Breast Cancer In Mexico Research Articles

Sexual Function and Satisfaction in Young Women with Breast Cancer: A Five-Year Prospective Study.

Young women with breast cancer (YWBC) face unique challenges that can impact their sexual health. This study aimed to identify factors associated with sexual activity, function, and satisfaction in YWBC up to five years post-diagnosis. We conducted a prospective cohort study of 474 women aged ≤40 years diagnosed with non-metastatic breast cancer in Mexico. Sexual function and satisfaction were assessed using the Female Sexual Function Index and the Sexual Satisfaction Inventory, respectively. Factors associated with sexual health outcomes were examined using mixed-effects models. The prevalence of sexual dysfunction increased from 33.6% at baseline to 52.9% at 4-5 years post-diagnosis. Factors associated with worse sexual function included older age (mean predicted FSFI score -1.35, p = .037), treatment-induced amenorrhea (-2.86, p < .001), depression (-4.11, p < .001), and anxiety (-2.13, p < .001). Lower sexual satisfaction was associated with lower educational attainment (mean predicted SSI score -5.61, p = .002), being single (-6.41, p < .001), treatment induced amenorrhea (-3.76, p = .004), bilateral oophorectomy (-8.21, p = .017), depression (-11.29, p < .001), and anxiety (-7.50, p < .001). Quality of life, body image, and systemic therapy side effects significantly impacted both outcomes. Three distinct trajectories of sexual function were identified: high (62.2%), intermediate (24.3%), and markedly declining (13.5%). Four trajectories of sexual satisfaction were found, ranging from intermediate-to-high (57.3%) to progressively worsening (27.5%). Sexual dysfunction is prevalent and persistent among YWBC. Multiple biological, psychological, and social factors influence sexual health outcomes in this population. These findings highlight the importance of routine screening and tailored interventions to address the sexual health of YWBC throughout survivorship.

Addressing the unmet needs of women with breast cancer in Mexico: a non-randomised pilot study of the digital ePRO intervention

ObjectivesThis study aimed to explore the acceptability, feasibility, usability, and preliminary effect of an electronic patient-reported outcome (ePRO) intervention for patients with breast cancer in Mexico.DesignWe conducted a multimethod non-randomised...

The unmet needs of women with metastatic breast cancer in Mexico: A qualitative study.

e13547 Background: Patients with metastatic breast cancer (mBC) have distinct unmet needs compared to those with early-stage disease. Recognizing this population's unique priorities is imperative to identify areas of opportunity to improve their care. This study aimed to explore the experiences and unmet needs of Mexican patients with mBC, a population for which information is scant. Methods: Patients aged ≥18 years with a diagnosis of mBC receiving systemic therapy or palliative care at a tertiary care center in Mexico City were invited to participate in a semi-structured interview. Those with intellectual disability, severe psychologic disorder, poor functional status (ECOG &gt; 2), or not interested in participating were excluded. Results: Of 13 patients interviewed (median age: 50 years), 46% had an educational level of middle school or lower, 50% were unemployed, 39% were in a relationship, and 23% were not undergoing active treatment. Key unmet needs emerged in 3 domains: (A) Information: The patients noted that the medical team was willing to provide information about their disease, but often the explanations provided were overly technical or lacked detail. They expressed a desire for clearer communication about their prognosis and treatment options, but also wanted to limit the information received to minimize delivery of bad news. (B) Physical/emotional: The patients emphasized the need for readily available and accessible medications, regardless of institutional affiliation or place of residency. They noted that more widespread knowledge about available services (e.g., nutrition, dentistry, psychology) was necessary and wanted to explore complimentary medicine interventions that could help address their symptoms. The patients expressed a desire for immediate psychological support to be offered when initially diagnosed with distant disease and identified interaction with women going through similar circumstances as useful. (C) Navigating daily life: The patients noted a need to receive financial assistance for non-drug medical costs (e.g., nutritional supplements), as well as for transportation to and from medical appointments. They also identified lack of assistance with household chores and childcare as potential areas of improvement. They recognized virtual consultations as an attractive alternative to in-person appointments that could decrease time-toxicity and expenses. Conclusions: This study is the first qualitative exploration of unmet needs among Mexican women with mBC. Our findings highlight multifaceted unmet needs that patients experience and may negatively impact quality of life. Further research and the development of targeted interventions that aim to address pervasive gaps in clinical communication, emotional support, financial assistance, and supportive care access is urgently needed to alleviate distress in this vulnerable population.

