From the print edition
Rebeca León didn’t know what to make of the lump she had discovered on one of her breasts in May 2011.
Friends told her it couldn’t be cancer because she’s too young. She has no family history. But a specialist confirmed it. León would begin her mid-30s by battling breast cancer.
“It was a shock,” León, 35, said. “I did not expect it. There have not been other cases of this type of cancer in my family.”
But León learned the type of insurance she had from the National Insurance Institute covered treatment at a private institution in Costa Rica, established specifically for remedying cancer patients. The Costa Rican Oncology Institute (ICOT) was inaugurated in January 2010 with the goal of becoming the premiere cancer treatment center in Central America.
ICOT originally only did chemotherapy, while the organization operated with five oncologists in a small hospital in eastern San José. At the beginning of 2012, ICOT moved to a larger location in La Uruca, a northwestern district of San José, next to the state-run Hospital México. By the end of the expansion, the institute will have invested a total of $10 million since 2010. For this year’s opening, ICOT added more than two dozen oncologists to its staff.
Oncologists specialize in fields that include hematology (for treating cancers like lymphoma and leukemia) and pediatrics. The premises offer clinical lab services, ultrasounds, mammograms, CT scans, X-rays and MRIs. Since opening the center in January, ICOT has received some 700
patients. They began performing their first surgeries in the new facilities on Tuesday.
Since her own diagnosis in July 2011, León has fought capably against breast cancer through the help of ICOT.
Almost a year has passed since León’s initial operation to remove the tumor, which was followed by reconstructive surgery and chemotherapy. She still undergoes hormonal therapy at ICOT and will need checkups to make sure the cancer does not come back stronger. She’s not yet able to return to work, but León believes “the worst is over.”
Her progress is impressive against the deadliest type of cancer for women in Costa Rica, causing 1,206 deaths in 2011 (see box). The disease is considered even more aggressive in younger patients.
ICOT officials hope for similar success fighting cancer in its new headquarters. They hope the institute’s 30 oncologists will help reduce cancer deaths in Costa Rica, which totaled 4,212 people last year, according to Health Ministry statistics.
Guillermo Rodríguez, president of ICOT, said he believes the private institute could serve as a cancer treatment place for the region, and also for medical tourists from the U.S. looking for more affordable options.
“We have put together a center where we can treat patients with cancer in a comprehensive way,” Rodríguez said.
The project still has one more stage to go before it’s completed. The new building only can handle out-patient surgery. But over the next three to five years, the institute plans to add another structure for cancer patients who require long-term hospital stays.
The ICOT building formerly was used for doing clinical trials, but a court ruling put a halt to clinical testing in 2009. The decision changed Rodríguez’s focus, and he started thinking of how to remodel the place into a cancer center.
Rodríguez’s office on the third floor of ICOT overlooks mountainsides. Downstairs, patients receiving chemo look out into a garden. Another room contains a large forum where doctors from throughout the country can discuss medical issues.
Although the institute will not accept payment from the Costa Rican Social Security System, ICOT contains many collaborative aspects.
Rodríguez said the cancer center will receive academic leadership from top U.S. cancer hospitals at M.D. Anderson in Houston, Texas, and the Sylvester Center in Miami, Florida. Local medical brands such as Hospital Metropolitano, Laboratorios Páez, Imágenes Médicas and Grupo Leisa also will have roles in the hospital. For example, Grupo Leisa runs the pharmacy while Hospital Metropolitano is in charge of the operating room.
Roberto Herrera, director of the privately run Hospital Metropolitano, in San José, said ICOT is essential for treating a disease that has become the scourge of the 21st century. The state-of-the-art lab equipment should help with prevention and early diagnosis.
“If you’re not able to work as a team, if you’re not able to involve many disciplines, then probably you will not be as good as you want to be in terms of cancer treatment,” Herrera said.
León said the staff also proved significant for preparing her to fight breast cancer.
She appreciated the closeness of the director of medicine, Joao Bautista, and the head of surgery, Efraín Cambronero, and she was grateful for the flexibility of the hospital’s insurance department. All these factors allowed her to feel more at ease while fighting a frightening disease.
“They’re all very close to me at this moment, like friends of mine,” León said. “They were a big help.”
A shortage of machines to fight cancer?
A recent report asserts that thousands of women in Costa Rica are waiting to receive a mammogram from the Social Security System (Caja). The problem is so prevalent in the country that patients can wait up to two years for an appointment, according to statistics released Monday by the National Union of Caja Employees (UNDECA).
Almost 53,800 women are waiting for a mammogram, UNDECA statistics showed. The mammogram is a tool used to detect and diagnose breast cancer, the most common type of cancer in women in Costa Rica.
The UNDECA statement said the reason for the logjam is that many hospitals have mammogram machines that are old or no longer work.
María Eugenia Villalta, a Caja medical manager, denied that the waits were as severe as what UNDECA claimed, although she did not provide figures proving otherwise.
A press release from the Caja stated that the organization did 90,000 mammograms in 2011, and the number of mammograms performed increased 24 percent between 2008 and 2011.
Villalta said the situation is improving, and the Caja in recent years bought 14 new mammography machines and hired 26 new radiologists. She said the Caja plans to hire 22 more in the upcoming year. She also said the reason some women might not be receiving mammograms more regularly is because it’s only necessary to receive a checkup every two years.
The American Cancer Society recommends yearly mammograms beginning at age 40. However, the U.S. Preventive Services Task Force recommends the procedure every two years, starting at age 50. A recent study stated frequent mammograms lead to “over-diagnosis” of breast cancer, meaning that the breast cancer detected is so minimal it is unlikely to cause harm throughout a woman’s lifetime. Therefore, a patient receives treatment and tests they do not actually need.