Influence of age on variation in patterns of care in patients with rectal cancer in Catalonia (Spain)

Background: Population ageing is a relevant concern in people diagnosed with rectal cancer. This study evaluates the adherence to clinical practice guidelines (CPGs) and patient outcomes in rectal cancer, with a particular focus on variation according to age. Methods: This is a multicentre retrospective cohort study of all patients surgically treated for the first time for primary rectal cancer with curative intent in public hospitals in Catalonia during two study periods: first, with data from 2005 to 2007, and then with data from 2011 to 2012. We obtained the study data through a comprehensive review of patients’ clinical records. Information on diagnosis, treatment and follow-up was collected and then compared with the relevant CPGs. We then performed a descriptive analysis of the categorical variables followed by a univariate and multivariate logistic regression analysis to calculate the odds ratio. Finally, we calculated the recurrence and death rates per person-year at 2 years’ follow-up. Results: In total, 3770 people were included in this study. The participants aged 70 and under were more likely to receive neoadjuvant therapy than those aged over 80 (2005/2007, 63 vs 17.4% p < 0.001; 2011/2012, 72 vs 41.1% p < 0.001); however, in the second study period there was less imbalance between the two groups in this regard, showing improved administration of neoadjuvant therapy in the elderly. The quality of surgery was suboptimal in a larger proportion of the elderly population, and the choice of surgical technique was dependent to some extent on the age of the participant. Recurrence and survival rates were significantly better in the second study period. Conclusions: Compared to younger patients, the most elderly were less likely to receive the recommended adjuvant treatment, laparoscopy and total mesorectal excision. However, we observed improved adherence to the recommended treatment regimen in the most elderly participants, resulting in decreased recurrence and increased survival rates in this population

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Long-term crude probabilities of death among breast cancer patients by age and stage: a population-based survival study in Northeastern Spain (Girona-Tarragona 1985-2004)

Background: We provide population-based long-term survival indicators of breast cancer patients by quantifying the observed survival, and the probabilities of death due to breast cancer and to other causes by age and tumor stage at diagnosis. Methods; We included a total of 10,195 female patients diagnosed before 85 years with invasive primary breast cancer in Girona and Tarragona during the periods 1985-1994 and 1995-2004 and followed-up until December 31st 2014. The survival indicators were estimated at 5, 10, 15 and 20 years of follow-up comparing diagnostic periods. Results: Comparing diagnostic periods: I) the probability of death due to other causes did not change; II) the 20-year survival for women diagnosed ≤ 49 years increased 13% (1995-2004 = 68%; 1985-1994:55%), whereas their probability of death due to breast cancer decreased at the same pace (1995-2004 = 29%; 1985-1994 = 42%); III) at 10 years of follow-up, decreases in the probabilities of death due to breast cancer across age groups switched from 11 to 17% resulting in a risk of death reduction of 19% after adjusting by stage. During 1995-2004, the stage-specific 10-year probabilities of death due to breast cancer switched from: 3-6% in stage I, 18-20% in stage II, 34-46% in stage III and surpassed 70% in stage IV beyond 5 years after diagnosis. Conclusions: In our study, women diagnosed with breast cancer had higher long-term probability to die from breast cancer than from other causes. The improvements in treatment and the lead-time bias in detecting cancer in an early stage resulted in a reduction of 19% in the risk of death between diagnostic periods

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Predicting the cancer burden in Catalonia between 2015 and 2025: the challenge of cancer management in the elderly

