Resumen Introducción: El cáncer de mama es una enfermedad de importancia mundial, caracterizada por un crecimiento anormal de las células que están en el tejido mamario, causada por distintos factores, los cuales pueden ser genéticos, esporádicos, hereditarios y ambientales. Objetivo: Analizar cómo se relacionan los diferentes factores con vigencia y no vigencia de la mamografía en mujeres chilenas dentro del rango etario entre 50 a 69 años, en el año 2023. Método: Estudio observacional, analítico y descriptivo. De esta forma, se analizaron dos grupos que investigar: las mujeres de 50 a 69 años con mamografía vigente (control) y las mujeres que no la tenían vigente (caso), para poder relacionar diversas variables en relación con ello. El total de la muestra fue de 207 mujeres, 119 controles y 88 casos. Resultados: Según la encuesta, las mujeres mayores de 59 años con una odds ratio de 1 (p < 0,87) no tenían diferencias respecto a la vigencia de su mamografía con las menores de 60 años, no así en las mujeres que no se preocupan por su salud, las cuales tienen cuatro veces más probabilidad de no tener la mamografía vigente (p < 0,81). Por otra parte, las mujeres que no poseían el conocimiento sobre la función de la mamografía poseen siete veces más probabilidad de no tener su mamografía vigente. Conclusiones: Es necesario realizar un abordaje diferenciado en cada uno de los factores, tanto de riesgo como protector, asociado al desarrollo del cáncer de mama.

Abstract Introduction: Breast cancer is a disease of global importance, characterized by abnormal growth of cells in the breast tissue, caused by different factors, which can be genetic, sporadic, hereditary and environmental. Objective: Analyze how the different factors are related to validity and non-validity of mammography in Chilean women within the age range between 50 and 69 years, in the year 2023. Method: Observational, analytical and descriptive study. In this way, the two groups to be investigated were analyzed: women between 50 and 69 years old with a current mammogram (control) and women who did not have it current (case), in order to relate various variables in relation to it. The total sample was 207 women, 119 controls and 88 cases. Results: According to the survey, women over 59 years of age with an odds ratio 1 (p < 0.87) had no differences regarding the validity of their mammography with those under 60 years of age, but not in women who do not worry about their health, which are four times more likely to not have a current mammogram (p < 0.81). On the other hand, women who did not have knowledge about the function of mammography are seven times more likely to not have a current mammogram. Conclusions: It is necessary to carry out a differentiated approach to each of the factors, both risk and protective, associated with the development of breast cancer.

Abstract Objectives: Analyze the degree of knowledge of health workers about cancer risk factors, as well as assess their attitudes towards prevention and the actions they take to prevent this disease. Materials and Methods: Retrospective, cross-sectional and analytical study of a Health person in Cd. Victoria, Tamaulipas, in the period from March to April 2023. A descriptive and analytical analysis was carried out. Results: 46.5% of health workers identified having three or more risk factors for cancer. However, only 27.4% could correctly identify three modifiable risk factors. In addition, there was low adherence to the screening guidelines, with only 33.6% answering correctly about the age to perform a mammogram after 40 years of age. Conclusions: These findings support the need for interventions aimed at improving cancer prevention among health workers, which could have a significant impact in reducing the burden of this disease in Mexico.

Resumen Objetivos: Analizar el grado de conocimiento de los trabajadores de la salud sobre los factores de riesgo del cáncer, así como evaluar sus actitudes hacia la prevención y las acciones que realizan para prevenir esta enfermedad. Materiales y Métodos: Estudio prospectivo, transversal y analítico a personal de Salud en Cd. Victoria, Tamaulipas, en el periodo comprendido de marzo a abril de 2023. Se realizó un análisis descriptivo y analítico. Resultados: El 46.5% de los trabajadores de la salud identificó tener tres o más factores de riesgo para el cáncer. Sin embargo, solo el 27.4% pudo identificar correctamente tres factores de riesgo modificables. Además, hubo una baja adherencia a las pautas de detección, con solo el 33.6% respondiendo correctamente sobre la edad para realizar una mamografía a partir de los 40 años. Conclusiones: Estos hallazgos respaldan la necesidad de intervenciones dirigidas a mejorar la prevención del cáncer entre los trabajadores de la salud, lo que podría tener un impacto significativo en la reducción de la carga de esta enfermedad en México.

