Purpose. We examined the impact of diabetes and hyperglycemia on cancer-specific survival of patients with metastatic or recurrent breast cancer (BC). Methods. We performed a retrospective analysis of 265 patients with advanced BC receiving palliative chemotherapy. BC-specific mortality was compared for diabetic and nondiabetic patients as well as for patients that presented hyperglycemia during treatment. Results. No difference was observed between the diabetic and nondiabetic patients in terms of overall survival (OS). A difference in OS was observed between nondiabetic patients and diabetic patients who had hyperglycemia. The OS was greater in diabetic patients with proper metabolic control than diabetic patients with hyperglycemia. The risk of death was higher in patients with mean glucose levels >130 mg/dL during treatment. Several factors were associated with poor OS: tumor stage, hormone-receptor-negative tumors, HER2 negative disease, multiple metastatic sites, presence of visceral metastases, and mean glucose >130 mg/dL. Conclusion. Elevated glucose levels are associated with a poor outcome in diabetic and nondiabetic patients in contrast to patients with normoglycemic levels, conferring an elevated risk of death. According to these results, clinicians should monitor glucose levels during treatment for advanced breast cancer disease and take action to maintain normal glucose levels.

Background: The majority of breast cancer patients in Mexico are treated through the public health system and >80% receive adjuvant chemotherapy. The aim of this prospective study was to characterize the impact of the Oncotype DX assay on adjuvant therapy decision making and the confidence in those decisions amongst public sector physicians in Mexico. Methods: Ninety-eight consecutive patients with ERþ, HER2À, stage I-IIIa, N0/N1-3 node-positive breast cancer from the Instituto Nacional de Cancerología were eligible for the study. The primary endpoint was the overall change in treatment recommendations after receiving the assay results. Results: Of 96 patients, 48% received a chemohormonal therapy recommendation prior to testing. Following receipt of results, treatment decisions changed for 31/96 (32%) patients, including 17/62 (27%) node-negative patients and 14/34 (41%) node-positive patients. The proportion of patients with a chemotherapy-based recommendation decreased from 48% pre-to 34% post-assay (P ¼ 0.024). 92% of physicians agreed that they were more confident in their treatment recommendation after ordering the assay. Conclusions: These results suggest that use of the 21-gene assay in the Mexican public health system has a meaningful impact on adjuvant treatment recommendations that may reduce the overall use of chemotherapy.

In early-stage breast cancer patients in Mexico, guiding decision making on adjuvant therapy using the 21-gene assay was projected to improve life expectancy in comparison with the current standard of care, with an ICER of MXN 25,244 (USD 1914) per life-year gained, which is within the range generally considered cost-effective.

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BACKGROUND: BREAST-Q is a patient-reported outcome (PRO) that has been designed to evaluate perception outcomes among women undergoing different types of breast surgery, the modules include evaluation for mastectomy, breast reconstruction, augmentation, reduction/mastopexy and breast-conserving therapy. OBJECTIVES: Generate a translated version that is conceptually equivalent to the original version and to validate for Mexican population. METHODS: A linguistic and psychometric validation was performed in 494 women. We carry out pre and postoperative test. Reliability and internal consistency were performed by Cronbach's alpha and intraclass correlation coefficient (ICC). RESULTS: The results of patient testing, number of participants, acceptability and reliability are shown in table 1. The average scores were in all cases >0.80. Summary of BREAST-Q validation analysisN =494Module=nMean age(range)Time to completion Test(minutes) average(range)Time to completion Retest(minutes) average(range)Number of itemsNumber of missing itemsCronbach's Alpha min-max*Test-Retest ICC min-max*Mastectomy=160Pre=6248(26-76)7.8(2-20)6.4(3-20)3700.81-0.940.72-0.94Post=9852(32-78)13(4-40)11(4-28)6310.87-0.970.87-0.96Breast Conserving Therapy=153Pre=8150(21-78)7(2-17)5.2(2-13)3220.88-0.950.82-0.95Post=7255(37-73)18.7(5-44)15.4(6-29)8720.92-0.980.92-0.98Reconstruction=181Pre=6544(23-64)7.9(3-22)6.4(2-20)4220.90-0.970.90-0.97Post=9246(24-74)18.5(8-41)15.7(5-42)11610.86-0.990.85-0.99Lattisimus Dorsi=2445(33-74)5(1-18)4(2-10)1910.95-0.960.96-0.96We report the low and the high value between all sub scales, per questionnaires The internal consistency and reproducibility support the reliability of the instrument; all of the scores were acceptable. DISCUSSION: The importance of measurements quality of life in patient whit cancer, become an essential end-point, we need validated tools that help us improve our performance in different methods of treatments. Is the first validation study of an instrument that measures the impact of surgical treatment on the quality of life of breast cancer patients in Mexico, our results support the equivalent Spanish version for Mexican population. Breast-Q will provide valuable metrics for a surgeon team to document and measure their clinical performance and improve quality of healthcare in our Hispanic patients. CONCLUSIONS: The Mexican Spanish version of tree Modules of Breast-Q is reliable and easy to implement in the population with breast cancer in different scenarios in México with the advantage to measure the quality of life and satisfaction on our population with a locally advanced stage that will help to improve quality of healthcare. The high acceptability of the questionnaire demonstrate that the version is well accepted for our population so we will include a significant number of patient in our country; therefore, more hospital centers will be invited to participate for further studies that allow us to evaluate the population in Latin America and thus compare our results. Citation Format: Bargalló-Rocha J, Gutiérrez-Zacarías L, Gallargo-Alvarado L, Maciel-Miranda J, Shaw-Dulin R, Esparza-Arias N, Figueroa-Padilla J, Vazquez-Romo R, Robles-Vidal C, Drucker-Zertuche M, Cabrera-Galeana P, Cantu-De Leon D. The BREAST-Q: Translation and validation for Mexican population [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-16-07.

