Mexican Breast Cancer Patients Research Articles

Predictors of Endocrine Resistance in a Cohort of Mexican Breast Cancer Patients.

This study aimed to determine the prevalence of endocrine resistance in a cohort of Hispanic Mexican breast cancer (BC) patients receiving care at Instituto Nacional de Cancerología (INCan). Additionally, the clinical-pathological factors associated with endocrine resistance were identified, and their impact on patient survival was explored. A retrospective analysis of 200 BC patients who attended INCan between 2012 and 2016 with estrogen receptor (ER) and progesterone receptor (PR) positive tumors was made. Endocrine resistance was defined according to the International Consensus Guidelines for Advance Breast Cancer 2 definition. Their clinicopathological characteristics were analyzed to determine the association with endocrine resistance presence. We used sensitivity analyses and multivariate-adjusted logistic regressions, Kaplan-Meier curves, and multivariate-adjusted Cox regressions. P-value < 0.05 was considered as statistically significant. Endocrine resistance was observed in 32.5% of patients included in this study. The distinction between hormone resistance and sensitivity was influenced by tumor size and node status. It had a mean diameter of 7.15 cm in endocrine resistance cases compared to 5.71 cm in non-endocrine, with N3 status present in 20% of endocrine resistance cases versus only 2.2% in non-endocrine (p-value < 0.001). The clinical stage exhibited a strong association with endocrine resistance (Risk Ratio [RR] 4.39, 95% confidence interval [95%CI] 1.50, 11.43). Furthermore, endocrine resistance significantly impacted mortality during the follow-up, with a Hazard Ratio [HR] of 23.7 (95%CI 5.20, 108.42) in multivariable-adjusted models. However, a complete pathological response reduced the endocrine resistance risk, as demonstrated by a Risk Ratio (RR) of 0.15 (95% CI 0.03, 0.75). Advanced clinical stage at diagnosis predicted endocrine resistance in Hispanic Mexican BC patients. Complete pathologic response in locally advanced disease patients was also a key predictor of endocrine resistance. These results indicated that endocrine resistance was a critical factor in BC during follow-up.

The high methylation level of a novel 151-bp CpG island in the ESR1 gene promoter is associated with a poor breast cancer prognosis

BackgroundThe ESR1 gene suffers methylation changes in many types of cancers, including breast cancer (BC), the most frequently diagnosed cancer in women that is also present in men. Methylation at promoter A of ESR1 is the worse prognosis in terms of overall survival; thus, the early detection, prognostic, and prediction of therapy involve some methylation biomarkers.MethodsTherefore, our study aimed to examine the methylation levels at the ESR1 gene in samples from Mexican BC patients and its possible association with menopausal status.ResultsWe identified a novel 151-bp CpG island in the promoter A of the ESR1 gene. Interestingly, methylation levels at this CpG island in positive ERα tumors were approximately 50% less than negative ERα or control samples. Furthermore, methylation levels at ESR1 were associated with menopausal status. In postmenopausal patients, the methylation levels were 1.5-fold higher than in premenopausal patients. Finally, according to tumor malignancy, triple-negative cancer subtypes had higher ESR1 methylation levels than luminal/HER2+ or luminal A subtypes.ConclusionsOur findings suggest that methylation at this novel CpG island might be a promising prognosis marker

Clinical utility of ABCB1 and ABCG2 genotyping for assessing the clinical and pathological response to FAC therapy in Mexican breast cancer patients.

Resistance to neoadjuvant chemotherapy with 5-fluorouracil, doxorubicin, and cyclophosphamide (FAC) in some patients with locally advanced breast cancer remains one of the main obstacles to first-line treatment. We investigated clinical and pathological responses to FAC neoadjuvant chemotherapy in Mexican women with breast cancer and their possible association with SNPs present in ABC transporters as predictors of chemoresistance. A total of 102 patients undergoing FAC neoadjuvant chemotherapy were included in the study. SNP analysis was performed by RT-PCR from genomic DNA. Two SNPs were analyzed: ABCB1 rs1045642 (3435 C > T) and ABCG2 rs2231142 (421 G > T). In clinical response evaluation, significant associations were found between the ABCB1 C3435T genotype and breast cancer chemoresistant and chemosensitive patients (p < 0.05). In the early clinical response, patients with genotype C/C or C/T were more likely to be chemosensitive to neoadjuvant therapy than patients with genotype T/T (OR = 4.055; p = 0.0064). Association analysis between the ABCB1 gene polymorphism and the pathologic response to FAC chemotherapy showed that the C/C + C/T genotype was a protective factor against chemoresistance (OR = 3.714; p = 0.0104). Polymorphisms in ABCG2 indicated a lack of association with resistance to chemotherapy (p = 0.2586) evaluating the clinical or pathological response rate to FAC neoadjuvant chemotherapy. The early clinical response and its association with SNPs in the ABCB1 transporter are preserved until the pathological response to neoadjuvant chemotherapy; therefore, it could be used as a predictor of chemoresistance in locally advancedbreast cancerpatients of the Mexican population.

