Breast cancer in Jalisco: a spatial analysis of mortality in the 2010-2017 period.

INTRODUCTION: In 2017, INEGI reported 84,142 deaths from malignant tumors in Mexico, while the World Health Organization indicated that the breast cancer mortality rate in 2018 was 11.2 per 100,000 women. OBJECTIVE: To show the trend of breast cancer mortality in women by municipality and health region of Jalisco in the 2010-2017 period. METHOD: Analytical study in which standardized mortality rates and relative risks of 3873 women were estimated by municipality of residence. Dispersion and central tendency spatial statistics were used. RESULTS: The mortality rate increased from 10.7 to 13.0 per 100,000 women in the 2010-2017 period. The highest values were found in the municipalities of Chapala (21.2) and Guadalajara (19.5); the mortality rate increased in four out of every 10 municipalities, and relative risk was up to 50-fold higher in some of the western and central Jalisco municipalities. CONCLUSIONS: An annual increase of 1.0 % was observed, although it was territorially differentiated. The results represent an opportunity to improve timely detection and diagnostic processes, as well as to guarantee the coverage of services. INTRODUCCIÓN: En 2017, el INEGI reportó 84 142 defunciones por tumores malignos en México y la Organización Mundial de la Salud indicó que la tasa de mortalidad por cáncer de mama en 2018 fue de 11.2 por 100 mil mujeres. OBJETIVO: Mostrar la tendencia de la mortalidad por cáncer de mama en mujeres según municipio y región sanitaria de Jalisco en el periodo 2010-2017. MÉTODO: Estudio analítico en el que se estimaron tasas estandarizadas de mortalidad y riesgos relativos por municipio de residencia de 3873 mujeres. Se utilizó estadística espacial de dispersión y tendencia central. RESULTADOS: La tasa de mortalidad aumentó de 10.7 a 13.0 por 100 mil mujeres en el periodo 2010-2017. Los valores más altos se encontraron en los municipios de Chapala (21.2) y Guadalajara (19.5), la tasa de mortalidad aumentó en cuatro de cada 10 municipios y el riesgo relativo fue hasta 50 veces mayor en algunos del occidente y centro de Jalisco. CONCLUSIONES: Se observó un incremento de 1.0 % anual, aunque territorialmente diferenciado. Los resultados representan una oportunidad para mejorar los procesos de detección y diagnóstico oportunos, así como para garantizar la cobertura de los servicios.

Androgen receptor expression and prognosis in Hispanic/Latino women with triple negative breast cancer.

INTRODUCTION AND OBJECTIVE: Triple-negative breast cancer (TNBC) is an aggressive subtype that has no available molecular targets. It occurs most often in premenopausal African-American and Hispanic/Latino women. In Colombia, its prevalence has been reported to be 20.6%. Androgen receptor (AR) belongs to the steroid nuclear receptor family and has been recently considered a potential biomarker for breast cancer. Considering the high prevalence of TNBC in Colombian women and the lack of knowledge of AR expression, our aim was to determine the frequency of AR expression and its association with pathological variables. MATERIALS AND METHODS: 149 women diagnosed with TNBC between 2011 and 2014 were included. Clinical and pathological data were obtained from medical and pathology reports. Information on hormone receptor status, Ki67 expression and HER2 was reevaluated by a pathologist. AR expression was considered positive when it exceeded 1% of nuclear staining in tumor cells. RESULTS: AR expression was detected in 41.6% of the samples. Although we did not find statistically significant differences in clinic-pathological variables according to AR expression, patients with AR expression over 50% were younger (53.92 years vs. 60.78 years, p=0.027) and presented higher Ki67 expression (64.06% vs. 47.32%, p=0.05), compared to patients with a low AR expression. The median overall survival in our sample of TNBC patients was 2.45 years. CONCLUSIONS: The expression of AR in our sample was similar to the expression in populations of European descent. We found statistically significant differences in age at diagnosis and Ki67 expression according to AR expression.

Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions.

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions. / Voluntariado radiológico para apoyar un programa de detección precoz del cáncer de mama en Perú: descripción del proyecto, presentación de los primeros resultados e impresiones.

Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.

[Participation of the immigrant population in breast cancer screening in Tarragona, Spain]. / Participación de la población inmigrante en el cribado de cáncer de mama de Tarragona, España.

OBJECTIVE: To evaluate the differences between autochthonous and allochthonous women's participation in a breast cancer screening programme. METHOD: Retrospective study based on data from the Breast Cancer Screening Programme of the province of Tarragona (2008-2015). The sample is the target population of the programme with known country of origin. RESULTS: Cohort of 40,824 women. Allochthonous women participate less than autochthonous women (41.8% vs. 72.3%) although they have a similar global detection rate to the latter but with differences according to the human development index of their country of origin. Both groups present similar tumour stages on detection (p=.59). CONCLUSIONS: Strategies specifically aimed at the immigrant population are required to improve their participation in breast cancer screening.

Aporte espiritual/religioso pela enfermagem no tratamento do câncer de mama: revisão integrativa / Spiritual/religious support for nursing in the treatment of breast cancer: integrative review / Apoyo espiritual/religioso de la enfermería en el tratamiento del cáncer de mama: revisión integrativa

Objetivo: analisar na literatura científica a importância da abordagem espiritual/religiosa pela equipe de enfermagem no tratamento do câncer de mama. Método: revisão integrativa, realizada na BDENF, LILACS e SCOPUS. Resultados: foram selecionados seis estudos, evidenciou-se que a abordagem espiritual/religiosa pelos profissionais de enfermagem auxilia para o enfrentamento positivo do câncer de mama. Assim, emergiu a categoria.: Abordagem espiritual/religiosa na assistência de enfermagem e suas repercussões positivas para o enfrentamento do câncer de mama. Conclusão: a categoria da enfermagem integra a rede de apoio social para o alívio do sofrimento, por meio do aporte espiritual/religioso, auxiliando para a minimização de sentimentos negativos associados ao diagnóstico e aos eventos adversos dos tratamentos, sendo importante incluir discussões acerca desta temática na formação de nível técnico e graduação em enfermagem.