Abstract Contrast-enhanced digital mammography (CEDM) is an emerging tool that has been increasingly implemented. It appears as an alternative to magnetic resonance imaging (MRI), using intravenous contrast to explore tumor angiogenesis. It combines conventional mammography (Mx) with post-contrast dual energy subtraction technique, resulting in increased detection of breast cancer, in a short study time and at a low cost. It is a promising method in selected cases and easy to read, being useful mainly in patients with breast cancer to detect additional lesions and determine the tumor size, that helps surgical planning, as well as in the evaluation of post-neoadjuvant chemotherapy response in the follow-up of patients treated with surgery, to address inconclusive findings in screening mammogram, or as an alternative when MRI is contraindicated. The purpose of this article is to assess the usefulness of contrasted mammography in daily practice and to determine its main indications. We review with our own cases the applications and characteristics of this method.

Resumen La mamografía contrastada (CEDM, contrast-enhanced digital mammography) es una herramienta nueva que ha ido implementándose de forma creciente. Aparece como alternativa a la resonancia magnética (RM), y al igual que esta, tiene como principio el uso de contraste endovenoso para explorar la angiogénesis tumoral. Combina la imagen de mamografía convencional (Mx) con la técnica de sustracción con energía dual poscontraste, lo que resulta en un incremento en la detección de cáncer de mama, en un tiempo corto de estudio y a un bajo costo. Es un método prometedor en casos seleccionados y de fácil lectura, siendo útil principalmente en pacientes con diagnóstico de cáncer de mama para detectar lesiones adicionales y determinar el tamaño tumoral, ayudando en la planificación quirúrgica, así como también en la evaluación de la respuesta a la neoadyuvancia. También en el seguimiento de pacientes operadas, para caracterizar lesiones dudosas en Mx y ecografía, o como alternativa ante contraindicación de la RM. El objetivo de este trabajo es valorar la utilidad de la mamografía contrastada en la práctica diaria y determinar sus principales indicaciones. Repasamos con casos propios las utilidades y características del método.

Abstract: Digital mammogram plays a key role in breast cancer screening, with microcalcifications being an important indicator of an early stage. However, these injuries are difficult to detect. In this paper, we propose a lightweight Convolutional Neural Network (CNN) for detecting microcalcifications clusters in digital mammograms. The architecture comprises two convolutional layers with 6 and 16 filters of 9×9, respectively at a full scale, a global pooling layer that eliminates the flattening and dense layers, and a sigmoid function as the output layer for binary classification. To train the model, we utilize the public INbreast database of digital mammograms with labeled microcalcification clusters. We used data augmentation techniques to artificially increase the training set. Furthermore, we present a case study that encompasses the utilization of a software application. After training, the resulting model yielded an accuracy of 99.3% with only 8,301 parameters. This represents a considerable parameter reduction as compared to the 67,797,505 used in MobileNetV2 with 99.8 % accuracy.

Describimos los resultados del proceso de diseño del contenido de los mensajes SMS para promover la mamografía. Se realizaron cuatro grupos de discusión en línea con mujeres de 50 y más años (n=14). Se utilizaron técnicas participativas para debatir las distintas opciones para cinco elementos estructurantes del mensaje SMS. Nuestros resultados mostraron que las mujeres señalaron que la línea de apertura debía proporcionar información clara sobre el tema del mensaje SMS. Los mensajes SMS deberían incluir el nombre de la mujer, información sobre quién y cómo hacerse una mamografía y utilizar una institución sanitaria como remitente. La frase final debe animar a las mujeres a hacerse una mamografía. Un SMS personalizado podría ser una buena forma de invitar a las mujeres, aunque su contenido debe diseñarse cuidadosamente para proporcionar información clara sobre cómo programar una mamografía. 5 n=14. n14 n n=14 . 14 (n=14) mujer remitente n1 n=1 1 (n=14 n= (n=1 (n= (n

We describe results of the design process of the content of the SMS messages to promote mammography. We conducted four online focus groups with women aged 50 or more (n=14). We used participatory techniques to debate the advantages and disadvantages of different options for the five structural elements of the SMS message. Our results showed that women argued that the opening line should provide clear information about the topic of the SMS message. SMS messages should include the woman’s name, information about who and how to get a mammogram and use a health institution as a sender. The closing line should encourage women to get a mammogram. A personalized SMS could be a good way of inviting women to perform the mammography. The content must be carefully designed to provide clear information about how to schedule an appointment. mammography 5 n=14. n14 n n=14 . 14 (n=14) message womans woman s name sender appointment n1 n=1 1 (n=14 n= (n=1 (n= (n