Abstract PS16-29: Clinicopathological features of PALB2 and BRCA2 mutation carriers with breast cancer

Abstract Background: The PALB2 gene is recognized as one of the most clinically relevant moderate to high penetrance breast cancer (BC) predisposition genes. Its product, PALB2, plays a crucial role in the homologous recombination pathway as a partner and localizer of BRCA2. Previous studies have reported significant frequencies of germline PALB2 and BRCA2 pathogenic variants (PVs) in Hispanic populations. However, no study has yet compared the baseline clinicopathological features of Mexican BC patients who carry PVs in these closely related genes. Methods: Medical records of BC patients from two centers located in Monterrey, Mexico who underwent a next-generation sequencing panel for BC predisposition genes (APC, ATM, BRCA1, BRCA2, BRIP1, CHEK2, CDH1, CDKN2A, MLH1, MSH2, MSH6, MUTYH, NF1, PALB2, PMS2, PTEN, RAD50, RAD51C, RAD51D, TP53) based on NCCN recommendations were reviewed. Patients with germline PVs in PALB2 or BRCA2 were considered eligible. Fisher’s exact and Mann Whitney U tests were employed to evaluate differences between groups based on mutation status. Results: Between 2014 and 2019, a total of 8 PALB2 (1.8%) and 24 BRCA2 (5.5%) pathogenic mutation carriers were identified from 437 BC cases. Baseline clinicopathological features are shown in Table 1. Overall, no statistically significant differences were observed between groups. The most common germline PVs were c.2167_2168delAT, p.Met723fs, frameshift mutation for PALB2 (57% of cases) and c.274C&amp;gt;T, p.Gln92Ter, nonsense mutation for BRCA2 (30% of cases). Of note, one male BC case occurred in a PALB2 mutation carrier, representing 13% (1/8) of BC cases in this carrier group and the only male BC case (out of three) associated with a germline PV. Conclusion: This is the first report detailing the clinicopathological features of Mexican BC patients with germline PALB2 PVs. According to our findings, BC tumors in PALB2 mutation carriers share similar baseline characteristics with those diagnosed in BRCA2 mutation carriers. Long-term follow-up is required in order to determine if prognosis is similar between groups and to further solidify the clinical relevance of germline PALB2 PVs in the Mexican population. Baseline clinicopathological features of PALB2 and BRCA2 mutation carriers with BCPALB2 mutation carriersBRCA2 mutation carriersMedian age at diagnosis (years)3938Median body mass index (kg/m2)2326Family history of BCYes5 (63%)19 (79%)No3 (38%)5 (21%)Clinical stageI2 (25%)2 (8%)II5 (63%)11 (46%)III08 (33%)IV1 (13%)3 (13%)Histological typeIDC6 (75%)22 (92%)Non-IDC2 (25%)2 (8%)Histological gradeG11 (13%)5 (21%)G24 (50%)10 (42%)G33 (38%)6 (25%)Missing03 (13%)Molecular subtypeHR+/HER2-6 (75%)11 (46%)HR+/HER2+04 (17%)HR-/HER2+00HR-/HER2-2 (25%)9 (38%)LateralityUnilateral8 (100%)21 (88%)Bilateral03 (13%) Citation Format: Alejandro Aranda-Gutierrez, Ana S Ferrigno, Juan Carlos A. García Marrufo, Mariana Moncada-Madrazo, Analy Gomez-Picos, Cynthia Villarreal-Garza, Dione Aguilar. Clinicopathological features of PALB2 and BRCA2 mutation carriers with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-29.