Objective: to analyze in the scientific literature the importance of the spiritual/religious approach by the nursing team in the treatment of breast cancer. Method: integrative review, carried out in BDENF, LILACS and SCOPUS. Results: six studies were selected, showing that the spiritual/religious approach by nursing professionals helps to cope positively with breast cancer. Thus, the following category emerged: Spiritual/religious approach in nursing care and its positive repercussions for coping with breast cancer. Conclusion: the nursing category is part of the social support network for relieving suffering, through spiritual/religious support, helping to minimize negative feelings associated with the diagnosis and adverse treatment events, and it is important to include discussions on this topic in technical and undergraduate nursing training.

Objetivos:analizar la importancia del abordaje espiritual/religioso por el equipo de enfermería en el tratamiento del cáncer de mama en la literatura científica. Método: revisión integradora, realizada en BDENF, LILACS y SCOPUS. Resultados: fueron seleccionados seis estudios que demuestran que el abordaje espiritual/religioso por profesionales de enfermería ayuda a enfrentar positivamente el cáncer de mama. Surgió la siguiente categoría: Enfoque espiritual/religioso en los cuidados de enfermería y sus repercusiones positivas para el afrontamiento del cáncer de mama. Conclusión: la categoría de enfermería forma parte de la red de apoyo social para aliviar el sufrimiento, a través del apoyo espiritual/religioso, ayudando a minimizar los sentimientos negativos asociados al diagnóstico y a los eventos adversos de los tratamientos, siendo importante incluir discusiones sobre este tema en la formación técnica y de pregrado de enfermería.

[Knowledge and attitude among general practitioners in Andalusia (Spain) on the identification of subjects at high risk of breast and colorectal cancer]. / Conocimientos y actitudes de los médicos de Atención Primaria de Andalucía (España) sobre la detección de personas con riesgo elevado de cáncer de mama y colorrectal.

AIMS: To assess the knowledge and attitude among general practitioners in Andalusia on the identification of subjects with elevated risk for breast cancer, colorectal cancer, and hereditary cancers, as well as to detect barriers to accessibility to the screening programs. METHODS: A descriptive, cross-sectional study was conducted based on an online survey of 24 questions. Data are shown as frequencies, and association tests were statistically used. The level of significance was set at<.05. RESULTS: Survey response rate was 32%, of which 224 were valid, and included 56% men, and a mean age±DE of 46±12 years. Established criteria for high risk breast cancer were already known by 71.4% [95% CI 65-76], being worst in those living in big cities (P<.014). Among general practitioners, 86% were allowed to order mammography in women with lumps or at moderate to high risk for breast cancer. As regards colorectal cancer, 87.9% of general practitioners knew the risk factors. Among general practitioners, 58.2% [95% CI 49-62] were allowed to order a colonoscopy if clinical suspicion was present, especially if they lived in large cities (P<.0001). CONCLUSIONS: The screening program for breast cancer is well-known by general practitioners, and the access to mammography is successful. Most of the general practitioners consider the follow-up program for persons at high risk for colorectal cancer appropriate, although half of those surveyed had some barriers to ordering colonoscopy. Knowledge on hereditary cancer is limited, and varies among areas. There is also a general lack of awareness on hereditary cancer and genetic counselling units.

Hallazgos mastográficos benignos que simulan malignidad: un dilema diagnóstico / Benign mammographic findings that simulate malignancy: a diagnostic dilemma

Resumen OBJETIVO: Identificar los principales hallazgos histopatológicos benignos y determinar la tasa de falsos positivos que suelen causar conflicto al categorizar las mastografías en el sistema BI-RADS por su aspecto, que puede simular un proceso maligno. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo, efectuado en pacientes atendidas en la Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) con reporte mastográfico alterado o sospecha clínica de malignidad. Para el análisis estadístico se utilizó el programa JASP 2.0 y χ2 para la diferencia de proporciones entre grupos. RESULTADOS: De un grupo de 11,481 pacientes, se reportaron 1643 mastografías alteradas: 444 con reportes falsos positivos, 23 pacientes con sospecha clínica y exclusión de 16 que no cumplieron con los criterios de inclusión establecidos. La muestra poblacional estudiada fue de 451 pacientes. La mayoría permaneció asintomática al momento del estudio (42.1%). El hallazgo histopatológico benigno con mayor prevalencia fue el fibroadenoma y su síntoma más relevante el nódulo palpable. La tasa de falsos positivos fue de 4.3%. CONCLUSIONES: En la actualidad, gracias a la implementación de programas de tamizaje es posible establecer diagnósticos de cáncer de mama en etapas tempranas, aunque con la desventaja que el reporte puede resultar falso positivo y ello dar lugar a incremento de la morbilidad y sobretratamiento. Los estándares internacionales indican que estos no deben sobrepasar el 10%.

