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Human inflammatory breast cancer (IBC) and canine inflammatory mammary cancer (IMC) are highly aggressive neoplastic diseases that share numerous characteristics. In IBC and IMC, chemotherapy produces a limited pathological response and anti-androgen therapies have been of interest for breast cancer treatment. Therefore, the aim was to evaluate the effect of a therapy based on bicalutamide, a non-steroidal anti-androgen, with doxorubicin and docetaxel chemotherapy on cell proliferation, migration, tumor growth, and steroid-hormone secretion. An IMC-TN cell line, IPC-366, and an IBC-TN cell line, SUM149, were used. In vitro assays revealed that SUM149 exhibited greater sensitivity, reducing cell viability and migration with all tested drugs. In contrast, IPC-366 exhibited only significant in vitro reductions with docetaxel as a single agent or in different combinations. Decreased estrogen levels reduced in vitro tumor growth in both IMC and IBC. Curiously, doxorubicin resulted in low efficacy, especially in IMC. In addition, all drugs reduced the tumor volume in IBC and IMC by increasing intratumoral testosterone (T) levels, which have been related with reduced tumor progression. In conclusion, the addition of bicalutamide to doxorubicin and docetaxel combinations may represent a potential treatment for IMC and IBC.
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Anilidas , Proliferação de Células , Docetaxel , Neoplasias Inflamatórias Mamárias , Neoplasias Mamárias Animais , Nitrilas , Compostos de Tosil , Compostos de Tosil/farmacologia , Humanos , Animais , Feminino , Nitrilas/farmacologia , Nitrilas/uso terapêutico , Linhagem Celular Tumoral , Anilidas/farmacologia , Cães , Neoplasias Inflamatórias Mamárias/tratamento farmacológico , Neoplasias Inflamatórias Mamárias/patologia , Neoplasias Inflamatórias Mamárias/metabolismo , Proliferação de Células/efeitos dos fármacos , Docetaxel/farmacologia , Neoplasias Mamárias Animais/tratamento farmacológico , Neoplasias Mamárias Animais/patologia , Neoplasias Mamárias Animais/metabolismo , Doxorrubicina/farmacologia , Camundongos , Sobrevivência Celular/efeitos dos fármacos , Movimento Celular/efeitos dos fármacos , Protocolos de Quimioterapia Combinada Antineoplásica/farmacologia , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Ensaios Antitumorais Modelo de Xenoenxerto , Antineoplásicos/farmacologia , Antineoplásicos/uso terapêutico , TestosteronaRESUMO
The triple-negative breast cancer (TNBC) subtype is characterized by the lack of expression of ERα (estrogen receptor α), PR (progesterone receptor) and no overexpression of HER-2. However, TNBC can express the androgen receptor (AR) or estrogen receptor ß (ERß). Also, TNBC secretes steroid hormones and is influenced by hormonal fluctuations, so the steroid inhibition could exert a beneficial effect in TNBC treatment. The aim of this study was to evaluate the effect of dutasteride, anastrozole and ASP9521 in in vitro processes using human TNBC cell lines. For this, immunofluorescence, sensitivity, proliferation and wound healing assays were performed, and hormone concentrations were studied. Results revealed that all TNBC cell lines expressed AR and ERß; the ones that expressed them most intensely were more sensitive to antihormonal treatments. All treatments reduced cell viability, highlighting MDA-MB-453 and SUM-159. Indeed, a decrease in androgen levels was observed in these cell lines, which could relate to a reduction in cell viability. In addition, MCF-7 and SUM-159 increased cell migration under treatments, increasing estrogen levels, which could favor cell migration. Thus, antihormonal treatments could be beneficial for TNBC therapies. This study clarifies the importance of steroid hormones in AR and ERß-positive cell lines of TNBC.