Abstract PO-214: Delay time in the diagnosis and treatment of breast cancer in the California-Mexican Border

Abstract Introduction The delay in the diagnosis and treatment of breast cancer has a direct correlation with more advanced stages of the disease and a lower survival rate. These delays represent an urgent situation in developing countries due to their high prevalence. Objective This study aims to determine the time intervals in the diagnosis and treatment of patients with breast cancer in the main public hospital in the city of Tijuana, to identify the mechanisms through which the different population aspects and Hospitals affect the treatment of patients. Methods A descriptive, observational, and retrospective study was conducted, including patients with breast cancer diagnoses treated at the General Hospital Tijuana in the period from January 2019 to December 2019. We used data from the medical record, including dates, demographics, histopathological, and clinical data from each visit. Descriptive statistics were calculated in SPSS V27. Results A total of 154 patients with breast cancer were treated at the TGH during 2019. Of these, 97 patients included in the study, with an average age of 52.34 ± 9.14 years. The patient delay time was higher than three months in 61% of cases. The diagnosis delay time was between 5 and 13 weeks. Conclusion Mexican breast cancer patients, as Latinas in California, are more likely to exhibit late-stage breast cancers at the time of diagnosis and have lower survival rates. Mexico counts an opportunistic or non-organized mammography screening program, leading to considerable delays in the diagnosis of breast cancer, even in border cities near to the US (where some people use multiple healthcare systems). With this context, it is necessary to recommend the creation of an organized screening program based on a more exceptional ability to cover the target population and, therefore, greater effectiveness at the community, as well as more equitable access. Citation Format: Antonio Galindo-Castañeda, Martín Gonzalez-Corral, Luis Garcia-Armas, Oscar Egurrola-Terán, Luis Martínez-Gómez, Jorge Albert Guadarrama-Orozco. Delay time in the diagnosis and treatment of breast cancer in the California-Mexican Border [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-214.

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.

Endocrine therapy adherence of premenopausal Mexican breast cancer patients.

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

Impact of invasive lobular carcinoma on long-term outcomes in Mexican breast cancer patients.

The aim of this study was to compare the difference in disease-free survival (DFS) and overall survival (OS) between invasive lobular carcinoma (ILC) and invasive ductal carcinoma (IDC) in our Hispanic population with breast cancer (BC). We retrospectively analyzed a database of 4533 non-metastatic BC patients treated for BC at the National Cancer Institute in Mexico (INCan) between 2006 and 2016. We compared clinical characteristics, treatment and survival between women with invasive ductal and invasive lobular BC. We evaluated differences between survival curves with the log-rank test and used Cox's proportional hazards model for the multivariate analysis. Median follow-up time was 42.13months (IQ25 25.2-IQ75 72.06). The median age was 50.9years (IQ25 43.5-IQ75 59.8). DFS at 5years was 80.8% for IDC versus 76.2% for ILC. 5years OS was 88.7% for IDC versus 84.3% for ILC. Multivariate analysis showed that factors that negatively affected the 5-year DFS include: clinical stage III [hazard ratio (HR) 4.2, 95% CI 3.36-5.35; p < 0.001], triple negative phenotype (HR 1.4, 95% CI 1.08-1.81; p = 0.009), Ki67 ≥ 18 (HR 1.6, 95% CI 1.28-2.11; p < 0.001), and lobular histological type (HR 1.6, 95% CI 1.09-2.49; p = 0.017). Factors associated with a negative impact on OS were: clinical stage III (HR 4.5, 95% CI 3.15-6.54; p < 0.001), triple negative phenotype (HR 2.4, 95% CI 1.69-3.48; p < 0.001), and Ki67 ≥ 18% (HR 1.9, 95% CI 1.27-2.92; p = 0.02). Our results highlight the different biology of ILC and show that long-term prognosis in terms of DFS is not as favorable as previously reported.

