Cumulative risk of cancer detection in breast cancer screening by protocol strategy.

BACKGROUND: There is little information on the individual risk of screen-detected cancer in women over successive participations. This study aimed to estimate the 10-year cumulative breast cancer detection risk (ductal carcinoma in situ and invasive carcinoma) in a population-based breast cancer screening program according to distinct protocol strategies. A further aim was to determine which strategies maximized the cancer detection risk and how this risk was affected by the radiologic protocol variables. METHODS: Data were drawn from a retrospective cohort of women from nine population-based screening programs in Spain from 1990 to 2006. We used logistic regression with discrete intervals to estimate the cumulative detection risk at 10 years of follow-up according to radiologic variables and protocol strategies. RESULTS: In women starting screening at the age of 45-59 years, the cumulative risk of screen-detected cancer at 10 years ranged from 11.11 to 16.71 per 1,000 participants according to the protocol strategy. The cumulative detection risk for overall cancer and invasive cancer was the highest with strategies using digital mammography, double reading, and two projections (16.71 and 12.07 ‰, respectively). For ductal carcinoma in situ, cumulative detection risk was the highest with strategies using screen-film, double reading, and two projections (2.32 ‰). The risk was the lowest with strategies using screen-film mammography, single reading, and two projections. CONCLUSIONS: This study found that at least eleven cancers are detected per 1,000 women screened in the first 10 years of follow-up. Enhanced knowledge of the variability in cumulative risk of screen-detected cancer could improve protocol strategies.

Cumplimiento de las recomendaciones dietéticas vigentes y variabilidad geográfica de la dieta en mujeres participantes en 7 programas de cribado de cáncer de mama en España / Compliance with current dietary recommendations and geographical variability of diet in women participating in 7 screening programs for breast cancer in Spain

Introducción: Una dieta saludable es especialmente importante durante la menopausia, periodo en el que aumenta el riesgo de varios problemas de salud. Analizamos la dieta de mujeres peri y postmenopáusicas españolas y el grado de cumplimiento de las recomendaciones actuales. Material y métodos: Estudio transversal en 3.574 mujeres de 45-68 años que acuden al cribado de cáncer de mama en 7 centros (A Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia y Zaragoza). Se recogió la dieta mediante un cuestionario de frecuencia de alimentos validado para población española. Para la valoración del cumplimiento de las recomendaciones actuales se utilizaron los rangos recomendados por la Sociedad Española de Nutrición Comunitaria para ingesta de grupos de alimentos y las Ingestas Diarias Recomendadas (IDR) para energía, vitaminas y minerales de la Federación Española de Nutrición, Alimentación y Dietética. Resultados: El 29% de las mujeres eran obesas y un 42% tenía sobrepeso. El aporte calórico medio fue de 2.053 kcal (DE: 480). El perfil calórico general fue de: 43% de la energía aportada por lo carbohidratos, 36% por las grasas, 20% por las proteínas. Se evidenció una ingesta deficiente de vitamina D en todos los nodos del estudio, con una ingesta media general de 2,14 μg/día. Se detectó a su vez una ingesta deficitaria de vitamina E en A Coruña y Burgos. Todos los centros presentaron una ingesta elevada de productos lácteos y de legumbres. El consumo de frutas y verduras fue muy heterogéneo siendo especialmente elevada su ingesta en Mallorca y Valencia mientras que fue baja para ambos grupos de alimentos en A Coruña. La ingesta de aceite de oliva fue elevada en todos los centros exceptuando Burgos con un 74,3% de las mujeres estudiadas por debajo de las 3 raciones al día recomendadas. Conclusiones: Una dieta con menos grasas y proteínas y más rica en vegetales, frutos secos y alimentos ricos en hidratos de carbono equilibraría el balance energético y mejoraría la calidad de la dieta corrigiendo las bajas ingestas de vitaminas D y E. Estas recomendaciones son especialmente importantes en las ciudades más alejadas de la costa mediterránea donde se han detectado mayores incumplimientos de las recomendaciones vigentes y una dieta más alejada de la dieta mediterránea (AU)

