Abstract P4-10-09: Delay in diagnosis of breast cancer in Mexican young women: Report of the “Joven y Fuerte” prospective cohort pilot phase

Background: Delay in diagnosis and treatment initiation of breast cancer (BC) has been associated with advanced stages and poor outcome. In developed countries, age has not been solely reported as an independent predictor of diagnosis delay. In Mexico, median time since tumor detection to treatment initiation is about 7 months, but young women are underrepresented in these studies. We aim to describe time intervals related to diagnosis in Mexican young women with BC (YWBC).

Methods: Newly diagnosed YWBC were invited to participate as part of this prospective cohort. Patient accrual began in November 2014 at two public cancer centers in Mexico. Patients completed self-report surveys including questions regarding mode of detection, time from first symptom to medical appointment (patient interval) and time from first symptom to diagnosis (total interval). Pearson chi-square tests were used to examine the effects of patient and clinical characteristics on patient interval and clinical stage.

Results: 96 YWBC with median age at diagnosis of 35 y (range 21-40) were enrolled in our pilot phase. 82.3% had tumor detected by self or partner. 62.5% of YWBC were diagnosed as locally advanced disease (IIB-IIIC). Median tumor size was 3.5 cm (0.5-12.0), with node involvement in 66.7%. 53.1% of YWBC had a patient interval of <6 months, but roughly 27.1% had a total interval <6 months. While only 13.5% had a patient interval >12 months, 39.6% reached a total interval >12 months. Patient interval and clinical stage were not significantly associated with occupation, education, marital status, current partner or method of detection.

 N(%)TimePatient intervalTotal interval<1 month29 (30.2)7 (7.3)1-3 months18 (18.8)9 (9.4)4-6 months4 (4.2)10 (10.4)7-12 months10 (10.4)24 (25.0)>12 months13 (13.5)38 (39.6)No symptoms0 (0.0)3 (3.1)NA22 (22.9)5 (5.2)Method of Detection Patient/Partner detected tumor79 (82.3)Clinical detection0 (0.0)Image detected9 (94)NA8 (8.3)Clinical stage 02 (2.1)IA13 (13.5)IB1 (1.0)IIA14 (14.6)IIB17 (17.7)IIIA28 (29.2)IIIB8 (8.3)IIIC7 (7.3)IV6 (6.2)

Conclusions: In this cohort, most patients had a greater total delay than previously reported in Mexico, possibly attributed to long health-system intervals, which could contribute to worse outcomes in YWBC. The prospective nature of this study allows the recollection of biologic characteristics, treatment scheme and adherence to treatment, to determine their impact on clinical outcome besides diagnosis delay. “Joven & Fuerte”, the first dedicated program for the care of young breast cancer patients in Latin America, aims to develop YWBC-tailored interventions to early diagnose or “downstage” BC among young women by endorsing patient navigation, increasing general population awareness and improving providers' knowledge in low-middle income countries, such as Mexico.

Citation Format: Castro-Sanchez A, Barragan-Carrillo R, Miaja M, Platas A, Martinez Cannon BA, Fonseca A, Vega Y, Bukowski A, Chapman J-A, Goss P, St. Louis J, Bargallo-Rocha JE, Mohar A, Peña-Curiel O, Villarreal-Garza CM. Delay in diagnosis of breast cancer in Mexican young women: Report of the “Joven y Fuerte” prospective cohort pilot phase [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-09.

