Caracterización de los resultados de biopsia por trucut en pacientes con BI-RADS 4 y 5 sin criterio quirúrgico

Introducción: La biopsia percutánea se ha convertido, en nuestros días, en el método diagnóstico más utilizado para la evaluación de las lesiones de mama sospechosas de malignidad. Objetivo: Caracterizar los resultados de biopsia por trucut en pacientes con categorías BI-RADS 4 y 5 sin criterio quirúrgico. Materiales y métodos: Se realizó un estudio observacional, descriptivo y transversal de 70 pacientes que presentaron lesión sospechosa de malignidad por ultrasonografía y que requirieron la realización de biopsia por aguja gruesa de la imagen reportada, entre enero de 2019 y diciembre de 2020. Se realizaron en la Consulta de Intervencionismo Mamario del Departamento de Imagenología del Hospital Universitario Clínico Quirúrgico Comandante Faustino Pérez Hernández, de Matanzas. Se analizaron las variables edad, categoría BI-RADS, resultado histopatológico, tamaño tumoral y complicaciones. Resultados: El grupo etario predominante fue el de 70-79 años (27,1). Se clasificaron 48 pacientes con categoría BI-RADS 5, para un 68,6 %. El carcinoma ductal infiltrante resulto ser el tipo histológico predominante, con 40 pacientes, representando el 57,1 % del total. Se obtuvo una media de 28,91 mm de diámetro de las lesiones biopsiadas. Todas las muestras resultaron útiles, aun en diámetros transversales inferiores a 2 cm. En la serie, las complicaciones reportadas fueron escasas. Conclusiones: La biopsia realizada con aguja gruesa bajo guía ecográfica con técnica de manos libres, es un método confiable para el diagnóstico de cáncer de mama, seguro y sin complicaciones graves. Se confirma que la categoría BI-RADS 5 coincide con diagnóstico histopatológico de cáncer mamario.

Introduction: Percutaneous biopsy has become, nowadays, the most used diagnostic method to evaluate breast lesions suspected of malignancy. Objective: To characterize the Tru-cut biopsy results in patients with BI-RADS 4 and 5 categories without surgical criteria. Materials and methods: An observational, descriptive and cross-sectional study was carried out between January 2019 and December 2020 on 70 patients who presented who presented a lesion suspicious of malignancy by ultrasonography and required a thick-needle biopsy of the reported image. They were performed at the Breast Intervention Clinic of the Imaging Department of the Clinical Surgical University Hospital Comandante Faustino Pérez Hernández, from Matanzas. The variables age, BI-RADS category, histopathological result, tumor size and complications were analyzed. Results: The predominant age group was the 70-79 years-old one (27.1). 48 patients were classified with BI-RADS 5 category, for 68.6%. Infiltrating ductal carcinoma resulted the predominant histological type, with 40 patients representing 57.1% of the total. An average diameter of 28.91 mm was obtained from the biopsied lesions. All samples were useful, even in transverse diameters less than 2cm. In the series, few complications were reported. Conclusion: Biopsy performed with thick needle under ultrasound guidance with free-hands technique, is a reliable method for breast cancer diagnosis, safe and without serious complications. It is confirmed that BI-RADS 5 category coincides with breast cancer pathological diagnosis.

Cáncer mamario y cervicouterino: el problema del absentismo femenino en la acción preventiva / Breast and cervical cancer: the problem of the lack of preventive actions in women

Introducción: La prevalencia del cáncer es un problema que vas más allá de la preocupación médica, por cuanto involucra aspectos subjetivos y sociales en la vida de quienes lo padecen o están en riesgo. Por esto, es de gran importancia detectarlo tempranamente, especialmente entre mujeres debido a su exposición a los factores de riesgo de cáncer de mama y cérvix. Objetivo: Analizar la abstención femenina en Chile a la Mamografía y Papanicolaou. Materiales y métodos: Se realizó un análisis multivariado de regresión logística binomial, de los datos disponibles en el Módulo de Salud de la Encuesta de Caracterización Socioeconómica Nacional (CASEN) en su edición del año 2015. Resultados: Se expone una generalizada abstención a la acción preventiva entre mujeres, aun cuando la prevalencia de ambos tipos de cáncer es alta. Los motivos personales aparecen como los más comunes para omitir Mamografía y/o Papanicolaou, especialmente la subvaloración de su importancia. Los factores que aumentan la probabilidad de abstención son la baja escolaridad, la ausencia de afiliación médica y la presencia de pareja. Conclusiones: Se plantea la necesidad de aumentar igualmente la cobertura del servicio preventivo, focalizar los recursos hacia la población vulnerable y mejorar las estrategias de incentivo hacia estos exámenes.

Introduction: The prevalence of cancer is a problem that goes beyond medical concern since it involves subjective and social aspects that affect the lives of those who either suffer from cancer or are at risk for it. Therefore, it is important to detect it early, especially among women due to their exposure to risk factors for breast and cervical cancer. Objective: To analyze women's abstention from mammography and Papanicolaou screening in Chile. Materials and methods: A multivariate binomial logistic regression analysis was conducted with available data from the Health Module of the National Socioeconomic Characterization Survey (NSCS) from 2015. Results: Even though there is a high prevalence of both types of cancer, there is a generalized female abstention from preventive actions. Personal reasons are the most common justifications given for avoidance of mammography and/or Papanicolaou test, especially undervaluing their importance. Factors that increase the probability of abstention include low education level, lack of medical affiliation, and presence of a partner. Conclusions: It is important to increase the coverage of preventive services, focus resources towards vulnerable populations, and create incentive strategies for women to take these exams.