Abstract OBJECTIVE: To identify the main benign histopathological findings that often cause conflict when categorizing mastographies in the BI-RADS system due to their appearance, which may simulate a malignant process and false positive rate. MATERIALS AND METHODS: Retrospective cohort study carried out in patients attended at the Unidad Médica de Alta Especialidad 4 Luis Castelazo Ayala (2019-2023) with an altered mastographic report or clinical suspicion of malignancy. For statistical analysis we used the JASP 2.0 programme and χ2 for the difference in proportions between groups. RESULTS: From a group of 11,481 patients, 1,643 altered mastograms were reported: 444 with false positive reports, 23 patients with clinical suspicion and exclusion of 16 who did not meet the established inclusion criteria. The population sample studied was 451 patients. The majority remained asymptomatic at the time of the study (42.1%). The most prevalent benign histopathological finding was fibroadenoma and the most relevant symptom was a palpable nodule. The false positive rate was 4.3%. CONCLUSIONS: Currently, thanks to the implementation of screening programmes it is possible to establish breast cancer diagnoses in early stages, although with the disadvantage that the report may be false positive and this may lead to increased morbidity and overtreatment. International standards indicate that these should not exceed 10%.

Mastectomia preventiva em situações de câncer de mama precoce / Preventive mastectomy in situations of early breast cancer: an integrative review

A mastectomia preventiva relacionada às neoplasias de mama precoces é um tema de grande importância na área da oncologia, especialmente para mulheres com alto risco genético de desenvolver câncer de mama. Objetivo: Descrever como a mastectomia relaciona-se com a prevenção de neoplasias de mama precoces. Métodos: Trata-se de uma revisão integrativa da literatura. Para construção da pesquisa, a coleta e análise de dados foi realizada através do Portal da Biblioteca Virtual da Saúde e da base de dados Medical Literature Analysis and Retrievel System Online via PubMed, através dos Descritores em Ciências da Saúde (DeCS): "Mastectomia Profilática", "Neoplasias da Mama" e "Fatores de Risco" combinados entre si pelo operador booleano AND. Como critérios de inclusão: estudos relacionados à temática excluindo-se as revisões de literatura, com delimitação temporal dos últimos cinco anos, nos idiomas inglês, português e espanhol. A questão norteadora foi construída com base na estratégia PICo de acordo com a descrição (População, Interesse e Contexto). Resultados: Foram encontrados 76 artigos, destes 64 foram excluídos devido aos filtros utilizados e a leitura dos resumos e na íntegra, restando apenas 12 estudos para compor a amostra final. Em suma, os estudos demonstram que a mastectomia preventiva pode oferecer às mulheres com alto risco genético uma opção para reduzir suas chances de desenvolver câncer de mama. Conclusão: A mastectomia preventiva relacionada às neoplasias de mama precoces é uma opção terapêutica complexa e individualizada, que busca reduzir o risco de desenvolvimento ou recorrência do câncer de mama em mulheres de alto risco

: Preventive mastectomy related to early breast neoplasms is a topic of great concern in the field of oncology, especially for women with a high genetic risk of developing breast cancer. Objective: To describe how mastectomy is related to the prevention of early breast cancer. Methods: This is an integrative literature review. For the construction of the research, data collection and analysis was carried out through the Virtual Health Library Portal and the Medical Literature Analysis and Retrievel System Online database via PubMed, through the Health Sciences Descriptors (DeCS): "Prophylactic Mastectomy","Breast Neoplasms" and "Risk Factors" combined with the Boolean AND operator. As inclusion criteria: studies related to the theme excluding literature reviews,with publication time delimitation of the last five years, in English, Portuguese and Spanish. The research question was structured based on the PICo strategy according to the description (Population, Interest and Context). Results: 76 articles were found, of which 64 were excluded after the filters application. We performed the reading of abstracts and full text, and 12 studies were selected to compose the final sample. In summary, studies demonstrate that preventive mastectomy can offer women at high genetic risk an option to reduce their chances of developing breast cancer. Conclusion: Preventive mastectomy related to early breast neoplasms is a complex and individualized therapeutic option that seeks to reduce the risk of breast cancer development or recurrence in high-risk women

[Primary breast synovial sarcoma]. / Sarcoma sinovial primario de mama.

Primary synovial sarcoma of the breast is very rare. We report a case of a 33-year-old woman, who had previously undergone a radical mastectomy, having been diagnosed with fusocellular breast carcinoma. Histopathology revealed a hypercellular lesion formed by spindle cells with storiform and herringbone patterns. Immunohistochemistry showed strong expression of vimentin and CD99, and focal bcl2, EMA, CK AE1-AE3, actin and desmin, with negativity for S100, CD34, CK7, CK14, CK19, hormone receptors, caldesmon and myosin. Molecular biology revealed the expression of the fusion product of the SS18 and SSX genes, indicative of the translocation t(X;18)(p11.2;q11.2), which confirmed the diagnosis of synovial sarcoma.

Estudo de avaliabilidade das ações para detecção precoce do câncer de mama na atenção primária / Evaluability study of actions for early detection of breast cancer in primary care

RESUMO O artigo tem como objetivo desenvolver um modelo avaliativo das ações de detecção precoce do câncer de mama na atenção primária. Trata-se de um estudo de avaliabilidade, realizado pelas etapas de análise documental, revisão de literatura e reunião de consenso para elaboração da matriz avaliativa. O resultado obtido foi o desenvolvimento da Matriz de Análise e Julgamento, composta por 14 indicadores, agregados em duas dimensões. A aplicação do modelo avaliativo permitirá a identificação das fragilidades e potencialidades das ações de detecção precoce do câncer de mama.

ABSTRACT The article aims to develop an evaluative model of actions for the early detection of breast cancer in primary care. This evaluability study was conducted through document analysis, literature review, and consensus meeting stages to prepare the evaluative matrix. The result was the development of the Analysis and Judgment Matrix, composed of 14 indicators aggregated into two dimensions. Applying the evaluative model will allow the identification of the weaknesses and strengths of actions for the early detection of breast cancer.

