Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2001
The aim of this trial was to evaluate in developing countries from different regions the diagnost... more The aim of this trial was to evaluate in developing countries from different regions the diagnostic performance of (99m)Tc-sestamibi scintimammography (SM) in palpable breast lesions and to verify the clinical usefulness of a joint evaluation with mammography and SM. From 10 countries, a total of 238 patients with palpable breast masses (n = 245) were included in this prospective multicenter trial. Prone SM was performed 10 min and 60-90 min (157 patients) after injection using an isotime acquisition of 10 min. Mammography was assessed by the same dedicated imaging radiologist according to breast imaging reporting and data system (BI-RADS) categories for malignancy and breast density. Masked SM findings and mammography findings were checked for a correlation with histopathology findings for excisional biopsy samples. Diagnostic values for breast cancer detection were calculated per lesion. Histopathology revealed 189 cancerous lesions and 56 benign lesions. The sensitivity and speci...
Molecular profile of breast cancer in Latin-American women was studied in five countries: Argenti... more Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher’s exact tests and the OS by Kaplan–Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60...
10596 Background: Breast cancer (BC) is the most frequent and the leading cause of death from can... more 10596 Background: Breast cancer (BC) is the most frequent and the leading cause of death from cancer in Uruguayan women. In a previous study, we found BRCA1/2 germline mutations in less than 25% of the Uruguayan breast/ovarian cancer families studied. Due the impact and relevance of genetic testing in BC prevention and with the commitment to assure a wide accessibility, we developed genetic testing facilities at the University Hospital with the aim of analyzing and characterizing germline mutations in non BRCA known susceptibility and likely susceptibility genes. Methods: We studied 104 families who met the National Comprehensive Cancer Network (NCCN) criteria of hereditary BC. Analysis by next generation sequencing of BRCA1/2 genes revealed that 23 out of 104 cases studied (22%) carried pathogenic variants. Germline DNA from 42 cases BRCA negative was sequenced and analyzed for nine additional susceptibility genes (ATM, BARD1, CDH1, CHEK2, NBN, PALB2, PTEN, STK11 y TP53) included i...
PurposesMost molecular-based published studies on breast cancer do not adequately represent the u... more PurposesMost molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches.Patients and MethodsWe collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes.ResultsPAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E...
Características del cáncer de mama masculino en una población uruguaya Characteristics of male br... more Características del cáncer de mama masculino en una población uruguaya Characteristics of male breast cancer in a Uruguayan population Características do câncer de mama masculino em uma população uruguaia
Arch Med Interna 37(3): 107-111 Objective: To evaluate the frequency and severity of Trastuzumab-... more Arch Med Interna 37(3): 107-111 Objective: To evaluate the frequency and severity of Trastuzumab-induced cardiotoxicity in HER2 positive breast cancer (BC) patients assisted in Onco- logic Services of the Hospital de Clinicas and Asociacion Espanola Primera en Salud. Methods: Retrospective observational study of HER2 positive BC patients from Hospital de Clinicas and Asociacion Espanola under systemic therapy with Trastuzumab (TTZ) from January 2007 to December 2013. Re- sults: The study included 69 patients, most were early BC, mean age was 50,1 years. 27% of the patients developed cardiotoxicity and 26% of them devel- oped symptomatic heart failure. All patients received adequate medical treat- ment and the most instances were reversible Conclusions: The frequency of cardiotoxicity observed in the study was 27% (IC 95 %: 16,27; 38,8). With the limitations of the study, it can verify reported similarities with other popula- tions, oscillating frequency between 3.7 and 34%. However,...
