Breast cancer management in middle-resource countries (MRCs): consensus statement from the Breast Health Global Initiative.

In middle resource countries (MRCs), cancer control programs are becoming a priority as the pattern of disease shifts from infectious diseases to non-communicable diseases such as breast cancer, the most common cancer among women in MRCs. The Middle Resource Scenarios Working Group of the BHGI 2010 Global Summit met to identify common issues and obstacles to breast cancer detection, diagnosis and treatment in MRCs. They concluded that breast cancer early detection programs continue to be important, should include clinical breast examination (CBE) with or without mammography, and should be coupled with active awareness programs. Mammographic screening is usually opportunistic and early detection programs are often hampered by logistical and financial problems, as well as socio-cultural barriers, despite improved public educational efforts. Although multidisciplinary services for treatment are available, geographical and economic limitations to these services can lead to an inequity in health care access. Without adequate health insurance coverage, limited personal finances can be a significant barrier to care for many patients. Despite the improved availability of services (surgery, pathology, radiology and radiotherapy), quality assurance programs remain a challenge. Better access to anticancer drugs is needed to improve outcomes, as are rehabilitation programs for survivors. Focused and sustained government health care financing in MRCs is needed to improve early detection and treatment of breast cancer.

Hereditary breast cancer associated with a germline BRCA2 mutation in identical female twins with similar disease expression.

The relative contribution of heritable and nonheritable factors to disease expression in BRCA2 mutation carriers is largely unknown. This report describes a familial breast cancer syndrome in a pair of identical female twins. These twins showed an extremely high concordance in their clinical histories; both twins exhibited similar cancer-related risk factors, and developed breast cancer at the same age with the same disease stage and identical histological features. No differences were detected in hormone receptors status, p53, bcl-2, erbB-2 and LI Ki67 expression by immunohistochemistry. A BRCA2 exon 11 protein truncation test showed a lower molecular weight band than the one expected for a normal allele, in both twins. Sequence analysis of DNA showed a 6 bp insertion between nucleotides 4359-4360, which resulted in a premature stop codon at position 1378. The remarkable disease similarity observed in this identical twin pair is in accordance with an important role for heritable factors in disease expression among patients carrying BRCA germline mutations.

Tumores epiteliales de ovario: estudio de 70 casos: análisis de factores de valor pronóstico: resultados terapéuticos / Epithelial tumors of the ovary: study of 70 cases: analysis of factors of prognostical value: therapeutical results

Se analizan 70 casos de TEO, cuya edad promedio fue de 54 años. Se estadificaron en E I 23 casos (33//), en E II 17 (24//), en E III 20 (29//) y 10 (14//) en E IV. Predominaron las variedades serosas con 29 casos (42//) y mucinosa con 24 (34//); los restantes fueron 8 endometroides, 7 anaplásicos y un caso de tumor a células claras y de Brenner. El tratamiento fue predominantemente quirúrgico, complementado o no de radioterapia o Melfalán en los E I-II; y con tratamiento sistémico (CMF o Hexa-CAF) para los E III-IV. La sobrevida a 5 años fue de 77// en E I, 55// en E II, 38// en E III, y 0// en E IV. No se encontró que la edad, ni los tipos histológicos salvo las formas anaplásicas fueran factores de significación pronóstica. En las formas avanzadas (E III-IV), se marca diferente pronóstico de acuerdo con el volumen tumoral residual post cirugía, sobrevida de 55// a 5 años con volúmenes menores a 2 cm de diámetro y 0// con volúmenes mayores. Se concluye en la importancia de configurar subgrupos en los que se interrelacionen factores de valor pronóstico que orienten el tratamiento. En lo terapéutico se destaca el valor del cisplatino como fármaco básico