RESUMEN

BACKGROUND: Breast cancer (BC) is a significant global health issue, accounting for 1 in 8 cancer diagnoses worldwide. HLA class I molecules are typically expressed on the cell surface, but cancer cells can develop mechanisms to evade recognition by CTLs, including the downregulation of HLA class I expression. In this context, we aimed to conduct a systematic review and meta-analysis to clarify the role of HLA class I expression in clinical outcomes for patients with BC. METHODS: A comprehensive literature search was conducted across PubMed, Scopus, Web of Science, and the Cochrane databases. Effect sizes, along with I2 and Tau2 statistics, were used to assess heterogeneity through a DerSimonian and Laird random-effects model. Statistical analyses were performed using R statistical software, version 4.2.3. RESULTS: Among the 8 included studies, most of the analyzed samples consisted of ductal carcinoma cases (1588, 86.39 %), from the luminal (A or B) intrinsic subtype (1865, 69.07 %), with no lymph node metastasis (2658, 57.24 %), no HER2 overexpression (2594, 67.46 %), negative Ki67 status (1721, 71.26 %), and positive hormone receptor status (4732, 64.05 %). The analysis revealed a significant reduction in disease-free survival (HR 0.57; 95 % CI 0.34 to 0.95; p = 0.034; I2 = 84 %) in the group with low HLA-I expression. However, no significant difference was found between the groups with high and low HLA-I expression regarding overall survival (HR 0.77; 95 % CI 0.28 to 2.14; p = 0.62; I2 = 86 %). CONCLUSIONS: This systematic review and meta-analysis demonstrated that HLA class I expression is associated with a significant improvement in disease-free survival, though no significant effect on overall survival was observed.

Asunto(s)

Neoplasias de la Mama , Supervivencia sin Enfermedad , Estado de Salud , Antígenos HLA

RESUMEN

This paper presents a prototype of a portable and modular electrical impedance tomography (EIT) system for breast tumor detection. The proposed system uses MATLAB to generate three-dimensional representations of breast tissue. The modular architecture of the system allows for flexible customization and scalability. It consists of several interconnected modules. Each module can be easily replaced or upgraded, facilitating system maintenance and future enhancements. Testing of the prototype has shown promising results in preliminary screening based on experimental studies. Agar models were used for the experimental stage of this project. The 3D representations provide clinicians with valuable information for accurate diagnosis and treatment planning. Further research and refinement of the system is warranted to validate its performance in future clinical trials.

Asunto(s)

Neoplasias de la Mama , Impedancia Eléctrica , Imagenología Tridimensional , Tomografía , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico , Humanos , Tomografía/instrumentación , Tomografía/métodos , Femenino , Imagenología Tridimensional/métodos , Diseño de Equipo

RESUMEN

Cancer cells have the ability to undergo an unlimited number of cell divisions, which gives them immortality. Thus, the cancer cell can extend the length of its telomeres, allowing these cells to divide unlimitedly and avoid entering the state of senescence or cellular apoptosis. One of the main effects of photobiomodulation (PBM) is the increase in the production of adenosine triphosphate (ATP) and free radicals, mainly reactive oxygen species (ROS). Existent data indicates that high levels of ROS can cause shortening and dysfunctional telomeres. Therefore, a better understanding of the effects induced by PBM on cancer cell telomere maintenance is needed. This work aimed to evaluate the effects of low-power red laser (658 nm) and blue LED (470 nm) on the TRF1 and TRF2 mRNA levels and telomere length in human breast cancer cells. MCF-7 and MDA-MB-231 cells were irradiated with a low-power red laser (69 J cm-2, 0.77 W/cm-2) and blue LED (482 J cm-2, 5.35 W/cm-2), alone or in combination, and the relative mRNA levels of the genes and telomere length were assessed by quantitative reverse transcription polymerase chain reaction. The results suggested that exposure to certain red laser and blue LED fluences decreased the TRF1 and TRF2 mRNA levels in both human breast cancer cells. Telomere length was increased in MCF-7 cells after exposure to red laser and blue LED. However, telomere length in MDA-MB-231 was shortened after exposure to red laser and blue LED at fluences evaluated. Our research suggests that photobiomodulation induced by red laser and low-power blue LED could alter telomere maintenance and length.