Impacto da COVID-19 no rastreamento do câncer de mama no Sistema Único de Saúde (SUS) / Impact of COVID-19 on breast cancer screening in the Brazilian Unified Health System (SUS)

Objetivos: investigar o impacto da pandemia no rastreamento do câncer de mama no Sistema Único de Saúde e comparar os dados obtidos com os de outros países. Métodos: foi realizado um estudo observacional transversal quantitativo, com dados provenientes do Sistema de Informação do Câncer ­ SISCAN sobre o número de mamografias feitas de 2014 a 2022 por mulheres, no Brasil. Resultados: os dados referentes à mamografia na população de risco elevado demonstraram uma queda de 38,39% de 2019 para 2020. Enquanto na mamografia de rastreamento a queda foi ligeiramente maior, de 39,18% nesse mesmo período. Em relação à mamografia diagnóstica, a redução foi de 33,15%, e na mamografia de população-alvo, o ápice foi em 2019 com 2.721.075. Em contrapartida, a realização de mamografia em pacientes já tratadas, teve uma menor queda, de 9,35%. Conclusões: observou-se uma queda significativa no número de mamografias realizadas em 2019 e 2020, o que poderá acarretar em diagnósticos tardios da doença e piores prognósticos (AU).

Objectives: investigating the impact of the pandemic on breast cancer screening in the Unified Health System, in addition to comparing the data obtained from other countries. Methods: a quantitative cross-sectional observational study was carried out, with references from the Cancer Information System - SISCAN on the number of mammograms performed from 2014 to 2022 by women in Brazil. Results: data regarding mammography in the high-risk population showed a drop of 38,39% from 2019 to 2020. While in screening mammography, the decline was slightly more significant, at 39.18% in the same period. Regarding diagnostic mammography, the reduction was 33.15%, and in target population mammography, the peak was in 2019 with 2.721.075. On the other hand, the performance of mammography in patients already treated had a smaller decrease of 9.35%. Conclusions: there was a significant reduction in the number of mammograms performed in 2019 and 2020, which might lead to a late diagnosis of the disease and a worse prognosis (AU),

Diagnósticos de enfermagem baseados na repercussão do câncer mamário e mastectomia / Nursing diagnoses based on breast cancer repercussion and mastectomy / Diagnósticos de enfermería basados en repercusión y mastectomía del cáncer de mama

Objetivo: Descrever diagnósticos de Enfermagem baseados nos discursos de mulheres sobre a repercussão do câncer mamário e mastectomia. Métodos: Trata-se de pesquisa descritiva, com abordagem qualitativa, realizada em uma Organização Não Governamental (ONG) no município de João Pessoa, Paraíba, Brasil. O universo amostral foi composto por todas as 15 mulheres mastectomizadas durante os meses de setembro e outubro de 2017. Essas mulheres responderam um roteiro de entrevista semiestruturada. A análise dos dados qualitativos foi norteada pela Técnica de Análise de Conteúdo proposta por Bardin. Após a delimitação das categorias, foram construídos diagnósticos de Enfermagem por meio da Classificação Internacional da Prática de Enfermagem (CIPE)®. Resultados: Foram identificadas três categorias temáticas: Sentimentos experenciados após diagnóstico de câncer e realização da mastectomia; Modificações biológicas e psicológicas após a mastectomia; Resiliência diante do sofrimento. Os diagnósticos de Enfermagem elencados foram: angústia, bem-estar prejudicado, bem-estar espiritual prejudicado, autoestima alterada, autoimagem alterada, capacidade de autocuidado prejudicada, dificuldades diárias, distúrbio da identidade pessoal, insatisfação com a vida e o corpo. Conclusão: é necessário enfatizar o cuidado no momento de verbalizar o diagnóstico, a escuta diante do outro e a percepção das mulheres diante do processo de adoecimento. (AU)

Objective: To describe nursing diagnoses based on women's discourse on the repercussions of breast cancer and mastectomy. Methods: This is a descriptive research, with a qualitative approach, carried out in a Non-Governmental Organization (NGO) in the city of João Pessoa, Paraíba, Brazil. The sample universe was composed of all 15 women undergoing mastectomy during the months of September and October 2017. These women answered a semi-structured interview script. The analysis of qualitative data was guided by the Content Analysis Technique proposed by Bardin. After delimiting the categories, Nursing diagnoses were constructed using the International Classification of Nursing Practice (ICNP) ®. Results: Three thematic categories were identified: Feelings experienced after cancer diagnosis and mastectomy; Biological and psychological changes after mastectomy; Resilience in the face of suffering. The nursing diagnoses listed were anguish, impaired well-being, impaired spiritual well-being, impaired self-esteem, impaired self-image, impaired self-care capacity, daily difficulties, personal identity disorder, dissatisfaction with life and body. Conclusion: it is necessary to emphasize care when verbalizing the diagnosis, listening to the other and the women's perception of the illness process. (AU)

Objetivo: Describir los diagnósticos de enfermería basados en el discurso de las mujeres sobre las repercusiones del cáncer de mama y la mastectomía. Métodos: Se trata de una investigación descriptiva, con enfoque cualitativo, realizada en una Organización No Gubernamental (ONG) en la ciudad de João Pessoa, Paraíba, Brasil. El universo muestral estuvo compuesto por las 15 mujeres sometidas a mastectomía durante los meses de septiembre y octubre de 2017. Estas mujeres respondieron un guión de entrevista semiestructurado. El análisis de datos cualitativos fue guiado por la Técnica de Análisis de Contenido propuesta por Bardin. Después de delimitar las categorías, los diagnósticos de enfermería se construyeron utilizando la Clasificación Internacional de la Práctica de Enfermería (CIPE) ®. Resultados: Se identificaron tres categorías temáticas: sentimientos experimentados después del diagnóstico de cáncer y mastectomía; Cambios biológicos y psicológicos después de la mastectomía; Resiliencia ante el sufrimiento. Los diagnósticos de enfermería enumerados fueron angustia, deterioro del bienestar, deterioro del bienestar espiritual, deterioro de la autoestima, deterioro de la autoimagen, deterioro de la capacidad de autocuidado, dificultades diarias, trastorno de la identidad personal, insatisfacción con la vida y el cuerpo. Conclusion: es necesario enfatizar el cuidado al verbalizar el diagnóstico, escuchar al otro y la percepción de la mujer sobre el proceso de la enfermedad. (AU)