Availability of mammographs in Mexico: Is it possible to expand coverage

Breast cancer screening coverage in Mexico is limited. It is necessary to configure the Mexican health system to make it capable of producing more mammograms, without neglecting quality and diagnostic opportunity. To project the coverage of breast cancer screening programs according to the mammographs availability in the Mexican Health System. An exploratory study was conducted correlating the number mammographs available in the Mexican Health System with women between 40 and 69 who are the target of screening programs in Mexico. The analysis consisted of calculating the coverage of breast cancer screening programs if each mammograph could perform 6336 screening mammograms per year. All the calculations were made with the information of the year 2020 as the most current data in terms of population density. It was determined that the number of mammographs is enough to raise the offer of screening studies to ≈50% at the national level. There are even states whose coverage capacity is projected above 70%. Some of them are Mexico City, Colima, Durango, Quintana Roo, Zacatecas, Baja California Sur and Coahuila. Also, it was observed that the distribution of mammographs is not equitable in the national territory, suggesting investment both in equipment and in screening strategies for breast cancer. Our data show that it is possible to advance in preventing breast cancer in Mexico, although the improvement of the management capacities of the Mexican Health System is required to improve both the coverage and quality of the breast cancer screening programs.

Design and evaluation of a digital health intervention with proactive follow-up by nurses to improve healthcare and outcomes for patients with breast cancer in Mexico: protocol for a randomised clinical trial

IntroductionNearly 30 000 Mexican women develop breast cancer annually, frequently presenting unmet supportive care needs. In high-income countries, incorporating electronic patient-reported outcomes (ePROs) into cancer care has demonstrated potential for...

Cost-effectiveness of the addition of CDK4/6 inhibitors to standard endocrine therapy in first-line treatment of women with advanced HR+/HER2- breast cancer in Mexico.

To estimate the cost-effectiveness of adding a CDK4/6 inhibitor to standard endocrine therapy in the first-line setting for advanced HR+/HER2- breast cancer in postmenopausal and premenopausal women, from the perspective of the Mexican public healthcare system. We used a partitioned survival model to simulate relevant health outcomes in a synthetic cohort of patients with breast cancer derived from the PALOMA-2, MONALEESA-2, MONARCH-3 trials for postmenopausal patients, and from the MONALEESA-7 study for premenopausal patients. Effectiveness was measured in life years gained. Cost-effectiveness is reported through incremental cost-effectiveness ratios (ICER). In postmenopausal patients, palbociclib led to an increase of 1.51 life years, ribociclib of 1.58years, and abemaciclib of 1.75years, compared to letrozole alone. The ICER was 36,648 USD, 32,422 USD, and 26,888 USD, respectively. In premenopausal patients, ribociclib led to an increase of 1.82 life years when added to goserelin and endocrine therapy, with an ICER of 44,579 USD. In the cost minimization analysis, for postmenopausal patients, ribociclib was the treatment with the highest costs due to follow-up requirements. Palbociclib, ribociclib, and abemaciclib demonstrated a significant increase in effectiveness in postmenopausal patients, and ribociclib in premenopausal patients, when added to standard endocrine therapy for patients with advanced HR+/HER2- breast cancer. At the national stablished willingness to pay, only the addition of abemaciclib to standard endocrine therapy in postmenopausal women would be considered cost-effective. However, differences on results between therapies for postmenopausal patients were not statistically significant.

