When she was 39, Kattia Espinoza Zamora felt a “little lump” in her left breast. Worried, she went to her health center and asked for a mammographyThere they asked him if he had relatives with breast cancer or if she had previously suffered from cancer. When she answered no, she was told that she could not undergo a mammogram because she was not yet 40 years old, although she was months away from reaching that age.
This resident of San Rafael de Heredia did not rest easy. She went to a private clinic and paid for a mammogram and an ultrasound. There, her suspicions were confirmed: that “little lump” was a malignant tumor. This happened in 2018.
With that diagnosis, she went to the Breast Clinic at the San Vicente de Paúl Hospital in Heredia. There she learned that her tumor was triple negativewhich is more common in people under 40 years of age. It is characterized by being more aggressive than other types of breast tumors, since the cancer cells reproduce quickly. At the Heredia hospital, she received chemotherapy, radiotherapy and underwent a quadrantectomy (surgery that removes the cancer and part of the tissue surrounding the tumor, without removing the breast completely).
Educator Kattia Espinoza Zamora is a cancer patient and has had to invest millions of colones in diagnosis. Photograph: Courtesy
Her oncologist scheduled a follow-up appointment for her six months later. During the waiting period, she had a relapse; she felt another “little lump” in the same breast and had to go back to private medicine. The result was positive. With that diagnosis, she returned to the hospital in Heredia, where they performed a mastectomy.
From that moment on, her follow-up appointments became every three months. In 2020, two cancerous nodules were detected in her right lung. That already meant metastasis. The process with the Costa Rican Social Security Fund (CCSS) became faster, but she always opted to have the biopsy done in a private hospital, which offered a shorter waiting time. That biopsy alone cost her ¢1 million.
“I couldn’t let any more time pass. I was very nervous. I had already lost my left breast and I didn’t want to waste any more time. I didn’t want to wait for the Fund to perform the biopsy. Every day I won was a lot for me,” she recalled.
Lung cancer had different genetic markers than breast cancer; the HER2 protein was found there, which can also make the disease more aggressive, with the advantage that this type of tumor responds well to targeted therapies.
Since the tumor was found in his lung, he had CT scans (computerized axial tomography) of his chest, abdomen and pelvis every three months, but never of his brain.
Woman had to undergo diagnostic tests in private to prevent her cancer from progressing
Cancer again, somewhere else
In January of this year, she began to suffer from very strong migraines that were already intolerable, something unusual for this educator, who had never suffered from headaches. Her fingers and toes became numb and she had lost mobility in her left arm.
“I went to the hospital many times with a headache. I explained to them that I was an oncology patient. They gave me a little injection, a pill. I knew it was something else. I had to go pay for a brain CT scan, because those headaches were not normal. It showed that I had a 3×4 tumor in the right parietal,” she recalled.
With that diagnosis, she went to the Heredia Hospital Emergency Room to show them the result, since her appointment with the oncologist was still a long way off. Upon seeing the result, she was referred to the Mexico Hospital, where she was hospitalized for 22 days. At that time, they couldn’t do an MRI due to the inflammation in her head, so she was told that she would be given an appointment for a later date.
That tumor also tested positive for the HER2 protein and Espinoza underwent surgery last March.
22 days ago, he had an MRI done privately, because he was still waiting for the exam at the CCSS. The cost of that test amounted to almost ¢400,000.
“I needed to get it done to see how I was doing, because I felt like I had to keep waiting for a long time for the Caja to do it for me,” she said.
If she counts the amount of money spent on diagnostic tests (biopsies, mammograms, ultrasounds, CT scans and MRIs) that have allowed her to gain time in the fight against cancer, the figure could easily exceed ¢5 million.
She does not regret the investment in health, but she also knows that she had the right to these exams in the public system, as an insured person.
This photograph was taken after Kattia Espinoza’s surgery for brain cancer. Photograph: Courtesy
Fight for cancer drug
Her struggles are now focused on obtaining a medication prescribed by her oncologist at the Heredia hospital since 2020, but which the CCSS has denied her on two occasions. It is called trastuzumab deruxtecan and would help her control her lung and brain tumors.
“I know that it is an expensive but effective treatment, and it would prevent my cancer cells from proliferating so quickly. The answer given by the CCSS is that it is not recommended for me because there is no measurable disease, that is, they cannot determine the size of the cells that may have remained in the brain after surgery. How are they going to give me that answer when the CCSS has not done an MRI to measure the disease?” she said.
With the help of the patient association Mujeres en Rosa, she filed an appeal to obtain this treatment.
“I want to live and have a quality of life. It’s not nice. This is my fourth relapse. Other patients go through the same thing, diagnoses should be more timely. And if my oncologist, who knows me and my disease, says that this medicine will do me good, they should take that into account,” he said.