Abstract P2-07-13: OncoproMex®: An intelligent decision support system for Mexican breast cancer patients

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

Supportive Care Needs Among Mexican Breast Cancer Patients: From Diagnosis to Post-Treatment Follow-Up Visit

Background: In Latin America, where 7.8% of worldwide new cancer cases occur, the implementation of supportive care services for cancer patients within public hospitals is not common practice and it is often a low priority. Identifying the priority care needs of these cancer patients is relevant to improve care provision, especially in Mexico, where breast cancer is highly prevalent and it is among the three leading causes of death in Mexican women. Objective: To investigate the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories. Methods: In this observational longitudinal study data from 172 patients were considered. Participants were assessed after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment and the first posttreatment follow-up visit. The Supportive Care Needs Survey (SCNS-SF34) was used to assess psychological, health system and information, physical and daily living, patient care and support, sexual, and additional care needs dimensions. Linear mixed models with maximum-likelihood estimation were computed. Results: The supportive care needs course was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first posttreatment follow-up visit. The highest care needs over time were those from the health system and information dimension. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in development of supportive care needs of these patients. Conclusion: Health system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.

Course and predictors of supportive care needs among Mexican breast cancer patients: A longitudinal study.

ObjectiveThis study examined the course and predictors of supportive care needs among Mexican breast cancer patients for different cancer treatment trajectories.MethodsData from 172 (66.4% response rate) patients were considered in this observational longitudinal study. Participants were measured after diagnosis, neoadjuvant treatment, surgery, adjuvant treatment, and the first post‐treatment follow‐up visit. Psychological, Health System and Information, Physical and Daily Living, Patient Care and Support, Sexual, and Additional care needs were measured with the Supportive Care Needs Survey (SCNS‐SF34). Linear mixed models with maximum‐likelihood estimation were computed.ResultsThe course of supportive care needs was similar across the different cancer treatment trajectories. Supportive care needs declined significantly from diagnosis to the first post‐treatment follow‐up visit. Health System and Information care needs were the highest needs over time. Depressive symptoms and time since diagnosis were the most consistent predictors of changes in course of supportive care needs of these patients.ConclusionsHealth system and information care needs of Mexican breast cancer patients need to be addressed with priority because these needs are the least met. Furthermore, patients with high depressive symptoms at the start of the disease trajectory have greater needs for supportive care throughout the disease trajectory.

Generation and partial characterization of cancer cell lines from Mexican breast cancer patients

Numerous cell models have been approached to study cancer biology. Some of those models are primary cell cultures, as well as, cancer cell lines derived from tumors. Several breast cancer cell lines are available for scientific research. Nevertheless, those cell lines do not represent all the cancer types and subtypes, neither their origin corresponds to most of the ethnic groups of the world. The main goal of this study is to generate and partially characterize cancer cell lines from tumor tissue obtained from Mexican patients with breast cancer, which can be used as models to study cancer biology and to characterize the phenotype and genotype of breast cancer affecting Mexican population. At present, four primary cell cultures (ID010, ID012, ID013 and ID014) have been established from primary tumor tissues representative of infiltrating ductal carcinomas, such as luminal B and HER‐enriched molecular subtypes. In addition, all the primary cell cultures showed the expression of cytokeratins, which suggests the presence of epithelial cells. The development and partial characterization of new breast cancer cell lines with different molecular subtypes, will allow us a better comprehension about the variations in morbidity, mortality and susceptibility to anti‐cancer drugs among different ethnicities.This abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Abstract P6-12-20: Impact of symptom burden on employment and quality of life in long-term Mexican breast cancer survivors treated in a tertiary referral center

