Retrasos en el tratamiento del cáncer de mama: una enfermedad peligrosa.

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Crisis de casos de cáncer de mama detectados en tamizaje durante el segundo año de la pandemia en el Incan.

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Impacto de la pandemia de Covid-19 en el tamizaje de cáncer de mama y algunas estrategias para actuar pronto y seguro.

Desde el comienzo de la pandemia de Covid-19 los servi-cios de prevención de cáncer de mama han sido aplazados gravemente. Esta acción provocó la reducción en el número acumulado de mastografías de detección a nivel mundial e incrementó las disparidades en salud, sobre todo entre las mujeres vulnerables. Si bien la evidencia que respalda las es-trategias para rescatar el tamizaje con mastografía en la fase de resolución de la pandemia no es suficiente, hay algunas consideraciones pragmáticas que pueden guiar su recupera-ción y garantizar su continuidad. Una de estas estrategias es prever los retrasos en el tamizaje y abordarlos a través de programas seguros que se alineen con la situación epidemio-lógica actual. Las acciones planteadas en el presente ensayo están en consonancia con las iniciativas internacionales de garantizar la continuidad de los programas de tamizaje de cáncer de mama en atención a que el cuidado de las mujeres sea una acción prioritaria, continua y permanente.

Anxiety-like Behavior and GABAAR/BDZ Binding Site Response to Progesterone Withdrawal in a Stress-Vulnerable Strain, the Wistar Kyoto Rats.

Stress susceptibility could play a role in developing premenstrual anxiety due to abnormalities in the hypothalamus-pituitary-adrenal (HPA) axis and impairments in the GABAA receptors' benzodiazepine (BDZ) site. Hence, we studied the stress-vulnerable Wistar Kyoto rat strain (WKY) to evaluate progesterone withdrawal (PW) effects on anxiety, HPA axis response, and to explore indicators of GABAA functionality in the BDZ site. For five days, ovariectomized WKY rats were administered 2.0 mg/kg of progesterone. Twenty-four hours after the last administration, rats were tested in the anxiety-like burying behavior test (BBT) or elevated plus maze test (EPM), and corticosterone was determined. [3H]Flunitrazepam binding autoradiography served as the BDZ binding site index of the GABAA receptor in amygdala nuclei and hippocampus's dentate gyrus (DG). Finally, different doses of diazepam in PW-WKY rats were tested in the BBT. PW induced anxiety-like behaviors in both BBT and EPM compared with No-PW rats. PW increased corticosterone, but was blunted when combined with PW and BBT. PW increased [3H]Flunitrazepam binding in the DG and central amygdala compared with No-PW rats. Diazepam at a low dose induced an anxiogenic-like response in PW rats, suggesting a paradoxical response to benzodiazepines. Overall, PW induced anxiety-like behavior, a blunted HPA axis response, and higher GABAAR/BZD binding site sensitivity in a stress-vulnerable rat strain. These findings demonstrate the role of stress-susceptibility in GABAAR functionality in a preclinical approximation of PMDD.

The apparent diffusion coefficient (ADC) on 3-T MRI differentiates myometrial invasion depth and histological grade in patients with endometrial cancer.

BACKGROUND: Diffusion-weighted magnetic resonance imaging (DW-MRI) with apparent diffusion coefficient (ADC) measurement provides additional information about tumor microstructure with potential relevance for staging and predicting aggressive disease in patients with endometrial cancer (EC). PURPOSE: To determine whether ADC values in EC diverge according to the tumor's histologic grade and myometrial invasion depth. MATERIAL AND METHODS: A sample of 48 pathologically confirmed cases of EC were reviewed retrospectively. The sample was distributed as follows: G1 (n = 9); G2 (n = 18); G3 (n = 21); with myometrial invasion <50% (n = 31); and with myometrial invasion ≥50% (n = 17). DW images were performed at 3.0T with b factors of 0-1000/mm2. The region of interest (ROI) was defined within the tumor with T1-weighted and T2-weighted imaging and copied manually to an ADC map. The tumor's grade and myometrial invasion's depth were determined by postoperative histopathological tests. RESULTS: The means of ADCmin and ADCmean values were significantly lower for patients with G2 and G3 endometrial tumors than G1. The same tendency was observed in myometrial invasion, as both ADCmin and ADCmean values were lower for patients with deep than for those with superficial myometrial invasion. The cut-off values of the ADCmin and ADCmean that predicted high-grade tumors were 0.69 × 10-3 mm2/s and 0.82 × 10-3 mm2/s, respectively, while those for myometrial infiltration were 0.70 × 10-3 mm2/s (ADCmin) and 0.88 × 10-3 mm2/s (ADCmean). CONCLUSION: ADCmin and ADCmean values correlated with histologic tumor grade and myometrial invasion depth; therefore, it is suggested that ADC on MRI may be a useful indicator to predict malignancy of ECs.