Introduccion: el cancer de mama (CM) es el cancer mas frecuente en la mujer uruguaya, cada ano se... more Introduccion: el cancer de mama (CM) es el cancer mas frecuente en la mujer uruguaya, cada ano se registran unos 1.840 casos nuevos y unas 660 mujeres mueren como consecuencia de esta enfermedad. Con el fin de mejorar la calidad de la asistencia de las pacientes portadoras de patologia mamaria se creo la Unidad Docente Asistencial de Mastologia (UDAM) en el ano 2009. Objetivo: valorar la calidad de la asistencia en la UDAM del Hospital de Clinicas. Material y metodo: estudio observacional, retrospectivo, que incluyo a las pacientes diagnosticadas y tratadas por CM en una UDAM desde junio de 2009 hasta junio de 2014. Para valorar la calidad de la asistencia se utilizaron los indicadores propuestos por la Sociedad Europea de Mastologia (EUSOMA) en 2010. Resultados: se incluyeron 115 pacientes tratadas por CM; la mediana de edad fue de 63 anos, la mayoria de las pacientes tuvieron CM limitados a la mama o axila, receptores hormonales (RRHH) positivos / HER2 negativos. Se cumplieron ...
Since December 2019, the world has been mired in an infectious pandemic that has displaced other ... more Since December 2019, the world has been mired in an infectious pandemic that has displaced other health priorities for 21st century populations. Concerned about this situation, Latin American experts on cancer decided to evaluate the impact of the pandemic on cancer control in the region. The analysis was based on information obtained from public sources and scientific publications and included the characteristics of the health care and cancer control prior to the pandemic, the COVID-19 pandemic and measures implemented by the governments of the region, and the regional impact of the pandemic on cancer control together with the costs of cancer care and possible impact of the pandemic on cancer expense. We compared 2019 and 2020 data corresponding to the period March 16-June 30 and found a significant reduction in the number of first-time visits to oncology services (variable depending on the country between –28% and –38%) and a corresponding reduction in pathology (between –6% and –...
PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal g... more PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were incl...
The participation of patients in precision oncology trials needs to fulfill molecular-based selec... more The participation of patients in precision oncology trials needs to fulfill molecular-based selection criteria. This strongly limits accrual, and as a consequence, screening successes have decreased, costs have increased, and fewer subjects are enrolled. To achieve narrowed targets, studies have been forced to be multicenter and multinational to reach a larger pool of candidates. However, this globalization faces many challenges, as, for example, in the case of precision oncology trials. These trials have a complex structure that is dependent upon a high-tech infrastructure and knowledge in a dynamic environment. Given the movement of precision clinical cancer research to regions other than Europe and the U.S., it is important to evaluate the feasibility of performing such trials in lower-middle- and low-income countries. Here we critically discuss the advantages of conducting precision oncology clinical trials in Latin America and make suggestions on how to overcome the main challe...
Las mutaciones de BRCA1 son raras en el cáncer de mama (CM) esporádico; sin embargo, su expresión... more Las mutaciones de BRCA1 son raras en el cáncer de mama (CM) esporádico; sin embargo, su expresión a nivel tumoral se encuentra disminuida o ausente en 30%-50% de los casos. Objetivo: valorar la expresión tumoral de BRCA1 por inmunohistoquímica (IHQ) en mujeres uruguayas diagnosticadas de CM antes de los 40 años. Material y método: se incluyeron pacientes diagnosticadas de CM antes de los 40 años. Se utilizaron los anticuerpos monoclonales anti-BRCA1 MS110 contra el extremo N-terminal y GLK-2 contra el extremo C-terminal. Se calculó la sobrevida global (SVG) y la sobrevida libre de enfermedad (SVLE), para la construcción de las curvas se utilizó el método de Kaplan-Meier y la diferencia de sobrevida se evaluó mediante el test de log rank. Resultados: se incluyeron 40 pacientes, la SVG y la SVLE a cinco años fueron de 73% y 60% respectivamente. La expresión de BRCA1 mediante GLK-2 fue £10% en 16 de las 40 pacientes (40%). La SVG y la SVLE a cinco años para las pacientes con expresión £10% fue de 56% vs 85% para las pacientes con expresión >10% (p=0,015) y de 40% vs 72% (p=0,034) respectivamente. La expresión de BRCA1 mediante MS110 fue £10% en 11 de las 40 pacientes (27,5%). No se encontraron diferencias en la SVG ni en la SVLE a cinco años con este marcador. Conclusión: la pérdida de la expresión tumoral de BRCA1 determinada mediante GLK-2 se encontró en el 40% de las pacientes incluidas y se asoció a una menor SVG y SVLE, por lo que podría tener un valor pronóstico desfavorable en estas pacientes.
