Factors associated with ever use of mammography in a limited resource setting. A mixed methods study.

OBJECTIVE: To evaluate facilitators and barriers influencing mammography screening participation among women. DESIGN: Mixed methods study. SETTING: Three hospital catchment areas in Hidalgo, Mexico. PARTICIPANTS: Four hundred and fifty-five women aged 40-69 years. INTERVENTION: Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method. MAIN OUTCOME MEASURE: Women were categorized as never having had mammography or having had at least one mammogram in the past. RESULTS: From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography. CONCLUSIONS: Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.

Mutational analysis of BRCA1 and BRCA2 genes in Mexican breast cancer patients.

Germline mutations in the BRCA1 and BRCA2 genes predispose to breast and ovarian cancer. A variable incidence of mutations has been reported for these genes. The contribution of BRCA1 and BRCA2 mutations to Mexican women with breast and/or ovarian cancer is not known. Because of the increasing prevalence of breast cancer in this population, it is necessary to study the presence of mutations in both genes. We screened BRCA1 and BRCA2 genes in 40 patients: 29 patients with a history of breast and/or ovarian cancer, and 11 patients with early-onset breast cancer (< 40 years), through denaturing high performance liquid chromatography analyses. We found two frameshift mutations in BRCA1 and one missense mutation in each gene. Additionally we found several intronic variants as well as synonymous mutations. We found 5% of deleterious mutations in the BRCA genes. Larger studies are needed to establish the significance and prevalence of BRCA mutations among Mexican women.

The systemic absorption of etoposide after intravaginal administration in patients with cervical intraepithelial lesions associated with human papillomavirus infection.

PURPOSE: The purpose of this study was to determine the systemic absorption and the release of etoposide in cervical tissue administered via a vaginal ovule to women diagnosed with cervical intraepithelial lesions associated with human papillomavirus (HPV). METHODS: Fifteen women with low- and high-grade intraepithelial neoplasia confirmed by colposcopic test received a 50-mg intravaginal etoposide dose three times a week for 3 weeks. At the end of the study period, paralleled with the last ovule administered, blood samples were collected over a period of 24 h, and in situ cervical samples were obtained at 3 and 10 h after drug administration. Etoposide concentrations were determined in plasma and in in situ cervical samples using the high-performance liquid chromatography method with electrochemical detection. RESULTS: Pharmacokinetic analyses of plasma data indicated low or lack of systemic exposure of etoposide after the vaginal administration. Nevertheless, high concentrations of etoposide were found in all in situ cervical samples, indicating that etoposide could be released from its pharmaceutical formulation. CONCLUSIONS: The results of the study suggest that the etoposide administered as intravaginal ovule is safe and tolerable and apparently could be a suitable option in patients with cervical intraepithelial neoplasia. Clinical results and the true impact on HPV infection and evolution of dysplasia need to be confirmed.

[Myocardial infarct and rupture of the left ventricular free wall. Some considerations on incidence, morphological characteristics and risk factors]. / Infarto del miocardio y ruptura de la pared libre del ventrículo izquierdo. Algunas consideraciones sobre la frecuencia, características morfológicas y factores de riesgo.

Rupture of the left ventricle free wall is a sudden and unexpected event in myocardial infarction. It is considered the third most common cause of death, following cardiogenic shock and arrhythmias. The frequency of rupture varies because many patients may survive the initial insult of myocardial infarction. Conflicting reports regarding risk factors have been published by several authors. With these considerations in mind, the present investigation was undertaken to evaluate ventricular rupture in an autopsy population from the Instituto Nacional de Cardiología. We analyzed the salient morphologic features and the risk factors. Our results indicated an incidence rate of 17.7% of cardiac rupture in patients who died of acute myocardial infarction and were autopsied. Ruptures are more common in elderly female patient during their first infarct, they were localized preferentially in the anterior wall and occurred within the first four days after infarction. Chance of rupture was greater in hypertensive patients, whereas a history of previous infarct protected against this contingency.

[Prevalence of microscopic coronary atheroma in young adults from Mexico City]. / Prevalencia del ateroma coronario microscópico en adultos jóvenes de la Ciudad de México.

The prevalence of microscopic atheroma in the proximal left anterior descending coronary artery was studied in thirty young males aged 20 to 29 years, living in Mexico City, who died in urban accidents. All of them were either unemployed or labor workers with a socioeconomical status considered to be representative of the majority of young males living in Mexico City. It was found that coronary atheroma was present in 11 of them (33%) with variable degrees of luminal obstruction. In two of them the luminal obstruction was greater than 75%. The prevalence found in this group was significantly different to that found in younger and older males who also died in accidents. Since the prevalence of coronary atheroma was not related to ventricular hypertrophy, valvular or congenital heart disease our findings indicate that in Mexico City as in other geographical regions, coronary atherosclerosis is not an unusual finding in males in the third decade of life, with a low socioeconomical status.

[Autopsy: reflection of intrahospital mortality]. / La autopsia, espejo de la mortalidad Intrahospitalaria.

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.

Angiocentric lymphomas of the palate: clinico-pathological considerations in 12 cases.

Angiocentric lymphomas (AL) involving the mid-face are infrequent lesions. Their incidence seems to be higher in certain Asian and Latin American countries, where most of the reported series reveal a predominance of T-cell lineage and a high frequency of EBV-positive cells. The clinical and pathological features of 12 AL that affected the palate are presented. Immunophenotypic studies were performed in nine of these cases. Seven (77%) demonstrated T-cell lineage, one was of B-cell origin and one could not be classified. The high incidence of T-cell lesions in this and other studies supports the existence of geographical and possibly of etiological differences in these neoplasms.