Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
risk factors for overall survival (OS).
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
Presented at the American Society for Clinical Oncology Gastroenterology in January 2017 in San Francisco by Eric Raymond
Background: Sunitinib was approved by the FDA in 2011 for treatment of progressive, well-differentiated, advanced pancreatic neuroendocrine tumors (pNETs) based on a pivotal phase III study (NCT00428597) that showed a significant increase in progression-free survival (PFS) over placebo following early study termination. Subsequently, the FDA requested a post-approval study to support these findings.
Methods: In this open-label, phase IV clinical trial (NCT01525550), patients with progressive, well-differentiated, unresectable advanced/metastatic pNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to the phase III study. Primary endpoint was investigator-assessed PFS per RECIST 1.0. This study is ongoing.
Results: Sixty one treatment-naïve and 45 previously treated patients with progressive pNETs were treated with sunitinib: mean age, 54.6 years; males, 59.4%; white, 63.2%; ECOG PS 0, 65.1% or PS 1, 34.0%; and prior somatostatin analog, 48.1% (treatment-naïve, 39.3%; previously treated, 60.0%). At the data cutoff date, 82 (77%) patients discontinued treatment, mainly due to disease progression (46%). Median duration of treatment was ~11.9 months. Investigator-assessed median PFS (mPFS) was 13.2 months (95% CI, 10.9–16.7) in the overall population, with comparable mPFS in treatment-naïve and previously treated patients (13.2 vs 13.0 months). mPFS per independent radiologic review was 11.1 months (95% CI, 7.4–16.6). Objective response rate (ORR) per RECIST was 24.5%: 21.3% in treatment-naïve and 28.9% in previously treated patients. Median overall survival, although not yet mature, was 37.8 months. Treatment-emergent, all-causality adverse events (AEs) reported by ≥20% of all patients included neutropenia, diarrhea, leukopenia, fatigue, hand–foot syndrome, hypertension, abdominal pain, dysgeusia, and nausea. Most common grade 3/4 AEs were neutropenia (22%) and diarrhea (9%).
Conclusions: The mPFS of 13.2 months and ORR of 24.5% observed in this study support the outcomes of the pivotal phase III study of sunitinib in pNETs and confirm its activity in this setting. AEs were consistent with known safety profile of sunitinib.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
This study was performed to analyze the efficacy and safety of con-current radiotherapy and weekly paclitaxel in the treatment of carcinoma of uterine cervix. Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-Intracavitary brachytherapy, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg ∕m2 during entire course of external beam radiotherapy. Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. The results of this study suggest that concurrent chemo radiotherapy is feasible in treatment of carcinoma cervix with acceptable and manageable toxicity and paclitaxel act as radio sensitizer in locally advanced cervical cancer.
Describes the emerging resistance of epithelial cancer of the ovary to current therapies and the role of PARP inhibitors in the management in view of the recent drug approvals.
Author: Dr Christa Maria Joel
Module: Effects of lifestyle on health
Supervisor: Ms Jane Tobias and Dr Daniel Boakye
University of the West of Scotland
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Impact of Multidisciplinary Discussion on Treatment Outcome For Gynecologic C...Emad Shash
Tumor conferences are multidisciplinary meetings at which the
management of cancer patients is discussed. They have been
an integral part of oncology services and are regarded
as an essential component of quality control and continuing
medical education. There are data to suggest that the tumor conference enhances patient care. Many studies of effectiveness have been conducted. Reported benefits include improved patient management and treatment. In this presentation, I'll try to assess the role of the multidisciplinary tumor conference in patient management in gynecologic oncology services.
Presented at the American Society for Clinical Oncology Gastroenterology in January 2017 in San Francisco by Eric Raymond
Background: Sunitinib was approved by the FDA in 2011 for treatment of progressive, well-differentiated, advanced pancreatic neuroendocrine tumors (pNETs) based on a pivotal phase III study (NCT00428597) that showed a significant increase in progression-free survival (PFS) over placebo following early study termination. Subsequently, the FDA requested a post-approval study to support these findings.
Methods: In this open-label, phase IV clinical trial (NCT01525550), patients with progressive, well-differentiated, unresectable advanced/metastatic pNETs received continuous sunitinib 37.5 mg once daily. Eligibility criteria were similar to the phase III study. Primary endpoint was investigator-assessed PFS per RECIST 1.0. This study is ongoing.