Introduccion: en Uruguay el cancer de mama (CM) es la principal causa de muerte por esta afeccion... more Introduccion: en Uruguay el cancer de mama (CM) es la principal causa de muerte por esta afeccion en la mujer. Aproximadamente 5,4% de los casos se diagnostican en menores de 40 anos, es decir, en mujeres en edad reproductiva y laboralmente activas. Objetivo: investigar la frecuencia, caracteristicas clinico-patologicas y evolucion de pacientes uruguayas diagnosticadas con CM antes de los 40 anos y su sobrevida de acuerdo al subtipo biologico. Material y metodo: se recolectaron datos relacionados con las caracteristicas clinico-patologicas y la evolucion de pacientes menores de 40 anos tratadas por CM en el periodo comprendido entre el 1o de enero de 2006 y 31 de diciembre de 2012 asistidas en las instituciones participantes. Se calculo la sobrevida global (SVG) y la sobrevida libre de enfermedad (SVLE) para todas las pacientes, globalmente, y segun el subtipo biologico. Resultados: se incluyeron 107 pacientes; edad mediana: 35 anos (rango 24 a 39 anos); las caracteristicas clinico-...
Introduccion: el cancer de mama (CM), principal causa de muerte por cancer en la mujer uruguaya, ... more Introduccion: el cancer de mama (CM), principal causa de muerte por cancer en la mujer uruguaya, constituye una enfermedad heterogenea. El estudio de la expresion tumoral del receptor del factor de crecimiento epidermico-2 (HER2), el receptor de estrogenos (RE) y el receptor de progesterona (RP) permite reconocer subtipos con diferentes caracteristicas clinico-patologicas y evolutivas.Objetivos: conocer el perfil de expresion tumoral de HER2, RE y RP y su relacion con caracteristicas clinico-patologicas en pacientes uruguayas con CM.Material y metodo: se revisaron las historias clinicas de pacientes intervenidas quirurgicamente por CM invasivo en un periodo de dos anos, seleccionandose las que contaban con la determinacion de RE, RP y HER2 mediante inmunohistoquimica. Se comparo el perfil de expresion de estos marcadores con la edad al diagnostico, tipo y grado histologico (GH) y estadio patologico (TNM).Resultados: se seleccionaron 197 pacientes cuyas caracteristicas fueron edad me...
El cáncer de pulmón constituye la primera causa de muerte por cáncer en Uruguay. Aproximadamente ... more El cáncer de pulmón constituye la primera causa de muerte por cáncer en Uruguay. Aproximadamente 80% de los casos corresponden a cánceres de pulmón a células no pequeñas (CPCNP), de los cuales alrededor de 40% se presentan con enfermedad localmente avanzada (estadio III) irresecable. El objetivo de este estudio fue evaluar la sobrevida de pacientes portadores de CPCNP estadio III irresecable y manejados según la práctica clínica estándar, de acuerdo a la extensión lesional y al tratamiento instituido. Se realizó la evaluación retrospectiva de todos los pacientes portadores de CPCNP estadio III irresecable referidos en el período 1o de enero de 1994 al 31 de julio de 1997. Se estudiaron 125 pacientes (edad mediana, rango: 66 años, 34-88; sexo masculino: n=89 pacientes), 40 con CPCNP estadio IIIA irresecable (radioterapia: n=21, tratamiento combinado asociando quimioterapia y radioterapia: n=15, tratamiento sintomático: n=4) y 85 con estadio IIIB (radioterapia exclusiva: n=36, quimiot...
