Shared Decision-making in Breast Cancer Reconstructive Surgery: Experience in a Leading Hospital.

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.

Androgen and Estrogen ß Receptor Expression Enhances Efficacy of Antihormonal Treatments in Triple-Negative Breast Cancer Cell Lines.

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.

[Results of the breast cancer population screening circuit at the San Carlos Clinical Hospital.] / Resultados del circuito de cribado poblacional de cáncer de mama en el Hospital Clínico San Carlos.

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.

Vitamin D: And its role in breast cancer.

Vitamin D is a fat soluble vitamin that plays a role in calcium and phosphorus homeostasis. Recently, extensive research on its extraskeletal actions has linked vitamin D deficiency to an increased risk of infection, diabetes mellitus types 1 and 2, cardiovascular disease, obesity, asthma, inflammatory bowel disease, colon, breast, prostate and ovarian cancer and some neurological diseases. There are various mechanisms by which vitamin D influences the natural history of cancer. These include the role of vitamin D in the induction of apoptosis, stimulation of cell differentiation, anti-inflammatory and antiproliferative effects and inhibition of angiogenesis, invasion and metastasis. The aim of this review is to clarify the true role of vitamin D in the onset of breast cancer and evolution of the disease after treatment. A further aim is to suggest new research directions to identify indications and requirements for vitamin D supplementation in patients with breast cancer.