Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Cancer Patients in Guatemala Breast cancer in Guatemala

Main Article Content

Hugo Castro-Salguero
Luis García Aceituno
Alba Kihn
Raúl Jiménez
Allan Ramos-Esquivel


Brest cancer, Guatemala, Survival


Background: Breast cancer (BC) is a leading cause of cancer related death worldwide. Unfortunately, data concerning clinicopathologic features of this malignancy in non-developed countries is scarce. This study aims to characterize a cohort of Guatemalan female patients with non-metastatic BC and to determine risk factors for overall survival (OS).
Methods: We retrieved data on consecutive patients from the Instituto Guatemalteco de Seguridad Social that were treated from 2008 to 2014. Clinical features and long-term outcomes were retrieved from medical records. Univariate and multivariate Cox regression analyses were conducted to identify variables associated with OS.
Results: 954 BC patients were identified during the time frame. A total of 436 women (46%) were younger than 50 years old. BC molecular subtypes categorized 537 patients (56.3%) with luminal A disease, 186 (19.5%) patients with triple negative tumors, 153 cases (16.1%) with HER-2 enriched tumors, and 78 patients (8.2%) with luminal B tumors. Clinical stage at presentation was stage I: 4.7% (n=45); stage II: 48.1% (n=459), and stage III: 47.2% (n=450). The overall 5-year survival rate was 75.2% (95% Confidence Interval: 72.0–78.3). In the multivariate analysis clinical stage, triple negative tumors and HER2 enriched tumors were independently associated with poor survival.
Conclusion: The majority of patients with non-metastatic BC are diagnosed with advanced disease and many of them are younger than 50 years old. OS in this cohort of Guatemalan patients is lower than that reported in developed countries.