Introduction: A healthy diet is especially important during menopause, a period which increases the risk of various health problems. We analyzed the diet of periand postmenopausal Spanish women and the degree of compliance with current recommendations. Material and methods: We studied 3574 women 45-68 years old who attended breast cancer screening programmes in 7 centres (A Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia and Zaragoza). Diet information was collected using a food frequency questionnaire validated for the Spanish population. For the assessment of compliance with current guidelines we used the recommendations by the Spanish Society of Community Nutrition for food groups intake and by the Spanish Federation of Nutrition, Food and Dietetics for energy, vitamins and minerals intake. Results: The 29% of women were obese and 42% overweight. The average caloric intake was 2.053 kcal (SD 480). The general energy profile was: 43% of the energy from the carbohydrates, 36% from fats, and 20% from proteins. There was a low vitamin D intake in all centres of the study, with an overall mean intake of 2.14 mg/day. A deficit of vitamin E intake in A Coruña and Burgos was also detected. Intake of dairy products and vegetables was high in all the study centers. The consumption of fruits and vegetables was very heterogeneous, with high intakes observed in Mallorca and Valencia and low for both food groups in A Coruña. The olive oil intake was high in all centers except Burgos with 74.3% of the women studied below the recommended 3 servings per day. Conclusions: A diet with less fat and protein and a higher consumption of vegetables, nuts and foods rich in carbohydrate might balance the energy intake and improve the quality of the diet correcting the low intakes of vitamins D and E. These recommendations are especially important in cities far from the Mediterranean coast where more breaches have been detected over the current recommendations with a lower adherence to the Mediterranean diet (AU)

[Compliance with current dietary recommendations and geographical variability of diet in women participating in 7 screening programs for breast cancer in Spain]. / Cumplimiento de las recomendaciones dietéticas vigentes y variabilidad geográfica de la dieta en mujeres participantes en 7 programas de cribado de cáncer de mama en España.

INTRODUCTION: A healthy diet is especially important during menopause, a period which increases the risk of various health problems. We analyzed the diet of periand postmenopausal Spanish women and the degree of compliance with current recommendations. MATERIAL AND METHODS: We studied 3574 women 45-68 years old who attended breast cancer screening programmes in 7 centres (A Coruña, Barcelona, Burgos, Palma de Mallorca, Pamplona, Valencia and Zaragoza). Diet information was collected using a food frequency questionnaire validated for the Spanish population. For the assessment of compliance with current guidelines we used the recommendations by the Spanish Society of Community Nutrition for food groups intake and by the Spanish Federation of Nutrition, Food and Dietetics for energy, vitamins and minerals intake. RESULTS: The 29% of women were obese and 42% overweight. The average caloric intake was 2.053 kcal (SD 480). The general energy profile was: 43% of the energy from the carbohydrates, 36% from fats, and 20% from proteins. There was a low vitamin D intake in all centres of the study, with an overall mean intake of 2.14 mg/day. A deficit of vitamin E intake in A Coruña and Burgos was also detected. Intake of dairy products and vegetables was high in all the study centers. The consumption of fruits and vegetables was very heterogeneous, with high intakes observed in Mallorca and Valencia and low for both food groups in A Coruña. The olive oil intake was high in all centers except Burgos with 74.3% of the women studied below the recommended 3 servings per day. CONCLUSIONS: A diet with less fat and protein and a higher consumption of vegetables, nuts and foods rich in carbohydrate might balance the energy intake and improve the quality of the diet correcting the low intakes of vitamins D and E. These recommendations are especially important in cities far from the Mediterranean coast where more breaches have been detected over the current recommendations with a lower adherence to the Mediterranean diet.

Cancer screening in Spain.

OBJECTIVE: To describe the current status of breast, colorectal and cervical cancer screening in Spain. METHODOLOGY: The situation was analysed on the basis of data drawn from surveys conducted in each autonomous region (Comunidad Autónoma). RESULTS: Currently, breast cancer screening coverage is 100%. In 2007, overall participation was 67.0% with an adherence of 91.2%. The detection rate was 3.4 per thousand, 15.1% intraductal and 30% invasive <1 cm in diameter, with 65% showing axilary node negative. Colorectal cancer screening had been implemented in six regions (4.5% of the target population). Participation ranged from 17.2% to 42.3%, with positive test percentages ranging from 1.7 per thousand (guaiac) to 9.5% (immunological). The invasive cancer detection rate was 1.7 per thousand (guaiac) and 3.4 per thousand (immunological). In most cases, cervical cancer screening was undertaken opportunistically, with an estimated coverage of 69.0%. CONCLUSIONS: In Spain, cancer screening is being conducted in accordance with national and international recommendations. The fact that screening programmes are operated as a network has led to a high degree of consensus as to the methodology and information systems to be used to enable joint evaluation.

