Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial

Abstract Background Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. Objective We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. Methods Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5 mg.kg-1 bolus then 0.12 mg.kg-1.h-1 infusion for the first 24 hours postoperatively. Group KM: received ketamine 0.5 mg.kg-1 and Mg sulfate 50 mg.kg-1, then ketamine 0.12 mg.kg-1.h-1 and Mg sulfate 8 mg.kg-1.h-1 infusions for the first 24 hours postoperative. The primary outcome was the morphine consumption in the first 24 hours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. Results Group KM had less postoperative opioid consumption (14.12 ± 5.11 mg) than Group K (19.43 ± 6.8 mg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. Conclusion Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Effect of magnesium sulfate with ketamine infusions on intraoperative and postoperative analgesia in cancer breast surgeries: a randomized double-blind trial.

BACKGROUND: Opioids are the cornerstone in managing postoperative pain; however, they have many side effects. Ketamine and Magnesium (Mg) are NMDA receptor antagonists used as adjuvant analgesics to decrease postoperative opioid consumption. OBJECTIVE: We assumed that adding Mg to ketamine infusion can improve the intraoperative and postoperative analgesic efficacy of ketamine infusion alone in cancer breast surgeries. METHODS: Ninety patients aged between 18 and 65 years and undergoing elective cancer breast surgery were included in this prospective randomized, double-blind study. Group K received ketamine 0.5.ßmg.kg...1 bolus then 0.12.ßmg.kg...1.h...1 infusion for the first 24.ßhours postoperatively. Group KM: received ketamine 0.5.ßmg.kg...1 and Mg sulfate 50.ßmg.kg...1, then ketamine 0.12.ßmg.kg...1.h...1 and Mg sulfate 8.ßmg.kg...1.h...1 infusions for the first 24.ßhours postoperative. The primary outcome was the morphine consumption in the first 24.ßhours postoperative, while the secondary outcomes were: intraoperative fentanyl consumption, NRS, side effects, and chronic postoperative pain. RESULTS: Group KM had less postoperative opioid consumption (14.12.ß...ß5.11.ßmg) than Group K (19.43.ß...ß6.8.ßmg). Also, Group KM had less intraoperative fentanyl consumption. Both groups were similar in postoperative NRS scores, the incidence of side effects related to opioids, and chronic neuropathic pain. CONCLUSION: Adding Mg to ketamine infusion can safely improve intraoperative and postoperative analgesia with opioid-sparing effect in cancer breast surgery.

Factores asociados a depresión en pacientes con cáncer de mama / Factors associated with depression in patients with breast cancer

Objetivo: Sistematizar los hallazgos de los estudios sobre los factores asociados a depresión en pacientes con cáncer de mama. Métodos: Se realizó una revisión sistemática de la literatura médica en Medline, SciELO y Google Scholar con los términos descriptores del Medical Subject Headings: depression, breast cancer. Se seleccionaron 6 artículos con los criterios de exclusión de artículos con un periodo de publicación entre 2013-2018, escritos en español o inglés, que analizaban a pacientes con depresión asociado a cáncer de mama y estudios con una muestra mínima de 80 participantes. Resultados: En esta revisión se han incluido 6 estudios. Los factores asociados a depresión en pacientes con cáncer de mama tenemos está la edad donde se ve que la población entre 40 y 60 años, estar divorciada o soltera, grado de instrucción hasta primaria, estar desempleado, pertenecer a una clase social baja, el estadío clínico 4 y el tratamiento de quimioterapia aumenta el riesgo de tener depresión en pacientes con cáncer de mama. Conclusión: Se concluye en la presente revisión que hace falta más estudios a mayor escala respecto a los factores asociados a depresión en pacientes con cáncer de mama especialmente a nivel de Perú, ya que se encontró solo un artículo relacionado al tema de interés. Por otra parte hace falta sistematizar bien los factores asociados ya que se encuentran diversos factores relacionados a depresión y con diferentes resultados dependiendo del tipo de hospital y de país, para poder plantear un buen programa de apoyo psicológico y educación sobre la enfermedad.