[Availability of mammographs in Mexico: Is it possible to expand coverage]. / Disponibilidad de mastógrafos en México: ¿Es posible ampliar la cobertura?

Background: Breast cancer screening coverage in Mexico is limited. It is necessary to configure the Mexican health system to make it capable of producing more mammograms, without neglecting quality and diagnostic opportunity. Objective: To project the coverage of breast cancer screening programs according to the mammographs availability in the Mexican Health System. Material and methods: An exploratory study was conducted correlating the number mammographs available in the Mexican Health System with women between 40 and 69 who are the target of screening programs in Mexico. The analysis consisted of calculating the coverage of breast cancer screening programs if each mammograph could perform 6336 screening mammograms per year. All the calculations were made with the information of the year 2020 as the most current data in terms of population density. Results: It was determined that the number of mammographs is enough to raise the offer of screening studies to ≈50% at the national level. There are even states whose coverage capacity is projected above 70%. Some of them are Mexico City, Colima, Durango, Quintana Roo, Zacatecas, Baja California Sur and Coahuila. Also, it was observed that the distribution of mammographs is not equitable in the national territory, suggesting investment both in equipment and in screening strategies for breast cancer. Conclusions: Our data show that it is possible to advance in preventing breast cancer in Mexico, although the improvement of the management capacities of the Mexican Health System is required to improve both the coverage and quality of the breast cancer screening programs.

Introducción: la cobertura de detección de cáncer de mama en México es limitada. Es necesario configurar al sistema de salud mexicano para hacerlo capaz de producir más mastografías, sin dejar de lado la calidad y la oportunidad diagnóstica. Objetivo: proyectar la capacidad de cobertura de los programas de detección oportuna de cáncer de mama en México en función de los mastógrafos disponibles en las instituciones públicas del país. Material y métodos: se hizo un estudio exploratorio correlacionando la cantidad de mastógrafos del sector público con las mujeres entre 40 y 69 años quienes son el objetivo de los programas de tamizaje en México. El análisis consistió en calcular la población blanco-cubierta, a nivel nacional y por estado, asumiendo que cada mastógrafo pudiera ejecutar 6336 estudios de tamizaje al año. Todos los cálculos se realizaron con la información del año 2020 por ser los datos más actuales en materia de densidad poblacional. Resultados: se determinó que se cuenta con el número de mastógrafos suficiente como para elevar la oferta de estudios de tamizaje al 50% a nivel nacional. Incluso hay estados cuya capacidad de cobertura se proyecta por arriba del 70%. Algunos de ellos son Ciudad de México, Colima, Durango, Quintana Roo, Zacatecas, Baja California Sur y Coahuila. También se observó que la distribución de estos equipos no es equitativa, habiendo estados con grandes necesidades de inversión en equipo y, por ende, en estrategias de tamización para cáncer de mama. Conclusiones: nuestros datos demuestran que es posible incrementar la cobertura de los programas de detección oportuna de cáncer de mama en México, aunque es necesario mejorar las capacidades gerenciales de nuestros programas para que estos impacten en la cobertura, pero también en la calidad.

Relationship between Health Inequalities and Breast Cancer Survival in Mexican Women.

OBJECTIVE: We aimed to analyze the relationship between the survival of patients with breast cancer and health inequalities. METHODS: A retrospective cohort study of women with stage III breast cancer according to public healthcare was conducted. Groups were stratified according to the course of treatment and the presence of chronic disease other than cancer. Survival functions were estimated by using the Kaplan-Meier estimator, while the Cox proportional hazards model was employed for prognostic assessment. RESULTS: The study was performed on 964 breast cancer patients. One hundred and seventy-six patients (18.23%) died during the follow-up period and 788 (81.77%) were alive at the end of the follow-up period. Education, marital status, personal history of prior biopsies, and socioeconomic status (SES) were found to be linked with survival. However, only SES exceeded the baseline risk of mortality when the treatment cycle was interrupted (full treatment: unadjusted 4.683, p = 0.001; adjusted 4.888 p = 0.001, partial treatment: unadjusted 1.973, p = 0.012; adjusted 4.185, p = 0.001). The same effect was observed when stratifying by the presence of chronic disease other than cancer (with chronic disease adjusted HR = 4.948, p = 0.001; unadjusted HR = 3.303, p = 0.001; without chronic disease adjusted HR = 4.850, p = 0.001; unadjusted HR = 5.121, p = 0.001). CONCLUSION: Since lower SES was linked with a worse prognosis, strategies to promote preventive medicine, particularly breast cancer screening programs and prompt diagnosis, are needed.