Background. Developing effective cancer control programmes requires information on the future cancer burden in an ageing population. In our study we predicted the burden of cancer in Catalonia from 2015 to 2025. Methods. Bayesian age-period-cohort models were used to predict the burden of cancer from 2015 to 2025 using incidence data from the Girona and Tarragona cancer registries and cancer mortality data from the Catalan mortality registry. Using the Bashir-Estève method, we divided the net change in the number of cases between 2015 and 2025 into changes due to population size (S), cancer risk (R) and age (A) distribution. Results. By 2025, there will be 21,743 new cancer cases in men (40% aged > 74 years) and 17,268 in women (37% aged > 74 years). More than 40% of the new cases will be diagnosed among population aged 74 and older in prostate, colorectal, lung, bladder, pancreatic and stomach cancers in men, and in colorectal, pancreatic and bladder cancers and leukaemia in women. During 2015-2025, the number of new diagnoses will increase by 5.5% in men (A + R + S = 18.1% − 13.3% + 0.7% = 5.5%) and 11.9% in women (A + R + S = 12.4% − 1.1% + 0.6% = 11.9%). Overall cancer mortality rates will continue to decrease during 2015-2025. Lung cancer will be the most lethal cancer among men (N = 2705) and women (N = 1174). Conclusions. The increase in the number of cancer cases in Catalonia from 2015 to 2025 will mostly affect the elderly, prompting the need for increased collaboration between geriatricians and oncologists

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Assessing predicted age-specific breast cancer mortality rates in 27 European countries by 2020

Background. We assessed differences in predicted breast cancer (BC) mortality rates, across Europe, by 2020, taking into account changes in the time trends of BC mortality rates during the period 2000-2010. Methods. BC mortality data, for 27 European Union (EU) countries, were extracted from the World Health Organization mortality database. First, we compared BC mortality data between time periods 2000-2004 and 2006-2010 through standardized mortality ratios (SMRs) and carrying out a graphical assessment of the age-specific rates. Second, making use of the base period 2006-2012, we predicted BC mortality rates by 2020. Finally, making use of the SMRs and the predicted data, we identified a clustering of countries, assessing differences in the time trends between the areas defined in this clustering. Results. The clustering approach identified two clusters of countries: the first cluster were countries where BC predicted mortality rates, in 2020, might slightly increase among women aged 69 and older compared with 2010 [Greece (SMR 1.01), Croatia (SMR 1.02), Latvia (SMR 1.15), Poland (SMR 1.14), Estonia (SMR 1.16), Bulgaria (SMR 1.13), Lithuania (SMR 1.03), Romania (SMR 1.13) and Slovakia (SMR 1.06)]. The second cluster was those countries where BC mortality rates level off or decrease in all age groups (remaining countries). However, BC mortality rates between these clusters might diminish and converge to similar figures by 2020. Conclusions. For the year 2020, our predictions have shown a converging pattern of BC mortality rates between European regions. Reducing disparities, in access to screening and treatment, could have a substantial effect in countries where a non-decreasing trend in age-specific BC mortality rates has been predicted (AU)

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A consensus statement on the gender perspective in lung cancer

Lung cancer is the most common cancer globally and has the highest mortality. Although this disease is not associated with a particular gender, its incidence is rising among women, who are diagnosed at an increasingly younger age compared with men. One of the main reasons for this rise is women taking up smoking. However, many non-smoking women also develop this disease. Other risk factors implicated in the differential development of lung cancer in women are genetic predisposition, tumour histology and molecular profile. Proportionally more women than men with lung cancer have a mutation in the EGFR gene. This consensus statement reviews the available evidence about the epidemiological, biological, diagnostic, therapeutic, social and psychological aspects of lung cancer in women (AU)

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Reoperations after primary breast conserving surgery in women with invasive breast cancer in Catalonia, Spain: a retrospective study

Background. Although complete tumor resection is accepted as the best means to reduce recurrence, reoperations after lumpectomy are a common problem in breast cancer. The aim of this study was to assess the reoperation rates after primary breast conserving surgery in invasive breast cancer cases diagnosed in Catalonia, Spain, between 2005 and 2011 and to identify variations based on patient and tumour characteristics. Methods. Women with invasive incident breast cancer identified from the Patient’s Hospital Discharge Database [174.0-174.9 codes of the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) as the primary diagnosis] and receiving primary breast conserving surgery were included in the study and were followed up to 3 and 12 months by collecting information about repeat breast cancer surgery. Results. Reoperation rates after primary breast conserving surgery decreased from 13.0 % in 2005 to 11.7 % in 2011 at 3 months and from 14.2 % in 2005 to 12.9 % in 2011 at 12 months’ follow-up. While breast conservation reoperations saw a slight, non-significant increase in the same period (from 5.7 to 7.3 % at 3 months, and from 6.0 to 7.5 % at 12 months), there was a significant decrease in radical reoperation (from 7.3 to 4.4 % at 3 months and from 8.2 to 5.4 % at 12 months). Overall, additional breast surgeries decreased among younger women. Conclusions. Despite the rise of breast conserving surgery, reoperation rates following initial lumpectomy in Catalonia decreased by 10 % at 3 and 12 months’ follow-up, remaining low and almost unchanged. Ultimately, there was also a significant decrease in mastectomies (AU)

