Background
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The Breast Health Global Initiative (BHGI) guideline for breast cancer healthcare in low-income and middle-income countries [13] offers four levels of guidance: basic (hormone receptor status by empiric assessment or response to treatment); limited (determination of ER status by IHC); enhanced (determination of PR status by IHC and measurement of HER2 overexpression); and maximal (gene profiling testing).
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The National Comprehensive Cancer Network (NCCN) framework for oncology care resource-stratification [14] offers four levels of guidance equivalent to those in the BHGI guideline.
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The American Society for Clinical Oncology (ASCO) offers a resource-stratified guideline for cervical cancer [15], which can be used to illustrate the need for a similar guideline for breast cancer.
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The World Health Organization (WHO) [16] offers guidance to countries on three resource scenarios (low, medium, high) with differential actions in the national cancer control programs, but has not yet offered a breast cancer specific resource-stratified guideline.
Methods
Hospital setting
Patients
Study design
Patient trajectory monitoring
UMLS code | UMLS description | Description in Spanish |
---|---|---|
Visit | ||
C0008952 | Clinic Visits |
Atención inicial en la unidad de medicina familiar (primer nivel de atención).
|
C2153644 | Visit for: gynecological exam |
Atención inicial en la consulta de ginecología (segundo nivel de atención).
|
Oncology | ||
C1620996 | Oncology; primary focus of visit; work-up, evaluation, or staging at the time of cancer diagnosis or recurrence |
Atención inicial en la consulta de oncología médica.
|
C1617848 | Oncology; primary focus of visit; expectant management of patient with evidence of cancer for whom no cancer- directed therapy is being administered or arranged at present |
Atención subsecuente en la consulta de oncología médica.
|
Request lab | ||
C2186763 | Request lab results from pathology |
Solicitud de estudios de patología.
|
C2186756 | Request lab results from hematology |
Solicitud de estudios básicos de laboratorio clínico.
|
C2186777 | Request lab results from x-ray |
Solicitud de estudios de imagen (tele de tórax, ultrasonido, mastografía).
|
C2186774 | Request lab results from CT |
Realización de estudios especiales de imagen (tomografía).
|
C2186775 | Request lab results from MRI |
Realización de estudios especiales de imagen (resonancia magnética).
|
Biopsy / Pathology | ||
C0177666 | Needle biopsy of breast |
Realización de biopsia con aguja fina o gruesa.
|
C0585992 | Surgical biopsy of breast |
Realización de biopsia por escisión quirúrgica.
|
C0807321 | Pathology report |
Reporte de estudio histopatológico.
|
Chemotherapy | ||
C0086965 | Selection for Treatment |
Selección de tipo de tratamiento (quimioterapia, radioterapia, cirugía).
|
C4302504 | Chemotherapy started |
Inicio de quimioterapia.
|
Surgery / Radiation | ||
C0436382 | Radiotherapy started |
Inicio de radioterapia.
|
C0024881 | Mastectomy |
Realización de mastectomía radical.
|
C0851238 | Lumpectomy of breast |
Realización de lumpectomía
|
IHC results | ||
C3248285 | Quantitative HER2 immunohistochemistry (IHC) evaluation of breast cancer consistent with the scoring system defined in the ASCO/CAP guidelines (PATH) |
Solicitud de estudios de inmunohistoquímica (Receptor de HER2).
|
C3248286 | Quantitative non-HER2 immunohistochemistry (IHC) evaluation of breast cancer (eg, testing for estrogen or progesterone receptors [ER/PR]) performed (PATH) |
Solicitud de estudios de inmunohistoquímica (Receptores de estrógeno y progesterona).
|
Treatment adjusted | ||
C1627778 | Treatment adjusted per protocol |
Ajuste de tratamiento de primera línea (posterior al primer ciclo de quimioterapia).
|
C0419989 | Hormone replacement therapy started |
Inicio de tratamiento de reemplazo hormonal.
|
Adverse events | ||
C0019993 | Hospitalization |
Complicación de proceso oncológico (internamiento a causa de cáncer)
|
C1282471 | Local recurrence of malignant tumor of breast |
Recaída de proceso oncológico (mismo sitio tumor primario). Recidiva local de tumor maligno de mama.
|
C3694291 | Metastasis from malignant neoplasm of breast |
Reconocimiento de metástasis (tumor secundario).
|
C13065577 | Death (finding) |
Fallecimiento / Muerte
|
Remission | ||
C0687702 | Cancer Remission |
Evolución favorable de paciente, mejoría clínica; remisión.
|
Missing data
Outliers
Clustering
Results
Characteristic | Total (%) | With IHC testing (%) |
---|---|---|
Overall | N = 402 | N = 30 |
Sex | ||
Female | 402 (100%) | 30 (100%) |
Male | 0 | 0 |
Age at diagnosis | ||
< 40 | 18 (4%) | 3 (10%) |
40–49 | 62 (15%) | 16 (53%) |
50–59 | 174 (43%) | 7 (23%) |
60–69 | 127 (32%) | 4 (13%) |
70+ | 21 (5%) | 0 |
BIRADS | ||
0,1,2 | 23 (6%) | 18 (60%) |
3 | 203 (50%) | 7 (23.3%) |
4,5,6 | 162 (40%) | 4 (13.3%) |
unknown | 14 (3%) | 1 (3.3%) |
Tumor stage | ||
I | 85 (21%) | 2 (7%) |
II | 122 (30%) | 12 (40%) |
III | 84 (21%) | 12 (40%) |
IV | 19 (5%) | 3 (10%) |
unknown | 92 (23%) | 1 (3%) |
Patients without IHC testing | 372 (93%) | 0 |
Patients with IHC testing | 30 (7%) | 30 (100%) |
ER testing | ||
positive | n.a. | 17 (57%) |
negative | 11 (37%) | |
unknown | 2 (7%) | |
PR testing | ||
positive | n.a. | 16 (53%) |
negative | 12 (40%) | |
unknown | 2 (7%) | |
HER2 testing | ||
positive | n.a. | 5 (17%) |
negative | 23 (77%) | |
unknown | 2 (7%) | |
Additional IHC testing | ||
Ki67, P53 | n.a. | 1 (3%) |
unknown | 29 (97%) | |
Subtype according to the Mexican Consensus [4] | ||
Luminal A | n.a. | 14 (47%) |
Luminal B | 3 (10%) | |
Basal-like/Triple negative | 9 (30%) | |
HER2 | 2 (7%) | |
not enough information to assign | 2 (7%) |