Objective: Systematize the findings of the studies on the factors associated with depression in patients with breast cancer. Methods: A systematic review of the medical literature was made in Medline, SciELO and Google Scholar with the descriptive terms of the Medical Subject Headings: depression, breast cancer. Six articles were selected with the exclusion criteria of articles with a publication period between 2013-2018, written in Spanish or English, which analyzed patients with depression associated with breast cancer and studies with a minimum sample of 80 participants. Results: In this review, 6 studies have been included. The factors associated with depression in patients with breast cancer we have this age where it is seen that the population between 40 and 60 years, be divorced or single, education grade up to primary, be unemployed, belong to a low social class, the stadium clinical trial 4 and chemotherapy treatment increases the risk of depression in patients with breast cancer. Conclusion: It is concluded in the present review that more studies on a larger scale are needed regarding the factors associated with depression in patients with breast cancer, especially the level of Peru, since only one article related to the topic of interest was found. On the other hand, it is necessary to systematize the associated factors well since there are several factors related to depression and with different results depending on the type of hospital and country, in order to propose a good program of psychological support and education about the disease.

Endocrine disruptors and their influence in the origin of breast neoplasm and other breast pathologies / Disruptores endócrinos e o seu papel na gênese das neoplasias e de outras patologias das mamas

A higher occurrence of early breast cancer in women has created the need to identify possible etiologic agents characterized as direct co-responsible. The motivation for this review is the relevance of detecting potential endocrine disruptors responsible for harmful effects on breast tissue and, consequently, its damage

Uma maior ocorrência no surgimento precoce das neoplasias das mamas em mulheres tem gerado a necessidade da descoberta dos possíveis agentes etiológicos caracterizados como corresponsáveis diretos. A relevância da detecção dos possíveis disruptores endócrinos responsáveis por exercer efeitos danosos nos tecidos mamários e, consequentemente, o seu comprometimento é a motivação da presente revisão

RELATIONSHIP BETWEEN OBESITY AND BREAST CANCER / Relação entre obesidade e câncer de mama

Obesity is a growing clinical condition around the world, considered a risk factor for numerous diseases such as hypertension, myocardial infarction, diabetes, and cancer. Among the neoplasms related to overweight, breast cancer stands out. Therefore, the objective of this review is to elucidate the impact of obesity on the most prevalent cancer among women, either as a direct risk factor for its onset or as a determinant of survival

A obesidade aponta como condição clínica em ascensão pelo mundo, considerada fator de risco para inúmeras doenças como hipertensão, infarto, diabetes e câncer. Dentre as neoplasias relacionadas com o excesso de peso, destaca-se o câncer de mama. O objetivo desta revisão é, portanto, elucidar o impacto que a obesidade causa no câncer mais prevalente entre as mulheres, seja como fator de risco direto para seu aparecimento, seja como determinante na sobrevida

Aplicación actual de la clasificación Inmunohistoquímica de cáncer de mama / Current Applicaton of Immunohistochemistry in Breast Cancer

Introducción: El cáncer de mama es la primera causa de mortalidad en el mundo y en Guatemala ocupa el segundo lugar en frecuencia. Desde 1991 su clasifcación ha evolucionado a fn de mejorar el pronóstco y su tratamiento basado en la descripción del tpo y grado histológico. El objetvo de este estudio es conocer la aplicación actual de la inmunohistoquímica en cancer de mama. Metodología: Estudio observacional descriptvo retrospectvo, sobre cáncer de mama clasifcado por inmunohistoquímica en 281 pacientes en el Insttuto Guatemalteco de Seguridad Social (IGSS) de enero 2012 a enero del 2017. Resultados: El subtpo Luminal A se presentó en el 31% de los pacientes y su tratamiento fue principalmente hormonal; seguido por el Triple Negatvo en el 26% tratado mayoritariamente con quimioterapia. El HER2 Positvo en el 21%, el subtpo B-like 13% y en menor frecuencia el Luminal B en el 9% de los casos. El subtpo triple negatvo presento mayor recurrencia y mortalidad con mayor elevación del P53 (40%, OR 2.4) y Ki67 (37%, OR 1.4). La edad en la mayoría de pacientes incluidas fueron superiores a los 40 años y los estadios II y III se presentaron con mayor frecuencia. Conclusiones: El estudio de la inmunohistoquímica realizado en los tejidos obtenidos permitó mostrar que el subtpo luminal A fue el más frecuente, recibiendo en la mayoría de los casos tratamiento hormonal. El más agresivo en recurrencia, metástasis, mortalidad y con valor elevado del Gen p53 y Ki67, fue el Triple Negatvo, tratado con quimioterapia.