Modulación en la expresión de biomarcadores (RE, RP y C-erbB2) en cáncer de mama tras tratamiento neoadyuvante / Modulation of biomarkers expression (OR, PR and C-erbB2) in breast

Introducción. El tratamiento oncológico pre ypostoperatorio en pacientes con carcinoma de mamaestá condicionado entre otros factores, por el resultadodel estudio inmunohistoquímico de los receptoreshormonales y por la expresión de c-erbB2. El objetivodel estudio es determinar la influencia del tratamientoneoadyuvante en la expresión de receptores de estrógeno(RE), progesterona (PR) y c-erbB2.Material y métodos. Estudiamos 53 pacientes concáncer de mama diagnosticadas mediante biopsia“trucut”. Las pacientes con carcinoma localmenteavanzado (20) se someten a quimioterapia preoperatoria.Se realiza extirpación quirúrgica en todos loscasos. Comparamos la expresión de receptores deestrógeno (RE), receptores de progesterona (PR) y cerbB2,en la biopsia”trucut” y en la pieza quirúrgica.Resultados. Encontramos diferencias significativasen la expresión de RE, RP entre biopsia/pieza quirúrgica,comparando el grupo de pacientes sometidasa tratamiento neoadyuvante frente al grupo de pacientessin tratamiento oncológico prequirúrgico.Encontramos diferencias de signo (positivizacióny negativización) entre un 10 y un 40% de casos en laexpresión inmunohistoquímica para RE, RP y c-erbB2entre la biopsia”trucut” y la resección quirúrgica en laspacientes tratadas con neoadyuvancia. Estas diferenciasde signo no tienen significación estadística

Introduction. Pre and post-operative oncological therapy in patients with breast cancer is determined, amongst other factors, by hormone receptor status and by c-erbB2 expression. The aim of this study is to determine the influence of neoadjuvant therapy on the expression of oestrogen receptor (OR), progesterone receptor (PR) and c-erbB2. Methods. Fifty-three patients with breast cancer diagnosed by tru-cut biopsy were studied. Patients with locally advanced carcinoma (20) had preoperative treatment. All patients underwent surgical resection. Expression of OR, PR and c-erbB2 in both the tru-cut biopsy and the gross specimen was compared. Results: We found significant differences in OR, PR expression in both biopsy and gross specimen, between the group of patients who underwent neoadjuvant treatment and the group without pre-surgical treatment. Changes in PR, OR and c-erbB2 status were found between the tru-cut biopsy and the gross specimen, in about 10 to 40% of the cases who received neoadjuvant therapy. These changes had no statistical significance

[Modulation of biomarkers expression (OR, PR and C-erbB2) in breast cancer following neoadjuvant treatment]. / Modulación en la expresión de biomarcadores (RE, RP y C-erbB2) en cáncer de mama tras tratamiento neoadyuvante.

INTRODUCTION: Pre and post-operative oncological therapy in patients with breast cancer is determined, amongst other factors, by hormone receptor status and by c-erbB2 expression. The aim of this study is to determine the influence of neoadjuvant therapy on the expression of oestrogen receptor (OR), progesterone receptor (PR) and c-erbB2. METHODS: Fifty-three patients with breast cancer diagnosed by tru-cut biopsy were studied. Patients with locally advanced carcinoma (20) had preoperative treatment. All patients underwent surgical resection. Expression of OR, PR and c-erbB2 in both the tru-cut biopsy and the gross specimen was compared. RESULTS: We found significant differences in OR, PR expression in both biopsy and gross specimen, between the group of patients who underwent neoadjuvant treatment and the group without pre-surgical treatment. Changes in PR, OR and c-erbB2 status were found between the tru-cut biopsy and the gross specimen, in about 10 to 40% of the cases who received neoadjuvant therapy. These changes had no statistical significance.

