A review of breast cancer care and outcomes in Latin America

Abstract

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.

Figure 1.

Breast cancer incidence and mortality in Latin America and other regions. Adapted from [2] with permission. Abbreviations: ASR, age-standardized rate; CEE, Central and Eastern Europe; LAC, Latin America and the Caribbean; Eur, Europe; US, United States.

Figure 2.

Burden of breast cancer in different regions: disability-adjusted life years lost. Adapted from [24] with permission. Abbreviation: CIS, Commonwealth of Independent States.

Figure 3.

Mortality-to-incidence ratios in 2002 and 2008. Adapted from [49] and [2] with permission. Abbreviation: MIR, mortality-to-incidence ratio.