Factores pronóstico en la supervivencia del cáncer epitelial de ovario invasivo en el área sanitaria de León

Objective

We studied survival and associated prognostic factors in invasive epithelial ovarian cancer in women from the health area of León between 1991 and 2001.

Subjects and method

There were 236 patients with a histological diagnosis of invasive epithelial ovarian cancer, but only 221 were included in the survival study due to losses to follow-up. Univariate analysis of overall survival was performed and the distinct clinical factors were compared by means of the Log-Rank test or the Mantle-Haenszel test. Variables that were significant (p < 0.05) in univariate analysis were submitted to multivariate analysis using Cox multiple regression and variables that remained significant in this analysis were considered to be predictive factors of the disease.

Results

The over all survival at 1, 5 and 10 years was 69.1%, 37.9% and 24.7%, respectively. The variables modifying survival were FIGO stage (p ≤ 0.001), histological type (p ≤ 0.001), age at diagnosis (p ≤ 0.001), hormonal status (p ≤ 0.001), serum CA-125 marker (p = 0.034), degree of tumor differentiation (p = 0.004), type of primary surgery carried out (p ≤ 0.001), type of chemotherapy administered (p ≤ 0.001), and disease recurrence (p = 0.054). Variables that remained significant after Cox regression were FIGO stage (p = 0.002), histological type(p = 0.008), and age at diagnosis (p = 0.004). For stage I and II tumors, the only variable thatmodified prognosis was disease recurrence (p ≤ 0.001). For advanced tumoral stages (III and IV), significant variables in the univariate analysis were age (p = 0.001), histological type(p = 0.023), hormonal status (p = 0.036), serum CA-125 marker (p ≤ 0.001), the type of primary surgery performed (p < 0.001), type of chemotherapy administered (p ≤ 0.001), and disease recurrence (p ≤ 0.001). The variables that remained significant after multivariate analysis were histological type (p = 0.006) and the type of surgery performed (p = 0.037).

Conclusions

In our study, the prognostic factors that modified survival in patients with invasive epithelial ovarian cancer in the health area of León were tumoral stage, age, and histological type.     

Descenso de la edad al diagnóstico en el cáncer de mama

Introduction

Increasingly younger women are apparently diagnosed with breast cancer. The aim of this study was to determine whether age at diagnosis of this disease is declining.

Material and methods

We calculated incidence rates for breast cancer in Zaragoza (Spain) by age groups. The median age at diagnosis over a 20-year period was calculated. A Joinpoint regression was subsequently performed to determine the trend.

Results

The median showed a downward trend with an annual percentage change of -0.3% (95% CI -0.6, -0.1) over the 20-year period. The crude incidence rates for age groups showed that the positive trend was highest among women aged more than 85 years, PAC = 14% (95% CI 4.03; 25.9), followed by the group aged 40-44 years with a PAC of 10% (95% CI 3.4, 17.1).

Conclusions

The median age at diagnosis of breast cancer has declined over the past 20 years.     

Influencia de las características tumorales del cáncer de mama en mujeres menores de 35 años en el pronóstico de la enfermedad

Background and objective

Two per cent of breast cancers develop in women aged 35 years old or younger. The aim of this study was to analyze the influence of the histological characteristics of the tumor and axillary involvement on the prognosis of the disease.

Methods

We performed a retrospective study of 71 women aged 35 years old or younger diagnosed with breast cancer in the 12 de Octubre Hospital from 1983 to 2000. A survival curve was designed using the Kaplan-Meier method.

Results

The most important prognostic factor was tumoral extension at diagnosis. A total of 66.7% of the patients in initial stage IV died within 5 years of follow-up. For stages 0 and I, 92.3% and 100% of the patients, respectively, were alive and had no evidence of disease. The most frequent histological type was infiltrating ductal carcinoma. Outcome was not influenced by tumoral type or histological grade. Recurrence was more frequent in patients with positive receptors than in those with negative receptors. One of the most important prognostic factors was axillary involvement. Recurrence occurred in 71.4% of the patients with nodal involvement compared with 31.4% of those without nodal invasion. The greater the number of affected nodes, the higher the risk of recurrence. Alteration of P53 and c-erb 2 were poor prognostic factors.

