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Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009 period to 33% in the 2013-2016 period, with most of this increase occurring among women with early-stage disease (17-52%). Improving access to care and reducing the financial burden of breast cancer in developing countries may lead to an increased use of breast conserving surgery.

Introduction Although temporal trends in breast conserving surgery (BCS) have been described for developed countries like the United States (US), there is a lack of information regarding the uptake of breast conservation in developing regions of the world. In developing countries, the implementation of breast conservation might be hindered by the availability of radiation therapy, lack of training among surgeons, or concerns regarding compliance with follow-up care and surveillance. In 2006, the Mexican government created Seguro Popular, which provided coverage for breast cancer care for all Mexican women, thus potentially mitigating the difficulties with obtaining care after BCS and improving access to multidisciplinary care. We undertook an overview of ten years of breast cancer surgery at our Mexican cancer center following the implementation of Seguro Popular, and explored changes in surgical technique over time. Methods A retrospective cohort analysis was conducted using the National Cancer Institute of Mexico (INCAN) database from 2006 to 2016. All patients with a diagnosis of breast cancer seen during that period were included. Patients who received surgery for breast cancer where then grouped together based on the type of surgery (mastectomy versus BCS). The effect of the year of diagnosis and of clinical stage at the time of presentation was evaluated. Logistic regression was used to model temporal trends in use of BCS over mastectomy for three 3-year periods (2006-2009, 2010-2012, and 2013-2016). Results The patient cohort consisted of 5289 women from the INCAN database, of which 4519 received some form of local surgical treatment. Sixty-one percent (n = 2764) had locally advanced disease (stages IIB-IIIC) at the time of presentation, and a quarter (n = 1156) had ≥60 days between diagnosis and receipt of surgical treatment. Eighty percent of the patients in the entire cohort (n = 3611) were treated with mastectomy, while 20% (n = 908) received BCS. For the 2006-2009 period, out of 1596 total surgeries, 9.9% were BCS (n = 158). The proportion of BCS increased for each of the other two studied periods, being 18.5% for the 2010-2012 period (n = 276/1490), and 33.1% for the 2013-2016 period (n = 474/1433) (p Citation Format: Enrique Bargalló-Rocha, Nancy Reynoso-Noveron, Jaime Corona, Nereida Esparza-Arias, María Teresa Ramírez-Ugalde, Caros Daniel Robles-Vidal, Robin Shaw-Dulin, Armen Stankov, Rafael Vazquez-Romo, Patricia Villarreal-Colin, Sergio Aguilar-Villanueva, Jaime Hidalgo-Bahena, Milagros Perez-Quintanilla, Fernando U Lara-Medina, Juan Alejandro Torres, Enrique Soto-Perez-de-Celis, Paula Cabrera-Galeana, Alejandro Mohar, Abelardo Meneses-García. Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-05.

Astrocytoma is the most common type of primary brain tumor. The risk factors for astrocytoma are poorly understood; however, germline genetic variants account for 25% of the risk of developing gliomas. In this study, we assessed the risk of astrocytoma associated with variants in AGT, known by its role in angiogenesis, TP53, a well-known tumor suppressor and the DNA repair gene MGMT in a Mexican population. A case-control study was performed in 49 adult Mexican patients with grade II-IV astrocytoma. Sequencing of exons and untranslated regions of AGT, MGMT, and TP53 from was carried in an Ion Torrent platform. Individuals with Mexican Ancestry from the 1000 Genomes Project were used as controls. Variants found in our cohort were then assessed in a The Cancer Genome Atlas astrocytoma pan-ethnic validation cohort. Variants rs1926723 located in AGT (OR 2.74, 1.40-5.36 95% CI), rs7896488 in MGMT (OR 3.43, 1.17-10.10 95% CI), and rs4968187 in TP53 (OR 2.48, 1.26-4.88 95% CI) were significantly associated with the risk of astrocytoma after multiple-testing correction. This is the first study where the AGT rs1926723 variant, TP53 rs4968187, and MGMT rs7896488 were found to be associated with the risk of developing an astrocytoma.

BACKGROUND The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm). METHODS The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis. RESULTS Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age

Objective: The aim of this study was to describe trends in lung cancer (LC) mortality and trends in tobacco use. Methods: This is an ecological time-series study to determine mortality trends due to lung cancer resulting from tobacco consumption, based on secondary open-access sources, such as the National Surveys. Smoking prevalence, tobacco use trends, mortality rates, and percentage were determined by LC. The mortality trend from LC was calculated, and a linear regression analysis was performed to evaluate the impact of the General Law for Tobacco Control. Results: The prevalence of tobacco use decreased steadily between 1988 and 2015, particularly in men. Mortality rates and percentage decreased between 1998 and 2018. During this period, the mortality rate decreased from 6.3 to 5.4 per 100,000 population (−0.032/100,000 each year, p

