PERSPECTIVE OF THE BREAST CANCER AND BREAST DISEASES IN GUATEMALA SERGIO RALON MD, FACS, FSSO*
In our country statistics have always been a problem, however there are reliable data sources, although we know that probably with some margin of sub registration that we have to consider. At the end of this work you will be able to consult the sources from where these data were extracted.
INCIDENCE OF BREAST CANCER IN GUATEMALA
11.9 per 100,000 women PREVALENCE OF BREAST CANCER IN GUATEMALA
48.9 per 100,000 women MORTALITY FOR CANCER DE MAMA IN GUATEMALA
5 per 100,000 women (15) Surgery Professor Surgical Oncology Division Breast Clinic Department of Surgery General Hospital San Juan de Dios, Guatemala San Carlos University of Guatemala ralon.sergio@usac.edu.gt
In the year 2000 the reports for patients over 50 years
50% (16)
In 2015 patients older than 50 years
69% (17)
900 New cases every year (2017)
PRESENTATION BREAST MASS 83%
SECRESSION 3%
ULCERATION 5%
MAMMOGRAPHICAL FINDINGS 2% (18)
DIAGNOSTIC METHOD USED (18) NEEDLE BIOPSY
6%
CORE BIOPSY
42%
EXCISIONAL BIOPSY 18%
INCISIONAL BIOPSY 5.5%
TRANSOPERATORY BIOPSY 4%
REVIEW OF PATHOLOGIES 27%
STAGES
In situ 2%
EARLY 3. 4% LOCALLY ADVANCED AND METASTASIC
69% (18) Impossible to classify them adequately for alterations in the handling of the surgical piece in private or non academic hospitals
28% (18)
INVASION TO AXILLARY NODES AT THE TIME OF DIAGNOSIS
42% (17)
HISTOLOGICAL TYPE
DUCTAL 80% -82% LOBULILLAR 4- 5% (17,18) OTHER 16%
HORMONAL STATUS
Estrogen Receptor + Progestin Receptor +
50%
Estrogen Receptor + Progestin Receptor -
8%
Estrogen Receptor - Progestin Receptor +
9%
Estrogen Receptor - Progestin Receptor -
34%
HER2 / NEU + TRIPLE NEGATIVE
20-30% (17,18) 10% (19)
MODIFIED RADICAL MASTECTOMY
88% CONSERVATIVE SURGERY
12% LYMPHATIC MAPPING AND SENTINEL NODE BIOPSY
2.2% (18)
COADYUVANT INCOMPLETE TREATMENT
Absence of Radiotherapy in the National Public System. Deficiencies in the Agreement with the company that should give Radiotherapy to Public Health patients Absence of medications such as Trastuzumab Absence of treatment for Metastasic disease
54.8% (18)
33% complete their Radiotherapy treatment (20)
PATIENTS WITH RECONSTRUCTIVE SURGERY
5 in the last 20 years in Public Health System
COMPLICATIONS OF SURGICAL TREATMENT Complications vary according to which hospital is evaluated
From a sample of 1092 patients undergoing surgical treatment in the four main cancer centers in Gt. (18)
Global Complications Index
10%
ISQ HEMATOMA L. NERVOSA DEHISCENCE
HR
5%
9%
1%
0%
SAN JUAN
2%
1%
0%
0%
IGGS
3%
9%
4%
1%
INCAN
6%
4%
1%
1%
LOCAL RECURRENCE AFTER CONSERVATIVE SURGERY
19% (21) GLOBAL RECURRENCE (Remember that only 33% complete their radiotherapy)
25% (22)
SURVIVAL AT FIVE YEARS ACCORDING TO IMMUNOHISTOCHEMISTRY STATUS (23) LUMINAL A
92.6%
LUMINAL B
92.4%
TRIPLE NEGATIVE
70.5%
HER2NEU Enriched
78.4%
SURVIVAL AT FIVE YEARS ACCORDING TO STAGE (27) I
100%
II
70%
III
20%
ENDOMETRIAL CANCER BY TAMOXIFEN(24) 0.8%
INCIDENCE OF ENDOMETRIAL HYPERPLASIA (24) 1.46%
METASTASES (18)
30% DEVELOP METASTASIC DISESASE THE MOST FREQUENT SITE PLEUROPULMONARY FOLLOWED BY BONE
1 CASE OF BREAST CANCER IN MAN FOR 200 WOMEN WITH BREAST CANCER
BILATERALITY OF BREAST CANCER
1%
BREAST BENIGN DISEASE
According to the statistics of the General Hospital San Juan de Dios Of 7500 patients evaluated in a year 2017 by the Clinic in Breast Diseases of the Department of Adult Surgery
22% with Cancer Diagnosis, new and follow-up cases 67% Benign Disease 4% Ductal Ectasia 7% Breast Pain
HOSPITALS TWO THIRD LEVEL HOSPITALS IN THE NATIONAL HEALTH SYSTEM WITH CLINICS SPECIALIZED IN TUMORS TUMORS CLINIC AND CLINICAL ONCOLOGY IN ROOSEVELT HOSPITAL CLINIC OF BREAST AND CLINICAL ONCOLOGY IN GENERAL HOSPITAL SAN JUAN DE DIOS
IN THE GUATEMALAN INSTITUTE OF SOCIAL SECURITY A BREAST CLINIC ATTENDED BY GYNECOLOGISTS
THE IGGS ONCOLOGY CLINIC IS THE ONLY ONE IN GUATEMALA THAT PROVIDES COMPLETE TREATMENT OF CHEMOTHERAPY, RADIOTHERAPY, TRASTUZUMAB, HORMONAL THERAPY, METASTASIS THERAPY AND PALLIATIVE CARE TO ALL ITS INSURED PATIENTS
A PRIVATE HOSPITAL DEDICATED TO CANCER TREATMENT WITH PRIVATE FINANCING (NGO) AND MONEY FROM THE MINISTRY OF PUBLIC HEALTH.
RADIOTHERAPY ONLY IN THE PRIVATE HEALTH SYSTEM. DOES NOT EXIST AS PART OF THE NATIONAL SYSTEM OF PUBLIC HEALTH AND SOCIAL ASSISTANCE
SUMMARY Unfortunately, the situation of the treatment of breast cancer in Guatemala has not changed much in the last 50 years. As Dr. Hernรกndez Paniagua described it when he studied the disease from 1960 to 1979 in the four main Guatemalan hospitals. (26) the same disparity in late diagnosis and difficulties in treating it we observed in the 21st century as in the second half of the 20th century. The only thing that has been seen as the Guatemalan population it grows is the increase in cases in number and the presence of the disease increasingly in younger women. It is the desire of the author of this book that the next generations of doctors dedicated to treating this disease in the coming years will succeed in changing this cruel reality and improving the treatment and conditions for these patients.
Cases and Rates of Prevalence of Breast Cancer in Guatemala by Region (25)
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