Conclusions

Tumoral size and stage, axillary involvement and the number of affected nodes were associated with a higher risk of recurrence and worse 5-year outcome. The presence of positive receptors was also related to an unfavorable outcome. Fifty percent of women lived for more than 15 years.     

Impacto psicológico de la mamografía de cribado en mujeres con resultados no concluyentes

Objective

To assess the impact of mammographic screening on anxiety, depression, and quality of life in women requiring a second mammogram 6 months after an inconclusive biennial screening mammogram.

Methodology

A total of 105 women were interviewed after they had been informed of the BI-RADS results of their screening mammography. Of these women, 72 were interviewed for a second time, after they had received a negative result of the follow-up mammogram. The assessment scales used were the Hospital Anxiety and Depression Scale, and the Medical Outcomes Short-Form General Health Survey (SF-36). Anxiety and perceived physical comfort during the screening and follow-up mammograms were also evaluated through two questions specifically designed for this study.

Conclusions

Levels of anxiety and depression, quality of life and physical discomfort were satisfactory, with no differences between the two time points of measurement. Mammography screening does not cause emotional distress. These results should be emphasized by breast screening campaigns.     

Metástasis peritoneales en cáncer de mama

Invasive lobular breast cancer has a special tropism for the peritoneal cavity and gastrointestinal and genitourinary systems. We describe 2 cases of peritoneal carcinomatosis secondary to metastatic spread of lobular carcinoma of the breast. The diagnosis was made several years after detection of the primary tumor. The peritoneal carcinomatosis (with genitourinary or gastrointestinal metastases) in breast cancer is rare and is most frequent in invasive lobular carcinoma. Diagnosis is difficult because the symptoms are often nonspecific and there is often a long interval between the initial diagnosis of breast cancer and peritoneal involvement. Clinical suspicion and histological-immunohistochemical study help to differentiate between a primary tumor of the peritoneal cavity and the presence of metastatic breast carcinoma. Treatment should be individualized in each patient.     

Hormonoterapia como primer tratamiento en pacientes no subsidiarias de cirugía en cáncer de mama

Objectives

To analyze the response to hormonotherapy and survival in non-surgical breast cancer patients.

Material and methods

We performed a retrospective study of 153 patients with inoperable breast carcinoma due to advanced disease, advanced age, severe comorbidity or refusal to accept conventional therapy, who were treated with hormonotherapy. Initial tumoral stage, response, overall survival and causes of death were evaluated.

Results

The mean age was 79 ± 7 years with a mean follow-up of 42.6 months (range: 0-180). At diagnosis, stage T4 tumors were found in 22%, clinical nodal involvement was found in 47% and metastasis in 16%. Tamoxifen was administered in 87.7% of the patients and aromatase inhibitors or megestrol in the remainder. Successive treatments were required in 22%. Complete response occurred in 5.8% and partial response in 31.8%. Of the remaining patients, 34.4% remained stable and 9.7% showed disease progression. The first event occurred at 35.7 ± 33 months of follow-up. Overall mortality was 68.7% and breast cancer mortality was 57.3%.

Conclusions

Because of its efficacy and scarce adverse effects, hormonotherapy may be an effective treatment in non-surgical patients with breast carcinoma.     

Cribado con resonancia magnética de la mama contralateral en pacientes con cáncer de mama

Case report

We report the case of a woman with an invasive carcinoma of the right breast, in whom magnetic resonance imaging (MRI) identified a ductal carcinoma in situ in the contralateral breast. This tumor had not been detected by other diagnostic tests.

Discussion

The authors review recent series that discuss the issue of MRI screening of the contralateral breast. The clinical impact of MRI screening is assessed.

Conclusions

MRI of the contralateral breast in breast cancer patients detects a small, but significant, number of breast cancers that would have been missed if MRI had not been performed. The effect of these findings on prognosis remains uncertain.     

¿Sabemos qué causa el cáncer de mama? Influencia actual de los diferentes factores de riesgo

Breast cancer is one of the most common malignancies among women. Its incidence is increasing, with 1,151,000 new cases diagnosed every year. Nowadays, it could be considered an epidemic disease because it is estimated that 1-2 women in every 10 will develop this cancer during their lives. Moreover, it is the first cause of death among women worldwide. A lot of work has been carried investigating the causes of breast cancer in the last few years. We have carried out a review of the scientific literature concerning the current situation of risk factors for breast cancer, and their influence in the development of the illness.     