The aim of this study was to compare the difference in disease-free survival (DFS) and overall survival (OS) between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) in our Hispanic population with breast cancer (BC). We retrospectively analyzed a database of 4533 non-metastatic BC patients treated for BC at the National Cancer Institute in Mexico (INCan) between 2006 and 2016. We compared clinical characteristics, treatment and survival between women with invasive ductal and invasive lobular BC. We evaluated differences between survival curves with the log-rank test and used Cox’s proportional hazards model for the multivariate analysis. Median follow-up time was 42.13 months (IQ25 25.2–IQ75 72.06). The median age was 50.9 years (IQ25 43.5–IQ75 59.8). DFS at 5 years was 80.8% for IDC versus 76.2% for ILC. 5 years OS was 88.7% for IDC versus 84.3% for ILC. Multivariate analysis showed that factors that negatively affected the 5-year DFS include: clinical stage III [hazard ratio (HR) 4.2, 95% CI 3.36–5.35; p

Background: Breast cancer in Mexico is the first cause of mortality due to malignant tumors among women. The five-year overall survival among Mexican breast cancer patients (MexBCP)treated at governmental facilities is about 75-80% as a result of an increased access to oncology treatments (WHO 20thmodel list essential medicines) in the Public Health Insurance called "Seguro Popular". Expert systems are computer programs that are derived from a branch of computer Science research called Artificial Intelligence (AI). We do not have a system based on artificial intelligence for MexBCP prognostic and predictive evaluation. The aim was develop an expert system that generates a model based on data mining techniques, which allowed predict the MexBCP survival Patients and Methods: This study was carried out by the methodology currently used in the processes of Knowledge Discovery from Databases (KDD), supported by the WEKA free distribution tool for the modeling of data mining techniques. The breast cancer data of 4,773 were provided by INCAN cohort of 4300 patients diagnosed from 2006 to 2013 with a median follow-up of 40.5 months and by INCMNSZ cohort of 473 patients from 2011 to may 2018 with a median follow-up of 39 months. The clinical and pathologic variables were: age, TNMc stage, hormonal status (pre or perimenopause or postmenopause), ER, PR, HER2, Ki67, nuclear grade. Date of histological diagnosis, date of recurrence or last medical consultation, date of death, date of death, specific cancer were used for Survival analysis. Results: The knowledge base for the expert system was based on the rules generated by the different data mining techniques. The rules used were generated by the Prism classification algorithm, which classify with a 97% percentage of instances correctly and a Kappa statistic of 0.9208. These rules obtained characteristics in each of the attributes, as well as the percentage of certainty of each of those rules. In addition to determining the average life of the group of patients that was classified in each of the generated rules. Finally, the basic elements that formed part of the architecture of the expert system carried out were the knowledge base, the inference engine, the database and the interface with the user. An on-line expert system was created, which allows users to interact and thus allow decision-making based on the results presented. Conclusion: As far as we know this is the first expert system that allows calculate prognosis according to clinical-pathological variables. It is of great relevance know the survival of a Mexican patient with breast cancer in the public health system with access to essential treatment. The applications of the system can be multiple in the usual clinical practice, education and in the taking of public policies for breast cancer in Mexico. We are currently working on a predictive model of oncological treatment benefit based also on an expert system. Citation Format: Armengol-Alonso A, Villalobos-Castaldi FM, Cabrera-Galeana P, Bargallo-Rocha E, Reynoso-Noverón N, Mohar A, Melo-Morin JP. OncoproMex®: An intelligent decision support system for Mexican breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-13.

Background: Nausea and vomiting are common complications on the chemotherapy (CINV) and can affect the quality of life of the patients. There are various antiemetic regiments that varies in both cost and effectiveness. The aim of this trial is to evaluate the efficacy in acute and delayed CINV of ondansetron vs palonosetron. Patients and methods: In his was a randomized, open label trial, we included breast cancer patients' candidate to (AC, TC, TCH regimens); arm A received palonosetron, dexamethasone and fosaprepitant and arm B ondansetron, dexamethasone, fosaprepitant; patients who had received previously any chemotherapy or radiotherapy were excluded.Presence of CINV were investigated, as well the ER visits due for CINV and QoL (EORTC QLQ 30 and EORTC B-23) were analyzed during the first cycle of treatment. Local ethics committee approved the trial. Results: 262 patients were included, 87% received AC and 13% TC; acute control was achieved in 87% and 94% respectively, p=ns and delayed control was achieved in 76% and 86% p=ns, toxicity was similar in both arms. QoL analysis showed no differences in family interaction, social life and financial troubles. ER visits due to severe symptoms were similar p=ns Conclusions: Palonosetron or ondansetron are equally effective in prevention acute and delayed CINV and they also maintain similar quality of life. Citation Format: Arce-Salinas C, Deneken-Hernandez Z, Flores-Diaz D, Gonzalez-Serrano JP, Matus-Santos JA, Ruiz-Garcia E, Calderillo-Ruiz G, Macedo O, Santamaría-Galicia J, Aguilar-Ponce JL, Reynoso-Noverón N. Efficacy and quality of life analysis of palonosetron vs ondansetron for high and moderate emetogenic chemotherapy for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-14.

