Mastectomía contralateral profiláctica con reconstrucción inmediata en pacientes con cáncer de mama unilateral sin mutación germinal en BRCA1/2

Introducción No existe un consenso sobre las indicaciones de mastectomía contralateral en pacientes diagnosticadas de cáncer de mama unilateral sin mutación germinal en BRCA1/2. Estudios previos han identificado algunos factores que pueden influir en la toma de la decisión dependientes del tumor, como el tamaño o histología, de la paciente, como la edad, y de la cirugía como la posibilidad de realizar una reconstrucción inmediata o la experiencia del cirujano. Métodos Estudio retrospectivo de una cohorte de 176 pacientes diagnosticadas de CM entre 2010 y 2016 a las que se les realizó cirugía mamaria. Se ha analizado la asociación de características del tumor y de la paciente con la toma de decisión de realizar mastectomía contralateral (MC) o no-MC. Asimismo, se han analizado los datos relacionados con la cirugía y la recurrencia por grupos mediante la curva de incidencia acumulada y el test de Gray. Resultados El número de MC se ha incrementado en nuestro centro. No hemos encontrado diferencias significativas en el desarrollo de complicaciones posquirúrgicas entre los 2 grupos de pacientes, pero sí en la estancia hospitalaria, siendo superior para MC. También hemos observado diferencias entre ambas cohortes en edad y tipo de tumor, siendo la MC más frecuente en aquellas pacientes más jóvenes y subtipo luminal A. Hemos hallado diferencias en la incidencia acumulada de recidiva entre ambos subgrupos (p = 0, 034). Conclusiones En nuestra cohorte la MC se realiza más frecuentemente en pacientes más jóvenes y con cáncer de mama luminal A. Introduction: There is no consensus on the indications for contralateral mastectomy (CM) in patients diagnosed with unilateral breast cancer without germline BRCA1/2 mutations. Prior studies have identified some factors that could influence decision-making. These factors include tumoural size and histological type; patient-related factors, such as age; and surgical factors such as the possibility of immediate reconstruction and the surgeon''s experience. Methods: Retrospective study of a cohort of 176 patients diagnosed with breast cancer between 2010 and 2016 who underwent breast surgery. We analysed the association between tumoural and patient-related characteristics with the decision to perform CM or not. We also analysed data related to surgery and recurrence by groups by using the cumulative incidence curve and the Gray test. Results: The number of CM has increased in our centre. We found no significant differences in the occurrence of post-surgical complications between the two patient groups but length of hospital stay was higher in CM. We also found differences between the two cohorts in age and tumoural type, with CM being more frequent in younger patients and those with luminal A subtype. Differences were found in the cumulative incidence of recurrence between subgroups (p = 0.034). Conclusions: In our cohort, CM was more frequent in younger patients and in those with luminal A breast cancer

The spread of agriculture in northern Iberia: new archaeobotanical data from El Mirón cave (Cantabria) and the open-air site of Los Cascajos (Navarra)

This paper presents archaeobotanical results from the Neolithic levels (5,300–4,000 b.c.) of two recently excavated sites in northern Iberia: El Mirón cave (Cantabria) and the open-air site of Los Cascajos (Navarra). A cereal grain from El Mirón is currently the earliest domesticated plant remain from this region. Despite the large number of samples examined, plant remains are few. They include basically cereals (Triticum monococcum, T. dicoccum, T. aestivum/durum/turgidum and Hordeum vulgare) and some nuts and fruits (Corylus avellana, Quercus sp., Vitis sp., etc.). The presence of free-threshing wheats at El Mirón opens up an interesting subject for debate, as until now naked wheats have been absent from the early Neolithic archaeobotanical record of the coastal Cantabrian region. Hulled wheat chaff is the main plant component from Los Cascajos, south of the Cantabrian Cordillera in Navarra, indicating waste from processing activities. The association of barley almost exclusively with both a burial and a ritual vase in Los Cascajos could be related specific rituals or ceremonies.Excavations at El Mirón Cave, directed by Straus and González Morales since 1996, have been funded by the Fundación M. Botín, the U.S. National Science Foundation, the National Geographic Society, the L.S.B. Leakey Foundation, the Gobierno de Cantabria and the University of New Mexico. Excavations at Los Cascajos, directed by J. García Gazólaz and J. Sesma Sesma, have been funded by the Gobierno de Navarra. L. Peña-Chocarro has worked with a post-doctoral contract within the I3P Program, funded by the European Social Fund. L. Zapata’s study was done under a postdoctoral research grant from the Basque Government (Ref. BFI01.12) as part of the Research Group of the University of the Basque Country, UPV/EHU 9/UPV00155.130-14570/2002.Peer reviewe