Negative magnetization and magnetic ordering of rare earth and transition metal sublattices in NdFe0.5Cr0.5O3.

We investigate the effect of alloying at the 3dtransition metal site of a rare-earth-transition metal oxide, by considering NdFe0.5Cr0.5O3mixed perovskite with two equal and random distribution of 3d ions, Cr and Fe, interacting with an early 4f rare earth ion, Nd. Employing temperature- and field- dependent magnetization measurements, temperature-dependent x-ray diffraction, neutron powder diffraction, and Raman spectroscopy, we characterize its structural and magnetic properties. Our study reveals bipolar magnetic switching (arising from negative magnetization) and magnetocaloric effect which underline the potential of the studied mixed perovskite in device application. The neutron diffraction study shows the absence of spin reorientation transition over the entire temperature range of 1.5-320 K, although both parent compounds exhibit spin orientation transition. We discuss the microscopic origin of this curious behavior. The neutron diffraction results also reveal the ordering of Nd spins at an unusually high temperature of about 40 K, which is corroborated by Raman measurements.

Strain control of a bandwidth-driven spin reorientation in Ca3Ru2O7.

The layered-ruthenate family of materials possess an intricate interplay of structural, electronic and magnetic degrees of freedom that yields a plethora of delicately balanced ground states. This is exemplified by Ca3Ru2O7, which hosts a coupled transition in which the lattice parameters jump, the Fermi surface partially gaps and the spins undergo a 90∘ in-plane reorientation. Here, we show how the transition is driven by a lattice strain that tunes the electronic bandwidth. We apply uniaxial stress to single crystals of Ca3Ru2O7, using neutron and resonant x-ray scattering to simultaneously probe the structural and magnetic responses. These measurements demonstrate that the transition can be driven by externally induced strain, stimulating the development of a theoretical model in which an internal strain is generated self-consistently to lower the electronic energy. We understand the strain to act by modifying tilts and rotations of the RuO6 octahedra, which directly influences the nearest-neighbour hopping. Our results offer a blueprint for uncovering the driving force behind coupled phase transitions, as well as a route to controlling them.

Phenological response to temperature variability and orography in Central Italy.

Even if the sensitivity of vegetation phenology to climate change has been accepted on global and continental scales, the correlation between global warming and phenotypic variability shows a modulated answer depending on altitude, latitude, and the local seasonal thermal trend. To connect global patterns of change with local effects, we investigated the impact of the observed signal of warming found in Central Italy on two different willow species, Salix acutifolia and Salix smithiana, growing in three phenological gardens of the International Phenological Gardens' network (IPG) located in different orographic positions. The time series of temperatures and phenological data for the period 2005-2018 were analysed first to find trends over time in the three gardens and then to correlate the recent local warming and the change in the two species phenology. The results confirmed the correlation between phenological trends and local trend of temperatures. In particular: budburst showed a trend of advancement of 1.4 days/year on average in all three gardens; flowering showed a divergent pattern between the gardens of either advancement of 1.0 days/year on average or delay of 1.1 days/year on average; while senescence showed a delay reaching even 3.3 days/year, although significant in only two gardens for both species. These trends were found to be correlated mainly with the temperatures of the months preceding the occurrence of the phase, with a shift in terms of days of the year (DOY) of the two species. Our conclusion is that the observed warming in Central Italy played a key role in controlling the phenophases occurrences of the two willow species, and that the orographic forcing leads to the different shift in DOY of phenophases (from 5 to 20 days) due to the local thermal forcing of the three phenological gardens.

Emergent magnetic order and correlated disorder in formate metal-organic frameworks.

