Implementing Standard Diagnosis and Treatment for Locally Advanced Breast Cancer Through Global Research in Latin America: Results From a Multicountry Pragmatic Trial.

PURPOSE: Breast cancer mortality rates in Latin America (LA) are higher than those in the United States, possibly because of advanced disease presentation, health care disparities, or unfavorable molecular subtypes. The Latin American Cancer Research Network was established to address these challenges and to promote collaborative clinical research. The Molecular Profiling of Breast Cancer Study (MPBCS) aimed to evaluate the clinical characteristics and treatment outcomes of LA participants with locally advanced breast cancer (LABC). PATIENTS AND METHODS: The MPBCS enrolled 1,449 participants from Argentina, Brazil, Chile, Mexico, and Uruguay. Through harmonized procedures and quality assurance measures, this study evaluated clinicopathologic characteristics, neoadjuvant chemotherapy response, and survival outcomes according to residual cancer burden (RCB) and the type of surgery. RESULTS: Overall, 711 and 480 participants in the primary surgery and neoadjuvant arms, respectively, completed the 5-year follow-up period. Overall survival was independently associated with RCB (worse survival for RCBIII-adjusted hazard ratio, 8.19, P < .001, and RCBII [adjusted hazard ratio, 3.69, P < .008] compared with RCB0 [pathologic complete response or pCR]) and type of surgery (worse survival in mastectomy than in breast-conserving surgery [BCS], adjusted hazard ratio, 2.97, P = .001). The hormone receptor-negative-human epidermal growth factor receptor 2-positive group had the highest proportion of pCR (48.9%). The analysis of the ASCO Quality Oncology Practice Initiative breast module revealed high compliance with pathologic standards but lower adherence to treatment administration standards. Notably, compliance with trastuzumab administration varied widely among countries (33.3%-88.7%). CONCLUSION: In LABC, we demonstrated the survival benefit of BCS and the prognostic effect of the response to available neoadjuvant treatments despite an important variability in access to key treatments. The MPBCS represents a significant step forward in understanding the real-world implementation of oncologic procedures in LA.

Adaptación y evaluación de la eficacia de un programa psicoeducativo de navegación para disminuir síntomas de ansiedad y depresión en mu-jeres mexicanas con cáncer de mama / Design and evaluation of the efficacy of a psychoeducational navigation program to reduce symptoms of anxiety and depression in Mexican women with breast cancer

Objetivo:El cáncer de mama (CAM) es un problema de salud pública mundial. La ansiedad y depresión son las principales comorbilidades que aquejan a este sector, el programa psicoeducativo de navegación (PPN) se presenta como una estrategia psicosocial eficaz en hospitales públicos de México. Método: Se realizó la adaptación del PPN y la evaluación de eficacia en 47 mujeres con CAM de tres hospitales de la Zona Metropolitana de Guadalajara. El PPN integró acompañamiento emocional, educación para la salud y técnicas de relajación. Se evaluaron los síntomas y los niveles de ansiedad y depresión, pre-post intervención con la Escala Hospitalaria de Ansiedad y Depresión (HADS). Resultados: Se encontró una disminución en los síntomas de ansiedad pre-test (M= 6,79, DT= 4,01) y pos-test (M= 4,19, DT= 3,03), igual que en los síntomas de depresión antes (M= 6,02, DT= 4,07) y después (M= 4,23, DT= 3,05). Se obtuvieron diferencias estadísticamente significativas entre las evaluaciones pre y post intervención tanto en las dimensiones, como en la puntuación global (p<0,001). Conclusiones: El PPN mostró eficacia para disminuir los síntomas y los niveles de ansiedad y depresión en mujeres mexicanas con CAM. Sugerimos replicar el programa en otros contextos de atención oncológica en seguimiento a las normativas nacionales (AU)