Asunto(s)

Neoplasias de la Mama , Terapia por Luz de Baja Intensidad , Telómero , Proteína 1 de Unión a Repeticiones Teloméricas , Proteína 2 de Unión a Repeticiones Teloméricas , Humanos , Neoplasias de la Mama/radioterapia , Neoplasias de la Mama/genética , Neoplasias de la Mama/patología , Femenino , Proteína 2 de Unión a Repeticiones Teloméricas/metabolismo , Proteína 2 de Unión a Repeticiones Teloméricas/genética , Telómero/efectos de la radiación , Terapia por Luz de Baja Intensidad/métodos , Proteína 1 de Unión a Repeticiones Teloméricas/metabolismo , Proteína 1 de Unión a Repeticiones Teloméricas/genética , Línea Celular Tumoral , ARN Mensajero/metabolismo , ARN Mensajero/genética , Células MCF-7 , Homeostasis del Telómero/efectos de la radiación , Complejo Shelterina , Proteínas de Unión a Telómeros

Asunto(s)

Neoplasias de la Mama , Receptor ErbB-2 , Humanos , Neoplasias de la Mama/genética , Femenino , Brasil , Receptor ErbB-2/análisis , Guías de Práctica Clínica como Asunto

RESUMEN

Mushroom ß-D-glucans can be isolated from several species, including the widely consumed Agaricus bisporus. Besides immunomodulatory responses, some ß-D-glucans may exhibit direct antitumoral effects. It was previously observed that a ß-(1→6)-D-glucan (BDG16) has indirect cytotoxicity on triple-negative breast cancer cells. In this study, the cytotoxicity of this same glucan was observed on estrogen receptor-positive (ER+) breast cancer cells (MCF-7). Cell viability was determined by multiple methods to assess metabolic activity, lysosomal membrane integrity, and adhesion capacity. Assays to evaluate cell respiration, cell cycle, apoptosis, necroptosis, and oxidative stress were performed to determine the action of BDG16 on MCF-7 cells. A gradual and significant cell viability reduction was observed when the cells were treated with BDG16 (10-1000 µg/mL). This result could be associated with the inhibition of the basal state respiration after incubation with the ß-D-glucan. The cells showed a significant arrest in G1 phase population at 1000 µg/mL, with no induction of apoptosis. However, an increase in necrosis and necroptosis at the same concentration was observed. No difference in oxidative stress-related molecules was observed. Altogether, our findings demonstrate that BDG16 directly induces toxicity in MCF-7 cells, primarily by impairing mitochondrial respiration and promoting necroptosis. The specific mechanisms that mediate this action are being investigated.

Asunto(s)

Agaricus , Antineoplásicos , Apoptosis , Neoplasias de la Mama , Supervivencia Celular , Estrés Oxidativo , Receptores de Estrógenos , Agaricus/química , Humanos , Células MCF-7 , Apoptosis/efectos de los fármacos , Neoplasias de la Mama/metabolismo , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Femenino , Supervivencia Celular/efectos de los fármacos , Estrés Oxidativo/efectos de los fármacos , Receptores de Estrógenos/metabolismo , Antineoplásicos/farmacología , Antineoplásicos/química , beta-Glucanos/farmacología , beta-Glucanos/química

RESUMEN

Objective: To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography. Data source: Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms "Artificial Intelligence," "Mammography," and their respective MeSH terms. We filtered publications from the past ten years (2014 - 2024) and in English. Study selection: A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work. Data collection: The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity. Data synthesis: It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone. Conclusion: AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals.

Asunto(s)

Inteligencia Artificial , Neoplasias de la Mama , Mamografía , Mamografía/métodos , Humanos , Femenino , Neoplasias de la Mama/diagnóstico por imagen , Detección Precoz del Cáncer/métodos , Sensibilidad y Especificidad , Algoritmos , Estudios de Validación como Asunto

RESUMEN

Pesticide exposure is a risk factor for the development of several diseases, including breast cancer (BC). The enzyme UGT2B7 participate in detoxification of pesticides and the presence rs7438135 (G > A) variant in your gene increases its glucuronidation potential, contributing to oxidative stress metabolites neutralization. Here we investigated the impact of occupational pesticide exposure on the systemic oxidative stress generation from 228 women with BC depending on their UGT2B7 rs7438135 (G > A) status. q-PCR investigated the presence of the rs7438135 variant, and oxidative stress markers (lipid peroxidation levels, total antioxidant capacity-TRAP, and nitric oxide metabolites-NOx) were measured in plasma. Pesticide exposure induced significant augment in the systemic lipid peroxidation in the presence of the variant for several clinicopathological conditions, including tumors with high proliferation index (ki67) and with high aggressiveness. NOx was augmented in high ki67, positive progesterone receptors, high-grade and triple-negative/Luminal B tumors, and low-risk stratified patients. TRAP was depleted in young patients at menopause and those with triple-negative/Luminal B tumors, as well as those stratified as at low risk for death and recurrence. These findings showed that the presence of the variant was not able to protect from pesticide-induced oxidative stress generation in BC patients.