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Androgênios , Neoplasias de Mama Triplo Negativas , Humanos , Androgênios/farmacologia , Receptores de Estrogênio , Neoplasias de Mama Triplo Negativas/tratamento farmacológico , Neoplasias de Mama Triplo Negativas/metabolismo , Receptor beta de Estrogênio/genética , Receptor beta de Estrogênio/metabolismo , Linhagem Celular Tumoral , Estrogênios/farmacologia , Receptores Androgênicos/metabolismo , Esteroides/farmacologia , Receptor alfa de Estrogênio , Proliferação de CélulasRESUMO
PURPOSE: The purpose of this study was to evaluate the frequency and clinical presentation of conjunctivitis in hospitalized patients with COVID-19. METHODS: A cross-sectional study was conducted at the Hospital Clinico San Carlos of Madrid, Spain. A total of 301 subjects from the COVID admission unit with laboratory-confirmed SARS-CoV-2 infection were included. The presence and clinical characteristics of conjunctivitis were evaluated. Laboratory, radiological, and clinical results in patients with and without conjunctivitis stratified by sex were analyzed. RESULTS: Of the 301 subjects included, 180 patients (59.8%) were male and the median age was 72 years (IQ 59-82). Overall, 35 patients (11.6%) were diagnosed with acute conjunctivitis. We found no relationship between the COVID-19 severity score and the presence of conjunctivitis (P = 0.17). However, conjunctivitis was more frequent in males with moderate clinical severity and in women classified as clinically mild. The natural history of the disease seems to be a rapid self-limited conjunctivitis that improves without treatment and does not affect visual acuity nor associate short-term complications. CONCLUSIONS: Approximately, 1 out of 10 hospitalized non-critical COVID-19 patients presents conjunctivitis during the disease. Compared with other viral conjunctivitis, we found distinctive clinical findings that could guide defining and differentiating conjunctivitis in COVID-19 patients. TRIAL REGISTRATION NUMBER: 20/336_E_COVID.
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Betacoronavirus/isolamento & purificação , Conjuntivite Viral/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções Oculares Virais/epidemiologia , Pneumonia Viral/epidemiologia , Idoso , Idoso de 80 Anos ou mais , COVID-19 , Conjuntivite Viral/diagnóstico , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Infecções Oculares Virais/diagnóstico , Feminino , Hospitalização , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Prevalência , Fatores de Risco , SARS-CoV-2 , Espanha/epidemiologiaAssuntos
Implantes de Mama/efeitos adversos , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/patologia , Linfoma Anaplásico de Células Grandes/diagnóstico por imagem , Linfoma Anaplásico de Células Grandes/etiologia , Adulto , Implante Mamário , Neoplasias da Mama/etiologia , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Biópsia Guiada por Imagem , Linfoma Anaplásico de Células Grandes/patologia , Imageamento por Ressonância Magnética , Mamoplastia , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Mastectomia Profilática , Ultrassonografia MamáriaRESUMO
BACKGROUND: Risk-reducing mastectomy is recommended for high-risk patients but may have significant psychological consequences. This study aimed to determine the differences in anxiety, depressive symptomatology, body image and quality of life in women with an increased risk of breast cancer immediately before and after undergoing risk-reducing mastectomy. METHODS: Eighty-eight women with an increased risk of breast cancer due to BRCA1/2 mutations or a previous cancer diagnosis participated in this study. Instruments used were the Hospital Anxiety and Depression Scale, Body Image Scale and the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and Breast 23, administered 15-30 days before and after surgery. RESULTS: Following surgery, there was an immediate and significant worsening in anxiety, depressive symptomatology and body image. There was a significant deterioration in global, physical, role, and social functioning, as well as in body image and sexual enjoyment scales. Additionally, there were increases in fatigue, nausea and vomiting, constipation, dyspnoea, insomnia, appetite loss, perceived financial difficulties, pain, systemic therapy side effects, and breast and arm symptoms. However, there was an improvement in future perspective. These changes occurred independently of whether participants had a cancer diagnosis or BRCA1/2 mutation. CONCLUSION: Risk-reducing mastectomies have immediate psychological consequences. While these procedures improve future health perspective, they increase anxiety and depressive symptomatology and decrease body image and quality of life, regardless of cancer diagnosis or BRCA1/2 mutation. These findings highlight the psychological consequences of such surgical procedures, emphasizing the need for comprehensive psychological interventions both before and after surgery.
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Background: The paradigm of healthcare has evolved toward patient-centered approaches, where shared decision-making (SDM) plays a pivotal role. This study aimed to explore the implementation of SDM during breast cancer reconstruction consultations and assess its impact on patient satisfaction and the decision-making process as a whole. Methods: A total of 102 female patients undergoing breast reconstruction were included in a multidisciplinary breast pathology unit. A streamlined SDM model involving choice introduction, option description, and preference exploration was implemented. A validated Spanish version of the nine-item Shared Decision Making Questionnaire was used alongside a complementary questionnaire. Data analysis was carried out using electronic data capture software. Results: The nine-item Shared Decision Making Questionnaire results indicate strong agreement in presenting various options and explaining their advantages and disadvantages. Patients were less confident about their participation in decision-making. The Complementary Shared Decision Making Questionnaire highlighted high satisfaction with interview times and language clarity but areas for improvement in consultation space and therapeutic choice participation. Conclusions: Integrating SDM into breast reconstruction consultations empowers patients in the decision-making process and enhances satisfaction. Decision aids prove effective in this context, facilitating patients' comprehension and reducing decisional conflict. There are areas for improvement within the SDM strategy, and they are detectable through scales. Although challenges in information transmission and patient involvement persist, adopting an SDM model has potential benefits that warrant further investigation.