Background: Breast cancer is the leading cause of death in the world, and in Guatemala it is the second most common cause of death. Since 1991, its classifcaton has evolved in order to improve prognosis and treatment based on the descripton of type and histological grade. The purpose of this study is to learn the current applicaton of immunohistochemistry of breast cancer. Methods: This retrospectve descriptve observatonal study of breast cancer classifed by immunohistochemistry was performed on 281 patents at the Guatemalan Social Security Insttute (IGSS) between January 2012 and January 2017. Results: The subtype Luminal A was present in 31% of the patents and treatment was mainly hormonal; followed by Triple Negatve in 26% of patents treated mainly with chemotherapy. HER2 positve in 21% of patents, subtype B-like in 13% and lower frequency Luminal B in 9% of the patents. The triple negatve subtype presented higher recurrence and mortality with P53 elevaton (40%, OR 2.4) and Ki67 (37%, OR 1.4). Average age in the study was 40 years old and stages II and III were more frequent. Conclusions: The study of immunohistochemistry performed on tssue obtained, demonstrated that Luminal A subtype is the most frequent, in which the majority of patents received hormonal treatment. The most aggressive in recurrence, metastasis, mortality and with high values of gene p53 and Ki67, was the Triple Negatve, which were treated with chemotherapy.

IMPROVEMENT ASSESSMENT OF MASTOLOGIST IN THE BREAST ONCOPLASTIC AND RECONSTRUCTIVE SURGERY OF SANTA CASA DE BELO HORIZONTE, MG, BRAZIL / Avaliação do aprimoramento do mastologista em cirurgia oncoplástica e reconstrutiva da mama da Santa Casa de Belo Horizonte

Objective: This study aims to investigate the efficacy and improvement of knowledge acquired by breast cancer specialists in a postgraduate course of Oncoplastic Surgery conducted in Santa Casa de Belo Horizonte (SCBH). Method: For this evaluation, an exploratory qualitative study was carried out. It was supported by an online survey questionnaire sent to 36 breast cancer specialists, who had taken the course in the period from 2012 to 2014. The data were interpreted using statistical methods, as well as probabilistic sampling. Results: After the Oncoplastic Surgery course, almost all breast cancer specialists who had taken it demonstrated the ability to reconstruct the breasts of women who had undergone mastectomies with oncoplastic techniques. A large portion of the specialists was able to develop bilateral treatment with breast reduction, mastopexy and rebuild areolas and nipples, as well as immediately reconstruct the breast with expanders or prosthesis and contralateral symmetrization. A significant amount of professionals was able to perform breast reconstruction with autologous flaps. Conclusion: The course for the Professional Development of Breast Cancer Specialists sponsored by the Teaching and Research Institute of Santa Casa de Belo Horizonte was able to improve the skills of the professionals involved in the different breast remodeling and reconstruction techniques. This enables a paradigm shift in the treatment of cancer patients.

Objetivo: Este trabalho objetiva investigar a eficácia e aprimoramento dos conhecimentos adquiridos por mastologistas no Curso de Pós-graduação de Oncoplastia Mamária da Santa Casa de Belo Horizonte (SCBH). Método: Para essa avaliação, realizou-se um estudo exploratório de natureza qualitativa. Como suporte, a aplicação de questionário de pesquisa, enviado online aos trinta e seis mastologistas que fizeram o Curso, no período de 2012 a 2014. Os dados foram interpretados por intermédio de métodos estatísticos, bem como por uma amostragem probabilística. Resultados: Após o Curso, quase a totalidade dos Mastologistas que se aprimoraram se mostram capazes de reconstruir a mama das mulheres mastectomizadas com técnicas oncoplásticas. Uma grande parcela tem condições de desenvolver tratamento bilateral com redução mamária, mastopexia e reconstruir aréolas e mamilos, e reconstruir de maneira imediata a mama, com expansores ou próteses e simetrização contralateral. Uma quantidade significativa dos profissionais é capaz de efetuar a reconstrução da mama com retalhos autólogos. Conclusão: O Curso promovido por esse Instituto de Ensino e Pesquisa foi capaz de aprimorar os profissionais envolvidos, nas diferentes técnicas de remodelamento e reconstrução mamária. Isso possibilita uma mudança de paradigma no tratamento da paciente oncológica.