Magnetic materials with strong local interactions but lacking long-range order have long been a curiosity of physicists. Probing their magnetic interactions is crucial for understanding the unique properties they can exhibit. Metal-organic frameworks have recently gathered more attention as they can produce more exotic structures, allowing for controlled design of magnetic properties not found in conventional metal-oxide materials. Historically, magnetic diffuse scattering in such materials has been overlooked but has attracted greater attention recently, with advances in techniques. In this study, we investigate the magnetic structure of metal-organic formate frameworks, using heat capacity, magnetic susceptibility and neutron diffraction. In Tb(DCO2)3, we observe emergent magnetic order at temperatures below 1.2 K, consisting of two k-vectors. Ho(DCO2)3 shows diffuse scattering above 1.6 K, consistent with ferromagnetic chains packed in a frustrated antiferromagnetic triangular lattice, also observed in Tb(DCO2)3 above 1.2 K. The other lanthanides show no short- or long-range order down to 1.6 K. The results suggest an Ising-like one-dimensional magnetic order associated with frustration is responsible for the magnetocaloric properties, of some members in this family, improving at higher temperatures. This article is part of the theme issue 'Mineralomimesis: natural and synthetic frameworks in science and technology'.

Translation, Adaptation and Validation of Rapid Geriatric Assessment to the Brazilian context.

OBJECTIVES: Translate, cross-culturally adapt and validate the Rapid Geriatric Assessment (RGA) for Brazilian community-dwelling adults. DESIGN: Cross-sectional study, using a quantitative approach. SETTING: Urban population from the city of São Carlos, located in the interior of São Paulo State, Brazil. PARTICIPANTS: 148 individuals aged 60 or over. MEASUREMENTS: Participants were assessed using the RGA, Fried Frailty Phenotype, International Physical Activity Questionnaire - long version, Addenbrooke´s Cognitive Exam - Revised Version, Mini Nutritional Assessment, short Form - 36, EuroQol 5-Dimension, Geriatric Depression Scale - short version, in addition to performing Dual Energy X-ray Absorptiometry to diagnose sarcopenia, according to the criteria established by the European Working Group on Sarcopenia in Older People. RESULTS: In the translation and adaption process of the RGA, steps recommended by the literature were followed: initial translation, synthesis of translations, backward translation, evaluation from the panel of judges, and pre-test. When evaluating the psychometric properties of the scale, satisfactory reliability (internal consistency and stability) and validity (content, concurrent criterion and convergent, divergent and discriminant construct) were verified. CONCLUSION: The Brazilian version of the RGA is reliable and valid, and can be used in the Brazilian context to evaluate the elderly population.

Multicentre clinical evaluation of the new highly sensitive Elecsys® thyroglobulin II assay in patients with differentiated thyroid carcinoma.

OBJECTIVE: A highly sensitive thyroglobulin assay (Elecsys® Tg II, Roche Diagnostics, Penzberg, Germany) has become available for monitoring patients with differentiated thyroid cancer (DTC). Here, we evaluated the clinical performance of Elecsys® Tg II assay in a multicentre patients series and compare it with the established Access® Tg assay (Beckman Coulter, Brea, CA, USA). DESIGN: Retrospective analysis on prospectively selected patients in four thyroid cancer referral centres with uniform DTC management. PARTICIPANTS: All DTC cases diagnosed, treated and followed up in four tertiary referral centres for thyroid cancer since January 2005 (n = 1456) were retrieved, and predefined selection criteria were applied to prevent relevant enrolment biases. A series of 204 patients was finally selected for this study. MEASUREMENTS: Samples had been stored at -80°C. Tg was measured by fully automated immunometric Elecsys® Tg II and Access® Tg assays in a centralized laboratory. RESULTS: Two hundred and four DTC were finally included. Of these, 10.8% had structural recurrence (sREC), and 81.4% showed no evidence of disease (NED) at the end of follow-up. There was a significant analytical bias between methods that cannot be used interchangeably. Using ROC curve analysis, the best basal and rhTSH-stimulated Tg cut-offs to detect sREC were 0.41 µg/L and 1.82 µg/L for Elecsys® and 0.36 µg/L and 1.62 µg/L for Access® assay, respectively. Using Cox proportional hazard regression, Tg was the only independent predictor of cancer relapse. CONCLUSIONS: Using appropriate assay-specific cut-offs, the clinical performance of the Elecsys® Tg II assay was comparable to that provided by the well-established Access® Tg assay.