Results: Sixty one treatment-naïve and 45 previously treated patients with progressive pNETs were treated with sunitinib: mean age, 54.6 years; males, 59.4%; white, 63.2%; ECOG PS 0, 65.1% or PS 1, 34.0%; and prior somatostatin analog, 48.1% (treatment-naïve, 39.3%; previously treated, 60.0%). At the data cutoff date, 82 (77%) patients discontinued treatment, mainly due to disease progression (46%). Median duration of treatment was ~11.9 months. Investigator-assessed median PFS (mPFS) was 13.2 months (95% CI, 10.9–16.7) in the overall population, with comparable mPFS in treatment-naïve and previously treated patients (13.2 vs 13.0 months). mPFS per independent radiologic review was 11.1 months (95% CI, 7.4–16.6). Objective response rate (ORR) per RECIST was 24.5%: 21.3% in treatment-naïve and 28.9% in previously treated patients. Median overall survival, although not yet mature, was 37.8 months. Treatment-emergent, all-causality adverse events (AEs) reported by ≥20% of all patients included neutropenia, diarrhea, leukopenia, fatigue, hand–foot syndrome, hypertension, abdominal pain, dysgeusia, and nausea. Most common grade 3/4 AEs were neutropenia (22%) and diarrhea (9%).
Conclusions: The mPFS of 13.2 months and ORR of 24.5% observed in this study support the outcomes of the pivotal phase III study of sunitinib in pNETs and confirm its activity in this setting. AEs were consistent with known safety profile of sunitinib.
Adjuvant therapy protocols for liver cancer in patients undergoing liver tran...hr77
Many patients undergo liver transplantation for a liver cancer in a setting of liver cirrhosis. When is it possible to consider chemotherapy in such patients? Is it even possible? Is there a role?
This study was performed to analyze the efficacy and safety of con-current radiotherapy and weekly paclitaxel in the treatment of carcinoma of uterine cervix. Hundred patients with locally advanced (stages IIB to IVA according to FIGO classification) carcinoma of uterine cervix were enrolled, radiotherapy was conventionally administered: 50.4 Gy/28 fractions by external beam (whole pelvis) followed by HDR-Intracavitary brachytherapy, 4 fractions of 7 Gy each. Paclitaxel was administered on weekly basis at dose of 40 mg ∕m2 during entire course of external beam radiotherapy. Treatment response was evaluated three months after the end of radiotherapy by means of clinical examination and ultrasonography. Complete Regression (CR) in 83%, partial response (PR) 14% and progressive disease 3%. At 26 months of median follow up 73 patients alive, 58 patients are disease free. The results of this study suggest that concurrent chemo radiotherapy is feasible in treatment of carcinoma cervix with acceptable and manageable toxicity and paclitaxel act as radio sensitizer in locally advanced cervical cancer.
Describes the emerging resistance of epithelial cancer of the ovary to current therapies and the role of PARP inhibitors in the management in view of the recent drug approvals.
Author: Dr Christa Maria Joel
Module: Effects of lifestyle on health
Supervisor: Ms Jane Tobias and Dr Daniel Boakye
University of the West of Scotland
A prospective study of breast lump andclinicopathologicalanalysis in relation...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
A retrospective study on ovarian cancer with a median follow-up of 36 months ...AI Publications
Ovarian cancer is relatively common but serious and has a poor prognosis. The aim of this study is to highlight the epidemiological, diagnostic, therapeutic and evolutionary aspects of this malignant pathology managed at the Bejaia university hospital center. This is a retrospective and descriptive study over a period of 3 years (2019 - 2022) carried out on 20 patients who developed ovarian cancer. The average age of the patients was 50 years old, 53.23% of whom were over 45 years old. The CA-125 blood test was positive in 18 out of 20 patients. The tumors were discovered on ultrasound in 87.10% of cases and at laparotomy in 12.90%. Total hysterectomy with bilateral adnexectomy was the most performed procedure (64.52%). The early postoperative course was simple. 15 patients underwent second look surgery (16.13%) for locoregional recurrences. Epithelial tumors were the most frequent histological type (93.55%), including 79% in the advanced stage ( IIIc -IV) and 21% in the early stage (Ia- Ib ). Adjuvant chemotherapy was administered in 80% of patients. With a median follow-up of 36 months, 2 patients were lost to follow-up. The evolution was favorable in 27.42% and in 25.81% deaths occurred late postoperatively. Ovarian cancer is not common but serious given the advanced stages and the high rate of late postoperative deaths which were largely observed in patients deprived of adequate neoadjuvant or adjuvant chemotherapy.
