Perspective of the breast cancer and bre

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)

REFERENCES

1. Atta, Hussein M. The American Surgeon; Atlanta Vol. 65, Iss. 12, (Dec 1999): 1190-2.

2. Breasted JH. The Edwin Smith Surgical Papyrus. Chicago: University of Chicago Press; 1930. p 49 3. WF Bynum Companion encyclopedia of the history of medicine 2013 - books.google.com 4. le Dran F: Me´moire avec une pre´cis de plusieurs observations sur le cancer.

Mem Acad Roy Chir Paris 3:1, 1757.

5. Petit JL: Oeuvres comple´tes, section VII. Limoges, R. Chapoulard, 1837 6. Paget J: On disease of the mammary areola preceding cancer of the mammary gland. St Bart Hosp Rep 10:87, 1874.

7. Moore C: On the influence of inadequate operations on the theory of cancer.

R Med Chir Soc Lond 1:244, 1867.

8. Halsted WS: The results of radical operations for cure of cancer of the breast.

Ann Surg 46:1, 1907.

9. Patey DH, Dyson WH: The prognosis of carcinoma of the breast in relation to the type of operation performed. Br J Cancer 2:7–13, 1948.

10. Giuliano AE, Kirgan DM, Guenther JM, Morton DL: Lymphatic mapping and sentinel lymphadenectomy for breast cancer. Ann Surg 220:391–398, 1994.

11. Francisco Asturias: Historia de la Medicina en Guatemala. Tipogragia Nacional.

Google books 1902 12. Ralon S., Puente J., Mapeo linfático y ganglio centinela en el manejo del cáncer de mama en Guatemala. Rev Guatem Cir .2002

13. Tale , Azul de Metileno como herramienta en el Mapeo Linfático en Cáncer de Mama.

Rev Guatem Cir Vol 20 2014 14. Ralon S., Puente J. Mamoplastia excisional en el tratamiento de tumor Filodes. Rev Guatem Cir Vol 2011 15. globocan.iarc.fr/Pages/fact_sheets_population.aspx 16. Ralon, Osorio. CÁNCER DE MAMA PERFIL CLÌNICO, EPIDEMIOLÒGICO Y TERAPÉUTICO DE PACIENTES CON CÁNCER DE MAMA DEL INSTITUTO GUATEMALTECO DE SEGURIDAD SOCIAL, DURANTE EL PERIODO COMPRENDIDO ENTRE EL 1 DE ENERO DE 1991 AL 31 DE DICIEMBRE DEL 2000. USAC 17. Sagastume

Carolina

.FACTORES

PRONOSTICOS

Y

PREDICTIVOS

HISTOPATOLOGICOS E INMUNOHISTOQUIMICOS DE CANCER DE MAMA. 2015 USAC 18. Ralon et al. “Características Epidemiológicas, Clínicas, Diagnósticas y Terapéuticas de Pacientes con Cáncer de Mama” Departamento de Cirugía Hospital General San Juan de Dios Hospital Roosevelt Instituto Guatemalteco de Seguridad Social, e Instituto de Cancerología 2001-2005. USAC 2007 19. Schlesinger Wug et al. Farmacovigilancia intensiva del tratamiento quimioterápico de pacientes con cáncer de mama en el Instituto de Cancerología y Hospital Dr. Bernardo del Valle S. –INCAN- .USAC 2013 20. Marcela de la Torre et al. INFORME DE EVALUACION DE LA RADIOTERAPIA ONCOLOGICA EN GUATEMALA. OPS/OMS, Washington DC, USA 2011

21. Moraga ferbe, et al. “EVOLUCIÓN CLÍNICA DEL CANCER DE MAMA BAJO TRATAMIENTO QUIRURGICO CONSERVADOR” IGGS, Departamento de Ginecología.

USAC 2014 22. Cambara Evangelina, Ralon Sergio, et al. CANCER DE MAMA GUATEMALA. USAC 2001

23. Ríos Gabriel, et al. SOBREVIDA DE LOS PACIENTES CON CÁNCER DE MAMA SEGÚN LOS RECEPTORES EXPRESADOS”. IGGS. USAC 2014 24. Montejo Gabriela, et al. LESIONES ENDOMETRIALES ASOCIADAS CON EL USO DE TAMOXIFENO. INCAN. USAC 2013 25. Colop Berta. VIGILANCIA EPIDEMIOLOGICA DEL CANCER. GUATEMALA 2014-2015.

MSPAS. 2015 26. Hernández Paniagua. Cáncer de mama. Estudio retrospectivo de 629 casos durante los años 1960-1979 en los hospitales general San Juan de Dios, INCAN, IGSS y Roosevelt USAC 1981

27. Reyes Francisco, et al. SOBREVIVENCIA DEL CÁNCER DE MAMA A LOS 5 AÑOS EN EL HOSPITAL DE GINECOLOGÍA Y OBSTETRICIA DEL INSTITUTO GUATEMALTECO DE SEGURIDAD SOCIAL EN EL ÁREA DE ONCOLOGÍA DE LAS PACIENTES QUE RECIBIERON TRATAMIENTO QUIRÚRGICO DE ENERO A DICIEMBRE DEL 2004.

USAC 2013