ESMO SUMMIT LATIN AMERICA 2019 · cancer incidence in latin america and the caribbean. females....
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ESMO SUMMIT LATIN AMERICA 2019 Breast Cancer in Latin America Yanin Chavarri Guerra, MD Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán March 2019
Transcript of ESMO SUMMIT LATIN AMERICA 2019 · cancer incidence in latin america and the caribbean. females....
ESMO SUMMIT LATIN AMERICA 2019
Breast Cancer in Latin America
Yanin Chavarri Guerra, MDInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán
March 2019
CONFLICT OF INTEREST DISCLOSURE
Roche (research funds)
BREAST CANCER INCIDENCE
Breast cancer is the most common cancer in Latin American women.
Rates:
113/ 100 000 inhabitants (Martinique)
37.4 / 100 000 inhabitants (Guatemala)
199, 734 cases (2018)
Goss, Chavarri-Guerra et al. Lancet Oncology 2013; 14:391 Globocan 2018
CANCER INCIDENCE IN LATINAMERICA AND THE CARIBBEANFemales
192,703
54,377
ASR per 10,000
BREAST CANCER INCIDENCE BY AGE
Central America South America
Di Sibio, et al. Cancer Epidemiology 2016: S110
Villarreal-Garza C, Chavarri Guerra Y et al. The Oncologist 2013;18:26-34
Country Mean age at diagnosis
Ecuador 55.9Colombia 56.7Mexico 52.7Costa Rica 57.8Chile 58Panama 56.7Venezuela 54.5Peru 54Brazil 56.1Argentina 60.2Uruguay 61
Breast cancer trends(1998-2007)Incidence increased: Brazil, Chile and Costa Rica.Incidence declined: Argentina
Di Sibio, et al. Cancer Epidemiology2016: S110
RISK FACTORSEpidemiological transition in the region
• Education and Wealth
• Obesity and overweigth
• Reproductive factors (fertiility rate, age at childbearing)• Population aging
• Population > 65 years: 10% Argentina, 14% Uruguay, 7% Mexico and Brazil
Nahila J, et al. The Oncologist 2013
POPULATION AGING
World Bank 2019
CANCER INCIDENCE BY AGELatin America
Soto Perez de Celis… Chavarri Guerra Y, et al. Clin Trans Oncol 2018; 20: 1117
CANCER INCIDENCE BY AGELatin America
Soto Perez de Celis… Chavarri Guerra Y, et al. Clin Trans Oncol 2018; 20: 1117
CANCER INCIDENCE IN WOMEN > 65
Latin America and the Caribbean United States
Pilleron S, et al. JAGS 2019
CANCER MORTALITYFemales
ASR per 10,000
47,777
BREAST CANCER MORTALITY BY AGE
Central America South America
Di Sibio, et al. Cancer Epidemiology 2016: S110
Breast cancer trends(1998-2007)
Mortality has been stable
Di Sibio, et al. Cancer Epidemiology2016: S110
Villarreal-Garza C, Chavarri Guerra Y et al. The Oncologist 2013;18:26-34
Country Mean age at death
Ecuador 60.2Colombia 58.5Mexico 57.1Costa Rica 62.7Chile 64.1Panama 62.8Venezuela 58.2Peru 58.4Brazil 59.5Argentina 66.4Uruguay 63.2
INCIDENCE TO MORTALITY RATIOS
Possible explanations:
Tumor biology
Disease Stage at diagnosis
Access to cancer care
Goss, Chavarri-Guerra et al. Lancet Oncology 2013; 14:391
BC MOLECULAR SUBTYPELatin America
64%17%
19%
ER+HER2+TN
Romieu I, et al. NPJ 2018
BC MOLECULAR SUBTYPES BY AGE AT DIAGNOSIS
23%
25%
52%TNHER2HR pos
15%
23%62%
TNHER2HR pos
< 45 years > 45 years
