Evolution of breast cancer management in the Dominican Republic in the 21st century.

Abstract

e12500 Background: Breast cancer is a major public health problem. Despite knowing the management, clinicians are forced to provide less than optimal care when diagnostic and/or treatment are lacking. For that, we decided to do a review about breast cancer treatment during the 21 st century in Dr. Heriberto Pieter Oncology Institute. Methods: A retrospective study was done to describe and evaluate the management of patients with breast cancer. A random sample of 100.00 patients was selected, which was reduced to 64.00 after the inclusion-exclusion criteria application like lacking immunohistochemistry, partial treatment. and less than 5 years with the diagnosis. Results: Molecular subtypes included luminal A: estrogen receptor+ and/or progesterone receptor+, Her2Neu3- (44%); luminal B: estrogen receptor + and/or progesterone receptor +, Her2Neu 3+(9%); Her2Neu 3: estrogen receptor-, progesterone receptor -, Her2Neu 3+ (19%); basal-like: estrogen receptor-, progesterone receptor-, Her2Neu3- (28%). Chemotherapy history: 63% with neoadjuvant chemotherapy; 78% with adjuvant chemotherapy, 18.75% as primary and 59.37% as secondary; 17% with palliative chemotherapy, 3% as primary and 14% as secondary. Surgical history: 31% with primary modified radical mastectomy (MRM), 63% with secondary MRM, and 2% with quadrantectomy. Radiotherapy: 11% with primary radiation therapy (RT), 36% with secondary RT, and 3% with palliative RT. Hormonal therapy of patients: 33% with tamoxifen, 11% with aromatase inhibitors, 8% with combination of hormonal therapy, and 22% with extended adjuvant hormone therapy of more than 5 years. Primary endpoints were disease-free survival at 5 years (67%), objective response rate to neoadjuvant chemotherapy (100% according to RECIST criteria), and overall survival at 5 years (87.5%). Currently in Dominican Republic there is availability of more target therapy for Her2Neu3 like pertuzumab, lapatinib, other drugs for positive hormone receptor named CDK4/6 inhibitors (palbociclib, ribociclib), olaparib for germline BRCA mutation and pembrolizumab for basal like or triple negative breast cancer (TNBC). Finally, according to the latest World Health Organization (WHO) data published in 2020, breast cancer deaths in Dominican Republic reached 1,460 or 2.14% of total deaths. The age adjusted death rate is 28.28 per 100,100 and the number of new cases in 2020 for breast cancer was 3,412 (17.2%). Conclusions: This review allows us to track the evolution of breast cancer management in Dominican Republic during the 21st century. It highlights the efforts made to apply guidelines on breast cancer management in general and global objective response to neoadjuvant regimen. It also highlights the need to implement more primary prevention and early detection since 52% of patients belong to the locally advanced category. [Table: see text]