Sharad Ghamande, MD, FACOG
Professor and Director of Gynecologic Oncology
Augusta University Cancer Center
Presentation to the Georgia Senate Women's Adequate Healthcare Study Committee
www.gacommissiononwomen.org
ORIGINAL PAPERRisk of colorectal cancer among long-term ce.docxalfred4lewis58146
ORIGINAL PAPER
Risk of colorectal cancer among long-term cervical cancer
survivors
Ana M. Rodriguez • Yong-Fang Kuo •
James S. Goodwin
Received: 1 February 2014 / Accepted: 25 March 2014 / Published online: 3 April 2014
! Springer Science+Business Media New York 2014
Abstract Because advances in therapy have increased
long-term survival for women with cervical cancer, it is
important to study the risk of secondary primary malig-
nancies in high-dose organ areas. From the 1973–2009
National Cancer Institute Surveillance, Epidemiology, and
End Results (SEER) program, we studied the risk of
developing cancer of the colon and rectum in 64,507 cer-
vical cancer patients over 35 years after initial radiation
treatment. We also assessed change in risk over time.
Kaplan–Meier estimator for survival curve and Cox pro-
portional hazards models was used. More than half (52.6 %)
of the cervical cancer patients received radiation treatment.
In the analyses adjusted for race/ethnicity, age, marital
status, surgery status, stage and grade, the risk of colon
cancer between those both with and without XRT diverged
beginning at approximately 8 years. After 8 years, the
hazard ratio for developing colon cancer was 2.00 (95 % CI
1.43–2.80) for women with radiation versus those without
radiation treatment. The risk of rectal cancer diverged after
15 years of follow-up (HR 4.04, 95 % CI 2.08–7.86). After
35 years of follow-up, the absolute risk of developing colon
cancer was 6.5 % for those who received radiation versus
2.5 % for those without, and 3.7 versus 0.8 % for rectum.
The risk of colon and rectum cancer over 20 years of fol-
low-up after radiation remained the same across three eras
(1973–1980, 1981–1990, and 1991–2000). Radiation-
induced second cancers of the colon and rectum may occur
8 years after radiation treatment for cervical cancer.
Keywords Cervical cancer ! SEER ! Second primary
cancer ! Radiotherapy ! Colon cancer ! Rectal cancer
Introduction
The incidence and mortality for cervical cancer has
decreased in the United States [1, 2]. As of 2012, of the
245,022 women surviving cervical cancer, 83 % have
already lived 5 years or more after the diagnosis [3, 4].
With the growing number of people surviving cancer in
general, it is vital to study the health complications that
might develop during the months or years following the
completion of the given treatment to treat the primary
tumor [5]. Developing a second cancer is one of the most
serious complications of cancer treatment [6, 7]. An esti-
mated 18 % of the incident malignancies in the United
States are a second (subsequent) cancer [8].
Patients with cervical cancer provide an excellent
opportunity to study the lasting effects of radiotherapy [6].
There is a sufficient number of patients available to study,
including non-irradiated patients available for comparison.
In addition, radiation doses received by other organs while
treating cervical cancer can be .
Original StudyType of Breast Cancer Diagnosis, Screening,a.docxvannagoforth
Original Study
Type of Breast Cancer Diagnosis, Screening,
and Survival
Carla Cedolini,1 Serena Bertozzi,1 Ambrogio P. Londero,2 Sergio Bernardi,3,4
Luca Seriau,1 Serena Concina,1 Federico Cattin,1 Andrea Risaliti1
Abstract
Organized, invitational breast cancer screening in our population succeeded in detecting early-stage tumors,
which have been consequently treated more frequently with breast and axillary conservative surgery, com-
plementary breast irradiation, and eventual hormonal therapy. The diagnosis of invasive cancer with screening
in our population resulted in a survival gain at 5 years from the diagnosis.
Introduction: Breast cancer screening is known to reduce mortality. In the present study, we analyzed the prevalence
of breast cancers detected through screening, before and after introduction of an organized screening, and we
evaluated the overall survival of these patients in comparison with women with an extrascreening imaging-detected
breast cancer or those with palpable breast cancers. Materials and Methods: We collected data about all women
who underwent a breast operation for cancer in our department between 2001 and 2008, focusing on type of tumor
diagnosis, tumor characteristics, therapies administered, and patient outcome in terms of overall survival, and re-
currences. Data was analyzed by R (version 2.15.2), and P < .05 was considered significant. Results: Among the 2070
cases of invasive breast cancer we considered, 157 were detected by regional mammographic screening (group A),
843 by extrascreening breast imaging (group B: 507 by mammography and 336 by ultrasound), and 1070 by extra-
screening breast objective examination (group C). The 5-year overall survival in groups A, B, and C were, respectively,
99% (95% CI, 98%-100%), 98% (95% CI, 97%-99%), and 91% (95% CI, 90%-93%), with a significant difference
between the first 2 groups and the third (P < .05) and a trend between groups A and B (P ¼ .081). Conclusion: The
diagnosis of invasive breast cancer with screening in our population resulted in a survival gain at 5 years from the
diagnosis, but a longer follow-up is necessary to confirm this data.
Clinical Breast Cancer, Vol. 14, No. 4, 235-40 ª 2014 Elsevier Inc. All rights reserved.
