Understanding Prognostic Factors for Human Papillomavirus Vaccination: A Rural Community Case–Control Study

HPV vaccination coverage rates can vary depending on several factors. The main objective of this study is to identify possible independent prognostic factors that have an impact on HPV vaccination in a rural community, specifically related to sexual and reproductive health. A case-control, retrospective, community-based study was carried out on women aged 15 to 40 in the primary health centers of Southern Catalonia's Terres de l'Ebre region, Spain, from 1 January 2020 to 31 December 2022. A random sample of 520 women with an average age of 29.3 (SD 7.8) years old was included in the study. Independent prognostic factors: age OR 0.680 (95% CI: 0.635-0.729, p < 0.001), immigrant origin OR 0.215 (95% CI: 0.109-0.422, p < 0.001), and HPV PCR OR 7.402 (95% CI: 2.504-21.880, p < 0.001). The variables that showed a barrier effect for HPV vaccination were age (OR 0.680, 95% CI 0.635-0.729, p < 0.001), and immigrant origin (OR 0.215, 95% CI 0.109-0.422, p < 0.001). The variable that showed a facilitating effect for HPV vaccination was HPV PCR (OR 7.402, 95% CI 2.504-21.880, p < 0.001)

Five-year results of accelerated partial breast irradiation: a single institution retrospective review of 289 cases

Purpose: the purpose of the study was to describe our institutional experience with accelerated partial breast irradiation (APBI) using multicatheter brachytherapy with high-dose-rate. We report 5-year survival outcomes, cosmesis, and treatment-related toxicity. Methods and materials: this included a retrospective review of patients who underwent breast-conserving surgery followed by APBI at our institution from 2004 to 2017. Results: a total of 289 patients were evaluated. Median followup was 72 months. Median age was 70 years. APBI was the only primary treatment in 86.2% of cases with early-stage breast cancer and a second conservative treatment in 13.8%. The implant was performed postoperatively in 213 patients (73.7%) and intraoperatively in 76 (26.3%). The most common radiation schemes were 10 fractions of 3.4 Gy and eight fractions of 4 Gy. Elderly or frail patients (10%) received a single 16 Gy dose. Of the 289 patients, 215 met Groupe Europ een de Curieth erapie-European Society for Radiotherapy and Oncology criteria for APBI; in this group, late side effects included Grade 2 (G2) fibrosis (14.8%), skin discoloration at the catheter points (8.8%), and telangiectasia (0.5%). The cosmetic result was considered excellent or good in 88.3% of cases. Five-year local control, disease-free, cancer-specific, and overall survival rates were 98.9%, 96.7%, 99.1%, and 95.6%, respectively. Conclusions: local control and survival outcomes at 5 years of followup in this group of well-selected patients were excellent, with low rates of treatment-related toxicity. These findings confirm the safety and effectiveness of APBI, even in elderly and frail patients. These results provide further support for the clinical use of APBI in suitable patients. 2021 Published by Elsevier Inc. on behalf of American Brachytherapy Society

Changes in peripheral immune cells after intraoperative radiation therapy in low-risk breast cancer

A detailed understanding of the interactions and the best dose-fractionation scheme of radiation to maximize antitumor immunity have not been fully established. In this study, the effect on the host immune system of a single dose of 20 Gy through intraoperative radiation therapy (IORT) on the surgical bed in low-risk breast cancer patients undergoing conserving breast cancer has been assessed. Peripheral blood samples from 13 patients were collected preoperatively and at 48 h and 3 and 10 weeks after the administration of radiation. We performed a flow cytometry analysis for lymphocyte subpopulations, natural killer cells (NK), regulatory T cells (Treg) and myeloid-derived suppressor cells (MDSCs). We observed that the subpopulation of NK CD56+high CD16+ increased significantly at 3 weeks after IORT (0.30-0.42%, P < 0.001), while no changes were found in immunosuppressive profile, CD4+CD25+Foxp3+Helios+ Treg cells, granulocytic MDSCs (G-MDSCs) and monocytic MDSCs (Mo-MDSCs). A single dose of IORT may be an effective approach to improve antitumor immunity based on the increase in NK cells and the non-stimulation of immunosuppressive cells involved in immune escape. These findings support future combinations of IORT with immunotherapy, if they are confirmed in a large cohort of breast cancer patients