Whole lesion histogram analysis of apparent diffusion coefficient predicts therapy response in locally advanced rectal cancer.

BACKGROUND: Whole-tumor apparent diffusion coefficient (ADC) histogram analysis is relevant to predicting the neoadjuvant chemoradiation therapy (nCRT) response in patients with locally advanced rectal cancer (LARC). AIM: To evaluate the performance of ADC histogram-derived parameters for predicting the outcomes of patients with LARC. METHODS: This is a single-center, retrospective study, which included 48 patients with LARC. All patients underwent a pre-treatment magnetic resonance imaging (MRI) scan for primary tumor staging and a second restaging MRI for response evaluation. The sample was distributed as follows: 18 responder patients (R) and 30 non-responders (non-R). Eight parameters derived from the whole-lesion histogram analysis (ADCmean, skewness, kurtosis, and ADC10th, 25th, 50th, 75th, 90th percentiles), as well as the ADCmean from the hot spot region of interest (ROI), were calculated for each patient before and after treatment. Then all data were compared between R and non-R using the Mann-Whitney U test. Two measures of diagnostic accuracy were applied: the receiver operating characteristic curve and the diagnostic odds ratio (DOR). We also reported intra- and interobserver variability by calculating the intraclass correlation coefficient (ICC). RESULTS: Post-nCRT kurtosis, as well as post-nCRT skewness, were significantly lower in R than in non-R (both P < 0.001, respectively). We also found that, after treatment, R had a larger loss of both kurtosis and skewness than non-R (∆%kurtosis and ∆skewness, P < 0.001). Other parameters that demonstrated changes between groups were post-nCRT ADC10th, ∆%ADC10th, ∆%ADCmean, and ROI ∆%ADCmean. However, the best diagnostic performance was achieved by ∆%kurtosis at a threshold of 11.85% (Area under the receiver operating characteristic curve [AUC] = 0.991, DOR = 376), followed by post-nCRT kurtosis = 0.78 × 10-3 mm2/s (AUC = 0.985, DOR = 375.3), ∆skewness = 0.16 (AUC = 0.885, DOR = 192.2) and post-nCRT skewness = 1.59 × 10-3 mm2/s (AUC = 0.815, DOR = 168.6). Finally, intraclass correlation coefficient analysis showed excellent intraobserver and interobserver agreement, ensuring the implementation of histogram analysis into routine clinical practice. CONCLUSION: Whole-tumor ADC histogram parameters, particularly kurtosis and skewness, are relevant biomarkers for predicting the nCRT response in LARC. Both parameters appear to be more reliable than ADCmean from one-slice ROI.

The apparent diffusion coefficient is a useful biomarker in predicting treatment response in patients with locally advanced rectal cancer.

BACKGROUND: Apparent diffusion coefficient (ADC) values achieve promising results in treatment response prediction in patients with several types of cancers. PURPOSE: To determine whether ADC values predict neoadjuvant chemoradiation treatment (nCRT) response in patients with locally advanced rectal cancer (LARC). MATERIAL AND METHODS: Forty-four patients with LARC who underwent magnetic resonance imaging scans before and after nCRT followed by delayed surgery were enrolled retrospectively. The sample was distributed as follows: responders (R), n = 8; and non-responders (Non-R), n = 36. Three markers of treatment response were considered: post-nCRT measures; ΔADC; and Δ%ADC. Statistical analysis included a Wilcoxon test, a Mann-Whitney U test, and a receiver operating characteristic (ROC) analysis in order to evaluate the diagnostic accuracy for each ADC value marker to differentiate between R and Non-R. RESULTS: Both minimum and mean ADC values were significantly higher after nCRT in the R group, while non-significant differences between basal and control ADC values were found in the non-R group. In addition, ΔADC and Δ%ADC exhibited increased values after nCRT in R when compared with non-R. ROC analysis revealed the following diagnostic performance parameters: post-nCRT: ADCmin = 1.05 × 10-3 mm2/s (sensitivity 61.1% and specificity 66.7%), ADCmean = 1.50 × 10-3 mm2/s (sensitivity 72.2% and specificity 83.3%), ΔADC: ADCmin = 0.35 (sensitivity 66.7% and specificity 83.3%), ADCmean = 0.50 (sensitivity 72% and specificity 83%); and Δ%ADC: ADCmin = 44% (sensitivity 66.7% and specificity 83.3%) and ADCmean = 60% (sensitivity 83% and specificity 99%). CONCLUSION: Our findings suggest that post-treatment rectal tumor ADC values, as well changes between pre- and post-treatment values, may be biomarkers for predicting treatment response in patients with LARC who underwent nCRT.