Distribución etaria, antecedentes familiares y estadio del cáncer de mama en mujeres asistidas en hospitales públicos en Córdoba: 2004 - 2010 / Age distribution, family history, and stage of breast cancer in women treated in public hospitals in Cordoba, Argentina: 2004 - 2010

INTRODUCCIÓN: El objetivo del presente estudio fue analizar la edad de la mujer al momento del diagnóstico de cáncer de mama, el estadio del mismo y los antecedentes familiares de cáncer de mama en las mujeres que consultaron en el ámbito público de la Ciudad de Córdoba durante el período 2004-2010. MATERIAL Y MÉTODOS: El presente fue un estudio observacional efectuado en cuatro instituciones públicas, a partir del total de datos de los Servicios de Anatomía Patológica y Estadística registrados en las historias clínicas (n=1423). Se evaluó la tendencia de edad de diagnóstico con regresión lineal y el tipo histológico y grado del tumor según la edad de la mujer, con regresión de Poisson. RESULTADOS: En relación a la edad del diagnóstico, el 8,74% de las mujeres estudia-das eran menores a 40 años, lo cual representa una mayor proporción a los valores in-formados en la literatura mundial. En relación a la distribución por edad del total de pacientes con cáncer de mama, la mayor frecuencia fue en el grupo de 50 a 59 años. DISCUSIÓN: La proporción de mujeres mayores de 40 años detectadas en estadio tardío fue el 44,22%, siendo superior a los valores informados en los países desarrollados. La tendencia de edad de diagnóstico se incrementó en un 0,39 por año, y no hubo cambio en el tipo del estadio. En términos de antecedentes familiares, se detectó la presencia en el 15,95% de los casos, si bien es de destacar que la frecuencia de registro de estos antecedentes en las historias clínicas fue limitada

INTRODUCTION: The aim of this study was to analyze the age at which women treated in public hospitals in the City of Córdoba, Argentina from 2004 to 2010 were diagnosed with breast cancer, their stage at diagnosis, and their family history of breast cancer. MATERIAL AND METHODS: This study was carried out in four public institutions, using the to-tal number of cases registered in medical records by the pathology and statistical services (n=1423). Trends in age at diagnosis over the study period was evaluated with linear regres-sion, and tumor stage and histology according to age was analyzed with Poisson regression. RESULTS: In terms of diagnostic age, 8.74% of the women studied were under 40 years of age, which represents a higher percentage of cases, in comparison with international literature. With regards to age distribution, the greatest number of cases was observed in the group be-tween 50 and 59 years of age. DISCUSSION: The proportion of women older than 40 years detected with late stage cancer was 44.22%, which is higher than the values reported in developed countries. The diagnostic age trend increased by 0.39 per year, and there was no change in the stage at diagnosis. Finally, 15.95% of the women had reported family history of breast cancer, although it is noteworthy that the frequency of recording family history in the medical charts was limited.

Representaciones sociales del cáncer de mama en pacientes, familiares acompañantes y especialistas / Social Representations of Breast Cancer in Patients, Accompanying Relatives and Specialists

RESUMEN Fundamento: develar las representaciones sociales del cáncer mamario puede acercar a profesionales de las ciencias psicológicas a comprender actitudes, conductas y las influencias que ejercen en pacientes, familiares y especialistas. Objetivo: determinar la estructura de las representaciones sociales (actitud, información, campo representacional) del cáncer mamario en los sujetos del estudio. Métodos: estudio exploratorio, transversal, de metodología mixta, en el período comprendido entre mayo 2014 a diciembre de 2015. Se aplicaron como técnicas: formulario datos sociodemográficos y clínicos, entrevista semiestructurada, composición, asociación libre. Las variables analizadas fueron: direccionabilidad de la actitud hacia el diagnóstico del cáncer mamario, direccionabilidad de la actitud hacia los tratamientos, en la dimensión información: conocimientos sobre conceptualización de la enfermedad, conocimientos de los síntomas, conocimientos sobre tratamientos, creencias sobre factores de riesgo, opiniones sobre las consecuencias del cáncer mamario, opiniones sobre necesidad de brindar conocimientos de la enfermedad a pacientes, familiares. Se efectuó análisis estadístico descriptivo de frecuencias. Se procesó la información de las variables en la base de datos del paquete estadístico SPSS 15.0 para Windows. Los resultados se expresaron en frecuencias absolutas y relativas. Resultados: pacientes, familiares mostraron direccionabilidad de la actitud negativa hacia el diagnóstico y tratamientos. Prevalencia de respuestas ajustadas en las áreas exploradas de la dimensión información, aunque con nivel de profundidad homogéneo los familiares. El campo representacional del cáncer mamario dio cuenta de modelos mayoritariamente de desafío a la enfermedad en los sujetos del estudio. Conclusiones: cómo se comportaron el conocimiento de la estructura de las representaciones sociales del cáncer mamario en los sujetos del estudio, contribuye al análisis del marco de referencia de la actuación sanitaria, desde un abordaje integral, holístico, por coexistir sentido común y ciencia.

ABSTRACT Background: unveiling the social representations of breast cancer can bring professionals in the psychological sciences to understand attitudes, behaviors and the influences they exert on patients, family members and specialists. Objective: to determine the structure of the social representations (attitude, information, representational field) of breast cancer in the study subjects. Methods: exploratory, cross-sectional study, of mixed methodology, in the period from May 2014 to December 2015. Applied as techniques: sociodemographic and clinical data form, semi-structured interview, composition, free association. The variables analyzed were: addressability of the attitude towards the diagnosis of breast cancer, addressability of the attitude towards treatments, in the information dimension: knowledge about disease conceptualization, knowledge of symptoms, knowledge about treatments, beliefs about risk factors , opinions on the consequences of breast cancer, opinions on the need to provide knowledge of the disease to patients, relatives. Descriptive statistical analysis of frequencies was performed. The information of the variables in the database of the statistical package SPSS 15.0 for Windows was processed. The results were expressed in absolute and relative frequencies. Results: patients, relatives showed addressability of the negative attitude towards diagnosis and treatment. There was a prevalence of adjusted responses in the explored areas of the information dimension, although with a homogeneous level of depth, in family members. The representative field of breast cancer accounted for mostly models of disease challenge in the study subjects. Conclusions: the subjects of the study in relation to breast cancer showed a negative attitude, there was a predominance of adjusted answers about the pathology information and mostly models of disease challenges.

Ultraestructura del inmunofenotipo CD44+/CD24- de una línea de células de cáncer de mama triple negativo / Ultrastructure of the CD44 + / CD24- immunophenotype of a line of triple negative breast cancer cells