Identifying Frailty Levels and Associated Factors in a Population Living in the Context of Poverty and Social Vulnerability.

This study aimed to investigate a vulnerable population living in the context of poverty in a Brazilian municipality, in order to identify the factors that are associated with frailty syndrome in elderly people. From the total population living in the area, a random sample of 363 community-dwelling people, 60 years and older, age and gender-stratified, was selected to participate in the research. After losses, a sample of 304 older adults was classified as non-frail, pre-frail and frail. According to the Fried frailty criteria, the prevalence was 12.2% for non-frail individuals, 60.5% pre-frail and 27.3% frail. The main factors associated with frailty in the studied sample were low level of physical activity (OR: 5.2, 95%CI: 2.5-11.0), the occurrence of two or more falls within 12 months (OR: 3.1, 95%CI: 1.4-7.1), mobility deficits (OR: 3.0, 95%CI: 1.5-5.8), and depressive symptoms (OR: 1.9, 95%CI: 1.1-3.7). This study identified the most important factors that must be evaluated to identify frailty syndrome in a socially vulnerable population in the context of poverty. The data should help to encourage effective strategies concerning public health policies for this population.

Immunohistochemical expression of heparanase isoforms and syndecan-1 proteins in colorectal adenomas.

The proteoglycan syndecan-1 and the endoglucuronidases heparanase-1 and heparanase-2 are involved in molecular pathways that deregulate cell adhesion during carcinogenesis. Few studies have examined the expression of syndecan-1, heparanase-1 and mainly heparanase-2 proteins in non-neoplastic and neoplastic human colorectal adenoma tissues. The aim of this study was to analyze the correlation among the heparanase isoforms and the syndecan-1 proteins through immunohistochemical expression in the tissue of colorectal adenomas. Primary anti-human polyclonal anti-HPSE and anti-HPSE2 antibodies and primary anti-human monoclonal anti-SDC1 antibody were used in the immunohistochemical study. The expressions of heparanase-1 and heparanase-2 proteins were determined in tissue samples from 65 colorectal adenomas; the expression of syndecan-1 protein was obtained from 39 (60%) patients. The histological type of adenoma was tubular in 44 (67.7%) patients and tubular-villous in 21 (32.3%); there were no villous adenomas. The polyps were <1.0 cm in size in 54 (83.1%) patients and ≥1.0 cm in 11 (16.9%). The images were quantified by digital counter with a computer program for this purpose. The expression index represented the relationship between the intensity expression and the percentage of positively stained cells. The results showed that the average of heparanase-1, heparanase-2 and syndecan-1 expression index was 73.29 o.u./µm², 93.34 o.u./µm², and 55.29 o.u./µm², respectively. The correlation between the heparanase-1 and syndecan-1 expression index was positive (R=0.034) and significant (P=0.035). There was a negative (R= -0.384) and significant (P=0.016) correlation between the expression index of heparanase-1 and heparanase-2. A negative (R= -0.421) and significant (P=0.008) correlation between the expression index of heparanase-2 and syndecan-1 was found. We concluded that in colorectal adenomas, the heparanase-1 does not participate in syndecan-1 degradation; the heparanase-2 does not stimulate syndecan-1 degradation by the action of heparanase-1, and the heparanase-2 may be involved in the modulation of the heparanase-1 activity.

Modeling olive pollen intensity in the Mediterranean region through analysis of emission sources.

