ABSTRACT
Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009 period to 33% in the 2013-2016 period, with most of this increase occurring among women with early-stage disease (17-52%). Improving access to care and reducing the financial burden of breast cancer in developing countries may lead to an increased use of breast conserving surgery.
Subject(s)
Breast Neoplasms/surgery , Insurance, Health/statistics & numerical data , Mastectomy, Segmental/trends , Adult , Aged , Breast Neoplasms/drug therapy , Breast Neoplasms/pathology , Female , Humans , Mexico , Middle Aged , Neoplasm Recurrence, Local , Neoplasm Staging , Retrospective StudiesABSTRACT
Breast cancer is classified based on clinical stage, cellular morphology and immunohistochemical analysis. More precise prognostic factors are necessary to aid with therapeutic decisions. Breast cancer subtypes that differ in their genetic expression and prognosis have been determined using cDNA microarrays. These findings confirm the differences between the phenotypes and provide new knowledge about the biology of breast cancer. Based on the presence or absence of expression of the estrogen receptor (ER), breast cancer is divided in two groups: ER+ and ER-. Genetic expression profile has identified two subtypes of the ER+ tumors: luminal A and luminal B. ER- tumors also include two subtypes, the HER2+ and the basal type. These subtypes differ in their biology and both demonstrate short disease-free periods after treatment and poorer outcome. This classification has shown the relationship between cDNA microarrays and clinical outcome of these tumors. This classification is proposed as a method of identifying those patients who will demonstrate better results with the different adjuvant modalities.
Subject(s)
Breast Neoplasms/classification , Gene Expression Profiling , Breast Neoplasms/chemistry , Breast Neoplasms/drug therapy , Breast Neoplasms/epidemiology , Breast Neoplasms/genetics , Cell Division/genetics , Cell Transformation, Neoplastic/genetics , DNA, Complementary/genetics , DNA, Neoplasm/genetics , Female , Forecasting , Genes, erbB-2 , Humans , Kaplan-Meier Estimate , Mexico/epidemiology , Models, Biological , Oligonucleotide Array Sequence Analysis , Receptor, ErbB-2/analysis , Receptors, Estrogen/analysis , Receptors, Estrogen/genetics , Treatment OutcomeABSTRACT
BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.
Subject(s)
Breast Neoplasms/diagnosis , Fibroma/diagnosis , Adolescent , Breast Neoplasms/surgery , Diagnosis, Differential , Female , Fibroma/surgery , Humans , Middle AgedABSTRACT
BACKGROUND: Breast fibromatosis (BF) is a rare benign pathological entity. Its etiology is unknown, but it has been associated with surgical trauma and certain genetic disorders. CLINICAL CASES: Case 1. The patient was a 17-year-old female with a 20 x 15 cm firm and fixed mass in the right breast. A core-needle biopsy was taken with a pathology report of a phyllodes tumor. Mammography revealed a well-differentiated lesion with no evidence of muscle invasion. The patient underwent wide surgical resection with thoracotomy and chest wall resection of the affected ribs. Pathology reported a 19 x 18 x 9 cm BF with a positive surgical margin. Oral colchicine was administered and at 3 months of follow-up the patient is disease free. CASE 2. The patient was a 49-year-old female with a 7 x 5 cm solid right breast mass located at the medial-upper quadrant and fixed to the pectoralis major muscle. Mammography and magnetic resonance imaging revealed a mass infiltrating thoracic muscles. Wide surgical resection was performed with immediate latissimus dorsi reconstruction. Pathology report showed a BF with muscle invasion. At 3 months postsurgery, the patient is disease free. CONCLUSIONS: BF is a rare entity with a locally aggressive behavior. The infiltrative nature of this disease is associated with a tendency to recur locally. Its clinical and imaging features can mimic breast cancer. Differential diagnosis should be made before attempting treatment. The standard therapeutic modality is wide surgical resection, and radiotherapy is reserved for some cases with positive surgical margins.
Subject(s)
Humans , Female , Adolescent , Middle Aged , Fibroma/diagnosis , Breast Neoplasms/diagnosis , Diagnosis, Differential , Fibroma/surgery , Breast Neoplasms/surgeryABSTRACT
Breast cancer is classified based on clinical stage, cellular morphology and immunohistochemical analysis. More precise prognostic factors are necessary to aid with therapeutic decisions. Breast cancer subtypes that differ in their genetic expression and prognosis have been determined using cDNA microarrays. These findings confirm the differences between the phenotypes and provide new knowledge about the biology of breast cancer. Based on the presence or absence of expression of the estrogen receptor (ER), breast cancer is divided in two groups: ER+ and ER-. Genetic expression profile has identified two subtypes of the ER+ tumors: luminal A and luminal B. ER- tumors also include two subtypes, the HER2+ and the basal type. These subtypes differ in their biology and both demonstrate short disease-free periods after treatment and poorer outcome. This classification has shown the relationship between cDNA microarrays and clinical outcome of these tumors. This classification is proposed as a method of identifying those patients who will demonstrate better results with the different adjuvant modalities.
