and outcomes in Latin America, as well as the challenges and opportunities for improvement. Information was gleaned through a review of the literature, public databases, and conference presentations, in addition to a survey of clinical experts and patient organizations from the region. Breast cancer annual incidence (114,900 cases) and mortality (37,000 deaths) are the highest of all women's cancers in Latin America, and they are increasing. Twice as many breast cancer deaths are expected by 2030. In Peru, Mexico, Colombia, and Brazil, diagnosis and death at younger ages deprives society of numerous productive years, as does high disease occurrence in Argentina and Uruguay. Approximately 30%-40% of diagnoses are metastatic disease. High mortality-to-incidence ratios (MIRs) in Latin America indicate poor survival, partly because of the late stage at diagnosis and poorer access to treatment. Between 2002 and 2008, MIRs decreased in all countries, albeit unevenly. Costa Rica's change in MIR outpaced incidence growth, indicating impressive progress in breast cancer survival. The situation is similar, although to a lesser extent, in Colombia and Ecuador. The marginal drops of MIRs in Brazil and Mexico mainly reflect incidence growth rather than progress in outcomes. Panama's MIR is still high. Epidemiological data are scattered and of varying quality in Latin America. However, one could ascertain that the burden of breast cancer in the region is considerable and growing due to demographic changes, particularly the aging population, and socioeconomic development. Early diagnosis and population-wide access to evidence-based treatment remain unresolved problems, despite progress achieved by some countries. The Oncologist 2013;18: 248 -256 Implications for Practice: Breast cancer imposes a heavy epidemiological, clinical, and economic burden on Latin American societies, and the situation will only worsen in the foreseeable future. Physicians and decision makers alike need to prepare to provide better care to more women as incidence of the disease grows and health care coverage expands. The main challenges to be addressed are barriers to early diagnosis and access to evidence-based treatment alternatives in a multidisciplinary way. Because breast cancer in Latin America affects women at younger ages than in Europe or North America and frequent population-based mammographic screening is not a reality, raising awareness is everyone's job, from the general practitioners to the oncologists, from the non-governmental organizations to the policy makers, from every woman to every man. INTRODUCTIONThe burden of breast cancer, as well as the management and organization of breast cancer care in 18 countries, was presented recently in the Global Breast Cancer Report [1]. Breast cancer is the most common form of cancer in women; with 5.2 million survivors(5yearsfollowingdiagnosis),itremainsthemostprevalent cancer in the world. In 2008, a total of 1.38 million new...

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