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Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics., Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil's Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk., Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio - HRadj=2.30 (95% confidence interval - 95%CI 1.34-3.94) and HRadj=2.51 (95%CI 1.61-3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36-7.49)., Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes.

The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome.

Objective: To investigate methods of fertility preservation in younger women exposed to adjuvant chemotherapy for breast cancer., Design: Systematic review of literature., Setting: Academic Department of Medical Oncology., Patient(s): Premenopausal women exposed to adjuvant chemotherapy for breast cancer., Main Outcome Measure(s): Fertility preservation., Result(s): Data for fertility preservation in this setting come from nonrandomized trials and observational studies. The main methods of fertility preservation are ovarian protection by gonadotropin-releasing hormone (GnRH) agonists, cryopreservation of embryos after in vitro fertilization, and preservation of operatively sampled ovarian tissue or eggs after stimulation and puncture. Ongoing trials are assessing the role of ovarian protection by GnRH agonists., Conclusion(s): At present, there are no high-level, evidence-based recommendations for preservation of fertility or of ovarian function in women with breast cancer. This is an important issue for young breast cancer survivors, and further studies are needed. Moreover, the interplay between ovarian protection by GnRH agonists and the efficacy of adjuvant chemotherapy remains elusive., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)