Introduction: Increases in disease-free survival and overall survival (OS) with the use of adjuva... more Introduction: Increases in disease-free survival and overall survival (OS) with the use of adjuvant chemotherapy in early breast cancer (BC) are widely known; however, the optimal time to initiate treatment with adjuvant chemotherapy remains controversial. Objective: To evaluate the time elapsed between surgery and the initiation of adjuvant chemotherapy and its possible impact on OS in patients diagnosed with BC stages I-III. Materials and Methods: This retrospective study included 112 patients diagnosed with BC stages I-III who received adjuvant chemotherapy at the Mastology Unit of the Hospital de Clínicas in Uruguay from 2009 to 2019. OS was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals. Results: No statistically significant association was found between the time from surgery to the initiation of chemotherapy and the described variables. OS was worse for patients initiating chemotherapy more than 90 days after breast surgery (n = 19) (HR 7.63; p = 0.004) and between 61 and 90 days after surgery (n = 46) (HR 4.58; p = 0.040) compared to those who started before 30 days (n = 23). Controlling by type of surgery and stage, the prognosis of patients who started chemotherapy between 61 and 90 days after surgery was similar to that of patients who underwent chemotherapy within the first 30 days, controlling for surgery (HR 4.10; p = 0.056) and controlling for stage (HR 3.76; p = 0.075). Prognosis was worse for patients with stage III disease (p = 0.022) who underwent a mastectomy and/or axillary lymph node dissection (p = 0.025). Conclusion: Patients who started chemotherapy more than 90 days following surgery and those with stage III disease or underwent mastectomy and/or axillary lymph node dissection who initiated it between 61 and 90 days had a worse OS. Multiple factors are involved in the time between surgery and the initiation of chemotherapy, and further studies are needed to evaluate which of these factors influence the delay of chemotherapy in order to design strategies to avoid such delays and their negative impact on survival.
O câncer de mama ocupa o primeiro lugar em incidencia e mortalidade no Uruguai. O conhecimento da... more O câncer de mama ocupa o primeiro lugar em incidencia e mortalidade no Uruguai. O conhecimento da distribuicao dos fatores de risco relacionados ao desenvolvimento da doenca facilita a incorporacao de estrategias de prevencao na pratica clinica de rotina, o que poderia contribuir para menores taxas de morbidade e mortalidade. Objetivos: Conhecer o perfil epidemiologico do câncer de mama e frequencia de controle da populacao mamografica investigada Material e Metodos: Uma pesquisa foi realizada entre mulheres uruguaias. Apos a mesma, ellas foram informadas sobre os fatores de risco e protetores e a importância da realizacao do controle mamografico. Resultados: 182 respondentes foram incluidas, a mediana de idade foi de 34 anos (18-75 anos). Excluindo o sexo feminino (fator de risco presente em todos os entrevistados), 73 entrevistados (48%) apresentavam um ou mais fatores de risco. A maioria das mulheres com idade superior a 50 anos (58, 87,8%) realizaram o controle mamografico pelo ...
PURPOSEThe National Cancer Institute (NCI) Center for Global Health promotes global oncology rese... more PURPOSEThe National Cancer Institute (NCI) Center for Global Health promotes global oncology research to reduce cancer burden worldwide. In 2009, NCI launched the Latin American Cancer Research Net...
Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in ... more Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. Materials and Methods: A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. Results: This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. Conclusions: Consistent with internati...
Journal of nuclear medicine : official publication, Society of Nuclear Medicine, 2001
The aim of this trial was to evaluate in developing countries from different regions the diagnost... more The aim of this trial was to evaluate in developing countries from different regions the diagnostic performance of (99m)Tc-sestamibi scintimammography (SM) in palpable breast lesions and to verify the clinical usefulness of a joint evaluation with mammography and SM. From 10 countries, a total of 238 patients with palpable breast masses (n = 245) were included in this prospective multicenter trial. Prone SM was performed 10 min and 60-90 min (157 patients) after injection using an isotime acquisition of 10 min. Mammography was assessed by the same dedicated imaging radiologist according to breast imaging reporting and data system (BI-RADS) categories for malignancy and breast density. Masked SM findings and mammography findings were checked for a correlation with histopathology findings for excisional biopsy samples. Diagnostic values for breast cancer detection were calculated per lesion. Histopathology revealed 189 cancerous lesions and 56 benign lesions. The sensitivity and speci...
