Circulating miRNAs signature on breast cancer: the MCC-Spain project.

PURPOSE: To build models combining circulating microRNAs (miRNAs) able to identify women with breast cancer as well as different types of breast cancer, when comparing with controls without breast cancer. METHOD: miRNAs analysis was performed in two phases: screening phase, with a total n = 40 (10 controls and 30 BC cases) analyzed by Next Generation Sequencing, and validation phase, which included 131 controls and 269 cases. For this second phase, the miRNAs were selected combining the screening phase results and a revision of the literature. They were quantified using RT-PCR. Models were built using logistic regression with LASSO penalization. RESULTS: The model for all cases included seven miRNAs (miR-423-3p, miR-139-5p, miR-324-5p, miR-1299, miR-101-3p, miR-186-5p and miR-29a-3p); which had an area under the ROC curve of 0.73. The model for cases diagnosed via screening only took in one miRNA (miR-101-3p); the area under the ROC curve was 0.63. The model for disease-free cases in the follow-up had five miRNAs (miR-101-3p, miR-186-5p, miR-423-3p, miR-142-3p and miR-1299) and the area under the ROC curve was 0.73. Finally, the model for cases with active disease in the follow-up contained six miRNAs (miR-101-3p, miR-423-3p, miR-139-5p, miR-1307-3p, miR-331-3p and miR-21-3p) and its area under the ROC curve was 0.82. CONCLUSION: We present four models involving eleven miRNAs to differentiate healthy controls from different types of BC cases. Our models scarcely overlap with those previously reported.

Examining Neural Connectivity in Schizophrenia Using Task-Based EEG: A Graph Theory Approach.

Schizophrenia (SZ) is a complex disorder characterized by a range of symptoms and behaviors that have significant consequences for individuals, families, and society in general. Electroencephalography (EEG) is a valuable tool for understanding the neural dynamics and functional abnormalities associated with schizophrenia. Research studies utilizing EEG have identified specific patterns of brain activity in individuals diagnosed with schizophrenia that may reflect disturbances in neural synchronization and information processing in cortical circuits. Considering the temporal dynamics of functional connectivity provides a more comprehensive understanding of brain networks' organization and how they change during different cognitive states. This temporal perspective would enhance our understanding of the underlying mechanisms of schizophrenia. In the present study, we will use measures based on graph theory to obtain dynamic and static indicators in order to evaluate differences in the functional connectivity of individuals diagnosed with SZ and healthy controls using an ecologically valid task. At the static level, patients showed alterations in their ability to segregate information, particularly in the default mode network (DMN). As for dynamic measures, patients showed reduced values in most metrics (segregation, integration, centrality, and resilience), reflecting a reduced number of dynamic states of brain networks. Our results show the utility of combining static and dynamic indicators of functional connectivity from EEG sensors.

Reconsidering the Use of Population Health Surveys for Monitoring of Mental Health.

Monitoring of the mental health status of the population and assessment of its determinants are 2 of the most relevant pillars of public mental health, and data from population health surveys could be instrumental to support them. Although these surveys could be an important and suitable resource for these purposes, due to different limitations and challenges, they are often relegated to the background behind other data sources, such as electronic health records. These limitations and challenges include those related to measurement properties and cross-cultural validity of the tools used for the assessment of mental disorders, their degree of representativeness, and possible difficulties in the linkage with other data sources. Successfully addressing these limitations could significantly increase the potential of health surveys in the monitoring of mental disorders and ultimately maximize the impact of the relevant policies to reduce their burden at the population level. The widespread use of data from population health surveys, ideally linked to electronic health records data, would enhance the quality of the information available for research, public mental health decision-making, and ultimately addressing the growing burden of mental disorders.

Fractal dimension analysis of resting state functional networks in schizophrenia from EEG signals.