Descrevemos os resultados do processo de concepção do conteúdo das mensagens SMS para promover a mamografia. Quatro grupos focais on-line foram conduzidos com mulheres com cinquenta anos ou mais (n=14). Técnicas participativas foram usadas para discutir opções para cinco elementos estruturantes da mensagem SMS. As mulheres indicaram que a linha de abertura deveria fornecer informações claras sobre o assunto da mensagem SMS. As mensagens SMS devem incluir o nome da mulher, informações sobre quem e como obter uma mamografia e usar uma instituição de saúde como remetente. A sentença final deve encorajar as mulheres a fazer uma mamografia. Um SMS personalizado poderia ser uma boa maneira de convidar mulheres, embora seu conteúdo deva ser cuidadosamente projetado para fornecer informações claras sobre como agendar uma mamografia. online on line n=14. n14 n n=14 . 14 (n=14) mulher remetente n1 n=1 1 (n=14 n= (n=1 (n= (n

We describe results of the design process of the content of the SMS messages to promote mammography. We conducted four online focus groups with women aged 50 or more (n=14). We used participatory techniques to debate the advantages and disadvantages of different options for the five structural elements of the SMS message. Our results showed that women argued that the opening line should provide clear information about the topic of the SMS message. SMS messages should include the woman’s name, information about who and how to get a mammogram and use a health institution as a sender. The closing line should encourage women to get a mammogram. A personalized SMS could be a good way of inviting women to perform the mammography. The content must be carefully designed to provide clear information about how to schedule an appointment.

Descrevemos os resultados do processo de concepção do conteúdo das mensagens SMS para promover a mamografia. Quatro grupos focais on-line foram conduzidos com mulheres com cinquenta anos ou mais (n=14). Técnicas participativas foram usadas para discutir opções para cinco elementos estruturantes da mensagem SMS. As mulheres indicaram que a linha de abertura deveria fornecer informações claras sobre o assunto da mensagem SMS. As mensagens SMS devem incluir o nome da mulher, informações sobre quem e como obter uma mamografia e usar uma instituição de saúde como remetente. A sentença final deve encorajar as mulheres a fazer uma mamografia. Um SMS personalizado poderia ser uma boa maneira de convidar mulheres, embora seu conteúdo deva ser cuidadosamente projetado para fornecer informações claras sobre como agendar uma mamografia.

Describimos los resultados del proceso de diseño del contenido de los mensajes SMS para promover la mamografía. Se realizaron cuatro grupos de discusión en línea con mujeres de 50 y más años (n=14). Se utilizaron técnicas participativas para debatir las distintas opciones para cinco elementos estructurantes del mensaje SMS. Nuestros resultados mostraron que las mujeres señalaron que la línea de apertura debía proporcionar información clara sobre el tema del mensaje SMS. Los mensajes SMS deberían incluir el nombre de la mujer, información sobre quién y cómo hacerse una mamografía y utilizar una institución sanitaria como remitente. La frase final debe animar a las mujeres a hacerse una mamografía. Un SMS personalizado podría ser una buena forma de invitar a las mujeres, aunque su contenido debe diseñarse cuidadosamente para proporcionar información clara sobre cómo programar una mamografía.

Abstract Objective To conduct a systematic review of external validation studies on the use of different Artificial Intelligence algorithms in breast cancer screening with mammography. Data source Our systematic review was conducted and reported following the PRISMA statement, using the PubMed, EMBASE, and Cochrane databases with the search terms “Artificial Intelligence,” “Mammography,” and their respective MeSH terms. We filtered publications from the past ten years (2014 – 2024) and in English. Study selection A total of 1,878 articles were found in the databases used in the research. After removing duplicates (373) and excluding those that did not address our PICO question (1,475), 30 studies were included in this work. Data collection The data from the studies were collected independently by five authors, and it was subsequently synthesized based on sample data, location, year, and their main results in terms of AUC, sensitivity, and specificity. Data synthesis It was demonstrated that the Area Under the ROC Curve (AUC) and sensitivity were similar to those of radiologists when using independent Artificial Intelligence. When used in conjunction with radiologists, statistically higher accuracy in mammogram evaluation was reported compared to the assessment by radiologists alone. Conclusion AI algorithms have emerged as a means to complement and enhance the performance and accuracy of radiologists. They also assist less experienced professionals in detecting possible lesions. Furthermore, this tool can be used to complement and improve the analyses conducted by medical professionals. mammography statement PubMed EMBASE Intelligence, Mammography, Mammography “Mammography, 2014 (201 2024 English 1878 1 878 1,87 research 373 (373 1,475, 1475 1,475 , 475 (1,475) 3 work authors location year AUC specificity (AUC alone lesions Furthermore “Mammography 201 (20 202 187 87 1,8 37 (37 147 1,47 47 (1,475 20 (2 18 8 1, (3 14 1,4 4 (1,47 2 ( (1,4 (1, (1

