Approach to the care process by nurse case managers in a breast unit.

OBJECTIVE: Breast units led by nurse case managers are being implemented to provide comprehensive care in the detection and treatment of breast cancer. However, their implementation is heterogeneous and the results of the care process with this professional have not been studied. The aim of the study is to describe the management in time and the approach of the process by a nurse case manager in the breast unit of women with suspected breast cancer pathology, derived from the breast cancer screening program. METHODS: Descriptive, cross-sectional, retrospective study carried out in 2021. Women treated in a breast unit managed by a nurse case manager in a hospital in southern Spain were included. Sociodemographic, clinical and care process characteristics were analysed RESULTS: A total of 118 women of Spanish nationality (92%) participated, with a mean age of 59 years. The diagnosis of malignancy was made in 74.6% of them. Seventy-nine percent of the women had their first visit within 3 days. The mean time to diagnosis was 3.98 days (SD: ±3.93), 4.2 weeks (SD: ±1.84) to initiate treatment and a total in-hospital time of 33 days (SD: ±13.45). CONCLUSIONS: The management of nurse case managers in breast units contributes to improving or speeding up times, in accordance with international guidelines, helping this approach in the continuity of the care process for women referred after screening for breast cancer detection.

Access disparities and underutilization of germline genetic testing in Chilean breast cancer patients.

PURPOSE: Latin American reports on genetic cancer risk assessments are scarce. In Chile, current breast cancer (BC) guidelines do not define strategies for germline genetic testing. Our study sought to quantify the disparities in access to genetic testing in Chilean BC patients, according to international standards and their clinical characteristics to explore improvement strategies. METHODS: Retrospective analysis of invasive BC databases including patients treated in a Public Hospital (PH) and in an Academic Private Center (AC) in Santiago, Chile between 2012 and 2021. RESULTS: Of 5438 BC patients, 3955 had enough data for National Comprehensive Cancer Network (NCCN) categorization. From these, 1911 (48.3%) fulfilled NCCN criteria for germline testing, of whom, 300 were tested for germline mutations and 268 with multigene panels. A total of 65 pathogenic variants were found in this subset. As expected, BRCA1/2 mutations were the most frequent (17.7%). Access to genetic testing was higher in AC versus PH (19.6% vs. 10.3%, p = 0.0001). Other variables associated with germline genetic testing were BC diagnosis after 2018, being 45 years old or younger at diagnosis, BC family history (FH), FH of ovarian cancer, non-metastatic disease, and triple-negative subtype. CONCLUSION: In our cohort, 15% of BC patients who met NCCN criteria for germline testing were effectively tested. This percentage was even lower at the PH. Current recommendations encourage universal genetic testing for BC patients; however, our findings suggest that Chile is far from reaching such a goal and national guidelines in this regard are urgently needed. To our knowledge, this is the first study of its kind in Chile and Latin America.

[Neoadyuvant endocrine therapy in breast cancer]. / Terapia endocrina neoadyuvante en cáncer de mama, una alternativa de tratamiento e investigación.

Neoadjuvant chemotherapy is an accepted strategy for patients with locally advanced breast cáncer. This approach increases the possibilities of conservative treatment and improves the resectability rates of initially unresectable tumors. In addition, preoperative systemic therapy allows the evaluation of prognostic and predictive factors, dynamically and in vivo. Since over 80% of these tumors express estrogen receptors (ER), endocrine therapy seems a logical treatment to employ in the neoadjuvant setting. The advent of new drugs that regúlate the ER function, along with the results of several clinical studies with the use of neoadjuvant endocrine therapy, support the feasibility and safety of utilizing this strategy before surgery. We herein analyze the available clinical evidence about the use of neoadjuvant therapy aiming to regúlate the activity of the ER. We also discuss the valué of predictive factors that could help the oncologist to select those patients most likely to benefit from this approach and the role of endocrine therapy as a research instrument.

Terapia endocrina neoadyuvante en cáncer de mama, una alternativa de tratamiento e investigación / Neoadyuvant endocrine therapy in breast cancer

Neoadjuvant chemotherapy is an accepted strategyforpatients with locally advanced breast cáncer. This approach increases the possibilities ofconservative treatment and improves the resectability rates ofinitially unresectable tumors. In addition, preoperative systemic therapy allows the evaluation of prognostic and predictive factors, dynamically and in vivo. Since over 80% ofthese tumors express estrogen receptors (ER), endocrine therapy seems a logical treatment to employ in the neoadjuvant setting. The advent ofnew drugs that regúlate the ERfunction, along with the results of severa! clinical studies with the use of neoadjuvant endocrine therapy, support the feasibility and safety of utilizing this strategy before surgery. We herein analyze the available clinical evidence about the use of neoadjuvant therapy aiming to regúlate the activity ofthe ER. We also discuss the valué of predictive factors that could help the oncologist to select those patients most likely to benefit from this approach and the role of endocrine therapy as a research instrument.