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BACKGROUND: Pelvic inflammatory disease is manifested by a broad spectrum of genital tract infections that include: endometritis, salpingitis, tubo-ovarian abscess, and pelvic peritonitis. This disease is associated with evidence of inflammation of the lower genital tract. OBJECTIVE: To evaluate the subgroup of patients with a diagnosis of acute pelvic inflammatory disease requiring hospitalization after implementation of the protocol for action in the patient with suspected pelvic inflammatory disease. MATERIAL AND METHODS: Retrospective analysis conducted between January and December 2011 in a cohort of patients diagnosed with severe pelvic inflammatory disease after implementation of a hospital protocol for suspected patients with this condition. Patients who met the diagnostic criteria of Centers for Disease Control and Prevention (CDC) and required hospitalization were considered with severe pelvic inflammatory disease. In all cases the same complementary tests were conducted and the same antibiotic protocol was prescribed. RESULTS: We included 38 patients and found a statistically significant relationship between the IUD and mixed gram-negative flora etiologic agent (p < 0.05). There was a negative correlation (Pearson correlation coefficient -0.334) between elevated leukocyte at the time of admission and the need for surgery. CONCLUSIONS: In cases of severe pelvic inflammatory disease IUD is associated with gram-negative mixed flora infection. The normal or moderately elevated concentrations of leukocytes were correlated with failure of medical treatment.
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Doença Inflamatória Pélvica/diagnóstico , Doença Inflamatória Pélvica/terapia , Adulto , Protocolos Clínicos , Feminino , Humanos , Estudos Retrospectivos , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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Neoplasias da Mama , Mamoplastia , Proteína BRCA1/genética , Neoplasias da Mama/genética , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/cirurgia , Feminino , Humanos , Mastectomia , Mutação , Qualidade de VidaRESUMO
Risk-reducing surgeries decrease the risk of developing breast cancer by 95%. But this type of surgery can be life-changing. This systematic review analyzed anxiety/depressive symptomatology, body image and quality of life on BRCA1/2 mutation carriers with or without a previous oncological history who have undergone risk-reducing mastectomy. PRISMA method was used to conduct this review. The initial search identified 234 studies. However, only 7 achieved the inclusion criteria. No statistically significant differences were found in terms of anxious symptomatology. One study found that depressive symptomatology had increased significantly in women without previous oncological history at the long-term follow-up measure. Women who underwent bilateral risk-reducing mastectomy and implant-based breast reconstruction tended to be satisfied with their body image/cosmetic outcome. No differences were reported at long-term follow-ups, independently of the surgery performed.
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OBJECTIVE: The objective of the study was to compare the time difference between diagnose and treatment with relation to switching protocols in screening program, DEPRECAM; and to analyze the screening program over our sample. METHODS: It is a retrospective study involving 173 patients with two no time concurrent clinical cohorts referred from DEPRECAM program to San Carlos Clinic Hospital (HCSC) between March 2017 and January 2019. It was compared the time differences between the group forwarded to Breast Pathology service (Group A; n=92) and the group directly forwarded to Radiology department (Group B; n=81), using the non-parametric Mann-Whitney U test, estimating the difference of the means together with its 95% confidence interval. RESULTS: The averaged time to final diagnosis for group A and group B was 38.55 and 35.01 days respectively; and averaged time to treatment was 102.46 and 95.6 days. The difference between groups was not statistically significant (diagnosis p=0.999; treatment p=0.451). The correlation between sizes recognized in imaging test was reasonable. The consistency between imaging test and Histopathology was weak. CONCLUSIONS: The change in protocol does not reduce time significantly.