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Demand for radiotherapy in Spain

Aim. Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. Material and methods. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. Results. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25-30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Conclusions. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning (AU)

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Multidisciplinary cancer care may impact on the postoperative mortality and survival of patients with oesophageal and oesophagogastric junction cancer: a retrospective cohort study

Background. Modern management of Oesophageal and oesophagogastric junction (OGJ) cancers requires a multidisciplinary approach, which was implemented at our health centre in 2005. This study aimed to assess the impact of this change on clinical outcomes. Methods. A retrospective cohort study was conducted, covering all patients treated for oesophageal and OGJ cancer at the cancer centre established by the Bellvitge University Hospital and Catalonian Institute of Oncology, over two time periods, i.e. 2000–2004 and 2005–2008. Descriptive and multivariate analyses were performed using survival at 1 and 3 years as dependent variables. Results. Between 1 January 2000 and 31 December 2008, 586 patients were included. Number of patients with unknown stage at diagnosis was significantly reduced. Preoperative strategies at the oesophageal location clearly increased in the recent period. A multidisciplinary approach resulted in a significant reduction in surgical mortality (11.8 vs. 2 %) in the period 2005–2008. Analysis restricted to patients undergoing surgery with curative intent indicated a significant increase in 1- and 3-year survival in the latter period (68.4 vs. 89.8 and 38.2 vs. 57.1 %, respectively). Multivariate analysis showed that variables associated with improved survival were: age; tumour stage; radical intent of treatment (surgery and radical combined chemoradiotherapy); and therapeutic strategy. Conclusion. Better selection of patients for therapy together with improved staging resulted in a significant improvement in 1- and 3-year survival in cases undergoing surgery with curative intent. These changes would support the adoption of a multidisciplinary approach to clinical decision-making in cases of oesophageal and OGJ cancer (AU)

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Cancer incidence and mortality projections up to 2020 in Catalonia by means of Bayesian models

PURPOSE: To predict the burden of cancer in Catalonia by 2020 assessing changes in demography and cancer risk during 2010-2020. ETHODS/PATIENTS: Data were obtained from Tarragona and Girona cancer registries and Catalan mortality registry. Population age distribution was obtained from the Catalan Institute of Statistics. Predicted cases in Catalonia were estimated through autoregressive Bayesian age-period-cohort models. RESULTS: There will be diagnosed 26,455 incident cases among men and 18,345 among women during 2020, which means an increase of 22.5 and 24.5 % comparing with the cancer incidence figures of 2010. In men, the increase of cases (22.5 %) can be partitioned in three components: 12 % due to ageing, 8 % due to increase in population size and 2 % due to cancer risk. In women, the role of each component was 9, 8 and 8 %, respectively. The increased risk is mainly expected to be observed in tobacco-related tumours among women and in colorectal and liver cancers among men. During 2010-2020 a mortality decline is expected in both sexes. CONCLUSION: The expected increase of cancer incidence, mainly due to tobacco-related tumours in women and colorectal in men, reinforces the need to strengthen smoking prevention and the expansion of early detection of colorectal cancer in Catalonia (AU)

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Clinical practice guidelines for cancer care: what are they for?