A case is presented of extensive pneumomastia seen on a screening mammogram of an asymptomatic patient who had helium plasma treatment 2 weeks earlier for flabby upper arms. CONTRIBUTION: Rare complications of subcutaneous emphysema, following helium plasma treatment, have been discussed to highlight that such emphysema is usually self-limiting.

Resumen El carcinoma mucinoso es una estirpe poco frecuente de cáncer de mama, la cual representa menos del 4% de todos los cánceres primarios. Suele presentarse en pacientes postmenopáusicas, alrededor de la séptima década de la vida. Clínicamente se caracteriza por manifestarse como un nódulo palpable, rara vez acompañado de otra sintomatología. Las herramientas de imagen, como la mastografía y el ultrasonido, son fundamentales para su diagnóstico; sin embargo, en algunas situaciones se puede subestimar el diagnóstico dado a las características similares que comparte con otras lesiones benignas. El diagnóstico definitivo se realiza por medio de histopatología. Debido a la rareza de estos tumores, no existe un consenso sobre el tratamiento más adecuado. Muchos autores concuerdan que la intervención quirúrgica continúa siendo la piedra angular, ya que tiene un impacto positivo en la supervivencia y baja incidencia de recurrencias. Esta se puede acompañar posteriormente de terapias endocrinas adyuvantes. Afortunadamente, el pronóstico de este tipo de tumores suele ser favorable, incluso la supervivencia supera el 90% a los 5 años.

Abstract Mucinous carcinoma is a rare type of breast cancer, which represents less than 4% of all primary cancers. It usually occurs in postmenopausal patients, around the seventh decade of life. Clinically, it is characterized by the presence of a palpable nodule, rarely accompanied by other symptoms. Imaging tools, such as mammogram and ultrasound, are essential for its diagnosis, however, in some situations the diagnosis can be underestimated due to the similar characteristics that it shares with other benign lesions. Definitive diagnosis is made by histopathology. Regarding treatment, there is no consensus on the most appropriate, due to the low incidence of these tumors. Many authors agree that surgical intervention continues to be the best option, showing a positive impact on survival and low recurrences. This can be accompanied later by adjuvant endocrine therapies. Fortunately, the prognosis of this type of tumor is usually favorable, even survival exceeds 90% at 5 years.

Resumen Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable. Objetivo Brasileño 20182019. 20182019 2018 2019. 2019 2018-2019 Métodos Siscan. Siscan . (Siscan) histopatología Resultados 807430 807 430 807.43 5069 50 69 50-6 estos 91 benigno 18 1 8 1,8 67 6 7 6,7 05 0 5 0,5 90 9 9,0% 16 1,6 339 33 33,9 54 4 5, 1000 000 1.00 Conclusión benignas internacional aceptable 2018201 201 2018-201 (Siscan 80743 80 43 807.4 506 50- 1, 6, 0, 9,0 3 33, 100 00 1.0 201820 20 2018-20 8074 807. 9, 10 1. 20182 2 2018-2 2018-

Abstract Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable. Objetive 201 2019 Methods SISCAN (SISCAN data databases Results 807430 807 430 807,43 5 6 91 result 18 1 8 1.8 67 7 6.7 05 0 0.5 9.0% 90 9 16 1.6 339 33 33.9 54 4 5. 1000 000 1,00 Conclusion followup follow up identified parameter acceptable 20 80743 80 43 807,4 1. 6. 0. 9.0 3 33. 100 00 1,0 2 8074 807, 9. 10 1,

Resumo Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável. Objetivo Saúde Brasil 20182019. 20182019 2018 2019. 2019 2018-2019 Métodos descritivo Câncer histopatologia Resultados 807430 807 430 807.43 5069 50 69 50-6 rastreadas dessas 91 benigno 18 8 1,8 67 6 7 6,7 05 0 5 0,5 9,0% 90 9 estimou se 16 1,6 339 33 33,9 delas 54 4 5, Conclusão identificouse identificou benignas internacional contudo adequada inconclusivas aceitável 2018201 201 2018-201 80743 80 43 807.4 506 50- 1, 6, 0, 9,0 3 33, 201820 20 2018-20 8074 807. 9, 20182 2 2018-2 2018-

