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Background: Concurrent diagnosis of breast cancer (BC) and pregnancy represents a therapeutic challenge as the indication of any treatment modality requires careful consideration of expected clinical benefit and fetal safety. Anthracycline-based chemotherapy regimens have been extensively studied and proven to be relatively safe to use during gestation. However, there is limited data about the safety of taxane-containing regimens during pregnancy or the predominant prescribing practices in real-world clinical settings despite NCCN and ESMO supporting their use when clinically indicated. This study aimed to systematically review and synthesize available evidence regarding gestational taxane use for BC treatment.. Methods: A literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from their inception up to April 14, 2021. Studies considered eligible for this analysis were those that reported gestational taxane use for BC, presented original findings, and disclosed patient-specific outcomes. The retrieved records were independently screened by two authors, with discrepancies resolved by a third. Descriptive statistics were undertaken. Results: A total of 438 unique records were retrieved, of which 32 reports describing 163 BC patients treated with taxane-containing regimens during pregnancy were identified. Of those, 25 publications disclosed sufficient detail to be included in the analysis (63 pregnancies, 64 newborns; median gestational age at taxane initiation = 24 weeks, range 14-32). The most commonly reported regimens were paclitaxel 80 mg/m2 weekly (20%) and docetaxel 75 mg/m2 every three weeks (15%). The median cumulative dose received during pregnancy was 550 mg/m2 (range: 240-1200) for patients treated with paclitaxel and 375 mg/m2 (range: 150-650) for those prescribed docetaxel. A total of 80% were exposed simultaneously or sequentially to other cytotoxic treatments during pregnancy, 13% were additionally treated with anti-HER2 agents, and 10% received G-CSF. Treatment-associated adverse effects or obstetric complications were reported in 41%, predominantly consisting of preterm contractions or rupture of membranes (11%), oligohydramnios (8%), preeclampsia/HELLP syndrome (8%), and cytopenias (8%). The outcome of all pregnancies was reported as live birth. Overall, 52% of deliveries were preterm ( Conclusions: In this review, a high rate of maternal and fetal adverse outcomes was found in cases exposed to taxanes during pregnancy. Anecdotal evidence suggests that a wide variability of taxane-containing regimens are used in clinical practice, with most cases being exposed simultaneously or sequentially to other systemic treatments. Future studies are needed to fully elucidate the optimal taxane-containing regimen to be used during pregnancy, with a special emphasis on treatment safety. Use of taxane-containing regimens during pregnancy. Data are shown as n (%). NR: Not reported Gestational age at taxane initiation 1rst trimester 1 (2%) 2nd trimester 26 (41%) 3rd trimester 13 (21%) NR 23 (37%) Taxane agent administered Paclitaxel 32 (51%) Docetaxel 19 (30%) Both/NR 12 (19%) Pregnancy complications Preterm delivery 33 (52%) Preterm contractions/PROM 7 (11%) Oligohydramnios 5 (8%) Pre-eclampsia/HELLP syndrome 5 (8%) IUGR 5 (8%) Method of delivery Vaginal 13 (20%) C-section 16 (25%) NR 35 (55%) Neonatal complications Preterm delivery 33 (52%) Small for gestational age (n=55) 15 (27%) Need for resuscitation or respiratory support 7 (11%) Hyperbilirubinemia 2 (3%) Citation Format: Ana S. Ferrigno, Andrea Becerril-Gaitan, Bryan F. Vaca-Cartagena, Hatem A. Azim Jr., Cynthia Villarreal-Garza. Use of taxane-containing regimens during pregnancy for the treatment of breast cancer: A systematic review [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-23-03.