A Case Series of Breast Metastases from Different Extramammary Malignancies and Their Literature Review.

Metastasis to the breast from all other primary sites is unusual. Twelve patients were diagnosed between 2007 and 2017 at National Cancer Institute, Mexico. Solitary or multiple masses, round or oval, and hypoechoic and solid lesions with posterior acoustic shadowing were patterns commonly reported in these patients; other arrangements include diffuse involvement of the breast simulating an inflammatory carcinoma. The development of a breast metastasis is revealed, in our experience, as a negative prognostic factor. Thus, the radiologist should know about the varied appearance of metastatic breast lesions and provide radiopathological correlations when available.

Anxiolytic- and anxiogenic-like effects of Montanoa tomentosa (Asteraceae): Dependence on the endocrine condition.

ETHNOPHARMACOLOGICAL RELEVANCE: Montanoa tomentosa Cerv. (MT) is a native plant from Mexico used in traditional medicine as a remedy for reproductive impairments and relaxing effects. In previous studies, it has been shown that the endocrine state could modify the antianxiety-like actions of anxiolytic compounds. Although women are the primary user of MT, no studies have evaluated the potential impact of the endocrine milieu on its anti-anxiety actions. AIMS OF THE STUDY: Ascertain the antianxiety effects of M. tomentosa in rats with different hormonal conditions, and to analyze the participation of the GABAA receptor in ovariectomized rats treated with MT. MATERIALS AND METHODS: The animal model of anxiety used was the elevated plus-maze (EPM). Rats' endocrine conditions were: a) Low hormone levels (rats in diestrus I and II phases); b) High hormone levels (proestrus/estrus phases); c) No hormones (ovariectomized rats); and d) Rats under progesterone withdrawal (PW). To evaluate the participation of the GABAA receptor in the anxiolytic-like action of MT the antagonist picrotoxin was used. RESULTS: Results showed that MT induced dose-dependent anxiolytic-like actions in rats with low hormone level conditions. Also, MT reduced anxiety-like behavior in female rats under PW, in contrast to diazepam which was ineffective. MT's anxiolytic-like effect was blocked by picrotoxin, suggesting the participation of the GABAA receptor complex. However, increased anxiety-like behavior was observed in rats with a high hormone level condition and low doses of MT. CONCLUSIONS: Beneficial anxiolytic-like actions of MT are observed under low hormone conditions, particularly in the PW challenge (a condition that can be related to a premenstrual period). Furthermore, the participation of the GABAA receptor is evidenced. However, hormonal variations could induce the opposite effects, hence women should be cautious.

Impacto de la pandemia de Covid-19 en el tamizaje de cáncer de mama y algunas estrategias para actuar pronto y seguro / Impact of the Covid-19 pandemic on breast cancer screening and how to act quickly and safely

Resumen: Desde el comienzo de la pandemia de Covid-19 los servicios de prevención de cáncer de mama han sido aplazados gravemente. Esta acción provocó la reducción en el número acumulado de mastografías de detección a nivel mundial e incrementó las disparidades en salud, sobre todo entre las mujeres vulnerables. Si bien la evidencia que respalda las estrategias para rescatar el tamizaje con mastografía en la fase de resolución de la pandemia no es suficiente, hay algunas consideraciones pragmáticas que pueden guiar su recuperación y garantizar su continuidad. Una de estas estrategias es prever los retrasos en el tamizaje y abordarlos a través de programas seguros que se alineen con la situación epidemiológica actual. Las acciones planteadas en el presente ensayo están en consonancia con las iniciativas internacionales de garantizar la continuidad de los programas de tamizaje de cáncer de mama en atención a que el cuidado de las mujeres sea una acción prioritaria, continua y permanente.