Abstract Background: The number of cancer survivors has increased worldwide during the last decade as a result of improvements in the Clinical Oncology Practice. Last year, more than 15.5 million cancer survivors were alive in the United States;3.5 million were breast cancer survivors (BCS). According to GLOBOCAN 2012, breast cancer incidence in Mexico was 24.8 per 100.000. Studies in Mexican breast cancer patients have reported a five-year overall survival of 80%, expecting 16.000 BCS and 66% of unemployment rates, however, associated factors remain unknown. The aim of this study was to associate symptom burden with employment and quality of life (QOL) in long-term breast cancer survivors (LTBCS) Patients and methods: A cross-sectional cohort study was performed including 54 patients with history of non-metastatic invasive breast cancer. Inclusion criteria were: ≤ 65 years and ≥ 2 years from diagnosis and off treatment and exclusion criteria was illiteracy. A written questionnaire (Quality of Life-Cancer Survivors, QOL-CS) developed by City of Hope National Medical Center (Spanish version) was used to measure QOL, including 41 items representing four domains: psychological well-being (18 items), physical well-being (8 items), social well-being (8 items), and spiritual well-being (7 items). Items were rated on a scale of 0 (worst outcome) to 10 (best outcome). Information was analyzed using SPSS v.21. A logistic regression was done to predict the impact of the independent variables. Results: Median age at diagnosis and at the time of the questionnaire application was 50 and 56 years, respectively. The median survival time from diagnosis was 5 years (percentile 25-75 = 3-8.2 years). Stages were: cTNM stage I 18 (33%), stage II 28 (52%), and stage III 8 (15%). Patients received the following treatment: 26 (48%) underwent conservative surgery, 28 (52%) mastectomy; 40 (74%) chemotherapy, 34 (63%) radiotherapy, and 41 (76%) hormonal therapy. Educational attainment was less than college completion in 38 (70%) patients; disease-related work loss in 15 (27.8%), 26 (48.1%) were unemployed, and 18 (33.3%) worked half time. In employed patients the average monthly self-reported income was US $ 300 dollars. A univariate comparison between QOL-CS scores from the National Coalition from Cancer Survivorship (NCCS) and our study found significant differences. Cancer treatment distress (OR 30.5 CI 95% 2.1-437.6 p=0.01) and family distress (OR 16.4 CI 95% 1.0-260.6 p=0.04) were associated with a worst score in the QOL-CS tool. Symptoms such as menstrual change/fertility (OR 1.36 CI 95% 1.04-1.77 p=0.02), physical appearance (OR 1.36 CI 95% 1.01-1.82 p=0.03), and self-concept (OR 1.36 CI 95% 1.00-1.84 p=0.04), were associated with disease-related work loss. Conclusion:This is one of the first studies that associates symptom burden with employment and QOL in LTBCS in Mexico. Although its limitations (small sample size), the present study highlights the need to carry out specific research to investigate the local needs in order to design public policies to subsequently improve the impact on QOL and employment in these patients in Latin America. Citation Format: Remolina-Bonilla YA, León-Rodríguez E, Armengol-Alonso A. Impact of symptom burden on employment and quality of life in long-term Mexican breast cancer survivors treated in a tertiary referral center [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-20.

Abstract P4-10-22: Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City

Abstract Background: In 2012, GLOBOCAN reported that the incidence of BC among Mexican women was 35.4 per 100.000 habitants According to some published studies, the five-year overall survival among Mexican breast cancer patients (BCP) treated at governmental facilities is about 75-80%. As a result of an increased access to oncology treatments, multidisciplinary breast cancer units (MBCU) have been developed all over the country aiming to improve outcomes in BCP, however, to date, information regarding quality of care measured by international criteria is lacking. In 2011 our institution was a pioneer in establishing MBCU The aim of the present study was to describe quality indicators in breast cancer care at our MBCU Patients and methods: This is a propective study including 357 breast cancer patients Jan 2011 to Dec 2016. 111 variables were recorded for each patient. Based on the 17 items to evaluate quality in BCP of 2008 European Society of Breast Cancer Specialist (EUSOMA), the EUSOMA-based evaluated criteria was: 1) Completeness of clinical and imaging diagnostic work-up, 2) Multidisciplinary discussion, 3) Waiting times, 4) Appropriate surgical approach (breast conservative surgery in IBC ≤ 3 cm), and 5)Post-operative radiotherapy. The analysis was performed using SPSS software v.21. Results: Three hundred and fifty-five patients were included (99.4% women). The median age was 57 years (P25-75 49-66 years). Stages were classified as: cTNM stage I (32.2%), stage II (34.7%), stage III (10.6%), and stage IV (18.2%). The results of the EUSOMA-based criteria were: 1) 95% of the cohort completed clinical and imaging diagnostic work-up (EUSOMA minimum standard 90%, target 95%, LoE III); 2) a multidisciplinary discussion at the time of diagnosis was established in 97% of BCP (EUSOMA minimum standard 90%, target 99%, LoE IV); 3) the median waiting time from histological diagnosis to primary treatment was 3.8 weeks (median time for surgery and systemic treatment was 4.5 and 1.4 weeks, respectively) (EUSOMA cut point 6 weeks, minimum standard 75%, target 90%, LoE IV); 4) surgical treatment was performed as first-line therapy in 196 BCP (127 (64.6%) conservative surgery and 69 (35.4%) mastectomy) (EUSOMA conservative surgery minimum standard 70%, target 80%, LoE I) 5) 95% of BCP with an indication for adjuvant radiotherapy had a median waiting time of 1.5 weeks (EUSOMA minimum standard 90%, target 95%, LoE I) Conclusion: According to these results, our MBCU meets the minimum standards of quality in 5 EUSOMA indicators. However, it is important to highlight that our MBCU is small,analyzing 100 new patients/year but comprising with enough infrastructure and staff for this demand; for this reason, real data representing other Mexican or Latin American MBCUs might not be accurate. Furthermore, to increase the quality of breast cancer care, all EUSOMA objectives should be measured (always adapting to the evaluated a breast cancer population) and only in this way areas of opportunity for improvement could be identified. The present study highlights the need to carry out specific research in breast cancer care qualitiy in low and middle income countries. Citation Format: Amengol-Alonso A, Chávarri-Guerra Y, Córtes-González R, Medina-Franco H, Espinoza de los Monteros A, Gamboa-Domínguez A, Candanedo-González F, Flores-Balcazar C, Ramos R, Fuentes-Corona R, Chapa-Ibarguengoitia M, Balboa-González P, Bazúa-Gerez A, León-Rodríguez E. Quality indicators in breast cancer care: Experience of a breast cancer multidisciplinary unit at Instituto Nacional de Ciencias Médicas y Nutrición. Dr Salvador Zubirán, (INCMNSZ) Mexico City [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-22.

