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BACKGROUND: Thyroxine (T4) has been positively associated with tumor cell proliferation, while the effect of triiodothyronine (T3) on cell proliferation has not been well-established because it differs according to the type of cell line used. In Mexico, it has been reported that 14.5% of adult women have some type of thyroid dysfunction and abnormalities in thyroid function tests have been observed in a variety of non-thyroidal illnesses, including breast cancer (BC). These abnormalities might change with body mass index (BMI) because thyroid hormones are involved in the regulation of various metabolic pathways and probably by menopausal status because obesity has been negatively associated with BC in premenopausal women and has been positively associated with BC in postmenopausal women. METHODS: To assess the association between serum thyroid hormone concentration (T4 and T3) and BC and the influence of obesity as an effect modifier of this relationship in premenopausal and postmenopausal women, we measured serum thyroid hormone and thyroid antibody levels in 682 patients with incident breast cancer (cases) and 731 controls, who participated in a population-based case-control study performed from 2004 to 2007 in three states of Mexico. We tested the association of total T4 (TT4) and total T3 (TT3) stratifying by menopausal status and body mass index (BMI), and adjusted for other health and demographic risk factors using logistic regressions models. RESULTS: Higher serum total T4 (TT4) concentrations were associated with BC in both premenopausal (odds ratio (OR) per standard deviation = 5.98, 95% CI 3.01-11.90) and postmenopausal women (OR per standard deviation = 2.81, 95% CI 2.17-3.65). In premenopausal women, the effect of TT4 decreased as BMI increased while the opposite was observed in postmenopausal women. The significance of the effect modification was marginal (p = 0.059) in postmenopausal women and was not significant in premenopausal women (p = 0.22). Lower TT3 concentrations were associated with BC in both premenopausal and postmenopausal women and no effect modification was observed. CONCLUSIONS: There is a strong association between BC and serum concentrations of TT3 and TT4; this needs to be further investigated to understand why it happens and how important it is to consider these alterations in treatment.

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OBJECTIVE: To estimate the effect of care-delivery delays on survival among women with breast cancer. MATERIALS AND METHODS: A retrospective analysis of 854 women attending 11 hospitals from 2007-2009 was carried out. Kaplan-Meier estimators and a Cox proportional-risk model were employed. RESULTS: A total of 10.5% of cases were diagnosed in stage I. 82% of sampled women delayed care for more than 67 days between noticing a symptom and initiating treatment. The median time from receipt of results of the mammography to biopsy was 31 days (IQR 14-56). Compared with those who were in quartile I (Q1), survival was lower among those in Q3 and Q4 (HR=1.68, 95%CI 0.94-3.00; HR=1.76, 95% CI 1.04-2.98, respectively). CONCLUSIONS: To increase survival, it is suggested that the time between receipt of the mammography results and diagnostic biopsy be reduced.

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Little is known about the possible influence of food consumption on the serum concentrations of endogenous sex hormones in postmenopausal women. We evaluated the relationships of the Western dietary pattern with serum concentrations of free estradiol and testosterone of postmenopausal women to test the hypothesis that a highly Western dietary pattern is associated with high serum concentrations of these hormones. We used data from a representative subsample of 305 women from the control group of a population-based case-control study conducted in Mexico from 2004 to 2007. A Western dietary pattern index value was compared with log natural serum concentrations of testosterone and estradiol using multiple linear regression models. The median values of serum concentrations of free estradiol and testosterone were 0.26 pg/mL (interquartile range, 0.14-0.43) and 0.40 pg/mL (interquartile range, 0.30-0.70), respectively. A multiple linear regression model showed that for each unit increase in the Western dietary pattern index, there was a 16.2% increase in the serum concentrations of free estradiol (ß=0.15; 95% confidence interval [CI], 0.01-0.29); for each additional serving per week of chicken eggs, the increase was 31.0% (ß=0.27; 95% CI, 0.106-0.441); for each additional serving per week of red meat, the increase was 64.9% (ß=0.50; 95% CI, 0.01-1.01). There was no relationship found between dietary patterns and serum concentrations of free testosterone. The present findings suggest that intake of a Western diet, particularly of chicken eggs and meat, increases serum concentrations of free estradiol; these results have implications for breast cancer prevention.