Lymphangioleiomyomatosis biomarkers linked to lung metastatic potential and cell stemness

Lymphangioleiomyomatosis (LAM) is a rare lung-metastasizing neoplasm caused by the proliferation of smooth muscle-like cells that commonly carry loss-of-function mutations in either the tuberous sclerosis complex 1 or 2 (TSC1 or TSC2) genes. While allosteric inhibition of the mechanistic target of rapamycin (mTOR) has shown substantial clinical benefit, complementary therapies are required to improve response and/or to treat specific patients. However, there is a lack of LAM biomarkers that could potentially be used to monitor the disease and to develop other targeted therapies. We hypothesized that the mediators of cancer metastasis to lung, particularly in breast cancer, also play a relevant role in LAM. Analyses across independent breast cancer datasets revealed associations between low TSC1/2 expression, altered mTOR complex 1 (mTORC1) pathway signaling, and metastasis to lung. Subsequently, immunohistochemical analyses of 23 LAM lesions revealed positivity in all cases for the lung metastasis mediators fascin 1 (FSCN1) and inhibitor of DNA binding 1 (ID1). Moreover, assessment of breast cancer stem or luminal progenitor cell biomarkers showed positivity in most LAM tissue for the aldehyde dehydrogenase 1 (ALDH1), integrin-ß3 (ITGB3/CD61), and/or the sex-determining region Y-box 9 (SOX9) proteins. The immunohistochemical analyses also provided evidence of heterogeneity between and within LAM cases. The analysis of Tsc2-deficient cells revealed relative over-expression of FSCN1 and ID1; however, Tsc2-deficient cells did not show higher sensitivity to ID1-based cancer inhibitors. Collectively, the results of this study reveal novel LAM biomarkers linked to breast cancer metastasis to lung and to cell stemness, which in turn might guide the assessment of additional or complementary therapeutic opportunities for LAM

Patrones de respuesta a quimioterapia neoadyuvante en cáncer de mama y conservación mamaria

