A Review and Comparison of Breast Cancer and Breast Cancer Screening in Costa Rica and Guatemala in the Context of the Historical Development and Healthcare Infrastructure of Each Country

BACKGROUND: Breast cancer is the most frequently diagnosed cancer in women worldwide. Costa Rica has rates of breast cancer and breast cancer survival comparable to those of highly developed nations and has had tremendous success in the prevention and treatment of the disease. Guatemala has made limited progress in its approach to breast cancer due to its fractured health system and the effects of a recent civil war. Both Central American countries have universal healthcare but have vastly different health outcomes. This dissertation will examine breast cancer and breast cancer screening as it pertains to each country's historical sociopolitical development and healthcare infrastructure. METHODS: A historical review was performed on the development of the government, social security, health system, and population demographics of Costa Rica and Guatemala. An academic review of literature pertaining to breast cancer and breast cancer screening in each country was performed utilizing PubMed searches and health databases. RESULTS: Over the past century, Costa Rica has enjoyed stability and economic growth while Guatemala was devastated by a brutal civil war and genocide. Costa Rica developed an organized and comprehensive public healthcare system which allowed the country to launch successful breast cancer prevention and treatment programs and keep breast cancer-related mortality low despite an increasing incidence rate. Unfortunately, Guatemala has not developed a cancer registry, so all cancer statistics are estimates, but it appears breast cancer mortality has been continuously rising over the past decade. Guatemala's inadequate health system cannot meet the basic healthcare or cancer needs of its population and significant health disparities exist between its rural, indigenous and urban, non-indigenous populations. CONCLUSION: Key differences in the countries' abilities to manage their health systems and thus prevent and treat cancer may explain the observed differences in the respective breast cancer mortality trends. Guatemala remains decades behind Costa Rica in its ability to track and prevent breast cancer throughout the country. As Guatemala continues to develop, many lessons can be learned from its Central American neighbor, Costa Rica, in regard to health system management and breast cancer control programs.