Factors from healthcare delivery affecting breast cancer survival in a health area of Northern of Spain.

OBJECTIVE: Clinical breast cancer decision-making significantly affects life expectancy and management of hospital resources. The aims of the present study were to estimate the time of survival for breast cancer patients and to identify independent factors from healthcare delivery associated with survival rates in a specific health area of Northern of Spain. METHODS: Survival analysis was conducted among a cohort of 2545 patients diagnosed with breast cancer between 2006 and 2012 from the population breast cancer registry of Asturias-Spain and followed up till 2019. Adjusted Cox proportional hazard models were used to identify the independent prognostic factors of all-cause from death. RESULTS: The 5-year survival rate was 80%. Advanced age (>80 years) (hazard ratio, HR: 4.35; 95% confidence interval, CI: 3.41-5.54), hospitalization in small hospitals (HR: 1.46; 95% CI: 1.09-1.97), treatment in oncology wards (HR: 3.57; 95% CI: 2.41-5.27), and length of stay >30 days (HR: 2.24; 95% CI: 1.32-3.79) were the main predictors of death. By contrast, breast cancer suspected via screening was associated with a lower risk of death (HR: 0.55; 95% CI: 0.35-0.87). CONCLUSION: There is room for improvement in survival rates after breast cancer in the health area of Asturias (Northern of Spain). Some healthcare delivery factors, and other clinical characteristics of the tumor influence the survival of breast cancer patients. Strengthening population screening programs could be relevant to increasing survival rates.

Data for the Spanish adaptation of Breast Cancer and Lymphedema Symptom Experience Index (BCLE SEI Esp).

Breast cancer is one of the most diagnosed cancer in women worldwide and lymphedema is one of the most common late and chronic adverse effects of breast cancer treatment. Lymphedema symptoms are essential signs of early-stage of lymphedema as they often precede changes in limb size or girth or a lymphedema diagnosis. Therefore, to achieve early detection and prevent lymphedema progression, it is important to promote patient selfcare in terms of the awareness symptoms identification. To this purpose Breast Cancer and Lymphedema Symptom Experience Index (BCLE SEI Esp) scale was used. Between October 2018 and June 2020, we collected data from 286 lymphedema and non-lymphedema patients post-breast cancer treatment on sociodemographic information, lymphedema symptoms, daily living-function and psychosocial distress, women and the data comparison between lymphedema and non-lymphedema patients were provided in this publication. This dataset can be used as a reference in clinical settings or in clinical studies or as an instructional tool to teach breast cancer patients and clinicians to be aware of lymphedema symptoms and to help clinicians and patients to achieve early identification of lymphedema symptoms and the impacts of lymphedema symptoms in women´s life and to develop future research, for example, to develop predictive algorithms.

Type 2 Diabetes and all-cause mortality among Spanish women with breast cancer.

PURPOSE: To explore the effect of type 2 diabetes mellitus (T2DM) on the risk of death among women with breast cancer (BC). METHODS: A survival analysis was conducted among a cohort of women diagnosed with BC between 2006 and 2012 in Spain (n = 4,493). Biopsy or surgery confirmed BC cases were identified through the state population-based cancer registry with information on patients' characteristics and vital status. Physician-diagnosed T2DM was confirmed based on primary health care clinical history. Cox regression analyses were used to estimate adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for all-cause death. Analyses were adjusted for age, hospital size, several clinical characteristics (including BC stage and histology, among others) and treatment modalities. RESULTS: Among the 4,493 BC women, 388 (8.6%) had coexisting T2DM. Overall, 1,299 (28.9%) BC women died during the completion of the follow-up and 785 (17.5%) did so during the first five years after BC diagnosis, resulting in a five-year survival rate of 82.5%. The death rate was higher in women with T2DM (43.8% died during whole period and 26.0% during the first five years) when compared with women without T2DM (27.5% and 16.7%, respectively). Accordingly, all-cause mortality was higher in women with T2DM (aHR: 1.22; 95% CI 1.03-1.44), especially if T2DM was diagnosed before BC (aHR:1.24; 95% CI 1.03-1.50) and in women with BC diagnosed before 50 years (aHR: 2.38; 95% CI 1.04-5.48). CONCLUSIONS: T2DM was associated with higher all-cause mortality among Spanish women with BC, particularly when the T2DM diagnosis was prior to the BC.

