Cribado del cáncer cervicouterino en colectivos de mujeres asintomáticas con factores de riesgo

Objectives

To determine the rates of cervical and vaginal disease in groups of asymptomatic women with risk factors and their degree of adhesion to the screening program.

Patients and methods

269 asimptomatic women attended during 1 year (1998) were interrogated in relation to risk practices; they underwent pap smear, colposcopy-biopsy of the cervix and determination of antibodies for VIH. A follow-up was made during 5 years.

Results

The prevalence of intaepithelial lesions was 26.8% and the accumulated incidence was 10.4%; 62.5% of the women never returned to revision more, whereas 37.6% returned at least once.

Conclusions

The women of the studied groups show high rates of cervical-vaginal pathology and high risk of developing cervical cancer. The adhesion of these women to the screening program is very low. Because of the low precision of the citology, this women must undergo a second screening test.     

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.     

Factores psicológicos en mujeres que padecen pelvialgia crónica grave operadas por laparoscopia o laparotomía

Purpose

To analyze the importance of psychological factors, understood as levels of anxiety and depression, among women with chronic pelvic pain and to evaluate the possibility of a relationship between these psychological factors and the persistence of pain after surgery.

Material and methods

We studied 41 women with chronic pelvic pain for more than 6 months who had undergone laparoscopy or laparotomy as a diagnostic-therapeutic method. The results in these women were compared with those in a control group of 86 women attending the clinic for bilateral tubal ligation. These patients were interviewed before surgery to evaluate their depression and anxiety levels using the Beck test and the STAI scale. The persistence of pain after surgery was assessed through a telephone survey.

Results

Levels of depression and anxiety were higher in the chronic pelvic pain group than in the control group but no differences were found in the trait anxiety variable. When interviews were carried out 3 months after surgery, the percentage of patients who continued to have postoperative pain was significantly higher in the chronic pelvic pain group than in the control group.

Conclusion

Quality of life is impaired in women experiencing pelvic pain for more than 6 months, due to increased levels of depression and state anxiety. Persistence of pain 3 months after surgery, despite elimination of its apparent gynecological cause, could be influenced by anxiety and depression.     

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.     

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.     

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.     

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.     

Tumores malignos ginecológicos sincrónicos. Casuística del Hospital de Manacor

Objective

To alert clinicians to the possibility of synchronous tumors in patients with gynecological cancer. An important tool in diagnosis is the family history. We describe several familial syndromes involving the development of synchronous gynecological tumors.

Subjects and methods

We studied all cases of synchronous gynecological tumors in the Manacor Hospital from 1997 to 2006.

Results

Synchronous gynecologic tumors represented 0.83% of all gynecological neoplasms treated in our center in the period studied.

Conclusions

This kind of tumor is uncommon but should be considered by clinicians, especially in women with a familial history of cancer or in those with certain genetic syndromes. Examination aimed at excluding the presence of synchronous tumors is recommended.     

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.     

Hiperplasia ductal atípica de mama: correlación de la biopsia percutánea y los resultados de la biopsia quirúrgica

Objetive

The purpose was to evaluate the prevalence of carcinoma found at surgical biopsy of llesions identified as atypical ductal hyperplasia by percutaneous breast biopsy.

Methods

We performed a retrospective study of all asymptomatic patients with a result of atypical ductal hyperplasia on percutaneous breast biopsy and who underwent surgical excision from January 2002 to December 2010.

Results

Sixty-eight patients were found to have atypical ductal hyperplasia at percutaneous breast biopsy and were evaluated with surgical biopsy. Seventeen patients (25%) had carcinoma at surgical excision, 10 had ductal carcinoma in situ, and 7 patients had invasive carcinoma. The mammographic characteristics associated with malignancy were analyzed.

Conclusions

A finding of atypical ductal hyperplasia at percutaneous breast biopsy frequently corresponds to cancer and is therefore an indication for surgical excision.     

Es posible aplicar protocolos de cribado de cáncer de cérvix en la práctica diaria

Objective

To evaluate whether screening protocols for cervical cancer can be implemented without delaying the diagnosis of cancer and whether this practice is well accepted by patients.

Subjects and methods

In 2005, we developed a protocol for the early diagnosis of cervical cancer based on carrying out cervical smears every 3 years in women over the age of 30 with three previous normal smears. We studied 300 patients who had attended an appointment in 2006 and another 300 in 2008. We reviewed our records to determine whether we had performed a smear and, if one was indicated, whether we had recommended attendance at a follow-up visit 3 years later, and whether the women had returned earlier. Adherence to the protocol in cancers diagnosed from 2005 was also reviewed.

Results

The number of smears decreased by 32% in 2008 compared with 2004, the year prior to screening. In 2008, 21% of women were recommended to attend the next review 3 years later and 3% returned earlier. Of 17 cancers diagnosed since 2005, only one woman with adenocarcinoma had undergone screening.