Objective: Breast cancer (BC) is a public health problem. Anxiety and depression are the main comorbidities that afflict this sector, the navigation psychoeducational program (NPP) is presented as an effective psychosocial strategy in public hospitals in Mexico.Method: The NPP was adapted and its efficacy evaluated in 47 women with BC from three hospitals in the Guadalajara Metropolitan Area. The NPP integrated emotional accompaniment, health education and relaxation techniques. Symptoms and levels of anxiety and depression were evaluated pre-post intervention with the Hospital Anxiety and Depression Scale (HADS). Results: A decrease was found in anxiety symptoms pre-test (M= 6.79, SD= 4.01) and post-test (M= 4.19, SD= 3.03), the same as in depression symptoms before (M= 6.02, SD= 4.07) and after (M= 4.23, SD= 3.05). Statistically significant differences were obtained between the pre- and post-intervention evaluations both in the dimensions and in the global score (p<0.001).Conclusions: The NPP showed efficacy in reducing symptoms and levels of anxiety and depression in Mexican women with BC. We suggest replicating the program in other cancer care contexts in compliance with national regulations (AU)

The Transcriptomic Portrait of Locally Advanced Breast Cancer and Its Prognostic Value in a Multi-Country Cohort of Latin American Patients.

Purposes: Most molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches. Patients and Methods: We collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes. Results: PAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E and 16·6% as Basal. Both OSC and DFS for LumA tumors were significantly better than for other subtypes, while Basal tumors had the worst prognosis. While the prognostic power of traditional subtypes calculated with hormone receptors (HR), HER2 and Ki67 determinations showed an acceptable performance, PAM50-derived risk of recurrence best discriminated low, intermediate and high-risk groups. Transcriptomic pathway analysis showed high proliferation (i.e. cell cycle control and DNA damage repair) associated with LumB, HER2E and Basal tumors, and a strong dependency on the estrogen pathway for LumA. Terms related to both innate and adaptive immune responses were seen predominantly upregulated in Basal tumors, and, to a lesser extent, in HER2E, with respect to LumA and B tumors. Conclusions: This is the first study that assesses molecular features at the transcriptomic level in a multicountry Latin American breast cancer patient cohort. Hormone-related and proliferation pathways that predominate in PAM50 and other breast cancer molecular classifications are also the main tumor-driving mechanisms in this cohort and have prognostic power. The immune-related features seen in the most aggressive subtypes may pave the way for therapeutic approaches not yet disseminated in Latin America. Clinical Trial Registration: ClinicalTrials.gov (Identifier: NCT02326857).

Porcentaje de adiposidad y su relación con el índice de inmunorreactividad de los receptores hormonales en mujeres mexicanas con cáncer de mama / Adiposity percentage relationship with hormone receptors immunoreactive score in breast cancer Mexican women

INTRODUCTION: Adipose tissue is an important estrogen resource and they are involved in breast cancer development. OBJECTIVE: To establish the relationship between adiposity percentage and the estrogen and progesterone receptors immunoreactive score in Mexican women with breast cancer. METHODS: This is a transversal and analytical study. We identified breast cancer women with cancer histologic diagnosis. We calculated: adiposity percentage and immunoreactive score. We performed correlation analysis between adiposity percentage, body mass index, diabetes mellitus and arterial hypertension, with estrogen and progesterone receptors in breast cancer samples. We perform logistic regression and Odds Ratio estimations. RESULTS: We studied 43 patients with breast cancer and we observed association between adiposity percentage and estrogen and progesterone immnunoreactive score (rP 0.470; p 0.003 and rP 0.328; p 0.042, respectively). The most important risk factor in breast cancer positive to estrogen receptors was obesity (OR 19.1, IC95% 2.1 a 169.1, p 0.008), and previous obesity in breast cancer positive to progesterone receptors (OR 20.7, IC95% 2.3 a 185.9, p 0.007). DISCUSSION: Adiposity percentage is an important risk factor to develop breast cancer positive to hormone receptors related with the risk of breast cancer positive to hormonal receptors (AU)

