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Introducción Las personas transgénero (varones y mujeres trans, género neutro, etc.) realizan tratamientos médicos y/o quirúrgicos a fin de adecuarse a su identidad de género. Dentro de los procedimientos disponibles, se encuentran incluidos aquellos que pueden modificar la glándula mamaria (tratamiento hormonal cruzado, mastectomía/masculinización del tórax/colocación de prótesis mamarias). Se desconoce actualmente el riesgo de desarrollar cáncer de mama en la población trans. Sin embargo, están establecidas pautas de screening mamario que permitirían un adecuado seguimiento de la salud mamaria, tanto en varones trans como en mujeres trans. Objetivo El objetivo principal es estudiar la situación actual respecto del screening mamario realizado a pacientes trans por parte de sus médicos de cabecera en un hospital de la Ciudad de Buenos Aires. Material y método Se evaluaron las historias clínicas de un total de 489 personas trans atendidas en el Hospital Durand entre los años 2006 y 2017. 1. Se relevó la realización de estudios mamarios de screening previos a la instauración del tratamiento hormonal cruzado (thc) en pacientes trans. 2. Se analizó la valoración de riesgo de cáncer de mama previo al inicio del thc. 3. Finalmente, se propone un algoritmo de evaluación previo y posterior al comienzo del tratamiento hormonal en estos pacientes, según hormonoterapia recibida, y la realización de cirugía mamaria, acorde a normas internacionales y la revisión de la bibliografía. Resultados Se observó que un 37,7% de varones trans y un 18,1% de mujeres trans tenían estudios mamarios realizados. Respecto de la valoración de riesgo, en un 11,5 y un 11,1% (varones y mujeres trans) no estaban recolectados los antecedentes familiares, y, en los casos en que figuraban, estaban incompletos. Conclusiones Se postula mantener las pautas de screening mamario aplicadas para mujeres cis tanto en varones trans hasta la realización de la mastectomía/masculinización del tórax (luego mantener el examen físico) como en mujeres trans que reciben thc
Introduction Transgender patients perform both medical and surgical treatments in order to adapt to their gender identity. Within the procedures, those that can modify the mammary gland are included (cross-hormonal treatment, mastectomy / placement of breast prostheses). The risk of developing breast cancer in the trans population is currently unknown. However, screening guidelines are established and would allow adequate monitoring of mammary health, both in trans men and trans women. Objective The main objective is to study the current situation regarding breast screening performed on trans patients by their family doctors in a hospital in the City of Buenos Aires. Materials and method The clinical histories of a total of 489 transgender people attended at the Durand Hospital between 2006 and 2017 were evaluated. We studied: 1. breast screening studies prior to the initiation of cross-hormone treatment (thc) in trans patients; 2. the risk assessment of breast cancer prior to the start of thc; 3. finally, an algorithm of evaluation before and after the start of hormonal treatment is proposed in these patients, according to hormone therapy received and the performance of breast surgery, according to international standards and bibliographic review. Results It was observed that 37.7% of trans men and 18.1% of trans women had breast studies performed. Regarding the risk assessment, 11.5 and 11.1% (men and trans women) there was no family history collected, and most cases they were incomplete. Conclusions It is postulated to maintain the mammary screening guidelines for cis women both in trans men until the completion of the mastectomy (then maintain the physical examination) and in trans women who receive thc
Subject(s)
Prostheses and Implants , Therapeutics , Breast Neoplasms , Transgender PersonsABSTRACT
Breast ultrasound is an essential tool in Mastology. This technology can help in the diagnosis of lesions affecting the mammary gland, identifying both benign and malignant tumors. However, ultrasound examination has precise indications in medical practice; and should be indicated cautiously, as one should not think it can tackle all diagnoses of the breast. In this paper, the author assesses 197 breast ultrasounds in the city of Chapecó, Santa Catarina, Brazil. The author reports lack of clinical criteria in many indications of ultrasound examination by health professionals at Basic Health Units of the city
O exame de ultrassom de mama é imprescindível em mastologia. Essa tecnologia pode ajudar no diagnóstico de lesões que acometem a glândula mamária, identificando tumores tanto benignos como, possivelmente, malignos. Entretanto, o uso desse exame tem indicações precisas na prática médica. Ele deve ser pedido com critério e não se deve acreditar que solucionará todos os diagnósticos das lesões mamárias. Neste trabalho, o autor analisa 197 pedidos de exame de ultrassom de mama, realizados na cidade de Chapecó (SC). O autor atribui a falta de critério clínico em muitas indicações para o exame de ultrassom pelos profissionais de saúde que atendem nas Unidades Básicas de Saúde da cidade
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Objective To evaluate the application of abbreviated protocol (AP) of magnetic resonance imaging (MRI) in screening of breast cancer with dense breast tissue.Methods Total 478 patients with dense breast tissue,who had negative X-ray mammography (MG),underwent dynamic contrast-enhanced MRI (DCE-MRI).The AP MRI,which consisted of first postcontrast subtracted (FAST) and maximum-intensity projection (MIP),and full diagnostic protocol (FDP) MRI images were analyzed by Breast Imaging Reporting and Data System (BI-RADS).Among 478 patients the histopathological diagnosis was available in 39 cases (41 breast lesions).With pathological diagnosis as gold standard,the sensitivity,specificity,positive predictive value (PPV) and negative predictive value (NPV) of AP and FDP in breast cancer detection were evaluated.Results In 41 breast lesions there were 16 malignant lesions and 25 benign lesions.FDP detected all 16 malignant lesions,including 9 cases of ductal carcinoma in situ,6 cases of invasive ductal carcinoma and 1 case of mucinous carcinoma;AP detected 15 out of 16 cases of breast cancer.The sensitivity of FDP and AP in detection of breast malignant lesions was 16/16 and 15/16,respectively (x2 =0.725,P =0.224).The specificity of FDP and AP was 92％ (23/25) and 76％ (19/25),respectively (x2 =6.327,P =0.012).Conclusion For women with dense breast tissue AP of MRI can be used in early screening of breast cancer.