Biopsia de ganglio centinela en pacientes con cáncer de mama multifocal y multicéntrico: 5 años de seguimiento / Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up

Objetivo: La biopsia selectiva del ganglio centinela (BSGC) como procedimiento de estadificación en el cáncer de mama múltiple es cuestión de controversia. Nuestro objetivo es evaluar la eficiencia de detección del ganglio centinela (GC) en las pacientes con cáncer multifocal o multicéntrico, y la seguridad de su aplicación clínica, tras un seguimiento prolongado. Material y métodos: Se realiza un estudio prospectivo descriptivo. Se estudian 89 pacientes con cáncer múltiple de mama sometidas a BSGC (73 procesos multifocales, 16 multicéntricos), comparándolas con las que presentaron neoplasia unifocal. En la mayor parte de las BSGC se realizó administración periareolar del radiocoloide. Se realiza la evaluación a los 67,2 meses de seguimiento medio (32-126 meses). Resultados: Las tasas de localización gammagráfica y quirúrgica del GC en las pacientes con cáncer de mama múltiple fueron respectivamente 95,5% y 92,1%, observándose mayor porcentaje de GC extraaxilares que en los procesos unifocales (11,7% frente a 5,4%) y un número de GC por paciente significativamente mayor (1,70 frente a 1,38). La tasa de localización del GC en el cáncer multicéntrico fue ligeramente inferior al multifocal (87,5% frente a 93,1%) y el hallazgo de drenajes extra-axilares más elevado (20% frente a 10%). El número promedio de GC por paciente fue significativamente superior en el cáncer multicéntrico (2,33 frente a 1,57). No se han registrado recurrencias axilares en el seguimiento de las pacientes con cáncer múltiple. Conclusiones: La BSGC mediante inyección periareolar es un procedimiento preciso y fiable de estadificación del cáncer de mama múltiple, incluso multicéntrico (AU)

Objective: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. Material and methods: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). Results: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SNlocalization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. Conclusions: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes (AU)

[Sentinel node biopsy in patients with multifocal and multicentric breast cancer: A 5-year follow-up]. / Biopsia de ganglio centinela en pacientes con cáncer de mama multifocal y multicéntrico: 5 años de seguimiento.

OBJECTIVE: Sentinel lymph node biopsy (SLNB) as a staging procedure in multiple breast cancer is a controversial issue. We have aimed to evaluate the efficacy of sentinel node (SN) detection in patients with multifocal or multicentric breast cancer as well as the safety of its clinical application after a long follow-up. MATERIAL AND METHODS: A prospective descriptive study was performed. Eighty-nine patients diagnosed of multiple breast cancer (73 multifocal; 16 multicentric) underwent SLNB. These patients were compared to those with unifocal neoplasia. Periareolar radiocolloid administration was performed in most of the patients. Evaluation was made at an average of 67.2 months of follow-up (32-126 months). RESULTS: Scintigraphic and surgical SN localization in patients with multiple breast cancer were 95.5% and 92.1%, respectively. A higher percentage of extra-axillary nodes was observed than in the unifocal group (11.7% vs 5.4%) as well as a significantly higher number of SN per patient (1.70 vs 1.38). The rate of SN localization in multicentric cancer was slightly lower than in multifocal cancer (87.5% vs 93.1%), and the finding of extra-axillary drainages was higher (20% vs 10%). Number of SN per patient was significantly higher in multicentric breast cancer (2.33 vs 1.57). No axillary relapses have been demonstrated in the follow-up in multiple breast cancer patients group. CONCLUSIONS: SLNB performed by periareolar injection is a reliable and accurate staging procedure of patients with multiple breast cancer, including those with multicentric processes.