Introducción: El tejido adiposo es una importante fuente de estrógenos, los cuales se encuentran implicados en el desarrollo de cáncer de mama. Objetivo: Establecer la relación entre el porcentaje de adiposidad y el índice de inmunorreactividad de los receptores a estrógenos y a progesterona en mujeres mexicanas con cáncer de mama. Métodos: Estudio transversal analítico en pacientes con cáncer de mama confirmado con estudio histopatológico. Se estimó el % de adiposidad, y el índice de inmunorreactividad. Se realizó el análisis de correlación entre el porcentaje de adiposidad, el IMC, la presencia de DM2 e hipertensión arterial con la expresión de receptores a estrógeno y progesterona y regresión logística con cálculo de Odds Ratio. Resultados: Se estudiaron 43 pacientes con cáncer de mama y se observó asociación entre el porcentaje de adiposidad y el índice de inmunoreactividad para los RE y RP (rP 0,470; p 0,003 y rP 0,328; p 0,042 respectivamente). El factor de riesgo más importante en cáncer positivo a receptores estrogénicos fue la obesidad (OR 19,1, IC 95% 2,1 a 169,1, p 0,008) y obesidad previa en cáncer positivo a receptores a progesterona (OR 20,7, IC 95% 2,3 a 185,9, p 0,007). Conclusión: El porcentaje de adiposidad es un factor de riesgo importante para desarrollar cáncer de mama positivo a receptores hormonales (AU)

[Adiposity percentage relationship with hormone receptors immunoreactive score in breast cancer mexican women]. / Porcentaje de adiposidad y su relación con el índice de inmunorreactividad de los receptores hormonales en mujeres mexicanas con cáncer de mama.

INTRODUCTION: Adipose tissue is an important estrogen resource and they are involved in breast cancer development. OBJECTIVE: To establish the relationship between adiposity percentage and the estrogen and progesterone receptors immunoreactive score in Mexican women with breast cancer. METHODS: This is a transversal and analytical study. We identified breast cancer women with cancer histologic diagnosis. We calculated: adiposity percentage and immunoreactive score. We performed correlation analysis between adiposity percentage, body mass index, diabetes mellitus and arterial hypertension, with estrogen and progesterone receptors in breast cancer samples. We perform logistic regression and Odds Ratio estimations. RESULTS: We studied 43 patients with breast cancer and we observed association between adiposity percentage and estrogen and progesterone immnunoreactive score (rP 0.470; p 0.003 and rP 0.328; p 0.042, respectively). The most important risk factor in breast cancer positive to estrogen receptors was obesity (OR 19.1, IC95% 2.1 a 169.1, p 0.008), and previous obesity in breast cancer positive to progesterone receptors (OR 20.7, IC95% 2.3 a 185.9, p 0.007). DISCUSSION: Adiposity percentage is an important risk factor to develop breast cancer positive to hormone receptors related with the risk of breast cancer positive to hormonal receptors.

Introducción: El tejido adiposo es una importante fuente de estrógenos, los cuales se encuentran implicados en el desarrollo de cáncer de mama. Objetivo: Establecer la relación entre el porcentaje de adiposidad y el índice de inmunorreactividad de los receptores a estrógenos y a progesterona en mujeres mexicanas con cáncer de mama. Métodos: Estudio transversal analítico en pacientes con cáncer de mama confirmado con estudio histopatológico. Se estimó el % de adiposidad, y el índice de inmunorreactividad. Se realizó el análisis de correlación entre el porcentaje de adiposidad, el IMC, la presencia de DM2 e hipertensión arterial con la expresión de receptores a estrógeno y progesterona y regresión logística con cálculo de Odds Ratio. Resultados: Se estudiaron 43 pacientes con cáncer de mama y se observó asociación entre el porcentaje de adiposidad y el índice de inmunoreactividad para los RE y RP (rP 0,470; p 0,003 y rP 0,328; p 0,042 respectivamente). El factor de riesgo más importante en cáncer positivo a receptores estrogénicos fue la obesidad (OR 19,1, IC 95% 2,1 a 169,1, p 0,008) y obesidad previa en cáncer positivo a receptores a progesterona (OR 20,7, IC 95% 2,3 a 185,9, p 0,007). Conclusión: El porcentaje de adiposidad es un factor de riesgo importante para desarrollar cáncer de mama positivo a receptores hormonales.