Evolución del cáncer de mama en Aragón (España). Proyecciones a 15 años

Objective

The aim of this study was to determine the trend in breast cancer in Aragon by projecting the incidence rates, prevalence and mortality over a 15-year period from 2008 to 2022.

Material and methods

Data were obtained from the National Institute of Statistics and the program used was the MIAMOD.

Results

We estimated that from 2008 to 2022, the incidence rate of breast cancer in Aragon will decrease from 53.06 to 45.56 (adjusted from 31.66 to 25.22). Mortality will decline gradually from 15.6 in 2008 to 12.9 (adjusted from 8.13 to 6.37) and the prevalence will decrease from 568.33 to 522.17 (adjusted from 322.15 to 271.32).

Conclusions

These projections indicate that the incidence, mortality and prevalence of breast cancer in Aragon will decrease, although only the reduction in the incidence rate will be statistically significant.     

Cáncer inflamatorio de mama. Factores pronósticos relacionados con la enfermedad

Objectives

To analyze the possible prognostic value of disease-related factors in inflammatory breast carcinomas (IBC) diagnosed and treated in our hospital.

Subjects and methods

This retrospective analysis included 40 patients with non-metastatic IBC diagnosed in our service between 1991 and 2004, with both clinical and pathological criteria of IBC.

Results

Treatment response was significantly better in tumors with positive hormone receptor status. Axillary invasion, involvement of more than 4 nodes, and lack of response to neoadjuvant chemotherapy were determinants of a high risk of recurrence.

Conclusions

Our data suggest that response to neoadjuvant chemotherapy is an important prognostic factor. Further studies are required to determine the most appropriate treatment of IBC.     

Pronóstico de pacientes con cáncer de mama tratadas con cirugía en un sistema privado extra de salud

Introduction

Many women enrolled in the Spanish National Health Service also take out private health insurance to improve gynecological follow-up and complementary examinations, such as annual mammograms. We analyzed the cure rate of these patients when diagnosed with breast cancer and treated with surgery with curative intent.

Material and methods

Both overall survival and prognosis were analyzed in patients with breast cancer without metastases referred to a private oncology facility and treated with definitive surgery in the context of multidisciplinary treatment.

Results

Between 1994 and 2009, 395 patients with breast cancer were analyzed. Thirty-eight had metastases at diagnosis and 357 could be treated with definitive surgery: conservative in 265 patients and mastectomy in the remaining 92. The median follow-up was 64 months and the 5-year survival rate was 91%: 97% for stage I, 94% for stage II and 77% for stage III. In women diagnosed by mammography, the 5-year survival rate was 96% versus 86% for women consulting a gynecologist after self palpation or for other symptoms (p = 0.0159). Treatment was conservative in 74%, with better survival than in the remaining 26% who were treated with mastectomy (p = 0.0024). Survival was greater in patients with positive hormone receptors than in those with negative hormone receptors (p = 0.0264). Hormone receptor status was the only independent prognostic factor in multivariate Cox analysis.

Conclusions

Patients with breast cancer treated with definitive surgery in a private health insurance system have high cure rate, possibly because they are diagnosed in an early stage.     

Tratamiento conservador en pacientes con cáncer de mama multicéntrico

Diagnosis of breast cancer is increasingly made in the early stages of the disease, allowing for less aggressive surgery (breast conservation and sentinel node biopsy). Until recently, breast conservation was generally considered to be contraindicated in multicentric breast cancer. However, recent studies have questioned this belief, suggesting that breast-conserving surgery might be an option in these cases if microscopically free margins are obtained. We present a case of multicentric breast cancer, diagnosed and treated conservatively in our department. We also review the data supporting the current use of breast-conserving surgery in multicentric breast cancer.     

Cáncer de mama en la mujer joven

Objective

To review the characteristics of breast cancer in young women.

Material and methods

The scientific literature was reviewed, indicating the etiological factors, diagnostic methods and treatment options, with special reference to the factors that can concur in young patients such as premature menopause, loss of fertility, pregnancy after breast cancer and breast cancer during pregnancy.

