Tumores malignos de la mama en Costa Rica, 1939-1953

Abstract

A study is presented of 259 cases of malignant tumors of the breast recorded with histopathological diagnosis in Costa Rica in the years 1939-1953. Of this number 5 (1,9%) occurred in men and 154 (98,1%) in women, of which 12 were Negroes. The following aspects are considered in the cases occurring in women: a) Geographic distribution: the lowest incidence rates obtain in the provinces of Guanacaste and Puntarenas, where the population has the greated proportion of native (Indian) ancestry. b) Age: the highest incidence is for the 45-49 year age group. For every age group, the incidence rate is lower than in Nordic countries for which comparable records are available (U.S.A. and Denmark). c) Marital status, births, and abortions: 80,2% of the patients were mar­ried, and 30,7% had no children. In Costa Rica the incidence rate of breast cancer in unmarried women (0,77%) is lower than in the United States (1,11%) according to GESCHICKTER, 15) d) Location: right breast, 49,6%, left breast 50,4%. The most frequently affected was the upper outer quadrant, and the least affected was the lower inner quadrant. Five bilateral cases occurred (metastatic?). e) Clinical classification: the 4-stage classification recommended by W. H. O. is used,with the following results: stage I, 7,5%; II, 26,8%; III, 56,1%; IV, 8,8%. In Costa Rica, patients still come for medical atten­tion tardily. f) Histological classification: epithelial tumors, 94,4%; epithelio-connective, 2,8%; and connective, 2,8%. Among epithelial tumors carcinoma was the most frequent and Paget's disease the least (0,4%). Correlations are made between histological types and age, number of children and abortions, primary location, and clinical diagnosis. g) Treatment: 229 radical mastectomies were carried out, 2 simple mastec­tomies and 2 local excisions. In 21 cases no surgical intervention was made. In several cases X ray and hormone therapy were employed. Oopho­rectomy was practiced in only 14 cases. h) Evolution: survival rates are shown according to year, age, number of children, location, clinical stage, histological type, pregnancy and bila­teral cases. i) Cases in Negro women showed no different characteristics from the rest of the group. Of the five cases in males, only one is living after 8 years (20% sur­vival after 5 years). This was the only patient who had children.