Aerobiological monitoring of Olea europaea L. is of great interest in the Mediterranean basin because olive pollen is one of the most represented pollen types of the airborne spectrum for the Mediterranean region, and olive pollen is considered one of the major cause of pollinosis in this region. The main aim of this study was to develop an airborne-pollen map based on the Pollen Index across a 4-year period (2008-2011), to provide a continuous geographic map for pollen intensity that will have practical applications from the agronomical and allergological points of view. For this purpose, the main predictor variable was an index based on the distribution and abundance of potential sources of pollen emission, including intrinsic information about the general atmospheric patterns of pollen dispersal. In addition, meteorological variables were included in the modeling, together with spatial interpolation, to allow the definition of a spatial model of the Pollen Index from the main olive cultivation areas in the Mediterranean region. The results show marked differences with respect to the dispersal patterns associated to the altitudinal gradient. The findings indicate that areas located at an altitude above 300ma.s.l. receive greater amounts of olive pollen from shorter-distance pollen sources (maximum influence, 27km) with respect to areas lower than 300ma.s.l. (maximum influence, 59km).

Pregnancy outcome in women treated with methimazole or propylthiouracil during pregnancy.

PURPOSE: Control of thyroid function in hyperthyroid women during pregnancy is based on antithyroid drugs (ATD) [propylthiouracil (PTU) and methimazole (MMI)]. While a teratogenic effect has been suggested for MMI and, more recently, for PTU, a clear demonstration is still lacking. Aim of this study was to assess the safety of ATD during pregnancy. METHODS: A total of 379 pregnancies were retrospectively recruited in eight Italian Departments of Endocrinology and divided in five groups: (1) MMI-treated and euthyroid throughout pregnancy (n = 89); (2) MMI-treated and hyperthyroid on at least two occasions (n = 35); (3) PTU-treated women and euthyroid throughout pregnancy (n = 32); (4) PTU-treated women and hyperthyroid on at least two occasions (n = 20); and (5) non-ATD-treated (n = 203). Data on maternal thyroid function, miscarriages, type of delivery, neonatal weight, length and TSH, perinatal complications and congenital malformation were analyzed. RESULTS: The gestational age at delivery, the rate of vaginal delivery, neonatal weight, length and neonatal TSH did not significantly differ among groups. In all groups, the rates of spontaneous miscarriage and of major congenital malformations were not higher than in the general population. No newborns were born with a phenotype similar to those described in the "MMI embryopathy". CONCLUSIONS: While a clear demonstration of a teratogenic effect of MMI is currently lacking, it seems reasonable to follow the current guidelines and advice for PTU treatment in hyperthyroid women during the first trimester of pregnancy. Further, large and prospective worldwide studies will be needed to fully clarify the issue of ATD safety during pregnancy.

Osteonecrosis of the jaw in a patient receiving cabozantinib.

Since the discovery of bisphosphonate-related osteonecrosis of the jaw, there has been increasing evidence in recent years of osteonecrosis induced by drugs other than bisphosphonates, mainly agents with antiangiogenic and antiosteoclastic activity. Mandibular osteonecrosis was observed in a 51-year-old female with medullary thyroid cancer receiving cabozantinib, a new tyrosine kinase inhibitor having antiangiogenic activity. The bone necrosis appeared after a dental extraction. The clinical, radiographic and histologic picture of a chronic non-healing extraction socket was consistent with drug-induced osteonecrosis of the jaw. Healing was achieved by segmental ostectomy. The osteonecrosis was likely associated with a vascular endothelial growth factor (VEGF) pathway inhibition, implying inhibition of angiogenesis and hampering of the local host defence mechanisms.

Band filling effect on polaron localization in La1-x(Ca(y)Sr1-y)xMnO3 manganites.