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Proceso asistencial y resultados en la cirugía de cáncer digestivo: diseño y resultados iniciales de un estudio de cohortes multicéntrico / Management and outcomes in digestive cancer surgery: design and initial results of a multicenter cohort study

Antecedentes: la mayoría de estudios que analizan la influenciade factores de estructura sobre los resultados son retrospectivos,realizados con bases de datos clínico-administrativas y basadosprincipalmente en el volumen de intervenciones.Objetivo: estudiar la variabilidad en el proceso y los resultadosde la cirugía oncológica de esófago, estómago, páncreas, metástasishepáticas y recto en Cataluña, así como los factores asociadosa esta.Pacientes y método: estudio de cohortes multicéntrico retrospectivo(2002) y prospectivo (2003-05). Se recogió informaciónsobre el paciente, el proceso y los resultados de la atenciónpreviamente a la cirugía, al alta, y a los 3 y 6 meses.Resultados: participaron 49 (80%) hospitales en la etapa retrospectiva,de los cuales 44 (90%) prosiguieron en la prospectiva.Se incluyeron 3.038 pacientes (98%). No se observaron diferenciasen el perfil de pacientes operados según el nivel de complejidaddel hospital pero no se pudo analizar el estadiaje clínico-patológicoy otras variables de estado funcional por presentar más del20% de valores ausentes. Existió una variabilidad importante en elvolumen de intervenciones por centro así como en algunos aspectosdel proceso asistencial según el tipo de cáncer y la complejidaddel centro. Se identificaron elevadas tasas de mortalidad en esófago(18,2% al alta, 27,3% a los 6 meses) y de complicaciones yreintervenciones en todos los cánceres evaluados, especialmenteen cáncer de recto (18,4% de reintervenciones a los 6 meses).Conclusiones: el estudio de la variabilidad identificada requeriráun adecuado ajuste del riesgo y debería tener en cuenta diferentesfactores de estructura. Es necesario mejorar la informaciónrecogida en la historia clínica(AU)

Background: most studies that analyze the influence of structurefactors on clinical outcomes are retrospective, based on clinical-administrative databases, and mainly focusing on surgical volume.Objective: to study variations in the process and outcomes ofoncologic surgery for esophagus, stomach, pancreas, liver metastasesand rectum cancers in Catalonia, as well as the factors associatedwith these variations.Patients and method: a retrospective (2002) and prospective(2003-05) multicenter cohort study. Data forms were designedto collect patient, process, and care outcome characteristicsbefore surgery, at hospital discharge, and at 3 and 6 monthsafter discharge. Main outcome measures were hospital and followupmortality, complications, re-interventions, and relapse rates.Results: 49 hospitals (80%) participated in the retrospectivephase, 44 of which (90%) also participated in the prospectivephase: 3,038 patients (98%) were included. No differences wereobserved in the profile of operated patients according to hospitallevel of complexity, but clinical-pathological staging and otherfunctional status variables could not be assessed because of over20% of missing values. There was significant variability in the volumeof interventions as well as in certain aspects of the healthcareprocess depending on type of cancer and center complexity. Highrates of esophageal cancer mortality (18.2% at discharge, 27.3%at 6 months) and of complications and re-interventions for all cancersassessed, especially rectal cancer (18.4% re-interventions at6 months), were identified.Conclusions: the study of the variability identified will requireadequate risk-adjustment and should take into account differentstructure factors. It is necessary that information included in medicalrecords be improved(AU)

Impacto del cáncer en Cataluña: consecuencias para las prioridades en prevención, diagnóstico y tratamiento / Impact of cancer in Catalonia: consequences for priorities in the prevention, diagnosis and treatment of cancer

FUNDAMENTO: El análisis de la evolución de la incidencia, la supervivencia y la mortalidad debe aplicarse para establecer las prioridades de prevención del cáncer y mejora de la atención oncológica en Cataluña. POBLACIÓN Y MÉTODO: Se revisa el impacto del cáncer en Cataluña y sus tendencias previsibles y las propuestas recientemente elaboradas en Europa sobre prevención del cáncer y mejora de la atención oncológica. RESULTADOS: La reducción del tabaquismo en todas las edades, pero especialmente en jóvenes, mujeres y personas de bajo nivel socioeconómico, continúa siendo el principal objetivo preventivo, junto con la reducción del sobrepeso y la obesidad, la mejora de la dieta y de la exposición solar excesiva. El cribado de cáncer de colon y recto debe cubrir toda la población catalana de 50-69 años. La atención oncológica debe orientarse más a modelos multidisciplinarios, basados en guías de práctica clínica y que tengan en cuenta los aspectos psicosociales y de rehabilitación. La evaluación sistemática de resultados en los centros hospitalarios y la mejora de la coordinación entre centros y profesionales son las asignaturas pendientes de la atención oncológica, que deben ser utilizadas para mejorar el proceso asistencial. CONCLUSIONES: Aplicar el conocimiento actual a la práctica clínica, tanto en el diagnóstico como en el tratamiento, con una orientación multidisciplinaria debe permitir mejorar los resultados clínicos en nuestro país. Reducir el tabaquismo y la obesidad y extender el cribado del cáncer colorrectal son otras prioridades que repercutirán en el impacto del cáncer en Cataluña