Background: Trastuzumab treatment plus adjuvant or neoadjuvant chemotherapy is the standard of care for women with HER2 positive breast cancer. Despite relative low rates of cardiotoxicity observed in randomized clinical trials, trastuzumab interruption driven by LVEF reduction is a major concern in current clinical practice. Patients and methods: We retrospectively identified women with stage I-III HER2 positive breast cancer who received 12 months of trastuzumab treatment after adjuvant or neoadjuvant chemotherapy at Instituto Nacional de Cancerología (INCan, Mexico City), between 2006 and 2018. Patients were eligible if a pre-therapy MUGA scan and ≥2 subsequent follow-up scans were available. Cardiotoxicity was defined as a ≥10% LVEF reduction to a value < 50%, associated with trastuzumab interruption. Results: 910 patients were included, with a median age at diagnosis of 50 (24-85) years and a median follow up of 7 (2-11 ) years. Among the whole cohort, 10.3% of patients had diabetes, 15.4% had hypertension, 78% were obese/overweight, and 40% had positive estrogen and/or progesterone receptor status. Anthracycline-based therapy was used in 819 (90%) patients, with a median (doxorubicin equivalent) cumulative dose of 200 mg/m2 (IQR 180-240). The median baseline LVEF was 61.8% (50-88.9). In total, 94 (10.3%) patients developed cardiotoxicity, but symptomatic heart failure was observed in only 31 (3.4%) individuals. In univariable analyses, the development of cardiotoxicity was not associated significantly with cardiovascular risk factors. Conclusions: In this large single-center cohort, cardiotoxicity rates remain high, thus, interventions to minimize the risk of cardiotoxicity and trastuzumab treatment interruption should be considered. Citation Format: Calvillo-Argüelles O, Flores-Diaz D, Gonzalez-Serrano J-P, López-Rojas A, Mendoza-Galindo L, Matus-Santos J-A, Reynoso-Noverón N, Cabrera-Galeana P, Bargalló-Rocha E, Arce-Salinas C. Prevalence of trastuzumab-induced cardiotoxicity in a real-world setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-05.

Background : Healthcare workers are at increased risk of SARS-CoV-2 infection. The positivity rates in hospitals that do not receive patients with COVID-19, such as the National Cancer Institute (INCan) in Mexico, and the associated factors are unknown. Objective : To assess the incidence and factors associated with SARS-CoV-2 infection in health workers at INCan. Methods : A cohort study of 531 workers who were followed for 6 months. RT-PCR analysis of saliva and nasopharyngeal swab samples were used in the baseline and to confirm cases during follow-up The incidence rate ratio was calculated according to the measured characteristics and the associated factors were calculated using logistic regression models. Results : Out of 531 workers, 9.6% tested positive for SARS-CoV-2, Being male (RR: 2.07, 95% CI: 1.1-3.8, p=0.02), performing administrative tasks (RR: 1.99, 95% CI: 1.0-3.9, p=0.04), and having relatives also working at INCan (RR: 3.7, 95% CI: 1.4-9.5, p

Purpose: Identification of a truly high-risk group of brain metastases (BM) in patients with non-small cell lung cancer (NSCLC) could lead to early interventions and probably better prognosis. The objective of the study was to identify this group by generating a multivariable model with recognized and accessible risk factors.Methods: A retrospective cohort from patients seen at a single center during 2010-2020, was divided into a training (TD) and validation (VD) datasets, associations with BM were measured in the TD with logit, variables significantly associated were used to generate a multivariate model. Model´s performance was measured by 10-Fold cross validation of the TD and in the VD with the AUC/C-statistic, Akaike information index, and Press´s Q precision test.Results: From 570 patients with NSCLC with complete records a TD and VD were formed, no significant differences were found amid both datasets. Variables associated with BM in the multivariate logit analyses were age [P 0.021, OR 0.97 (95%CI 0.94-0.99)]; male gender [P 0.010, OR 2.44 (95%CI 1.24-4.82)]; mutational status [P 0.03, OR 2.1 (95%CI 1.07-4.12); and carcinoembryonic antigen levels [P 0.002, OR 1.002 (95%CI 1.001 – 1.003). BM were diagnosed in 23% of the whole cohort. Stratification into low, medium, or high-risk groups after simplification of the model, displayed a frequency of BM in the VD of 8%, 16% and 40% respectively (P 0.027).Conclusion: A multivariate model comprising age, gender, CEA, and mutation status allowed the identification of a truly high-risk group of BM in NSCLC patients.

