Summary Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology ...showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
The interactions between pregnancy and breast cancer (BC) are complex. Overall, parity is associated with long-term protective effects against BC, however in a small group of susceptible patients, ...pregnancy can lead to the development of a form of BC with a particularly poor prognosis. Pregnancy-associated breast cancer (PABC) remains an under-studied but important and growing clinical problem worldwide. Several aspects of PABC, including risk factors and mechanisms involved in its occurrence and aggressiveness, are incompletely understood. This review aims to summarize the epidemiology, biology, patho-physiology and clinical characteristics of PABC. We emphasize that age at first pregnancy, absence of breastfeeding and family history stand out as possible risk factors for developing PABC that ought to be incorporated into clinical tools for assessing a woman's risk of developing PABC. Also, improved methods for identifying women at risk of developing PABC in the general population are needed.
•Pregnancy exerts a dual effect on the subsequent risk of developing breast cancer (BC).•Pregnancy-associated breast cancer (PABC) is a BC case that occurs during pregnancy or within 1 year following birth.•Mechanisms causing PABC are unclear due to hormonal and immune changes that occur during pregnancy and breast involution.•Older age- first pregnancy, no breastfeeding, and family history of BC are possible clinical biomarkers for developing PABC.•A higher awareness and improved methods for identifying women at risk in the general population are needed.
Background. Incorporation of molecular analysis of the epidermal growth factor receptor (EGFR) gene into routine clinical practice represents a milestone for personalized therapy of the ...non-small-cell lung cancer (NSCLC). However, the genetic testing of EGFR mutations has not yet become a routine clinical practice in developing countries. In view of different prevalence of such mutations among different ethnicities and geographic regions, as well as the limited existing data from Latin America, our aim was to study the frequency of major types of activating mutations of the EGFR gene in NSCLC patients from Uruguay. Methods. We examined EGFR mutations in exons 18 through 21 in 289 NSCLC Uruguayan patients by PCR-direct sequencing. Results. EGFR mutations were detected in 53 of the 289 (18.3%) patients, more frequently in women (23.4%) than in men (14.5%). The distribution by exon was similar to that generally reported in the literature. Conclusions. This first epidemiological study of EGFR mutations in Uruguay reveals a wide spectrum of mutations and an overall prevalence of 18.3%. The background ethnic structure of the Uruguayan population could play an important role in explaining our findings.
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Background: In Latin America (LatAm), cancer is a major public health issue with high mortality rates. Patient navigation (PN) programs have emerged as a strategy to improve access to cancer ...care for underserved populations. Unfortunately, there is a lack of educational opportunities for those willing to become patient navigators in LatAm. The aim of this study was to develop and implement an educational PN curriculum for healthcare workers interested in improving cancer care in Mexico. Methods: A multidisciplinary team of national top-level cancer experts designed an online comprehensive PN curriculum, which was implemented online following the ECHO model. It consisted of a four-day virtual conference including virtual lectures and workshops. Participants were ask to develop or improve PN programs tailored for their specific institutional needs. After the conference, attendees were tasked with implementing their planned programs. They participated in eight monthly conference video calls designed to reinforce PN project implementation, assist in overcoming barriers and continue conversations with expert faculty. Participants completed pre- and post- course knowledge and satisfaction questionnaires. Progress of participants’ individual goals implementation was assessed at 4 and 8 months after the conference. Results: 28 participants attended the online conference, 56% of them were physicians, 16% psychologists, 4% nurses, and 4% social workers. 89% worked in a public hospital, 72% took care of adults with solid cancer, and 28% of children with hematologic/solid cancers. 93% considered the program was excellent and 100% that the information improved their knowledge. Participants’ baseline knowledge score was 66% (range 27-76%) with a significant increase in the proportion of correct answers of 12% (p < 0.01) at the end of the program (final score 74%; range 58-84%). At 4- and 8-month follow-up, participants reported 54% and 60% of progress regarding their goals on implementing a PN program at their institutions. Most common barriers to PN program implementation were communication issues with other healthcare providers in 44% of participants, and lack of financial support in 11%. At 8 months, most participants felt that they were well prepared for providing PN for patients with cancer (mean = 4.2/5; SD 0.42); and well prepared for managing patient and institutional barriers for cancer care (mean = 4/5; SD 0.67). Conclusions: Our results showed that implementing a virtual educational PN curriculum was feasible, that healthcare providers' knowledge on PN topics significantly increased and that it helped with their PN implementation plans. Educational PN programs like the one we propose could help and guide healthcare providers to implement PN programs for cancer care at institutions across countries in LatAm, where patients face similar barriers for accessing cancer care.
Summary Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean ...countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
Abstract The HER2 receptor as measured by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) is overexpressed in 15–20% of all breast cancers and traditionally represents ...adverse biology and a guarded prognosis, particularly in HER2 positive metastatic breast cancer (MBC). Trastuzumab and newer anti-HER2 targeting agents have significantly improved the clinical outcomes of patients with HER2 positive MBC. The development of new techniques has led to discovery of promising biomarkers that can lead to more precise selection of patients for anti-HER2 therapies. This paper summarizes these new biomarkers, useful in selecting patients for treatment with new and emerging therapies for HER2 positive MBC. Emerging next generation sequencing techniques have truly changed the landscape of HER2 positive MBC. Deployment of multiple anti-HER2 therapies in combination is a strategy which has yielded additive or even synergistic effects and has led to markedly improved patient outcomes in HER2+ MBC. In the future, in order to further improve the treatment of these patients and to reduce toxicities, we need to improve our understanding of HER2-dependent pathways and their function, and to develop further treatment combinations while optimizing selection of patients by identifying new biomarkers. The results of prospective studies using CTCs, cDNA and other promising new biomarkers are awaited with great interest.
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