Breast cancer clinical characteristics and outcomes in Trinidad and Tobago.

Trinidad and Tobago (TT) is the country with the highest breast cancer mortality in the Caribbean. It is unknown whether biological, behavioral, environmental, or clinical factors play a significant role in such outcome. A total of 2,614 incident cases, histologically confirmed and recorded in the TT cancer registries between 1995 and 2005, with follow-up through 2009 were analyzed. Half of the cases were diagnosed between the ages of 40-59 years, 12.5% before the age of 40 years; 45% of women were diagnosed at localized stage and 43.7% were hormone receptor positive. Women diagnosed with distant staging were more likely to undergo chemotherapy compared to those with localized staging (OR 1.39; 95% CI 1.01-1.89). Hormone receptor negative cases were significantly less likely to undergo radiation or surgery therapy (OR 0.66; 95% CI 0.56-0.79 and OR 0.67; 95% CI 0.51-0.88 respectively) compared to those who were hormone receptor positive, but more than 1.5 times as likely to undergo chemotherapy. In multivariate analyses, advanced stage disease and negative hormone receptor status were independently significantly associated with poorer survival outcome. No racial/ethnic differences were observed with respect to treatment or survival. Although access to breast cancer screening and treatment is free in Trinidad and Tobago, breast cancer diagnosis occurs at advanced stages; use of multimodality therapy as a first course of treatment is low.