PERSPECTIVE OF THE BREAST CANCER AND BREAST DISEASES IN GUATEMALA

1. 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

2. In the year 2000 the reports for patients over 50 years
50% (16)
In 2015 patients older than 50 years
69% (17)
900New cases every year (2017)

3. PRESENTATION
BREAST MASS 83%
SECRESSION 3%
ULCERATION 5%
MAMMOGRAPHICAL FINDINGS 2% (18)

4. 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%

5. 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)

6. 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)

7. MODIFIED RADICAL MASTECTOMY
88%
CONSERVATIVE SURGERY
12%
LYMPHATIC MAPPING AND SENTINEL NODE BIOPSY
2.2%(18)

8. 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
5in the last 20 years in Public Health System

9. 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%

10. LOCAL RECURRENCE AFTER CONSERVATIVE SURGERY
19%(21)
GLOBAL RECURRENCE
(Remember that only 33% complete their radiotherapy)
25%(22)

11. 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%

12. METASTASES (18)
30% DEVELOP METASTASIC DISESASE
THE MOST FREQUENT SITE PLEUROPULMONARY
FOLLOWED BY BONE
1CASE OF BREAST CANCER IN MAN FOR 200 WOMEN WITH BREAST CANCER
BILATERALITY OF BREAST CANCER
1%

13. 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

14. 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

15. 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.

16. Cases and Rates of Prevalence of Breast Cancer in
Guatemala by Region (25)

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Mem Acad Roy Chir Paris 3:1, 1757.
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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.
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Ann Surg 46:1, 1907.
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mama en Guatemala. Rev Guatem Cir .2002
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