Keywords: Breast cancer, Breast cancer screening, Invasive breast cancer, Mammographic screening, Overall survival
Introduction
Because of the detection of early-stage tumors, breast cancer
screening reduced breast cancer mortality in Europe by 25%-31%
in patients who were invited for screening and by 38%-48% in
those who were actually screened during the last decade of the
twentieth century and the first decade of the twenty-first.1 In our
region of Italy, an organized breast cancer screening was firstly intro-
duced in 2005, but despite the high compliance of invited women
1Clinic of Surgery
2Clinic of Obstetrics and Gynecology
University of Udine, Udine, Italy
3Department of Surgery, Ospedale Civile di Latisana, Udine, Italy
4 ...
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
Radiation-Induced Angiosarcoma of the Breast: Retrospective Analysis at a Reg...semualkaira
Radiation-induced angiosarcoma (RIA) of the breast is an uncommon but morbid complication after radiotherapy for breast cancer. This retrospective study analysed the treatment and outcome of breast RIA patients at Cambridge University Hospital (CUH), a regional treatment centre in the East of England.
En esta presentación se hace un repaso rápido de mecanismos de acción y efectos adversos de la quimoterapia. In this presentation we show it action mechanism and chemotherapy toxicities
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Are There Any Natural Remedies To Treat Syphilis.pdf
Clinicopathologic Features and Survival Analysis of Non-metastatic Breast Cancer Patients in Guatemala
1. low incidence-to-mortality ratio, which it is often
related to delays in diagnosis and to the
2
unavailabilityofsurgicalormedicaltreatment.
Clinical characteristics and outcomes of BC
patients vary depending on the study population.
Previous studies have acknowledged that Hispanic
patients feature different tumor subtypes and share
poor long-term outcomes in comparison to non-
3,4
Hispanicpopulations.
Guatemala is a low-middle income country
(LMIC) with 17 million habitants, mainly composed
5
by mestizos (60.1%) and indigenous (39.3%) people.
Like some other countries in Central America,
Introduction
Breast cancer (BC) is the most common
malignancy and the major cause of cancer-related
1
death among women worldwide. In developing
countries, the burden of this disease is reflected in the
ARTICLE INFO
Conclusion: The majority of patients with non-metastatic BC are diagnosed
with advanced disease and many of them are younger than 50 years old. OS in this
cohortofGuatemalanpatientsis lowerthanthatreportedindevelopedcountries.
Background: Breast cancer (BC) is a leading cause of cancer related death
worldwide. Unfortunately, data concerning clinicopathologic features of this
malignancy in non-developed countries is scarce. This study aims to characterize a
cohort of Guatemalan female patients with non-metastatic BC and to determine
riskfactorsforoverallsurvival(OS).
Methods: We retrieved data on consecutive patients from the Instituto
Guatemalteco de Seguridad Social that were treated from 2008 to 2014. Clinical
features and long-term outcomes were retrieved from medical records. Univariate
and multivariate Cox regression analyses were conducted to identify variables
associatedwithOS.
Results: 954 BC patients were identified during the time frame. A total of 436
women (46%) were younger than 50 years old. BC molecular subtypes categorized
537 patients (56.3%) with luminal A disease, 186 (19.5%) patients with triple
negative tumors, 153 cases (16.1%) with HER-2 enriched tumors, and 78 patients
(8.2%) with luminal B tumors. Clinical stage at presentation was stage I: 4.7%
(n=45); stage II: 48.1% (n=459), and stage III: 47.2% (n=450). The overall 5-year
survival rate was 75.2% (95% Confidence Interval: 72.0–78.3). In the multivariate
analysis clinical stage, triple negative tumors and HER2 enriched tumors were
independentlyassociatedwithpoorsurvival.
Received:
Accepted:
survival
03 June 2020
12 August 2020
Key words:
Guatemala;
Revised:
18 August 2020
Brest cancer;
Address for correspondence:
Hugo Castro, MD.
Address: Grupo Médico Angeles, 2da calle 25-19 zona 15,
Vista Hermosa I; Edificio Multimedica, of 10-15, Guatemala
City, Guatemala.
Tel: (+502) 2385-7572
E-mail: Hugoraulcastro@gmail.com
111
ABSTRACT
Clinicopathologic Features and Survival Analysis of Non-metastatic
Breast Cancer Patients in Guatemala
a
Grupo Médico Ángeles, Guatemala City, Guatemala
b
Social Security Institute of Guatemala, Guatemala City, Guatemala
c
Nacional Institute of Cancer of Guatemala, Guatemala City, Guatemala
d
School of Medicine, University of Costa Rica, San José, Costa Rica
a b c b d
Hugo Castro-Salguero* , Luis García Aceituno , Alba Kihn , Raúl Jiménez , Allan Ramos-Esquivel
Open AccessOriginal Article
Castro, et al. Arch Breast Cancer 2020; Vol. 7, No. 3: 111-118
DOI: 10.32768/abc.202073111-118
2. Given the expected increase of BC incidence and
mortality in the coming years, and the relevance of
these unknown data to Health care providers, we
decided to conduct this study in order to describe
clinical characteristics of non-metastatic BC patients
from Guatemala and to identify clinical determinants
ofOS.