Molecular profile of breast cancer in Latin-American women was studied in five countries: Argenti... more Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher’s exact tests and the OS by Kaplan–Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60...
10596 Background: Breast cancer (BC) is the most frequent and the leading cause of death from can... more 10596 Background: Breast cancer (BC) is the most frequent and the leading cause of death from cancer in Uruguayan women. In a previous study, we found BRCA1/2 germline mutations in less than 25% of the Uruguayan breast/ovarian cancer families studied. Due the impact and relevance of genetic testing in BC prevention and with the commitment to assure a wide accessibility, we developed genetic testing facilities at the University Hospital with the aim of analyzing and characterizing germline mutations in non BRCA known susceptibility and likely susceptibility genes. Methods: We studied 104 families who met the National Comprehensive Cancer Network (NCCN) criteria of hereditary BC. Analysis by next generation sequencing of BRCA1/2 genes revealed that 23 out of 104 cases studied (22%) carried pathogenic variants. Germline DNA from 42 cases BRCA negative was sequenced and analyzed for nine additional susceptibility genes (ATM, BARD1, CDH1, CHEK2, NBN, PALB2, PTEN, STK11 y TP53) included i...
PurposesMost molecular-based published studies on breast cancer do not adequately represent the u... more PurposesMost molecular-based published studies on breast cancer do not adequately represent the unique and diverse genetic admixture of the Latin American population. Searching for similarities and differences in molecular pathways associated with these tumors and evaluating its impact on prognosis may help to select better therapeutic approaches.Patients and MethodsWe collected clinical, pathological, and transcriptomic data of a multi-country Latin American cohort of 1,071 stage II-III breast cancer patients of the Molecular Profile of Breast Cancer Study (MPBCS) cohort. The 5-year prognostic ability of intrinsic (transcriptomic-based) PAM50 and immunohistochemical classifications, both at the cancer-specific (OSC) and disease-free survival (DFS) stages, was compared. Pathway analyses (GSEA, GSVA and MetaCore) were performed to explore differences among intrinsic subtypes.ResultsPAM50 classification of the MPBCS cohort defined 42·6% of tumors as LumA, 21·3% as LumB, 13·3% as HER2E...
Características del cáncer de mama masculino en una población uruguaya Characteristics of male br... more Características del cáncer de mama masculino en una población uruguaya Characteristics of male breast cancer in a Uruguayan population Características do câncer de mama masculino em uma população uruguaia
Arch Med Interna 37(3): 107-111 Objective: To evaluate the frequency and severity of Trastuzumab-... more Arch Med Interna 37(3): 107-111 Objective: To evaluate the frequency and severity of Trastuzumab-induced cardiotoxicity in HER2 positive breast cancer (BC) patients assisted in Onco- logic Services of the Hospital de Clinicas and Asociacion Espanola Primera en Salud. Methods: Retrospective observational study of HER2 positive BC patients from Hospital de Clinicas and Asociacion Espanola under systemic therapy with Trastuzumab (TTZ) from January 2007 to December 2013. Re- sults: The study included 69 patients, most were early BC, mean age was 50,1 years. 27% of the patients developed cardiotoxicity and 26% of them devel- oped symptomatic heart failure. All patients received adequate medical treat- ment and the most instances were reversible Conclusions: The frequency of cardiotoxicity observed in the study was 27% (IC 95 %: 16,27; 38,8). With the limitations of the study, it can verify reported similarities with other popula- tions, oscillating frequency between 3.7 and 34%. However,...
