Original Articles
Vol. 21 No. 2 (2026)
Epidemiological and spatial analysis of breast cancer mortality and survival among women in San Luis Potosi, Mexico 2009-2019
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Published: 23 July 2026
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This study investigated variations in breast cancer mortality among women in San Luis Potosí, Mexico using an epidemiologicalspatial approach covering the period 2009–2019. Additionally, global and specific survival and its associations with clinical stage, age at diagnosis, marginalization index, recurrence and arsenic concentration in water were evaluated. We conducted a retrospective ecological, study involving1, 626 confirmed breast cancer cases and 264 related deaths registered at a public hospital. Survival analysis was performed using the Kaplan-Meier method and Log-Rank tests. Spatial distribution patterns of municipal average mortality were assessed using Moran’s I and visualized in ArcMap 10.1. At the state-level the mean age at diagnosis among deceased patients was 53.49 years, with 84% presenting at advanced stages (IIB–IV). A progressively increased mortality, particularly in Health Jurisdiction IV and the municipality of Cerro de San Pedro, was observed, with peaks in 2016. The 5-year global survival rate was 83.78%. Factors significantly associated with reduced survival included advanced stage, older age, higher marginalization index and recurrence. Although arsenic exposure was not statistically significant, patients exposed to levels exceeding 0.025 mg/L exhibited longer survival times. The integration of spatial epidemiology with survival analysis underscored critical geographic and sociodemographic disparities and offer valuable insights for targeted healthcare planning and resource allocation, particularly in high-priority regions.
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Citations
Armienta MA, Segovia N, 2008. Arsenic and fluoride in the groundwater of Mexico. Environ Geochem Health 30:345-53.
ASC. Etapas del cáncer de seno. [Stages of breast cancer.] 2021 [cited 2025 Jan 14]. Available from: https://www.cancer.org/es/cancer/tipos/cancer-de-seno/comprension-de-un-diagnostico-de-cancer-de-seno/etapas-del-cancer-de-seno.html
Azamjah N, Soltan-Zadeh Y, Zayeri F, 2019. Global trend of breast cancer mortality rate: a 25-year study. APJCP 20:2015-2020.
Azim HA, Partridge AH, 2014. Biology of breast cancer in young women. Breast Cancer Res 16:427.
Barcellos C, Buzai GD, Santana P, 2018. Geografía de la salud: bases y actualidad. [Health Geography: Fundamentals and Current Issues.]Salud Colectiva 14:1-4.
CDC. Breast Cancer Basics. 2024 [cited 2024 Nov 3]. Available from: https://www.cdc.gov/breast-cancer/about/index.html
Chiou HY, Hsueh YM, Liaw KF, Horng SF, Chiang MH, Pu YS, Lin JS, Huang CH, Chen CJ, 1995. Incidence of internal cancers and ingested inorganic arsenic: a seven-year follow-up study in Taiwan. Cancer Res 55:1296-300.
CNEGSR. Cáncer de la mujer. [Women’s cancer] 2015 [cited 2024 Dic 1]. Available from: https://www.gob.mx/cms/uploads/attachment/file/248801/CancerdelaMujer.pdf
CONAPO. Informe de pobreza y evaluación 2020. [Report on poverty and evaluation 2020.] 2020 [cited 2025 Jan 9]. Available from: https://www.coneval.org.mx/coordinacion/entidades/Documents/Informes_de_pobreza_y_evaluacion_2020_Documentos/Informe_SLP_2020.pdf
CONAPO. La situación demográfica en México. [The demographic situation of Mexico]. 1999 [cited 2024 Nov 28]. Available from: https://www.gob.mx/conapo/documentos/la-situacion-demografica-de-mexico-1999
Díaz MP, Corrente JE, Osella, AR, Muñoz SE, Aballay LR, 2010. Modeling spatial distribution of cancer Incidence in Cordoba. ApplCancer Res 30:245-252.
DOF. Norma Oficial Mexicana NOM-041-SSA2-2011, Para la prevención, diagnóstico, tratamiento, control y vigilancia epidemiológica del cáncer de mama. [For the prevention, diagnosis, treatment, management, and epidemiological surveillance of breast cancer.] 2011 [cited 2025 Mar 7]. Available from: http://dof.gob.mx/nota_detalle.php?codigo=5194157&fecha=09/06/2011
DOF. Norma Oficial Mexicana NOM-127-SSA1-2021, Agua para uso y consumo humano. Límites permisibles de la calidad del agua. [Water for human use and consumption. Permissible limits for water quality.] 2022 [cited 2025 Mar 1]. Availablefrom: https://www.dof.gob.mx/nota_detalle.php?codigo=5650705&fecha=02/05/2022#gsc.tab=0
Engelman KK, Cizik AM, Ellerbeck EF, Rempusheski VF, 2012. Perceptions of the screening mammography experience by Hispanic and non-Hispanic White women. Womens Health Issues 22:395-401.
