Barriers in Latin America for the management of locally advanced breast cancer.

Breast cancer (BC) is a highly prevalent malignancy in Latin American women, most cases being diagnosed at locally advanced or metastatic stages when options for cancer care are limited. Despite its label as a public health problem in the region, Latin American BC patients face several barriers in accessing standard of care treatment when compared with patients from developed countries. In this review, we analyse the landscape of the four main identified barriers in the region: i) high burden of locally advanced/advanced BC; ii) inadequate access to medical resources; iii) deficient access to specialised cancer care and iv) insufficient BC research in Latin America. Unfortunately, these barriers represent the main factors associated with the BC poor outcomes seen in the region. Targeted actions should be conducted independently by each country and as a region to overcome these limitations and create an enhanced model of BC care.

Pulgarización del índice en el tratamiento de la hipoplasia de pulgar: técnica quirúrgica / Index finger pollicization in the treatment of thumb hypoplasia: surgical technique

La pulgarización del dedo índice permite reconstruir la pinza de la mano. Fue ampliamente realizada para una reconstrucción de una pérdida de pulgar en condiciones de trauma. Sin embargo, hoy por hoy, es la técnica de elección para las hipoplasias congénitas de pulgar. En los niños permite crear una pinza, especialmente para objetos grandes y entrega una apariencia más normal de la mano. Es una técnica demandante, pero con pasos que están bien definidos y perfeccionados, que al ser realizados de forma cuidadosa, reducen al mínimo sus complicaciones.

The pollicization of the index finger allows reconstructing the hand's ability to pinch. It has been broadly used to address traumatic loss of the thumb. However today it is the procedure of choice for severe congenital thumb hypoplasia. It allows children to pinch, particularly large objects, it also gives the hand a more normal appearance. It is a demanding procedure, with a series of technical steps that are well defined and perfected, such that if they are performed in a careful way, complications are minimized.

Factores prognosticos en cáncer de mama, estadio clínico temprano (I-IIa) sometidos a cirugía como tratamiento de inicio / Prognostic factors in breast cancer patients in early stages (I - IIa) that underwent surgery as initial therapy

El cáncer de mama lidera las causas de muerte por cáncer en mujeres peruanas. Mientras los programas de control de cáncer se enfocan en incrementar el diagnóstico de estadios tempranos, es importante conocer bien los factores de prognóstico en este grupo de pacientes. El objetivo de este estudio fue Identificar factores prognósticos en pacientes con cáncer de mama en estadios clínicos tempranos (I-IIA) sometidas a cirugía como tratamiento de inicio. Se realizó un estudio observacional descriptivo de una serie de casos retrospectiva de pacientes diagnosticados con cáncer de mama en estad¡os I-IIA entre enero del 2000 hasta diciembre de 2005. Se incluyeron 952 pacientes. Se identificó el tamaño del tumor, número de ganglios comprometidos, estadio patológico, receptor de estrógeno, tipo de cirugía y a la hormonoterapia como factores prognósticos de sobrevida libre de recurrencia a distancia; mientras que para la sobrevida global las variables fueron la edad, el estadio T patológico, el tamaño del tumor, el número de ganglios comprometidos, el estadio patológico, los receptores de estr¢geno y progesterona, el fenotipo y la hormonoterapia. El análisis multivariado mostró que los factores de prognóstico independientes para la sobrevida libre de recurrencia a distancia fueron el estadio T patológico (HR=1,51, para T2, comparado a T1), y el estadio N patológico (HR=1,82, para N2, comparado a N1), mientras que para la sobrevida global fueron la edad (HR=4,14, para ≥70 años, comparado a <50), el estadio T patológico (HR=1,74, para T2, comparado a T1), estadio N patológico (HR=1,93, para N1, comparado a N0). En conclusión, la edad, estadios patológicos T y N, fueron los factores de prognóstico m s importantes.

Breast cancer is the leading cause of cancer death in Peruvian women and while the cancer control programs focus on increasing the diagnosis of early stages, it is important to know prognostic factors in this subgroup of patients. The aim of this study was to identify prognostic factors in patients with breast cancer in early clinical stages patients (I-IIA) with surgery as first treatment. We conducted a descriptive study of retrospective case series of patients diagnosed with breast cancer stages I-IIA is from January 2000 to December 2005 in the Instituto Nacional de Enfermedades Neopl sicas. During the study period 952 patients met eligibility criteria and were included in the study. The tumor size, number of involved nodes, pathological stage, estrogen receptor, the type of surgery and hormone therapy were identified predictors of recurrence-free survival at a distance, while for overall survival, variables were age at diagnostic, the pathological T stage, tumor size, number of involved nodes, pathological stage, estrogen receptor and progesterone status and the hormone phenotype. Multivariate analysis showed that independent prognostic factors for recurrence-free survival were pathological T stage (HR = 1.51, for T2, compared to T1), and pathologic N stage (HR = 1.82, for N2, compared to N1), whereas for overall survival were age at diagnosis (HR = 4.14, for ≥ 70 years, compared to <50), pathological T stage (HR = 1.74, for T2, compared to T1), pathologic N stage (HR = 1.93 for N1, compared to N0). In conclusion, age, pathologic T and N stages were the most important prognostic factors.