Abstract P5-04-09: Analysis of an update to a novel breast cancer screening web-app

Abstract Introduction A minority of women with breast cancer in Mexico are diagnosed through a screening program with a low rate of national coverage of about 20%, which translates into late diagnosis and worse outcomes. The detection of high-risk groups through easy-access interventions is essential to increase the screening rate. OBJECTIVE To identify and analyze patients at high risk of breast cancer, through a web app specially designed for this purpose. MATERIAL AND METHODS The web app stratified respondents according to breast cancer risk into 4 categories: very high risk (symptomatic), high lifetime risk, average risk (usual screening recommendations), or low risk. The app was programmed to guide patients to a risk-based information page or urge them to seek medical advice if indicated (https://cuccuanl.com/tamiz_mama/). The web app also provided the contact information of our center, or an appointment could also be scheduled within the app. Distribution was made via social media. An upgrade of the app was launched, which expanded the functionality with the inclusion of the Gail model to identify women with a high lifetime risk for developing breast cancer and the option for a simple interpretation of mammographic results. In version 2.0, the patients were divided into 2 populations, the first one which already had a breast imaging test but wished to know what the BIRADS score obtained meant and the other group were those who answered a simple survey similar to the one available on version 1.0, with added questions to calculate the Gail model risk. RESULTS The web app was originally released in October 2021 with a total number of 1,012 women answering the survey. The update was released in June 2022 with 406 new subjects. 281 patients wished for a risk calculation with no prior breast imaging tests and 124 patients already had a breast image diagnosis test that wanted a simple interpretation. Table1 depicts the answers given between both versions. Among the group of patients that had a mammography but had doubts about the result 12.9% (n=16) reported a BIRADS 0, 12.1% (n=15) BIRADS 1, 46% (n=57) BIRADS 2, 14.5% (n=18) BIRADS 3, and 14.4% (n=18) BIRADS 4 or 5. To date 41 patients have booked an appointment at the cancer prevention clinic directly within the webapp for further evaluation. DISCUSSION AND CONCLUSION The changes in the criteria of high risk did not translate into changes in the proportion of patients considered at high lifetime risk of breast cancer, but these changes made might be more specific for subsequent screening and chemoprevention strategies. The app persisted with a high proportion of symptomatic patients. The results of integration of the simple mammography interpretation were surprising, with a high proportion of subjects with indication for a biopsy founded. In the Mexican population there is a significant gap between the screening mammography and the first consultation with a specialist, averaging 113 days from an abnormal screening test to a diagnosis of breast cancer (1), which delays treatment initiation resulting on a worst outcome. These kinds of apps may empower patients to seek earlier consultation if warranted or educate patients on their personal risk for developing cancer so they may have a closer adherence to early detection programs. These results and subsequent updates might help evolve the app into something more akin to a digital navigator for patients. Bibliography 1)Unger-Saldaña K, Cedano Guadiamos M. Delays to diagnosis and barriers to care for breast cancer in Mexico and Peru: a cross sectional study. The Lancet Global Health. 2020 Apr 1;8:S16. Table 1 Results stratified by risk groups between version 1.0 and 2.0 Citation Format: Jose F. Muñoz Lozano, Omar Zayas Villanueva, Estefania Abundis Marquez, Fernando Alcorta Nuñez, Maria Fernanda Noriega, Carlos Salazar Mejia, Celia B. Gonzalez Alcorta, Diana Cristina Pérez Ibave, Victor Oyervides Juarez, Larisa M. Renteria Garcia, Adelina Alcorta Garza, Juan Francisco Gonzalez Guerrero, David Hernandez, Rafael Piñeiro Retif, Oscar Vidal Gutiérrez. Analysis of an update to a novel breast cancer screening web-app [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-09.