Background Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources Objective The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models’ overall performance. Methods We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model’s overall accuracy. Results We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. Conclusions Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. Trial Registration PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242110

BACKGROUND Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources OBJECTIVE The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models’ overall performance. METHODS We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model’s overall accuracy. RESULTS We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history. CONCLUSIONS Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented. CLINICALTRIAL PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242110

Compare through a systematic literature review, the sex distribution of patients with carotid body tumors in Mexico and Latin America with the rest of the world. The eligibility criteria included retrospective cohort studies of more than 15 patients with a diagnosis of carotid body tumor (regardless of Shamblin's classification or clinical manifestations), which also reported the number of women and men affected, as well as their mean age. We divided the countries where the studies were conducted into regions (Latin America, USA, and Europe/Asia). The sex ratio difference between regions was calculated using a chi-square test. A p

Brain tumors can be classified as primary if they originate from intracranial elements, and secondary if they originate from another organ, as metastases. The global prevalence of central nervous system (CNS) neoplasms in 5 years is approximately 771,110 cases. Primary brain tumors represent 1.7% of all cancers and global incidence is 3.9 per 100,000 person-years for all central nervous system tumors; this incidence varies from age, gender, race and region, with higher frequency in Northern Europe, followed by Australia, United States and Canada. African-Americans show higher incidence of benign neoplasms, whereas Caucasian individuals show a higher rate of malignant neoplasms incidence. Central nervous system neoplasms are more frequent in women with meningiomas having the most significant difference. In primary brain tumors, meningiomas are the most frequent, representing 36.8% of all neoplasms; gliomas are the most common malignant type, representing 75% of the malignant central nervous system tumors, with a global incidence of 6 per 100,000 person-years. Global mortality of CNS neoplasms represents 2.71% of all deaths by cancer. The only risk factors confirmed for brain tumors are associated with ionizing radiation and hereditary cancer, such as phakomatosis syndromes (neurofibromatosis, tuberous sclerosis, von Hippel-Lindau’s, Gorlin’s, and Cowden’s) and other hereditary cancer syndromes (Lynch and Li-Fraumeni). Mortality tends to be higher in adults than in the child population. The 5-year survival rate for anaplastic astrocytoma is 30% and for glioblastoma (GB) is 5.6%, the 10-year survival rate for patients with glioblastoma is 0.71%. This chapter focuses on the epidemiological basis of brain tumors.

Breast cancer is one of the leading causes of mortality in women worldwide, and neoadjuvant chemotherapy has emerged as an option for the management of locally advanced breast cancer. Extensive efforts have been made to identify new molecular markers to predict the response to neoadjuvant chemotherapy. Transcripts that do not encode proteins, termed long noncoding RNAs (lncRNAs), have been shown to display abnormal expression profiles in different types of cancer, but their role as biomarkers in response to neoadjuvant chemotherapy has not been extensively studied. Herein, lncRNA expression was profiled using RNA sequencing in biopsies from patients who subsequently showed either response or no response to treatment. GATA3-AS1 was overexpressed in the nonresponder group and was the most stable feature when performing selection in multiple random forest models. GATA3-AS1 was experimentally validated by quantitative RT-PCR in an extended group of 68 patients. Expression analysis confirmed that GATA3-AS1 is overexpressed primarily in patients who were nonresponsive to neoadjuvant chemotherapy, with a sensitivity of 92.9% and a specificity of 75.0%. The statistical model was based on luminal B-like patients and adjusted by menopausal status and phenotype (odds ratio, 37.49; 95% CI, 6.74–208.42; P = 0.001); GATA3-AS1 was established as an independent predictor of response. Thus, lncRNA GATA3-AS1 is proposed as a potential predictive biomarker of nonresponse to neoadjuvant chemotherapy.

Young women with breast cancer represent 15% of cancer cases in Latin America. Genomic studies have found that early-onset breast-cancer cases exhibit a higher genetic susceptibility and a specific genomic signature as compared to their older counterparts. The aim of this study was to describe clinically relevant germline mutations in a cohort of young women with breast cancer. To achieve this, we analyzed hereditary-cancer genes from whole-exome sequencing data in 108 unrelated women with an extreme phenotype of breast cancer (≤40 years of age), diagnosed and treated at the National Cancer Institute of Mexico; 11% of the patients carried a pathogenic variant. BRCA2 comprised 46% of the mutations, followed by BRCA1 with 23%; PALB2 with 15%; and TP53 and RAD51C with 8 % each. This article describes a novel pathogenic mutation in RAD51C c.519dupT. The median age at diagnosis was 35 years overall; however, it was six years younger in patients with mutations. Age at diagnosis (OR=0.82, CI 95% 0.71-0.94; P= 0.008) and first-degree family history of cancer (OR=8.26, CI95% 1.35-50; P= 0.022) were the only epidemiological variables associated with mutational status. We found no differences in disease-free survival (p=0.403) or overall survival (p=0.735) among mutational status subgroups.