Esri. Data classification methods. [cited 2026 May 2]. Available from: https://pro.arcgis.com/en/pro-app/latest/help/mapping/layer-properties/data-classification-methods.htm
Esri. How inverse distance weighted interpolation Works. [cited 2026 May 2]. Available from: https://pro.arcgis.com/en/pro-app/3.4/help/analysis/geostatistical-analyst/how-inverse-distance-weighted-interpolation-works.htm
García-Esquinas E, Pollán M, Umans JG, Francesconi KA, Goessler W, Guallar E, Howard B, Farley J, Best LG, Navas-Acien A, 2013. Arsenic exposure and cancer mortality in a US-based prospective cohort: the strong heart study. Cancer Epidemiol Biomarkers Prev 22:1944-53.
González-Ortega JM, Morales-Wong MM, López-Cuevas Z, Díaz-Valdéz M, 2011. Factores pronósticos del cáncer de mama. [Prognostic Factors for Breast Cancer]. Rev Cubana Cir 50:130-8.
Hazra A, Gogtay N. Biostatistics series module 9: survival analysis. Indian J Dermatol 2017;62:251-7.
Heredia-Caballero ÁG, Palacios-López GG, 2018. Supervivencia a 5 años postratamiento de cáncer de mama: experiencia institucional. [5-year post-treatment survival for breast cancer: institutional experience.] Ginecolobstet Méx 86:575-83.
IBM. Kaplan-Meier survival analysis. 2026 [cited 2026 May 2]. Available from: https://www.ibm.com/docs/es/spss-statistics/32.0.0?topic=statistics-kaplan-meier-survival-analysis
INEGI. Defunciones registradas de mujeres por tumor maligno de la mama por entidad federativa de residencia habitual de la persona fallecida y grupo quinquenal de edad, serie anual de 2010 a 2023. [Registered deaths of women due to malignant breast tumors, by state of usual residence of the deceased and five-year age group, annual series from 2010 to 2023.] 2023 [cited 2025 Jan 9]. Available from: https://www.inegi.org.mx/app/tabulados/interactivos/?px=Mortalidad_05&bd=Mortalidad
INEGI. Estadísticas de Defunciones Registradas (EDR). [Statistics on Registered Deaths.] 2024 [cited 2025 Mar 1]. Available from: https://www.inegi.org.mx/contenidos/saladeprensa/boletines/2024/EDR/EDR2023_Dtivas.pdf
INEGI. México en cifras, San Luis Potosí. [Mexico in numbers, San Luis Potosí.] 2025 [cited 2025 Jan 9]. Available from: https://www.inegi.org.mx/app/areasgeograficas/?ag=24#collapse-Resumen
Jaramillo L, Galindo M, Real J, González J, Idrovo S, 2020. Clúster espacial de mortalidad por cáncer de mama en Ecuador. [Clustering of breast cancer mortality in Ecuador.] J Health Med Sci 6:29-36.
Jassem J, Ozmen V, Bacanu F, Drobniene M, Eglitis J, Lakshmaiah KC, Kahan Z, Mardiak J, Pieńkowski T, Semiglazova T, Stamatovic L, Timcheva C, Vasovic S, Vrbanec D, Zaborek P, 2014. Delays in diagnosis and treatment of breast cancer: a multinational analysis. Eur J Public Health 24:761-7.
Kuo CC, Balakrishnan P, Gribble MO, Best LG, Goessler W, Umans JG, Navas-Acien A, 2022. The association of arsenic exposure and arsenic metabolism with all-cause, cardiovascular and cancer mortality in the Strong Heart Study. Environ Int 159:107029.
Lodi M, Scheer L, Reix N, Heitz D, Carin AJ, Thiébaut N, Neuberger K, Tomasetto C, Mathelin C, 2017. Breast cancer in elderly women and altered clinico-pathological characteristics: a systematic review. Breast Cancer Res Treat 166:657-68.
López-Carrillo L, Suárez-López L, Torres-Sánchez L, 2009. Detección del cáncer de mama en México: síntesis de los resultados de la Encuesta Nacional de Salud Reproductiva. [Breast cancer detection in mexico: a summary of the results of the National Reproductive Health Survey.] Salud pública Méx 51:345-349.
Maffuz-Aziz A, Labastida-Almendaro S, Sherwell-Cabello S, Ruvalcaba-Limón E, Domínguez-Reyes CA, Tenorio-Torres JA, Rodríguez-Cuevas S, 2016. Supervivencia de pacientes con cáncer de mama. Análisis por factores pronóstico, clínicos y patológicos. [Survival of breast cancer patients: analysis by prognostic, clinical, and pathological factors.] Ginecol Obstet Mex 84:498-506.
Ocón-Hernández O, Fernández-Cabrera MF, Pérez-Vicente S, Dávila-Arias C, Expósito-Hernández J, Olea-Serrano N, 2010. Supervivencia en cáncer de mama tras 10 años de seguimiento en las provincias de Granada y Almería. [Breast cancer survival after 10 years of follow-up in the provinces of Granada and Almería.] Rev Esp Salud Publica 84:705-15.