We report on a ìSR and 55 Mn NMR investigation of the magnetic order parameter as a function of temperature in the optimally doped La(5/8)(CaySr(1.y))(3/8)MnO3 and in the underdoped La1.xSrxMnO3 and La1.xCaxMnO3 metallic manganite families. The study is aimed at unravelling the effect of lattice distortions, implicitly controlled by the Ca-Sr isoelectronic substitution, from that of hole doping x on the Curie temperature TC and the order of the magnetic transition. At optimal doping, the transitions are second order at all y values, including the y = 1 (La(5/8)Ca(3/8)MnO3) end member. By contrast, they are first order in the underdoped samples, which show a finite (truncated) order parameter at the Curie point, including La(0.75)Sr(0.25)MnO3 whose TC is much higher than that of La(5/8)Ca(3/8)MnO3. The order parameter curves, on the other hand, exhibit a very minor dependence on x, if truncation is excepted. This suggests that the effective exchange interaction between Mn ions is essentially governed by local distortions, in agreement with the original double-exchange model, while truncation is primarily, if not entirely, an effect of under- or over-doping. A phase diagram, separating in the x.y plane polaron-driven first order transitions from regular second order transitions governed by critical fluctuations, is proposed for the La(1.x)(CaySr(1.y))xMnO3 system.

Fifteen-year phenological plant species and meteorological trends in central Italy.

The present study was carried out in a phenological garden in central Italy that contains vegetative clones of shrubs and trees common to several international phenological gardens, such as Cornus sanguinea L.; Corylus avellana L.; Ligustrum vulgare L.; Robinia pseudoacacia L.; Salix acutifolia Willd. and Sambucus nigra L. Vegetative plant growth monitoring was carried out weekly using common international keys: BBCH07, bud break and leaf unfolding; BBCH19, young unfolded leaf; BBCH91, adult leaves; BBCH93, beginning of leaf colouring. The phenological dates thus obtained provide a model of the development for these different species in relation to the 15-year period of observation (1997-2011). From a meteorological point of view, temperature and precipitation trends were studied, with the highest anomalies during the study period recorded during the first 2 months of the year (January, February). There was relative invariance in the manifestation of the open bud phase and the contemporary advance of the young open leaves phase, particularly from 2006. This was accompanied by shortening of the leaf opening period, which appeared due to more rapid spring temperature increases over the last few years. The advance tendency of the BBCH91 phase showed adult leaves from the first summer weeks with fully green foliage monitored for a long time. Generally, the autumn leaf colouring phase tended to remain constant, with the exception of Salix acutifolia and Sambucus nigra, for which, on the other hand, the first leaf development phases appeared to be most likely influenced by the photoperiod.

Delayed onset of electromyographic activity of vastus medialis obliquus relative to vastus lateralis in subjects with patellofemoral pain syndrome.

Patellofemoral Pain Syndrome (PFPS) is a common musculoskeletal complaint. The presence of a delay between vastus medialis obliquus (VMO) and vastus lateralis (VL) muscle onset has been suggested in the literature as a possible cause of PFPS, with poor agreement amongst authors on the value of the delay. In this study we computed the delay in the activation of VMO and VL in 15 PFPS patients and 20 age-matched controls (Ctrls) during the following tasks: sit to stand, stand to sit, squat, step up and step down. Activation instants were detected from surface EMG data by a double-threshold statistical detector. In order to compare the muscle activity throughout the task, we computed the delay between the instants in which the VMO and VL normalised envelopes reached subsequent normalised amplitude levels, until the envelope peak. In all investigated tasks but sit to stand, the onset delay was lower or equal then 0.02s, without group differences. Similarly, no differences between Ctrls and PFPS timing were found throughout all tasks, until the peak. Our results do not support the hypothesis that an onset delay between VMO and VL can be one of the causes of PFPS.

The diagnostic accuracy of the immunocytochemical markers in the pre-operative evaluation of follicular thyroid lesions.