RESUMEN: El cáncer de mama es la principal causa de muerte debido al cáncer en mujeres. La microscopía electrónica permite establecer características constitutivas de las células entre diferentes poblaciones celulares. Las células madre del cáncer mamario con inmunofenotipo CD44alta/CD24baja son una población de células intratumorales asociada a la quimioresistencia y metástasis, cuya ultraestructura aún no ha sido bien estudiada. El objetivo de este trabajo fue conocer características ultraestructurales de células con fenotipo de células madre del cáncer de la línea celular MDA-MB-436 de tumor mamario triple negativo comparándolas con células madre adiposas. Se utilizó microscopía electrónica de barrido y de transmisión. Previamente, mediante separación inmunomagnética positiva empleando anticuerpos anti CD44 y anti CD24 unidos a perlas magnéticas, se obtuvo una población de células con fenotipo CD44alta/CD24baja a partir de 10x106 células de la línea MDA-MB-436, la cual igual que las células madre adiposas fue cultivada en cubreobjetos para microscopía electrónica de barrido; en tanto que para microscopía electrónica de transmisión se obtuvo un pellet de células, luego se fijó con glutaraldehído al 2,5 % y post fijó con OsO4 1 %. Para microscopía óptica de alta resolución se usó azul de toluidina como tinción. Luego de obtener el fenotipo de células madre del cáncer se corroboró su pluripotencia detectando la expresión de los genes Oct4 y nanog mediante RT-PCR. Nuestros resultados muestran que las células de este fenotipo son pequeñas, redondeadas, recubiertas por microvellosidades abundantes pero cortas; el citoplasma tiene organelas de secreción celular y abundantes mitocondrias alargadas; el núcleo es excéntrico ocupando la mitad del volumen celular, el nucléolo es voluminoso y la heterocromatina está adosada a la membrana nuclear interna. Se concluye que el inmunofenotipo celular estudiado es una sub población celular dentro de la línea estudiada que difiere en tamaño y ultraestructura de las células madre adiposas.

SUMMARY: Breast cancer is the leading cause of cancer deaths in women. Electron microscopy allows establishing constitutive characteristics of cells between different cell populations. CD44 high / CD24 low mammary cancer stem cells are a population of intratumoral cells associated with chemoresistance and metastasis, whose ultrastructure has not yet been well studied. The objective of this work was to know the ultrastructural characteristics of cells with cancer stem cell phenotype, of the triple negative mammary tumor cell line MDAMB-436 436 using scanning and transmission electron microscopy, and to contrast them with adipose-derived mesenchymal stem cells. Previously, by immunomagnetic purification using anti CD44 and anti CD24 antibodies bound to magnetic beads, cells populations was obtained from 10x106 cells of the MDA-MB-436 line, which, adipose-derived mesenchymal stem whereas cultivated on coverslips for scanning electron microscopy; while for transmission electron microscopy a cell pellet was obtained, then fixed with 2.5 % glutaraldehyde and post fixed with OsO4 1 %. For high resolution optical microscopy, toluidine blue was used as staining. After obtaining the phenotype of cancer stem cells, their pluripotency was corroborated by detecting the expression of the Oct4 and nanog genes by RT-PCR. Our results show that the cells of this phenotype are small, rounded, covered by abundant but short microvilli; the cytoplasm has organelles of cellular secretion and abundant elongated mitochondria; the nucleus is eccentric occupying half of the cellular volume, the nucleolus is bulky and the heterochromatin is attached to the inner nuclear membrane. It is concluded that the cellular immunophenotype studied is a sub-cellular population within the line studied that differs in size and ultrastructure of the adipose stem cells.

CLINICAL, MAMMOGRAPHIC AND HISTOPATHOLOGICAL CORRELATION OF BREAST CANCER IN WOMEN AGED BETWEEN 50 AND 70 YEARS / Correlação clínica, mamográfica e histopatológica do câncer mamário em mulheres com idade entre 50 e 70 anos

Objective: To correlate the clinical, mammographic and histopathological findings of women aged between 50 and 70 years old who were diagnosed with breast cancer and were assisted between 1998 and 2013 at the Mastology Outpatient Clinic of the Center for Full Attention to Women's Health in Universidade Estadual de Campinas (CAISM-Unicamp). Methods: This was a cross-sectional and retrospective study, in which the medical records and mammograms of 160 women were analyzed, a sufficient sample size for the statistical analysis. The variables used for comparison were the clinical, mammographic and histopathological findings, analyzed through descriptive and associative statistics. Results: Of the 160 cases analyzed, 76.9% were symptomatic, and the main clinical findings included palpable nodule (68.1%) and skin alterations (30%). The prevalent mammographic presentations in asymptomatic women were microcalcifications (48.7%), nodules (43.2%) and architectural distortion (8.1%). Regarding the histological type, 81.3% presented invasive ductal carcinoma (IDC) and 10.7%, ductal carcinoma in situ (DCIS). Conclusion: The present study showed that there was a predominance of symptomatic women with mammographic presentation of spiculated nodules and histological type of IDC. In the other patients with lesions detected in the screening test, pleomorphic microcalcifications were prevalent as the main finding of DCIS. Diagnostic mammography was the main form of detection of breast cancer, which may represent the lack of access of these women to screening or early detection of malignant lesions. This reveals the need to improve control actions and care protocols of these patients.

Objetivo: Correlacionar os achados clínicos, mamográficos e histopatológicos de mulheres na faixa etária entre 50 e 70 anos que tiveram diagnóstico de câncer mamário e foram atendidas, entre 1998 e 2013, no Ambulatório de Mastologia do Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (CAISM-Unicamp). Métodos: Trata-se de um estudo de corte transversal e retrospectivo, no qual foram analisados os prontuários e as mamografias de 160 mulheres, tamanho amostral suficiente para a análise estatística. As variáveis usadas para comparação foram os achados clínicos, mamográficos e histopatológicos, analisados por meio da estatística descritiva e associativa. Resultados: Entre os 160 casos analisados, 76,9% eram sintomáticos e os principais achados clínicos incluíram nódulo palpável (68,1%) e alterações de pele (30%). As apresentações mamográficas prevalentes nas mulheres assintomáticas foram microcalcificações (48,7%), nódulos (43,2%) e distorção arquitetural (8,1%). Com relação ao tipo histológico, 81,3% apresentaram carcinoma ductal invasivo (CDI) e 10,7%, carcinoma ductal in situ (CDIS). Conclusão: O presente trabalho evidenciou que houve uma predominância de mulheres sintomáticas, com apresentação mamográfica de nódulos espiculados e tipo histológico de CDI. Já nas demais pacientes com lesões detectadas no exame de rastreamento predominaram as microcalcificações pleomórficas como o principal achado do CDIS. A mamografia diagnóstica foi a principal forma de detecção do câncer mamário, podendo representar a falta de acesso dessas mulheres aos exames de rastreamento ou à não detecção precoce das lesões malignas, o que revela a necessidade de melhorar as ações de controle e os protocolos de atendimento dessas pacientes.