Abstract PD8-08: Employment status change in a cohort of young women with breast cancer in Mexico

Abstract Background: Breast cancer diagnosis and treatment generates disruption in multiple aspects in the life of patients, including work-related outcomes. The disruption in employment may exacerbate the economic burden on patients and their families, contributing to financial toxicity and ultimately impacting quality of life, especially in young women. However, the evidence of employment status at diagnosis for this group and its trajectory thereafter is limited. This study aims to document the first change in employment experienced by Mexican young women with a recent diagnosis of breast cancer and determine which factors are associated with a decrease in work activities. Methods: Mexican women from the Joven &amp; Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented disease recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Employment status was categorized on a scale as follows: full-time &amp;gt; part-time &amp;gt; student &amp;gt; medical leave &amp;gt; unemployed. Only the first employment status change was included in this analysis. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activity (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). In univariable analysis, having a partner at diagnosis demonstrated a lower hazard for experiencing a decrease in work activities; in contrast, postmenopausal status at 1 year was associated with a higher hazard of experiencing a decrease in employment status. However, in a competing-risks model including both partner and menopausal status, only the latter was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Age, education, monthly income, number of people who contribute to the household, having a partner at diagnosis, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with a higher probability of reduction in work activity. Conclusion: This cohort is one of the few initiatives assessing the impact of diagnosis and treatment of BC in young patients, specifically Latin American women. Our results show that there are relevant employment status changes after BC, possibly as a consequence of their treatment. Physical and psychological elements of menopause might influence the decrease in work status. Further studies are needed to deepen our understanding of employment changes in Latin American young women and guide interventions that address unintended limitations of work activities. Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Misael Salazar, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Lucero Labra, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status change in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-08.

Abstract P6-05-01: Employment status patterns in a cohort of young women with breast cancer in Mexico

Abstract Background: Breast cancer diagnosis and treatment carries a disruption in multiple aspects in the life of women. For young women affected by this condition, the evidence of employment status and its change is limited. This study aims to document the first change in employment that may be experienced by young women with breast cancer and determine which factors could influence such patterns. Methods: Mexican women from the Joven &amp; Fuerte prospective multicenter cohort, aged ≤40, diagnosed with stage I-III breast cancer between 2015-2021 with at least 6 months of follow-up were included. Participants with a documented recurrence, missing employment status information, diagnosis of a new primary breast cancer or a second type of cancer were excluded from the analysis. Patients completed surveys at baseline, 6 months, and yearly for up to 5 years to assess sociodemographic characteristics, employment status, medical and treatment data. Women were categorized on a scale of employment status as follows: full-time &amp;gt; part-time &amp;gt; student &amp;gt; medical leave &amp;gt; unemployed. Subsequently, an increase or reduction in employment status was considered whenever a participant moved up or down a category, respectively. Only the first employment status change was analyzed. The Kaplan-Meier failure estimate was employed to calculate the increase or decrease in employment status at 1 year and 2 years post-diagnosis. Competing risk regression models were undertaken to explore variables associated with a decrease in employment status. Results: A total of 142 women with a median age at diagnosis of 36.5 years (IQR 33-39) and median follow-up of 17 months were included in the analysis. Baseline employment status for these patients was: employed - full time (27%), employed - part time (14%), student (1%), medical leave (4%) and unemployed (54%). At 12 months, 18.5% of participants had a reduction in their work activities (95% CI 12.8 - 26.4%) and this proportion further increased to 25.8% at 24 months (95% CI 18.7 - 34.8%). In contrast, 11.8% (95% CI 7.3 - 19.0%) and 23.2% (95% CI 15.9 - 33.2%) of participants exhibited an increase in their work activity at 12 and 24 months, respectively. The most common patterns in first employment status change were from unemployed to employed - full time (19%), employed - full time to employed - part time (13%) and employed - full time to unemployed (13%). Age, education, monthly income, number of people who contribute to the household, number of children, being financially responsible for another person, mastectomy, chemotherapy, radiotherapy and endocrine treatment were not associated with an increase or reduction in work activity. Postmenopausal status at 1 year postdiagnosis was associated with a higher hazard for experiencing a reduction in work activity (SHR=3.05, 95% CI 1.38 - 6.72, p=0.006). Conclusion: The results from the present study appear to be in line with those of a European cohort. Further studies are needed to identify other potential factors that influence employment status trajectories. The development of interventions that tackle actionable characteristics of young patients with breast cancer at risk of employment disruption is imperative. Citation Format: Cynthia Villarreal-Garza, Ana Ferrigno, Luis F. Enriquez, Alan Fonseca, Alejandra Platas, Marlid Cruz-Ramos, Melina Miaja, Bryan Vaca-Cartagena, Andrea Becerril-Gaitan, Fernanda Mesa-Chavez, Enrique Bargallo-Rocha, Alejandro Mohar. Employment status patterns in a cohort of young women with breast cancer in Mexico [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-05-01.