Although the epidemiology of breast cancer in older women has been widely described before, little is known about the clinical characteristics and prognosis of older patients living in developing countries. Here, we studied older women with breast cancer treated at a public cancer center in Mexico City, and compared their outcomes with their younger counterparts.We retrospectively analyzed a database of 5488 women treated for breast cancer at a single institution. We compared clinical characteristics, treatment and survival between women aged65 and ≥65 years of age. Survival analyses were performed for each molecular subtype.851 women (15.5%) were ≥65 years of age, of which 45% presented with Stages III-IV disease. Compared with their younger counterparts, older women had lower grade disease, a larger proportion of hormone receptor positive tumors, and were less likely to receive both chemotherapy and radiotherapy. At 5 years, no differences in both disease free and overall survival were found between younger and older women in a multivariate model including stage, grade, tumor subtype and treatment received.In contrast with reports from high-income countries, older women with breast cancer in developing nations present with more advanced disease requiring more aggressive treatment. Strategies aimed at earlier detection, improved access to care, and downstaging among older adults are greatly needed in Mexico and in the rest of the developing world.

To analyze the impact of gender on the clinicopathologic features and survival of patients with surgically treated papillary renal cell carcinoma (papRCC) using a comprehensive international multicenter database.Data of 2325 patients undergoing surgery for unilateral papRCC between 1984 and 2015 in 17 European and North American centers were retrospectively collated. The impact of clinicopathologic features on the likelihood of nephron-sparing surgery (NSS) was evaluated using a multivariable logistic regression model. The influence on cancer-specific mortality (CSM) and other-cause mortality was analyzed by multivariable competing-risk regression models. Finally, subgroup analyses were conducted for organ-confined (n = 2075) and non-organ-confined tumors (n = 250). The median follow-up was 47 months.The study cohort included 1782 (77%) male patients (male-to-female ratio 3.3:1.0). Considering age, symptoms at presentation, performance status, pathologic tumor size, stage, and grade, we observed that there were no significant gender-specific differences. In contrast, female patients underwent NSS significantly less frequently (P .001). On multivariable analysis, the likelihood of NSS was 72% higher in male patients after adjusting for all relevant cofactors (P .001). No significant gender-specific differences in terms of CSM and other-cause mortality were demonstrated, but CSM was 59% lower in female patients in the subgroup of organ-confined tumors (P = .001).No impact of gender on survival was found analyzing this large cohort of patients undergoing surgery for papRCC. However, CSM appears to be lower in female patients with organ-confined disease. In this context, it is interesting that the likelihood of NSS seems to be significantly higher in male patients.

Purpose Cancer in a country like Mexico is a challenge for the current health system and for public health. However, the statistics about cancer in Mexico are scarce, so epidemiologic surveillance needs to be improved. The objectives of this article were to describe the extent of cancer and to estimate the national burden of cancer through 2020. Materials and Methods To meet this objective, an analysis of secondary official sources was performed. The cancer cases through 2020 were estimated on the basis of trends in mortality and the projection of incident cases reported by GLOBOCAN. Results In 2013, cancer was the cause of 12.84% of all deaths in Mexico. It is projected that the prevalence of cancer will be 904,581 by 2017 and will reach 1,262,861 by early in the next decade (ie, 2020). Conclusion Available data for cancer are incomplete. The development and implementation of population-based cancer registries in Mexico are essential. Assessment of the future outlook of cancer in Mexico will provide awareness of future challenges and can help health systems prepare to face them.