Asunto(s)

Neoplasias de la Mama , Glucuronosiltransferasa , Estrés Oxidativo , Plaguicidas , Humanos , Femenino , Neoplasias de la Mama/genética , Neoplasias de la Mama/metabolismo , Estrés Oxidativo/efectos de los fármacos , Plaguicidas/toxicidad , Persona de Mediana Edad , Glucuronosiltransferasa/genética , Glucuronosiltransferasa/metabolismo , Adulto , Pronóstico , Exposición Profesional/efectos adversos , Anciano , Alelos , Peroxidación de Lípido/efectos de los fármacos , Polimorfismo de Nucleótido Simple

Asunto(s)

Neoplasias de la Mama , Enfermedades Bronquiales , Recurrencia Local de Neoplasia , Humanos , Femenino , Neoplasias de la Mama/complicaciones , Constricción Patológica/etiología , Enfermedades Bronquiales/etiología , Enfermedades Bronquiales/diagnóstico por imagen , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , Broncoscopía

RESUMEN

In this study, we identified miRNAs and their potential mRNA targets that are intricately linked to primary chemotherapy response in patients with invasive ductal carcinomas. A cohort of individuals diagnosed with advanced invasive breast ductal carcinoma who underwent primary chemotherapy served as the cornerstone of our study. We conducted a comparative analysis of microRNA expression among patients who either responded or did not respond to primary systemic therapy. To analyze the correlation between the expression of the whole transcriptome and the 24 differentially expressed (DE) miRNAs, we harnessed the extensive repository of The Cancer Genome Atlas (TCGA) database. We mapped molecular mechanisms associated with these miRNAs and their targets from TCGA breast carcinomas. The resultant expression profile of the 24 DE miRNAs emerged as a potent and promising predictive model, offering insights into the intricate dynamics of chemotherapy responsiveness of advanced breast tumors. The discriminative analysis based on the principal component analysis identified the most representative miRNAs across breast cancer samples (miR-210, miR-197, miR-328, miR-519a, and miR-628). Moreover, the consensus clustering generated four possible clusters of TCGA patients. Further studies should be conducted to advance these findings.

Asunto(s)

Biomarcadores de Tumor , Neoplasias de la Mama , Carcinoma Ductal de Mama , MicroARNs , Humanos , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/genética , Femenino , MicroARNs/análisis , Biomarcadores de Tumor/análisis , Carcinoma Ductal de Mama/tratamiento farmacológico , Carcinoma Ductal de Mama/genética , Carcinoma Ductal de Mama/patología , Persona de Mediana Edad , Perfilación de la Expresión Génica , Regulación Neoplásica de la Expresión Génica , Adulto , Anciano , Transcriptoma

RESUMEN

OBJECTIVE: Phyllodes tumors in the breast are exceptionally uncommon fibroepithelial tumors. In the literature, they are typically categorized as benign phyllodes tumor, borderline phyllodes tumor, and malignant phyllodes tumor. This study aims to assess and present the clinical and surgical outcomes of patients diagnosed with phyllodes tumor. METHODS: The outcomes of patients aged 18 years and above diagnosed with phyllodes tumor between 2006 and 2023 were retrospectively reviewed. Patients were grouped as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared by clinical and surgical results. RESULTS: Of all 57 patients with phyllodes tumor, 64.9% (n=37) were benign phyllodes tumor and 35.1% (n=20) were borderline/malignant phyllodes tumor [22.8% (n=13) borderline phyllodes tumor and 12.3% (n=7) malignant phyllodes tumor]. When the patients were divided into two groups as benign phyllodes tumor and borderline/malignant phyllodes tumor and compared, our cumulative (total) recurrence rate was 14.0%, with final surgical margin width between groups [(0

Asunto(s)