Resources for the attention of patients with breast cancer in Mexico

Resources for the attention of patients with breast cancer in Mexico

Applicability of a web app for breast cancer risk calculation and personalized recommendations for screening in Mexico.

1567 Background: A minority of women with breast cancer in Mexico are being diagnosed through a screening program, which translates into late diagnosis and a worse prognosis. It is imperative to develop easy access and low-cost interventions to increase the screening rate. Methods: We developed a web app tailored to guide patients to seek medical consultation if they were at high risk for breast cancer or standard screening recommendations based on the predicted risk for age (https://cuccuanl.com/calcula-tu-riesgo-de-cancer-de-mama/). The web app consisted of an 8-question survey designed using object-based programming with HTML5, the additional logic was programmed on JavaScript. The program logic automatically guided patients to medical consultation if they were at high risk for breast cancer, or standard screening recommendations based on their predicted risk for age. On each confirmation page, the contact information of the hospital appeared, also, consultation at the clinic could be scheduled within the web app. The web app was distributed via social media on International Breast Cancer Awareness Day. Results: A total of 1,012 persons answered the survey after a follow-up period of two weeks. The median age of respondents was 34 years. Among participants, 10.8% were considered at very high risk for breast cancer due to symptoms, 22% were classified as high risk based on family history or more than 5 years of contraceptive use, and 19% were considered as average-risk population for whom age-based screening tests were recommended. The remaining 48% of participants were considered at low risk for breast cancer development and were directed to educational information about breast cancer awareness. Among all persons that answered our survey, 21 requested a specialized medical appointment within the web app. Conclusions: This pilot study showed a high response of Mexican population seeking breast cancer risk evaluation, 11% of women that responded to our survey had symptoms highly suggestive of breast cancer. The use of web apps can result in mass diffusion which will help reach people with less medical access, a common scenario in many developing countries. Further analysis should be made to measure the real impact on breast cancer diagnosis and oncological outcomes. This study shows how effective social media is as a means of diffusion on health topics. [Table: see text]

Energy homeostasis genes modify the association between serum concentrations of IGF-1 and IGFBP-3 and breast cancer risk

Breast cancer is a multifactorial disease in which the interplay among multiple risk factors remains unclear. Energy homeostasis genes play an important role in carcinogenesis and their interactions with the serum concentrations of IGF-1 and IGFBP-3 on the risk of breast cancer have not yet been investigated. The aim of this study was to assess the modifying effect of the genetic variation in some energy homeostasis genes on the association of serum concentrations of IGF-1 and IGFBP-3 with breast cancer risk. We analyzed 78 SNPs from 10 energy homeostasis genes in premenopausal women from the 4-Corner’s Breast Cancer Study (61 cases and 155 controls) and the Mexico Breast Cancer Study (204 cases and 282 controls). After data harmonization, 71 SNPs in HWE were included for interaction analysis. Two SNPs in two genes (MBOAT rs13272159 and NPY rs16131) showed an effect modification on the association between IGF-1 serum concentration and breast cancer risk (Pinteraction < 0.05, adjusted Pinteraction < 0.20). In addition, five SNPs in three genes (ADIPOQ rs182052, rs822391 and rs7649121, CARTPT rs3846659, and LEPR rs12059300) had an effect modification on the association between IGFBP-3 serum concentration and breast cancer risk (Pinteraction < 0.05, adjusted Pinteraction < 0.20). Our findings showed that variants of energy homeostasis genes modified the association between the IGF-1 or IGFBP-3 serum concentration and breast cancer risk in premenopausal women. These findings contribute to a better understanding of this multifactorial pathology.