[Sentinel node in breast cancer. Histological study of 67 cases]. / Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos.

BACKGROUND: The extirpation of the sentinel node is a widespread surgical technique whose aim is to avoid axillary resection in patients with breast cancer at early stages. Determination of tumoral infiltration can be evident in the case of macrometastasis (>2mm), or difficult to detect in micrometastasis (<2mm). For this reason we use a protocol of serialized sections, to increase our capacity for detecting micrometastasis. Realisation of this protocol is highly laborious and represents a high cost, thus its effectiveness and efficacy must be studied. MATERIAL AND METHODS: We reviewed 67 sentinel nodes corresponding to 48 patients with breast cancer treated at our hospital in the last three years. All the samples received at the Pathology Unit were included. Serialized sections of three microns were made on each node and with a depth of 40 microns between them. A total of fourteen cuts were made. Every five cuts there was an alternation of immunostaining with a cocktail of queratines (AE1/AE3) and with haemotoxylin-eosin. RESULTS: Sixty-seven sentinel nodes were extirpated from 48 patients. Fourteen positive (20%) were detected. Of these metastases, 6 were macrometastases >2mm, 5 were micrometastases <2mm and 3 were isolated cellular groups (between 0.2 and 2mm). In 6 cases (43%), the metastases only became evident with queratine staining in serialized cuts. Axillary resection was carried out in 44 cases. CONCLUSIONS: The histological study of the sentinel nodes makes it possible to evaluate the status of tumoral infiltration of the axillary ganglions and to greatly reduce axillary lymphadenectomies. The conventional study of the sentinel node (with a single section) is insufficient for the diagnosis of tumoral infiltration. In our series, histological study using a protocol of serialized sections has enabled us to detect some 43% of metastases in the sentinel node that were not evident in the initial section.

Programa de detección precoz de cáncer de mama. Resultados de proceso e indicadores de impacto (1990-2002) / Breast cancer screening program. Results of the process and impact indicators (1990-2002)

Fundamento. Existe un consenso general en la recomendación de aplicar con carácter poblacional programas de cribado de cáncer de mama. El Departamento de Salud puso en marcha en el año 1990 un Programa de Detección Precoz de Cáncer de Mama, con el objetivo de disminuir la mortalidad por este tumor, que en este momento está finalizando su séptima vuelta. El presente trabajo tiene como objetivo analizar los resultados obtenidos, describiendo los principales indicadores de proceso y predictores de impacto según los factores más determinantes. Material y métodos. Se han recopilado los datos de las exploraciones de cribado realizadas desde el comienzo del programa hasta el 31 de diciembre de 2002 clasificando por edad en el momento de la exploración, tipo de exploración y vuelta. Resultados. Durante el período se han realizado 354.575 exploraciones. Indicadores de proceso: en el 11,22 por ciento se recomendó realizar una exploración adicional. El 0,67 por ciento de las mujeres han sido enviadas a unidades hospitalarias para valoración diagnóstica. Se ha confirmado un tumor maligno en el 0,34 por ciento de las mujeres exploradas. A 8,37 por ciento de las mujeres se les ha recomendado realizar una exploración intermedia antes de la nueva de cribado. Indicadores predictores de impacto: la captación global es de 88,68 por ciento, la participación global de 87,91 por ciento y la adherencia al programa de 96,32 por ciento. La tasa de detección alcanza la cifra de 3,95 por 1.000 mujeres exploradas. De los tumores detectados, 19,17 por ciento son intraductales, y 37,23 por ciento de los invasivos tienen un tamaño igual o inferior a 10 mm. El 74,89 por ciento del total de tumores no presenta invasión ganglionar. Conclusiones. Considerando las referencias que para programas de cribado establece la Unión Europea, todos los indicadores predictores calculados superan los estándares exigidos (AU)

Ganglio centinela en cáncer de mama. Estudio histológico de 67 casos / Sentinel node in breast cancer. Histological study of 67 cases