Neoplasias de la Mama , Márgenes de Escisión , Recurrencia Local de Neoplasia , Tumor Filoide , Centros de Atención Terciaria , Humanos , Tumor Filoide/cirugía , Tumor Filoide/patología , Femenino , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/patología , Adulto , Estudios Retrospectivos , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Adulto Joven , Resultado del Tratamiento , Periodo Posoperatorio , Mastectomía/métodos , Anciano , Adolescente

RESUMEN

Introduction: Breast cancer progression involves physiological mechanisms such as metastasis. Delays in diagnosis and treatment increase the risk of mortality and are associated with barriers to healthcare access. In Chile, breast cancer is highly prevalent, and early diagnosis has improved, although disparities in the disease evolution persist. This study characterized diagnostic and staging tests, waiting times, and sociodemographic profiles to identify delays and inequities in care. Methods: Survey study. Using a non-probabilistic sample, a questionnaire was applied in an encrypted platform with prior informed consent. The instrument collected data on requested tests, associated times, staging, and sociodemographic characteristics. These variables were analyzed using descriptive statistics, tests of association, confidence intervals, and comparison tests using bootstrapping. Results: A sample of 263 persons was obtained. The most requested tests were biopsy (99.62%) and blood tests (80.23%). The median number of tests requested was six (Q1:4, Q3:8), with a mean of 5.87 (standard deviation: 2.24). No significant differences were observed in the percentage of persons from whom the total number of examinations were requested according to the studied variables. The day-hour-result intervals ranged from 1 to 365 days. The median day-hour-result of the biopsy was 15 days (Q1:10, Q3:30). People between 40 and 49 years old, non-residents of the capital city, belonging to income quintile I, with high school education, from the public health system, with late-stage diagnosis had higher median day-hour-result in biopsy. There was no significant difference in the number of requested tests according to staging (I and II, or III and IV). Conclusions: Biopsy in Chile is the test of choice for diagnostic confirmation in breast cancer. Other tests are requested regardless of the diagnosis stage, contrary to the recommendations of clinical guidelines. Cancer prognosis is crucial, especially in countries with greater inequalities.

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Introducción: La progresión del cáncer de mama involucra mecanismos fisiológicos como metástasis. Los retrasos en diagnóstico y tratamiento aumentan el riesgo de mortalidad y se asocian a barreras de acceso a la salud. En Chile, el cáncer de mama es altamente prevalente y su diagnóstico temprano ha mejorado, aunque persisten disparidades en el proceso de enfermedad. Este estudio caracterizó exámenes de diagnóstico y etapificación, tiempos de espera y perfiles sociodemográficos para identificar demoras e inequidades en la atención. Métodos: Estudio de encuesta. Utilizando una muestra no probabilística, se aplicó un cuestionario en plataforma encriptada previo consentimiento informado. En el instrumento se recogieron datos de exámenes solicitados, tiempos asociados, etapificación y características sociodemográficas. Estas variables fueron analizadas utilizando estadística descriptiva, test de asociación, intervalos de confianza y test de comparación utilizando . Resultados: Se logró una muestra de 263 personas. Los exámenes más solicitados fueron biopsia (99,62%) y exámenes de sangre (80,23%). La mediana de exámenes solicitados fue de 6 (Q1:4, Q3:8), con media 5,87 (desviación estándar: 2,24). No se observaron diferencias significativas en el porcentaje de personas a quienes se solicitó la totalidad de exámenes según variables estudiadas. Los intervalos día-hora-resultado oscilaron entre 1 y 365 días. La mediana día-hora-resultado de la biopsia fue de 15 días (Q1:10, Q3:30). Las personas entre 40 y 49 años, no residentes de la capital, pertenecientes al quintil I de ingreso, con educación media, del sistema público de salud, con diagnóstico en etapa tardía presentaron mayores medianas de día-hora-resultado en biopsia. No hubo diferencia significativa en la cantidad de exámenes solicitados según etapificación (I a II y III a IV). Conclusiones: La biopsia en Chile es el examen de elección para la confirmación diagnóstica en cáncer de mama. Otros exámenes son solicitados independientemente de la etapa del diagnóstico, existiendo una discordancia con las recomendaciones de la guía clínica. El pronóstico del cáncer es crucial, especialmente en países con mayores inequidades.