Resumen Objetivo: analizar indicadores del tamizaje de cáncer de mama en población femenina atendida por Sistema Único de Salud Brasileño, de 2018-2019. Métodos: estudio descriptivo basado en Sistema de Información del Cáncer (Siscan). Los indicadores de detección se calcularon después de vinculación determinista de bases de datos de mamografía e histopatología. Resultados: en 2018, 807.430 mujeres de 50-69 años examinaram cáncer de mama. De estos, 91% tuvo resultado benigno, 1,8% probablemente benigno, 6,7% resultado no concluyente y 0,5% sugestivo de cáncer. La tasa de mamografías positivas fue 9,0%. Se estimó indicación de biopsia en 1,6% de las mujeres, resultado maligno en 33,9% y tasa de confirmación de cáncer de 5,4 por 1.000 mujeres. Conclusión: se identificó alta pérdida de seguimiento de las lesiones benignas. La tasa de mamografías positivas fue inferior al parámetro internacional, pero la tasa de detección de cáncer fue adecuada y el porcentaje de mamografías no concluyentes aceptable.

Resumo Objetivo: analisar indicadores de monitoramento do rastreamento do câncer de mama na população feminina usuária do Sistema Único de Saúde, Brasil, no período 2018-2019. Métodos: estudo descritivo, a partir do Sistema de Informação do Câncer; foram calculados indicadores de rastreamento após relacionamento determinístico das bases de dados de mamografia e histopatologia. Resultados: em 2018, 807.430 mulheres na faixa etária de 50-69 anos foram rastreadas, e dessas, 91% apresentaram resultado benigno, 1,8% provavelmente benigno, 6,7% inconclusivo e 0,5% sugestivo de câncer; a taxa de mamografia positiva foi de 9,0%; estimou- -se indicação de biópsia para 1,6% das mulheres, resultado maligno para 33,9% delas, e taxa de confirmação de câncer de 5,4 por 1 mil mulheres. Conclusão: identificou-se elevada perda de seguimento das lesões benignas; a taxa de mamografias positivas foi inferior ao parâmetro internacional; contudo, a taxa de detecção de câncer foi adequada, e o percentual de mamografias inconclusivas, aceitável.

Abstract Objetive: to analyze breast cancer screening monitoring indicators in the female population using the Brazilian National Health System, from 2018 to 2019. Methods: this was a descriptive study based on Cancer Information System (SISCAN) data; screening indicators were calculated following deterministic linkage of the mammography and histopathology databases. Results: in 2018, 807,430 women aged 50 to 69 years were screened for breast cancer, 91% of whom had a benign result, 1.8% probably benign, 6.7% inconclusive results and 0.5% results suggestive of cancer; the positive mammogram rate was 9.0%; biopsy was estimated to be indicated for 1.6% of the women, 33.9% of whom had a malignant result, and the cancer confirmation rate was 5.4 per 1,000 women. Conclusion: high benign lesion loss to follow-up was identified; the positive mammogram rate was lower than the international parameter, but the cancer detection rate was adequate and the percentage of inconclusive mammograms was acceptable.

Abstract Objectives: to analyze the impact of the covid-19 pandemic on screening, diagnosis and treatment of breast cancer in Pernambuco, Northeastern Brazil. Method: cross-sectional study, based on secondary data from consultations with a mastologist, ultrasound, mammogram, biopsies, new cases, chemotherapy, radiotherapy and surgery, carried out in women for the screening, diagnosis and treatment of breast cancer, from January to December of the years 2019 to 2021. Results: the covid-19 pandemic reduced consultations with mastology (46.3%), ultrasounds (34.8%), mammogram (41.5%), biopsy (49.6%), new cases 45.7 % and surgery 34.6% in 2020 compared to 2019. On the other hand, with the exception of consultations with a mastologist and surgeries, all services where a significant reduction was observed in 2020, increased significantly in 2021 and returned to the same level of production in the pre-pandemic period. The pandemic did not negatively affect the supply of chemotherapy and radiotherapy. Conclusions: the findings of this study indicate negative impacts on breast cancer care, due to covid-19, during the first year of the pandemic, especially in consultations with a mastologist and surgery, which continued with low production in 2021. It is reasonable to assume that the reduction observed in procedures may reflect an increase in late diagnoses and a higher mortality rate in the coming years Objectives covid19 covid 19 covid-1 screening Pernambuco Brazil Method crosssectional cross sectional ultrasound biopsies 201 Results 46.3%, 463 46.3% , 46 3 (46.3%) 34.8%, 348 34.8% 34 8 (34.8%) 41.5%, 415 41.5% 41 5 (41.5%) 49.6%, 496 49.6% 49 6 (49.6%) 457 45 7 45. 346 34.6 202 hand surgeries prepandemic pre period Conclusions care covid19, 19, covid1 1 covid- 20 46.3 4 (46.3% 34.8 (34.8% 41.5 (41.5% 49.6 (49.6% 34. 2 46. (46.3 (34.8 41. (41.5 49. (49.6 (46. (34. (41. (49. (46 (34 (41 (49 (4 (3 (