Respuesta tumoral a la quimioterapia neoadyuvante en subtipos moleculares de cáncer de mama en Medellín, Colombia. Estudio de cohorte retrospectivo / Tumor response to neoadjuvant chemotherapy in molecular breast cancer subtypes in Medellin, Colombia. Retrospective cohort study

Objetivos: Describir la frecuencia de la respuesta clínica y patológica, entre los diferentes subtipos moleculares de cáncer de mama, en pacientes que previamente recibieron quimioterapia neoadyuvante. Materiales y métodos: Cohorte retrospectiva, descriptiva. Se incluyeron mujeres mayores de 18 años, con diagnóstico histológico de carcinoma invasivo de mama, en estadios IIA, IIB, IIIA, IIIB y IIIC, con clasificación por subtipos moleculares, que hubieran recibido quimioterapia neoadyuvante, atendidas en una clínica de alto nivel de complejidad localizada en Medellín (Colombia), entre el 1 de julio de 2017 y el 30 de julio de 2019. Las variables recolectadas fueron edad, estadio clínico, características histológicas, clasificación molecular y la respuesta clínica y patológica completa por subtipo molecular. Se realizó análisis descriptivo. Resultados: 255 pacientes cumplieron con los criterios de inclusión. La edad media fue de 55,2 años; los estadios clínicos con mayor prevalencia fueron IIIB (28,6 %) y IIB (26,3 %), respecto al grado histológico, los más frecuentes fueron grado 3 (48,2 %) y 2 (37,3 %). La frecuencia por subtipos moleculares fue: luminal A (10,2 %), luminal B HER2 negativo (39,6 %), triple negativo (23,1 %), luminal B HER2 positivo (13,7 %), y HER2 puro (13,3 %). La respuesta clínica completa posquimioterapia por subtipo molecular fue: luminal A (26,9 %), luminal B HER2 negativo (37,6 %), luminal B HER2 positivo (48,6 %), HER2 puro (41,2 %), triple negativo (45,8 %); se logró respuesta patológica completa por subtipo molecular, así: luminal A (19,2 %), luminal B HER2 negativo (32,7 %), luminal B HER2 positivo (54,3 %), HER2 puro (50 %), triple negativo (42,4 %). Conclusiones: En la práctica clínica, la clasificación por subtipos moleculares en cáncer de mama permite hacer una aproximación a la respuesta de la quimioterapia neoadyuvante. Se requieren estudios prospectivos en la región para determinar la capacidad predictiva de la respuesta patológica completa respecto a la sobrevida global y libre de enfermedad.

Objectives: To describe the frequency of clinical and pathological response in different molecular subtypes of breast cancer, in patients receiving prior neoadjuvant chemotherapy. Materials and methods: Descriptive retrospective cohort. The study population consisted of women 18 years of age and older with a histological diagnosis of invasive breast cancer stages IIA, IIB, IIIA, IIIB and IIIC, with a classification by molecular subtypes, who had received prior neoadjuvant chemotherapy, seen at a high complexity clinic in Medellin (Colombia), between July 1, 2017, and July 30, 2019. We measured age clinical stage, histological characteristics, molecular classification, and complete clinical and pathological responses by molecular subtype. A descriptive analysis was conducted. Results: Overall, 255 patients met the inclusion criteria. Mean age was 55.2 years; the clinical stages with the highest prevalence were IIIB (28.6 %) and IIB (26.3 %), and the most frequent by histologic grading were grades 3 (48.2 %) and 2 (37.3 %). Frequency by molecular types was as follows: luminal A (10.2 %), HER2-negative luminal B (39.6 %), triple-negative (23.1%), HER2-positive luminal B (13.7 %), and pure HER2 (13.3 %). Complete clinical response following chemotherapy, by molecular type, was as follows: luminal A (26.9 %), HER2-negative luminal B (37.6 %), HER2-positive luminal B (48.6 %), pure HER2 (41.2 %), triple-negative (45.8 %). Complete pathological response by molecular subtype was achieved in the luminal A (19.2 %), HER2-negative luminal B (32.7 %), HER2-positive luminal B (54.3 %), pure HER2 (50 %) and triple-negative (42.4 %) subtypes. Conclusions: In clinical practice, breast cancer classification by molecular subtypes is a means to approach the assess the to neoadjuvant chemotherapy. Se requieren estudios prospectivos en la región para determinar la capacidad predictiva de la respuesta patológica completa respecto a la sobrevida global y libre de enfermedad.

Caracterização de teses e dissertações sobre neoplasia mamária em homens / Characterization of theses and dissertations on breast cancer in men / Caracterización de tesis y disertaciones sobre cáncer de mama masculino

Objetivo: caracterizar as teses e dissertações disponíveis no banco de teses da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior que abordem a neoplasia mamária masculina. Método: Realizou-se uma revisão de literatura, de caráter bibliométrico, selecionando 7 estudos, por meio de check list previamente estabelecido. Resultados: Identificou-se que 85,7% dos estudos selecionados eram dissertações de mestrado, publicadas entre 2007 e 2019. A maioria foi produzida na Universidade de São Paulo (42,8%). Quanto à publicação de artigos originados das teses e dissertações, 71,4% dos autores não publicaram. Conclusão: embora os métodos de diagnóstico do câncer de mama tenham avançado, a produção científica sobre o câncer de mama masculino ainda se faz incipiente no Brasil. Esse é um dado importante que pode auxiliar na elaboração de novos trabalhos, objetivando um melhor atendimento e prognóstico nesses pacientes.

