Preocupações sobre a recorrência do câncer em mulheres mexicanas sobreviventes do câncer de mama. Propriedades psicométricas da escala CARS

Fear of recurrence is one of the main affectations of cancer survivors. In Latin-American exist a lack of evidence on the subject and of valid instruments to measure it. The objective of this study was to determine the psychometric properties of the Concerns About Recurrence Scale in Mexican breast cancer survivors. An instrumental study was carried out with 200 women breast cancer survivors with a mean age of 53 years old and a mean survival of 52.5 months. A confirmatory factor analysis of the original version of the scale identified four factors that explained 77 % of the variance and satisfactory goodness of fit indicators: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071 as well as high internal consistency α = .945. Significant associations were also identified between general fear subscale, anxiety subscale of the HADS and total HADS score (r = .638 and r = .607; p = .01). The CARS presented adequate validity, reliability and factorial structure. It is recommended for usage in clinical care and research with Mexican breast cancer survivors.El miedo a la recurrencia es una de las principales afectaciones de los supervivientes de cáncer. En América Latina existe una falta de evidencia en el tema y de instrumentos válidos para medirlo. El objetivo del presente estudio fue determinar las propiedades psicométricas de la Escala de Preocupaciones Acerca del Cáncer (CARS, por su sigla en inglés) en supervivientes de cáncer de mama mexicanas. Se llevó a cabo un estudio instrumental con 200 mujeres supervivientes de cáncer mamario con una edad promedio de 53 años y una sobrevida promedio de 52.5 meses. Un análisis factorial confirmatorio de la versión original del instrumento identificó cuatro factores que explicaron el 77 % de la varianza de la escala e indicadores de bondad de ajuste satisfactorios: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071, así como una elevada consistencia interna α = .945. Asimismo, se identificaron asociaciones significativas entre las subescalas de miedo general, ansiedad de la HADS y puntaje total de la HADS (r = .638 y r = .607; p = .01). La escala CARS presentó adecuada validez, confiabilidad y estructura factorial. Es recomendable su uso en escenarios clínicos y de investigación con supervivientes de cáncer de mama mexicanas.O medo da recorrência é uma das principais sequelas dos sobreviventes do câncer. Na América Latina há uma falta de evidências sobre o assunto e uma falta de instrumentos válidos para medi-lo. O objetivo do presente estudo foi determinar as propriedades psicométricas da Escala Preocupações sobre o Câncer (CARS) em sobreviventes do câncer de mama mexicanas. Foi realizado um estudo instrumental com 200 mulheres sobreviventes de câncer de mama com uma média de idade de 53 anos e uma sobrevivência média de 52,5 meses. Uma análise fatorial confirmatória da versão original do instrumento identificou quatro fatores que explicaram 77 % da variação da escala e indicadores satisfatórios de bondade de ajuste: CFI = 0,967, TLI = 0,957, SRMR = 0,035, RMSEA = 0,071, assim como alta consistência interna α = 0,945. Associações significativas também foram identificadas entre as subescalas de medo geral, ansiedade HADS e pontuação total HADS (r = 0,638 e r = 0,607; p = 0,01). A escala CARS mostrou adequada validade, confiabilidade e estrutura de fatores. É recomendado seu uso em ambientes clínicos e de pesquisa com sobreviventes do câncer de mama mexicanas

Concurrent chemo-radiotherapy following neoadjuvant chemotherapy in locally advanced breast cancer