Asunto(s)

Neoplasias de la Mama , Diagnóstico Tardío , Estadificación de Neoplasias , Humanos , Chile , Femenino , Neoplasias de la Mama/diagnóstico , Neoplasias de la Mama/patología , Persona de Mediana Edad , Adulto , Diagnóstico Tardío/estadística & datos numéricos , Anciano , Encuestas y Cuestionarios , Disparidades en Atención de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Factores de Tiempo , Biopsia/estadística & datos numéricos , Detección Precoz del Cáncer , Adulto Joven , Tiempo de Tratamiento/estadística & datos numéricos

RESUMEN

Breast cancer (BC) accounts for 24.2% of all women's malignant tumors, with rising survival rates due to advancements in chemotherapy and targeted treatments. However, second primary cancers, particularly lung cancer (LC), have become more prevalent, often emerging approximately 10 years after BC treatment. This study presents a case series of 9 women diagnosed with second primary LC following BC, treated at a high-complexity hospital in Colombia between 2014 and 2019. All initial BCs were ductal carcinomas, 7 were triple negative, 1 was human epidermal growth factor receptor 2 positive, and 1 was estrogen and progesterone positive. Each patient had undergone radiation therapy, and 7 had received chemotherapy, increasing their LC risk. The second primary LCs, all adenocarcinomas, were confirmed using immunohistochemical stains for thyroid transcription factor-1 (TTF-1), Napsin A, and estrogen receptor (ER) status. The interval between treatments and LC detection ranged from 1 to 17 years, with 4 cases identified after 10 years and 3 within 1 to 3 years, underscoring the need for prolonged surveillance. Seven LCs were ipsilateral to the BC and radiation site, while 2 were contralateral, highlighting the necessity of monitoring both sides for potential LC development. This case series enhances the local epidemiological understanding, showing that prior radiotherapy for BC and histological analysis are key in characterizing second primary LC patients. The study emphasizes the critical role of accurate histological diagnosis in guiding treatment approaches for lung lesions in BC survivors.

Asunto(s)

Neoplasias de la Mama , Neoplasias Pulmonares , Neoplasias Primarias Secundarias , Humanos , Femenino , Neoplasias Pulmonares/patología , Neoplasias Primarias Secundarias/patología , Persona de Mediana Edad , Neoplasias de la Mama/patología , Neoplasias de la Mama/terapia , Anciano , Adulto , Adenocarcinoma/patología , Adenocarcinoma/terapia , Ácido Aspártico Endopeptidasas , Colombia

RESUMEN

BACKGROUND: The increased incidence of breast cancer implies the appearance of frequent symptoms associated with disease and treatments, such as pain. For the management of this issue, auricular therapy has been used in a complementary manner, especially for its safety and analgesic action. OBJECTIVE: This systematic review aims to summarize available evidence on the effects of auricular therapy on pain in women undergoing breast cancer treatment. METHODS: This is a systematic review that includes randomized controlled trials that evaluated the effects of auricular therapy on pain in women with breast cancer, as compared with other interventions (sham or placebo auricular therapy, other nonpharmacological interventions, and routine pain treatments) during the treatment of the disease. Pain, whether induced or not by cancer treatments, is the main outcome to be evaluated. The search for the studies was performed in the following databases: MEDLINE through PubMed, CINAHL, CENTRAL, Embase, Web of Science, Scopus, VHL, TCIM Americas Network, CNKI, and Wanfang Data. The reviewers have independently evaluated the full texts, and in the near future, they will extract the data and assess the risk of bias in the included studies. The certainty of the evidence will be assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE), and a meta-analysis will be carried out to evaluate the intervention, considering the homogeneity of the results, using the Cochran Q test and quantified by the Higgins inconsistency index. The guidelines of the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) have been respected in the elaboration of this protocol. RESULTS: The records screening stage has been completed, and the synthesis and meta-analysis were conducted in February 2024. We hope to have finished the preparation of the paper for publication by September 2024. Review reporting will follow standard guidelines for reporting systematic reviews. The results will be published in peer-reviewed scientific journals. CONCLUSIONS: This review will compile the strength of evidence for the use of auricular therapy in the management of pain in women with breast cancer during the treatment of the disease, identifying gaps in the available evidence as well as assisting health professionals in indicating the intervention for clinical practice. TRIAL REGISTRATION: PROSPERO CRD42022382433; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=382433. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/55792.