Guía práctica y resultados de la implementación de un programa de auditoría y calidad en imágenes mamarias / Practical Guide and Results of the Implementation of an Audit and Quality Program in Breast Imaging

Objetivo: Describir la experiencia del Centro de Diagnóstico para la Mujer, de la Fundación Santa Fe de Bogotá (FSFB), en la implementación de un sistema práctico de auditoría en imágenes mamarias y su utilidad en los procesos de calidad, basados en parámetros establecidos por el American College of Radiology (ACR). Métodos: Evaluación de los indicadores propuestos por el ACR mediante bases de datos y sistemas de información de imágenes de la FSFB (enero 2012-diciembre 2014). Se incluyeron todos los estudios mamográficos y biopsias de mama realizadas por ecografía y estereotaxia. Los resultados se compararon con los descritos en BIRADS ® 5ta. edición. Se realizó una búsqueda de la literatura en PubMed para definir el estado del arte de los procesos de auditoría en imágenes mamarias. Resultados: Incluimos 13 artículos originales y 4 guías internacionales de auditoría en imágenes mamarias. Se evaluaron 19.132 mamografías (6.060 en 2012, 6.568 en 2013 y 6.504 en 2014). El 95 % de las mamografías correspondieron a tamizaje de oportunidad. El rellamado global disminuyó 19,6 %, el VPP de las biopsias realizadas aumentó a 15,36 % y mejoró la detección de cáncer invasivo de menor tamaño con una diferencia significativa entre 2013 y 2014 (p=0,03). La detección del cáncer mínimo se encuentra en 54,23 %. Conclusión: Los programas de control de la calidad y auditoría en imágenes mamarias basados en recomendaciones internacionales permiten garantizar resultados clínicamente relevantes en pacientes que asisten a tamizaje mamográfico. Las recomendaciones de sociedades internacionales proveen un continuo mejoramiento en los indicadores.

Objective: To describe the experience of the Center of Diagnosis for Women, of the Fundación Santa Fe de Bogotá (FSFB) in the implementation of a practical system of auditing in mammary images and its utility in quality processes, based on parameters established by the American College of Radiology benchmarks. Methods: We evaluated the benchmarks proposed by the ACR's audit program, based on our imaging databases and FSFB imaging information between January 2012 and December 2014. We include all mammograms, ultrasound-guided and stereotacticguided breast biopsies. The results were compared with those described in BI-RADS 5 edition. A literature review was performed using PubMed to define the state of the art of the breast imaging audit process. Results: We included 13 original articles and 4 international guidelines of breast imaging audit. We included 19132 mammograms, 6060 from 2012, 6568 from 2013 and 6504 from 2014. 95% of the mammograms belong to opportunity screening program. Recall rate decreased in 19.6%, PPV of the biopsies increased to 15,36% and the detection of smaller invasive cancer increased with significant difference between 2013 and 2014 (p=0.03). Minimal breast cancer detection corresponds to 54.34%. Conclusion: Quality Control and Audit programs in breast imaging based on international recommendations allow assuring clinical results in patients from a screening program. The recommendations of international societies provide a medium to provide a continuous improvement in the indicators.

The inverse equity hypothesis: does it apply to coverage of cancer screening in middle-income countries?