Abstract: Prolonged delays in breast cancer screening related to the Covid-19 pandemic may lead to delayed diagnoses, poor health consequences, and an increase in cancer disparities among women already experiencing health inequities. There is a void in empirical high-quality evidence to support a specific strategy for administering cancer screening during a pandemic and its resolution phase, but several pragmatic considerations can help guide its recovery and ensure its continuity. One of these strategies is to address the backlogs in the diagnostic and follow-up of breast cancer, designing programs that align with the current epidemiological situation. Here, we present some approaches for the generation of breast cancer detection programs which embody recommendations and obligations to overcome the SARS-CoV-2. With this initiative, we reinforce our commitment to advance health care by ensuring more women have access to preventive care.

An Uncommon Case of Bilateral Breast Enlargement Diagnosed as Tumoral Pseudoangiomatous Stromal Hyperplasia: Imaging and Pathological Findings.

The incidence of reported pseudoangiomatous stromal hyperplasia (PASH), as well as the variability and severity of clinical presentations, is increasing in the literature. In parallel, several authors posit the need for an improved classification of PASH to avoid possible variables associated with this diagnosis. Here, we present a 25-year-old woman with PASH accompanied by severe bilateral and symmetrical breasts enlargement, highlighting an uncommon clinical presentation of PASH as much as the careful interdisciplinary review and correlation of histology and all available imaging studies to confirm the definitive diagnosis.

68Ga-DTPA Anti-HER2 positron emission tomography/CT successfully predicts the overexpression of human epidermal growth factor receptor in lung metastases from breast cancer.

Molecular identification of a metastatic tumour without the inconvenience of a biopsy and the time required for pathological characterization is possible using molecular imaging. Here, we present the case of a patient with breast cancer in whom 68Ga-diethylenetriamine pentaacetic acid anti-human epidermal growth factor receptor 2 positron emission tomography-CT was successfully employed to characterize the expression of human epidermal growth factor receptor 2 in metastatic sites.

GABAA/benzodiazepine receptor complex mediates the anxiolytic-like effect of Montanoa tomentosa.

ETHNOPHARMACOLOGICAL RELEVANCE: Montanoa tomentosa also named Cihuapatli is a native plant of Mexico that has been used in traditional medicine for the last five centuries mainly as a remedy for reproductive impairments. However, there are reports indicating that this plant was also consumed by Mexican ancient people for its relaxing properties. In order to corroborate this information, the present study was conducted to evaluate the effect of Montanoa tomentosa lyophilisate (MT) on rat׳s anxiety-like behavior and to analyze its mechanism of action. MATERIALS AND METHODS: The anxiolytic-like action of MT (1.5, 3.0, 6.0 and 12.0 mg/kg) was investigated in male Wistar rats tested in three animal models of anxiety: the burying behavior, the elevated plus maze and the hole-board tests. As a positive control, the anti-anxiety effects of different doses of the selective GABAA receptor agonist muscimol were also analyzed. In order to evaluate the participation of the GABAA and oxytocin receptors in the anxiolytic-like actions of MT, the GABAA receptors blockers picrotoxin (0.25 and 0.50 mg/kg), bicuculline (2.0 mg/kg) and flumazenil (5.00 and 10.0 mg/kg), the neurosteroid inhibitor finasteride (50.0 and 100 mg/kg) and the oxytocin receptor antagonist atosiban (0.25 µg) were used. Finally, to evaluate general activity, and motor coordination, the open field and rota-rod tests were used. RESULTS: MT at 3.0 mg/kg showed anxiolytic-like effects in the three anxiety paradigms without affecting reactivity, general motor activity or motor coordination; however, at higher doses sedative effects were observed. Picrotoxin (0.25 and 0.50 mg/kg), flumazenil (10.0 mg/kg) and finasteride (100 mg/kg) antagonized the anxiolytic-like actions of MT in the burying behavior test. In the plus maze and hole-board tests bicuculline (2.0 mg/kg) blocked the effects of the plant as well. Atosiban (0.25 µg) did not antagonize the anxiolytic-like actions of MT. CONCLUSIONS: The results corroborate the anxiolytic-like actions of Montanoa tomentosa and suggest that this effect is mediated through GABAA receptors but not oxytocin receptors.