perspective of the breast cancer and breast diseases in guatemala

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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 [email protected]

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Page 1: Perspective of the breast cancer and breast diseases in guatemala

PERSPECTIVE OF THE BREASTCANCER AND BREAST DISEASES IN

GUATEMALASERGIO 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

[email protected]

Page 2: Perspective of the breast cancer and breast diseases in guatemala

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)

Page 3: Perspective of the breast cancer and breast diseases in guatemala

PRESENTATION

BREAST MASS 83%

SECRESSION 3%

ULCERATION 5%

MAMMOGRAPHICAL FINDINGS 2% (18)

Page 4: Perspective of the breast cancer and breast diseases in guatemala

DIAGNOSTIC METHOD USED (18)

NEEDLE BIOPSY

CORE BIOPSY

6%

42%

EXCISION AL BIOPSY 18%

INCISIONAL BIOPSY 5.5%

TRANSOPERATORY BIOPSY 4%

REVIEW OF PATHOLOGIES 27%

Page 5: Perspective of the breast cancer and breast diseases in guatemala

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)

Page 6: Perspective of the breast cancer and breast diseases in guatemala

INVASION TO AXILLARY NODES AT THE TIME OF DI A GNOSIS

42% (17)

HISTOLOGICAL TYPE

DUCTAL 80% -82%

LOBULILLAR 4- 5% (17,18)

OTHER 16%

HORMONAL STATUS

Estrogen Receptor + Progestin Receptor +

Estrogen Receptor + Progestin Receptor -

Estrogen Receptor - Progestin Receptor +

Estrogen Receptor - Progestin Receptor -

50%

8%

9%

34%

HER2 / NEU +

TRIPLE NEGATIVE

20-30% (17,18)

10% (19)

Page 7: Perspective of the breast cancer and breast diseases in guatemala

MODIFIED RADICAL MASTECTOMY

88%

CONSERVATIVE SURGERY

12%

LYMPHATIC MAPPING AND SENTINEL NODE BIOPSY

2.2% (18)

Page 8: Perspective of the breast cancer and breast diseases in guatemala

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

Page 9: Perspective of the breast cancer and breast diseases in guatemala

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

SAN JUAN

IGGS

INCAN

5%

2%

3%

6%

9%

1%

9%

4%

1%

0%

4%

1%

0%

0%

1%

1%

Page 10: Perspective of the breast cancer and breast diseases in guatemala

LOCAL RECURRENCE AFTER CONSERVATIVE SURGERY

19% (21)

GLOBAL RECURRENCE

(Remember that only 33% complete their radiotherapy)

25% (22)

Page 11: Perspective of the breast cancer and breast diseases in guatemala

SURVIVAL AT FIVE YEARS ACCORDING TO

IMMUNOHISTOCHEMISTRY STATUS (23)

LUMINAL A

LUMINAL B

TRIPLE NEGATIVE

HER2NEU Enriched

92.6%

92.4%

70.5%

78.4%

SURVIVAL AT FIVE YEARS ACCORDING TO

STAGE (27)

I

II

III

100%

70%

20%

ENDOMETRIAL CANCER BY TAMOXIFEN (24)

0.8%

INCIDENCE OF ENDOMETRIAL HYPERPLASIA (24)

1.46%

Page 12: Perspective of the breast cancer and breast diseases in guatemala

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%

Page 13: Perspective of the breast cancer and breast diseases in guatemala

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

Page 14: Perspective of the breast cancer and breast diseases in guatemala

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

Page 15: Perspective of the breast cancer and breast diseases in guatemala

SUMMARY

Unfortunately, the situation of the treatment of breast cancer in Guatemala has not

changed much in the last 50 years. As Dr. Hernández 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.

Page 16: Perspective of the breast cancer and breast diseases in guatemala

Cases and Rates of Prevalence of Breast Cancer in

Guatemala by Region (25)

Page 17: Perspective of the breast cancer and breast diseases in guatemala
Page 18: Perspective of the breast cancer and breast diseases in guatemala

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

REFERENCES

Page 19: Perspective of the breast cancer and breast diseases in guatemala

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, Departa mento de Ginecología.

USAC 2014

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

2001

Page 20: Perspective of the breast cancer and breast diseases in guatemala

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

Page 21: Perspective of the breast cancer and breast diseases in guatemala