A Review of Breast Cancer Care and Outcomes in Latin America

• Published in: The oncologist (Dayton, Ohio) Ohio), 2013-03, Vol.18 (3), p.248-256
• Main Authors: Justo, Nahila, Wilking, Nils, Jönsson, Bengt, Luciani, Silvana, Cazap, Eduardo
• Format: Article
• Language: English
• Subjects: Access; Breast Cancer; Breast Neoplasms - drug therapy; Breast Neoplasms - epidemiology; Breast Neoplasms - therapy; Burden; Female; Humans; Latin America; Latin America - epidemiology; Medicin och hälsovetenskap; Outcomes; Socioeconomic Factors; Treatment; Treatment Outcome
• ISSN: 1083-7159; 1549-490X; 1549-490X
• DOI: 10.1634/theoncologist.2012-0373

Learning Objectives Describe associations between epidemiologic factors and breast cancer risk in the countries included in this review. Compare presentation profiles among the countries studied and discuss implications for outcomes. 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. 摘要 本文概述了拉丁美洲乳腺癌疾病的治疗、负担、转归、面临的挑战和可以改进的机会。通过回顾文献、公共数据库和会议演讲收集信息，此外信息来源还包括该地区临床专家和患者组织开展的一项调查结果。在拉丁美洲所有女性癌症中，乳腺癌的年发病（11.49万例）和死亡（3.7万例）患者数均高居榜首，且仍在升高。预计到2030年，乳腺癌死亡患者数将翻倍。在秘鲁、墨西哥、哥伦比亚和巴西，乳腺癌的低龄诊断和死亡导致了大量的生产年损失，而在阿根廷和乌拉圭，该病发病率很高。约30%~40%的患者在诊断时即为转移性疾病。拉丁美洲乳腺癌死亡‐发病比（MIR）较高，表明生存率低，部分原因在于患者在诊断时已处于晚期且治疗可及性较差。2002 ~2008年，所有国家的MIR均降低，但降幅各异。哥斯达黎加的MIR变化幅度超过发病率升幅，表明乳腺癌生存进步明显。哥伦比亚和厄瓜多尔的情况类似，但进步较小。巴西和墨西哥的MIR降幅处于边缘状态，主要反映了发病率升高，而非转归进步。巴拿马的MIR依然很高。拉丁美洲的流行病学数据分散，质量参差不齐，但有一点可以确定，由于人口结构的变