Methods
We retrospectively reviewed the clinical records
of all patients diagnosed with non-metastatic BC at
the Instituto Guatemalteco de Seguridad Social
(IGSS) between January 2008 and December 2014.
The IGSS is a referral center that provides health
services to about 17% of the Guatemalan employed
7
population. All cases were histologically confirmed
by excisional or core needle biopsy before treatment.
All patients were classified according to the
American Joint Committee on Cancer Staging
8
Manuel (TNM), Seventh Edition. For eligible
patients we collected clinical data from medical
records.
The adjuvant/neoadjuvant treatment regimens
were decided by the medical oncologist in charge,
and consisted of one of the following regimens: a)
four cycles of adriamycin 60 mg/m2 and
cyclophosphamide 600 mg/m2 (AC) every 21-days
followed by paclitaxel 80 mg/m2 weekly for 12
weeks or for 4 cycles of docetaxel 75 mg/m2 every
21-days; b) 4 cycles of neoadjuvant AC followed by
surgery and 4 cycles of adjuvant docetaxel
Patients were evaluated to receive neoadjuvant
therapy in a multidisciplinary session. Patients with
clinical response to neoadjuvant treatment were
evaluated before each chemotherapy cycle, those with
stable disease considered to be inoperable underwent
radiotherapy followed by surgery. Pathological
complete response (pCR) was considered to be the
absence of any tumor cells both in the tumor and
13
lymph nodes (ypTis orypT0 and ypN0).
Guatemala has undergone an epidemiological and
demographic transition, and the incidence and
mortality of BC is increasing, with few data reported
on the clinical characteristics and determinants of
6
overallsurvival(OS)and disease-freesurvival.
The BC pathologist in charge assessed
histological subtype, nuclear grade, and interpreted
the immunohistochemical (IHC) analysis of all cases
in formalin-fixed paraffin-embedded tissues from
incisional biopsies taken for diagnosis. Estrogen
receptor (ER), progesterone receptor (PR), Ki-67
index, and expression and/or HER2 gene
amplification were conducted following current
9, 10
recommendations. HER2 was deemed positive
based on American Society of Clinical Oncology
11
(ASCO) guideline. Breast cancer intrinsic subtypes
12
were specified based on St Gallen 2015 Consensus.
Tumor size and lymph node involvement were
reportedinthepathologicalspecimenaftersurgery.
(recommended for high risk patients based on the
presence of at least one of the following
characteristics: four or more positive axillary nodes,
grossly evident extracapsular nodal extension, large
primary tumors, and very close (< 1mm) or positive
deep margins of resection of the primary tumor); c)
dose-dense chemotherapy (recommended for
women suffering from advanced or inflammatory
breast cancer); d) platinum-based regimen
(recommended for patients with TNT); e) six cycles
of cyclophosphamide 600 mg/m2, methotrexate 40
mg/m2 and 5-fluorouracil 600 mg/m2 (CMF
regimen); f) 4 cycles ofAC adjuvant (recommended
in low risk patients); g) endocrine therapy
(tamoxifen, anastrozol or letrozol). Patients with
HER2 positive tumors received trastuzumab for 52
weeksintheadjuvantsetting.
Routine follow-up of these patients comprised
clinical examination every three months during the
first three years and yearly thereafter. An annual
mammography was performed on all included
patients.
Statisticalanalysis
Continuous variables are presented as means and
standard deviations (SD). Categorical variables are
presented as frequencies. The comparisons between
continuous variables were made by theANOVAtest.
The Chi-square test was run to evaluate the statistical
association between categorical variables. The
Kaplan-Meier method was used to determine the
probability of OS and DFS. Follow-up was
determined from the date of diagnosis to the date of
last follow-up or death from any cause. Recurrence
was defined by the clinical or histopathological
evidence of metastatic disease as measured by the
RECIST 1.1 criteria. The survival curves were
compared by the log-rank test. Univariate and
multivariate Cox’s regression analyses were
performed to determine the hazard ratio (HR) with
95% confidence interval (95%CI) for OS. The
multivariate model included only those variables
with p values less than 0.10 in the univariate analysis.
A p value less than 0.05 was assumed to be
statistically significant. The statistical analysis was
performed using SPSS version 22 for Mac (SPSS,
Inc.,Chicago,IL,USA).
