Prevención y seguimiento del cáncer de mama, según categorización de factores de riesgo y nivel de atención

Efficacy and efficiency of a new therapeutic approach based on activity-oriented proprioceptive antiedema therapy (TAPA) for edema reduction and improved occupational performance in the rehabilitation of breast cancer-related arm lymphedema in women: a controlled, randomized clinical trial

BACKGROUND

Breast cancer (BC) is a major public health issue. More than one out of five women treated for breast cancer will develop lymphedema in an upper extremity. Current evidence advocates transdisciplinary oncological rehabilitation. Therefore, research in this area is necessary since limited consensus having been reached with regard to the basic essential components of this rehabilitation. Consensus has, however, been reached on the use of decongestive lymphedema therapy (DLT), but due to a lack of tests, the necessary dosages are unknown and its level is moderately strong. This study attempts to verify both the efficacy of activity-oriented proprioceptive antiedema therapy (TAPA), as compared to conventional treatments such as DLT or Complex Physical Therapy (CPT), as well as its efficiency in terms of cost-effectiveness, for patients affected by breast cancer-related arm lymphedema.

METHODS

Controlled, randomized clinical trial with dual stratification, two parallel arms, longitudinal and single blind. 64 women with breast cancer-related arm lymphedema will take part in the study. The experimental group intervention will be the same for stage I and II, and will consist of neuro-dynamic exercises oriented to the activity, proprioceptive neuromuscular facilitation activities and proprioceptive anti-edema bandaging. The control group intervention, depending on the stage, will consist of preventive measures, skin care and exercise-prescribed training in the lymphedema workshop as well as compression garments (Stage I) or conservative Complex Decongestive Therapy treatment (skin care, multi-layer bandaging, manual lymphatic drainage and massage therapy) (Stage II).

RESULTS

Sociodemographic and clinical variables will be collected for the measurement of edema volume and ADL performance. Statistical analysis will be performed on intent to treat.

DISCUSSION

It has been recommended that patient training be added to DLT, as well as a re-designing of patient lifestyles and the promotion of health-related aspects. In addition, clinical trials should be undertaken to assess neural mobilization techniques and proprioceptive neuromuscular facilitation should be included in the therapy. Cohesive bandaging will also be performed as an early form of pressotherapy. The proposed study combines all of these aspects in order to increased comfort and promote the participation of individuals with lymphedema in everyday situations.

LIMITATIONS

The authors have proposed the assessment of the experimental treatment for stages I and II. One possible limitation is the lack of awareness of whether or not this treatment would be effective for other stages as well as the concern for proper hand cleansing during use of bandages, given the current COVID-19 pandemic situation.

TRIAL REGISTRATION

This trial was registered in ClinicalTrials.gov ( NCT03762044 ). Date of registration: 23 November 2018. Prospectively Registered.

Synchronous Ovarian and Breast Cancers with a Novel Variant in BRCA2 Gene: A Case Report

We report a case of a 52-year-old female with a family history of pancreatic and colon cancers who presented with a right breast mass positive for high-grade medullar carcinoma with triple-negative biomolecular profile. Further workup was performed finding a left ovarian mass. The patient underwent laparotomy performing optimal cytoreduction on bilateral ovarian tumors; the pathology and immunohistochemistry confirmed bilateral ovary adenocarcinoma with positive peritoneal malignancy. Due to her synchronic breast and ovarian cancers, a genetic profile was performed detecting a new pathogenic variant in the BRCA2 gene: c.3606_3607del (p.Ser1203Cysfs). She was given chemotherapy with carboplatin and paclitaxel obtaining complete clinical response. Regarding her breast cancer, she had a right modified radical mastectomy and prophylactic left mastectomy obtaining complete clinical response. This case presents with an unusual subtype and difficult histologic diagnosis of a synchronic medullar breast cancer and ovary carcinoma associated with a new mutation of the BRCA2 gene.

Is it possible to predict the presence of colorectal cancer in a blood test? A probabilistic approach method

INTRODUCTION

The assessment of the state of immunosurveillance (the ability of the organism to prevent the development of neoplasias) in the blood has prognostic implications of interest in colorectal cancer. We evaluated and quantified a possible predictive character of the disease in a blood test using a mathematical interaction index of several blood parameters. The predictive capacity of the index to detect colorectal cancer was also assessed.

METHODS

We performed a retrospective case-control study of a comparative analysis of the distribution of blood parameters in 266 patients with colorectal cancer and 266 healthy patients during the period from 2009 to 2013.

RESULTS

Statistically significant differences (p < 0.05) were observed between patients with colorectal cancer and the control group in terms of platelet counts, fibrinogen, total leukocytes, neutrophils, systemic immunovigilance indexes (neutrophil to lymphocyte ratio and platelet to lymphocyte ratio), hemoglobin, hematocrit and eosinophil levels. These differences allowed the design of a blood analytical profile that calculates the risk of colorectal cancer. This risk profile can be quantified via a mathematical formula with a probabilistic capacity to identify patients with the highest risk of the presence of colorectal cancer (area under the ROC curve = 0.85).

CONCLUSIONS

We showed that a colorectal cancer predictive character exists in blood which can be quantified by an interaction index of several blood parameters. The design and development of interaction indexes of blood parameters constitutes an interesting research line for the development and improvement of programs for the screening of colorectal cancer.