ABSTRACT
Background: Gynecological cancers of the uterus and cervix are common malignancies in women. The correct management of these tumors involves many figures. Material and methods: Therefore, to respond to these multidisciplinary needs in June 2019 in Azienda Ospedialiero-Universitaria of Modena was born a Diagnostic and Therapeutic Care Pathways (DTCP) with gynaecologists, radiotherapists, medical oncologists, radiologists, nuclear medical doctors, pathologists, anaesthesiologists, a nurse Case Manager and a patients' association representative. A molecular biologist, endocrinologists and nutritionists have already enriched the team after the first year of activity. The group performs weekly collegial discussions of clinical cases and cohort visits, continued in the COVID era. Results: The new diagnoses in the first year of activity were 53 endometrial cancers (EC) and 24 cervical ones (CC). The median age at diagnosis was 51 years between EC patients and 70 years in CC. 87% of EC were endometrioid subtypes, while 65% CC were squamous cell ones. 70% EC patients (pts) were stage (st) I (52% IA and 48% IB), 5,5% st II, 9,4% st III and 11,3% st IV. Immunohistochemical analysis for estrogen and progesterone receptor, p53 and mismatch repair (MMR) proteins were performed on 20 EC. All tumours tested are p53 negative. We found 3 pts who had MMR deficiency, none of them diagnosed with Lynch syndrome at the subsequent genetic counselling. After surgery, 66% pts in st I underwent observation and 34% made radiotherapy (RT). Among st II pts, 1 patient performed RT, one other platinum- based chemotherapy (pCT) and the third did not perform any adjuvant treatment for ECOG. All except one st III pts (67%) underwent pCT with RT. Among st IV one received surgery, pCT and palliative RT, the others (83%) made pCT. Most CC were diagnosed in early st. 9 pts underwent upfront surgery, followed in 2 cases with RT and in 3 with RT and pCT. One patient received neoadjuvant chemo-RT. Radical RT with weekly cisplatin was performed in 9 pts, other 4 pts made RT alone due to advanced age and/or ECOG. One patient started observation for age, ECOG and absence of symptoms. Conclusions: In our experience, DTCP allows the optimization of the diagnostic and therapeutic strategy in EC and CC pts, especially in most complex cases.
ABSTRACT
INTRODUCTION: The present analysis aims to evaluate the consequences of a 2-month interruption of mammographic screening on breast cancer (BC) stage at diagnosis and upfront treatments in a region of Northern Italy highly affected by the severe acute respiratory syndrome-related coronavirus-2 (SARS-CoV-2) virus. METHODS: This retrospective single-institution analysis compared the clinical pathological characteristics of BC diagnosed between May 2020 and July 2020, after a 2-month screening interruption, with BC diagnosed in the same trimester of 2019 when mammographic screening was regularly carried out. RESULTS: The 2-month stop in mammographic screening produced a significant decrease in in situ BC diagnosis (-10.4%) and an increase in node-positive (+11.2%) and stage III BC (+10.3%). A major impact was on the subgroup of patients with BC at high proliferation rates. Among these, the rate of node-positive BC increased by 18.5% and stage III by 11.4%. In the subgroup of patients with low proliferation rates, a 9.3% increase in stage III tumors was observed, although node-positive tumors remained stable. Despite screening interruption, procedures to establish a definitive diagnosis and treatment start were subsequently carried out without delay. CONCLUSION: Our data showed an increase in node-positive and stage III BC after a 2-month stop in BC screening. These findings support recommendations for a quick restoration of BC screening at full capacity, with adequate prioritization strategies to mitigate harm and meet infection prevention requirements.