Asunto(s)

Auriculoterapia , Neoplasias de la Mama , Manejo del Dolor , Femenino , Humanos , Neoplasias de la Mama/complicaciones , Neoplasias de la Mama/terapia , Metaanálisis como Asunto , Manejo del Dolor/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Revisiones Sistemáticas como Asunto

RESUMEN

BACKGROUND: Neoadjuvant chemotherapy (NAC), traditionally used for locally advanced disease, is now applied for operable disease, particularly to treat aggressive breast cancer (BC). This study aimed to characterize the pathological complete response (pCR) and its relationship with overall survival (OS) and disease-free survival (DFS) among BC patients receiving NAC in a Brazilian public reference center, as well as the association between pCR and BC subtypes. METHODS: A retrospective cohort study used a comprehensive BC database from a Brazilian women's health reference center, including patients diagnosed between 2011 and 2020 who underwent NAC. We collected demographic, cancer-specific, and treatment-related data, analyzing OS and DFS based on pCR status using the semiparametric Kaplan-Meier method, with the date of BC diagnosis as the starting point. RESULTS: The study included 1,601 patients, with an average age of 49 years and a majority presenting stage IIIa disease (35%). Most had invasive nonspecial type (NST) BC (94%), and a significant portion (86.7%) exhibited a Ki-67 index <14. The overall pCR rate was 22.7%, with higher frequencies observed in the triple negative and luminal B subtypes. Patients who achieved pCR had significantly higher survival rates (89% alive vs. 61%, P<0.001) and better DFS (90% vs. 66%, P<0.001), except in the luminal A subtype, where pCR did not correlate with improved OS or DFS. CONCLUSIONS: These updated real-world data (RWD) from BC patients who underwent NAC in Brazil revealed a pCR rate of 22.7% in all cancer subtypes and stages. pCR was not associated with better outcomes in patients with luminal A, contrasting with other subtypes.

Asunto(s)

Neoplasias de la Mama , Terapia Neoadyuvante , Humanos , Femenino , Neoplasias de la Mama/tratamiento farmacológico , Neoplasias de la Mama/patología , Neoplasias de la Mama/mortalidad , Persona de Mediana Edad , Terapia Neoadyuvante/métodos , Estudios Retrospectivos , Brasil , Adulto , Anciano , Estudios de Cohortes , Resultado del Tratamiento

RESUMEN

HER2-positive breast cancer accounts for 10% to 20% of all breast cancer diagnoses. The mAb trastuzumab is crucial in treating this disease, significantly improving survival outcomes. Despite its inclusion in the World Health Organization's Model List of Essential Medicines, access to trastuzumab remains limited worldwide. In this issue of the journal, Norris and colleagues report that only 45% of eligible patients with HER2-positive breast cancer in the United Kingdom received trastuzumab between 2012 and 2017. This finding in a high-income country with universal health care is worrisome and points toward even greater barriers to access in developing nations. Some solutions to improve accessibility, which we discuss, include shorter durations of trastuzumab treatment and encouraging the registration and availability of biosimilars. The data presented by Norris and colleagues point toward a disconnect between the academic oncology landscape, focused on expensive drugs with marginal benefits, and everyday practice in which even essential interventions may not be available. Ensuring the accessibility to proven, essential medicines should be as relevant as innovation to improve patient outcomes and create a more sustainable healthcare system. See related article by Norris et al., p. 1298.

Asunto(s)

Antineoplásicos Inmunológicos , Neoplasias de la Mama , Guías de Práctica Clínica como Asunto , Trastuzumab , Humanos , Trastuzumab/uso terapéutico , Neoplasias de la Mama/tratamiento farmacológico , Femenino , Antineoplásicos Inmunológicos/uso terapéutico , Receptor ErbB-2/metabolismo