Abstract P4-20-04: Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort

Background: Despite high rates of breast cancer in young women from low-and-middle-income countries (LMICs), their needs and concerns are not systematically studied or addressed. Understanding the characteristics of young women with breast cancer (YWBC) and the issues they face is of great relevance to the medical community, in order to tailor clinical interventions and supportive care for this unique and understudied patient population. The Mexican cohort “Mujer Joven y Fuerte” (Young and Strong Woman) has the goal of comprehensively characterizing and assessing the needs of YWBC in Mexico using patient- and physician-based surveys. Methods: A prospective cohort of newly diagnosed YWBC was established in November 2014 at two Mexican cancer centers in Mexico City and Monterrey. Eligible women answer web-based surveys on relevant topics including physical activity, genetics, psychosocial needs, and fertility. Clinicians complete pre-specified surveys using the US NIH BOLD Task Force common data elements registering clinical/pathologic characteristics and outcomes. Patients are evaluated at diagnosis, after 6 months, and annually for 5 years. Sub-studies assessing changes in cognition, sexual function and satisfaction, quality of life and depression/anxiety are being conducted, and biologic samples are stored for future research. Results: 96 YWBC with median age at diagnosis of 34 (21-41 y) were accrued to our pilot phase. 26% were single and 25% childless. 43% had higher education and 28% were employed. 90% presented with a self-detected mass. Clinical stage at diagnosis was distributed as follows: stage 0: 2%; I: 15%; IIA: 13%; IIB: 17%; III: 47%, and stage IV: 6%. The most frequent molecular subtype was HR+/HER2- (47%), followed by HER2+ (26%) and triple negative (21%). First follow-up results will be available shortly. Conclusions: To our knowledge, this represents the first prospective cohort of YWBC in Latin America. We are expanding this project to other centers in the region. Our findings will help develop culturally tailored interventions aimed at improving the psychosocial and medical outcomes of this vulnerable patient population.

Citation Format: Villareal-Garza CM, Platas A, Castro-Sánchez A, Miaja M, Bargalló-Rocha E, Martinez-Cannon BA, Vega Y, Fonseca A, Ramos-Elias P, Márquez-Perez CJ, Bukowski A, Goss P, St. Louis J, Chapman J-A, Partridge A, Meneses A, Mohar A. Young women with breast cancer in Mexico: A report of the pilot phase of the “Mujer Joven y Fuerte” prospective cohort [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-04.

Abstract P4-17-03: Global Cancer Institute online tumor boards to improve global patterns of clinical practice for breast cancer

Background: The Global Cancer Institute (GCI) breast cancer multi-disciplinary tumor boards (MTBs) are live, online telemedicine discussions of breast cancer patient case scenarios between breast cancer specialists in low- and middle-income countries (LMICs) and expert breast cancer specialists in the United States (US). In the US MTBs are routinely held in most cancer centers and have been shown to improve patient outcomes and patient and family quality of life. GCI launched breast cancer MTBs in 2012 with the goals to improve breast cancer patient care in underserved populations globally, to establish an online platform to allow live communication and collaboration among oncologists, and to serve as an educational tool for oncologists.

Methods: During our MTBs case scenarios are presented by global oncologists for discussion and input by a panel of both community/tertiary care expert breast oncologists from our global network. During each MTB, three cancer centers present challenging breast cancer patient scenarios. Patient scenarios are presented in English, according to a standard PowerPoint template. After presentation guideline - or clinical trial-based discussions are held for each case. As the patient cases originate from oncologists in LMICs, optimal and best locally available clinical care in rural and remote settings are discussed. For educational purposes the MTBs and the associated YouTube panel discussions are archived online and can subsequently be viewed by practicing oncologists and trainees globally. Links to relevant international guidelines, published and ongoing clinical trials, and other educational resources are also provided to all MTB attendees.

Results: Since its initiation in 2012, the GCI MTBs have engaged a network of 370 oncologists in LMICs and 20 expert panelists from nine cancer centers in the United States. Together the oncologists in LMICs represent 28 tertiary cancer centers and 116 community oncologists in 19 countries across Latin America, Eastern Europe, Asia, and Africa.

Conclusions: GCI breast cancer MTBs are a powerful educational and networking tool for oncologists in LMICs to improve their patterns of clinical practice, conduct multi-disciplinary discussions and access research collaborations. GCI invites oncologists throughout Latin America, Europe, Asia, and Africa to join our tumor boards and further expansion of its MTB network. GCI currently surveys oncologists in our network before and after attendance of MTBs to measure modifications in oncologists' practice and adherence to international clinical practice guidelines.

Citation Format: St. Louis J, Bukowski A, Paulino E, Ferreyra ME, Nunes J, Mejia G, Duarte C, Ruiz R, Touya D, Polo S, Chavarri-Guerra Y, Moreno J, Georgieva N, Tsolko T, Obayedullah Baki M, Luna HC, Goss PE. Global Cancer Institute online tumor boards to improve global patterns of clinical practice for breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-17-03.