title: Breast cancer characteristics and survival in a Hispanic population of costa rica.
abstract: BACKGROUND
  Breast cancer characteristics may vary according to the patient's ethnic group. The goal of this cohort study was to evaluate the characteristics of a group of Costa Rican breast cancer patients and their relationship with survival.
  
  
  METHODS
  Age, stage, tumor grade, immunohistochemistry, lymphovascular invasion, recurrence, and survival data on 199 Hispanic patients with breast cancer diagnosis, treated between January 2009 and May 2010, were collected from a single institution in San Jose, Costa Rica. The data were statistically analyzed for significance.
  
  
  RESULTS
  Median age at diagnosis was 53 years. With a median follow-up of 46.5 months, there was an 88% overall survival rate. Thirty-seven percent of the patients (p < 0.001) were at stages III and IV during diagnosis. The hormone receptor human epidermal receptor negative phenotype (HR-HER2-) (p < 0.001) was present in 17% of the cases. In a multivariate analysis, local (risk ratio, RR: 7.2; confidence interval, CI 95%: 3.8-7.6; p = 0.06) and distant recurrence (RR: 14.9; CI 95%: 7.7-28.9; p = 0.01) showed the strongest association with the probability of death from the disease. Patients with HR-HER2- phenotype tumors reported more local recurrences (p = 0.04), a higher tumor grade (p < 0.01), and lower overall survival than patients with other breast cancer phenotypes (p = 0.01).
  
  
  CONCLUSIONS
  Although this study analyzes a modest number of cases, it is an initial insight into factors that may contribute to differences in breast cancer outcomes among Hispanic women in Costa Rica. The higher proportion of triple negative tumors, advanced stage, and younger median age at diagnosis could contribute to the inferior prognostic described among Hispanic women. There may be a different distribution of tumor subtypes compared to non-Hispanic white women. Further studies are necessary to confirm such findings.
authors.affiliation: Servicio de Oncología Quirúrgica, Unidad de Mama, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica.
authors.forename: Nadia
authors.initials: N
authors.lastname: Srur-Rivero
authors.affiliation: Escuela de Salud Pública, Universidad de Costa Rica, San Pedro Montes de Oca, Costa Rica.
authors.forename: Mayra
authors.initials: M
authors.lastname: Cartin-Brenes
keywords: Costa Rica; Hispanic; breast; cancer; immunohistochemistry