Facing scarcity of medicines and broken-down medical equipment, women diagnosed with breast cancer in Venezuela resort to more radical means of treatment.
When she realised that she could not continue to afford the therapy that would save her life, Dennis Mercado felt desperate. Aged 48 years, Mercado had been diagnosed with breast cancer 3 years before. As part of her post-surgical treatment, she had been taking the hormonal blocker goserelin for several years, costing about US$100 per month. As an internal medicine specialist, Mercado urges her patients to do everything they can to complete their treatment; a non-completed treatment scheme, Mercado says, can be useless. But as a patient, she could not afford to do so. Mercado only makes about $20 a month.
“My hormone level was rising, and I knew that there was no other option than to do another surgery”, she said. In April, 2018, Mercado had an oophorectomy to remove both her ovaries, the most radical solution to stop hormone production.
Being diagnosed with breast cancer is a shock for any woman, but if that woman lives in Venezuela today, it means an endless struggle to obtain and pay for treatment. Often, it can mean losing both breasts and ovaries, even though alternative treatments have been proven to be more effective.
“Mastectomies in our hospital have risen by 30–40% in the past 5 years”, says Gabriel Romero, head of the breast cancer unit at the Luis Razetti Cancer Hospital in Caracas. He says that oophorectomies are also on the rise in his hospital, and possibly in the whole country, although there are no data available to confirm this at the time.
Doing radical surgery to treat breast cancer might have been standard practice 30 years ago, says the 66-year-old surgeon, but nowadays, breast cancer is treated by pre-surgical or post-surgical chemotherapy, radiology, and, in case of a hormone-driven cancer, a hormonal treatment. These complementary treatments allow surgeons to preserve the breast in most cases.
But in Venezuela, these treatments are no longer available in public hospitals. The country's health system has been deteriorating for the past 20 years; maternal mortality, for instance, has increased by 30% since 1998, according to Marino Gónzalez, chair of public health at Simón Bolivar University and member of the Venezuelan Medical Academy.
The decline of the Venezuelan health sector accelerated in 2014, when the recession started. “This recession is the worst one Latin America has ever been in, and is among the worst recessions worldwide”, says Gónzalez. The country's hyperinflation, which has been rising since November, 2017, is set to hit a record level, with the International Monetary Fund saying in July that hyperinflation could reach an annualised rate of 1 million % by the year's end, setting Venezuela within the countries with the worst inflation rates in history. “The public health system in Venezuela is at its worst at the moment, and it will become worse as hyperinflation continues”, says Gónzalez.
In his hospital “we only had two radiotherapy units, but these were damaged years ago”, says Romero. The unavailability of radiotherapy is the case not only at the Luis Razetti hospital, which is the national public hospital for patients with cancer, but throughout Venezuela, he says. According to him, patients wait for more than a year to get radiotherapy and relapses and deaths have increased.
Diagnostic facilities are also scarce—there are few functioning mammography screening units in the country and doing immunohistochemistry is complicated by the inadequate supply of slides and reagents. Romero's list of what is missing in the Luis Razetti hospital is seemingly endless—cancer drugs, surgical instruments, syringes, gloves, palliative drugs, and reagents are all unavailable. “At the moment we can only do four surgeries a week, because we have no material”, says Romero. “A patient diagnosed [in July] will be on my operation list in December.”
In these circumstances, many doctors, medical technicians, and nurses have chosen to leave the country. “The doctors who have stayed are busy getting the paperwork done to leave”, says Romero. “What is most important is that we maintain our capacity to train our oncology students.”
Therefore, breast cancer is being diagnosed late. “Last year, 65% of the cases I saw were locally advanced cancer, whereas in 2010, only 38% of the patients came with advanced cancer”, says Romero. “In medicine in Venezuela, we are going back to the beginning of the 20th century.”