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Abstract Objective: To estimate the effect of care-delivery delays on survival among women with breast cancer. Materials and methods: A retrospective analysis of 854 women attending 11 hospitals from 2007-2009 was carried out. Kaplan-Meier estimators and a Cox proportional-risk model were employed. Results: A total of 10.5% of cases were diagnosed in stage I. 82% of sampled women delayed care for more than 67 days between noticing a symptom and initiating treatment. The median time from receipt of results of the mammography to biopsy was 31 days (IQR 14-56). Compared with those who were in quartile I (Q1), survival was lower among those in Q3 and Q4 (HR=1.68, 95%CI 0.94-3.00; HR=1.76, 95% CI 1.04-2.98, respectively). Conclusions: To increase survival, it is suggested that the time between receipt of the mammography results and diagnostic biopsy be reduced.

Resumen Objetivo: Estimar el efecto del tiempo de atención sobre la supervivencia de mujeres con cáncer de mama. Material y métodos: Se realizó el análisis retrospectivo de 854 mujeres atendidas en 11 hospitales entre 2007 y 2009. Se emplearon estimadores de Kaplan-Meier y un modelo de riesgos proporcionales de Cox. Resultados: 10.5% se diagnosticó en etapa I, mientras que 82.1% demoró más de 67 días entre la percepción de un síntoma y el inicio del tratamiento. La mediana del tiempo desde la entrega de los resultados de la mastografía hasta la biopsia fue de 31 días (RIQ 14-56); en comparación con quienes se encontraron en el cuartil 1 (Q1), la supervivencia fue menor en aquellas que se encontraron en los Q3 y Q4 (HR=1.68, IC95% 0.94-3.00; HR=1.76, IC95% 1.04-2.98, respectivamente). Conclusiones: Se sugiere reducir el tiempo desde la entrega de los resultados de la mastografía a la biopsia diagnóstica para incrementar la supervivencia.

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BACKGROUND: The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. METHODS: This was a cross-sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). RESULTS: The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. CONCLUSIONS: In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment.

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BACKGROUND: Many studies have analyzed the effect of behavioral risk factors such as common lifestyle patterns on the risk of disease. The aim of this study was to assess the effect of a healthy lifestyle index on the risk of breast cancer. METHODS: A population-based case-control study was conducted in Mexico from 2004 to 2007. One thousand incident cases and 1,074 controls, matched to cases by 5-year age category, region, and health institution, participated in the study. A healthy lifestyle index was developed by means of principal components by using dietary pattern, physical activity, alcohol consumption, and tobacco smoking. A conditional logistic regression model was used to assess this association. RESULTS: The healthy lifestyle index was defined as the combined effect of moderate and/or vigorous-intensity physical activity, low consumption of fat, processed foods, refined cereals, complex sugars, and the avoidance of tobacco smoking and alcohol consumption. Results showed a protective effect on both pre- (OR = 0.50, 95% CI: 0.29-0.84) and postmenopausal women (OR = O.20, 95% CI: 0.11-0.37) when highest versus lowest index quintiles were compared. CONCLUSIONS: Healthy lifestyle was associated with a reduction in the odds of having breast cancer. Primary prevention of this disease should be promoted in an integrated manner. Effective strategies need to be identified to engage women in healthy lifestyles. IMPACT: This study is the first to assess a healthy lifestyle index in relation to the risk of breast cancer.

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BACKGROUND: Invasive breast cancer is the most common neoplasia in women attended at IMSS health system since 2004. OBJECTIVE: To compare clinical and radiological characteristics on initial appraisal, as well as surgical treatment, pathological features and adjuvant treatment in women with primary breast cancer of 40 years old and younger vs 70 years old and older. MATERIAL AND METHOD: Clinical, radiological and pathological data of 150 patients with breast cancer treated at Hospital de ginecoobstetricia Luis Castelazo Ayala, from January 2003 to June 2006 were collected, and after divided in two groups: 1) patients with 40 years old and younger (n = 50), and 2) patients with 70 years old and older (n = 100). RESULTS: Tumoral size and radiological characteristics were similar in both groups. Group 1 and group 2 had 22 and 13%, respectively, of family history of breast cancer. Fine needle biopsy has positive predictive value of 50% for group 1, and 36% for group 2. Conservative surgery was less common at group 2. Most frequent histological type in both groups was infiltrating ductal carcinoma, followed by infiltrating lobular carcinoma, most common in older women (19 vs 12%), and we found more well differentiated ductal carcinomas in the group of 70 years old and older (12 vs 4%). Seventy-six percent of group 1 and 75% of group 2 were classified as early stage breast cancer (stages I and II). Cytotoxic therapy was offered mostly to group 1, 92 vs 35%. Radiotherapy (80 vs 59%), and hormonal therapy was given only to 56% of group 1 vs 80% of group 2. CONCLUSIONS: Clinical and staging features were similar in both groups. Family history was more influential to group 1. Fine needle biopsy has a low positive predictive value for diagnostic. Well-differentiated carcinomas were higher in patients of group 2, and group 1 had more high-grade carcinomas. There was a trend to perform more conservative surgery at group 1, as well as they underwent more adjuvant chemotherapy and radiotherapy. Use of hormonal therapy was more common at group 2.