Fundamento. La extirpación del ganglio centinela es una técnica quirúrgica muy extendida cuyo objetivo es evitar el vaciamiento axilar en pacientes con cáncer de mama en estadios iniciales. La determinación de la infiltración tumoral puede ser evidente en caso de macrometástasis (>2mm), o difícil de detectar en las micrometástasis (2mm, 5 fueron micrometástasis <2 mm y 3 grupo celular aislado (entre 0,2 y 2 mm) . En 6 casos (43 por ciento), las metástasis sólo se hicieron patentes con la tinción de queratina en los cortes seriados. Se realizó resección axilar en 44 casos. Conclusiones. El estudio histológico del ganglio centinela permite evaluar el estatus de infiltración tumoral de los ganglios axilares y reducir en gran medida las linfadenectomías axilares. El estudio convencional del ganglio centinela (con un único corte) resulta insuficiente para el diagnóstico de la infiltración tumoral. En nuestra serie el estudio histológico mediante un protocolo de cortes seriados nos ha permitido detectar un 43 por ciento de metástasis en ganglio centinela que no eran evidentes en el corte inicial (AU)

[Breast cancer screening program. Results of the process and impact indicators (1990-2002)]. / Programa de detección precoz de cáncer de mama. Resultados de proceso e indicadores de impacto (1990-2002).

BACKGROUND: There is a general consensus on the recommendation of applying breast cancer screening programs to the population. In March 1990, the Health Department set in motion a Program for the Early Detection of Breast Cancer, with the aim of reducing mortality due to this tumour. At present, the program is reaching the end of its seventh round. The present study aims to analyze the results obtained, describing the principal indicators of the process and the impact predictions according to the most determinant factors. METHODS: Data was collected for the screening explorations carried out from the start of the program up until December 31st 2002; the data was classified according to age at the time of exploration, type of exploration and round. RESULTS: During the period, 354,575 explorations were carried out. Process indicators: an additional exploration was recommended for 11.22% of the women. Naught point sixty seven percent (0.67%) of the women were sent to hospital units for a diagnostic evaluation. A malignant tumour was confirmed in 0.34% of the women subjected to exploration. It was recommended that 8.37% of the women should carry out an intermediate exploration before the next call from the screening program. Predictive impact indicators: global recruitment was 88.68%; global participation 87.91%; and adherence to the program was 96.32%. The rate of detection reached the figure of 3.95 per 1,000 women explored. Of the tumours detected: 19.17% were intraductal and 37.23% of the invasive tumours had a size equal to or below 10mm. Seventy-four point eighty nine percent (74.89%) of total tumours did not show ganglionary invasion. CONCLUSIONS: Considering the references established by the European Union for screening programs, all of the calculated predictive indicators exceed the required standards.

[State of infectious disease notification (I.D.N.'s) in Navarra. 1996]. / Situación de las enfermedades de declaración obligatoria (E.D.O.'s) en Navarra. 1996.

The System of Infectious Disease Notification (I.D.N.) encompasses the notification of 41 infectious transmissible diseases to which are added epidemic outbreaks of any etiology or cause. In Navarra, the I.D.N.'s are reported to the Section of Vigilance and Epidemiological Control of the Public Health Institute. A sharp increase of alimentary toxic-infections is observed due to two community outbreaks produced by Salmonella enteritidis that affected 410 persons. The incidence of pulmonary tuberculosis, 15.37 cases per 100,000 inhabitants has remained at the same levels as previous years and with lower rates than those published in neighbouring Autonomous Communities such as La Rioja and the Autonomous Community of the Basque Country. In the group of Exanthematic Diseases, an outbreak of German measles is noteworthy that affected males between the ages of 16 and 20. During the year 1996 there were 17 cases of Meningococcal Disease that meant a rate of 3.27 per 100,000 inhabitants, the second lowest rate in the last 25 years after the rate of 2.29 of 1994. With respect to the causative serogroup, serogroup C was isolated on 7 occasions, serogroup B on four occasions and on 6 it could not be grouped. Hydatidosis through reports of I.D.N.'s and active search in the hospitals remained steady, with 26 cases, remaining within the regular values of recent years. An important decline with respect to recent years was observed in cases of hepatitis A, hepatitis B and brucellosis.