BACKGROUND: It is uncertain whether the inverse equity hypothesis-the idea that new health interventions are initially primarily accessed by the rich, but that inequalities narrow with diffusion to the poor-holds true for cancer screening in low and middle income countries (LMICs).This study examines the relationship between overall coverage and economic inequalities in coverage of cancer screening in four middle-income countries. METHODS: Secondary analyses of cross-sectional data from the WHO study on Global Ageing and Adult Health in China, Mexico, Russia and South Africa (2007-2010). Three regression-based methods were used to measure economic inequalities: (1) Adjusted OR; (2) Relative Index of Inequality (RII); and (3) Slope Index of Inequality. RESULTS: Coverage for breast cancer screening was 10.5% in South Africa, 19.3% in China, 33.8% in Russia and 43% in Mexico, and coverage for cervical cancer screening was 24% in South Africa, 27.2% in China, 63.7% in Mexico and 81.5% in Russia. Economic inequalities in screening participation were substantially lower or non-existent in countries with higher aggregate coverage, for both breast cancer screening (RII: 14.57 in South Africa, 4.90 in China, 2.01 in Mexico, 1.04 in Russia) and cervical cancer screening (RII: 3.60 in China, 2.47 in South Africa, 1.39 in Mexico, 1.12 in Russia). CONCLUSIONS: Economic inequalities in breast and cervical cancer screening are low in LMICs with high screening coverage. These findings are consistent with the inverse equity hypothesis and indicate that high levels of equity in cancer screening are feasible even in countries with high income inequality.

[Local recurrence based on size after conservative surgery in breast cancer stage T1-T2. A population-based study]. / Relación del tamaño tumoral con la recidiva tras cirugía conservadora en el cáncer de mama en estadio tumoral T1-T2. Estudio poblacional.

BACKGROUND: Conservative surgery can be regarded as the standard treatment for most early stage breast tumors. However, a minority of patients treated with conservative surgery will present local or locoregional recurrence. Therefore, it is of interest to evaluate the possible factors associated with this recurrence. METHODS: A population-based retrospective study using data from the Tumor Registry of Castellón (Valencia, Spain) of patients operated on for primary nonmetastatic breast cancer between January 2000 and December 2008 was designed. Kaplan-Meier curves and log-rank test to estimate 5-year local recurrence were used. Two groups of patients were defined, one with conservative surgery and another with nonconservative surgery. Cox multivariate analysis was conducted. RESULTS: The total number of patients was 410. Average local recurrence was 6.8%. In univariate analysis, only tumor size and lymph node involvement showed significant differences. On multivariate analysis, independent prognostic factors were conservative surgery (hazard ratio [HR] 4.62; 95% confidence interval [CI]: 1.12-16.82), number of positive lymph nodes (HR 1.07; 95% CI: 1.01-1.17) and tumor size (in mm) (HR 1.02; 95% CI: 1.01-1.06). CONCLUSIONS: Local recurrence after breast-conserving surgery is higher in tumors >2 cm. Although tumor size should not be a contraindication for conservative surgery, it should be a risk factor to be considered.

Antecedentes: la cirugía conservadora es un patrón de referencia del tratamiento de la mayor parte de los tumores mamarios en estadios iniciales. Sin embargo, una minoría de pacientes intervenidas con esta opción tendrá recurrencia local o locorregional. Por ello resulta de interés evaluar los posibles factores relacionados con esta recurrencia. Material y métodos: estudio retrospectivo, con base poblacional, efectuado con base en los datos del Registro de Tumores de Castellón (Comunidad Valenciana, España) de pacientes intervenidas de cáncer primario de mama no metastático de enero de 2000 a diciembre de 2008. Se utilizaron las curvas de Kaplan-Meier y la prueba de log-rank para estimar la recurrencia local a cinco años. Se definieron dos grupos de pacientes, uno con cirugía conservadora y otro con cirugía no conservadora de la mama. Se realizó un estudio multivariado de Cox. Resultados: se encontraron 410 pacientes con promedio de 6.8% de recurrencias locales. En el análisis univariado sólo el tamaño tumoral y la afectación ganglionar demostraron diferencias significativas. En el análisis multivariado los factores pronóstico independientes fueron: la cirugía conservadora (Hazard ratio [HR] 4.62; IC [intervalo de confianza] 95% 1.12-16.82), el número de ganglios linfáticos positivos (HR 1.07; IC 95% 1.01-1.17) y el tamaño del tumor en milímetros (HR 1.02; IC 95% 1.01-1.06). Conclusiones: la recurrencia local postcirugía conservadora de mama es mayor en tumores de más de 2 cm. Aunque el tamaño del tumor no debería ser una contraindicación para esta cirugía sí deben tomarse en cuenta como un factor de riesgo.

