Oswaldo Sánchez

Pilot Implementation of Breast Cancer Early Detection Programs in Colombia.

Breast cancer is increasing in developing countries, and Colombia has a double burden from cervical and breast cancer. Suitable guidelines for breast cancer early detection are needed, and the Breast Health Global Initiative provides a favorable framework for breast cancer control in low resource nations. The Colombian National Cancer Institute developed evidence-based guidelines for breast cancer early detection in which coordinated early detection in symptomatic women and hospital-based screening in women aged 50–69 are recommended. A pilot project to evaluate programmatic approaches (opportunistic screening) was designed, and it is expected that organized hospital-based screening for breast cancer will represent a move towards population-based screening in the near future in accordance with country specific conditions.

Cobertura de examen clínico y mamografía de tamización para cáncer de mama en mujeres bogotanas

Resumen Objetivo Determinar la cobertura de examen clinico y mamografia de tamizacion para cancer de mama en un grupo de mujeres bogotanas afiliadas a seguros de salud. Metodos Se realizo una encuesta telefonica a 4.526 mujeres entre 50 y 69 anos, residentes en Bogota y en municipios vecinos, afiliadas a tres companias de seguros de salud. Se excluyeron las mujeres con antecedente personal de cancer de mama. La cobertura de tamizacion se valoro como la proporcion de mujeres con antecedente de mamografia y examen clinico de la mama. Se estimo la frecuencia en la vida, en los ultimos dos anos y en el ultimo ano. Se analizaron factores asociados a la practica de tamizacion, mediante el calculo de OR ajustados. Resultados La frecuencia de vida de uso del examen clinico y mamografia fue de 59,3% y 79,8% respectivamente; el 49,7% y el 65,6% de las mujeres se realizo los examenes con fines de tamizacion; el resto, con fines diagnosticos (sintomaticas). El 34,2% tenia examen clinico en el ultimo ano, y el 54%, mamografia en los ultimos dos anos. La educacion y el antecedente familiar de cancer de mama estuvieron asociados a la practica de tamizacion. Conclusiones La cobertura de examen clinico de la mama como metodo de tamizacion es baja. Las coberturas de mamografia son superiores a lo exigido por el sistema colombiano, pero inferiores a las coberturas utiles reportadas en paises desarrollados.

Increased breast cancer screening and downstaging in Colombian women: A randomized trial of opportunistic breast-screening.

The lack of breast cancer screening in low and middle‐income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50–69 years attending clinics for non‐breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated (“usual care”). Women were followed for 2‐years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1–9.2), 1.0 (0.3–3.5) and 1.9 (0.9–4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7–2.8) by the end of follow‐up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late‐stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well‐designed opportunistic clinic‐based breast cancer screening programs may be useful for early breast cancer detection in LMICs.

Adaptación transcultural de dos escalas para medir la calidad de vida en pacientes con cáncer en Colombia: EORTC QLQ-C30 y QLQ-BR23

Resumen Objetivos Obtener una version en espanol colombiano de dos instrumentos que miden la calidad de vida relacionada con la salud: EORTC QLQ C-30 (instrumento general) y el EORTC QLQ BR23 (instrumento especifico). En estas versiones se busca que el lenguaje y los significados de los contenidos sean consistentes con los diferentes escenarios de aplicacion en Colombia. Metodos Para el proceso de adaptacion cultural se siguieron las recomendaciones sugeridas por el grupo de calidad de vida de EORTC relacionadas con las traducciones, los grupos piloto y los procesos de ajuste de escalas de calidad de vida relacionada con la salud. Resultados Tanto en el proceso de traduccion como en el de los grupos piloto, se introdujeron cambios que ajustaron el significado del instrumento para ser usado en el contexto colombiano. Las modificaciones fueron incorporadas en el conjunto de instrumentos del grupo EORTC. Conclusiones Existe una version disponible en espanol colombiano de las escalas EORTC C30 y EORTC BR23.

Neoadyuvancia en cáncer de mama

Resumen El tratamiento neoadyuvante —tambien denominado “terapia primaria sistemica” o “terapia preoperatoria”— tiene cuatro finalidades en cancer de mama: disminuir el volumen tumoral para hacer operable lo que antes era inoperable, mejorar las probabilidades para hacer una cirugia conservativa, analizar la quimiosensibilidad in vivo y evaluar el manejo de las micrometastasis. Esta revision descriptiva toma en cuenta los principales estudios clinicos sobre terapia sistemica neoadyuvante publicados hasta mayo del 2009.

Increased breast cancer screening and downstaging in Colombian women

The lack of breast cancer screening in low and middle‐income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50–69 years attending clinics for non‐breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated (“usual care”). Women were followed for 2‐years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1–9.2), 1.0 (0.3–3.5) and 1.9 (0.9–4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7–2.8) by the end of follow‐up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late‐stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well‐designed opportunistic clinic‐based breast cancer screening programs may be useful for early breast cancer detection in LMICs.

Increased breast cancer screening and downstaging in Colombian women: A randomized trial of opportunistic breast-screening: Downstaging with Opportunistic Screening for Breast Cancer in Colombia

The lack of breast cancer screening in low and middle‐income countries results in later stage diagnosis and worsened outcomes for women. A cluster randomized trial was performed in Bogotá, Colombia between 2008 and 2012 to evaluate effects of opportunistic breast cancer screening. Thirteen clinics were randomized to an intervention arm and 13 to a control arm. Physicians in intervention clinics were instructed to perform clinical breast examination on all women aged 50–69 years attending clinics for non‐breast health issues, and then refer them for mammographic screening. Physicians in control clinics were not explicitly instructed to perform breast screening or mammography referrals, but could do so if they thought it indicated (“usual care”). Women were followed for 2‐years postrandomization. 7,436 women were enrolled and 7,419 (99.8%) screened in intervention clinics, versus 8,419 enrolled and 1,108 (13.1%) screened in control clinics. Incidence ratios (IR) of early, advanced and all breast cancers were 2.9 (95% CI 1.1–9.2), 1.0 (0.3–3.5) and 1.9 (0.9–4.1) in the first (screening) year of the trial, and the cumulative IR for all breast cancers converged to 1.4 (0.7–2.8) by the end of follow‐up (Year 2). Eighteen (69.2%) of 26 women with early stage disease had breast conservation surgery (BCS) versus 6 (42.5%) of 14 women with late‐stage disease (p = 0.02). Fifteen (68.2%) of 22 women with breast cancer in the intervention group had BCS versus nine (50.0%) of 18 women in the control group (p = 0.34). Well‐designed opportunistic clinic‐based breast cancer screening programs may be useful for early breast cancer detection in LMICs.

Carcinoma córtico-adrenal. Revisión de la literatura

Resumen El carcinoma cortico-adrenal es una entidad que se presenta raras veces; su evolucion es agresiva, con una alta probabilidad de recaida y una supervivencia a 5 anos que no supera el 60%. El unico tratamiento curativo es la cirugia, siempre y cuando esta sea completa y a los pacientes se los diagnostique en estadios tempranos. Otras intervenciones que se pueden brindar son la radioterapia, la quimioterapia y el control de secrecion hormonal en el contexto adyuvante o paliativo. En algunos casos (sindrome de Cushing) el bloqueo hormonal previo a la cirugia es imperativo. En esta revision se describen la patogenesis, el diagnostico, los factores pronosticos y el tratamiento del carcinoma cortico-adrenal, con el proposito de guiar el enfoque diagnostico y el tratamiento.