[Evaluation of patient satisfaction with the quality of health care received within the EORTC IN-PATSAT32 trial by patients with breast and colorectal cancer, and non-Hodgkin lymphoma at different stages. Correlation with sociodemographic characteristics, comorbidities and other procedural variables at the Mexican Institute of Social Security]. / Análisis de la satisfacción con los cuidados en salud a través del cuestionario EORTC IN-PATSAT32 en pacientes con cáncer de mama, linfoma no Hodgkin y cáncer colo-rectal en diferentes etapas clínicas. Relación con las características socio-demográficas, estados co-mórbidos y variables del proceso de atención en el Instituto Mexicano del Seguro Social.

INTRODUCTION: In Mexico cancer is a public health burden. Nowadays the health care systems pay special attention to patient's perception and satisfaction of the health care received. Satisfaction with quality of health care has an impact in the adherence to the treatment. OBJECTIVE: To evaluate the satisfaction with the quality of health care received at the IMSS in a group of cancer patients [non Hodgkin lymphoma (NHL), breast and colorectal cancer]. Socio-demographic features, co-morbid diseases, and attendance processes impact on satisfaction are also evaluated. RESULTS: 476 cancer patients were studied: 314 with breast cancer, 92 with NHL and 70 with colorectal cancer. In women with breast cancer the mean score to nurses' interpersonal skills in non-classified disease group and clinical stage III group were: 73.64 ± 32.53, 90.00 ± 18.25 respectively (p=0.005), nurses' availability in non-classified and clinical stage III group were: 69.71 ± 30.25, 89.21 ± 19.00 respectively (p=0.003). In subjects with NHL the mean scores for doctors' technical skills in clinical stage I and III groups, were: 63.69 ± 37.78, 80.30 ± 18.46 respectively (p=0.017), doctors' information provision scores in subject in clinical stage I and IV were: 49.40 ± 40.75, 79.49 ± 24.63 respectively (p=0.043). In the group of colorectal cancer patients the mean of the score to exchange of information between clinical stage II and clinical stage III group were 50.00 ± 41.83, 84.21 ± 22.37 respectively (p=0.036). Were not observed association between attendance processes features and general satisfaction. CONCLUSIONS: In Mexico 50% of cancer patients are attended at the IMSS. The continued evaluation of the satisfaction with health care received by the health care service users is important to enhance attention's quality.

[Neoadjuvant treatment for locally advanced breast cancer. Comparison of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide]. / Tratamiento neoadyuvante del cáncer de mama localmente avanzado. Comparación de dos esquemas a base de docetaxel-epirrubicina versus 5-fluoraciloepirrubicina-ciclofosfamida.

BACKGROUND: Breast cancer is the most common type of cancer in women worldwide. In Mexico, >34% of patients are in locally advanced stages at the time of diagnosis. Neoadjuvant chemotherapy is administered to control local disease, make surgical resection possible and increase the possibility of breast tissue conservation. METHODS: We performed a double-blind, randomized clinical trial in patients with locally advanced breast cancer (stages IIB and IIIA) with two therapy schemes; 5-fluorouracil-epirubicin-cyclophosphamide (control group) vs. docetaxel-epirubicin (study group). Both were indicated in three preoperative cycles, and patients were submitted afterwards to surgery. Pathological response was measured. RESULTS: Forty one patients were included in our study. They were distributed in two homogeneous groups: 21 in the control group and 20 in the study group. Dimensional pathological response was higher in the study group than in the control one (p <0.05). Five patients in the control group and ten patients of the study group experienced complete pathological response (p <0.05). The most common secondary events were leucopenia, neutropenia and fever. Morbidity, number of lymph nodes, disease-free survival and general survival did not show significant differences between groups. No mortality was reported during a minimum follow-up of 28 months. CONCLUSIONS: Our results confirm the effectiveness of docetaxel-epirubicin to obtain complete pathological response. Neoadjuvant therapy has been shown to increase the pathological response when a taxane is added to an anthracycline. This combination presented more secondary events, but they can be effectively managed medically. Neoadjuvant docetaxel-epirubicin followed by surgery is an appropriate regimen for patients with locally advanced breast cancer.

