Stage at diagnosis and stage-specific survival of breast cancer in Latin America and the Caribbean: A systematic review and meta-analysis

Abstract

BackgroundFemale breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries.MethodsWe searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493.ResultsFor pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2 = 99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study.ConclusionsLAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment.

Race disparities in mortality by breast cancer from 2000 to 2017 in São Paulo, Brazil: a population-based retrospective study

“…In South America and the Caribbean, the ratio between mortality and incidence is more significant than observed in Europe and North America [ 6 ]. In Latin America, 41% of women are diagnosed in stages III and IV, increasing incidence and mortality [ 10 ]. In Brazil, a country with significant regional inequalities, between 1980 and 2009 there was a trend to reduce mortality rates in the economically favoured Southeast region and to increase rates in the most impoverished Northeast region [ 11 ].…”

Race Disparities in Mortality by Breast Cancer from 2000 to 2017 in São Paulo, Brazil: is it a Matter of Access to Care?

“…In South America and the Caribbean, the ratio between mortality and incidence is greater than observed in countries of Europe and North America [6]. In Latin America, 41% of women are diagnosed in stages III and IV, with increasing incidence and mortality [10]. In Brazil between and 2009, a country with great regional inequalities, there was a trend to reduce mortality rates in the economically favoured Southeast Region, and to increase rates in the poorest Northeast region [11].…”

Race Disparities in Mortality By Breast Cancer From 2000 to 2017 in São Paulo, Brazil: A Time-Series Study

“…In South America and the Caribbean, the ratio between mortality and incidence is more signi cant than observed in Europe and North America [6]. In Latin America, 41% of women are diagnosed in stages III and IV, increasing incidence and mortality [10]. In Brazil, a country with signi cant regional inequalities, between 1980 and 2009 there was a trend to reduce mortality rates in the economically favoured Southeast region and to increase rates in the most impoverished Northeast region [11].…”