Introducción: La quimioterapia neoadyuvante (QMTN), estándar en el cáncer de mama localmente avanzado, ha extendido su uso al cáncer de mama en estadio inicial. Existen diversos patrones histológicos de respuesta a QMTN: respuesta concéntrica (foco central tumoral, envuelto por fibrosis), repuesta parcheada o en nidos celulares (fibrosis alternando con nidos celulares dispersos) y respuesta Mixta. Objetivos: Determinar que variables clínicas e histológicas determinan el patrón de respuesta a QMTN que favorece y permite la conservación mamaria. Análisis de los patrones de respuesta. Parámetros de predicción del tipo de respuesta, porcentaje de cirugía conservadora, cambios en la técnica quirúrgica y comparación de los volúmenes tumorales y quirúrgicos. Curvas de supervivencia Metodología: 177 cánceres de mama que corresponden a 173 pacientes (4 de casos de cáncer bilateral), tratados con QMTN y cirugía posterior entre 1 febrero de 2010 y Octubre de 2013. Estudio retrospectivo de variables clínicas, revisión de los patrones de respuesta y seguimiento oncológico. Resultados: La tasa de conservación mamaria fue del 67.3 %. La respuesta patológica completa (pCR) fue del 25.5%. Los factores predictores de respuesta completa patológica completa, son: ausencia de multicentricidad, receptor de estrógeno (RE) negativo, el receptor de progesterona (RP) negativo, el Grado histológico 3, Ki 67 > 20 % y sobrexpresión de Her 2. En el estudio multivariado, RE negativo y Her 2. El tipo molecular subrogado que predice respuesta completa es Her 2 positivo. Cuando no existe pCR, el patrón de respuesta más frecuente es en nidos celulares o parcheada (42%), concéntrica (21.9%) y mixta el 8.9%. Los factores predictores de la respuesta concéntrica son, tamaño tumoral de 20% y necrosis tumoral. El tipo molecular subrogado que predice respuesta concéntrica es el triple negativo. En la respuesta concéntrica el porcentaje de cirugía conservadora es superior (78.4% versus 58.1%), es más frecuente la necesidad de marcaje prequirúrgico, la ampliación de márgenes intraoperatoria y el número de márgenes ampliados. A pesar del claro efecto del “downstaging” de la quimioterapia neoadyuvante, no existe una correlación entre el tamaño tumoral oncológico teórico postquimioterapia y el volumen oncológico quirúrgico, siendo el volumen oncológico quirúrgico superior al teórico. Esta correlación es independiente del patrón de respuesta. Con un seguimiento de 33 meses de mediana, solo en el grupo de las respuesta completas existen diferencias en supervivencia global. Conclusiones: Existen variables clínicas que predicen el patrón de respuesta a QMTN. Existe un claro efecto de “downstaging” de los volúmenes tumorales que condicionan cambios en la técnica quirúrgica, pero no modifican los volúmenes quirúrgicos que son independientes del tipo de respuesta. El único patrón que impacta en la supervivencia global es la respuesta complete.Introduction: Neoadjuvant chemotherapy (NAC), standard treatment for locally advanced breast cancer, is nowadays very common in early breast cancer. Exists different histological response patterns to NAC: concentric response (central tumoral focus, surrounded by fibrosis), patched pattern response or in cell nests (fibrosis and scattered cell nests), mixed response. Objectives: To study which clinical and histological variables determine the response pattern to NAC that allows breast conservation. To analyse: the response patterns, response predictive parameters, percentage of conservative surgery, changes of surgical techniques and comparison between theoretical oncologic post chemotherapy volumes and surgical ones. Analysis of survival curves. Methods: 177 breast cancers that correspond to 173 patients (4 cases with bilateral breast cancer), treated with NAC and posterior surgery between February 1st 2010 and October 2013. Retrospective study of clinical variables, review of response patterns and oncologic follow up Results: Breast conservation rate was 67.3%. Pathologic complete response rate (pCR) was 25.5%. pCR predictive factors were: absence of multicentric tumors, negative estrogen receptor (ER), negative progesterone receptor (PR), histological grade 3, Ki67 >20% and overexpression of Her 2. In the multivariate study, negative ER and Her 2 were predictive factors of pCR. The subrogated molecular type that predicts a complete response was Her 2 overexpression. The most common pattern when there is not pCR, is cell nests or patched (42%), concentric (21%) and mixed (8.9%). The concentric response predictive factors are tumor size 20% and tumor necrosis. The subrogated molecular type that predicts concentric response is the triple negative. In the concentric response there is a superior percentage of conservative surgery (78.8% versus 58.1%), it is more frequent the need of pre surgical marking, surgical margins extension and the number of extended margins. Despite the downstaging effect of neoadjuvant chemotherapy, there is no relation between post-surgery theoretical oncologic tumor size and surgical oncologic volume, being the surgical oncologic volume superior to theoretical one. This correlation is independent from the response pattern. With a mean of 33 months of follow up, only in the complete response group there was a differences in overall survival. Conclusions: It exists clinical variables that predict the response pattern to NAC. It exists a clear downstaging effect of tumor volumes that determines surgical technique changes, but does not modify surgical volumes, that are independents from the response type. The only pattern that has an impact on overall survival is the complete response

HPV Vaccination Coverage Rate in a Rural Area: An Observational, Retrospective, and Cohort Study