Reconstrução de mama com retalho excedente de abdominoplastia reversa / Breast reconstruction with excess reverse abdominoplasty flap

Introdução: A mastectomia é um procedimento muito traumático para a mulher. A reconstrução mamaria é parte fundamental do tratamento para melhorar o bem estar psicossocial e a qualidade de vida destas pacientes. Muitas técnicas foram descritas e evoluíram até chegar à atual diversidade de procedimentos modernos associados ou não as próteses mamárias. Esta diversidade de técnicas possibilita a seleção adequada para cada caso, oferecendo melhores resultados. O objetivo deste trabalho é apresentar uma alternativa cirúrgica de reconstrução mamária com retalho de abdome superior associado à prótese mamária. Método: paciente de 59 anos com mastectomia radical direita e três cirurgias prévias de reconstrução mamária com prótese de silicone, sem sucesso. Foi utilizada abdominoplastia reversa com aproveitamento do retalho excedente direito para cobertura de prótese no mesmo tempo cirúrgico. Simetrização da mama contralateral foi obtida dois anos depois, através de mastopexia com troca de prótese. Resultado: Foi obtido o resultado planejado para reconstrução do volume mamário. Discretos sinais inflamatórios no pós-operatório imediato, principalmente no polo superior, tratado com corticoterapia por duas semanas, com regressão completa dos sinais e sintomas. Aspirado seroma (20 ml) com seringa no dia 15º pós cirúrgico, sem recidiva. Não ocorreram complicações como epiteliólise ou necrose do retalho. Conclusão: A reconstrução mamária com retalho abdominal resultante de abdominoplastia reversa pode ser uma opção em casos especiais, oferecendo resultado satisfatório.

Introduction: Mastectomy is a highly traumatic procedure for many women, and mammary reconstruction is a fundamental part of the treatment. Reconstruction has been shown to improve the psychosocial wellbeing and quality of life of these patients, and several techniques and advancements thereof have been described in order to reach the current diversity of modern procedures, whether associated with breast implants or not. This diversity in techniques enables an appropriate selection for each individual case, thus attaining better results. The objective of this report was to present an alternative breast reconstruction method using an upper abdominal flap along with breast implants. Method: A 59-year-old woman had undergone right radical mastectomy and three previous breast reconstruction operations with silicone prostheses, without success. We first performed reverse abdominoplasty with exploitation of an excess right flap used as prosthesis coverage. Two years later, we performed contralateral breast symmetrization using mastopexy with a change of prosthesis. Result: The planned breast volume reconstruction was achieved. Discrete inflammatory signals were observed in the immediate postoperative period, mainly in the upper pole, and treated with corticosteroid therapy for two weeks; this resulted in complete regression of all signs and symptoms. Seroma was aspirated (20 ml) with a syringe on the 15th postoperative day, with no recurrence. No complications, such as epitheliolysis or flap necrosis, occurred. Conclusion: Breast reconstruction with an abdominal flap from reverse abdominoplasty may be an option in a subset of cases, and offers satisfactory results.

Etapificación pre-operatoria con TC de pacientes con cáncer mamario. Alternativa a la RM en un hospital público / Preoperative CT staging of breast cancer patients. Alternative to MRI in a public hospital

The preoperative study in search of multifocality, multicentricity and bilaterality is essential for the proper therapeutic management of breast cancer. The reference standard to accomplish this is breast Magnetic Resonance Imaging (MRI). Based on the literature, we adapted the thorax CT protocol for the study of the breast. The aim of this paper is to demonstrate the feasibility of CT with emphasis on the breast, as an alternative to preoperative MRI in places where it is not available. Pre-operative CT was performed in all patients with newly diagnosed breast cancer between August 2013 and September 2014...

El estudio preoperatorio en búsqueda de multifocalidad, multicentricidad y bilateralidad es fundamental para el adecuado manejo terapéutico del cáncer (CA) mamario. El estándar de referencia para realizarlo es la resonancia magnética (RM) mamaria. Basados en la literatura, adaptamos el protocolo de TC de tórax para el estudio de la mama. El objetivo de este trabajo es demostrar la factibilidad de la TC con énfasis en mama como método alternativo a la RM pre-operatoria, en lugares donde ésta no está disponible. Se realizaron TC pre-operatorias en todas las pacientes con diagnóstico reciente de CA mamario entre agosto de 2013 y septiembre de 2014...

Metástasis enoftalmiantes de la órbita: una excepción a la regla / Enophthalmos due to orbit metastasis: an exception to the rule

De los tipos de cáncer que metastatizan la órbita, el de la mama, el pulmon y la próstata ocupa un lugar preeminente. En ocasiones el diagnóstico del tumor primario permanece elusivo a pesar de una evaluación exhaustiva. La mayoría de las veces producen proptosis ocular y son fácilmente detectados. En otras producen todo lo contrario, enoftalmía, haciendo entonces el problema menos aparente y el diagnóstico elusivo. La metástasis mamaria enoftalmiante de la órbita es un raro evento y debe ser considerada como un diagnóstico diferencial inicial en mujeres maduras con enoftalmía no traumática. En elpresente trabajo presentamos una serie de ocho pacientes con carcimona lobulillar infiltrante y escirroso de la órbita productor de enoftalmía, describimos sus características clínicas y hacemos notar su mal pronóstico vital

Of the types of cancer that metastatize the orbit, the breast, lung and prostate occupy a pre-eminet place. Sometimes the diagnosis of the primary tumor remains elusive despite a thorough assessment. Most of the times produce eye proptosis and are easily detected. In other cases they produce just the oppsite, enophthalmos, then doing the problem least apparent and the diagnosis elusive. Enopthalmos and breast metastasis are a rare event and should be considered as an initial differential diagnosis in especially in mature women with non-traumatic enophthalmos. In this paper we present a series of eight patients with infiltrating lobulillar and scirrous carcinoma of the orbit producing enophthalmos, we described their clinical features and do note their poor vital prognosis

Cáncer de mama asociado a mutaciones genéticas de los BRCA 1 y 2 / Breast cancer associated to BRCA 1 and 2 genetic mutations

Entre el 5 al 10 % de los cánceres de ovario y mama son atribuidos a una transmisión autosómica dominante de mutaciones heredadas en los genes BRCA 1 y BRCA 2. Estos explican el 90 % y el 50 % de los cánceres hereditarios de ovario y mama, respectivamente. Las mujeres que heredan la mutación en el gen BRCA tienen mayor riesgo de cáncer de mama, de ovario y los varones poseedores de dicho gen tienen un riesgo de cáncer de próstata. Las mujeres con la mutación en el gen BRCA 2 también tienen riesgo (aunque menor) de presentar cáncer de mama y de ovario, y en varones hay un riesgo de cáncer de mama. Sin embargo, hay otros síndromes que explican el cáncer hereditario de mama y ovario y otros genes que aún están por descubrirse. Entre estos están el Lynch II, el síndrome Li-Fraumeni, el síndrome de ataxia – telangiectasia, el síndrome de Cowden y el síndrome de Bloom. En la actualidad es posible ofrecer la identificación de estas mutaciones con base en el DNA y en una historia familiar completa, pero la utilidad de la predicción de las pruebas genéticas requiere de una adecuada asesoría para la interpretación de sus resultados.