Results
Generalcharacteristics
A total of 954 patients were identified during the
time frame. Table 1 summarizes the clinical
characteristics of the population and categorized
based on breast cancer intrinsic subtype, as assessed
by IHC. In total, 436 women (46%) were younger
than 50 years old, and only 72 patients (7.5%) were
older than 70 years. The majority of patients (n=725,
76%) were diagnosed with advanced disease (stages
IIBtoIIIC).
Breast cancer in Guatemala
112 Castro, et al. Arch Breast Cancer 2020; Vol. 7, No. 3: 111-118
3. Median OS and DFS according to clinical stage,
breast cancer subtype, and tumor grade are provided
in Table 2. The results of the univariate and
multivariate analyses for OS are depicted in Table 3.
Figure 2 depicts the rate of OS according to breast
cancer intrinsic subtype. 5-year OS according to
clinical stage was 88.1% (95%CI: 78 – 97%) for
stage I, 87.4% (95%CI: 84 – 90%) for stage II, and
60%(55 – 64%)forstageIII.(Figure3)
Overall median survival time after breast cancer
diagnosis was 112 months (95%CI: 95.3 – 128.8),
and the overall 5-year survival rate was 75.2% (95%
CI:72.0–78.3).
Most common distant sites at recurrence included
lung (n=114; 44.7%), bone (75; 29.4%), central
nervous system (n=47; 18.4%), and liver (n=38;
14.9%). Local recurrent disease was presented in 35
(13.7%)cases.
events were confirmed by biopsy. The majority of
patients with recurrent events (n=167; 65.5%) were
treated with chemotherapy, followed by best
supportive care in 34 patients (13.3%), and hormonal
therapy in 27 patients (10.6%). Only 15.6% of
patients with hormone-receptor positive disease at
recurrenceweretreatedwithhormonaltherapy.
Pathological complete response was achieved by
27% and 33% of patients with HER2 positive tumors
and TNT, respectively. The OS analysis showed that
patients achieving pCR had better OS than their
counterparts (Hazard ratio: 0.56; 95%CI: 0.36-0.88;
p=0.001).
Long-term outcomes
A total of 678 (71.0%) patients were treated with
adjuvant chemotherapy, and 277 patients (29%)
underwent neoadjuvant therapy. Among patients
receiving preoperative chemotherapy, we identified
72 patients (26%) with pCR, and 183 patients (66%)
with partial response. A total of 8 cases (3%) had
progressive disease during neoadjuvant
chemotherapy.
Median OS among patients with pCR was 100
months (95% CI: 46.9-153.0), while patients without
pCR had a median OS time of 73 months (95%CI:
59.7 – 86.3months).(Figure1)
Medical therapy and response to neoadjuvant
chemotherapy
After a median follow up of 52 months, a total of
242 patients died (25.4%) and 255 (26.8%) had a
recurrent event. Only 28.4% of these recurrent
Table 1. Demographic characteristics of patients included in the study with breast cancer
Characteristic Luminal A
(n=537; 56.3%)
Luminal B
(n=78; 8.2%)
All (n=954) HER2
(n=153; 16.1%)
Triple Negative
(n=186; 19.5%)
P Value
Age
(Years, SD)
Clinical stage (%)
Histological Type (%)
Nuclear grade (%)
Body Mass Index (%)
Treatment (%)
Age
IA
IB
IIA
IIB
IIIA
IIIB
IIIC
Ductal
Lobular
Unknown
Low