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Objective: To analyze the cost-effectiveness of mammography screening for Chinese women. Methods: A model of Markov process adapted with clinical data about breast cancer and population of Chinese women was developed to simulate the progression of breast cancer. The model was running over ten cycles (each cycle represents one year) and then to estimate the total cost/effectiveness of mammography screening by summing across those cycles. Results: For women groups aged between 35-59 years and 35-69 years, ICER (incremental cost-effectiveness ratio) of mammography screening group will be 216 656.00 yuan/QALY (quality adjusted life year) and 248 727.50 yuan/QALY respectively compared with non-screening group, and mammography screening can reduce the mortality of breast cancer by 14.66% and 14.79%, respectively. The ICER is closely correlated with the incidence of breast cancer, sensitivity and specificity of mammography screening and the costs for screening. Conclusion: The result of this analysis indicates that mammography screening in Chinese women can reduce the breast cancer mortality about 15%. According to the incidence rate, mean screening performance (including sensitivity and specificity) and screening costs of breast cancer in Chinese women, the mammography screening is not of cost-effectiveness at present. However, the cost-effectiveness of mammography screening is closely correlated with the incidence rate of breast cancer, screening performance and screening costs, the screening for breast cancer in Chinese women will be of or even good costeffectiveness with the increased incidence of breast cancer, the decreased costs of screening and the improved performance of screening. © 2012 by Tumor.
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Aim: Found to be effective in its treatment. The increased incidence of breast cancer supports the implementation of breast cancer screening programs. The present study evaluates the opinion among nurses regarding breast cancer screening programs in United Arab Emirates (UAE). Materials and Methods: The study population included 154 nurses practicing at different hospitals in United Arab Emirates (UAE), all nurses who participated in the breast cancer awareness programme organized by Gulf Medical University, Ajman, UAE. A self-administered, pretested, structured, close-ended questionnaire was used for data collection. Statistical Analysis was performed using Predictive Analytic Software (PASW 17). Results: The participants' age ranged between 20 and 59 years. Fifty percent of the participants strongly agreed with the early detection of breast cancer by performing breast self examination. Thirty-nine percent were of the opinion that women aged 40 years and older should have a mammogram every year and continue to do so and 25.3% strongly felt that women in their 20s and 30s should have clinical breast examination as part of their periodic health examination by health professionals. 33.8% of the respondents strongly agree on providing information on the benefits and limitations of BSE to the female population. Twenty-six percent of the participants strongly agree that women at high risk should get magnetic resonance imaging and mammogram done every year. Conclusion: The present study indicates the need for providing workplace training programs thus equipping them with better knowledge and enhancing their service among the general population.
Subject(s)
Adult , Breast Neoplasms/diagnosis , Breast Neoplasms/epidemiology , Breast Neoplasms/pathology , Breast Self-Examination , Carcinoma/diagnosis , Carcinoma/epidemiology , Carcinoma/pathology , Early Detection of Cancer , Expert Testimony , Female , Humans , Iran , Magnetic Resonance Imaging , Mammography , Middle Aged , Nurses , Patient Education as Topic , Surveys and Questionnaires , United Arab EmiratesABSTRACT
Phyllodes tumors are an infrequent breast tumor presentation. A phyllodes tumor with a synchronous invasive ductal carcinoma is rarely described and has never been reported with lobular carcinoma in situ component. A 53-year-old female presented with a nine-year history of twice core biopsy proven fibroadenoma. After an increase in the tumor's growth velocity it was decided upon to undergo an excisional biopsy. Microscopic examination of the well-circumscribed pale-tan mass found focal areas of leaf like architecture with variable number of mitoses present, representing a phyllodes tumor of borderline malignant potential. Incidentally, at one edge of the mass was found a tubular carcinoma and lobular carcinoma in situ components. Thorough, routine follow-up of patients with biopsy proven benign breast masses is important to finding a masked malignant component.
Subject(s)
Female , Humans , Middle Aged , Adenocarcinoma , Biopsy , Breast , Breast Neoplasms , Carcinoma, Ductal , Carcinoma, Lobular , Fibroadenoma , Follow-Up Studies , Mammography , Masks , Mitosis , Phyllodes TumorABSTRACT
Sonography is an attractive supplement to mammography in breast cancer screening because it is relatively inexpensive, requires no contrast-medium injection, is well tolerated by patients, and is widely available for equipment as compared with MRI. Sonography has been especially valuable for women with mammographically dense breast because it has consistently been able to detect a substantial number of cancers at an early stage. Despite these findings, breast sonography has known limitations as a screening tool; operator-dependence, the shortage of skilled operators, the inability to detect microcalcifications, and substantially higher false-positive rates than mammography. Further study of screening sonography is still ongoing and is expected to help establish the role of screening sonography.