Screening in Mexico finds most breast cancer in women 60 and younger

Nearly 70% of cancers found in Mexico’s first breast cancer screening program were in women younger than 60 years old, the reverse of the pattern seen in the U.S. and other developed countries.

Mexico’s first voluntary mammography screening program was organized by the Mexican Foundation for Education in Prevention and Opportune Detection of Breast Cancer (FUCAM) and the Mexico City government. It targeted women over 40.

More than 96,000 mammograms were performed in mobile units for residents in Mexico City’s Federal District over a 22-month period ending in December 2006, according to a new study (Breast J 2009 Aug. 17:epub ahead of print).

Out of 949 women with abnormal mammograms, 208 had breast cancer, a rate of 2.1%. Most were in situ stage I (29.4%) or stage II (42.2%). One percent were in BI-RADS 0, 4, or 5.

Of the women diagnosed with cancer, 68.5% were younger than 60, with an average age of 53.5. Thirty-eight percent of the cancers occurred in women 49 or younger. In the U.S. and other developed countries, a majority of breast cancers are found in women 60 and older.

The prevalence of breast cancer at an earlier age in Mexico is, in part, explained by the predominance of young women in the population; there are more young women than older ones, the researchers said.

“Unfortunately, breast cancer in Mexico is diagnosed in local advanced stages, with prevalence between 40 and 49 years old,” said Dr. Eva Ruvalcaba-Limon, a gynecological oncologist at FUCAM. “Most of the women are low income and have poor accessibility to mammography.”

Screening rates are low because there are not enough health centers with mammography equipment, she said. Most mammograms are diagnostic, not screening.

Another problem is a lack of technicians and radiologists trained in breast imaging. In Mexico there are only 72 radiologists with supplementary breast radiology training for a population of 20 million women in at-risk age groups, the authors wrote.

That’s why FUCAM joined with the Mexico City government to help the population most at risk, according to Ruvalcaba-Limon. But even after screening mammograms were performed in mobile units, 21% of women with BI-RADS categories 0, 4, and 5 did not present for follow-up care at specialized breast centers.

When women don’t present for their follow-up care it creates repercussions, like notable increases in program costs, and it endangers the viability of governmental and nongovernmental screening program efforts, the authors wrote. Women who don’t present for follow-up care often come in later with more advanced stages of breast cancer, which is more difficult and costly to treat.

As in other countries, breast cancer screening programs in Mexico could identify breast cancer in early stages, which would reduce treatment costs and decrease mortality, Ruvalcaba-Limon said.

“Breast cancer in Mexico is considered a public health problem and this type of screening program is the most important tool to meet the objectives of lowered cost and mortality,” she said.