Fractal dimension (FD) has been revealed as a very useful tool in analyzing the changes in brain dynamics present in many neurological disorders. The fractal dimension index (FDI) is a measure of the spatiotemporal complexity of brain activations extracted from EEG signals induced by transcranial magnetic stimulation. In this study, we assess whether the FDI methodology can be also useful for analyzing resting state EEG signals, by characterizing the brain dynamic changes in different functional networks affected by schizophrenia, a mental disorder associated with dysfunction in the information flow dynamics in the spontaneous brain networks. We analyzed 31 resting-state EEG records of 150 s belonging to 20 healthy subjects (HC group) and 11 schizophrenia patients (SCZ group). Brain activations at each time sample were established by a thresholding process applied on the 15,002 sources modeled from the EEG signal. FDI was then computed individually in each resting-state functional network, averaging all the FDI values obtained using a sliding window of 1 s in the epoch. Compared to the HC group, significant lower values of FDI were obtained in the SCZ group for the auditory network (p < 0.05), the dorsal attention network (p < 0.05), and the salience network (p < 0.05). We found strong negative correlations (p < 0.01) between psychopathological scores and FDI in all resting-state networks analyzed, except the visual network. A receiver operating characteristic curve analysis also revealed that the FDI of the salience network performed very well as a potential feature for classifiers of schizophrenia, obtaining an area under curve value of 0.83. These results suggest that FDI is a promising method for assessing the complexity of the brain dynamics in different regions of interest, and from long resting-state EEG signals. Regarding the specific changes associated with schizophrenia in the dynamics of the spontaneous brain networks, FDI distinguished between patients and healthy subjects, and correlated to clinical variables.

Prevalence and variability of depressive symptoms in Europe: update using representative data from the second and third waves of the European Health Interview Survey (EHIS-2 and EHIS-3).

BACKGROUND: Assessing the prevalence of clinically relevant depressive symptoms and their possible variation by country and over time could be a valuable resource to inform the development of public health policies and preventive resources to reduce mental health burden. We aimed to assess cross-national differences in the point prevalence of clinically relevant depressive symptoms in Europe in 2018-20, and to evaluate point prevalence differences between countries and over time between 2013-15 and 2018-20. METHODS: In this population-based study, data from participants in the second and third waves of the European Health Interview Survey (EHIS-2 from 2013 to 2015 and EHIS-3 from 2018 to 2020) from 30 European countries were used (n=542 580). From the total sample, 283 692 participants belonging to EHIS-3 were included in the study (52·4% women and 47·5% men). The non-response in EHIS-3 ranged by country, from 12% to 78%. Point prevalence of clinically relevant depressive symptoms was evaluated using a cutoff score of 10 or more for the 8-item version of the Patient Health Questionnaire. Crude prevalence ratios and adjusted prevalence ratios (aPRs) were obtained to assess differences in the prevalence between countries and over time within countries. FINDINGS: The point prevalence of clinically relevant depressive symptoms in Europe in 2018-20 was 6·54% (95% CI 6·34-6·73), ranging across countries from 1·85% (1·53-2·17) in Greece to 10·72% (10·04-11·40) in Sweden. Compared with the other European countries, those with the lowest aPRs were Greece, Serbia, and Cyprus and those with the highest aPRs were Belgium, Slovenia, and Croatia. A small but significant increase in the prevalence between EHIS-2 and EHIS-3 was observed (aPR 1·11 [1·07-1·14]). A wide variability over time in the point prevalence within countries was observed, ranging from an aPR of 0·63 (0·54-0·74) in Hungary to 1·88 (1·53-2·31) in Slovenia. INTERPRETATION: This study, based on large and representative datasets and a valid and reliable screening tool for the assessment of depression, indicates that the point prevalence of clinically relevant depressive symptoms in Europe from 2013 to 2020 remains relatively stable, with wide variability between countries. These findings could be considered a baseline for monitoring the prevalence of clinically relevant depressive symptoms in Europe, and could inform policy for the development of preventive strategies for depression both at a country and European level. FUNDING: Center for Biomedical Research in Epidemiology and Public Health Network and AGAUR.

