Breast cancer in Latin America: global burden, patterns, and risk factors / Cáncer de mama en América Latina: carga, patrones y factores de riesgo

Breast cancer is a major public health problem in Latin America (LA) and the most common form of cancer among women. An important variability according to ethnicity/race with respect to incidence/mortality, clinical characteristics, and prognosis is observed throughout LA. In addition, women are more likely to develop breast cancer (BC) at younger age and to be diagnosed at an advanced stage compared to western women. While little is known about specific risk factors, changes in reproductive pattern (parity, breastfeeding) and lifestyle factors including sedentary behaviours, unhealthy diet, and alcohol intake may contribute to the increase of BC incidence. In this paper we give an overview of the burden and patterns of BC, review the leading causes of BC and discuss the possible ways to improve BC prevention and control in LA.

El cáncer de mama (CaMa) es uno de los mayores problemas de salud pública en América Latina (AL) y el cáncer más frecuente en mujeres. Se observa una importante variabilidad en la incidencia/mortalidad, las características clínicas y el pronóstico según la etnia/raza a lo largo de AL. Además, las mujeres latinoamericanas son más propensas a desarrollar CaMa en edades más tempranas y a ser diagnosticadas en una etapa más avanzada, comparando con mujeres occidentales. Aunque poco se sabe sobre sus factores de riesgo específicos, cambios en los patrones reproductivos (paridad y lactancia) y estilos de vida, incluyendo los hábitos sedentarios, las dietas poco saludables y el consumo de alcohol, podrían contribuir al incremento de la incidencia del CaMa. En este artículo se da una visión general de la carga y los patrones del CaMa, se revisan las causas principales del CaMa y se discuten posibles vías para mejorar la prevención y el control del CaMa en AL.

TP53 Gene and Li-Fraumeni Syndrome

Cancer is a disease that strikes most families and itsdevastating effects bring suffering and instability to bothpatient and family. Clustering of cancers in certainfamilies is even more devastating, leading medicine tostudy its origin and ways to prevent it. Many cancersyndromes have been identified due to the repeatedoccurrence of specific tumors over a certain age-range.The rare cancer predisposition Li-Fraumeni syndrome(OMIM #151623; LFS) is transmitted in an autosomaldominant pattern, which predisposes affectedindividuals to an increased risk of developing a varietyof cancers at an early age, including childhood. The mostcharacteristic forms of cancers in LFS include soft-tissuesarcoma, breast cancers, brain tumors, and adrenocorticalcarcinomas. LFS is a dominantly inherited syndrome,frequently associated with germline mutations in theTP53 gene (OMIM #191170), which encodes protein p53.This protein regulates cell cycle, apoptosis, DNA repair,differentiation, senescence and development. Activationof p53 prevents DNA replication and cell proliferationwhen cells are subjected to stress that may disturb geneticor genomic integrity. Thus, TP53 acts as a major tumorsuppressor gene by exerting simultaneous control onmany components of the molecular mechanisms ofcarcinogenesis. Loss of p53 function may favor cancerdevelopment and explains predisposition in germlineTP53 mutation carriers. This review will discuss the maincharacteristics of TP53, its regulation, the consequencesof its inactivation in cancer, the germline TP53 mutationrelated to Li-Fraumeni syndrome and strategies forsurveillance.