Between 5 and 10 % of breast and ovarian cancers can be traced to an autosomal dominant mode of inheritance of hereditary mutations in a pair of genes known as BRCA 1 and BRCA 2. They explain 90 % and 50 % of hereditary breast and ovarian cancer, respectively . Women carrying a mutation in the BRCA 1 gene, have a life risk for developing breast cancer and for ovarian cancer, a higher risk of colon cancer and men have a high risk of prostatic cancer. Women having the BRCA 2 gene mutation also have the same risk to develop breast cancer but the ovarian cancer is lower (10 % at 70 years) and is characterized for a risk of 6 % of breast cancer in men. Besides there are other known causes of these hereditary syndromes, other implicated genes still to be discovered. The more renoume syndromes are Lynch II, Li-Fraumeni, Ataxia – Telangiectasia, Cowden and Bloom syndromes, etc. Currently, it is possible to convey detection of carriers of these mutations based on DNA and a complete family history, but the useful prediction of genetic tests requires a formal counseling to interpret the results.

Aplicación del estimador intrínseco a tasas de mortalidad por cáncer de mama / Application of the intrinsic estimator to breast cancer mortality rates

OBJETIVO: Valorar la utilización de la técnica del estimador intrínseco (EI) en el campo de la epidemiología. MÉTODOS: Se aplicó el enfoque EI al análisis de datos sobre cáncer de mama en la Argentina a fin de observar las tendencias asociadas a "edad, período y cohorte" (EPC). Esta metodología recurre a la aplicación de una regresión por componentes principales para obtener un único conjunto de tendencias estimadas. Se compararon sus resultados con los obtenidos por el método convencional "modelos lineales generalizados restringidos" (MLGR) que incluye una restricción adicional a las tradicionales en el modelo estadístico. RESULTADOS: Ambos métodos proporcionaron resultados compatibles en las tendencias asociadas a EPC, aunque difirieron en los intervalos de confianza, con mayor eficiencia por parte del EI. La curva asociada a edad mostró el patrón de cambio esperado según el transcurso de la vida: a mayor edad, mayor riesgo. En relación a cohortes, se evidenció un decrecimiento de los efectos asociados a las cohortes más recientes, mientras que para período los efectos estimados presentaron muy poca variación. CONCLUSIONES: La comparación entre los resultados obtenidos por el método EI y el de MLGR reveló los alcances de la solución genérica provista por el EI al problema de estimación en un modelo EPC. El método EI se basa en una transformación de los datos observados utilizando una matriz de ponderaciones de sencilla aplicación y proporciona estimaciones con propiedades estadísticas deseables.

OBJECTIVE: Assess use of the intrinsic estimator (IE) technique in epidemiology. METHODS: The IE approach was applied to the analysis of breast cancer data in Argentina in order to observe the trends associated with "age, period, and cohort" (APC). This method involves the use of a principal components regression to obtain a single set of estimated trends. The results were compared to the findings obtained with the conventional method, which consists of adjusting a generalized linear model that includes the traditional constraints of the statistical model as well as an additional constraint (CGLM). RESULTS: Both methods yielded compatible results in the trends associated with APC. However, they differed in the confidence intervals, with IE yielding greater efficiency. The curve associated with age showed the expected pattern of change across the life course: the greater the age, the greater the risk. With regard to cohorts, a decrease in the effects associated with the most recent cohorts was evident, whereas there was very little variation in the estimated effects for the period. CONCLUSIONS: A comparison of the results obtained with the IE method and the CGLM method revealed the reach of the generic solution provided by the IE to the problem of estimates in an APC model. The IE method is based on conversion of the data observed using a weighting matrix that is simple to apply and provides estimates with desirable statistical properties.

Concordancia clínica, mamográfica y anatomopatológica en el cáncer mamario / Clinical mammographic, and pathologic concordance in breast cancer

Se efectuó un estudio observacional, descriptivo y transversal para caracterizar, según variables generales, clínicas, anatomopatológicas e imagenológicas, a las 100 pacientes con cáncer de mama que acudieron a la Consulta de Mastología en el Hospital Oncológico Docente Conrado Bení­tez de Santiago de Cuba, desde agosto de 2009 hasta julio de 2010. Se utilizaron el porcentaje como medida de resumen para validar estadísticamente los resultados y el í­ndice de Kappa para determinar la concordancia diagnóstica. En la casuística primaron las féminas de 40-49 años, con antecedentes de mastopatías fibroquísticas y lesión palpable, así­ como también el nódulo en la mama derecha, cuadrante superior externo y periferia del seno; el tumor mayor de un centímetro de dá¡metro y el carcinoma ductal infiltrante en las etapas III-b y IV.

An observational descriptive and cross-sectional study was carried out in 100 patients with breast cancer, who attended the Breast Care Department at Conrado Benítez Teaching Oncology Hospital in Santiago de Cuba from August 2009 to July 2010, to characterize them according to imaging, pathological, clinical, and general variables. Percentage as summary measure to statically validate the results and Kappa index to determine diagnostic concordance were used. Women between 40-49 years with history of fibrocystic breast disease and palpable lesions, as well as lump in the right breast, upper outer quadrant and periphery of the breast, tumor greater than one centimeter in diameter and infiltrating ductal carcinoma in the stages III-b and IV prevailed in the case material.

Detección temprana y diagnóstico del cáncer mamario / Early detection and diagnosis of breast cancer

El aumento global en la frecuencia del cáncer mamario ha sido más preocupante en las naciones con economías en desarrollo como la nuestra, donde las carencias en infraestructura, culturales y en la comunicación fallan para difundir la gravedad del problema y los mecanismos para su detección precoz y tratamiento adecuado. Las cifras de mortalidad por cáncer mamario en México son desde hace 5 años superiores a las del carcinoma cérvicouterino, que era la primera causa de defunciones por cáncer en la mujer. La aplicación de campañas nacionales de tamizaje con mastografías anuales generalizadas a toda la población femenina superior a los 40 años de edad, ha conseguido en los países desarrollados reducir de manera muy importante la mortalidad por cáncer mamario y ha demostrado ser el método de elección para lograr tal reducción. En nuestra realidad nacional la detección del cáncer mamario se realiza cuando los tumores de la mama son palpables en la inmensa mayoría de los casos, por lo que la autoexploración es el recurso a nuestro alcance hasta que puedan efectuarse campañas generalizadas de mastografías de tamizaje que puedan detectar la enfermedad en etapas curables y así abatir las elevadas tasas mortalidad de esta terrible enfermedad.

