title: Access to care issues adversely affect breast cancer patients in Mexico: oncologists' perspective.
abstract: BACKGROUND
  Despite recently implemented access to care programs, Mexican breast cancer (BC) mortality rates remain substantially above those in the US. We conducted a survey among Mexican Oncologists to determine whether practice patterns may be responsible for these differences.
  
  
  METHODS
  A web-based survey was sent to 851 oncologists across Mexico using the Vanderbilt University REDCap database. Analyses of outcomes are reported using exact and binomial confidence bounds and tests.
  
  
  RESULTS
  138 participants (18.6% of those surveyed) from the National capital and 26 Mexican states, responded. Respondents reported that 58% of newly diagnosed BC patients present with stage III-IV disease; 63% undergo mastectomy, 52% axillary lymph node dissection (ALND) and 48% sentinel lymph node biopsy (SLNB). Chemotherapy is recommended for tumors > 1 cm (89%), positive nodes (86.5%), triple-negative (TN) (80%) and HER2 positive tumors (58%). Trastuzumab is prescribed in 54.3% and 77.5% for HER2 < 1 cm and > 1 cm tumors, respectively. Tamoxifen is indicated for premenopausal hormone receptor (HR) positive tumors in 86.5% of cases and aromatase inhibitors (AI's) for postmenopausal in 86%. 24% of physicians reported treatment limitations, due to delayed or incomplete pathology reports and delayed or limited access to medications.
  
  
  CONCLUSIONS
  Even though access to care programs have been recently applied nationwide, women commonly present with advanced BC, leading to increased rates of mastectomy and ALND. Mexican physicians are dissatisfied with access to appropriate medical care. Our survey detects specific barriers that may impact BC outcomes in Mexico and warrant further investigation.
authors.forename: Yanin
authors.initials: Y
authors.lastname: Chavarri-Guerra
authors.forename: Jessica
authors.initials: J
authors.lastname: St Louis
authors.forename: Pedro E R
authors.initials: PE
authors.lastname: Liedke
authors.forename: Heather
authors.initials: H
authors.lastname: Symecko
authors.forename: Cynthia
authors.initials: C
authors.lastname: Villarreal-Garza
authors.forename: Alejandro
authors.initials: A
authors.lastname: Mohar
authors.forename: Dianne M
authors.initials: DM
authors.lastname: Finkelstein
authors.affiliation: MGH-Avon International Breast Cancer Program, Massachusetts General Hospital, Boston, MA, USA. pgoss@partners.org.
authors.forename: Paul E
authors.initials: PE
authors.lastname: Goss
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000473:pathology* / Q000628:therapy*; D003625:Data Collection; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008800:Mexico; D008875:Middle Aged; D010820:Physicians; D010818:Practice Patterns, Physicians'; D012959:Socioeconomic Factors; D055815:Young Adult