Prevalence and factors associated with supportive care needs among newly diagnosed Mexican breast cancer patients

PurposeMexican breast cancer patients are generally diagnosed in advanced stages of the disease and often experience delays in cancer treatment delivery. Currently, little is known about these patients’ psychological care needs. This study assessed levels and correlates of supportive care needs of Mexican breast cancer patients around the time of cancer diagnosis.MethodsOne hundred seventy-three newly diagnosed Mexican breast cancer patients participated in the study. Supportive care needs, anxiety, depression, and patients’ sociodemographic and clinical characteristics were assessed. Multiple regression analyses were used to examine factors associated with care needs.ResultsUp to 44% of patients showed unmet care needs. Health system/information needs were the most prevalent (68%), while physical/daily living needs the least (19%). Level of depressive symptoms was most consistently related to care needs. Patients with higher levels of depressive symptoms had higher psychological (β = 0.38), physical/daily living (β = 0.43), patient care/support (β = 0.17), and additional unmet care needs (β = 0.30), than patients with lower levels of depressive symptoms.ConclusionsThis study suggests that mainly health system/information needs arise at the time of cancer diagnosis among Mexican breast cancer patients. Patients suffering high levels of depressive symptoms reported the highest levels of unmet needs. Future studies should be conducted to elucidate the care needs throughout the disease trajectory, as such information can inform health care professionals and policy makers and lead to improvements in the organization and provision of health care services for Mexican breast cancer patients.

Abstract P2-02-04: Li-Fraumeni syndrome in females with early onset breast cancer in a Mexican population

Abstract Background: Breast cancer in Mexican patients presents in average 10 year earlier compared to other populations. Among patients with TP53 mutations, breast cancer is the most common malignancy. In this study we aim to determine the rate of TP53 mutations among young Mexican breast cancer patients. Methods: Breast cancer patients younger that 45 were retrospectively identified, only patients without BRCA1/2 mutations were included. Clinical records and pedigrees were reviewed. Next generation sequencing test for TP53 was performed from blood specimens. All pathogenic mutations were confirmed by Sanger sequencing and verified if were included in the IACR TP53 database. Results: Among the 78 patients younger than 45yo evaluated and tested with next generation sequencing, we identified 5 patients with a TP53 mutation (6.4%). All were younger than 36 corresponding to a rate of 9.4% of mutations in this group of individuals (n = 53). Two, not previously described, frameshift mutations were found (c.291delC and c.273dupG) and three missense mutations (c.844C&amp;gt;T, c.517G&amp;gt;A, c.604C&amp;gt;T). A VUS c.672G&amp;gt;A that causes a silent mutation in a splicing-donor site was identified. All patients with a TP53 mutation had locally advanced disease and tumors were high grade and Her2 positive. Conclusions: Among Mexican women younger than 45yo, the rate of TP53 mutations was higher than in other populations where it's estimated to be 1%. Among patients younger than 36 the proportion was even higher. All patients had a family history suggestive of Li-Fraumeni syndrome. The VUS found in our series needs a deeper analysis (family segregation, structure and function of the resulting protein). Our results support the international recommendation of performing molecular testing for TP53 in breast cancer patients younger than 35 years. Identification of patients with TP53 mutation has important prognostic, therapeutic and quality of life implications for the proband in addition of the risk reduction strategies and intensive surveillance recommended in their families. Citation Format: Gallardo-Alvarado LN, Cantu-De Leon DF, Tusie-Luna T, Tusie-Luna I, Diaz-Chavez J, Herrera EM, Chavez-MacGregor M, Bargallo-Rocha E, Villarreal C, Herrera.Montalvo LA, Segura-Kato YX. Li-Fraumeni syndrome in females with early onset breast cancer in a Mexican population [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-02-04.