The global increase in the frequency of breast cancer has been more worrisome in developing countries, in which economies like ours where infrastructural, cultural, and communication deficiencies fail to spread information about the severity of this problem and the mechanisms for its early detection and appropriate treatment. The mortality rate figures due to breast cancer in Mexico, in the last 5 years, have been higher than those of cervix cancer, which used to be the first cause of cancer death in women. The implementation of screening national programs with annual mammographies performed on all female population aged forty years or older, has accomplished, in developed countries, an important reduction in breast cancer mortality rate, and has proved to be the first choice to achieve such a decrease. In our national reality, the detection of breast cancer is mostly performed when breast lumps are large enough to be palpated. That is why breast self-examination is the main resource within our reach until generalized screening mammography campaigns that may detect the disease in early, healing stages, and thus lower the high mortality rates of this terrible disease.

Resonancia magnética mamaria preoperatoria: la gran polémica / Preoperative breast MRI: the great controversy

Preoperative examination intended to detect multifocality, multicentricity and bilaterality-once considered the strongest indication of breast magnetic resonance imaging (MRI)-is currently being strongly questioned in medical literature. This paper aims at evaluating, based on our experience at Clínica Alemana, Santiago, Chile, breast MRI ability to improve preoperative radiological tumour staging by conventional methods, as well as to determine the proportion of patients in which this diagnostic procedure generated changes in the surgical management. We retrospectively reviewed preoperative MRI studies carried out between January 2009 and June 2010. Classification: Group 1: MRI provided no new information. Group 2: by detecting additional lesions, MRI improved radiological staging without changing the type of surgery planned. Group 3: MRI showed new benign lesions and caused unnecessary surgery. Group 4: MRI successfully changed the type of surgery planned based on conventional studies. A total of 419 breast MRI scans were performed during a 18-month period; 39 percent of them were carried out preoperatively. For the analysis, 128 patients were enrolled and distributed in the following categories: Group 1 (66 percent), Group 2 (20 percent), Group 3 (2 percent) and Group 4 (12 percent). In 95.3 percent of the patients, a single surgery with clear margins was performed. This work demonstrated the usefulness of preoperative MRI in our practice, i.e., it allowed for a better radiological staging in one third of the patients and even successfully changed the surgical approach in 12 percent of cases.

El estudio preoperatorio en búsqueda de multifocalidad, multicentricidad y bilateralidad -antes considerada la indicación más sólida de la resonancia magnética (RM) mamaria- hoy se encuentra fuertemente cuestionada en la literatura. En este trabajo nos propusimos evaluar la capacidad de la RM mamaria en nuestro centro para mejorar la etapificación radiológica preoperatoria realizada por métodos convencionales y determinar la proporción de las pacientes en que genera cambio en el enfoque quirúrgico. Hemos revisado retrospectivamente las RM preoperatorias entre enero de 2009 y junio de 2010. Clasificación: Grupo1: la RM no aportó información nueva. Grupo 2: al detectar lesiones adicionales, mejoró la etapificación radiológica, sin cambiar el tipo de la cirugía planificada. Grupo3: demostró nuevas lesiones no malignas y causó cirugía inútil. Grupo 4: cambió correctamente el tipo de cirugía planeada en base a los estudios convencionales. En los 18 meses se realizaron 419 RM mamarias, el 39 por ciento de ellas en preoperatorio. Para el análisis se han reclutado 128 pacientes con la siguiente distribución en los grupos predeterminados: Grupo 1(66 por ciento), Grupo 2(20 por ciento), Grupo 3(2 por ciento) y Grupo 4(12 por ciento). En el 95,3 por ciento de las pacientes se logró realizar una sola cirugía con márgenes libres. Este trabajo demostró la utilidad de la RM preoperatoria en nuestra práctica: permite una mejor etapificación radiológica en el tercio de las pacientes e incluso cambia correctamente el enfoque quirúrgico en el 12 por ciento de los casos.

Cáncer de mama en Chile: tardanzas en su atención médica / Breast cancer in Chile: delays in its diagnosis

Objetivos. Destacar el problema del cáncer de mama en Chile y determinar las características de las pacientes con estadíos avanzados III y IV, en el servicio de salud sur oriente de Santiago (SSMSO), años 1997 y 2007. Además, comparar los intervalos normados GES en su atención y el anterior a la primera consulta, no normado. Material y método. Es un estudio retrospectivo analítico de todos los estadíos avanzados III y IV del SSMSO, comparando 1997 con 2007 (39 y 51 pacientes mujeres) en base a una encuesta validada, además de revisar fichas clínicas y otros documentos. Resultados. Hubo mejoría pero sin grandes diferencias, como promedios, de los intervalos normados en las pacientes 2007 (post-GES) comparado con 1997 (pre-GES). Se observó mayor edad (66,6 por ciento vs 56,4 por ciento sobre 49 años) y significativa mayor mortalidad a los 30 meses en pacientes 2007 (39,2 por ciento vs 17,9 por ciento), influida por estadíos III B y IV, comparado con 1997, también a los 30 meses. La proporción global de estadíos III y IV fue el 2007 de 19,7 por ciento comparado con 1997 en que fue 74,6 por ciento. Conclusiones. Se debería estudiar las causas de la enorme tardanza promedio, 12 y 20 meses, entre percepción de patología mamaria y primera consulta. Se sugiere priorizar edades mayores y cánceres avanzados III y IV, cuya alta proporción nacional del 30 por ciento influye en la alta y creciente mortalidad por cáncer de mama en Chile. El SSMSO, sin tamizaje mamográfico, ha demostrado que tiene la menor mortalidad de la región metropolitana e inferior al nivel nacional, atribuible a su menor proporción actual de cánceres avanzados, bajo 20 por ciento.

Objective. To characterize advanced breast cancers in the metropolitan south eastern health service in Santiago (SSMSO), years 1997 and 2007. Also, to evaluate whether regulated maximal delays in medical care for this cancer have been accomplished in 2007.Material and method. A retrospective study of all advanced stages III and IV (39 and 51 female patients) at SSMSO through a validated questionnaire and other documents was carried out. Personal characteristics, family background, gynecologic, obstetric antecedents, and both disease development and delays in health care were studied. Results. Personal and family variables were similar in 2007 and 1997 patients. A huge delay before first consultation was observed in some patients. Intervals among the different stages of patient management were achieved in 2007 as prescribed in the Guaranteed Health Care Regime of Chile (started in 2005) but with a great dispersion and without a reduction in mortality. Conclusions. The national breast cancer control program should focus on higher ages and advanced stages. Delays before a first consultation should be studied. The SSMSO shows the best sanitary results for breast cancer in the metropolitan region in spite of not having a mammographic screening program.