Park EH, Min SY, Kim Z, Yoon CS, Jung KW, Nam SJ, Oh SJ, Lee S, Park BW, Lim W, Hur MH, 2017. Korean Breast Cancer Society. Basic facts of breast cancer in Korea in 2014: The 10-year overall survival progress. J Breast Cancer 20:1-11.
Pérez-Michel LM, González-Lizarraga M, Ornelas-Aguirre JM, 2009. Recurrencia de cáncer de mama en mujeres del Noroeste de México. [Breast cancer recurrence in women in Northwest Mexico.] Cir Cir 77:179-185.
Ramos-Herrera IM, Reyna-Sevilla A, González-Castañeda ME, Robles-Pastrana JD, Herrera-Echauri DD, González-Rivera CA, 2020. Cáncer de mama en Jalisco, Análisis espacial de la mortalidad en 2010-2017. [Breast Cancer in Jalisco: A Spatial Analysis of Mortality Rates from 2010 to 2017.] Gac Méd Méx 156:542-8.
Reyna-Sevilla A, Ramos-Herrera IM, González-Castañeda ME, Cruz-Ramos A, 2020. Estadio clínico tardío de cáncer de mama en el estado de Jalisco: magnitud y variaciones espaciotemporales. [Late-stage breast cancer in the state of Jalisco: prevalence and spatiotemporal variations.] Acta Univ 30:2487.
Roche LM, Skinner R, Weinstein RB, 2002. Use of a geographic information system to identify and characterize areas with high proportions of distant stage breast cancer. J Public Health Manag Pract 8:26-32.
Rodríguez-Sarria YM, Delisle-Ureña G, Sagaró-del-Campo NM, Escalona-Fonseca M, 2018. Prediction factors and survival of women with breast cancer in Santiago de Cuba. MEDISAN 22: 477-482.
Smith AH, Marshall G, Yuan Y, Steinmaus C, Liaw J, Smith MT, Wood L, Heirich M, Fritzemeier RM, Pegram MD, Ferreccio C, 2014. Rapid reduction in breast cancer mortality with inorganic arsenic in drinking water. Ebio Medicine 1:58-63.
SSa. Histórico de bases CLUES. 2022 [cited 2025 Jan 9]. Available from: http://gobi.salud.gob.mx/Bases_Clues.html
Tatalovich Z, Zhu L, Rolin A, Lewis DR, Harlan LC, Winn DM, 2015. Geographic disparities in late stage breast cancer incidence: results from eight states in the United States. Int J HealthGeogr 14:31.
Terán-Figueroa Y, García-Díaz J, Gutiérrez-Enríquez SO, Alcántara-Quintana LE, Luna-Arias JP, Gaytán-Hernández D, 2024. Supervivencia por cáncer de mama en mujeres beneficiarias del seguro popular en San Luis Potosí, México. [Breast cancer survival among women enrolled in the public health insurance program in San Luis Potosí, Mexico.] IyCUAA 32.
UNC. Modelos extendidos para el análisis espacial en epidemiologia del cáncer. [Extended models for spatial analysis in cancer epidemiology.] 2015 [cited 2025 Feb 25]. Available from: https://catalogo.biblio.unc.edu.ar/index.php/Record/economicas.26965/Cite?sid=72969992
Unger-Saldaña K, Bandala-Jacques A, Huerta-Gutierrez R, Zamora-Muñoz S, Hernández-Ávila JE, Cabrera-Galeana P, Mohar A, Lajous M, 2023. Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study. Lancet Reg Health Am 23:100541.
Unger-Saldaña K, Fitch-Picos K, Villarreal-Garza C, 2019. Breast cancer diagnostic delays among young mexican women are associated with a lack of suspicion by health care providers at first presentation. J Glob Oncol 5:1-12.
WHO. Breast cancer. 2024 [cited 2024 Nov 23]. Available from: https://www.who.int/es/news-room/fact-sheets/detail/breast-cancer
WHO. World Bank and WHO: Half the world lacks access to essential health services, 100 million still pushed into extreme poverty because of health expenses. 2017 [cited 2025 Mar 12]. Available from: https://www.who.int/es/news/item/13-12-2017-world-bank-and-who-half-the-world-lacks-access-to-essential-health-services-100-million-still-pushed-into-extreme-poverty-because-of-health-expenses
CRediT authorship contribution
All authors participated in the study: they provided feedback and paid for the analysis, contributed to the presentation and interpretation of all results, integrated constructive criticism in the discussion, and also reviewed various drafts of the manuscript through to its final version. All authors agree with the final version submitted for publication.
Data Availability Statement
All data generated or analyzed during this study are included in this published article.
How to Cite
Epidemiological and spatial analysis of breast cancer mortality and survival among women in San Luis Potosi, Mexico 2009-2019. (2026). Geospatial Health, 21(2). https://doi.org/10.4081/gh.2026.1490
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