Srur-Rivero and Cartin-Brenes
108 BREAST CANCER: BASIC AND CLINICAL RESEARCH 2014:8
Hines et al
found tumor single marker staining for
HER2+ was 31.9% in Hispanics, compared to 14.3% in non-
Hispanic whites. In our study, 18.5% of the tumors displayed
single marker staining for HER2+, or were FISH+. e
slightly higher survival in this study for the HR+HER2+ sub-
type compared to the HR+HER2- may be explained in part
by public access to treatment and systemic therapies, as well as
sample size and short follow-up period.
Information from patient records was not found for tumor
grade in 18.1% of the cases and for lymphatic invasion in 50%
of the cases. No standardized synoptic report for breast can-
cer was used by pathologists at the time; therefore, informa-
tion was omitted in some pathology reports. Future changes
in reporting are expected with the recent implementation of
the standardized synoptic report for breast pathology, and the
assignment of a specialized group of pathologists to work on
e study's weakness is that the patient cohort is from a
single institution, which is a reference cancer treatment center
for Costa Rica’s South Central Region; hence, the data may
not reect the true epidemiology of the entire Hispanic popu-
lation in Costa Rica.
is is the rst published study of breast cancer clinical-
pathological characteristics and survival of Costa Rican breast
cancer patients, according to Medline search terms: breast
cancer, Costa Rica.
ese ndings may provide an initial insight to factors that con-
tribute to dierences in breast cancer outcomes among Hispanic
women in Costa Rica. e higher proportion of triple negative
tumors, advanced stage, and younger median age at diagnosis
could lead to a worse cancer prognosis in this group.
e higher proportion of stages III and IV tumors
at diagnosis demands a review of the region’s breast cancer
screening program. It is important to make emphasis on breast
cancer awareness programs for the population and primary
care physicians, and to investigate social and cultural barriers
that make earlier cancer detection a dicult task.
Since patients are diagnosed at a younger age, it is desir-
able to organize programs for fertility preservation and genetic
testing, among others, to improve patient care.
We thank Allan Ramos MD for providing data collection
support, and Yetty Vargas MD, Adonay Jaen and Jason, San
Juan de Dios IHC pathology technicians for their help with
the IHC specications for our study. We also thank Angela
Ulloa for her help editing the manuscript.
Conceived and designed the experiments: NSR. Analyzed the
data: NSR, MCB. Wrote the rst draft of the manuscript: NSR.
Contributed to the writing of the manuscript: NSR, MCB.
Agree with manuscript results and conclusions: NSR, MCB.
Jointly developed the structure and arguments for the paper:
NSR, MCB. Made critical revisions and approved nal ver-
sion: NSR, MCB. All authors reviewed and approved of the
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