Objective: to characterize the theses and dissertations available in the theses bank of the Coordination for the Improvement of Higher Education Personnel that address male breast cancer. Method: A bibliometric literature review was carried out, selecting 7 studies, using a previously established checklist. Results: We identified that 85.7% of the selected studies were master's theses, published between 2007 and 2019. Most were produced at the University of São Paulo (42.8%). As for the publication of articles originating from theses and dissertations, 71.4% of the authors did not publish. Conclusion: although methods for diagnosing breast cancer have advanced, scientific production on male breast cancer is still incipient in Brazil. This is an important fact that can help in the development of new studies, aiming at better care and prognosis for these patients.

Objetivo: caracterizar tesis y disertaciones disponibles en el banco de tesis de la Coordinación de Perfeccionamiento del Personal de Educación Superior que abordan el cáncer de mama masculino. Método: Se realizó una revisión bibliométrica de la literatura, seleccionando 7 estudios a través de un checklist previamente establecido. Resultados: Se identificó que el 85,7% de los estudios seleccionados fueron tesis de maestría, publicadas entre 2007 y 2019. La mayoría fueron producidos en la Universidad de São Paulo (42,8%). Cuanto la publicación de artículos provenientes de tesis y disertaciones, el 71,4% de los autores no publicó. Conclusión: aunque los métodos de diagnóstico del cáncer de mama han avanzado, la producción científica sobre el cáncer de mama masculino es aún incipiente en Brasil. Este es un hecho importante que puede ayudar en el desarrollo de nuevos estudios, con el objetivo de mejorar la atención y el pronóstico de estos pacientes.

Incidência de câncer de mama em trabalhadoras agrícolas do Paraná / Incidence of breast cancer in female agricultural workers in Paraná / Incidencia de cáncer de mama en trabajadoras agrícolas de Paraná

É crescente, nas últimas duas décadas, o número de estudos brasileiros sobre a incidência do câncer de mama, contudo, ainda há carência de trabalhos que avaliem este indicador em populações agrícolas. Objetivou-se analisar a incidência de câncer de mama feminino em trabalhadoras agrícolas residentes no estado do Paraná, no período de 2003 a 2018. Foi realizado um estudo ecológico, exploratório, transversal, constituído pelos casos novos de mulheres diagnosticadas com câncer de mama notificados no Registro Hospitalar de Câncer, entre 2003 e 2018. Calculou-se a taxa de incidência dos novos casos de câncer de mama, usando como referência o número de trabalhadoras agrícolas registradas na Relação Anual de Informações Sociais (RAIS). A regressão linear simples foi utilizada para avaliar as variações anuais da taxa, com intervalo de confiança de 95% (IC95%). E ainda, foram estimadas as Razão de Chances ou Odds Ratio (OR) (IC95%) de ocorrência do agravo para esse grupo ocupacional. A taxa de incidência variou de 136,61 casos por 100 mil trabalhadoras agrícolas em 2003 a 1.225,49/100 mil em 2018. Houve acréscimo significativo de 0,014 casos/100 mil a cada ano (p<0,001) ao longo dos 16 anos da série temporal. As trabalhadoras agrícolas tiveram, em todo o período, maiores chances de desenvolver câncer de mama, quando comparadas com trabalhadoras de outros setores (OR 14,85, IC95% 12,70 - 17,36 em 2018). Conclui-se que a incidência do câncer de mama em trabalhadoras agrícolas é significativa no Paraná e que, ser estar empregada neste setor, aumentou significativamente as chances de desenvolver câncer de mama. A partir desses dados, espera-se auxiliar na elaboração de políticas, orientando prioridades e ações de redução da incidência e mortalidade deste agravo, contribuindo com o alcance da meta 3 "saúde e bem estar' dos Objetivos do Desenvolvimento Sustentável (ODS).

In the last two decades, the number of Brazilian studies on the incidence of breast cancer has been increasing; however, there is still a lack of studies that evaluate this indicator in agricultural populations. We aimed to analyze the incidence of female breast cancer in agricultural workers residing in the state of Paraná, in the period from 2003 to 2018. An ecological, exploratory, cross-sectional study was conducted, consisting of the new cases of women diagnosed with breast cancer notified in the Hospital Cancer Registry, between 2003 and 2018. The incidence rate of new cases of breast cancer was calculated, using as reference the number of female agricultural workers registered in the Annual Social Information Report (RAIS). Simple linear regression was used to evaluate the annual variations of the rate, with a 95% confidence interval (95% CI). We also estimated the Odds Ratio (OR) (95%CI) of occurrence of the grievance for this occupational group. The incidence rate ranged from 136.61 cases per 100,000 female agricultural workers in 2003 to 1,225.49/100,000 in 2018. There was a significant increase of 0.014 cases/100 thousand each year (p<0.001) over the 16 years of the time series. Female agricultural workers had higher odds of developing breast cancer over the entire period compared to female workers in other sectors (OR 14.85, 95% CI 12.70 - 17.36 in 2018). It is concluded that the incidence of breast cancer in female agricultural workers is significant in Paraná and that being a worker in this sector, significantly increases the chances of developing breast cancer. From these data, it is expected to assist in policymaking, guiding priorities and actions to reduce the incidence and mortality of this grievance, contributing to the achievement of goal 3 'health and well-being' of the Sustainable Development Goals (SDGs).