Villarreal-Garza C, et al. Clinical Breast Cancer 2016
BRCA1/2 FREQUENCY
Argentina 19-28.3%
Bahamas 2.8-23%
Brazil 2.3-35.5%
Chile 7.1-20.4%
Colombia 1.2-24.6%
Costa Rica 4.5%
Cuba 2.6%
Mexico 4.3-28%
Peru 5%
Puerto Rico 47.8%
Uruguay 17%
Venezuela 17.2%
Chavarri Guerra Y et al. Rev Inv Clin 2018
BRCA1/2 MUTATIONS
BRCA 1/2 frequency 1.2 – 4.9% / ∼ 20 – 30%
BRCA 1: most frequent Founder mutations (ex9-12del, A17082, 3450del4, 5382insC) Large rearrangements OR 4-6 (del exon 1-2, 9-12, 14, 16-17)
• BRCA 2: Costa Rica, Cuba, Puerto Rico, Uruguay 3034del4, c.156_157insAlu
Chavarri Guerra Y et al. Rev Inv Clin 2018
BRCA 1
Dutili, et al. Breast Cancer Research Treat 2015
BRCA 2
Dutili, et al. Breast Cancer Research Treat 2015
ADMIXTURE IN LATIN AMERICA
Adhikari, et al. Curr Opin Genet Dev 2016; 41: 106
STAGE AT DIAGNOSIS
Nahila J, et al. The Oncologist 2013
0
20
40
60
80
100
120
MinasGerais, BR
Porto Alegre,BR
Rio Grande,BR
Rio deJaneiro, BR
Sta Catarina,BR
Sao Paulo,BR
Chile Colombia Mexico Peru Uruguay
Stage 1 Stage II Stage III Stage IV
Mammogram coverageDelays in cancer care
MAMMOGRAM COVERAGE
Reyes Ortiz CA et al. Preventive Medicine 2006; 42:375
DELAYS
Bukowski A, Goia A, Chavarri Guerra Y JGO 2017:3
DISPARITIES IN ACCESS TO CAREBrazil (public vs private hospitals)
Liedke P… Chavarri Guerra Y ,et al. CEBP 2014: 23
ACCESS TO CAREImprovement in the region during the lastdecade
Reforms towards more universal health care access
Argentina: All patients with BC have free access to oncology treatment by law.
Brazil: In 2009, new oncological drugs were incorporated, 60 days law
Colombia: Public and private sectors are integrated
Peru: Public health insurance covers BC diagnosis
Nahila J, et al. The Oncologist 2013
PATIENT NAVIGATION PROGRAMSLatin America
Rio de Janeiro, Brazil60% of cases started treatmentwithin the law 60 days period
GuatemalaEnsure tratment plan350 patients
Mexico CityReferral within the health public systemReferral time 7 days
Goia S SABCS 2018Flood D JGO 2018Chavarri Guerra Y The Oncologist 2018
Patient navigators work within hospitals to help patients find physicians, deal with insurance, treatment adherence, to get supportive care and follow-up with patients to make sure theyget to appointments.
ACCESS TO CARESeguro PopularMexico
Reynoso Noveron N, et al. J Glob Oncol 2017:3
OUTCOMESMexico (Seguro Popular)
Reynoso Noveron N, et al. J Glob Oncol 2017:3
MORTALITY/INCIDENCE RATIO2002/2008
Nahila J, et al. The Oncologist 2013
CONCLUSIONS• Breast cancer is the leading cause of cancer deaths in Latin America.
New cases 192,000 / Deaths 77,000
• Incidence is increasing.
• Epidemiological transition/ Aging of the population.
• Higher proportion of younger women/ TNBC/ BRCA carriers
• Reduced survival compared to other countries (due to late diagnosis).
• Outcomes has improve during the last years.
• Reforms /Iniciatives to imporve access to care should continue and be tailored according to the region needs.
Thank you
Thank you!!!
