UICC World Cancer Congress 2006

Breast cancer and its management in the emerging world Overview of breast cancer in Latin America J. de la Garza Instituto Nacional de Cancerologia Mexico

Latin America has a population approximately of more than 500 millions. And it is consider that approximate more than 20% correspond to a female population older than 25 years old. Breast cancer is the second leading cause of deaths in Latin America,and there is an alarming increase in the number of women developing the disease,in the last two decades breast cancer was not a significant public health concern in Latin America and the Caribbean(LAC),however frequency and mortality rates from breast cancer have been increasing for at least 40 years in most LAC countries. Socioeconomic development and consequent changes in reproductive behaviors over the the past 50 years are thought to have contributed to the increase risk of breast cancer and also increased womenxs health awareness and therefore the demand for quality services. Some studies shows that out of three available screening methods(mammography,clinical breast examination,and breast self examination) only mammography for women 50-69 years of age has been effective reducing mortality.A survey done in LatinoAmerica and the Caribbean shows that most of their breast cancer screening policies are not justified by available scientific evidence,moreover, as seen by relatively high mortality/incidence ratios, breast cancer cases are not being adequately managed in many LAC countries. It is crutial that both women and health care providers have access to up-to-date information on which to base their decisions.(Reference:Robles S.C.,Galanis E. Rev. Panamericana de Salud Publica 2002 Mar 2002) Diagnosis and Treatment of Breast Cancer in LAC, is very variable from country to country, and depends mainly in the Socioeconomic situation, Education is fundamental to follow National Programs in detection in early cancer and the implementation of the conventional initial treatment depending in the facilities that the country have. It was difficult to find data for many LAC countries, In Brasil and Mexico they have a a very active and effective National Program for the early detection and control of breast cancer, other countries have local medical Societies that have similar programs but are not govermental and for ende there are not National.I tried to obtain more information from other countries about if they have National programs but was not possible to obtain this information. The most common Breast Cancer patients seen in LAC is in Advanced Disease, locally(LABC 40-60%) Metastatic (20%) Early diagnosis stage I-II (>20%), We have to consider that patients seen in a private practice is different than in the Public or University Hospitals, more frequent the early diagnosis in the private than in the public Institutions. The percentage of mammographies performed is variable but in general is lower than 25%, in Brazil they have more than 3000 Mammographic units and in Mexico are more than 650 units.The diagnosis is in general made by the Breast Surgeon and Gynecologist, In general the time to diagnosis is from 2 to 6 months.(variable in different countries and type of practice)Immunohistochemistry is in general available, access to multidisciplinary care in Public Hospitals is 10% and in Private Medicine is more than 50% Surgery is the initial treatment for stages I-II, Stage III is Neo-Adjuvant Chemotherapy-followed by surgery and radiotherapy, and for stage IV the use of Systemic Treatments(chemo-hormono-others) Breast conserving Surgery is approximate 15-70%,Halsted Surgery <10% Radical Mastectomy(Patey) 60-70%,Sentinel node variable according to the country and type of practice(<10% to>90%) In general there are insuficient number of raditherpay units in LAC Chemotherapy regimens are usually established in LAC There is clear need to: Educate the population,General Practitioner and Breast Surgeons. During the presentation I will give more data. (References:A.C.Buzaid,G.Schwartzmann,A..S.Guercovich)