Cultural aspects of healthy BRCA carriers from two ethnocultural groups.

We explored the experiences of Ashkenazi Jewish and French Canadian women and meanings attributed to their hereditary breast and ovarian cancer (HBOC) risk. We purposively sampled 40 BRCA1 or BRCA2 (BRCA) mutation carriers and conducted theoretically driven semistructured interviews. According to content analysis, participants from these two ethnocultural groups held divergent meanings associated with being a BRCA carrier and different views pertaining to the illness experience and risk awareness. All participants identified a genetic basis; however, the French Canadian women also expressed other causes. The French Canadian women reported not knowing other carriers in their social environment, whereas the Ashkenazi Jewish women emphasized a strong sense of community contributing to their ethnic risk awareness. Based on these findings, we suggest that French Canadian women could benefit from greater awareness of the HBOC genetic risk and that health care providers should consider ethnically related and individual-based experiences and meanings during counseling.

Perilous Uncertainty: Situating Women's Breast-Health Seeking in Northern Peru.

Breast cancer rates in Peru, as in other low- and middle-income countries, continue to rise, and survival rates are poor, in part because many women are diagnosed with late-stage disease. As part of a pilot project to improve breast cancer screening and diagnostic services in remote regions of Peru, the Program for Appropriate Technology in Health (PATH) partnered with Peruvian organizations to train community health workers in breast health promotion and providers in clinical breast exam (CBE). To inform these strategies, we undertook a qualitative study to determine factors that influence Peruvian women's decisions to seek CBE. Anthropological approaches incorporating the PRECEDE/PROCEED public health model guided our conversations with providers and women living in the region of the pilot intervention. Grounded theory analysis helped us uncover a central theme of uncertainty, a state of doubt and insecurity that created a sense of impotent worry and impeded clinical health-seeking behaviors.

Cáncer de mama embarazo: presentación de dos casos / Breast cancer pregnancy: presentation of two cases

La primera paciente de 46 años en la cual durante el primer trimestre de embarazo se identifica un carcinoma mamario derecho. No tenía antecedentes de cáncer mamario familiar ni hereditario. La punción biopsia por aguja fina reveló adenocarcinoma de alto grado nuclear. Fue estadificado como T3 NI M0 Estadio IIIa. A las 13 semanas de embarazo se realizó una histerectomía en bloque más salpingo ooferectomia bilateral. Se inicio 4 ciclos de quimioterapia neoadyuvante A la conclusión tratamiento se realizo mastectomia La segunda paciente de 37 años de edad que en su primera consulta prenatal a las 34 semanas, se diagnostica CA de mama derecha inflamatorio. Se estadifico T4 N2 M0 Estadio IIIb. Resultado de la PAAF concluyó positivo para células neoplásicas, compatible con adenocarcinoma. Se decide interrumpir el embarazo mediante cesárea mas ovariectomia bilateral a las 36 semanas. Posteriormente se realiza 4 ciclos de quimioterapia neoadyuvante, para finalmente realizar mastectomia simple.

Cancer of breast during the pregnancy is an infrequent clinic circumstance. This asociation raises questions with respect to the handling of the mother in special her condicin fisiolgic and the security of the fetus. We presented displayed two cases: The first patient of 46 ears in which during the first trimester a mamary carcinoma is identified straight. It Ins't antecedents of cancer mamary hereditary relative nor. Puncin biopsy by positive fine needle revel for adenocarcinom of high nuclear degree. That he was estadific like T3 NI M0 IIIa Stage. To the 13 weeks of realiz pregnancy one histerectomi in bilateral block whit salpingo ooferectomia. Beginning 4 cyles of neoadjuvant chemotherapy. To conclusin make mastectomia simple. The second patient of 37 ears of age that in his first prenatal consultation to the 34 weeks, diagnostic inflammatory CA of right breast. That estadific T4 N2 M0 IIIb Stage. Result of positive for cels neoplasic, the PAAF concluy with adenocarcinom. It is decided To interrupt the pregnaney by means of bilateral surgeri but oferectomia to the 36 weeks, later is made 4 cycles of neoadjuvant chemotherapy, finally to make mastectomia simple.