Reliability and cross-country equivalence of the 8-item version of the Patient Health Questionnaire (PHQ-8) for the assessment of depression: results from 27 countries in Europe.

Background: The 8-item version of the Patient Health Questionnaire (PHQ-8) is one of the self-reported questionnaires most frequently used worldwide for the screening and severity assessment of depression. However, in some European countries its reliability is unknown, and it is unclear whether its psychometric properties vary between European countries. Therefore, the aim of this study was to assess the internal structure, reliability and cross-country equivalence of the PHQ-8 in Europe. Methods: All participants from the 27 countries included in the second wave of the European Health Interview Survey (EHIS-2) between 2014 and 2015 with complete information on the PHQ-8 were included (n = 258,888). The internal structure of the PHQ-8 was assessed using confirmatory factor analyses (CFA) for categorical items. Additionally, the reliability of the questionnaire was assessed based on the internal consistency, Item Response Theory information functions, and item-discrimination (using Graded Response Models), and the cross-country equivalence based on multi-group CFA. Findings: The PHQ-8 shows high internal consistency for all countries. The countries in which the PHQ-8 was more reliable were Romania, Bulgaria and Cyprus and less reliable were Iceland, Norway and Austria. The PHQ-8 item with highest discrimination was item 2 (feeling down, depressed, or hopeless) in 24 of the 27 countries. Measurement invariance between countries in Europe was observed from multigroup CFA at the configural, metric and scalar levels. Interpretation: The results from our study, likely the largest study to the date assessing the internal structure, reliability and cross-country comparability of a self-reported mental health assessment measure, shows that the PHQ-8 has an adequate reliability and cross-country equivalence across the 27 European countries included. These results highlight the suitability of the comparisons of the PHQ-8 scores in Europe. They could be helpful to improve the screening and severity assessment of depressive symptoms at the European level. Funding: This work was partially funded by CIBER Epidemiology and Public Health (CIBERESP) as part of the Intramural call of 2021 (ESP21PI05).

Integration-segregation dynamics in functional networks of individuals diagnosed with schizophrenia.

Schizophrenia has been associated with dysfunction in information integration/segregation dynamics. One of the neural networks whose role has been most investigated in schizophrenia is the default mode network (DMN). In this study, we have explored the possible alteration of integration and segregation dynamics in individuals diagnosed with schizophrenia with respect to healthy controls, based on the study of the topological properties of the graphs derived from the functional connectivity between the nodes of the DMN in the resting state. Our results indicate that the patients show a diminution of the modularity of the DMN and a higher global efficiency, in sparse graphs. Our data emphasise the interest in studying temporal changes in network measures and are compatible with the hypothesis of randomization of functional networks in schizophrenia.

Association of occupational heat exposure and colorectal cancer in the MCC-Spain study.

OBJECTIVE: Heat exposure and heat stress/strain is a concern for many workers. There is increasing interest in potential chronic health effects of occupational heat exposure, including cancer risk. We examined potential associations of occupational heat exposure and colorectal cancer (CRC) risk in a large Spanish multi-case--control study. METHODS: We analyzed data on 1198 histologically confirmed CRC cases and 2690 frequency-matched controls. The Spanish job-exposure matrix, MatEmEsp, was used to assign heat exposure estimates to the lifetime occupations of participants. Three exposure indices were assessed: ever versus never exposed, cumulative exposure and duration (years). We estimated odds ratios (OR) and 95% confidence intervals (CI) using unconditional logistic regression adjusting for potential confounders. RESULTS: Overall, there was no association of ever, compared with never, occupational heat exposure and CRC (OR 1.09, 95% CI 0.92-1.29). There were also no associations observed according to categories of cumulative exposure or duration, and there was no evidence for a trend. There was no clear association of ever occupational heat exposure and CRC in analysis conducted among either men or women when analyzed separately. Positive associations were observed among women in the highest categories of cumulative exposure (OR 1.81, 95% CI 1.09-3.03) and duration (OR 2.89, 95% CI 1.50-5.59) as well as some evidence for a trend (P<0.05). CONCLUSION: Overall, this study provides no clear evidence for an association between occupational heat exposure and CRC.