Resumo Objetivos: analisar o impacto da pandemia da covid-19 nos atendimentos para rastreamento, diagnóstico e tratamento do câncer de mama em Pernambuco, Nordeste do Brasil. Métodos: estudo transversal, com base em dados secundários de consultas com mastologista, ultrassonografia, mamografia, biópsias, casos novos, quimioterapia, radioterapia e cirurgia, realizadas em mulheres para o rastreamento, diagnóstico e tratamento do câncer de mama, de janeiro a dezembro dos anos 2019 a 2021. Resultados: a pandemia da covid-19 reduziu as consultas com a mastologia (46,3%), ultrassonografias (34,8%), mamografia (41,5%), biópsia (49,6%), casos novos 45,7% e cirurgia 34,6% no ano de 2020 em relação ao ano de 2019. Por outro lado, com exceção das consultas com mastologista e cirurgias, todos os serviços onde se observou redução significativa em 2020, aumentaram significativamente em 2021 e voltaram ao patamar de produção do período pré-pandemia. A pandemia não afetou negativamente a oferta de quimioterapia e radioterapia. Conclusões: os achados deste estudo apontam impactos negativos na atenção ao câncer de mama, em decorrência da covid-19, durante o primeiro ano da pandemia, sobretudo nas consultas com mastologista e cirurgia, que continuaram com baixa produção em 2021. É razoável supor que a redução constatada nos procedimentos poderá refletir em um aumento de diagnósticos tardios e maior taxa de mortalidades nos próximos anos. Objetivos covid19 covid 19 covid-1 rastreamento Pernambuco Brasil Métodos transversal ultrassonografia biópsias 201 Resultados 46,3%, 463 46,3% , 46 3 (46,3%) 34,8%, 348 34,8% 34 8 (34,8%) 41,5%, 415 41,5% 41 5 (41,5%) 49,6%, 496 49,6% 49 6 (49,6%) 457 45 7 45,7 346 34,6 202 lado cirurgias prépandemia. prépandemia pré pandemia. pré-pandemia Conclusões covid19, 19, covid1 1 covid- 20 46,3 4 (46,3% 34,8 (34,8% 41,5 (41,5% 49,6 (49,6% 45, 34, 2 46, (46,3 (34,8 41, (41,5 49, (49,6 (46, (34, (41, (49, (46 (34 (41 (49 (4 (3 (

Resumen Objetivo: Revisar los aspectos clínicos necesarios a tomar en cuenta por el médico tratante al interpretar los reportes de los hallazgos radiológicos en la mamografía y de otras pruebas diagnósticas para un diagnóstico integral del cáncer de mama. Métodos: Se realizó una revisión sistemática de manuscritos publicados entre el 2010 y el 2020 sobre factores de riesgo y factores protectores que pueden verse involucrados en la incidencia del cáncer de mama. Se revisaron publicaciones de investigaciones realizadas en mujeres con diagnóstico de cáncer de mama de tipo ensayos clínicos aleatorizados, casos y controles, revisiones sistemáticas, metaanálisis y guías internacionales. Se buscó en las bases de datos bibliográficas PubMed, EBSCO y Scopus, publicaciones en inglés o español, utilizando términos provenientes de los Descriptores en Ciencias de la Salud (DeCS). Resultados: Se identificaron un total de 735 artículos en las búsquedas, de los cuáles se excluyeron 508 por su poca relevancia de acuerdo con el título. De los 227 restantes se excluyeron 22 por estar repetidos en las distintas bases, 12 porque no cumplían con los criterios de inclusión, 83 durante la revisión del resumen, y 28 al revisar el texto completo. En total se incluyeron 82 artículos para elaborar esta revisión. Los factores identificados en la revisión de la literatura se clasificaron en tres áreas: fisiopatológicos, gíneco-obstétricos y ambientales. Los factores de riesgo fisiopatológicos son la historia familiar, hiperplasia epitelial atípica, etnia, mayor edad, diabetes tipo II, síndrome metabólico, mayor peso y talla y mutaciones genéticas; los gíneco-obstétricos son la menarquía temprana, la menopausia tardía y la nuliparidad; y los ambientales incluyen fármacos, hábitos de vida, procedimientos médicos y alimentación. Mientras que, entre los factores protectores, los factores fisiopatológicos son el hipotiroidismo, el asma y la rinitis alérgica; los gínecoobstétricos son la multiparidad, el primer embarazo a una edad temprana y dar lactancia; y los ambientales incluyen fármacos, procedimientos médicos y alimentación.