OBJETIVO: El objetivo del estudio fue comparar la diferencia de tiempos hasta el diagnóstico y tratamiento del cáncer de mama, en relación con el cambio de protocolo en el programa de cribado DEPRECAM, así como analizar dicho programa sobre nuestra muestra. METODOS: Se trató de un estudio retrospectivo de 173 pacientes, con dos cohortes clínicas no concurrentes en el tiempo, derivadas desde el Programa Regional de Detección Precoz del Cáncer de Mama (DEPRECAM) al Hospital Clínico San Carlos (HCSC) entre marzo de 2017 y enero de 2019. Se compararon las diferencias de tiempos entre un grupo remitido a consulta de Patología Mamaria (grupo A, n=92) y otro grupo derivado directamente a Radiología (grupo B, n=81), mediante el test no paramétrico U de Mann-Whitney, estimando la diferencia de las medias junto a su intervalo de confianza al 95%. RESULTADOS: La media de tiempo hasta el diagnóstico definitivo del grupo A y del grupo B fue de 38,55 días y 35,01 días, respectivamente, y hasta el tratamiento de 102,46 y 95,6 días, respectivamente. La diferencia entre los tiempos no fue estadísticamente significativa (diagnóstico: p=0,999; tratamiento: p=0,451). La correlación entre los tamaños hallados en las distintas pruebas de imagen fue moderada, siendo débil la fuerza de concordancia entre las pruebas de imagen y el estudio histopatológico. CONCLUSIONES: El cambio de protocolo no reduce el tiempo de manera significativa.
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Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/terapia , Feminino , Hospitais , Humanos , Mamografia , Programas de Rastreamento/organização & administração , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Avaliação de Programas e Projetos de Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , EspanhaRESUMO
BACKGROUND: Surgery for the primary tumor in metastatic breast cancer is usually not recommended, assuming that local therapy provides no advantage. Recent reports suggest a survival improvement after locoregional treatment, but this is still controversial. We aimed to evaluate the effectiveness of locoregional treatment in primary metastatic breast cancer and to determine associated factors. METHODS: A retrospective analysis of 39 women with de-novo metastatic breast cancer at La Paz University Hospital, from January 2012 to June 2016, grouped by locoregional treatment (n=23) or not (n=16). Multivariate assessment of prognostic factors was performed using Cox regression analysis. RESULTS: Mean tumor size was 6 cm. Eighteen patients (46.2%) had multifocal tumors, 29 (74.4%) multicentric and 10 (25.7%) bilateral breast cancer. Eighteen patients (46.2%) had an oligometastatic disease and 21 (53.8%) multiorgan metastatic disease. The average time from diagnosis to surgery was 7.7 months, without delay in the start of systemic treatment compared to the no-surgery group. The main surgical procedure was mastectomy in 18 (78.3%) patients. Half of the patients survived 48 months (95% CI: 39-57). In the multivariate analysis, we have not detailed differences in survival by age, chemotherapy, neoadjuvancy, number of systemic treatment lines, radiotherapy, and tumor histology or grade. However, surgery (HR=0.2; 95% CI: 0.07-0.57) and high tumor burden (HR=2.96, 95% CI: 1.23-7.13) have acted as a protective and a risk factor respectively. CONCLUSIONS: Our cohort supports that locoregional treatment in selected patients with de-novo MBC significantly improved survival, so it might be considered in combination with systemic therapy.
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Neoplasias da Mama/patologia , Mastectomia/métodos , Idoso , Neoplasias da Mama/terapia , Feminino , Hospitais Universitários , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Metástase Neoplásica , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Fatores de Risco , Espanha , Taxa de Sobrevida , Tempo para o TratamentoRESUMO
INTRODUCTION: The completion of postmastectomy breast reconstruction (BR) in women with breast cancer can last from months to years, and to our knowledge, there is a lack of studies that analyse how the different types and times of reconstruction impact on the patient's quality of life and psychosocial adjustment.The primary aim of the BREast Cancer Reconstruction (BRECAR Study) is twofold. First, to describe health-related quality of life (HRQoL), overall satisfaction with surgery and psychological impact (body image, self-esteem, depression and anxiety) on women who will have undergone a mastectomy with planned BR, considering the varied timing of BR procedures (immediate BR (iBR), delayed BR (dBR) and two-stage BR (2sBR)). To measure the impact on surgical outcomes, we will obtain data prior to and after surgery (6-9 and at 18 months of follow-up). Second, to analyse sociodemographic, clinical and psychosocial factors associated with HRQoL, satisfaction with surgery and psychological impact. METHODS AND ANALYSIS: A prospective, observational, clinical cohort study of women diagnosed with breast cancer who have an indication for mastectomy treated at La Paz University Hospital (Madrid, Spain).Patients will be classified into one of three groups under conditions of routine clinical practice, based on the type of BR planned: the iBR group, the dBR group and the 2sBR group.Under typical clinical practice conditions, we will perform three visits: baseline visit (presurgery), V1 (6-9 months after diagnosis) and V2 (18 months after diagnosis). A sample size of 210 patients is estimated. ETHICS AND DISSEMINATION: The study protocol and informed consent form have been reviewed and approved by the Institutional Review Board of La Paz Hospital (no. PI-2036). Dissemination of results will be via journal articles and conference presentations.