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OBJECTIVE: To evaluate the effect of moderate physical activity (hours per week and METs hours per week) on the risk of breast cancer (BC) in Mexican women. MATERIAL AND METHODS: This is the initial stage of a case control multicentric study based in the Federal District, Monterrey and Veracruz, Mexico, during 2004. Fifty eight cases paired to 58 control cases on quinquennium of age, and belonging to the health system were analyzed: three hospitals from the IMSS, three from ISSSTE and three from SS participated. RESULTS: In postmenopausal women, there was a reduction of the risk in BC by every additional hour per week of moderate physical activity (RM= 0.91; IC95% 0.85-0.97); in premenopausal women, the reduction of the risk was not statistically significant (RM= 0.99; IC95% 0.94-1.05) (p= 0.048, effect modification). CONCLUSIONS: Moderate physical activity reduces the risk of BC in postmenopausal Mexican women.

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OBJETIVO: Evaluar el efecto de la actividad física moderada (en horas por semana y METs-hora por semana) sobre el riesgo de cáncer de mama (CM). MATERIAL Y MÉTODOS: Se trata de la primera fase de un estudio multicéntrico de casos y controles con base poblacional que se desarrolló en el Distrito Federal, Monterrey y Veracruz, México, en el año 2004. Se analizaron 58 casos y 58 controles pareados a los casos por quinquenio de edad, y pertenencia al sistema de salud; participaron tres hospitales del Instituto Mexicano del Seguro Social, tres del Instituto de Seguridad Social al Servicio de los Trabajadores del Estado y tres de la Secretaría de Salud. RESULTADOS: En mujeres posmenopáusicas se observó una reducción del riesgo de CM por cada hora semanal adicional de actividad física moderada (RM= 0.91; IC95 por ciento 0.85-0.97); en mujeres premenopáusicas, la disminución del riesgo no tuvo significancia estadística (RM= 0.99; IC95 por ciento 0.94-1.05) (p= 0.048, modificación de efecto). CONCLUSIONES: La actividad física reduce el riesgo de CM en mujeres mexicanas posmenopáusicas.

OBJECTIVE: To evaluate the effect of moderate physical activity (hours per week and METs hours per week) on the risk of breast cancer (BC) in Mexican women. MATERIAL AND METHODS: This is the initial stage of a case control multicentric study based in the Federal District, Monterrey and Veracruz, Mexico, during 2004. Fifty eight cases paired to 58 control cases on quinquennium of age, and belonging to the health system were analyzed: three hospitals from the IMSS, three from ISSSTE and three from SS participated. RESULTS: In postmenopausal women, there was a reduction of the risk in BC by every additional hour per week of moderate physical activity (RM= 0.91; IC95 percent 0.85-0.97); in premenopausal women, the reduction of the risk was not statistically significant (RM= 0.99; IC95 percent 0.94-1.05) (p= 0.048, effect modification). CONCLUSIONS: Moderate physical activity reduces the risk of BC in postmenopausal Mexican women.

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BACKGROUND: Breast cancer incidence associated with hormonal replacement therapy have been evaluated in many studies, which have found a hard to proof increment due to several particular patient factors. AIMS: Many studies have been assessed the incidence of breast cancer in relation to the use of replacement therapy, however it is difficult to prove absolutely, every women has a different risk, influenced by genetic factors, nuliparity, late parity, menarche, menopause, use of estrogens, mastographic density and previous mammary disease. OBJECTIVE: To identify if there is an increase in the number of cases of breast cancer in postmenopausal women with replacement therapy, with low and medium level in Mainero's classification. MATERIAL AND METHODS: Cohort study prospective, and closed in 316 women with a 0, 1 or 2 result according to the Mainero's classification. 25 were excluded, 74 with a score of 0, 193 score of 1 and 24 score of 2, we followed all the women for 60 to 90 months with replacement therapy. RESULTS: We did not find patients with breast cancer and replacement therapy. CONCLUSION: Mainero's classification is an easy option to evaluate and decide replacement therapy taking the oncology risk.