Abstract Aim: To review relevant clinical aspects for the attending physician to consider when interpreting the reports of radiological findings in the mammogram and other diagnostic tests for a comprehensive breast cancer diagnosis. 2 ISSN 0001-6012 • eISSN 2215-5856 / Acta méd. costarric. 2022 / octubre-diciembre; 64 (4): 1-11 Cáncer mama factores de riesgo y de protección Methods: A systematic literature review was carried out focusing on risk and protective factors associated with breast cancer incidence, within peer-reviewed scientific articles published between 2010 and 2020. Published research on women with a breast cancer diagnoses who participated in randomized clinical trials, case control studies, systematic reviews, meta-analysis, and international guides were used. Research terms were searched on PubMed, EBSCO and Scopus databases, published in Spanish and English, using terms from the Medical Subject Headings (MeSH). Results: A total of 735 publications were found of which 508 were excluded due to title content being irrelevant to the review. Of the remainder 227, 22 were excluded due to been repeated across the different databases used, 12 because they did not meet the inclusion criteria, 83 after abstract review, and 28 after reading the whole text. A total of 82 papers were used for this review. The identified factors were categorized in three areas: pathophysiological, gynecological and obstetrics, and environmental factors. The pathophysiological risk factors are, family history, atypical hyperplasia, ethnicity, age, diabetes type II, metabolic syndrome, greater weight and height and genetic mutations; the gynecological and obstetric factors are early menarche, late menopause and nulliparity; and the environmental factors include prescription drugs, lifestyle habits, medical procedures and eating habits. Regarding the protector factors, the pathophysiological factors include hypothyroidism, asthma and allergic rhinitis; in the gynecological and obstetrics category are multiparity, the first pregnancy at early age and breast feeding; lastly, the environmental factors include prescription drugs, medical procedures and eating habits. Conclusions: Considering the risk and protector factors for breast cancer would allow a more comprehensive approach in the diagnosis and treatment of breast cancer.

Resumen: Introducción: se han producido múltiples avances tecnológicos en la historia de la mamografía. En los años más recientes surge la mamografía digital directa con tomosíntesis con mayores capacidades para detectar el cáncer. Objetivo: evaluar el efecto de la nueva tecnología en el desempeño de la mamografía, en la Unidad de Diagnóstico Mamario del Hospital Británico. Material y métodos: se compara el desempeño de la mamografía durante los años 2019-2020 en relación con los años 2010-2018. En el año 2019 se sustituyó la tecnología anterior por un mamógrafo digital directo con tomosíntesis, Hologic modelo Selenia Dimensions. Resultados: en los años 2019 a 2020 se realizaron 10.725 mamografías. Se detectaron 84 cánceres y la tasa de detección de cáncer fue de 8/1.000. El VPP fue de 35%. En los años 2010 a 2018 se realizaron 45.438 mamografías. Se detectaron 229 cánceres y la tasa de detección de cáncer fue de 5/1.000. EL VPP fue de 40%. En relación a las manifestaciones imagenológicas, se destaca el aumento de las microcalcificaciones en el período 2019-2020, que pasaron de ser 7% de los casos, a ser 19% de los casos. Las distorsiones aumentaron de 11% a 13%. En relación a los tipos histológicos de cáncer, se destaca el porcentaje del carcinoma ductal in situ (CDIS) que fue 4 veces superior en el período 2019-2020 en relación al anterior (17% de todos los casos detectados). Conclusiones: con la incorporación de la tomosíntesis aumentó 60% la tasa de detección de cáncer y el porcentaje de CDIS aumentó 4 veces.