BACKGROUND: The results of analysis of incidence, survival and mortality should be applied to set the priorities in cancer prevention and screeningand improvement of cancer care in Catalonia. POPULATION AND METHODS: A review of the impact of cancer in Catalonia and its foreseeable tendencies, as well as the recent proposals made across Europe regarding cancer prevention and care, was carried out. RESULTS: The main priority in prevention continues to be smoking prevention in all age groups but especially among young women and people with a low socioeconomic position, together with overweight and obesity reduction, dietary improvements, and avoidance of excessive sun exposure. Colorectal cancer screening should cover all people aged 50 to 69 years old. Cancer care should be based on a multidisciplinary approach, with clinical practice guidelines, and should take into account the psychosocial and rehabilitation aspects of care. Areas that deserve greater efforts to improve oncology care are outcomes assessment among hospitals and improvements in coordination among centers and health professionals. CONCLUSIONS: The main priority should be to apply current knowledge to clinical practice, both in diagnosis and in treatment, within a multidisciplinary framework to improve outcomes. Other priorities aimed at reducing the impact of cancer in Catalonia are reducing the prevalence of smoking and obesity and extending the coverage of colorectal cancer screening to the target population

Análisis de la incidencia, la supervivencia y la mortalidad según las principales localizaciones tumorales, 1985-2019: cáncer de pulmón / No disponible

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Hallazgos colonoscópicos del estudio piloto de cribado de cáncer colorrectal realizado en Cataluña / No disponible

Objetivo: evaluar las lesiones detectadas en las dos rondas yafinalizadas del Programa Piloto de Cribado en Cáncer Colorrectal(CCR) llevado a cabo en L’Hospitalet de Llobregat (Barcelona).Material y métodos: el programa de cribado de CCR se inicióen el año 2000. La población, comprendida entre 50 y 69años residentes en el área, fue invitada a participar a través de ladeterminación bienal de sangre oculta en heces mediante el testguaiaco y colonoscopia en los participantes con test positivo. Serealizó polipectomía de las lesiones detectadas o biopsias cuandono era posible la extirpación. Los pólipos se clasificaron según criteriosde la Organización Mundial de la Salud.Resultados: se realizaron 442 colonoscopias de los 495 testpositivos. En 213 individuos, se detectaron: 36 cánceres invasivos,121 adenomas de alto riesgo, 29 adenomas de bajo riesgo y27 pólipos hiperplásicos. En el 25,8% de los casos, el tamaño delos adenomas fue < 10 mm. La mayoría de las lesiones diagnosticadas(37,2%) estaban localizadas en el colon distal, el 5,7% a nivelproximal y ambas localizaciones en el 5,2%. Las neoplasiasavanzadas se asociaron significativamente al sexo masculino y lalocalización distal. La prevalencia de neoplasias avanzadas a nivelproximal entre los pacientes sin pólipos distales fue del 5,1%.Conclusiones: los adenomas de alto riesgo de localizacióndistal han sido las lesiones detectadas con mayor frecuencia. Elcribado poblacional mediante la determinación de sangre ocultaen heces es un método factible para detectar pequeñas lesionesprecancerosas, factor clave para disminuir la incidencia de CCR