Health-Related Quality of Life (HRQOL) Instruments and Mobility: A Systematic Review.

Physical function is one of the most important constructs assessed in health-related quality of life (HRQOL), and it could be very useful to assess movement ability from the perspective of the patient. The objective of this study was to compare the content of the domains related to mobility covered by the HRQOL questionnaires based on the International Classification of Functioning, Disability and Health (ICF) and to evaluate their quality according to the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) guidance. For this, a systematic review was carried out in the databases Scopus, Web of Science and Science Direct. The inclusion criteria were development and/or validation studies about generic HRQOL measures, and the instruments had to include items related to mobility and studies written in English or Spanish. The comparison of content was performed using the ICF coding system. A total of 3614 articles were found, 20 generic HRQOL instruments were identified and 120 (22.4%) mobility-related items were found. Walking was the most represented category. Low-quality evidence on some measurement properties of the generic HRQOL instruments was revealed. The CAT-Health is a useful questionnaire to be used in rehabilitation due to its psychometric properties and its content.

Effect of the use of prediagnosis hormones on breast cancer prognosis: MCC-Spain study.

OBJECTIVE: To extend knowledge about the long-term use of hormones in hormone therapy or oral contraception as prognostic factors in breast cancer. METHODS: The MCC-Spain project is a cohort of 1,685 women with incident breast cancer recruited in Spain. Recruitment was carried out between 2007 and 2010, and the follow-up finished in December 2017. The impact of hormone therapy or oral contraception on breast cancer prognosis was analyzed considering year of birth and menopausal status (1,095 women [65%] were postmenopausal). Hazard ratios (HRs) were estimated using Cox regression models. Death by any cause was considered as the event, and hormone therapy or oral contraception were analyzed as regressors. RESULTS: Oral contraception use for less than 5 years shows an HR of 1.10 (95% CI, 0.75 to 1.62), whereas use for 5 or more years shows an HR of 1.46 (95% CI, 0.95 to 2.25), with a P trend of 0.01, showing a dose-dependent response. Regarding hormone therapy and restricting the analysis to postmenopausal women born between1940 and 1959, where most hormone therapy (consumption) is concentrated, the results did not show any trend. CONCLUSION: Concerning oral contraception use, our results demonstrate that their use is related to poor prognosis in breast cancer. However, research in this field is limited and controversial, indicating the need for more research in this area. Regarding hormone therapy consumption, our results indicate no association with better prognosis, which contradicts what has previously been published.

What Aspects of Religion and Spirituality Affect the Physical Health of Cancer Patients? A Systematic Review.

In recent years, the literature on the relationship between religion and spirituality (R/S) and the health of cancer patients has been flourishing. Although most studies focus on mental health, many study the physical health of these individuals. In order to summarize the findings of these studies, we reviewed the most recent research on this subject using the PubMed and PsycInfo databases. The objective of this systematic review was to recognize the primary R/S variables studied in research on physical health in cancer contexts. We found that spiritual well-being was the most-researched variable in studies of these characteristics, followed by R/S struggles and other variables such as religious coping; religious commitment or practice; or self-rated R/S. In general, R/S seems to have a positive association with the physical health of cancer patients, although the results are quite heterogeneous, and occasionally there are no relationships or the association is negative. Our results may assist in improving interventions that include spirituality in clinical settings as well as the development of holistic approaches, which may have a positive impact on the quality of life and well-being of cancer patients.

Religiosity, Emotions and Health: The Role of Trust/Mistrust in God in People Affected by Cancer.

