FROM THE EDITORS

The Challenge of Breast Cancer

We are pleased to present this issue of MEDICC Review, focusing on one of the most pressing health problems in Cuba and worldwide: while both in Cuba and in the world, lung cancer is the most common form, breast cancer closely follows. Worldwide, 1.2 million new cases of lung cancer are reported annually; and just over 1 million new breast cancer cases. In Cuba, over 2,000 new cases of breast cancer are reported annually.

The trends in morbidity and mortality in breast cancer reflect the complexities of chronic diseases and their management: while cancers (breast cancer among them) have often been associated with aging populations, industrialized societies, and higher socio-economic status in general; it is now clear that over 50% of the world’s cancer burden—in terms of both numbers of cases and deaths—already occurs in developing countries.

The latter in itself may be quite an understatement, given that the more fragile health systems in poorer countries mean later detection and higher mortality rates: the probability of being diagnosed with cancer is more than twice as high in industrialized vs. developing countries, but 80% of those diagnosed in developing countries will die of these cancers, as opposed to 50% in the wealthier nations, due primarily to late diagnosis.
(WHO, www.who.int/mediacentre/releases/2003/pr27/en).

Clear in both developing and developed countries is the need to ratchet up prevention strategies: lifestyle changes in particular can mean preventing cancer altogether; and early detection can bring life-saving treatment to patients in time. In the case of breast cancer alone, and despite the recent debates over mammography, the WHO estimates that mammography screening programs can reduce breast cancer mortality by 20%. (Ibid.)

In this MR issue, you will find a description and projections for breast cancer rates in Cuba, in Breast Cancer Risk in Cuba, which notes that “ An average of 2 222 new cases were diagnosed every year in the 1998-2000 period, for an annual average rate of 40.0 cases per 100 000 inhabitants.” The article further describes the highest risk group, women over 65, “with an average of 801 cases in the 1998-2000 three-year period, and an average annual rate of 151.5 per 100 000 women. This group represents 36% of the cases diagnosed.”

In Spotlight….., Dr. Rolando Camacho, Chair of Cuba’s National Cancer Control Commission, reports on the role of the National Cancer Control Program since its creation in 1986.

Education’s Role in the Prevention of Breast Cancer in Cuba is explored by Dr. Teresa Romero, describing national programs to “increase the efficacy of the objectives of the National Breast Cancer Control Program, by encouraging women’s effective participation in self-examinations; and visits to their family doctor, at least once a year, for a clinical examination or mammogram.”

Diagnosis and treatment of breast cancer in Cuba are addressed in Immunotherapy as an Innovative Treatment for Advanced Breast Cancer, Chemotherapy in Breast Cancer in Cuba , and Presence of estrogen receptor and Her2 in a sample of breast cancer patients .

Completing this issue, an MR Interview with Dr. Maria Luisa Buch, who directs Cuba’s National Breast Cancer Control Program; and a MEDICC Feature presenting a winner in the 2002-2003 Research Competition on Women’s Health.

And, don’t forget to take a look at What’s New at MEDICC , and Health News from Cuba, which includes the recently publicized position taken by the Cuban Academy of Sciences on cloning and stem cell research.

We invite you to open the e-pages of this quarter’s journal, and send us your comments at medic@infomed.sld.cu.

Coming up in our next issue: The Arts and Health in Cuba .

Gail A. Reed, MS
Editor

Michele Frank, MD
Associate Editor