Reduction in the Treatment Gap for Breast Cancer in Mexico under Seguro Popular, 2007 to 2016

ABSTRACT As Mexico’s government restructures the health system, a comprehensive assessment of Seguro Popular’s Fund for Protection against Catastrophic Expenses (FPGC) can help inform decision makers to improve breast cancer outcomes and health system performance. This study aimed to estimate the treatment gap for breast cancer patients treated under FPGC and assess changes in this gap between 2007 (when coverage started for breast cancer treatment) and 2016. We used a nationwide administrative claims database for patients whose breast cancer treatment was financed by FPGC in this period (56,847 women), Global Burden of Disease breast cancer incidence estimates, and other databases to estimate the population not covered by social security. We compared the observed number of patients who received treatment under FPGC to the expected number of breast cancer cases among women not covered by social security to estimate the treatment gap. Nationwide, the treatment gap was reduced by more than half: from 0.71, 95% CI (0.69, 0.73) in 2007 to 0.15, 95%CI (0.09, 0.22) in 2016. Reductions were observed across all states . This is the first study to assess the treatment gap for breast cancer patients covered under Seguro Popular. Expanded financing through FPGC sharply increased access to treatment for breast cancer. This was an important step toward improving breast cancer care, but high mortality remains a problem in Mexico. Increased access to treatment needs to be coupled with effective interventions to assure earlier cancer diagnosis and earlier initiation of high-quality treatment.

Value of a breast imaging unit in the detection of breast cancer in Mexico.

The screening breast cancer detection rate in Mexico is low. The main objective of this study was to determine the breast cancer detection rate in a Mexican population that attended a breast imaging unit, in which the same radiologist comprehensively evaluated and interpreted breast imaging studies. A total of 5,429 mammograms performed between 2015 and 2016 were evaluated. Rates for biopsy indication, biopsies performed and positive biopsies for cancer were determined. The malignancy detection rate, after a comprehensive imaging evaluation in a breast imaging unit, was 24.3 per 1,000 mammograms. In symptomatic women was 52.9 per 1,000 mammograms, and in screening women was 11.1 per 1,000 mammograms. Breast imaging units in which a comprehensive imaging approach is performed represent an opportunity for low- and middle-income countries without population-based screening programs to achieve a more efficient detection of breast cancer, without generating a higher cost.

High-early recurrence rate in a cohort of young women with breast cancer in Mexico.