Objective: to evaluate lesions detected in two screeningrounds performed in a pilot screening program for colorectal cancerin Catalonia, Spain.Material and methods: a colorectal cancer screening programwas initiated in 2000. The target population included menand women aged 50-69 years. Screening consisted of biennialguaiac-based fecal occult blood testing (FOBT), and colonoscopyfor participants with a positive FOBT. Any polyps found were removed,and biopsies were performed for any masses.Results: Colonoscopies were performed in 442 of 495 peoplewith positive FOBT. In 213 (48.2%), 36 invasive cancers, 121high-risk adenomas, 29 low-risk adenomas, and 27 hyperplasticpolyps were diagnosed. Lesion size was smaller than 10 mm in25.8% of cases. Most detected lesions (37.2%) were located in thedistal colon, followed by the proximal colon (5.7%) and both locations(5.2%). Advanced neoplasm was significantly associated withmale gender and distal location. The prevalence of advancedproximal neoplasms among patients with no distal polyps was5.1%.Conclusions: the most common lesions detected bycolonoscopy were high-risk adenomas located in the distal colon.FOBT is a suitable method for detecting small precancer lesionsduring population screening, and is thus a key factor in reducingthe incidence of colorectal cancer

Integración de la Radioterapia Oncológica en un sistema de salud y un Plan de cáncer. La experiencia en Cataluña / The integration of Radiotherapy Oncology in Health Systems and Cancer Units. The experience of Catalonia

En este artículo se describen los principios y características generales de la integración de la oncología radioterápica dentro de una atención oncológica global en la Comunidad Autónoma de Catalunya y dentro del modelo sanitario específico promovido por el Servei Catalá de la Salut. Se describen en detalle las tendencias de la organización del sistema sanitario en los próximos años y como se deben adecuar al Plan de Cáncer de Catalunya. Finalmente se comentan los retos específicos de la oncología radioterápica concretamente relacionados con la planificación de recursos sanitarios (AU)

The authors of this paper outline the integration of Radiotherapy Oncology within the global oncological service provided by the Autonomous Community of Catalonia health care system and the specific health care model promoted by the Catalan Health Care System (AU)

Tratamiento quirúrgico de los aneurismas de la arteria comunicante posterior basado en el estudio de angio-tac con reconstrucción tridimensional y sin angiografía preoperatoria / Surgical management of posterior communicating artery aneurysms based on computed tomographic angiography with three-dimensional reconstruction and without preoperative angiography

Objetivos. Estudiar el valor de la exploración mediante angiotomografía computarizada con reconstrucción tridimensional (angio-TC-3D) en el tratamiento microquirúrgico de los aneurismas del territorio de la arteria comunicante posterior (AComP).Material y Métodos. Se comparan 27 pacientes con aneurismas de la AComP diagnosticados mediante angio-TC-3D y sin angiografía preoperatoria (grupo A) con otros 34 diagnosticados con angiografía cerebral (grupo B). Otros 5 pacientes fueron estudiados con angiografía tras un estudio de angio-TC-3D no concluyente. Se valoran los hallazgos de la angio-TC-3D, angiografía, exploración microquirúrgica y los datos clínicos. Resultados. Se diagnosticaron un total de 75 aneurismas en los 66 pacientes, además de 3 lesiones adicionales en el postoperatorio en los pacientes del grupo A. La sensibilidad global de la angio-TC-3D es del 91.7 por ciento en el diagnóstico de cualquier aneurisma con una especificidad del 100 por ciento. La sensibilidad de la angiografía es del 100 por ciento, con una especificidad del 94.9 por ciento. La mortalidad global fue del 4.5 por ciento, sin diferencias entre los grupos con relación a resultados clínicos o complicaciones. En el grupo A el tiempo preoperatorio y la estancia total medias fueron menores que en el grupo B. Conclusiones. El estudio de los pacientes con hemorragia subaracnoidea mediante angio-TC-3D permite un diagnóstico seguro de los aneurismas de la AComP. También se obtiene información de utilidad a la hora de planificar el abordaje microquirúrgico para la exclusión del aneurisma. Comparado con la angiografía, el diagnóstico de los aneurismas de AComP mediante angio-TC-3D permite mejorar algunos indicadores asistenciales con resultados clínicos semejantes (AU)

La evidencia del cribado del cáncer de mama: la historia continúa / The evidence on breast cancer screening: the story continues