Tratamiento neoadyuvante del cáncer de mama localmente avanzado: comparación de dos esquemas a base de docetaxel-epirrubicina versus 5-fluoraciloepirrubicina-ciclofosfamida / Neoadjuvant treatment for locally advanced breast cancer: comparison of two schemes based on docetaxel-epirubicin vs. 5-fluorouracil-epirubicin-cyclophosphamide

BACKGROUND: Breast cancer is the most common type of cancer in women worldwide. In Mexico, >34% of patients are in locally advanced stages at the time of diagnosis. Neoadjuvant chemotherapy is administered to control local disease, make surgical resection possible and increase the possibility of breast tissue conservation. METHODS: We performed a double-blind, randomized clinical trial in patients with locally advanced breast cancer (stages IIB and IIIA) with two therapy schemes; 5-fluorouracil-epirubicin-cyclophosphamide (control group) vs. docetaxel-epirubicin (study group). Both were indicated in three preoperative cycles, and patients were submitted afterwards to surgery. Pathological response was measured. RESULTS: Forty one patients were included in our study. They were distributed in two homogeneous groups: 21 in the control group and 20 in the study group. Dimensional pathological response was higher in the study group than in the control one (p <0.05). Five patients in the control group and ten patients of the study group experienced complete pathological response (p <0.05). The most common secondary events were leucopenia, neutropenia and fever. Morbidity, number of lymph nodes, disease-free survival and general survival did not show significant differences between groups. No mortality was reported during a minimum follow-up of 28 months. CONCLUSIONS: Our results confirm the effectiveness of docetaxel-epirubicin to obtain complete pathological response. Neoadjuvant therapy has been shown to increase the pathological response when a taxane is added to an anthracycline. This combination presented more secondary events, but they can be effectively managed medically. Neoadjuvant docetaxel-epirubicin followed by surgery is an appropriate regimen for patients with locally advanced breast cancer.

[Reduction of lymphatic drainage posterior to modified radical mastectomy with the application of fibrin glue]. / Reducción del drenaje linfático posterior a mastectomía radical modificada con la aplicación de gel de fibrina.

OBJECTIVE: Our objective was to investigate the effectiveness of fibrin glue to reduce hemato-lymphatic fluid production after modified radical mastectomy (MRM) in women with breast cancer. MATERIAL AND METHODS: A total of 43 women treated surgically were randomly assigned to receive 10 ml of fibrin glue at the end of the breast resection plus closed suction drains (n = 22), or drain system only as a control group (n = 23). Outcome variables were fluid collected in the drainage system measured each 24 h. Drains were removed when a 50 ml output per day was obtained. Seroma formation and flap complications were also investigated. RESULTS: The average age was 48.36 +/- 8.9 years for the study group and 52.87 +/- 9.74 years for the control group (p = 0.11). Body mass index (BMI) ranged between 22 and 35 kg/m2: 28.1 +/- 2.7 vs. 29.92 +/- 4.0 kg/m2 (p = 0.27). A reduction of the fluid drained was observed from the first postoperative day in the study group in contrast with the control (174.55 +/- 64.69 vs. 281.22 +/- 116.91, p = 0.001). A correlation between the BMI and the exposed surgical area was also statistically significant (p < 0.002), as well as the day the drains were extracted (p < 0.05). The incidence of seroma formation was 9% in the study group and 34.78% in the control, a statistically significant finding (p < 0.05). CONCLUSIONS: Fibrin glue locally applied to the surgical wound under the flap and axilla significantly reduced the amount and duration of lymphatic fluid produced after MRM with axillary dissection. Also, a significant reduction in the incidence of seromas was observed.