In order to reduce the incidence and mortality rate of cervical cancer, the World Health Organization (WHO) declared the Global Strategy Goal for 2030, advocating for reaching a vaccination coverage rate of &gt;90% against human papillomavirus for girls by the age of 15 years. The main objectives of this study were (1) to determine the papillomavirus vaccination coverage among women 15&ndash;40 years old and (2) to identify the at-risk subgroups and possible barriers to achieving WHO&rsquo;s 2030 goal. Multicentre, observational, retrospective, and community-based cohort studies were conducted on women from a rural area in southern Catalonia until 31 December 2021. A total of 23,136 women were included, with a mean age of 26.6 (SD = 5.6) years. The average dose number was 1.7 (SD = 0.7). The results showed overall vaccination coverage of 17.4% among the target women. This coverage was unequal across regions (16.6&ndash;24.5%, p &lt; 0.001), primary healthcare teams (15.5&ndash;24.3%, p &lt; 0.001), and age groups (56.7% (15&ndash;19-year-olds) vs. 3.8% (35&ndash;40-year-olds), p &lt; 0.001), related to accessibility to vaccination and economic&ndash;geographical indicators. Clinical practice guidelines on screening individuals at risk in terms of vaccination access and public vaccination protocols should be implemented in order to improve the vaccination coverage rate

Self-assessment of a breast care nursing model within a Breast Unit: learning process and keys to improving breast care

Aim and objectives: To assess the adherence of a nursing care model in a multidisciplinary breast cancer unit in a tertiary hospital to the recommended competencies and quality indicators.Background: Aligning the competencies of the breast care nurse with international recommendations for this role helps better fulfil patient needs, increases satisfaction and ensures continuity of care.Design: Cohort study.Methods: Breast care nursing was assessed in all patients treated at the Functional Breast Unit from 1 July 2016 to 30 June 2017. Patients were followed for 1 year. Sociodemographic, clinical and pathological data, treatments performed and nursing interventions were collected. The strobe checklist has been used to report this study. Results: We analysed nursing interventions carried out in 382 patients attended over 1 year in a multidisciplinary breast cancer unit. All patients with early disease had contact with the nurse at different times during their primary treatment. Only 58% of patients with advanced disease had contact with the nurse during their first year of illness. Moreover, first contact with the nurse was delayed by more than a week from diagnosis, the interval recommended by international guidelines.Conclusion: The nursing care model meets the core competencies defined for the breast care nurse in patients with early breast cancer, but the first visit should be organised earlier, and follow-up should extend beyond the completion of primary treatment.Relevance to clinical practice: This study evaluated the breast care nurse model in one breast cancer unit according to international guidelines. Nursing care adhered to most guideline requirements in patients with early breast cancer, but not in those with advanced disease. New models of care need to be developed for women with advanced breast cancer in order to achieve true patient-centred care

Role of sentinel node biopsy in breast cancer: a review

Axillary lymph node involvement is still an important predictor of recurrence and survival in breast cancer. Axillary staging was classically done by axillary lymph node dissection (ALND), but the introduction of sentinel lymph node biopsy (SLNB) has led to a progressive and continuing de-escalation in its use. Therefore, SLNB can now be considered the standard procedure for axillary staging in clinically N0 patients. Different studies have also begun to report that a positive sentinel node does not always require ALND, reducing the morbidity derived from this technique. Fears that this sentinel node approach might not be accurate for neoadjuvant chemotherapy have been allayed by several studies showing that post-neoadjuvant SLNB in clinical N0 patients reduces the rate of ALND. This approach benefits from axillary pathological complete response with an acceptable false-negative rate. By contrast, however, cN1 disease still requires that we optimise the technique to reduce the rate of false negatives. Currently, SLNB is the best method for axillary staging in breast cancer, allowing patients to be treated according to risk of recurrence, and with good evidence that morbidity is lower than with other more radical techniques