La publicación de la nueva revisión Cochrane sobre el cribado de cáncer de mama mediante mamografía ha iniciado un nuevo período de discusión y reflexión sobre este cribado. Los autores de dicha revisión se han reafirmado en la falta de eficacia del cribado mamográfico, mientras que la actualización de la revisión de los estudios suecos y dos nuevas revisiones sistemáticas realizadas por la Agency for Healthcare Research and Quality para la US Preventive Services Task Force y por un grupo de trabajo bajo los auspicios de la IARC, que han tenido muy en cuenta las discusiones sobre los aspectos metodológicos de los ensayos discutidos en los últimos años, se han reafirmado en la eficacia del cribado mamográfico. No obstante, sigue abierto el debate sobre la efectividad y las recomendaciones en mujeres menores de 50 años. El debate actual ha puesto sobre la mesa aspectos como la mejor medida de los beneficios de un ensayo sobre cribado o los potenciales efectos adversos del cribado en forma de sobrediagnóstico o sus repercusiones sobre el tratamiento, que se discuten en este artículo. Asimismo, nos reafirma en la necesidad de introducir cribados de beneficio demostrado y discutir e informar a la población sobre estos beneficios, pero también sobre los riesgos y las incertidumbres del cribado del cáncer (AU)

The publication of the new Cochrane review on screening for breast cancer with mamography has revived the debate on breats screening and raised some new topics. Whereas the Cochrane reviewers reasserted on their previous conclusion of the lack of efficacy of breast screening, the new review of the Swedish studies, the new systematic review of the Agency for Healthcare Research and Quality commissioned by the US Preventive Services Task Force, and the recent review of an IARC working group supported the efficacy of breast screening after carefully considering the methodological quality of trials. Nevertheless, the efficacy of breast screening for younger women remains controversial. The present controversy has raised other issues like the measure of the benefit in screening trials or the potential adverse effects of screening, particularly, overdiagnosis and its impact on therapy that are discussed in this papers. It also stresses of evaluating screening before introducing it and the need to inform the population about the benefits and the potential harms and about uncertainties about cancer screening (AU)

Tratamiento quirúrgico de los aneurismas de la arteria comunicante anterior basado en el estudio de angio-TAC con reconstrucción tridimensional y sin angiografía preoperatoria / Surgical management of anterior communicating artery aneurysms based in computed tomographic angiography with three-dimensional reconstruction and without preoperative angiography

Objetivos. Estudiar el valor de la exploración mediante angiotomografía computarizada con reconstrucción tridimensional (angio-TC-3D) en el tratamiento microquirúrgico de los aneurismas del territorio de la arteria comunicante anterior (AComA).Material y Métodos. Se intervinieron consecutivamente 28 pacientes con aneurismas de la AComA rotos y diagnosticados mediante angio-TC-3D y sin angiografia preoperatoria. Se valoran los hallazgos de la angioTC-3D, exploración microquirúrgica y los datos clínicos. Resultados. No hubo falsos positivos ni falsos negativos en el diagnóstico de los aneurismas de AComA, siendo la sensibilidad global de la técnica del 87.9 por ciento. El estudio mediante angio-TC-3D demuestra una dominancia del segmento Al izquierdo en el 53.6 por ciento de los casos, del segmento Al derecho en el 14.3 por ciento e igualdad de ambos segmentos en el 32.1 por ciento. Los aneurismas que asentaban en el trayecto de la AComA se asociaban a segmentos Al de calibre semejante y trayecto de la AComA paralelo al eje transversal, mientras que los aneurismas localizados en la unión Al-A2 se asociaban a segmentos Al homolaterales dominantes y a un trayecto oblicuo de la arteria AComA. El clipaje microquirúrgico se efectuó una media de 3.7 días tras el sangrado. Conclusiones. El estudio de los pacientes con hemorragia subaracnoidea mediante angio-TC-3D permite un diagnóstico seguro de los aneurismas de la AComA. La exploración proporciona datos anatómicos que permiten estudiar los cambios hemodinámicos involucrados en la génesis de los aneurismas. También se obtiene información de utilidad a la hora de planificar el abordaje microquirúrgico para la exclusión del aneurisma. El estudio mediante angio-TC-3D permite mejorar algunos indicadores asistenciales pero el impacto en el resultado final de los pacientes no ha podido ser evaluado en el presente estudio (AU)