1. World Health Organization. International Agency for Research on Cancer. (accesed 16 January 2020)
2. Hu K, Ding P, Wu Y, Tian W, Pan T, Zhang S. Global patterns and trends in the breast cancer incidence and mortality according to sociodemographic indices: an observational study based on the global burden of diseases. BMJ Open 2019;9:e028461. doi: 10.1136/bmjopen-2018-028461.
3. Hines LM, Risendal B, Byers T, Mengshol S, Lowery J, Singh M. Ethnic disparities in breast tumor phenotypic subtypes in Hispanic and non-Hispanic white women. J Womens Health (Larchmt). 2011 Oct; 20(10):1543-50.
4. Lara-Medina F, P´rez-Sánchez V, Saavedra-Pérez D, Blake-Cerda M, Arce C, Motola-Kuba D, et al. Triple?negative breast cancer in Hispanic patients. Cancer 2011; 117: 3658-3669. doi:10.1002/cncr.25961
5. Instituto Nacional de Estadística ,Guatemala. [cited 2020 Jan 21]; Available from:
6. Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros N, de Vries E, et al. Cancer patterns and trends in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1; S23-S42.
7. Becerril-Montekio, López-Dávila. Sistema de Salud de Guatemala. Salud Pub Mex 2011; 53:S197-S-208.
8. Edge SB, Compton CC. The American Joint Committee on Cancer: the 7th edition of the AJCC cancer staging manual and the future of TNM. Ann Surg Oncol 2010; 17(6): 1471-1474.
9. Hammond ME, Hayes DF, Dowsett M, Allred DC, Hagerty KL, Badve S, Fitzgibbons PL, Francis G, Goldstein NS, Hayes M, Hicks DG, Lester S, Love R, et al. American Society of Clinical Oncology/College of American Pathologists guideline recommendations for immunohistochemical testing of estrogen and progesterone receptors in breast cancer (unabridged version) Arch Pathol Lab Med. 2010;134:e48–72.
10. Dowsett M, Nielsen TO, A'Hern R, Bartlett J, Coombes RC, Cuzick J, Ellis M, Henry NL, Hugh JC, Lively T, McShane L, Paik S, Penault-Llorca F, et al. Assessment of Ki67 in breast cancer: recommendations from the International Ki67 in Breast Cancer working group. J Natl Cancer Inst. 2011;103:1656–64
11. Wolff AC, Hammond ME, Hicks DG, Dowsett M, McShane LM, Allison KH, Allred DC, Bartlett JM, Bilous M, Fitzgibbons P, Hanna W, Jenkins RB, Mangu PB, et al. Recommendations for human epidermal growth factor receptor 2 testing in breast cancer: American Society of Clinical Oncology/College of American Pathologists clinical practice guideline update. J Clin Oncol. 2013;31:3997–4013.
12. Coates AS, Winer EP, Goldhirsch A, Gelber RD, Gnant M, Piccart-Gebhart M, Thürlimann B, Senn HJ, Panel Members Tailoring therapies--improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol. 2015;26:1533–46
13. von Minckwitz G, Untch M, Blohmer JU, Costa SD, Eidtmann H, Fasching PA, et al. Definition and impact of pathologic complete response on prognosis after neoadjuvant chemotherapy in various intrinsic breast cancer subtypes. J Clin Oncol. 2012; 30:1796-804.
14. Justo N, Wilking N, Jonsson B, Luciani S, Cazap E. A Review of Breast Cancer care and Outcomes in Latin America. 2013; 18: 248-256.
15. Graves KD, Huerta E, Cullen J, Kaufman E, Sheppard V, Luta G, et al. Perceived Risk of Breast Cancer among Latinas Attending Community Clinics: Risk Comprehension and Relationship with Mammography Adherence. Cancer Causes Control 2008; 19:1373-82.
16. Lund MJ, Butler EN, Hair BY, et al. Age/race differences in HER2 testing and in incidence rates for breast cancer triple subtypes: a population-based study and first report. Cancer. 2010; 116: 2549?2559
17. Swede H, Gregorio DI, Tannenbaum SH, Brockmeyer JA, Ambrosone C, Wilson LL, et al. Prevalence and Prognostic Role of Triple-Negative Breast Cancer by Race: A surveillance study. Clin Breast Cancer 2011; 11:332-341.
18. Kurebayashi J, Moriya T, Ishida T, et al. The prevalence of intrinsic subtypes and prognosis in breast cancer patients of different races. Breast. 2007;16:S72–S77.
19. Lara-Medina F, Pérez-Sánchez V, Saavedra-Pérez D, Blake-Cerda M, Arce C, Motola-Kuba D, et al. Triple-negative breast cancer in Hispanic patients. Cancer 2011; 117: 3658-3669
20. Srur-Rivero N, Cartin-Brenes M. Breast cancer characteristics and survival in a Hispanic population of Costa Rica. Breast Cancer (Auckl) 2014; 8:103-108.
21. Parise CA, Bauer KR, Caggiano V. Variations in breast cancer subtypes with age and race/ethnicity. Crit Rev Oncol Hematol 2010; 44-52.
22. Gaudet MM, Gierach GL, Carter BD, et al. Pooled analysis of nine cohorts reveals breast cancer risk factors by tumor molecular subtype. Cancer Res. 2018;78:6011-6021]
23. DeSantis CE, Ma J, Gaudet MM, Newman LA, Miller KD, Sauer AG, et al. Breast cancer statistics 2019; CA A Cancer ] Clin 2019; 69:438-451
24. Piñeros M, French S, Frazier L, Laversanne M, Barnoya J, Garrido C, et al. Advancing Reliable Data for Cancer Control in the Central America Four Region. J Global Oncol 2018; 4.1-11.
25. Maggard MA, O´Connel JB, Lane KE, Liu JH, Etzioni DA, Ko CY. Do young breast cancer patients have worse outcomes? J Surg Res 2003; 113:109-113.]
26. Zhang L, King J, Wu XC, Hsieh MC, Chen VW, Yu Q, et al. Racial/ethnic differences in the utilization of chemotherapy among stage IIII breast cancer patients, stratified by subtype: Findings from ten National Program of Cancer Registries states. Cancer Epidemiol 2019; 58:1-7.
27. Puig CA, Hoskin TL, Day CN, Habermann EB, Boughey JC. National Trends in the Use of Neoadjuvant Chemotherapy for Hormone Receptor-Negative Breast Cancer: A National Cancer Data Base Study.Ann Surg Oncol 2017; 24: 1242-1250.
28. Cortazar P, Zhang L, Untch M, Mehta K, Constantino JP, Wolmark N. Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet 2014; 384:164-172.
29. World Health Organization: Global health expenditure database. [cited 2020 Jan 21]; Available from:
30. Goss PE, Lee BL, Badovinac-Crnjevic T, et al. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 14:391-436, 2013.