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Neoplasias da Mama/psicologia , Neoplasias da Mama/cirurgia , Mamoplastia/métodos , Qualidade de Vida , Ansiedade , Imagem Corporal/psicologia , Depressão , Feminino , Humanos , Mastectomia , Análise Multivariada , Satisfação do Paciente , Estudos Prospectivos , Análise de Regressão , Projetos de Pesquisa , Autoimagem , Espanha , Fatores de TempoRESUMO
El Consejo Genético Oncológico (CGO) es una herramienta útil para la detección de familias con alto riesgo cáncer de mama/ ovario hereditario, con la detección de mutaciones patogénicas en los genes BRCA1 y 2. Objetivo: valorar la percepción de riesgo de cáncer en mujeres con historia personal y/o familiar de cáncer de mama/ ovario hereditario, valorar la percepción de riesgo en función de la detección de la presencia/ ausencia de una mutación patogénica en el estudio genético, y de la medida preventiva elegida tras la realización del estudio genético (seguimiento periódico o cirugía reductora de riesgo). Método: se realizó una valoración de variables sociodemográficas, clínicas y percepción de riesgo de cáncer retrospectivamente en un grupo de mujeres portadoras de mutación sometidas a estudio genético desde 1998, y prospectivamente en un grupo de mujeres sometidas a estudio genético a partir de 2015. La muestra global estaba compuesta por 262 mujeres (173 mujeres recién estudiadas y 89 mujeres portadoras de mutación estudiadas previamente). Resultados: se encontraron diferencias significativas en las mujeres que decidieron optar por una cirugía reductora de riesgo, que presentaban una percepción de riesgo mayor que las que eligieron seguimiento y se observó una disminución significativa de esa percepción tras llevar a cabo la cirugía. Conclusiones: se resalta la necesidad de evaluar la percepción de riesgo de las participantes en CGO. (AU)
The cancer genetic counseling oncology helps for detecting families at high risk for hereditary breast/ovarian cancer, due to BRCA1/2 pathogenic mutations. Objective: To assess the perception of cancer risk in women with a personal and/or family history of hereditary breast/ovarian cancer, assess the perception of risk based on the detection of the presence/absence of a pathogenic mutation, and the preventive measure chosen after completion of the study genetic (periodic follow-up or risk-reducing surgery). Method: an assessment of sociodemographic and clinical variables and perception of cancer risk was carried out retrospectively in a group of women carriers of the mutation who underwent genetic testing since 1998, and prospectively in a group of women who underwent genetic testing since 2015. The global sample was made up of 262 women (173 newly studied women and 89 previously studied mutation carrier women). Result: Significant differences were found in women who decided to opt for risk-reducing surgery, who presented a higher risk perception than those who chose follow-up, and a significant decrease in this perception was observed after carrying out the surgery. Conclusions: It is necessary to evaluate the perception of risk of the participants in CGO. (AU)
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Humanos , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Neoplasias da Mama/genética , Neoplasias Ovarianas/genética , Aconselhamento Genético , Neoplasias da Mama/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Fatores Socioeconômicos , Estudos Prospectivos , Grau de RiscoRESUMO
Objetivo: analizar los niveles de sintomatología ansiosa y depresiva, imagen corporal y calidad de vida en un grupo de mujeres con vulnerabilidad genética de cáncer de mama que se iban a someter a una mastectomía reductora de riesgo. Método: 184 mujeres participaron en este estudio, todas ellas tenían riesgo aumentado de cáncer de mama, bien por ser portadoras de una mutación BRCA1/2 o por agregación familiar. Los instrumentos utilizados fueron: Escala de Ansiedad y Depresión Hospitalaria, Escala de Imagen Corporal, European Organisation for Research and Treatment of Cancer calidad de vida oncológica C30y BR23. Resultados: Los resultados de este estudio mostraron que las participantes presentaban niveles clínicos en sintomatología ansiosa y subclínicos en sintomatología depresiva. Sin embargo, se encontraban en niveles normativos en imagen corporal y calidad de vida. Las participantes con antecedentes oncológicos manifestaban, mayor insatisfacción con la imagen corporal, niveles inferiores en las escalas de funcionamiento físico, cognitivo y global de la calidad de vida, así como mayor fatiga, dolor general, en el brazo y en la mama en comparación con las mujeres sin diagnósticos previos. Conclusiones: Las mujeres sin mutación poseían mayor sintomatología en la mama y en el brazo que las mujeres con mutación, las cuales presentaban más dificultades económicas que las mujeres no portadoras. Evidenciando la necesidad de realizar una intervención psicológica antes de la cirugía especialmente en este colectivo (AU)