e12560 Background: Young women with breast cancer (YWBC) have worse survival outcomes compared to their older counterparts. Even though a higher recurrence rate has been previously documented in this population, there is still limited information regarding the timing, prevalence and type of disease recurrence. This study aims to describe the patterns of early recurrence in Mexican YWBC. Methods: Women aged ≤40 years at diagnosis, accrued in the Joven &amp; Fuerte prospective cohort, with stage I-III BC and having at least a 2-year follow-up were analyzed. Recurrence-free survival (RFS) and overall survival (OS) at 2 years were evaluated using the Kaplan-Meier estimate. Log-rank and Fisher’s exact tests were employed for group comparisons; the Cox regression method was used to identify factors associated with RFS and OS. Results: A total of 210 patients with a median age at diagnosis of 36 years (range: 21-40) were analyzed. Most patients were diagnosed with stage II (50%) and III (39%). Distribution according to molecular subtype was: 50% HR+/HER2-, 26% TNBC, 17% HR+/HER2+, and 7% HR-/HER2+. In total, 31 (15%) patients experienced early disease recurrence. The two BC subtypes with the highest recurrence rate were TNBC (12/54; 22%) and HR+/HER2+ (6/35; 17%), followed by HR+/HER2- (12/106; 11%) and HR-/HER2+ (1/15; 7%). Stage at diagnosis was associated with a higher risk of recurrence (stage III: 21/82 (68%); stage II: 10/94 (32%); p= 0.003). Of the total recurrences, 23% were locorregional and the remaining 77% were distant metastases. The most common sites of distant metastases were lung (46%), bone (38%) and central nervous system (33%). Notably, 50% of distant recurrences affected multiple organs. Overall, RFS at 2 years was 85.2% (95%CI 79.7-89.4). In the univariate analysis, age ( &lt; 35 v ≥35), type of surgery (conservative v mastectomy) and BMI ( &lt; 25 v ≥25 kg/m²) were not significantly associated with RFS. In a multivariate model, node involvement (HR = 2.76; p= 0.044), not receiving chemotherapy (HR = 3.86; p= 0.024) and TNBC (HR = 2.47; p= 0.035) were independently associated with worse RFS. The OS found in this cohort was 92.9% (95%CI 88.4-95.6). In a multivariate model, TNBC (HR = 3.71; p= 0.029) and stage III at diagnosis (HR = 5.55; p= 0.008) were associated with worse OS. Conclusions: This cohort of YWBC experienced a low RFS at 2 years. As previously reported, patients with node involvement and TNBC faced a greater risk of early recurrence. Noteworthy, a high prevalence of distant metastases was observed, with half of them involving &gt; 1 site. Future studies are warranted to elucidate the factors associated with early recurrence in YWBC. In addition, the incorporation of new treatment strategies is urgently needed to improve disease outcomes in this group.

Prospective Study of Fertility Preservation in Young Women With Breast Cancer in Mexico.

Despite the risk of treatment-related infertility, implementation of fertility-preservation (FP) strategies among young patients with breast cancer is often suboptimal in resource-constrained settings such as Mexico. The "Joven & Fuerte: Program for Young Women With Breast Cancer" strives to enhance patient access to supportive care services, including FP measures through alliances with assisted-reproduction units and procurement of coverage of some of these strategies. This study describes patients from Joven & Fuerte who have preserved fertility, and assesses which characteristics were associated with the likelihood of undergoing FP. Women aged ≤40 years with recently diagnosed breast cancer were prospectively accrued. Sociodemographic and clinicopathologic data were collected from patient-reported and provider-recorded information at diagnosis and 1-year follow-up. Descriptive statistics, chi-square test, and simple logistic regression were used to compare patients who preserved fertility with those who did not. In total, 447 patients were included, among which 53 (12%) preserved fertility, representing 38% of the 140 women who desired future biologic children. Oocyte/embryo cryopreservation was the most frequently used method for FP (59%), followed by temporary ovarian suppression with gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy (26%), and use of both GnRHa and oocyte/embryo cryopreservation (15%). Younger age, higher educational level, being employed, having private healthcare insurance, and having one or no children were associated with a significantly higher likelihood of preserving fertility. By facilitating referral and seeking funds and special discounts for underserved patients, supportive care programs for young women with breast cancer can play a crucial role on enhancing access to oncofertility services that would otherwise be prohibitive because of their high costs, particularly in resource-constrained settings. For these efforts to be successful and widely applied in the long term, sustained and extended governmental coverage of FP options for this young group is warranted.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

The challenges of breast cancer care in Mexico during health-care reforms and COVID-19.

Association between quality of life and positive coping strategies in breast cancer patients

ABSTRACT According to the World Health Organization, breast cancer is one of the most prevalent cancers in the Hispanic female population, and it carries a great psychological impact. Acceptance and personal learning derived from the individual’s life experiences and understanding of their emotional state has been suggested as an adaptive profile toward the patient’s perception of the disease. This study aims to explore which psychological variables are related to breast cancer patients’ perception of their quality of life. A cross-sectional, correlational, and non-probabilistic study was performed on 113 women diagnosed with stage 1–3 breast cancer in Mexico and Spain, based on self-reporting through the Mental Adjustment to Cancer Scale, the Positive and Negative Affect Scale, and the EORTC Quality of Life Questionnaire. Recruitment was conducted from March 2015 to April 2018. Through multiple regression analysis, the study found that fighting spirit and positive affect explained 34.2% of quality of life variance F (2, 110) = 30.14, p <.005 of participants. The results support the need to contemplate the importance of positive psychological variables for a multidisciplinary approach to women diagnosed with breast cancer.