Results

Importantly, breast cancer in young women is very rare but is on the increase. Tumors are larger in young women and have positive margins, making the disease more aggressive and leading to higher mortality. Diagnosis is more difficult than in older women and the triple test (mammography, ultrasound and biopsy) is of great importance. Treatment options are the same as in older women.

Conclusions

Breast cancer in young women shows certain characteristics that differentiate it in some respects from breast cancer diagnosed in older women.     

Implementación de la biopsia selectiva del ganglio centinela en pacientes con cáncer de mama tratadas en hospitales comarcales de la Comunidad Autónoma de Cantabria

Objective

To evaluate the results of sentinel lymph node (SLN) biopsy in women with breast cancer treated in hospitals without a nuclear medicine unit.

Subjects and methods

Eighty-eight patients with early-stage breast cancer treated in two district hospitals between February 2007 and July 2010 were included. The day before surgery a lymphoscintigraphy was performed in the specialized hospital. Intraoperative localization of the SLN was accomplished by the combined use of a hand-held gamma probe and a manual gamma-camera.

Results

Surgical localization of the SLN was successful in 97.7% of the patients. The mean number of lymph nodes excised by each procedure and each surgical team was 2.1±1.4 and 2.5±1.2. Axillary lymph node dissection was performed in 27.2% of the patients. There was one false-negative result and one false-positive result.

Conclusion

The implementation of SLN biopsy in district hospitals provides similar results to those obtained in the supervising hospital.     

Criterios de calidad en el manejo del cáncer de mama en Castilla y León,mejorando nuestra eficiencia

Objectives

To assess the quality of care provided to breast cancer patients in the public hospitals of Castile-Leon.

Material and methods

Data collection was carried out through a survey on quality criteria endorsed by the European Society of Breast Cancer Specialists (EUSOMA), which was sent to the public hospitals in Castile-Leon. A total of 1235 patients diagnosed with breast cancer in 2011 participated in the survey.

Results

A total of 81.81% of criteria were achieved. Ninety percent of patients received treatment within 6 weeks of diagnosis. Surgical, radiotherapeutic, and systemic treatment complied with quality criteria. However, too many surgical excisions were performed in benign disease. The cases of 87% of cancer patients were discussed by a multidisciplinary team. There was excessive follow-up in asymptomatic patients and excessive study of tumoral extension.

Conclusion

Although the healthcare provided exceeded most quality criteria, we identified areas that could be improved to achieve more efficient resource use.     

Tuberculosis genital. Diagnóstico diferencial con cáncer de ovario

In women with an adnexal mass, ascites and elevated serum markers, ovarian carcinoma must be excluded. However, several other entities, including genital tuberculosis, may produce similar symptoms. A 38-year-old woman with no personal or familial history of interest presented with abdominal pain, ascites, constitutional syndrome, high fever and elevated Ca₁₂₅ and Ca_15.3 levels. Computed tomography revealed severe septated ascites and an adnexal mass. A skin tuberculin test was negative for tuberculosis.     

Resultados de la aplicación de la técnica SNOLL versus tumorectomía guiada con arpón en el cáncer de mama

Objective

To compare the results of the SNOLL technique with those of wire-guided lumpectomy in the treatment of breast cancer.

Material and methods

A retrospective study conducted in the Breast Pathology Unit of the Vigo University Hospital from May 2010 to February 2012.

Results

We studied 73 patients. The SNOLL technique was used in 34 women and wire-guided lumpectomy in 39. In both groups, the most common histological type was infiltrating ductal carcinoma (94% and 64.1%, respectively, P=.005). In the intraoperative study, 55.3% of tumors in the SNOLL group and 44.7% of those in the wire-guided group were found to touch the surgical margin. The rate of margin extension in the same intervention was higher in the SNOLL group (P=.160). The reoperation rate for margin extension was 0% in the SNOLL group and 13% in the wire-guided group (P=.57). In the final surgical specimen, the mean disease-free margin was 7.21 mm in the SNOLL group and 4.66 mm in the wire-guided group (P=.01).

Conclusions

The re-excision rate was similar in the two groups. The SNOLL technique allows a greater margin of safety.