Exploring the prevalence of abortion and its characteristics in Perú.

OBJECTIVES: Our paper presents the analysis of a nationwide survey that explored induced abortion among women using a ballot-box technique. Our objective was to determine the prevalence of abortion and the main characteristics of the procedure. STUDY DESIGN: We conducted surveys in households with 2400 women aged 18-49 from urban areas nationwide, between October 15 and 29, 2018. Data collection was overseen by the Instituto de Opinión Pública de la Universidad Católica del Perú. We performed a probabilistic, multistage, and socioeconomic level-stratified sampling. Our study used the "ballot-box technique" to ensure anonymity and reduce the risk of social desirability. RESULTS: We visited 15,433 houses nationwide. Among those households where surveys could not be conducted, it was due to abandoned or inaccessible property, unwilling to participate, absent members, out of quota, or inconclusive survey. On average, 19.0% of Peruvian women at all socioeconomic levels reported having had at least one abortion in their lifetime. Induced abortion is reported at all socioeconomic levels and reported age of the abortion is concentrated between 19 and 29 years old. In 57.7% of cases, women sought healthcare personnel for their last induced abortion. Among them, procedure abortion (45.3%) stands out over medical abortions (34.0%). Thirty-three percent of women who reported having had at least one induced abortion in their lifetime were admitted to a hospital after their last abortion. CONCLUSIONS: The illegality of abortion has not prevented its occurrence in Peru. Our results suggest that, in Peru, legal restrictions on induced abortion create an unfavorable context for women's health, exposing them to services whose safety is not guaranteed. Efforts should be made to increase awareness and education about contraception and family planning methods to prevent unwanted pregnancies and reduce the need for abortion. IMPLICATIONS: These findings should be considered in public policy discussions regarding abortion, since they might have a great impact for better decision making. They demonstrate that legal restrictions have not prevented the occurrence of abortion but has only created unsafe conditions around it.

Effect of Ki-67 assessment in the distribution of breast cancer subtypes: Evaluation in a cohort of Latin American patients.

Breast cancer (BC) is a heterogeneous disease composed of four main subtypes with distinct clinical and epidemiological features. Although several reports have described the distribution of BC subtypes in Latin America, the majority of them have not included the cellular marker, Ki-67, in the immunohistochemical (IHC) panel. The aim of the present study was to describe the distribution of BC subtypes in a cohort of Latin American women using an IHC panel with Ki-67. A prospective cohort of 580 patients in three centers of Peru (the Hospital Nacional Edgardo Rebagliatti Martins, the Hospital Nacional Guillermo Almenara Irigoyen, the Hospital Nacional Alberto Sabogal, Lima) and one in Uruguay (Instituto Nacional del Cáncer, Montevideo) were evaluated. BC phenotypes were classified according to an IHC panel: Estrogen receptor (ER), progesterone receptor (PgR), HER2 and Ki-67. Silver in situ hybridization was used when the HER2 status, as determined by IHC, was equivocal. The associations between the BC phenotypes and their clinicopathological features were evaluated. ER was positive in 65% of the cases (n=377), and PgR in 50% (n=203). In total, 79.1% (n=459) were HER2-negative, 19.8% (n=115) were HER2-positive and 1% (n=6) had an equivocal status. With respect to Ki-67, 44.7% of the patients exhibited staining in >14% of the tumor cells (n=259). The distribution of subtypes was as follows: Luminal A, 31.9% (n=183); luminal B, 35% (n=201); HER2, 12.1% (n=70); and triple-negative, 20.9% (n=120). When Ki-67 was not included in the panel, the frequency of luminal A was 41.1% and luminal B, 25.8% (9.2% of the cases were misclassified). Ki-67 was most highly expressed in triple-negative and HER2 tumors. Inclusion of Ki-67 in the IHC panel to assign subtypes revealed a higher frequency of luminal B tumors than was reported previously for Latin American women with BC, whereas the distribution of triple-negative and HER2 tumors were similar to that previously reported. In conclusion, these results demonstrated that excluding Ki-67 from the panel of IHC markers may lead to an underestimation of the rates of luminal B tumors.