Aim: analyze depressive and anxiety symptomatology, body image and quality of life in a group of women with genetic vulnerability to breast cancer who were going to undergo a risk-reducing mastectomy. Method:184 women participated in this study, all of whom had an increased risk of breast cancer, either because they were BRCA1/2 mutation carriers or because they had several affected relatives. The psychological instruments used were: Hospital Anxiety and Depression Scale, Body Image Scale, European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Core 30 and BR23. Results: The results of this study showed that the participants presented clinical anxiety symptomatology and subclinical depressive symptomatology. However, all the sample were at normative levels in body image and quality of life. Participants with previous diagnosis of cancer showed, higher dissatisfaction with their body image, lower levels on the scales of physical, and cognitive and global functioning on quality of life, as well as higher fatigue, more general pain also in the breast and in the arm compared to women without diagnosis. Conclusions: BRCA1/2 non-mutation carriers showed more symptomatology in the breast and in the arm fatigue than BRCA1/2 mutation carriers. BRCA1/2 mutation carriers had more economic difficulties than non-carriers. It is highly recommended a psychological intervention before a risk-reducing surgery. (AU)
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Humanos , Feminino , Pessoa de Meia-Idade , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/psicologia , Mastectomia Profilática/psicologia , Ansiedade/psicologia , Depressão/psicologia , Estudos Transversais , Biomarcadores Tumorais/sangue , Qualidade de Vida/psicologia , Imagem Corporal/psicologiaRESUMO
Objetivo. Conocer la situación actual de la cirugía locorregional y reconstrucción mamaria (RM) en pacientes con cáncer de mama metastásico (CMM) en España. Método. Desde abril a septiembre de 2016 se recogieron datos de una encuesta online difundida a médicos implicados en el tratamiento de este grupo de pacientes. Resultados. Hubo un total de 124 encuestados: 46% cirujanos plásticos, 17,5% cirujanos generales, 30% ginecólogos especializados en enfermedad mamaria y 6,5% de otras especialidades no quirúrgicas. El 47,5% de los encuestados indicó la cirugía locorregional en el CMM al diagnóstico. El 80% de los encuestados aceptó la RM en el CMM, de los cuales un 71,5% lo consideraría previa solicitud por la paciente. En pacientes que no recibirán radioterapia, el 84% de los encuestados optó por RM inmediata, el 72,5% mediante prótesis. En pacientes radiadas, el 77,5% de los encuestados optó por reconstrucción autóloga, un 74,5% con colgajo miocutáneo dorsal ancho; no hubo diferencias entre RM inmediata o RM diferida. Factores considerados para aceptar la RM fueron una expectativa de vida de al menos 2 años, las comorbilidades, la carga tumoral, la respuesta al tratamiento sistémico o un tiempo de enfermedad estable superior a 6 meses. Motivos para no realizar la RM fueron un mal pronóstico asociado y el riesgo de progresión metastásica ante la suspensión temporal del tratamiento sistémico. Conclusión. La mitad de los encuestados consideró la RM en una paciente con CMM al diagnóstico, valorando la carga tumoral, la expectativa de vida y la enfermedad estable. Se necesitan protocolos de actuación al respecto (AU)
Objective. To identify the current situation of locoregional surgery and breast reconstruction (BR) in patients with metastatic breast cancer (MBC) in Spain. Method. From April to September 2016, data were collected from an online survey sent to physicians involved in treating this group of patients. Results. There were 124 respondents: 46% plastic surgeons, 17.5% general surgeons, 30% gynecologists specialized in breast disease and 6.5% physicians from other specialties. A total of 47.5% of the respondents recommended locoregional surgery in MBC at the time of diagnosis. Eighty percent of respondents performed BR in MBC, of which 71.5% would consider it after a patient request. In patients not receiving radiotherapy, 84% of respondents chose immediate BR, 72.5% of them with a prosthesis. In irradiated patients, 77.5% of respondents preferred autologous reconstruction, 74.5% of them with latissimus dorsi myocutaneous flap. There were no differences between immediate BR or delayed-BR. Factors important in the decision to accept or refuse BR were a life expectancy of at least 2 years, the patient's comorbidities, tumor burden, response to systemic treatment, or more than 6 months of stable disease. The reasons for not performing BR were a poor prognosis and the risk of metastatic progression due to a temporary suspension of systemic treatment. Conclusion. Half of the respondents considered BR in a patient with MBC at diagnosis, assessing tumor burden, life expectancy, and stable disease. Protocols are required in this regard (AU)