Abstract: Introduction: significant technological progress has been made in the history of mammography. Recently, direct digital mammography plus tomosynthesis arrived and improved breast cancer screening. Objective: to evaluate the effects of new technology in the performance of mammography, at the Breast Diagnostic Service of the British Hospital. Method: mammography performance during 2019- 2020 was compared to that between 2010 and 2018. In 2019 the previous tehcnology was substituted by a direct digital mammogram with tomosynthesis, Hologic, Selenia Dimensions model. Results: 10.725 mammographies were done in 2019-2020. Cancer was detected in 84 cases and the cancer detection rate was 8 per 1000 persons. PPV was 35%. 45.438 mammographies were done in 2010-2018. Cancer was detected in 229 cases and the cancer detection rate was 5 per 1.000 persons. PPV was 40%. As to images, it is worth pointing out an increase in microcalcifications between 2019 and 2020, when they grew from 7% of cases to 19% of cases and distortions increased from 11% to 13%. DCIS was 4 times greater in 2019-2020 when compare to the previous period of time (17% of all detected cases). Conclusions: the integration of tomosynthesis increased 60% the cancer detection rate and the DCIS was 4 times greater.

Resumo: Introdução: a história da mamografia registra vários avanços tecnológicos. Nos anos mais recentes, a mamografia digital direta com tomossíntese surgiu com uma maior capacidade de detectar a presença de câncer. Em 2019 a Unidade de Diagnóstico de Mama (UDM) do Hospital Britânico no Uruguai, incorporou um mamógrafo digital direto com tomossíntese, Hologic modelo Selenia Dimensions. Objetivo: avaliar desempenho do mamógrafo digital direto com tomossíntese na UDM. Material e métodos: faz-se uma comparação dos resultados das mamografias durante dois períodos 2019-2020 e 2010-2018. Resultados: no período 2019 a 2020 foram realizadas 10.725 mamografias; 84 cânceres foram detectados com una taxa de detecção de 8/1000. O valor preditivo positivo (VPP) foi de 35%. No período 2010-2018, foram realizadas 45.438 mamografias, 229 cânceres foram detectados com una taxa de detecção de 5/1000. O VPP foi de 40%. Em relação às manifestações de imagem, destaca-se o aumento das microcalcificações no período 2019-2020, que passou de 7% para 19% dos casos. As distorções aumentaram de 11% para 13%. Em relação aos tipos histológicos de câncer, destaca-se a porcentagem de carcinoma ductal in situ (CDIS), que foi quatro vezes maior no período 2019-2020 do que no anterior (17% do total de casos detectados). Conclusões: com a incorporação da tomossíntese, a taxa de detecção de câncer aumentou 60% e a porcentagem de CDIS aumentou quatro vezes.

Resumo 28. A mama masculina pode ser afetada por uma variedade de entidades benignas e malignas. O hemangioma da mama é um tumor vascular benigno raro que pode ocorrer em ambos os sexos, sendo ainda mais raro em homens, com poucos casos relatados na literatura. Apresenta-se um caso de um homem de 78 anos com antecedentes de cancro da laringe avançado, previamente tratado com radioterapia, que recorreu ao nosso serviço de urgência por dispneia grave. Realizou- se uma tomografia computadorizada do pescoço e do tórax que revelou alterações pós- radicas cervicais, sem alterações pulmonares significativas. Um nódulo incidental na mama esquerda foi também revelado e considerado indeterminado. A mamografia e ecografia realizadas demonstraram um nódulo oval, hiperdenso e hipoecogénico, bem circunscrito, sem espiculações ou calcificações, demonstrando uma ecoestrutura ligeiramente heterogénea, sem sombra acústica posterior. Foi realizada microbiópsia ecoguiada e o exame histopatológico foi compatível com um hemangioma cavernoso, de tipo sinusoidal.

Abstract 23. The male breast can be affected by a variety of benign and malignant entities. Breast hemangioma is a rare benign vascular tumor occurring in both genders, being even rarer in men, with only a few cases reported in the literature. This is a case report of a 78-year- old male patient with a known history of advanced laryngeal cancer previously treated with radiotherapy who was admitted to our emergency department in the setting of severe dyspnea. A neck and chest computerized tomography were performed, revealing post radiation changes of the neck and no significant pulmonary abnormalities. An incidental left breast nodule was noted and considered indeterminate. The mammogram and the breast ultrasound revealed a well-circumscribed hyperdense and hypoechoic oval nodule, without spiculations nor calcifications. It also demonstrated a slightly heterogeneous echo pattern with no posterior acoustic shadowing. An ultrasound-guided core needle biopsy was performed and the histopathologic examination was compatible with a cavernous hemangioma.