Actualización en reconstrucción mamaria / An update on breast reconstruction

La Reconstrucción Mamaria es un amplio y demandante campo de la Cirugía Plástica que exige manejo en el ámbito estético y reparador. Existen numerosas técnicas que permiten ofrecer la mejor indicación a cada paciente, tales como uso de implantes, colgajos pediculados y libres, y reducción y pexia mamaria. El objetivo de este artículo es dar a conocer el estado actual de la cirugía de Reconstrucción Mamaria. Además se presenta una sugerencia de reconstrucción para cada una de las situaciones clínicas más frecuentes.

Breast Reconstruction is a wide and challenging field of Plastic Surgery. It demands both, aesthetic and reconstructive surgical skills. There are many techniques allowing the surgeon to offer the best indication for each patient, such as breast implants, pedicled and free flaps, breast reduction and mastopexy techniques. The aim of this article is to show the state of the art in breast reconstruction surgery. Surgical indications for the most frequent clinical scenarios are proposed.

Cánceres mamarios de buen pronóstico: presentación de una serie de 80 casos / Breast cancers of good prognosis: presentation of a series of 80 cases

INTRODUCCIÓN. Se conoce que el tipo histológico del cáncer de mama influye fuertemente en el pronóstico de la enfermedad y que existe una correlación directa entre este y los índices de supervivencia. El objetivo de este estudio fue evaluar las variedades histopatológicas que están asociadas a un buen pronóstico de la enfermedad. MÉTODOS. Se realizó un estudio descriptivo, longitudinal y retrospectivo de la influencia de las variedades histológicas sobre el pronóstico del cáncer mamario en pacientes operadas entre enero de 1976 y diciembre de 2007. De un total de 597 cánceres de mama atendidos en ese período, fueron tomados 80 casos con tipos histológicos de buen pronóstico. RESULTADOS. Se encontraron 23 cánceres de mama no invasivos, todos con un índice de supervivencia elevado. Se presentaron 14 carcinomas mucinosos con un 57 por ciento de metástasis ganglionar, que se evidenció en los tumores con más de 4 cm de diámetro. Se registraron 10 casos de carcinomas tubulares y cribiformes (1,8 por ciento), con un pronóstico excelente. Se estudiaron 16 carcinomas papilares invasores, donde a pesar del gran tamaño no se encontraron ganglios metastáticos en las 168 adenopatías analizadas. Fueron evaluados 17 carcinomas medulares mamarios, para una incidencia del 2,85 por ciento y un pronóstico relativamente favorable. CONCLUSIONES. Todas estas variedades histopatológicas, exceptuando las no invasivas, tuvieron caracteres invasores comunes, márgenes bien delimitados y un excelente pronóstico luego del tratamiento quirúrgico(AU)

INTRODUCTION. It is known that the histopathological type of breast cancer exerts a strong influence on the prognosis of the disease and that there exists a direct correlation between this and the survival rates. The objective of this study was to evaluate the histopathological varieties associated with a good prognosis of the disease. METHODS. A retrospective, longitudinal, and descriptive study on the influence of the histological varieties on the good prognosis of breast cancer in patients operated on at Dr. Mario Muñoz Monroy University Hospital of Colón, Matanzas Province, from January 1976 to December 2007, was conducted. Of a total of 597 breast cancers attended in that period, 80 cases with histological types of good prognosis were taken. RESULTS. We found 23 non-invasive breast cancers, all of them with an elevated survival rate. 14 mucinous carcinomas were detected with 57 percent of ganglionic metastasis, which was evidenced in the tumors over 4 cm of diameter. Ten cases of tubular and cribriform carcinomas (1.8 percent) with an excellent prognosis were reported. 16 invasive papillary carcinomas were studied. In spite of their great size, no metastatic ganglia were found in the 168 analyzed.adenopathies. 17 medullary breast carcinomas were evaluated for an incidence of 2.85 percent and a relatively favorable prognosis. CONCLUSIONS. All these histopathological varieties, excepting the non-invasive, had common invasive characters, well delimited margins and an excellent prognosis after the surgical treatment(AU)

Aspectos psicossociais e afetivo-conjugais em mulheres com e sem câncer da mama / Psychosocial and affective-conjugal aspects of women with and without breast cancer

O câncer da mama acomete inúmeras mulheres e preocupa profissionais de diferentes áreas da saúde, em busca de alternativas para a prevenção e o tratamento dessa doença. Esta pesquisa visou a contribuir para os avanços teóricos em psicooncologia, investigando os aspectos psicossociais e afetivo-conjugais na história de mulheres com câncer, comparativamente a mulheres sem câncer, com base no referencial sistêmico. Foram realizados estudo quantitativo e análise qualitativa, por meio da aplicação de questionários semi-estruturados em 80 pacientes, sendo 40 mulheres com diagnóstico de câncer de mama e 40 mulheres sem diagnóstico de câncer da mama (grupo-controle), com idade de 45 a 65 anos, que têm ou tiveram esperiência conjugal. Nos resultados obtidos, as participantes de ambos os grupos relataram a ocorrência de eventos psicossociais e afetivo-conjugais geradores de estresse, encontrando-se diferenças significativas entre os grupos quanto à maneira como lidam com esses eventos. Encontram-se, também, diferenças significativas entre ambos os grupos, quanto aos motivos e às expectativas da união conjugal, ao modo de enfrentamento das crises e aos sentimentos presentes na relação. Concluiu-se pela prevalência de fatores de enfrentamento afetivo-emocionais de estresse patogênico no grupo de mulheres com câncer.

The cancer of breast hits inumerable women and worries professionals of different areas of health, in search of alternatives to the prevention and treatment of this disease. This research aims to contribute to the theoretical advances in psycho-oncology, investigating psychosocial, affective and conjugal aspects in the background of women with cancer, compare the women not cancer, based in the systemic referential. A quantitative study and qualitative analysis were performed, by the application of semi-structured questionnaires in 80 subjects, being 40 women with breast cancer diagnostic and 40 women without breast cancer diagnostic (control group), with ages from 45 to 65, who have or had conjugal experience. The results obtained indicated that the participating women from both groups declare the occurrence of stress generating affective-conjugal and psychosocial events, finding signicant differences between the groups in relation to the way they deal with those events. Significant differences were also found between both groups, in relation to the motives and expectations of the conjugal union, to the way of coping with crisis and to the feelings present in the relation. It is concluded that there are prevalence of emotional-affective coping factors of pathogenic stress in the group of women with cancer.