Intermediate
High
Unknown
Obese
Overweight
Normal
Underweight
Unknown
Adjuvant
chemotherapy
Neoadjuvant
chemotherapy
Chemotherapy +
Radiotherapy
Surgery alone
Surgery +
endocrine therapy
Neoadjuvant and
adjuvant
chemotherapy
Unknown
52.4 ± 12.5
5 (0.5)
40 (4.2)
184 (19.3)
275 (28.8)
318 (33.3)
119 (12.5)
13 (1.4)
893 (93.6)
59 (6.2)
2 (0.2)
122 (12.8)
403 (42.2)
310 (32.5)
119 (12.5)
232 (24.3)
362 (37.9)
336 (35.2)
12 (1.3)
12 (1.3)
549 (57.5)
184 (19.3)
36 (3.8)
8 (0.8)
82 (8.6)
93 (9.7)
2 (0.3)
54.0 ± 12.2
5 (0.9)
25 (4.7)
117 (21.8)
158 (29.4)
174 (32.4)
54 (10.1)
4 (0.7)
490 (91.2)
47 (8.8)
0 (0)
91 (16.9)
258 (48.2)
109 (20.2)
79 (14.7)
132 (24.6)
208 (38.7)
183 (34.1)
7 (1.3)
7 (1.3)
329 (61.3)
85 (15.8)
20 (3.7)
2 (0.4)
72 (13.4)
28 (5.2)
1 (0.2)
52.08 ± 12.9
0 (0)
2 (2.6)
13 (16.6)
26 (33.3)
27 (34.8)
9 (11.4)
1 (1.3)
74 (94.9)
4 (5.1)
0 (0)
6 (7.7)
38 (48.7)
23 (29.5)
11 (14.1)
21 (26.9)
26 (33.3)
26 (33.3)
1 (1.3)
4 (5.2)
43 (55.1)
12 (15.4)
1 (1.3)
0 (0.0)
8 (10.3)
13 (16.7)
1 (1.3)
51.05 ± 12.9
0 (0)
9 (5.9)
24 (15.7)
35 (22.9)
49 (32.0)
30 (19.6)
6 (3.9)
150(98.0)
1 (0.7)
2 (1.3)
10 (6.5)
48 (31.4)
85 (55.5)
10 (6.5)
30 (19.6)
58 (37.9)
64 (41.8)
1 (0.7)
0 (0)
85 (55.6)
30 (19.6)
5 (3.3)
3 (2.0)
1 (0.7)
29 (19.0)
0 (0.0)
49.37 ± 11.9
0 (0)
4 (2.2)
30 (16.0)
56 (30.1)
68 (36.6)
26 (14.0)
2 (1.1)
179 (96.2)
7 (3.8)
0 (0)
15 (8.1)
59 (31.7)
93 (50.0)
19 (10.2)
49 (26.3)
70 (37.7)
63 (33.9)
3 (1.6)
1 (0.5)
92 (49.5)
57 (30.6)
10 (5.4)
3 (1.6)
1 (0.5)
23 (12.4)
0 (0.0)
< 0.001
0.016
< 0.001
< 0.001
0.158
< 0.001
Breast cancer in Guatemala
113Castro, et al. Arch Breast Cancer 2020; Vol. 7, No. 3: 111-118
4. Figure 1.
Figure 2.
Breast cancer in Guatemala
114 Castro, et al. Arch Breast Cancer 2020; Vol. 7, No. 3: 111-118
5. Figure 3.
Table 2. Overall survival and disease-free survival according to clinical stages, intrinsic breast cancer subtypes, and
tumor grade.
Variable P ValueMedian Disease-Free
Survival (months)
(95% CI)
Median Overall
Survival (months)
(95% CI)
5 years Overall
Survival rate
(95% CI)
P Value
Clinical stage
Intrinsic
breast cancer
subtype
IA
IB
IIA
IIB
IIIA
IIIB
IIIC
Luminal A
Luminal B
HER2 positive
Triple negative
Histological grade
I or II
III
33 (27.9 – 38.1)
35 (17.3 – 52.7)
30 (26.6 – 33.4)
24 (19.9 – 28.1)
21 (16.7 – 25.3)
16 (10.0 – 22.0)
31 (25.9 -36.0)
35 (24.8 – 45.2)
19 (13.3 – 24.6)
16 (21.2 – 26.9)
30 (26.4 – 33.6)
19 (15.4 – 22.6)
< 0.001
< 0.001
< 0.001
97 (72.9 – 121.1)
Not reached*
Not reached*
85 (72.7 – 127.6)
51 (34.0 – 67.9)
35 (28.3 – 41.6)
112 (non calculable**)
78 (non calculable**)
Not reached*
72 (57.5 – 86.5)
112 (95.2 – 128.8)
85 (73.6 – 96.4)
80 (47 – 100)
89 (79 – 98)
88 (82 – 93)
86 (81 – 90)
71 (65 – 76)
39 (29 – 48)
44 (16 – 71)
83 (79 – 86)
68 (56 – 79)
69 (61 – 77)
59 (51 – 66)
83 (79 - 87)
60 (53 - 66
< 0.001
< 0.001
< 0.001
*Not reached: Longer follow-up is needed in order to achieve the median overall survival in this subgroup.
**Non-calculable: The formula for the estimation of the 95% confidence interval was not applicable due to large sample variation.