En las últimas dos décadas, el número de estudios brasileños sobre la incidencia de cáncer de mama ha ido en aumento, sin embargo, todavía hay una falta de estudios que evalúen este indicador en poblaciones agrícolas. Tuvimos como objetivo analizar la incidencia de cáncer de mama femenino en trabajadoras agrícolas residentes en el estado de Paraná, en el período de 2003 a 2018. Se realizó un estudio ecológico, exploratorio, transversal, constituido por los casos nuevos de mujeres con diagnóstico de cáncer de mama notificados en el Registro Hospitalario de Cáncer, entre 2003 y 2018. Se calculó la tasa de incidencia de nuevos casos de cáncer de mama, tomando como referencia el número de trabajadoras agrarias registradas en el Informe Anual de Información Social (RAIS). Se utilizó regresión lineal simple para evaluar las variaciones anuales de la tasa, con un intervalo de confianza del 95% (IC 95%). También se estimó la Odds Ratio (OR) (IC 95%) de ocurrencia del agravio para este grupo ocupacional. La tasa de incidencia osciló entre 136,61 casos por 100.000 trabajadoras agrarias en 2003 y 1.225,49/100.000 en 2018. Hubo un aumento significativo de 0,014 casos/100 mil cada año (p<0,001) a lo largo de los 16 años de la serie temporal. Las trabajadoras agrícolas tuvieron mayores probabilidades de desarrollar cáncer de mama durante todo el período en comparación con las trabajadoras de otros sectores (OR 14,85; IC 95% 12,70 - 17,36 en 2018). Se concluye que la incidencia de cáncer de mama en trabajadoras agrícolas es significativa en Paraná y que ser trabajadora de este sector, aumenta significativamente las probabilidades de desarrollar cáncer de mama. A partir de estos datos, se espera ayudar en la formulación de políticas, orientando prioridades y acciones para reducir la incidencia y mortalidad de este agravio, contribuyendo a la consecución del objetivo 3 'salud y bienestar' de los Objetivos de Desarrollo Sostenible (ODS).

A percepção e conduta sobre a medida da pressão arterial em pacientes com neoplasia de mama em cardiologistas e mastologistas / The perception and management of blood pressure measurement in patients with breast cancer in cardiologists and mastologistas

Embora pacientes submetidas ao tratamento cirúrgico para Neoplasia de Mama, de modo geral e frequente, recebam orientações para não medir a pressão arterial no braço homolateral ao seu tratamento, devemos reavaliar contemporaneamente e cientificamente estas recomendações. O propósito deste trabalho é demonstrar os dados de Medicina Baseada em Evidências e considerar a evolução da abordagem cirúrgica neste grupo de pacientes, atualizando estas recomendações e demostram dados de enquete sobre o assunto entre médicos de diferentes especialidades. Há suficiente suporte científico e explicações para que orientemos de forma individualizada e coerentemente estas pacientes em relação a medida da pressão arterial e consequentemente sua relação com o aparecimento do linfedema no braço homolateral, porém a Sociedade Brasileira de Cardiologia, pelo seu Departamento de Hipertensão Arterial não tem recomendações sobre este assunto. Que deve ser contextualizado devido a má percepção sobre o assunto, em repostas a uma enquete feita com Cardiologistas e Mastologistas sobre este tema (AU)

Although patients undergoing surgical treatment for breast cancer are often advised against measuring blood pressure in the arm on the same side as their treatment, it is crucial to reevaluate these recommendations using contemporary and scientific evidence. The objective of this study is to present empirical data on Evidence-Based Medicine and explore the evolving surgical approaches in this patient population. By updating these recommendations and showcasing survey results from physicians across different specialties, we aim to provide comprehensive guidance on the topic. While there is ample scientific support and explanations to individually and coherently guide these patients regarding blood pressure measurement and its potential association with lymphedema in the affected arm, it is important to note that the Brazilian Society of Cardiology, specifically its Department of Arterial Hypertension, does not currently offer recommendations on this matter. This contextualization is necessary due to the limited awareness and understanding of the subject, as revealed through responses obtained from Cardiologists and Mastologists participating in our survey.

Prevalencia de subtipos de cáncer de mama y su asociación con factores reproductivos / Prevalence of breast cancer subtypes and their association with reproductive factors

Introducción: Los factores reproductivos se asocian con cáncer de mama. Actualmente se estudia el comportamiento según subtipos moleculares. Objetivo: Establecer la prevalencia de estos subtipos y su asociación con factores reproductivos en mujeres atendidas en centros del nororiente colombiano. Método: Estudio observacional de corte transversal, en mujeres con cáncer de mama subtipos luminales y HER2 durante 2012-2021. Se indagaron variables sociodemográficas, factores reproductivos y estadio tumoral. Resultados: En total, 347 pacientes cumplieron criterios de elegibilidad, correspondiendo a luminal A el 49,8% (intervalo de confianza del 95% [IC95%]: 44,5-55,1), a luminal B el 29,1% (IC95%: 24,3-33,9) y a HER2 el 15,5% (IC95%: 11,7-19,4). Las mujeres con tumores de mama luminal B tenían más riesgo de tener estadios localmente avanzados (odds ratio [OR]: 1,83; IC95%: 1,11-3,01; p = 0,02). Agrupando los subtipos luminales frente a HER2 se encontró que el 40,72% de las pacientes con subtipos luminales no habían lactado, frente al 69,71% con HER2 (diferencia estadísticamente significativa a favor de luminal A; OR: 1,91; IC95%: 1,02-3,53; p = 0,041). Conclusiones: La prevalencia de tumores luminales es del 84,5%. Existe asociación diferencial entre el antecedente de lactancia materna y la aparición de subtipos luminales, es decir, las mujeres que no lactaron se corresponden con mayor frecuencia con HER2. No se estableció asociación con otros factores estudiados.