Conhecimento e prática do auto-exame de mamas por enfermeiras / Knowledge and practice of breast self-examination by nurses / Conocimiento y practica del autoexamen de mama por enfermeras

Estudo qualitativo, com onze enfermeiras especializandas de enfermagem obstétrica em Teresina-PI, cujos objetivos foram descrever o conhecimento e práticas destas sobre medidas de controle do câncer mamário e discutir a prática do auto-exame pelas enfermeiras. A técnica utilizada foi a do grupo focal. Os resultados mostram morte ou mutilações, seguidas pelo prognóstico ruim como as significações associadas ao câncer mamário. Como medidas de controle referiram hábitos saudáveis e realização de exames; destacando-se auto-exame; mamografia; ultra-sonografia; exame clínico, estático e dinâmico; e biópsia na confirmação da malignidade. Dentre as orientações dadas à clientela, destacaram-se o auto-exame, alimentação saudável, atividade física e abstenção de vícios. Conclui-se que estas profissionais não realizavam o auto-exame com freqüência, mas a maioria mantinha uma alimentação saudável.

A qualitative study, with eleven nurses studying obstetric nursing in Teresina-PI, the objectives of which were to describe their knowledge and practice of measures to control breast cancer and to discuss the practice of self-examination by nurses. A focus group was used as technique. The results show death or mutilations, followed by a bad prognosis, such as significances associated with breast cancer. They mentioned control measures such as healthy habits and examinations, especially self-examination, mammography, ultrasonography, clinical, static and dynamic examination, and biopsy in the confirmation of malignancy. Among the guidelines provided to customers, self-examination, healthy food habits, physical activity and no addictions were the most important ones. It can be concluded that these professionals did not perform self-examination very often, but the majority had healthy food habits.

Estudio cualitativo realizado con once enfermeras del último año del curso de especialización en enfermería obstétrica en Teresina-Pi, cuyos objetivos fueron describir el conocimiento y las prácticas que tuvieron sobre las medidas de control del cáncer mamario y discutir la práctica del autoexamen. La técnica fue la del grupo focal. Los resultados muestran muerte o mutilaciones, después del prognóstico desfavorable. Como medidas de control las enfermeras se refirieron a los hábitos saludables y a la realización de exámenes. Entre ellos están: el autoexamen; mamografía; ultrasonografía; examen clínico, estático y dinámico y la biopsia, al confirmarse la malignidad. Entre las orientaciones dadas a la clientela, se destacaron el autoexamen, una alimentación sana, la actividad física y la abstención de vicios. Se concluye que las profesionales no realizaban el autoexamen con frecuencia, pero mantenían una alimentación sana.

Estudo dos fatores de risco para a recidiva local em pacientes com câncer mamário estádios I e II tratadas com conservação da mama

O Tratamento do carcinoma mamário estádios I e II com conservação da mama, já é tido como sendo tão seguro e confiável quanto a mastectomia. Entretanto são esperadas taxas de recidiva local da patologia entre 5 e 22% após 5 anos de seguimento, tornando-se assim, de capital importância o estudo dessas recorrências. O objetivo deste trabalho foi analisar 25 fatores clínicos, laboratoriais e anatomopatológicos de carcinomas mamários estádio I e II que pudessem estar associados à recorrência do tumor na mama tratada. O grupo estudado foi constituído por 156 pacientes com menos de 70 anos, acometidas por tumores de até 4 cm no maior diâmetro; tratadas por tumorectomia, dissecção axilar, implantação de agulhas de iridium e telerradioterapia, das quais 25 apresentaram subseqüentemente recidiva na mama tratada. Por análise univariativa, utilizando-se tabelas de vida pelo método de Kaplan-Meyer e analisando-se pelo teste de Logrank, os fatores associados ao risco de reicidiva local foram: idade- 41 anos, tamanho clínico do tumor- 3 cm, carcinoma ductal graus II e III, tamanho anatômico do tumor- 2 cm, presença de necrose intratumoral, comprometimento axilar histológico e estádio pós- cirúrgico II (p E II). Para obter a inter-relação das variáveis utilizou-se a regressão logística de cox, em que somente o estádio pós-cirúrgico II e a presença de necrose intratumoral se mostraram como variáveis significativamente independentes. Com estas duas variáveis, foi possível separar o risco de recidiva local em três grupos: “Baixo risco” (p E I e necrose ausente), onde a taxa acumulativa de recidiva local foi de 4% aos cinco anos; “Risco intermediário” (pE I e necrose presente ou pE II e necrose ausente), em que a taxa acumulativa de RL aos cinco anos foi de 17%; e “Alto Risco” (p E II e necrose presente), com esta taxa de 40%. Por fim são sugeridos estudos que deverão indicar qual a melhor forma de tratamento para as pacientes enquadradas no grupo de alto risco para recidiva local

There is now enough evidence with regards to the safety and reliability of breast conserving therapy for early breast cancer. However, it is expected that between 5 and 22% of the patients, will develop local relapse after a 5-year follow up, thus it is of great importance to study these radiation failures. The aims of this study was to analyse 25 clinicallaboratory, and pathological factors that could be associated to relapse in a treated breast. The studied group comprised 156 patients with tumours up to 4 cm in diameter, aged up to 70 years, and treated by tumourectomy, axillary clearance, implant of iridium wires and external radiotherapy, of whom 25 developed breast relapse subsequently. The study included both a univariative analysis by means of Kaplan-Meyer life tables and analysis by long-rank test. The features that appeared associated with breast relapse were: age-41 years, tumour clinical size- 3cm, ductal carcinoma grade II orIII, tumor anatomical size- 2 cm, presence of intratumouralnecrosis, axillary lymph nodes metastases and post-surgical stage II. In order to obtains the relationship among variables, a Cox regression model was used, that identified only the post-surgical stage II and necrosis as significantly independent variables. With these two factores it was possible to create three local relapse risk groups: 1-Low risk (p E I and – ve necrosis) in whom a cumulative local relapse rate after a 5 year follow up was 4%; 2- Intermediate risk ) p E I and +ve necrosis or p E II and –ve necrosis) with a cumulative 5 year local failure rate being 17%; 3- High risk group (p E II and +ve necrosis) with this rate of 40%. Finally, it is suggested that the local relapse high risk group should be tested in prospective trials in order to stablish the best kind of treatment