The aim of this study was to report clinical features and management of penile cancer (CP) at the National Cancer Institute (INCan) of Mexico City over 20 years.We retrospectively reviewed the medical records of 405 cases of primary penile cancer (PC) treated at our institution between 1989 until 2015. Diagnosis, treatment and oncological outcomes are reported.Clinicopathologic and demographic information was available for 375 patients (mean age, 56 ys). At diagnosis, 140 (37.3 %) patients were cN0, 71(18.9%) cN1, 164 (43.37%) cN2 and 33 (8%) cN3. 14% had metastatic disease (lung and bone). Initial treatment included partial penectomy (n=123; 33.6%), and total penectomy (n=126;33.6%). 138 (36.2%) patients with high risk disease underwent bilateral inguinal lymph node dissection. 8% (56) had positive lymph nodes. Kaplan-Meier survival analysis showed a 10-year CSS (cancer specific survival) rate of 70%. There was no significant difference in CSS when stratifying per age. Five-year CSS for pT1, pT2, pT3 and T4 was 96%, 88%, 58% y T4 0%, respectively. A difference in CSS was found between pT2 and pT3 (p=0.047).The findings of our descriptive analysis provide information on natural history of penile cancer in Mexico. The surgical penile removal of the primary tumour remains standard of care. There was no difference in survival for age group.Revisar las características clínicas y el manejo del cáncer de pene (CP) en el Instituto Nacional de Cancerología (INCan) de la Ciudad de México en 20 años de experiencia.MATERIAL Y MÉTODOS: Revisamos de forma retrospectiva a 405 pacientes con diagnóstico de CP tratados en INCan entre enero de 1989 hasta diciembre de 2015. Se describieron la modalidad de presentación de los casos, los resultados de patología, tratamiento y la sobrevida.Las informaciones clínico-patológicas y los resultados oncológicos fueron completas en 375 pacientes (edad media 56,82). Al diagnóstico 140 casos (n.37,3%) fueron cN0, 71 casos (18,9%) cN1, 164 casos (43,37%) cN2, 33 casos (8%) cN3. El 14% tuvieron metástasis a distancia (pulmón, huesos). El tratamiento inicial incluyó falectomía parcial (n=123; 33,6% y falectomía total (n=126; 33,6%). De 138 (36,2%) pacientes de alto riesgo sometidos a disección de ganglios linfáticos inguinales bilaterales, solo el 8% (n.56) tenían ganglios linfáticos positivos. El análisis de supervivencia de Kaplan-Meier mostró una tasa de SCE (sobrevida cáncer específica) a 10 años del 70%. No hubo diferencias significativas en la supervivencia para el grupo de edad. La CSS a 5 años para pT1, pT2, pT3 y T4 fue del 96%, 88%, 58% y 0%, respectivamente. Se encontró diferencia en la supervivencia entre pT2 y pT3 (p 0,047).CONCLUSIÓN: Los hallazgos de nuestra casuística proporcionan información sobre la historia natural del cáncer de pene en México. La amputación quirúrgica del tumor primario sigue siendo el patrón uro-oncológico para el tratamiento definitivo del CP. No hubo diferencias en la supervivencia para el grupo de edad.

Background Cervical cancer (CC) is a global problem; it is among the five leading causes of cancer death in women. Several studies have examined the association between age and disease prognosis; however, controversy still exists. The objective of the present study is to determine if age at diagnosis has an impact on overall survival (OS) and disease-free survival (DFS). Materials and Methods Retrospective cohort of 2,982 patients with CC treated at the National Cancer Institute of Mexico from 2005 to 2015. We collected demographic, clinical, and treatment data, as well as current status, of 2 groups: women under and over 40 years of age. We calculated OS and DFS rates with Kaplan-Meier estimates. Cox proportional hazards modeling was used to determine risks. Results The median follow-up time was 26.5 months (percentile [P]25–P75, 11–60.23). When comparing DFS, OS, stage, and histologic subtype between young patients 40, we did not observe any difference. We found that in both groups, locally advanced and advanced stage, neuroendocrine subtype, hydronephrosis, and positive inguinal lymph nodes increased the risks of death and recurrence. Having been pregnant was identified as protective factor in DFS (hazard ratio, 0.54; 95% confidence interval, 0.04–0.71). Conclusion We corroborated that age at diagnosis is not a prognostic factor for decreased or increased OS or DFS, and in both groups, the stage, histologic subtype, hydronephrosis, and node involvement were identified as factors adverse to OS and DFS, and pregnancy history was a protective factor in DFS. Implications for Practice The present study directly affects everyday clinical practice because it allows us to focus on the most relevant prognostic factors in patients with cervical cancer. When planning treatment and follow-up, clinicians should focus on stage at diagnosis, histologic subtype, hydronephrosis, and distant metastasis instead of patients’ age. They should also be aware of any previous pregnancies and poor response, or nonresponse, to treatment, which results in disease progression and persistence. Paying attention to these factors affecting overall survival and disease-free survival will help treat patients better and increase their chances of survival and improve their quality of life.

Background Older patients with breast cancer treated in high-income countries often present with early-stage disease, leading to a lack of information on the use of neoadjuvant chemotherapy in this population. We analyzed the real-world outcomes of older women with breast cancer treated with neoadjuvant chemotherapy at a single institution in Mexico. Materials and Methods The study included 2,216 patients treated with neoadjuvant chemotherapy. Regarding achievement of pathologic complete response (defined as no invasive residual tumor in the breast and lymph nodes), 243 patients aged ≥65 years were compared with 1,973 patients aged Results Older women were less likely to have a pathologic complete response than their younger counterparts (26.3 vs. 35.3%, p < .001). When response rates by subtype were analyzed, this difference was significant only for women with triple-negative tumors. Achieving less than a pathologic complete response was associated with a greater chance of recurrence, but age was not an independent factor for recurrence for any subtype. Reaching a pathologic complete response was significantly associated with improved survival among older women with breast cancer, with the exception of those with hormone receptor–positive, HER2− disease. Conclusion Although older women have fewer pathological complete responses, their outcomes after neoadjuvant chemotherapy are comparable to those of younger patients. This is particularly relevant for the treatment of older adults with breast cancer in developing countries, who present in advanced stages and more often need neoadjuvant therapy. Implications for Practice The majority of older patients with breast cancer in high-income countries present with early-stage disease, leading to a lack of information regarding the use of neoadjuvant chemotherapy in real-world settings. This article reports the outcomes of older Mexican women with breast cancer who received neoadjuvant chemotherapy compared with their younger counterparts. Although older women (particularly those with triple-negative tumors) were less likely to have a pathologic complete response after neoadjuvant treatment, age was not an independent factor for recurrence. Achieving a pathologic complete response was associated with improved survival, regardless of age.