Introduction: Stimulus-estrogenic factors are associated with breast cancer. Currently, the behavior according to molecular subtypes is being studied. Objective: To establish the prevalence of these subtypes and their association with reproductive factors in women attended in centers in northeastern Colombia. Method: Observational cross-sectional study in women with breast cancer subtypes luminal and HER2 during 2012 -2021. Sociodemographic variables, stimulus-estrogenic factors and tumor stage were investigated. Results: In total, 347 patients met eligibility criteria, corresponding to luminal A 49.8% (95% confidence interval [95%CI]: 44.5-55.1), luminal B 29.1% (95%CI: 24.3-33.9) and HER2 15.5% (95%CI: 11.7-19.4). Women with luminal B breast tumors were at higher risk of having locally advanced stages (odds ratio [OR]: 1.83; 95%CI: 1.11-3.01; p = 0.02). Grouping the luminal subtypes versus HER2 showed that 40.72% of patients with luminal subtypes had not lactated, compared to 69.71% HER2 (statistically significant difference in favor of luminal A; OR: 1.91; 95%CI: 1.02-3.53; p = 0.041). Conclusions: The prevalence of luminal tumors is 84.5%. There is a differential association between the history of breastfeeding and the appearance of luminal subtypes, i.e., women who did not breastfeed are more likely to have HER2. No association was established with other factors studied.

Márgenes quirúrgicos en afeitado de cavidad en cuadrantectomía por cáncer de mama / Surgical margins in shaved cavity in quadrantectomy for breast cancer in Medellín, Colombia

Resumen OBJETIVOS: Determinar la utilidad del afeitado de la cavidad de la cuadrantectomía por cáncer de mama en la reducción de reoperación y explorar sus factores asociados y describir las características sociodemográficas y clínicas de las pacientes. MATERIALES Y MÉTODOS: Estudio de cohorte, retrospectivo y descriptivo efectuado entre el 1 enero de 2017 y el 31 de diciembre de 2018 en pacientes mayores de 18 años con diagnóstico histológico de carcinoma invasivo e in situ de mama a quienes se practicó cuadrantectomía con afeitado de todos los márgenes de la cavidad. Se trata del registro de las pacientes de un cirujano de Medellín, Colombia. Se recopilaron datos demográficos, clínicos, paraclínicos y se analizaron con estadística descriptiva. RESULTADOS: Se incluyeron 194 pacientes con edad media de 61.6 años. Los márgenes fueron negativos en el 85.6% (n = 161) y positivos en el 14.4% (n = 28). La cavidad afeitada estaba afectada en el 16% (n = 31), no se requirió reintervención en el 95.9% (n = 186) y se reintervinieron 4.1% (n = 8). La reducción de la reintervención fue del 10.3% (n = 20%). Los factores asociados con márgenes positivos fueron: marcación con arpón (OR = 1.19; IC95%: 1.07-1,32; p = 0.04), tumor multifocal (OR = 3.95; IC95%: 2.29-6.81; p = 0.00), afeitado afectado (OR = 3.26; IC95%: 1.75-6.04). Entre los grupos no se encontró mayor riesgo de recurrencia local (OR = 0.85; IC95%: 0.80-0.90; p = 0.35). CONCLUSIONES: El afeitado de todos los márgenes de la cavidad de la cuadrantectomía tuvo una reducción en la tasa de márgenes afectados y disminución de las reintervenciones. Los factores asociados con márgenes positivos fueron: marcación con arpón, tumor multifocal y el daño del afeitado; no hubo mayor riesgo de recurrencia.

Abstract OBJECTIVES: To determine the usefulness of quadrantectomy cavity shaving for breast cancer in reducing reoperation and to explore its associated factors and describe sociodemographic and clinical data of the patients. MATERIALS AND METHODS: A retrospective, descriptive, retrospective cohort study conducted between January 1, 2017 and December 31, 2018 in patients older than 18 years with histologic diagnosis of invasive and in situ breast cancer who underwent quadrantectomy with shaving of all cavity margins. This is the registry of patients of a surgeon in Medellin, Colombia. Demographic, clinical, and paraclinical data were collected and analyzed using descriptive statistics. RESULTS: 194 patients with a mean age of 61.6 years were included. The margins were negative in 85.6% (n = 161) and positive in 14.4% (n = 28). The shaved cavity was involved in 16% (n = 31), no reintervention was required in 95.9% (n = 186), and 4.1% (n = 8) underwent reintervention. The reduction in reoperation was 10.3% (n=20). Factors associated with positive margins were: harpoon marking (OR = 1.19; 95%CI: 1.07-1.32; p = 0.04), multifocal tumor (OR = 3.95; 95%CI: 2.29-6.81; p = 0.00), affected shave (OR = 3.26; 95%CI: 1.75-6.04). No increased risk of local recurrence was found between groups (OR = 0.85; 95%CI: 0.80-0.90; p = 0.35). CONCLUSIONS: Shaving all margins of the quadrantectomy cavity was associated with a lower rate of involved margins and fewer reinterventions. Factors associated with positive margins were: harpoon marking, multifocal tumor, and shave damage; there was no increased risk of recurrence.

Avaliação de indicadores de monitoramento do rastreamento do câncer de mama na população do sexo feminino atendida no Sistema Único de Saúde, Brasil, 2018-2019: estudo descritivo / Evaluación de indicadores del tamizaje de cáncer de mama en la población femenina atendida en el Sistema Único de Salud, Brasil, 2018-2019: estudio descriptivo / Evaluation of breast cancer screening indicators in the female population using the National Health System, Brazil, 2018-2019: a descriptive study

Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.