Trust in God implies the conviction that God looks after a person's own interests. The first evidence of a relationship between this construct and people's psychological and emotional health dates back several centuries. However, the literature on this is limited, especially for people with physical health conditions, such as cancer. Therefore, the purpose of this study is to test the relationships between trust/mistrust in God, social support and emotions in people affected by cancer. The sample consisted of 177 women and men in Spain diagnosed with cancer. The instruments used were the Trust/Mistrust in God Scale, the Positive and Negative Affect Schedule and the Multidimensional Scale of Perceived Social Support. Correlation analysis and hierarchical regression analysis were performed to compare several explanatory models for the dependent variables: positive and negative emotions. The results show significant relationships between all variables. It was observed that, when trust/mistrust in God is included in the model, only mistrust in God predicts both types of emotions. In addition, both social support and some sociodemographic variables help to predict the dependent variables. This study shows that valuing the religiosity and spirituality of oncology patients in healthcare settings can have a significant positive impact on the health of these individuals. Moreover, it represents an important approach to the study of trust/mistrust in God in the context of a traditionally Catholic country.

Reporting and Interpreting Effect Sizes in Applied Health-Related Settings: The Case of Spirituality and Substance Abuse.

Inferential analysis using null hypothesis significance testing (NHST) allows accepting or rejecting a null hypothesis. Nevertheless, rejecting a null hypothesis and concluding there is a statistical effect does not provide a clue as to its practical relevance or magnitude. This process is key to assessing the effect size (ES) of significant results, be it using context (comparing the magnitude of the effect to similar studies or day-to-day effects) or statistical estimators, which also should be sufficiently interpreted. This is especially true in clinical settings, where decision-making affects patients' lives. We carried out a systematic review for the years 2015 to 2020 utilizing Scopus, PubMed, and various ProQuest databases, searching for empirical research articles with inferential results linking spirituality to substance abuse outcomes. Out of the 19 studies selected, 11 (57.9%) reported no ES index, and 9 (47.4%) reported no interpretation of the magnitude or relevance of their findings. The results of this review, although limited to the area of substance abuse and spiritual interventions, are a cautionary tale for other research topics. Gauging and interpreting effect sizes contributes to a better understanding of the subject under scrutiny in any discipline.

Electrophysiological Prints of Grit.

While scientific interest in understanding the grit trait has grown exponentially in recent years, one important gap in the grit literature relates to its biological and neural substrate. In the present study, we adopted a hypotheses-driven approach in a large sample of young adults (N = 120) with diverse educational backgrounds and work experiences in order to investigate the electrophysiological correlates of grit both during rest and while performing a learning task. Additionally, we selected a measure of impulsiveness to better understand the neural similarities and differences between grit and related self-control constructs. Based on previous work that implicated the prefrontal cortex in grit, we hypothesized that high grit participants would have lower frontal theta/beta ratio (a broadly used index that reflects prefrontally-mediated top-down processes, which might indicate better control over subcortical information). Furthermore, we expected the perseverance of effort facet of grit to be linked to higher complexity during task engagement because previous research has shown complexity indexes (entropy and fractal dimension) to be linked to effort while performing cognitive tasks. Our results revealed that although there were no differences at rest as a function of grit, the participants with high grit and high consistency of interest scores exhibited lower frontal theta/beta ratios during the learning task. This pattern suggests that individual differences in grit might be more evident when top-down control processes are at work. Furthermore, there was a positive association between perseverance of effort and entropy at task, which might indicate more effort and engagement in the task. Finally, no association was found between the neural indexes (frontal theta/beta ratio, entropy, or fractal dimension) and impulsiveness, neither impulsiveness mediated between grit and brain measures. Finally, when controlling for impulsiveness and demographic variables (gender, age, education, and work experience) the effects at the facet level remained statistically significant. While there is still a long way to fully understand the neural mechanisms of grit, the present work constitutes a step toward unveiling the electrophysiological prints of grit.

Polygenic risk score across distinct colorectal cancer screening outcomes: from premalignant polyps to colorectal cancer.