Dengue in Nicaragua, 1994: reintroduction of serotype 3 in the Americas / Dengue en Nicaragua, 1994: reintroducción del serotipo 3 en las Américas

El objetivo principal de este informe fue describir la reaparición del serotipo 3 del dengue en las Américas después de 17 años de ausencia, tal como se observó recientemente en Nicaragua. Se examinaron en total 356 muestras de suero obtenidas por medio del sistema nicaragüense de vigilancia del dengue durante una epidemia en octubre de 1994. En 43% de las muestras se detectaron anticuerpos IgM contra el dengue y los sueros de 12 de las 18 áreas atendidas por los sistemas locales integrales de salud dieron resultados positivos. Además, se aislaron virus de dengue en 5 de 24 sueros de pacientes con síntomas hemorrágicos: en 3 se aisló el serotipo 3 y en 2, el serotipo 1. Mediante pruebas de laboratorio, en 26 de 39 pacientes hospitalizados en León y Managua se consideró probable o se confirmó el diagnóstico de dengue con manifestaciones hemorrágicas o dengue hemorrágico. En 18 pacientes diagnosticados de dengue con manifestaciones hemorrágicas, los síntomas más comunes fueron fiebre, cefalea, vómito, mialgia, artralgia y epistaxis. Los ocho pacientes restantes, en los que se diagnosticó dengue hemorrágico probable, tuvieron fiebre, malestar general, hemorragias, trombocitopenia y hemoconcentración, y los títulos de anticuerpos a la prueba de inhibición de la hemaglutinación oscilaron de 640 a 20 480. Se confirmó así la reintroducción del serotipo 3 del dengue en la Región y su capacidad para producir casos de dengue hemorrágico. En Nicaragua, por lo menos, es evidente que la reintroducción del serotipo 3 del dengue ha producido un aumento de los casos de dengue clásico y dengue hemorrágico. Si no se presta atención urgente al control del mosquito vector de la enfermedad, la experiencia descrita podría constituir el preludio lúgubre de futuros acontecimientos similares en las Américas

The principal aim of the report presented here is to describe the reappearance of dengue serotype 3 in the Americas, following a 17-year absence, through the recent experience of Nicaragua. In all, 356 serum samples obtained through Nicaragua's dengue monitoring system in October 1994 during an epidemic were examined. Anti-dengue IgM antibodies were detected in 43% of these, with sera from 12 of the 18 areas covered by Nicaragua's local integrated health care systems yielding positive results. In addition, dengue virus was isolated from 5 of 24 sera obtained from patients with hemorrhagic symptoms, dengue 3 being isolated from 3 of these samples and dengue 1 from the other 2. A diagnosis of dengue with hemorrhagic manifestations or of hemorrhagic dengue was supported or confirmed by laboratory findings obtained from 26 of 39 patients hospitalized in León or Managua. The most frequent symptoms of 18 patients diagnosed as having dengue with hemorrhagic manifestations were fever, headache, vomiting, myalgia, arthralgia, and epistaxis. The remaining eight patients, diagnosed as having probable hemorrhagic dengue, exhibited fever, general malaise, hemorrhaging, thrombocytopenia, hemoconcentration, and hemagglutination-inhibition antibody titers ranging from 640 to 20 480. Overall, the reappearance of dengue serotype 3 in the Region was confirmed, together with its ability to produce cases of hemorrhagic dengue. At least in Nicaragua, it is apparent that the introduction of dengue serotype 3 has prompted an increase in the number of classical dengue and hemorrhagic dengue cases, a scenario that might constitute the grim prelude to future developments in the Americas if urgent attention is not given to controlling the disease's mosquito vector

Dengue in Nicaragua, 1994: reintroduction of serotype 3 in the Americas

The principal aim of the report presented here is to describe the reappearance of dengue serotype 3 in the Americas, following a 17-year absence, throughthe recent experience of Nicaragua. In all, 356 serum samples obtained through Nicaragua's dengue monitoring system in October 1994 during an epidemic were examined. Anti-dengue IgM antibodies were detected in 43 percent of these, with sera from 12 of the 18 areas covered by Nicaragua's local integrated health care systems yielding positive results. In addition, dengue virus was isolated from 5 of 24 sera obtained from patients with hemorrhagic sympthoms, dengue 3 being isolated from 3 of these samples and dengue 1 from the other 2. A diagnosis of dengue with hemorrhagic manifestations or of hemorrhagic dengue was supported or confirmed by laboratory findings obtained from 26 of 39 patients hospitalized in Leon or Managua. The most frequent sympthoms of 18 patients diagnosed as having dengue with hemorrhagic manifestations were fever, headache, vomiting, myalgia, arthralgia, and epistaxis. The remaining eight patients, diagnosed as having probable hemorragic dengue, exhibited fever, general malaise, hemorrhaging, thromboctytopenia, hemoconcentration, and hemagglutination-inhibition antibody titers ranging from 640 to 20 480. Overall, the reappearance of dengue serotype 3 in the Region was confirmed, together with its ability to produce cases of hemorrhagic dengue. At least in Nicaragua, it is apparent that the introduction of dengue serotype 3 has prompted an increase in the number of classical dengue and the hemorrhagic dengue cases, a scenario that might constitute the grim prelude to future developments in the Americas if urgent attention is not given to controlling the disease's mosquito vector (AU)