Assuntos
Humanos , Feminino , Mamoplastia , Neoplasias da Mama/cirurgia , Mastectomia/métodos , Pesquisas sobre Atenção à Saúde/estatística & dados numéricos , Metástase Neoplásica/terapia , Satisfação do Paciente/estatística & dados numéricosRESUMO
OBJETIVO: El objetivo del estudio fue comparar la diferencia de tiempos hasta el diagnóstico y tratamiento del cáncer de mama, en relación con el cambio de protocolo en el programa de cribado DEPRECAM, así como analizar dicho programa sobre nuestra muestra. MÉTODOS: Se trató de un estudio retrospectivo de 173 pacientes, con dos cohortes clínicas no concurrentes en el tiempo, derivadas desde el Programa Regional de Detección Precoz del Cáncer de Mama (DEPRECAM) al Hospital Clínico San Carlos (HCSC) entre marzo de 2017 y enero de 2019. Se compararon las diferencias de tiempos entre un grupo remitido a consulta de Patología Mamaria (grupo A, n=92) y otro grupo derivado directamente a Radiología (grupo B, n=81), mediante el test no paramétrico U de Mann-Whitney, estimando la diferencia de las medias junto a su intervalo de confianza al 95%. RESULTADOS: La media de tiempo hasta el diagnóstico definitivo del grupo A y del grupo B fue de 38,55 días y 35,01 días, respectivamente, y hasta el tratamiento de 102,46 y 95,6 días, respectivamente. La diferencia entre los tiempos no fue estadísticamente significativa (diagnóstico: p = 0,999; tratamiento: p = 0,451). La correlación entre los tamaños hallados en las distintas pruebas de imagen fue moderada, siendo débil la fuerza de concordancia entre las pruebas de imagen y el estudio histopatológico. CONCLUSIONES: El cambio de protocolo no reduce el tiempo de manera significativa
OBJECTIVE: The objective of the study was to compare the time difference between diagnose and treatment with relation to switching protocols in screening program, DEPRECAM; and to analyze the screening program over our sample. METHODS: It is a retrospective study involving 173 patients with two no time concurrent clinical cohorts referred from DEPRECAM program to San Carlos Clinic Hospital (HCSC) between March 2017 and January 2019. It was compared the time differences between the group forwarded to Breast Pathology service (Group A; n=92) and the group directly forwarded to Radiology department (Group B; n=81), using the non-parametric Mann-Whitney U test, estimating the difference of the means together with its 95% confidence interval. RESULTS: The averaged time to final diagnosis for group A and group B was 38.55 and 35.01 days respectively; and averaged time to treatment was 102.46 and 95.6 days. The difference between groups was not statistically significant (diagnosis p = 0.999; treatment p = 0.451). The correlation between sizes recognized in imaging test was reasonable. The consistency between imaging test and Histopathology was weak. CONCLUSIONS: The change in protocol does not reduce time significantly
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico , Programas de Rastreamento/organização & administração , Mamografia/estatística & dados numéricos , Biópsia por Agulha Fina/métodos , Detecção Precoce de Câncer/métodos , Tempo para o Tratamento/estatística & dados numéricos , Estudos RetrospectivosRESUMO
Objetivo. El Ki67 es un marcador de proliferación celular cuya expresión en tumores mamarios se ha relacionado con peor pronóstico y buena respuesta al tratamiento con quimioterapia. Sin embargo, aún no es considerado un marcador independiente y su uso no está extendido en la práctica clínica. El objetivo principal es estudiar el valor del Ki67, determinando su relación con cada uno de los demás factores pronósticos y predictivos clásicos utilizados en el cáncer de mama. Pacientes y método. Estudio transversal descriptivo analítico que incluyó 110 pacientes consecutivas con cáncer de mama en estadios iniciales y candidatas a cirugía como primer tratamiento. Se analizó la relación entre el Ki67 y una serie de factores pronósticos y predictivos clásicos del cáncer de mama. Resultados. El porcentaje de expresión del Ki67 fue significativamente mayor en los tumores con tamaño mayor a 15 mm, grado histológico 3, y que no expresan receptores hormonales. Además se observó una relación inversa entre la sobreexpresión de Ki67 y la expresión del receptor de estrógenos. Conclusiones. Nuestros resultados indican que existe una relación significativa entre el Ki67 y el grado histológico, el tamaño tumoral y los receptores hormonales (AU)