RESUMEN

PURPOSE: To assess whether health-related quality of life (HRQOL) improved through a postmastectomy care program focused on breast cancer-related lymphedema (BCRL) protection/awareness. METHODS: Postoperative breast cancer patients were enrolled prospectively (February-2018 to September-2019) at Nursing and Obstetrics Faculty, Durango, Mexico. Sociodemographic/clinical characteristics, arm measurements, and HRQOL evaluation with Functional Assessment Cancer Therapy-Breast Cancer were collected at baseline and after six follow-up assessments between six-to-twelve-month postmastectomy. Lymphedema was verified through circometry. Descriptive analysis and McNemar-Bowker test were used to evaluate paired differences in HRQOL. Subgroup analysis was conducted to assess sociodemographic/clinical characteristics of BCRL using Pearson's chi-squared or Fisher exact test along with odds ratios (OR) and 95% confidence intervals (CI). All tests were two-sided with P-values < 0.05 considered statistically significant. RESULTS: One-hundred-two patients developed BCRL (incidence 66.2%, n = 154). All dimensions of HRQOL improved after the postmastectomy care program (P < 0.05). The subgroup analysis indicated that elementary academic degree (OR = 2.40, 95%CI: 1.01-5.69), laborer (OR = 9.85, 95%CI: 3.30-29.3), and total mastectomy (OR = 4.23, 95%CI: 1.20-14.9) were more associated with BCRL (P < 0.05). Conversely, high school academic degree (OR = 0.46, 95%CI: 0.22-0.94), married status (OR = 0.42, 95%CI: 0.21-0.86), housewife (OR = 0.27, 95%CI: 0.12-0.61), professional occupation (OR = 0.10, 95%CI: 0.01-0.64), and having no comorbidities (OR = 0.31, 95%CI: 0.15-0.63) were less associated with BCRL (P < 0.05). CONCLUSION: Although HRQOL improved through the postmastectomy care program, our findings suggest that lower education, working as a laborer, and total mastectomy may be more associated with BCRL. Continuing research may uncover liabilities among BCRL patients within limited-resources settings.

Asunto(s)

Mastectomía , Calidad de Vida , Humanos , Femenino , Estudios Prospectivos , México , Persona de Mediana Edad , Mastectomía/efectos adversos , Adulto , Anciano , Linfedema del Cáncer de Mama/etiología , Linfedema del Cáncer de Mama/terapia , Neoplasias de la Mama/cirugía , Neoplasias de la Mama/complicaciones

RESUMEN

Objective: To determine the relationship between early age at menarche, late age at menopause with specific subtypes of breast cancer (BC). Methods: A literature search was conducted in Embase, Lilacs, PubMed, Scopus, and Scielo databases, following the Joanna Briggs Institute scoping review protocol and answering the question "How early age at menarche or late age at menopause are related to different breast cancer subtypes?". Results: A number of 4,003 studies were identified, of which 17 were selected. Most of the included articles found a clear relationship between early menarche, late menopause and some subtypes of BC, mainly, PR+, ER+, luminal, and HER-2 tumors. However, some studies have found a contradictory relationship and one study didn't find any relationship between them. Conclusion: A relationship between early age at menarche and advanced age at menopause was observed with some subtypes of breast cancer, since other factors must be considered in its understanding.

Asunto(s)

Neoplasias de la Mama , Menarquia , Menopausia , Humanos , Menarquia/fisiología , Femenino , Menopausia/fisiología , Factores de Edad

RESUMEN

Objective: To evaluate early complications in prepectoral breast reconstruction. Methods: A retrospective cohort study including 180 consecutive cases of nipple-sparing mastectomy, comparing immediate breast reconstruction with subpectoral to prepectoral mammary implants in 2012-2022. Clinical and demographic characteristics and complications in the first three months following surgery were compared between the two techniques. Results: The prepectoral technique was used in 22 cases (12.2%) and the subpectoral in 158 (87.8%). Median age was higher in the prepectoral group (47 versus 43.8 years; p=0.038), as was body mass index (25.1 versus 23.8; p=0.002) and implant volume (447.5 versus 409 cc; p=0.001). The prepectoral technique was more associated with an inframammary fold (IMF) incision (19 cases, 86.4% versus 85, 53.8%) than with periareolar incisions (3 cases, 13.6% versus 73, 46.2%); (p=0.004). All cases in the prepectoral group underwent direct-to-implant reconstruction compared to 54 cases (34.2%) in the subpectoral group. Thirty-eight complications were recorded: 36 (22.8%) in the subpectoral group and 2 (9.1%) in the prepectoral group (p=0.24). Necrosis of the nipple-areola complex/skin flap occurred in 27 patients (17.1%) in the subpectoral group (prepectoral group: no cases; p=0.04). The groups were comparable regarding dehiscence, seroma, infection, and hematoma. Reconstruction failed in one case per group (p=0.230). In the multivariate analysis, IMF incision was associated with the prepectoral group (aOR: 34.72; 95%CI: 2.84-424.63). Conclusion: The incidence of early complications was comparable between the two techniques and compatible with previous reports. The clinical and demographic characteristics differed between the techniques. Randomized clinical trials are required.