UNLABELLED: Aim of the study was to consider the diagnostic accuracy of galectine-3 (GAL3) in the pre-operative cytological evaluation of follicular lesions. MATERIALS AND METHODS: We retrospectively evaluated 100 patients suffering from thyroid nodular disease submitted to thyroidectomy from 2006 to 2007 in our Institution. Before surgery all patients underwent fine needle aspiration biopsy. The immunocytochemical analysis was performed on fine needle aspiration specimens using species-specific monoclonal antibodies and a biotin-free detection system. Based on preoperative cytological reports, 40 patients had pre-operative malignant results, and 60 patients (46 females and 14 males) showed follicular lesions. The sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of GAL3 was evaluated. STATISTICAL ANALYSIS: Chi-square test was used to compare frequencies of GAL3 expression between the different hystopathological groups. RESULTS: GAL3 proved to have 55% sensitivity, 100% specificity, 70% negative predictive value, and 78% diagnostic accuracy. The GAL3 expression in neoplastic and benign lesions was significantly different (GAL3+ in 16 out of 29 neoplastic lesions, GAL3+ 0 out of 31 benign lesions, p<0.01). Even comparing the GAL3 positivity between the follicular adenomas (0 GAL3+ out of 20) and the group of follicular carcinomas (5 GAL3+ out of 6), we found a statistically significant difference (p<0.01). CONCLUSIONS: Based on the data from our experience, the patients with a cytological diagnosis of GAL3 positive follicular neoformation should be referred for surgery without any further immunocytological testing.

Low thyroglobulin concentrations after thyroidectomy increase the prognostic value of undetectable thyroglobulin levels on levo-thyroxine suppressive treatment in low-risk differentiated thyroid cancer.

DESIGN: Recombinant human TSH-stimulated thyroglobulin (Tg) levels (rhTSH-Tg) are sufficient for early follow-up of low-risk differentiated thyroid cancer (DTC) patients after thyroidectomy and radioiodine (131I) remnant ablation (RAI). Serum Tg levels at the time of remnant ablation (ablation-Tg) is thought to be related with rhTSH-Tg and may be predictive of recurrent disease. During long-term follow-up, Tg levels on levo-T4 (L-T4) suppressive treatment (suppressive-Tg) is sufficiently sensitive to avoid further evaluations in patients with undetectable rhTSH-Tg. The aim of our study was to verify whether, in a subgroup of low-risk DTC patients, the association of low ablation-Tg levels (<10 microg/l) with undetectable suppressive-Tg concentrations has a sufficient negative predictive value (NPV) for recurrence of disease, leading to avoid rhTSH testing. METHODS: We enrolled 169 low-risk DTC patients treated by thyroidectomy + RAI and undetectable suppressive-Tg at 12-month followup. In all patients, we retrospectively evaluated ablation-Tg and rhTSH-Tg. For all patients, 2-yr follow-up was available. RESULTS: Based on rhTSH-Tg>2 microg/l, relapsing disease was histologically proven in 2 patients. rhTSH-Tg levels between 0.6-2.0 microg/l, with no evidence of disease, was observed in 10 patients (6%). One hundred and fifty-seven patients showed undetectable rhTSH-Tg. The NPV of undetectable suppressive- Tg was 92.8%. The ablation-Tg level was <10 microg/l in 140 patients. In this group, the NPV of undetectable suppressive- Tg was 100%. CONCLUSION: Our data indicate that undetectable suppressive-Tg value, combined with ablation- Tg levels <10 microg/l, may avoid a significant number of high-cost rhTSH-Tg test.

Breast cancer in Latin America: experts perceptions compared with medical care standards.

BACKGROUND: The BCRF II study presents a systematic review of the norms, recommendations and guidelines that are considered medical care standards (MCS) for breast cancer in 12 Latin American and Caribbean countries. Three key questions from the BCRF I survey data on early detection and diagnosis are presented to identify implementation practice patterns related to MCS. METHODS: Information related to MCS was requested from governmental health authorities, cancer institutes, and national scientific and professional societies in 12 Latin American and Caribbean countries. Documents received were reviewed by breast cancer experts from each respective country. Three key survey questions from the BCRF I survey on early detection and diagnosis were reprocessed to provide information related to implementation practice of existing MCS. RESULTS: All countries included in the BCRF II study had medical care standards (MCS) whether published by governmental authorities, national professional or scientific associations, cancer institutes, or adoption of international MCS. Experts reported different practice patterns at a Country level versus a Center level. Overall, 85% of the experts reported that less than 50% of the women with no symptoms undergo a mammography at the Country level compared to 43% at the Center level. For diagnostic suspicion of breast cancer, 80% of experts considered the diagnostic suspicion at a Country level to come from the patient compared to 50% at a Center level. About 30% of patients waited for more than 3 months for a diagnosis at the Country level compared to 7% at the Center level. CONCLUSION: All the Latin America and Caribbean countries in the study reported the use of similar MCS for breast cancer care. The reported difference between care practiced at a Country level versus a Center level suggests the challenge is not in generating new MCS, but in implementing policies and control mechanisms for compliance with existing MCS, guaranteeing their applicability to all populations.