A 22q11.2 amplification in the region encoding microRNA-650 correlates with the epithelial to mesenchymal transition in breast cancer primary cultures of Mexican patients.

Breast cancer ranks first in incidence and mortality in working age women. Cancer initiation and progression relies on accumulation of genetic and epigenetic aberrations that alter cellular processes, among them, epithelial to mesenchymal transition (EMT) denotes particularly aggressive neoplasias given its capacity to invade and metastasize. Several microRNAs (miRNA) have been found able to regulate gene expression at the core of EMT. In this study, the Affymetrix CytoScan HD array was used to analyze three different primary tumor cell isolates from Mexican breast cancer patients. We found an amplification in band 22q11.2 shared by the three samples, in the region that encodes miRNA-650. Overexpression of this miRNA has been associated with downregulation of tumor suppressors ING4 and NDRG2, which have been implicated in cancer progression. Using the Pathway Linker platform the ING4 and NDRG2 interaction networks showed a significant association with signaling pathways commonly deregulated in cancer. Also, several studies support their participation in the EMT. Supporting the latter, we found that the three primary isolates were E-cadherin negative, vimentin positive, presented a cancer stem cell-like phenotype CD44+CD24−/low and were invasive in Transwell invasion assays. This evidence suggests that the gain of region 22q11.2 contributes to trigger EMT. This is the first evidence linking miR-650 and breast cancer.

Antineoplastic treatment effect on bone mineral density in Mexican breast cancer patients.

BackgroundBreast cancer is the most deadly malignancy in Mexican women. Although treatment has improved, it may significantly affect bone mineral status in those who receive it. The aim of this study was to assess the impact of cancer treatment on bone mineral density (BMD) and bone mineral content (BMC), in patients with breast cancer and explore the interaction of menopausal status and clinical stage with cancer treatment on such changes.MethodsA quasi-experimental design was applied with measurements before and after a chemotherapy treatment in 40 patients with primary diagnosis of invasive breast cancer. BMD and body composition measurements were taken by dual X-ray absorptiometry (DXA) and changes in these variables due to therapy were analyzed using mixed regression for repeated measurements.ResultsSignificant loss was found in femoral neck and L2-L4 BMD (p < 0.001). Patients diagnosed with osteopenia or osteoporosis received calcium + vitamin D supplementation (600 mg/200 IU day). It showed a protective effect in the decrease of femoral neck BMD and total BMC. BMD loss in both femoral neck and L2-L4 BMD was higher in premenopausal women: 0.023 g/cm2 in femoral neck and 0.063 g/cm2 in L2-L4 (p < 0.001), while in postmenopausal women BMD loss was 0.015 g/cm2 in femoral neck and 0.035 g/cm2 in L2-L4 (p = 0.021 and p = 0.001 respectively). Change in lumbar spine BMD was prominent in premenopausal women with advanced clinical stage (IIB, IIIA, IIIB): 0.066 g/cm2 (p = 0.003).ConclusionThe antineoplastic breast cancer treatment with chemotherapy had a negative impact on BMD, in premenopausal women overall, although a differential effect was found according to clinical stage and calcium supplementation status.

Fertility issues among Mexican young breast cancer patients and impact of a dedicated program for preservation decisions.

e21678Background: In Latin America there are no previous studies addressing the attitudes of young women with breast cancer (YWBC) regarding infertility risk and associated factors. Also, it is unk...

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program

Abstract IA23: Steps to address the profound disparity in access to genetic cancer risk assessment in Mexico: Documenting hereditary breast and ovarian cancer and the beginning of a prevention program