Table 3. Univariate and multivariate analysis of overall survival for the entire population
Variable Univariate analysis Multivariate analysis
1.00 (0.99-1.01)
Reference
3.56 (1.66-7.57)
3.79 (2.81-5.10)
0.45 (0.35-0.58)
1.28 (0.97-1.70)
2.55 (1.94-3.34)
Age (years)
Clinical stage
I
II
III
ER positive
HER2 positive
Triple negative
0.98
< 0.001
< 0.001
0.081
< 0.001
Reference
2.72 (1.83 – 4.05)
5.44 (3.66 – 8.10)
1.11 (0.68 – 1.81)
1.87 (1.21 – 2.89)
3.32 (1.88 – 5.89)
<0.001
0.67
0.005
<0.001
P ValueHazard ratio (95% CI) P ValueHazard ratio (95% CI)
115Castro, et al. Arch Breast Cancer 2020; Vol. 7, No. 3: 111-118
Breast cancer in Guatemala
6. Although BC mortality in Guatemala ranks
among the lowest worldwide1, the 5-year OS is
considerably lower than that reported in developed
23
countries. Similarly, the 5-year OS by subtype was
lower than previously reported, particularly in TN
23
and HER2 positive tumors. These differences can
be attributed to the unavailability of medical
therapies or delays in referral and treatment initiation
in our cohort, as previous authors have already
24
noticed, but also can be a reflection of the over-
representativeness of young patients with high grade
and TN tumors, since some authors have argued that
young age at diagnosis is independently related to
25
worse long-termprognosis.
Our study also revealed a high proportion of
patients younger than 50 years old. This percentage
is higher than that reported forAmerican populations
16
according to the SEER Registry (46% vs. 19%) , but
similar to the percentage previously reported in
21
Mexican patients. Similarly, Hispanic patients
living in USA usually are younger than their White
17
counterparts. This finding is of paramount
importanceforscreeningpurposes inourcountry.
Our findings also showed that the percentage of
patients with TN tumors (19.5%) is higher than that
16,17
reported for Caucasian (10-12.5%) and Asian
18
populations (8%) , and similar to that reported in
19 20
Mexico (23.1%) and Costa Rica (17.1%) Indeed,
clinical characteristics of patients with TN tumors
are very similar to Mestizo populations reported
21
elsewhere , such as young age at diagnosis, and high
grade histological differentiation. These differences
in BC subtypes among ethnic groups can reflect
variations in the prevalence of risk factors, as well as
22
aconsequenceofintrinsicgeneticvariations.
Our study also described the results of
neoadjuvant chemotherapy in operable BC patients.
Although the percentage of patients undergoing
preoperative treatment was similar to that reported in
26, 27
other cohorts (19.3%) , our data suggest that
neoadjuvant therapy was underused, since the
majority of patients in our cohort had locally
Our study reports, for the first time, a clinical
depiction of a cohort of Guatemalan patients with
non-metastatic BC. These findings show that the
majority of cases presented with large tumors and
lymph nodal metastases. It has been postulated that
lack of access to health services and lack of screening
policies are responsible for the high incidence of
locally advanced tumors in this particular
14
population. Indeed, only one-third of patients were
diagnosed at an early stage, suggesting a lack of BC
awareness and little access to screening and health
care services. Previous authors have reported that
adherence to mammography guidelines is
considerably low among Guatemalan females as a
consequence of a lack of insurance coverage and low
15
education.
Discussion
Otherauthorsdeclarenoconflictsofinterest.
advanced disease. In concordance with previous
28
reports , our data showed an OS improvement in
favor of those patients who achieved pCR, a finding
that must be interpreted cautiously because of the
small sample size undergoing neoadjuvant
chemotherapyinourcohort.
The Guatemalan government´s expenditure on
health care is among the lowest of Central American
29
countries. This, and other challenges such as the
30
low health insurance coverage , and the low
prevalence of screening, are among the main barriers
this country faces in order to reduce the burden of
BC. Other needs that must be fulfilled include the
lack of national cancer centers and protocols, the
lack of trained personnel, and poor access to primary
14,30
careinruralareas.
In summary, our studied population is diagnosed
at locally advanced stages, indicating the need to
increase awareness about BC among Guatemalan
women and to improve the screening program for
earlier detection of the disease. Given the high
percentage of BC patients under the age of 50, we
recommend starting screening mammography prior
thisage.
This work was partly funded by Roche Servicios
S.A.
Hugo Castro has received honoraria from Roche,
Novartis, Bayer, Pfizer, consulting for Roche and
Bayer. Allan Ramos-Esquivel has received honoraria
from Roche and Pfizer, consulting for Roche, Bayer,
and Novartis; and travel and accommodations
expenses from Bayer, Roche, Novartis, and Johnson
&Jonhson.
Our findings cannot accurately reflect the
prognosis and clinical characteristics of all
Guatemalan patients affected with BC due to its
unicenter design. Besides, its retrospective design
could bias the results due to some missing data from
clinical records. For instance, we did not have access
to other potential confounder variables associated
31
with prognosis, such as smoking , alcohol
32 33
consumption , or previous hormone use. Despite
these caveats, our study provides a first clinical
picture that can contribute to improve health policies
in Guatemala. Further national efforts must be
carried out to better describe the epidemiology of
cancerpatientsinour country.
ConflictofInterest
FinancialSupport
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