Oncosmart: A Private Initiative to Improve Breast Cancer Care in Costa Rica
Authors: Wiernik Andres , Fernandez Loretta , Lami Leonardo , Vindas Greivin , Durman Marissa , Ramirez Millie 
Published: October 2018

Purpose Founded in 2010, Hospital Metropolitano is the fastest growing health care system in Costa Rica with a network of two hospitals, 27 clinics, and more than 90,000 patients enrolled in its health plan, Medismart. Given the challenges faced by the national public health care system in providing cancer care, the Oncosmart program was launched in November 2016 with the goal of providing population-based cancer screening, diagnostics, cancer treatment, and survivorship care. The program has no restrictions on preexisting conditions and has a monthly membership cost of $14 USD per patient. Here, we summarize our breast cancer program results during the first 16 months of implementation. Methods We performed a retrospective analysis that evaluated data from our radiology department, cancer center, and survivorship program. We determined the number of patients with breast cancer who were diagnosed and/or received care in our health care system from November 2016 to March 2018. Results During this period analyzed, 5,687 mammograms were performed at our health care system and 215 patients were reported to have a Breast Imaging Reporting and Data System 4 to 5 requiring a breast biopsy. Of these, 24% were diagnosed with breast cancer, 36% had a nonmalignant breast condition, and 41% were false positives. Among patients with newly diagnosed breast cancer, 11% had noninvasive breast cancer and 89% had invasive disease. Twenty-seven percent of all breast cancer diagnosis occurred in women younger than age 50 years and two patients were diagnosed with a BRCA1/2 mutation. All biopsies performed at our program were reported within 30 days from abnormal imaging. During this period, we performed 53 breast cancer surgeries and provided chemotherapy and/or endocrine therapy to 32 patients, and among all patients who followed-up in the survivorship clinic, 22 followed-up for breast cancer survivorship. Conclusion Oncosmart is a low-cost and effective private initiative that improves access to breast cancer screening and breast cancer care in the middle-income country of Costa Rica. On the basis of national statistics, after 16 months of implementation, approximately 4% to 5% of all patients with breast cancer in the country are diagnosed within our program. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Andres Wiernik Consulting or Advisory Role: Grupo Montecristo Leonardo Lami Employment: Roche, Genetech (I) Travel, Accommodations, Expenses: Roche/Genetech (I) Marissa Durman Consulting or Advisory Role: Grupo Montecristo