BACKGROUND: Different risk-based colorectal cancer (CRC) screening strategies, such as the use of polygenic risk scores (PRS), have been evaluated to improve effectiveness of these programs. However, few studies have previously assessed its usefulness in a fecal immunochemical test (FIT)-based screening study. METHODS: A PRS of 133 single nucleotide polymorphisms was assessed for 3619 participants: population controls, screening controls, low-risk lesions (LRL), intermediate-risk (IRL), high-risk (HRL), CRC screening program cases, and clinically diagnosed CRC cases. The PRS was compared between the subset of cases (n = 648; IRL+HRL+CRC) and controls (n = 956; controls+LRL) recruited within a FIT-based screening program. Positive predictive values (PPV), negative predictive values (NPV), and the area under the receiver operating characteristic curve (aROC) were estimated using cross-validation. RESULTS: The overall PRS range was 110-156. PRS values increased along the CRC tumorigenesis pathway (Mann-Kendall P value 0.007). Within the screening subset, the PRS ranged 110-151 and was associated with higher risk-lesions and CRC risk (ORD10vsD1 1.92, 95% CI 1.22-3.03). The cross-validated aROC of the PRS for cases and controls was 0.56 (95% CI 0.53-0.59). Discrimination was equal when restricted to positive FIT (aROC 0.56), but lower among negative FIT (aROC 0.55). The overall PPV among positive FIT was 0.48. PPV were dependent on the number of risk alleles for positive FIT (PPVp10-p90 0.48-0.57). CONCLUSIONS: PRS plays an important role along the CRC tumorigenesis pathway; however, in practice, its utility to stratify the general population or as a second test after a FIT positive result is still doubtful. Currently, PRS is not able to safely stratify the general population since the improvement on PPV values is scarce.

Assessing reforestation failure at the project scale: The margin for technical improvement under harsh conditions. A case study in a Mediterranean Dryland.

Poor reforestation outcomes imply failure to fulfill program goals and tend to erode institutional willpower and political momentum towards reforestation efforts, affecting both public and private support. However, program improvement in real reforestation projects is challenging, due to the conjunction of many different variables that mutually interact and feed back on each other inextricably. This study develops a comprehensive assessment framework for reforestation programs, for which technical and environmental information is gathered and related to indicators of performance in both the short- and mid-term. This assessment, tested on a case study, aimed to provide reliable end-results for survival and growth, revealed pitfalls in successful plantation establishment and taught us how to improve plantation performance and what the margin for this improvement was. The selected project was carried out on harsh site conditions, with different species, cultivation treatments and contractors, and was affected by the driest year on record. Plantation mortality was high and increased progressively over time, particularly in the short-term when the rate was 53% (rising to 83% after ten years), showing high variation between sites and species (Pinus pinaster and Quercus faginea died more than 94% after ten years while Junipus phoenicea only 40%). All the hardwoods and the juniper showed lower growth rate after ten years (average stem volume < 40 cm3) than pines (stem volume > 470 cm3). Technical variables (project planning and execution) had a relatively important impact on plantation performance in the first two years (11-29%), but decreased with time, whilst environmental variables (site and meteorological) were more important ten years after planting (>50%). In the short-term, soil moisture and meteorology during the planting season were identified as key factors that triggered the effects of both technical decisions (planting date and planting technique) and other environmental variables on performance. In the design phase, some decisions related to zoning, species selection and cultural treatments were related to poor performance. The results provide practical information and guidelines about all potential drivers of plantation performance and contribute to identify those aspects more related to success of forest restoration in Mediterranean drylands.

Improving suicide surveillance systems through the use of the Patient Health Questionnaire-9.