Introduccion: el cancer de mama (CM) es el cancer mas frecuente en la mujer uruguaya, cada ano se... more Introduccion: el cancer de mama (CM) es el cancer mas frecuente en la mujer uruguaya, cada ano se registran unos 1.840 casos nuevos y unas 660 mujeres mueren como consecuencia de esta enfermedad. Con el fin de mejorar la calidad de la asistencia de las pacientes portadoras de patologia mamaria se creo la Unidad Docente Asistencial de Mastologia (UDAM) en el ano 2009. Objetivo: valorar la calidad de la asistencia en la UDAM del Hospital de Clinicas. Material y metodo: estudio observacional, retrospectivo, que incluyo a las pacientes diagnosticadas y tratadas por CM en una UDAM desde junio de 2009 hasta junio de 2014. Para valorar la calidad de la asistencia se utilizaron los indicadores propuestos por la Sociedad Europea de Mastologia (EUSOMA) en 2010. Resultados: se incluyeron 115 pacientes tratadas por CM; la mediana de edad fue de 63 anos, la mayoria de las pacientes tuvieron CM limitados a la mama o axila, receptores hormonales (RRHH) positivos / HER2 negativos. Se cumplieron ...
Since December 2019, the world has been mired in an infectious pandemic that has displaced other ... more Since December 2019, the world has been mired in an infectious pandemic that has displaced other health priorities for 21st century populations. Concerned about this situation, Latin American experts on cancer decided to evaluate the impact of the pandemic on cancer control in the region. The analysis was based on information obtained from public sources and scientific publications and included the characteristics of the health care and cancer control prior to the pandemic, the COVID-19 pandemic and measures implemented by the governments of the region, and the regional impact of the pandemic on cancer control together with the costs of cancer care and possible impact of the pandemic on cancer expense. We compared 2019 and 2020 data corresponding to the period March 16-June 30 and found a significant reduction in the number of first-time visits to oncology services (variable depending on the country between –28% and –38%) and a corresponding reduction in pathology (between –6% and –...
PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal g... more PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were incl...
The participation of patients in precision oncology trials needs to fulfill molecular-based selec... more The participation of patients in precision oncology trials needs to fulfill molecular-based selection criteria. This strongly limits accrual, and as a consequence, screening successes have decreased, costs have increased, and fewer subjects are enrolled. To achieve narrowed targets, studies have been forced to be multicenter and multinational to reach a larger pool of candidates. However, this globalization faces many challenges, as, for example, in the case of precision oncology trials. These trials have a complex structure that is dependent upon a high-tech infrastructure and knowledge in a dynamic environment. Given the movement of precision clinical cancer research to regions other than Europe and the U.S., it is important to evaluate the feasibility of performing such trials in lower-middle- and low-income countries. Here we critically discuss the advantages of conducting precision oncology clinical trials in Latin America and make suggestions on how to overcome the main challe...
Las mutaciones de BRCA1 son raras en el cáncer de mama (CM) esporádico; sin embargo, su expresión... more Las mutaciones de BRCA1 son raras en el cáncer de mama (CM) esporádico; sin embargo, su expresión a nivel tumoral se encuentra disminuida o ausente en 30%-50% de los casos. Objetivo: valorar la expresión tumoral de BRCA1 por inmunohistoquímica (IHQ) en mujeres uruguayas diagnosticadas de CM antes de los 40 años. Material y método: se incluyeron pacientes diagnosticadas de CM antes de los 40 años. Se utilizaron los anticuerpos monoclonales anti-BRCA1 MS110 contra el extremo N-terminal y GLK-2 contra el extremo C-terminal. Se calculó la sobrevida global (SVG) y la sobrevida libre de enfermedad (SVLE), para la construcción de las curvas se utilizó el método de Kaplan-Meier y la diferencia de sobrevida se evaluó mediante el test de log rank. Resultados: se incluyeron 40 pacientes, la SVG y la SVLE a cinco años fueron de 73% y 60% respectivamente. La expresión de BRCA1 mediante GLK-2 fue £10% en 16 de las 40 pacientes (40%). La SVG y la SVLE a cinco años para las pacientes con expresión £10% fue de 56% vs 85% para las pacientes con expresión >10% (p=0,015) y de 40% vs 72% (p=0,034) respectivamente. La expresión de BRCA1 mediante MS110 fue £10% en 11 de las 40 pacientes (27,5%). No se encontraron diferencias en la SVG ni en la SVLE a cinco años con este marcador. Conclusión: la pérdida de la expresión tumoral de BRCA1 determinada mediante GLK-2 se encontró en el 40% de las pacientes incluidas y se asoció a una menor SVG y SVLE, por lo que podría tener un valor pronóstico desfavorable en estas pacientes.