Cáncer de mama Latinoamericano / Breast cancer in Latin America

La incidencia del cáncer de mama en países latinoamericanos es menor que en países más desarrollados, mientras que la tasa de mortalidad es mayor. Estas diferencias están relacionadas probablemente con diferencias en estrategias de despistaje y acceso al tratamiento. Se necesitan datos basados en población a fin de que sea posible tomar decisiones informadas. En el año 2006 se llevó a cabo una encuesta telefónica de 65 preguntas, que incluyó a 100 expertos en cáncer de mama de 12 países latinoamericanos, efectuando un análisis exploratorio del estado actual del tratamiento de cáncer de mama en estas regiones, tanto a nivel país como a nivel centro. Más del 90% de los países no tienen ley nacional o guía para screening mamográfico. La tasa de acceso a mamografía fue del 66,3% a nivel país y del 47,0% a nivel centro. La diferencia en la atención, basada en el nivel (país versus centro), fue indicada por la iniciación del tratamiento luego del diagnóstico, el tiempo desde el diagnóstico inicial al tratamiento y el tiempo desde la cirugía hasta la quimioterapia inicial. Sin embargo, las pruebas diagnósticas más sofisticadas para receptores hormonales y moleculares están disponibles en la mayoría de los centros (>80%), y en total, casi el 80% de las pacientes comenzaron el tratamiento dentro de los 3 meses del diagnóstico. La variación en la atención entre el nivel del centro versus el nivel del país para la atención del cáncer de mama, indica una necesidad de programas nacionales para el cuidado del cáncer. También se concluye que son necesarias estrategias alternativas de recolección de datos, a fin de comprender mejor el estado de los programas de control del cáncer de mama en países en desarrollo

Cáncer de mama Latinoamericano / Breast cancer in Latin America

La incidencia del cáncer de mama en países latinoamericanos es menor que en países más desarrollados, mientras que la tasa de mortalidad es mayor. Estas diferencias están relacionadas probablemente con diferencias en estrategias de despistaje y acceso al tratamiento. Se necesitan datos basados en población a fin de que sea posible tomar decisiones informadas. En el año 2006 se llevó a cabo una encuesta telefónica de 65 preguntas, que incluyó a 100 expertos en cáncer de mama de 12 países latinoamericanos, efectuando un análisis exploratorio del estado actual del tratamiento de cáncer de mama en estas regiones, tanto a nivel país como a nivel centro. Más del 90% de los países no tienen ley nacional o guía para screening mamográfico. La tasa de acceso a mamografía fue del 66,3% a nivel país y del 47,0% a nivel centro. La diferencia en la atención, basada en el nivel (país versus centro), fue indicada por la iniciación del tratamiento luego del diagnóstico, el tiempo desde el diagnóstico inicial al tratamiento y el tiempo desde la cirugía hasta la quimioterapia inicial. Sin embargo, las pruebas diagnósticas más sofisticadas para receptores hormonales y moleculares están disponibles en la mayoría de los centros (>80%), y en total, casi el 80% de las pacientes comenzaron el tratamiento dentro de los 3 meses del diagnóstico. La variación en la atención entre el nivel del centro versus el nivel del país para la atención del cáncer de mama, indica una necesidad de programas nacionales para el cuidado del cáncer. También se concluye que son necesarias estrategias alternativas de recolección de datos, a fin de comprender mejor el estado de los programas de control del cáncer de mama en países en desarrollo