Vertigo is a common condition occurring in the general population and is usually self-limited. Reports studying vertigo in patients with brain metastasis (BM), are scarce. Therefore, the aim of this study was to analyze if the presence of vertigo in cancer patients is associated with the presence of BM.This study was conducted in a cancer referral center, where patients with confirmed systemic cancer sent for a neuro-oncologic consultation from May 2012 to March 2018 were included for review.Of 3220 patients, 723 were diagnosed with BM, and 204 had vertigo. Of these patients, 22.5% of those who had vertigo were diagnosed to have BM and 6% of those with BM had vertigo as an initial symptom (odds ratio [OR] 0.9; p = 0.9). An additional symptom was present in 104 patients with vertigo. Bivariate regression analysis disclosed a higher risk of having BM in patients with vertigo accompanied by headache (OR18.6; p 0.0001), ataxia (OR12.1; p 0.0001), seizures (OR10.9; p = 0.04), visual symptoms (OR10.4; p 0.0001), speech impairment (OR6.3; p = 0.01), altered mental status (OR7.4; p 0.0001), and focal weakness (OR7.4; p = 0.001), or focal sensitive complaint (OR6.9; p = 0.003). Vertigo with headache or ataxia remained statistically significant after multivariate analysis.In this cohort, a higher risk of having BM was associated with the presence of vertigo coexistent with headache, ataxia, seizures, visual symptoms, speech impairment, altered mental status, focal weakness, or focal sensitive complaint. On the basis of these results, these accompanying symptoms must be considered as red flags in patients with systemic cancer.

To briefly describe the process of establishment and preliminary results of the Mérida Population-based Cancer Registry (Mérida-PBCR).Mérida-PBCR started in 2016 as a research project in the IMSS, with a gradual increase in its information sources. It covers a population of 908 536 inhabitants. Data collection is active and passive, international standards are used; CanReg5 software enables data entry, storage and analysis.Current data include 71.5% of sources. For the period 2015- 2016, a total of 2 623 new cancer cases were registered, the majority of these (60.1%) among females. 81.5% of the cases had morphological verification. Prostate (17.4%), colorectal (8.5%) and stomach (8.1%) cancers were the most common among males, and breast (31.6%), cervix (12%) and corpus uteri (7.6%) cancers, the most common among females. Ageadjusted cancer incidence rates (per 100 000) for all sites combined were 114.9 among males and 145.1 among females.The implementation of the Mérida-PBCR has followed particular parameters, with important efforts to include new information sources. Although the data are still preliminary and must be interpreted with great caution, the main cancers follow a similar pattern to that of the national and regional estimates.Describir brevemente el proceso de implementación y resultados preliminares del Registro de Cáncer de Base Poblacional (RCBP) de Mérida.RCBP-Mérida inició en 2016 como un proyecto de investigación del IMSS, con cobertura poblacional de 908 536 habitantes. El número de fuentes de información ha incrementado gradualmente. Se realizó colección de datos de forma pasiva y activa en software CanReg5 utilizando estándares internacionales.Se han incluido al RCBP-Mérida 71.5% de las fuentes de información. Durante 2015-2016 se registraron 2 623 casos nuevos, la mayoría (60.1%) mujeres. El 81.5% de los casos tuvo verificación morfológica. En hombres, el cáncer de próstata (17.4%), colorrectal (8.5%) y estómago (8.1%) son los más comunes; en mujeres, mama (31.6%), cérvix (12.0%) y cuerpo-uterino (7.6%). Las tasas de incidencia ajustadas por edad (100 000 habitantes) para todos los sitios combinados son 114.9 hombres y 145.1 mujeres.La implementación del RCBP-Mérida ha seguido parámetros particulares, con importante esfuerzo para incluir fuentes de información. Aunque los datos son preliminares y se deben interpretar con precaución; los principales tipos de cáncer siguen un patrón similar a las estimaciones nacionales y regionales.