Introduction Although temporal trends in breast conserving surgery (BCS) have been described for developed countries like the United States (US), there is a lack of information regarding the uptake of breast conservation in developing regions of the world. In developing countries, the implementation of breast conservation might be hindered by the availability of radiation therapy, lack of training among surgeons, or concerns regarding compliance with follow-up care and surveillance. In 2006, the Mexican government created Seguro Popular, which provided coverage for breast cancer care for all Mexican women, thus potentially mitigating the difficulties with obtaining care after BCS and improving access to multidisciplinary care. We undertook an overview of ten years of breast cancer surgery at our Mexican cancer center following the implementation of Seguro Popular, and explored changes in surgical technique over time. Methods A retrospective cohort analysis was conducted using the National Cancer Institute of Mexico (INCAN) database from 2006 to 2016. All patients with a diagnosis of breast cancer seen during that period were included. Patients who received surgery for breast cancer where then grouped together based on the type of surgery (mastectomy versus BCS). The effect of the year of diagnosis and of clinical stage at the time of presentation was evaluated. Logistic regression was used to model temporal trends in use of BCS over mastectomy for three 3-year periods (2006-2009, 2010-2012, and 2013-2016). Results The patient cohort consisted of 5289 women from the INCAN database, of which 4519 received some form of local surgical treatment. Sixty-one percent (n = 2764) had locally advanced disease (stages IIB-IIIC) at the time of presentation, and a quarter (n = 1156) had ≥60 days between diagnosis and receipt of surgical treatment. Eighty percent of the patients in the entire cohort (n = 3611) were treated with mastectomy, while 20% (n = 908) received BCS. For the 2006-2009 period, out of 1596 total surgeries, 9.9% were BCS (n = 158). The proportion of BCS increased for each of the other two studied periods, being 18.5% for the 2010-2012 period (n = 276/1490), and 33.1% for the 2013-2016 period (n = 474/1433) (p<0.01 for trend). While the increase in BCS was significant for all stages, it was most pronounced for women with early-stage disease (Stages I-IIA), going from 17% in 2006-2009 to 52% in 2013-2016 (p<0.01), than in those with locally-advanced disease (6.5 to 18%, p<0.01). Conclusions In the ten years after the start of the Seguro Popular public insurance program, the proportion of BCS at a Mexican cancer center increased significantly, particularly for women with early-stage disease. The rates seen at INCAN for the period between 2013-2106 resemble those reported by the US National Cancer Database, in which approximately 61% of women with stage I-II breast cancer and 20% of women with stage III disease receive BCS. Potential reasons for the increase in the uptake of BCS include improved access to adjuvant radiation therapy, improved access to systemic treatment, and higher adherence to follow-up care after the start of Seguro Popular, as well as improvements in surgical training. In addition, changes in BCS may also be related to improvements in the implementation of multidisciplinary teams over time, which may lead to a more homogeneous and comprehensive care. Our results show that improving access to care for patients living in developing countries positively impacts the uptake of BCS for women with breast cancer. Citation Format: Enrique Bargalló-Rocha, Nancy Reynoso-Noveron, Jaime Corona, Nereida Esparza-Arias, María Teresa Ramírez-Ugalde, Caros Daniel Robles-Vidal, Robin Shaw-Dulin, Armen Stankov, Rafael Vazquez-Romo, Patricia Villarreal-Colin, Sergio Aguilar-Villanueva, Jaime Hidalgo-Bahena, Milagros Perez-Quintanilla, Fernando U Lara-Medina, Juan Alejandro Torres, Enrique Soto-Perez-de-Celis, Paula Cabrera-Galeana, Alejandro Mohar, Abelardo Meneses-García. Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS1-05.