Introduccion: en Uruguay el cancer de mama (CM) es la principal causa de muerte por esta afeccion... more Introduccion: en Uruguay el cancer de mama (CM) es la principal causa de muerte por esta afeccion en la mujer. Aproximadamente 5,4% de los casos se diagnostican en menores de 40 anos, es decir, en mujeres en edad reproductiva y laboralmente activas. Objetivo: investigar la frecuencia, caracteristicas clinico-patologicas y evolucion de pacientes uruguayas diagnosticadas con CM antes de los 40 anos y su sobrevida de acuerdo al subtipo biologico. Material y metodo: se recolectaron datos relacionados con las caracteristicas clinico-patologicas y la evolucion de pacientes menores de 40 anos tratadas por CM en el periodo comprendido entre el 1o de enero de 2006 y 31 de diciembre de 2012 asistidas en las instituciones participantes. Se calculo la sobrevida global (SVG) y la sobrevida libre de enfermedad (SVLE) para todas las pacientes, globalmente, y segun el subtipo biologico. Resultados: se incluyeron 107 pacientes; edad mediana: 35 anos (rango 24 a 39 anos); las caracteristicas clinico-...
Introduccion: el cancer de mama (CM), principal causa de muerte por cancer en la mujer uruguaya, ... more Introduccion: el cancer de mama (CM), principal causa de muerte por cancer en la mujer uruguaya, constituye una enfermedad heterogenea. El estudio de la expresion tumoral del receptor del factor de crecimiento epidermico-2 (HER2), el receptor de estrogenos (RE) y el receptor de progesterona (RP) permite reconocer subtipos con diferentes caracteristicas clinico-patologicas y evolutivas.Objetivos: conocer el perfil de expresion tumoral de HER2, RE y RP y su relacion con caracteristicas clinico-patologicas en pacientes uruguayas con CM.Material y metodo: se revisaron las historias clinicas de pacientes intervenidas quirurgicamente por CM invasivo en un periodo de dos anos, seleccionandose las que contaban con la determinacion de RE, RP y HER2 mediante inmunohistoquimica. Se comparo el perfil de expresion de estos marcadores con la edad al diagnostico, tipo y grado histologico (GH) y estadio patologico (TNM).Resultados: se seleccionaron 197 pacientes cuyas caracteristicas fueron edad me...
El cáncer de pulmón constituye la primera causa de muerte por cáncer en Uruguay. Aproximadamente ... more El cáncer de pulmón constituye la primera causa de muerte por cáncer en Uruguay. Aproximadamente 80% de los casos corresponden a cánceres de pulmón a células no pequeñas (CPCNP), de los cuales alrededor de 40% se presentan con enfermedad localmente avanzada (estadio III) irresecable. El objetivo de este estudio fue evaluar la sobrevida de pacientes portadores de CPCNP estadio III irresecable y manejados según la práctica clínica estándar, de acuerdo a la extensión lesional y al tratamiento instituido. Se realizó la evaluación retrospectiva de todos los pacientes portadores de CPCNP estadio III irresecable referidos en el período 1o de enero de 1994 al 31 de julio de 1997. Se estudiaron 125 pacientes (edad mediana, rango: 66 años, 34-88; sexo masculino: n=89 pacientes), 40 con CPCNP estadio IIIA irresecable (radioterapia: n=21, tratamiento combinado asociando quimioterapia y radioterapia: n=15, tratamiento sintomático: n=4) y 85 con estadio IIIB (radioterapia exclusiva: n=36, quimiot...