El uso de Medicina alternativa y complementaria (MAC) se ha incrementado en pacientes con cancer, pero los datos sobre su uso son escasos. objetivo: Describir la frecuencia de uso de MAC en pacientes oncologicos atendidos en el Instituto Nacional de Cancerologia. Material y metodos: Se aplico una encuesta estructurada y validada sobre datos sociodemograficos y uso de MAC. resultados: Se incluyeron 492 pacientes con cancer de mama, cervix y pulmon principalmente, el 76.6% eran mujeres. El ejercicio, suplementos alimenticios y herbolaria se reporto en un 80%, fue mas frecuente en mujeres de 51-66 anos y con mas de cuatro anos de diagnostico. La escolaridad y el tipo de neoplasia se asociaron con el uso de estas terapias. conclusiones: El uso de MAC es frecuente en pacientes oncologicos. Es necesario identificarlas a fin de orientar sobre su uso y considerarlas en el tratamiento integral del cancer

Objective To explore the clinical prognostic factors for adults affected with astrocytoma. Patients and methods Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated. Results The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy + radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years. Conclusion In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n = 14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.

Objective. To estimate the indirect costs generated by adults with cancer in Mexico from 2002-2020. Materials and methods. Using information from national sources and the national cancer incidence from GLOBOCAN, we estimated income lost due to premature death (ILPD), short-term benefits (STBs), disability pensions (DPs), and opportunity costs for the carer (OCCs) generated by patients with cancer. Amounts were reported in Mexican pesos. Results. We estimated 23 359 deaths and 216 679 new cases of cancer by 2020, which would be associated with a total indirect cost of 20.15 billion Mexican pesos. Men are expected to generate 54.9% of these costs. ILPD is expected to comprise the highest percentage of the cost (60%), followed by OCCs (22%), STBs (17%) and DPs (1%). Conclusions. From an economic perspective, the results emphasize the need to strengthen preventive interventions and early detection of cancer among adults to reduce its effect on the productivity of Mexico. DOI: http://dx.doi.org/10.21149/spm.v58i2.7792

Chronic noncommunicable diseases (NCDs), including can- cer, have become the leading cause of human morbidity and mortality. In Mexico, cancer is the third leading cause of death, with a high incidence among the economically active popula- tion, a high proportion of advanced stages at diagnosis and limited care coverage for patients. However, no public policy aimed at managing this important public health problem has been developed and implemented to date. This manuscript describes the first interinstitutional proposal of a National Program for Cancer Control, considering the known risk factors, early detection, treatment, palliative care and patient rehabilitation. This manuscript also outlines a series of thoughts on the difficulties and needs that the Mexican health system faces in achieving the main objectives of the program: to decrease the incidence of cancer, to increase survival and to improve the quality of life for this group of patients. DOI: http://dx.doi.org/10.21149/spm.v58i2.7804

Antecedentes La histerectomia radical abierta con linfadenectomia pelvica bilateral es el tratamiento estandar para el cancer de cervix uterino (CACU) en etapas temprana (1A2-1B1); la histerectomia radical por laparoscopia (HRL) es una opcion segura y viable. Objetivo Evaluar la seguridad y la factibilidad de la HRL en un centro hospitalario de atencion de cancer. Metodo Estudio retrospectivo que incluyo 17 pacientes con CACU en etapa temprana intervenidas con HRL entre abril de 2013 y noviembre de 2016 en el Instituto Nacional de Cancerologia de Mexico. Resultados Las 17 pacientes se encontraban en etapa clinica IB1, en 10 (58.8%) fue subtipo epidermoide, en 4 (23.5%) adenocarcinoma y en 3 (17.6%) adenoescamoso. La media de edad fue de 42 ± 8 anos. El tamano del tumor fue de 2.3 ± 0.9 cm, y en el 94.1% los margenes quirurgicos estaban libres de enfermedad. El promedio de tiempo operatorio fue de 341 ± 65 minutos, con una perdida sanguinea de 107 ± 64 ml, no requirieron trasfusion sanguinea y no hubo conversion a cirugia abierta. La media de estancia hospitalaria fue de 2.7 dias (rango: 2-7 dias). No se presentaron complicaciones intraoperatorias ni posoperatorias. Conclusiones La HRL es una alternativa segura y confiable para el tratamiento del CACU en etapa temprana. Background Open radical hysterectomy with bilateral pelvic lymphadenectomy is the standard treatment in early stages (1A2-1B1) of uterine cervical cancer (UCC); laparoscopic radical hysterectomy (LRH) is a safe and viable option. Objective To evaluate the safety and feasibility of LRH in a hospital cancer care center. Method Retrospective study that included the first 17 patients with UCC in an early stage operated with LRH in the period from April 2013 to November 2016 at the National Cancer Institute of Mexico. Results The 17 patients were stage IB1 clinical, of which 10 (58.8%) was epidermoid subtype, 4 (23.5%) adenocarcinoma and 3 (17.6%) adenoescamoso. The mean age was 42 ± 8 years. The tumor size was 2.3 ± 0.9 cm, and in 94.1% the surgical margins were free of disease. The average operative time was 341 ± 65 minutes and blood loss of 107 ± 64 ml, no patient required blood transfusion and there was no case of conversion to open surgery. The average length of hospital stay was 2.7 days (range: 2-7 days). There were no intraoperative or postoperative complications. Conclusions LRH is a safe and reliable alternative for the treatment of early stage UCC.