<p>Abstract</p> <p>Background</p> <p>Despite broad advances in multimodal treatment of locally advanced breast cancer (LABC), 30 to 40% of patients develop loco-regional relapse. The aim of this study was to analyze in a retrospective manner the effectiveness of concurrent chemo-radiotherapy (CCRTh) after neoadjuvant chemotherapy (NCT) in patients with LABC.</p> <p>Methods</p> <p>One hundred twelve patients with LABC (stage IIB-IIIB) were treated with NCT (5-fluorouracil 500 mg/m², doxorubicin 50 mg/m², and cyclophosphamide 500 mg/m²(FAC), or doxorubicin 50 mg/m²and cyclophosphamide 500 mg/m²(AC) IV in four 21-day courses) followed by CCRTh (60 Gy breast irradiation and weekly mitomycin 5 mg/m², 5-fluorouracil 500 mg/m², and dexamethasone 16 mg, or cisplatin 30 mg/m², gemcitabine 100 mg/m²and dexamethasone 16 mg), and 6–8 weeks later, surgery and two additional courses of FAC, AC, or paclitaxel 90 mg/m²weekly for 12 weeks, and in case of estrogen-receptor positive patients, hormonal therapy.</p> <p>Results</p> <p>Stages IIB, IIIA and -B were 21.4, 42.9, and 35.7%, respectively. Pathological complete response (pCR) in the breast was 42% (95% CI, 33.2–50.5%) and, 29.5% (95% CI, 21.4–37.5%) if including both the breast and the axillary nodes. Multivariate analysis showed that the main determinant of pCR was negative estrogen-receptor status (HR = 3.8; 95% CI, 1.5–9; <it>p </it>= 0.016). The 5-year disease-free survival (DFS) was 76.9% (95% CI, 68.2–84.7%). No relationship between pCR and DFS was found. Multivariate analysis demonstrated that the main DFS determinant was clinical stage (IIB and IIIA <it>vs. </it>IIIB, HR = 3.1; 95% CI, 1.02–9.74; <it>p </it>= 0.04). Only one patient had local recurrence. Five-year overall survival was 84.2% (95% CI, 75–93.2%). The toxicity profile was acceptable.</p> <p>Conclusion</p> <p>This non-conventional multimodal treatment has good loco-regional control for LABC. Randomized clinical trials of preoperative CCRTh following chemotherapy, in patients with LABC are warranted.</p

The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2−) breast cancer::When might multigene assays be of value?

A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions

Full-Exon Pyrosequencing Screening of BRCA Germline Mutations in Mexican Women with Inherited Breast and Ovarian Cancer

Hereditary breast cancer comprises 10% of all breast cancers. The most prevalent genes causing this pathology are BRCA1 and BRCA2 (breast cancer early onset 1 and 2), which also predispose to other cancers. Despite the outstanding relevance of genetic screening of BRCA deleterious variants in patients with a history of familial cancer, this practice is not common in Latin American public institutions. In this work we assessed mutations in the entire exonic and splice-site regions of BRCA in 39 patients with breast and ovarian cancer and with familial history of breast cancer or with clinical features suggestive for BRCA mutations by massive parallel pyrosequencing. First we evaluated the method with controls and found 41–485 reads per sequence in BRCA pathogenic mutations. Negative controls did not show deleterious variants, confirming the suitability of the approach. In patients diagnosed with cancer we found 4 novel deleterious mutations (c.2805_2808delAGAT and c.3124_3133delAGCAATATTA in BRCA1; c.2639_2640delTG and c.5114_5117delTAAA in BRCA2). The prevalence of BRCA mutations in these patients was 10.2%. Moreover, we discovered 16 variants with unknown clinical significance (11 in exons and 5 in introns); 4 were predicted as possibly pathogenic by in silico analyses, and 3 have not been described previously. This study illustrates how massive pyrosequencing technology can be applied to screen for BRCA mutations in the whole exonic and splice regions in patients with suspected BRCA-related cancers. This is the first effort to analyse the mutational status of BRCA genes on a Mexican-mestizo population by means of pyrosequencing

Concerns about cancer recurrence in Mexican women breast cancer survivors. Psychometric properties of the CARS scale

Fear of recurrence is one of the main affectations of cancer survivors. In Latin-American exist a lack of evidence on the subject and of valid instruments to measure it. The objective of this study was to determine the psychometric properties of the Concerns About Recurrence Scale in Mexican breast cancer survivors. An instrumental study was carried out with 200 women breast cancer survivors with a mean age of 53 years old and a mean survival of 52.5 months. A confirmatory factor analysis of the original version of the scale identified four factors that explained 77 % of the variance and satisfactory goodness of fit indicators: CFI = .967, TLI = .957, SRMR = .035, RMSEA = .071 as well as high internal consistency α = .945. Significant associations were also identified between general fear subscale, anxiety subscale of the HADS and total HADS score (r = .638 and r = .607; p = .01). The CARS presented adequate validity, reliability and factorial structure. It is recommended for usage in clinical care and research with Mexican breast cancer survivors

The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2-) breast cancer: When might multigene assays be of value?

A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions.status: publishe