Suicide is a major public health problem worldwide and continues to be one of the main causes of death. Implementing surveillance strategies for suicidal thoughts and behaviours would make it possible to identify individuals at high risk of ending their lives by suicide. While a universal screening would be controversial, the increasing use of the 9-item version of the Patient Health Questionnaire (PHQ-9) in different healthcare settings, such as primary care or hospital emergency departments, offers an opportunity for testing its performance for suicide surveillance. Beyond being a screening of depression, the PHQ-9 has shown merit as a marker of suicidal thinking, thoughts of self-harm, and suicide. Implementing systematic surveillance strategies for suicide in different healthcare settings including data from the PHQ-9 might be an effective way to improve case detection. This could help to enhance the identification of highest risk population groups and, consequently, to avoid potentially preventable suicides.

Consumption of ultra-processed foods and drinks and colorectal, breast, and prostate cancer.

AIMS: To study whether the consumption of ultra-processed foods and drinks is associated with breast, colorectal, and prostate cancers. METHODS: Multicentric population-based case-control study (MCC-Spain) conducted in 12 Spanish provinces. Participants were men and women between 20 and 85 years of age with diagnoses of colorectal (n = 1852), breast (n = 1486), or prostate cancer (n = 953), and population-based controls (n = 3543) frequency-matched by age, sex, and region. Dietary intake was collected using a validated food frequency questionnaire. Foods and drinks were categorized according to their degree of processing based on the NOVA classification. Unconditional multivariable logistic regression was used to evaluate the association between ultra-processed food and drink consumption and colorectal, breast, and prostate cancer. RESULTS: In multiple adjusted models, consumption of ultra-processed foods and drinks was associated with a higher risk of colorectal cancer (OR for a 10% increase in consumption: 1.11; 95% CI 1.04-1.18). The corresponding odds for breast (OR 1.03; 95% CI 0.96-1.11) and prostate cancer (OR 1.02; 95% CI 0.93-1.12) were indicative of no association. CONCLUSIONS: Results of this large population-based case-control study suggest an association between the consumption of ultra-processed foods and drinks and colorectal cancer. Food policy and public health should include a focus on food processing when formulating dietary guidelines.

Adequacy of early-stage breast cancer systemic adjuvant treatment to Saint Gallen-2013 statement: the MCC-Spain study.

The St Gallen Conference endorsed in 2013 a series of recommendations on early breast cancer treatment. The main purpose of this article is to ascertain the clinical factors associated with St Gallen-2013 recommendations accomplishment. A cohort of 1152 breast cancer cases diagnosed with pathological stage < 3 in Spain between 2008 and 2013 was begun and then followed-up until 2017/2018. Data on patient and tumour characteristics were obtained from medical records, as well as their first line treatment. First line treatments were classified in three categories, according on whether they included the main St Gallen-2013 recommendations, more than those recommended or less than those recommended. Multinomial logistic regression models were carried out to identify factors associated with this classification and Weibull regression models were used to find out the relationship between this classification and survival. About half of the patients were treated according to St Gallen recommendations; 21% were treated over what was recommended and 33% received less treatment than recommended. Factors associated with treatment over the recommendations were stage II (relative risk ratio [RRR] = 4.2, 2.9-5.9), cancer positive to either progesterone (RRR = 8.1, 4.4-14.9) or oestrogen receptors (RRR = 5.7, 3.0-11.0). Instead, factors associated with lower probability of treatment over the recommendations were age (RRR = 0.7 each 10 years, 0.6-0.8), poor differentiation (RRR = 0.09, 0.04-0.19), HER2 positive (RRR = 0.46, 0.26-0.81) and triple negative cancer (RRR = 0.03, 0.01-0.11). Patients treated less than what was recommended in St Gallen had cancers in stage 0 (RRR = 21.6, 7.2-64.5), poorly differentiated (RRR = 1.9, 1.2-2.9), HER2 positive (RRR = 3.4, 2.4-4.9) and luminal B-like subtype (RRR = 3.6, 2.6-5.1). Women over 65 years old had a higher probability of being treated less than what was recommended if they had luminal B-like, HER2 or triple negative cancer. Treatment over St Gallen was associated with younger women and less severe cancers, while treatment under St Gallen was associated with older women, more severe cancers and cancers expressing HER2 receptors.