Establishing a program for individuals at high risk for breast cancer.

Our need to create a program for individuals at high risk for breast cancer development led us to research the available data on such programs. In this paper, we summarize our findings and our thinking process as we developed our own program. Breast cancer incidence is increasing worldwide. Even though there are known risk factors for breast cancer development, approximately 60% of patients with breast cancer have no known risk factor, although this situation will probably change with further research, especially in genetics. For patients with risk factors based on personal or family history, different models are available for assessing and quantifying risk. Assignment of risk levels permits tailored screening and risk reduction strategies. Potential benefits of specialized programs for women with high breast cancer risk include more cost -effective interventions as a result of patient stratification on the basis of risk; generation of valuable data to advance science; and differentiation of breast programs from other breast cancer units, which can result in increased revenue that can be directed to further improvements in patient care. Guidelines for care of patients at high risk for breast cancer are available from various groups. However, running a high-risk breast program involves much more than applying a guideline. Each high-risk program needs to be designed by its institution with consideration of local resources and country legislation, especially related to genetic issues. Development of a successful high-risk program includes identifying strengths, weaknesses, opportunities, and threats; developing a promotion plan; choosing a risk assessment tool; defining "high risk"; and planning screening and risk reduction strategies for the specific population served by the program. The information in this article may be useful for other institutions considering creation of programs for patients with high breast cancer risk.

Reconstrucción mamaria postmastectomía: revisión de 28 casos / Postmastectomy breast reconstruction: review of 28 cases

El objetivo de este trabajo es evaluar las reconstrucciones mamarias operadas en el Hospital del Salvador y Hospital Luis Tisné, sus complicaciones y grado de satisfacción cosmética de las pacientes. Se analizan en forma retrospectiva 26 pacientes con mastectomía, a las que se les realizó reconstrucción mamaria inmediata o diferida usando colgajo musculocutáneo de recto abdominal (TRAM). Mediante una encuesta se evaluó el grado de satisfacción de las pacientes. En un período de 68 meses se operaron 28 reconstrucciones mamarias en 26 pacientes. Hubo un 14,2 por ciento de complicaciones, una necrosis parcial de colgajo, una necrosis parcial de la piel nativa de la mama, una dehiscencia de la sutura umbilical y una hernia de pared. Veinticinco pacientes evaluaron con nota 7 el resultado cosmético y una con nota 3. Se concluye que el TRAM es una buena técnica de reconstrucción mamaria con escasas complicaciones, buen resultado estético e importante grado de satisfacción de parte de las pacientes.

[Cost-benefit in the study of the dissemination of stage I and II in breast cancer]. / Costo beneficio del estudio de diseminación en estadios I y II del cáncer de mama.

BACKGROUND: Chest X ray, abdominal ultrasound and bone scintigraphy are usually requested to study a possible dissemination of breast carcinoma. AIM: To study the yield and costs of these exams in the study of dissemination of stage I and II breast carcinoma. MATERIAL AND METHODS: A retrospective analysis of patients operated for a breast carcinoma in a public surgical service. A chest X ray, abdominal ultrasound and bone scintigraphy was requested to all patients in the immediate postoperative period. Age, stage according to pathological TNM and costs per patient were registered. RESULTS: Of 210 women operated, 40 were in stage I (19%) and 85 in stage II (41%). Dissemination study was negative in all stage I patients and in all but two patients in stage II. The yield for detection of distant metastases in these patients was 0.9% for chest X ray, 0% for abdominal ultrasound and 0.9% for bone scintigraphy. The total cost of the study, in Chilean pesos, was $10,369,620 in a public hospital and $16,535,400 in a private clinic. DISCUSSION: Additional exams to detect distant metastases in early stages of breast carcinoma have a low yield and high costs.