Introduction: Increases in disease-free survival and overall survival (OS) with the use of adjuva... more Introduction: Increases in disease-free survival and overall survival (OS) with the use of adjuvant chemotherapy in early breast cancer (BC) are widely known; however, the optimal time to initiate treatment with adjuvant chemotherapy remains controversial. Objective: To evaluate the time elapsed between surgery and the initiation of adjuvant chemotherapy and its possible impact on OS in patients diagnosed with BC stages I-III. Materials and Methods: This retrospective study included 112 patients diagnosed with BC stages I-III who received adjuvant chemotherapy at the Mastology Unit of the Hospital de Clínicas in Uruguay from 2009 to 2019. OS was estimated using the Kaplan-Meier method, and a Cox proportional hazards model was used to estimate hazard ratios (HRs) and 95% confidence intervals. Results: No statistically significant association was found between the time from surgery to the initiation of chemotherapy and the described variables. OS was worse for patients initiating chemotherapy more than 90 days after breast surgery (n = 19) (HR 7.63; p = 0.004) and between 61 and 90 days after surgery (n = 46) (HR 4.58; p = 0.040) compared to those who started before 30 days (n = 23). Controlling by type of surgery and stage, the prognosis of patients who started chemotherapy between 61 and 90 days after surgery was similar to that of patients who underwent chemotherapy within the first 30 days, controlling for surgery (HR 4.10; p = 0.056) and controlling for stage (HR 3.76; p = 0.075). Prognosis was worse for patients with stage III disease (p = 0.022) who underwent a mastectomy and/or axillary lymph node dissection (p = 0.025). Conclusion: Patients who started chemotherapy more than 90 days following surgery and those with stage III disease or underwent mastectomy and/or axillary lymph node dissection who initiated it between 61 and 90 days had a worse OS. Multiple factors are involved in the time between surgery and the initiation of chemotherapy, and further studies are needed to evaluate which of these factors influence the delay of chemotherapy in order to design strategies to avoid such delays and their negative impact on survival.
O câncer de mama ocupa o primeiro lugar em incidencia e mortalidade no Uruguai. O conhecimento da... more O câncer de mama ocupa o primeiro lugar em incidencia e mortalidade no Uruguai. O conhecimento da distribuicao dos fatores de risco relacionados ao desenvolvimento da doenca facilita a incorporacao de estrategias de prevencao na pratica clinica de rotina, o que poderia contribuir para menores taxas de morbidade e mortalidade. Objetivos: Conhecer o perfil epidemiologico do câncer de mama e frequencia de controle da populacao mamografica investigada Material e Metodos: Uma pesquisa foi realizada entre mulheres uruguaias. Apos a mesma, ellas foram informadas sobre os fatores de risco e protetores e a importância da realizacao do controle mamografico. Resultados: 182 respondentes foram incluidas, a mediana de idade foi de 34 anos (18-75 anos). Excluindo o sexo feminino (fator de risco presente em todos os entrevistados), 73 entrevistados (48%) apresentavam um ou mais fatores de risco. A maioria das mulheres com idade superior a 50 anos (58, 87,8%) realizaram o controle mamografico pelo ...
PURPOSEThe National Cancer Institute (NCI) Center for Global Health promotes global oncology rese... more PURPOSEThe National Cancer Institute (NCI) Center for Global Health promotes global oncology research to reduce cancer burden worldwide. In 2009, NCI launched the Latin American Cancer Research Net...
Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in ... more Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. Materials and Methods: A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. Results: This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. Conclusions: Consistent with internati...
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