Conclusions

The overuse of cytology/smears in daily clinical practice can be avoided.     

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.     

Cáncer cervical uterino en el área sanitaria III de Asturias: eficacia del cribado oportunista

Objective

To investigate the number of invasive cervical carcinomas detected in our hospital over a 10-year period (1996-2005), to study the mean age at diagnosis of squamous cell carcinomas, adenocarcinomas, and the relation of cervical screening in its diagnosis. Establish the mean number of negative smears in women without cervical human papilloma virus (HPV) infection.

Material and methods

Data on all diagnoses of cervical cancer, the presence of smear tests prior to biopsy, and the interval between the two procedures were gathered. The Mann-Whitney test was applied. The mean number of negative cytologies without evidence of HPV infection during the period studied was established.

Results

Between 1996 and 2005, 67 cervical carcinomas (49 squamous cell carcinomas and 18 adenocarcinomas) were diagnosed. In 40% cytology had never been performed. The mean age at diagnosis was 59 years for squamous cell carcinoma and was 49 years for adenocarcinoma. The mean number of negative cytologies per healthy woman was 3.59.

Conclusions

Opportunistic screening for cervical cancer, the most common form of screening in Spain, is not accessible to many women with cervical carcinoma and wastes substantial healthcare resources on performing unneccessary cytologies in healthy women.     

Análisis inicial de eficiencia en la aplicación clínica de las nuevas recomendaciones para la prevención secundaria del cáncer de cuello de útero

Aim

To evaluate the efficiency of the application of the new cervical cancer screening recommendations sponsored by the Spanish Society of Obstetrics and Gynecology.

Material and methods

A total of 631 women, aged 30 years or older, who attended the Gynecology Unit of the Santa Cristina Hospital, Madrid, for cervical cancer screening underwent cervical cytology and DNA/human papilloma virus determination (Hybrid Capture 2).

Results

Analysis of the hospital's costs showed that the new prevention strategy generated an estimated saving of 198.47 € per woman undergoing cervical cancer screening.

Conclusions

The new cervical cancer screening recommendations sponsored by the Spanish Society of Gynecology and Obstetrics are highly efficient.     

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.     

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.     

Análisis de la relación entre riesgo gestacional y ansiedad materna

Objective

To evaluate levels of maternal anxiety in third trimester pregnancies according to pregnancy risk, classified as low, medium and high-risk/very high-risk.

Patients and methods

We performed an observational, analytical and cross-sectional study of anxiety levels in 174 pregnant women followed-up in our hospital. Levels of both state anxiety and trait anxiety were evaluated in the three groups of pregnant women.

Results

Of the 174 participants in the study, 98 (56.3%) had low risk pregnancies, 40 showed medium risk (23%) and 36 (20.7%) had high risk or very high risk pregnancies. We obtained a mean of 32.8 points for state anxiety and of 27.3 points for trait anxiety. Mean anxiety levels scores were 44.1 points in the high/very high risk group, 33 points in the medium risk group, and 28.5 points in the low risk group, with statistically significant differences (P = .0001 for the high risk group and P = .038 for the medium risk pregnancies). A significant correlation was found between trait anxiety and state anxiety (P = .0001). Statistically significant differences were observed in anxiety related to the number of children (P = .0001).

Conclusions

In pregnant women, anxiety levels were higher than average levels in the general population. Anxiety levels increased in accordance with greater risk in the pregnancy. The greater the number of children the mother already had the lower her anxiety level.     

Actualización en linfomas primarios de mama: serie de casos y revisión de la literatura

Introduction

Primary breast lymphomas (PBL) are a rare malignant disease of the breast that can be mistaken for breast carcinoma. Knowledge of PBL allows a correct diagnostic-therapeutic approach to this uncommon malignancy (0.04- 0.5% of breast cancers).

Material and methods

This update is based on an analytic retrospective study of a series of cases recorded at the Hospital Príncipe de Asturias and a comprehensive review of the oncologic and gynecologic literature available.

Discussion

PBL are virtually indistinguishable from breast carcinomas because of their similar age distribution, clinical presentation and imaging features. Diagnosis can only be confirmed by histology. The most effective treatment is combined therapy based on chemotherapy (the most widely used being the CHOP-R regimen). Surgery and radiotherapy play a secondary role. The course of PBL varies widely, from early dissemination to complete remission. Prognostic factors play an important role in PBL. Prompt diagnosis is essential to improve outcome.

Conclusion

Because of their low prevalence, PBL are a diagnostic-therapeutic challenge. There is no agreement on treatment regimens, and outcome is highly variable. New in-depth studies are required to unify criteria and knowledge of this entity.