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BACKGROUND: Wide surgical margins are prognostic indicators to prevent recurrences after conservative surgery in breast cancer; type of surgery and histopathological analysis are key factors too. OBJECTIVES: To evaluate tumoral size and surgical margins of quadrantectomy specimens utilizing mammography and histopathology, and decide if mammography of quadrantectomy specimens are useful for close margins prediction. MATERIALS AND METHODS: Prospective, observational and descriptive study based on the findings of specimen projections of two mammography quadrantectomies, and histopathological data. Ten patients with breast cancer were evaluated from May to November 2006. Surgical margins of quadrantectomys were marked with radiopaque material. RESULTS: Tumoral size was similar in mammography and histopathological analysis of quadrantectomys, however there was a tendency to report a larger size in mammography. With mammography only one case was reported as close superficial margin, the rest of patients has adequate margins (1 cm or higer). Five cases were close by histopathology (3 in the deep margin, one superior and one more in the superior and inferior margins), and five had adequate margins. Four additional surgical procedures where practiced (3 re-excisions and one mastectomy), in one of them additional surgery was unnecessary. CONCLUSIONS: Mammography evaluation was useful to identify peripheral margins (superior, inferior medial and lateral) as well as tumoral size, but useless to identify close borders (deep and superficial areas). It is necessary to evaluate more cases to improve this technique and to establish a common language between specialists.

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Durante un periodo de cinco años fueron diagnosticados y tratados 52 casos de carcinoma ductal in situ. La edad promedio de las pacientes fue de 54.7 años, existía antecedente familiar de carcinoma mamario en 11.4 por ciento y nuliparidad o paridad tardía en el 19.2 por ciento. Once casos (21.2 por ciento) se asociaron a otro carcinoma mamario, ya fuese sincrónica o metacrónicamente. El 81 por ciento tenían tumor palpable; el tamaño promedio fue de 3.1 cm. El subtipo histológico más frecuente fue el comedocarcinoma (42 por ciento), seguido del sólido (23 por ciento) y del cribiforme (21 por ciento). Veinte pacientes fueron tratados con mastectomía radical modificada y cinco con mastectomía total; en estos casos no hubo recurrencia locorregional. Doce mujeres fueron tratadas con cuadrantectomía más radioterapia y hubo un caso (8.3 por ciento) recurrente. También hubo recurrencia en el 40 por ciento los casos tratados con resección amplia más radioterapia y en 40 por ciento de los manejados sólo con extirpación del tumor. Los factores que mostraron una mayor asociación con las recurrencias fueron: subtipo comedocarcinoma, grado nuclear 3, índice de necrosis (+++). cuando el procedimiento quirúrgico fue amplio (cuadrantectomía), se registraron menos recurrencias en las mujeres tratadas conservadoramente. La radioterapia posoperatoria se asoció a menor índice de recurrencias. Factores como tamaño tumoral, relación mama/tumor, localización del tumor, número de lesiones, estado de los bordes posresección y antecedente de radioterapia previa son todos los factores a tomarse en cuenta para decidir si el caso deberá ser tratado conservadoramente o con mastectomía

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El tumor desmoide se origina en las fascias o aponeurosis musculares. Es una neoplasia poco frecuente y está incluida en el grupo de las fibromatosis. aunque se describe como un tumor benigno, su tendencia a la recurrencia y su poder de invasión local han hecho que algunos autores lo consideren un sarcoma de bajo grado de malignidad. Presentamos una revisión de 20 casos atendidos en el Servicio de Oncología del Hospital General de México. Se hace énfasis en la localización del tumor, tamaño, estructuras involucradas, cuadro clínico, las diversas modalidades de tratamiento y en la evolución

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Se presentan los resultados de la revisión de expedientes del Servicio de Oncología del Hospital General de México, SS, del período comprendido entre el 1 de enero de 1984 al 31 de diciembre de 1988. Se hace una presentación de las neoplasias malignas corroboradas histológicamente, agrupándolas de acuerdo a su frecuencia y en orden decreciente, desde el punto de vista general y por cada Unidad del Servicio de Oncología. Se utilizó la clasificación de tumores malignos de la Unión Internacional Contra el Cáncer de 1987. Los resultados se comparan con los del Registro Nacional del Cáncer correspondiente al período 1983-84 y con los del Hospital de Oncología del Centro Médico Nacional del Instituto Mexicano del Seguro Social registrados de 1983 a 1984.

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