[Evaluation of breast cancer treatment at a tertiary-level institution with Popular Health Insurance in Mexico].
BACKGROUND
In our country breast cancer represents a major health problem. Only 45% of all population has access to health services, the consequence is delay in diagnosis and treatment. In Mexico, 66% of all new cases of breast cancer are diagnosed in locally advanced stages. From May 2007 the Health System Protection Against Catastrophic Expenses, called Seguro Popular (SP), breast cancer was included in covering the treatment of this neoplasm in any patient without access to social security.


OBJECTIVE
To evaluate the results and impact of SP in the adjuvant and neoadjuvant treatment of a group of patients diagnosed with breast cancer at an institution of national reference.


METHODS
We analyzed a group of 259 patients in stages (I-IIIC). The clinical stages I and II (55 patients) were treated with adjuvant chemotherapy FAC -T (fluorouracil 500 mg/m2, adriamycin 50 mg/m2 and cyclophosphamide 500 mg/m2 (FAC) followed by 12 weeks of paclitaxel 80 mg/m2 +/- trastuzumab loading dose of 4 mg/kg followed by 2 mg/kg); 204 patients in locally advanced stages (IIB-IIIC) received FAC-T +/- trastuzumab followed by surgery. Adjuvant treatment consisted of endocrine therapy for hormone-sensitive patients and radiotherapy 50 cGy according to international standards.


RESULTS
The age at diagnosis was 47 years (range 23-68). 80% of them were locally advanced stages (IIB-IIIC) and were treated in a neoadjuvant setting, 20% was in early stages, treated with surgery and adjuvant chemotherapy The disease-free survival and overall survival at 30 months was 85.7 and 90% respectively. Overall pathologic complete response was obtained in 15% of cases. In the subgroup analysis showed that 41% of patients HER2 (+), 29% of triple-negative patients and 9% of hormone-sensitive tumors achieved complete pathological response (p = 0.0001).


CONCLUSIONS
This is the first analysis of efficacy of adjuvant and neoadjuvant treatment in breast cancer since the introduction of popular secure non-entitled population. It is clear that treatment efficacy is similar to that reported in the literature, with 15% of pRC and survival to 30 months in 94-80%. The coverage of health expenditures treats a larger number of patients optimally. Along with this, efforts should be made to reduce the high frequency of diagnosis at advanced stage.
Departamento de Tumores Mamarios, Oncología Médica, Instituto Nacional Cancerología, Tlalpan, México, DF. haydee_arce96@yahoo.com.mx
Claudia
C
Arce-Salinas
Fernando Ulises
FU
Lara-Medina
Alberto
A
Alvarado-Miranda
Noel
N
Castañeda-Soto
Enrique
E
Bargalló-Rocha
María Teresa
MT
Ramírez-Ugalde
Víctor
V
Pérez-Sánchez
Lesbia
L
Rivera
Carlos
C
Gambo-Vignole
Julieta
J
Santamaría-Galicia
Rosa Isela
RI
Nieves-Casas
Héctor
H
Morán-Muñoz
Alejandro
A
Mohar-Betancourt
D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000008:administration & dosage; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000191:economics / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D003520:Cyclophosphamide / Q000008:administration & dosage; D019468:Disease Management; D018572:Disease-Free Survival; D004317:Doxorubicin / Q000008:administration & dosage; D004967:Estrogens; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D018734:Genes, erbB-2; D006801:Humans; D007354:Insurance, Major Medical; D053208:Kaplan-Meier Estimate; D008408:Mastectomy; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009367:Neoplasm Staging; D009376:Neoplasms, Hormone-Dependent / Q000453:epidemiology / Q000628:therapy; D010352:Patient Dropouts / Q000706:statistics & numerical data; D011374:Progesterone; D018714:Radiotherapy, Adjuvant; D000068878:Trastuzumab; D016896:Treatment Outcome; D055815:Young Adult
D061067:Antibodies, Monoclonal, Humanized; D018931:Antineoplastic Agents, Hormonal; D004967:Estrogens; D011374:Progesterone; D004317:Doxorubicin; D003520:Cyclophosphamide; D000068878:Trastuzumab; D005472:Fluorouracil