Short inter-pregnancy interval and pregnancy-associated breast cancer

The relationship between pregnancy and breast cancer risk is not fully understood. Most of the literature has described this interaction in terms of the age at first pregnancy and the number of full-term pregnancies. During the prospective accrual of the “Joven & Fuerte: Program for young women with breast cancer in Mexico” cohort, a series of cases with pregnancy-associated breast cancer and a history of a short inter-pregnancy interval was identified. To date, there is a very limited number of descriptions about the interaction between a short inter-pregnancy interval and breast cancer, but none specifically regarding the association of a short inter-pregnancy interval and pregnancy-associated breast cancer. Based on findings from a prospective cohort of young Mexican breast cancer patients, we hypothesize that a short inter-pregnancy interval may increase the incidence of pregnancy-associated breast cancer, possibly by amplifying the effects of the pregnancy-associated factors involved in the development of breast cancer.

Real-world clinical outcomes in patients receiving cyclin-dependent kinase 4/6 inhibitors (iCDK 4/6) for hormone receptor-positive, human epidermal growth factor receptor 2-negative (HR+/HER2-) metastatic breast cancer in Mexico.

e13053 Background: Breast cancer was the second most common malignant tumor diagnosed in 2018 worldwide, and the main cause of cancer death in women. In Mexico is the leading cause of cancer deaths, the most common molecular subtypes is HR+/HER2- (63%). The addition of iCDK 4/6 can enhance the benefit seen with endocrine therapy (ET) alone. In this work we will describe the experience in a “real world” model, of two tertiary-level hospitals in Mexico, with the use of iCDK 4/6 in a period of 3 years. Methods: Retrospective review of medical records of all consecutive pts with histological diagnosis of metastatic breast cancer HR+/HER2- and iCDK 4/6 treatment at our Institutions from July 2016 to January 2019. Clinical and pathological variables at diagnosis were recorded. Progression free survival was estimated using Kaplan-Meier method and survival distributions were compared using the Log-rank test. To assess association variables and progression we use Chi square. Results: 65 pts were treated, all with iCDK 4/6 in combination with ET, either aromatase inhibitor or irreversible estrogen receptor antagonist. 62 with palbociclib and 3 with ribociclib; Median age was 53 y/o (IQR 42-63), ECOG 0-1 (92.3%), 80% was metastatic recurrent disease, 92% of these patients received endocrine adjuvant treatment. Median estrogen receptor percentage was 90 (IQR 61-92), progesterone 50 (9-83), KI67 20 (10-30). The metastatic sites were bone (64.6%), liver (41.5%), nodal (33.8%), lung (21.5%), CNS (3.1%) and others (18.5%). 26 pts (40%) received iCDK 4/6 in the first line, 21 (32.3%) in the second line, and 27% in subsequent lines. Any grade of toxicity was presented in 44 pts (67.7%), Most common toxicities were neutropenia (63%), fatigue (16.9%), anemia (9.2%), grade 3-4 toxicities were presented in 21.5% and 17 pts (26.2%) required any dose adjustment. At the cut-off date, 28 pts (43.1%) had disease progression, median time to progression for the 65 pts was 10 months (1-84). OR for first line treatment vs subsequent lines was 0.14 (0.04-0.47, 95%, p = 0.001). OR for pulmonary metastases were 4.21 (1.15-15.31, 95%, p = 0.03), for other sites of metastasis were NS. Conclusions: Our outcomes suggest that the PFS is better when iCDK 4/6 are used as a first line treatment. Pulmonary metastases are may associated with poorly outcomes. In low- and middle-income countries, efforts should be focused on early therapy with iCDK 4/6.