Asunto(s)

Neoplasias de la Mama , Mamoplastia , Pezones , Complicaciones Posoperatorias , Humanos , Estudios Retrospectivos , Femenino , Persona de Mediana Edad , Adulto , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Pezones/cirugía , Mamoplastia/métodos , Neoplasias de la Mama/cirugía , Estudios de Cohortes , Músculos Pectorales , Mastectomía Subcutánea/métodos , Factores de Tiempo , Implantes de Mama

RESUMEN

Introduction: Breast cancer survivors often experience pre and post-treatment physical and psychological symptoms, negatively affecting their quality of life. Regular physical exercise is associated with better quality of life and lower recurrence of cancer, and therefore all oncological patients are recommended to practice it in a regular basis. Despite this, breast cancer survivors have low adherence to physical exercise. The purpose of this study is to identify barriers, facilitators and preferences of Chilean breast cancer survivors to practice physical exercise. Methods: Phenomenological qualitative study of 12 in-depth interviews with adjuvant radiation therapy concluded at least three months ago. Results: Breast cancer survivors ignored the benefits of physical exercise during and after treatment. The barriers were physical symptoms, psychological barriers, sociocultural barriers, health system barriers, disinformation and sedentary lifestyle. Facilitators were coping with physical symoptoms, psychological issues, having information and active lifestyle. The preferences were painless and familiar exercises. Preferred exercise was walking. Conclusions: Breast cancer survivors may adhere to physical exercise despite barriers when certain facilitators are present, which may be promoted by the health team when reporting the benefits of the physical exercise, prescribing personalized, safe and painless physical exercise and educating both patient and her family about the role of the physical exercise in cancer recovering process.

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Introducción: Las sobrevivientes de cáncer de mama suelen ver afectada negativamente su calidad de vida por síntomas físicos y psicológicos pre y post tratamiento. La práctica regular de ejercicio físico se asocia a mejor calidad de vida y menor recurrencia del cáncer, por esto es recomendado a todos los pacientes oncológicos. Sin embargo, existe baja adherencia a este. El propósito de este artículo es identificar barreras, facilitadores y preferencias de sobrevivientes de cáncer de mama chilenas para realizar ejercicio físico. Métodos: Estudio cualitativo fenomenológico, basado en entrevistas en profundidad a 12 sobrevivientes de cáncer de mama que terminaron la radioterapia adyuvante hace tres o más meses. Resultados: Las sobrevivientes de cáncer de mama desconocían la importancia del ejercicio físico durante y después del tratamiento. Las barreras identificadas fueron síntomas físicos, barreras psicológicas, socioculturales, del sistema de salud; desinformación y sedentarismo. Los facilitadores fueron físicos, psicológicos, contar con información y práctica de ejercicio físico antes del diagnóstico. Las preferencias fueron ejercicios indoloros y familiares. El ejercicio preferido fue caminar. Conclusiones: Es posible que las sobrevivientes de cáncer de mama adhieran al ejercicio físico, a pesar de las barreras cuando hay ciertos facilitadores presentes. Estos pueden ser generados por el equipo médico al informar los beneficios del ejercicio físico, prescribir ejercicio físico personalizado, seguro e indoloro y educar a la paciente y a su familia sobre el rol del ejercicio físico en la recuperación de sobrevivientes de cáncer de mama.

Asunto(s)

Neoplasias de la Mama , Supervivientes de Cáncer , Ejercicio Físico , Entrevistas como Asunto , Calidad de Vida , Humanos , Femenino , Neoplasias de la Mama/psicología , Neoplasias de la Mama/rehabilitación , Neoplasias de la Mama/terapia , Supervivientes de Cáncer/psicología , Chile , Ejercicio Físico/fisiología , Persona de Mediana Edad , Adulto , Anciano , Adaptación Psicológica , Prioridad del Paciente , Cooperación del Paciente , Investigación Cualitativa , Radioterapia Adyuvante

Asunto(s)

Neoplasias de la Mama , Detección Precoz del Cáncer , Humanos , Neoplasias de la Mama/diagnóstico por imagen , Neoplasias de la Mama/diagnóstico , Femenino , Detección Precoz del Cáncer/métodos , Mamografía