Female breast cancer in Suriname: Defining disparities in breast cancer care through the lens of a upper middle income country

Globally, 60% of all breast cancers are projected to occur in low and middle income countries (LMIC). Suriname, a LMIC in South America has an ethnically and culturally diverse population of 541,638. Trend analyses show breast cancer incidence has increased over time. Data were obtained from the Pathology Department, Academic Hospital Paramaribo for 2008-2011. Census data of 2012 were retrieved from the General Bureau of Statistics. The total number of cancer diagnoses was 2524. Of these diagnoses, 70% were in women (1766). For breast cancer, 674 cases (26.7%) were identified. Ductal carcinoma represented more than 90% of these diagnoses. The mean age at diagnosis was 55.76±14.42. Most cases (67.5%) were identified within the 40-69 age group. Almost 13% of the confirmed diagnoses were younger than 40 years. Data also showed significant differences of age at diagnosis between the Creole (57.3) and Javanese (51.9, p=0.006) subpopulations. Results indicate an excess of cancer in women and in particular breast cancer, with different distributions within age and ethnic groups. Poor outcomes could be attributed to the lack of a continuum of care paradigm in cancer care as exemplified by late stage diagnosis. This is caused by absence of a national screening and early detection program, and limited access to supporting diagnostics and adjuvant therapy. Influencing factors include differences in genetics, susceptibility, epigenetics, and lifestyle. The study is intended to promote the development of a comprehensive cancer care policy in Suriname and could serve as a potential blueprint for other LMICs.