Objective. Ki67 is a biomarker of cell proliferation and its expression in breast tumors has been associated with worse prognosis and a better response to chemotherapy. However, Ki67 is not yet considered an independent marker and is not yet widely used in clinical practice. The aim of this study was to analyze the value of Ki67, by determining the relationship between Ki67 and each of the other predictive and prognostic factors used in breast cancer. Patients and methods. This cross-sectional, analytic and descriptive study included 110 consecutive patients with early-stage breast cancer who were candidates for surgery as the initial treatment. We analyzed the relationship between Ki67 and a series of other classical prognostic and predictive factors. Results. The percentage of Ki67 expression was significantly higher in tumors larger than 15 mm, histological grade 3, and tumors not expressing hormone receptors. Linear regression analysis showed a significant inverse relationship between Ki67 expression and estrogen receptor expression. Conclusions. Our results showed a significant association between Ki67 and histological grade, tumor size, and hormone receptors (AU)
Assuntos
Humanos , Feminino , Neoplasias da Mama/diagnóstico , Diagnóstico Precoce , Prognóstico , Biomarcadores , Antígeno Nuclear de Célula em Proliferação/análise , Avaliação de Sintomas/tendências , Estudos Transversais/métodos , Análise de VariânciaRESUMO
Objetivo: Analizar los resultados a corto y medio plazo de la aplicación de la cinta transobturadora para el tratamiento de la incontinencia urinaria de esfuerzo (IUE) femenina. Pacientes y método: Estudio descriptivo y de seguimiento retrospectivo de 66 pacientes, diagnosticadas de IUE y sin afección de suelo pélvico asociada, a las que se les aplicó una cinta suburetral transobturadora. La evaluación preoperatoria consistió en anamnesis, examen pélvico, ecografía transvaginal y cistometría simple. El período de estudio fue de enero de 2002 a junio de 2005.Resultados: El porcentaje de curación de la IUE fue del 84,6% (55/66). Como complicaciones relevantes destacamos 2 pacientes (3%) que exteriorizaron la cinta y la expulsaron a través de la pared vaginal anterior y 4 pacientes (6,1%) que presentaron síntomas obstructivos leves. Conclusiones: La aplicación de la cinta suburetral transobturadora es una alternativa eficaz y segurapara la corrección de la IUE
Objective: To analyze the short-and medium-term results of the use of the transobturator sling for thetreatment of female stress urinary incontinence (SUI).Patients and method: We performed a descriptive retrospective study of 66 patients diagnosed with SUI and without associated pelvic floor disorders. The patients underwent placement of a transobturator sling. Preoperative evaluation consisted of history taking, pelvic evaluation, transvaginal ultrasound, and cystometry. The study period was from January 2002 to June 2005. Results: Complete patient satisfaction was achieved in 84.6% (55 patients). Notable complicationsconsisted of mesh extrusion through the anterior vaginal wall in two patients (3%) and mild obstruction in four patients (6.1%). Conclusions: Application of a transobturator sling is a safe, simple and rapid procedure for thetreatment of female SUI
Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Incontinência Urinária por Estresse/cirurgia , Resultado do Tratamento , Estudos Retrospectivos , SeguimentosRESUMO
El manejo tradicional del embarazo ectópico intersticial implica laparotomía y resección cornual. Los recientes avances en ultrasonografía y el desarrollo de técnicas sensibles de determinación de beta-hCG han conducido a un diagnóstico cada vez más temprano de estos casos permitiendo el empleo de opciones terapéuticas conservadoras, como el metotrexato sistémico, que se presenta como una opción segura y eficaz. Presentamos un caso de embarazo ectópico intersticial resuelto con éxito con metotrexato
Traditional management of interstitial pregnancy involves laparotomy with cornual resection. Recent advances in transvaginal ultrasonography and sensitive beta-hCG assays have led to earlier diagnosis of these cases. We report a case of interstitial pregnancy successfully treated with parenteral methotrexate. Prompt recognition of interstitial pregnancy allows conservative approachment and systemic methotrexate presents as an effective and safe option