Background: Breast cancer (BC) is the most common malignancy and the leading cause of cancer-related deaths among young women worldwide. This population usually presents with more advanced stages at diagnosis compared to their older counterparts, exposing them to more intensive treatments which compromise their quality of life (QOL). This study aims to determine the change in QOL in young women with locally-advanced BC over time. Methods: Women aged ≤40, newly diagnosed with locally-advanced BC from 2016 to 2020 at three cancer referral centers in Mexico and accrued in the Joven & Fuerte cohort were included and asked to complete the EORTC QLQ-C30 and QLQ-BR23 questionnaires at diagnosis, six months, and one year follow-up. Differences in mean values were analyzed using repeated measures ANOVA tests. The Mauchly's test was employed to assess the assumption of sphericity and if violated the Huynh-Feldt correction was used. Adjustment of multiple comparisons was performed with the Bonferroni correction. Results: A total of 195 patients with a median age at diagnosis of 35 years (IQR: 32-38) were analyzed. Most patients (59%) were married or in a domestic partnership and the majority (60%) were housewives or unemployed. The distribution of clinical stages at diagnosis was: IIB (41%), IIIA (39%), IIIB (11%), and IIIC (10%). Regarding treatment modalities, most patients underwent mastectomy (n=111, 57%), neoadjuvant (n=103, 53%) or adjuvant chemotherapy (n=79, 41%), and adjuvant endocrine therapy (n=106, 54%). QLQ changes over time are shown in the Table. Most functional scales worsened significantly at six months. Although most of them improved at one year of follow-up, they did not reach baseline levels. Certain symptoms such as fatigue, insomnia, financial difficulties, and arm symptoms worsened from baseline. When analyzing QLQ changes according to the different treatment modalities (mastectomy vs lumpectomy), (neoadjuvant vs neoadjuvant/adjuvant vs adjuvant chemotherapy) and (receiving hormone therapy vs not) no significant differences were found in functional scales or BC symptoms over time. Conclusion: Young women with BC experience physical and psychological distress that negatively impacts their QOL. Several BC specific domains worsened from baseline, such as body imaging, sexual satisfaction, and arm symptoms. Thus, strategies aimed at addressing these specific areas are warranted. QLQ-C30 and QLQ-BR23 at baseline, six months and one yearMean (SEM)NumberBaselineSix monthsOne yearp valueQLQ-C30Global health status14277.76 (1.65)73.53 (1.81)78.46 (1.59)0.047Physical Functioning14290.09 (0.93)86.62 (1.16)89.20 (1.02)0.026Role Functioning14286.97 (1.53)80.16 (1.86)87.68 (1.37) Citation Format: Cynthia Villarreal-Garza, Bryan F Vaca-Cartagena, Andrea Becerril-Gaitan, Alejandra Platas, Melina Miaja, Fernanda Mesa-Chavez, Ana S Ferrigno, Alan Fonseca, Marlid Cruz-Ramos, Lucero Labra, Enrique Bargallo-Rocha, Alejandro Mohar. Quality of life in Mexican young women with locally-advanced breast cancer: A cohort study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-20.

Background: The implementation of genetic cancer risk assessment (GCRA) in resource-constrained settings is limited due to multiple factors, including insufficient access to preventive strategies. In our center, GCRA was formally established in 2014, and access to genetic testing is provided to underserved patients through a research collaboration with City of Hope's CCGCRN. The aim of this study is to determine the proportion of patients with germline mutations that underwent risk-reducing surgeries (RRS) and followed recommended breast cancer (BC) screening strategies. Methods: Patients that received GCRA in a center located in Monterrey, Mexico who met NCCN criteria for testing for BC predisposition genes were eligible. Information on mutation status, performance of RRS and BC screening strategies was prospectively collected. The patients were grouped by type of healthcare (i.e. private vs public), with differences explored using Fisher's exact or Mann Whitney U tests, as appropriate. Results: Between 2014 and 2019, a total of 437 probands and 139 of their relatives underwent GCRA. Of these, 23% and 37% were identified as mutation carriers, respectively: BRCA1/2 (72.5%), PALB2 (6.4%), CHEK2 (6.4%) and others (14.7%). The median time elapsed from disclosure of genetic test results to collection of data was 16 months. The median age was 41 years, with no statistical difference according to type of healthcare. Based on NCCN guidelines, 151 RRS were recommended according to mutational status and age, of which 52 (34%) were performed: 28 risk-reducing mastectomies (RRM) and 24 risk-reducing salpingo-oophorectomies (RRSO). A substantial proportion of these were funded by non-governmental organizations, while the rest were covered by public health insurance (as adjuvant treatment), private health insurance or the patient herself. Regarding BC screening, after excluding 78 patients because of active BC treatment, bilateral mastectomy or male sex, 92% of eligible patients followed NCCN recommendations. No differences in the performance of RRS or BC screening strategies were found according to type of healthcare delivery. Conclusion: In this cohort, an adequate adherence to recommended screening strategies was observed but only one-third of recommended RRS were performed. Notably, type of healthcare was not a determining factor for the adherence to NCCN's recommended prevention strategies, suggesting that economical barriers might not be the main limiting factor. Efforts to elucidate if sociocultural barriers limit adherence to RRS are being conducted in order to enhance standard of care at Mexican centers with GCRA programs. Characteristics according to healthcare coverage.Private insurancePublic insurancep valueMutational status- Probands: carriers/tested32/117 (27%)67/320 (21%)NS- Relatives: carriers/tested10/42 (24%)42/97 (43%)0.036RRS- RRM performed/recommended9/24 (38%)19/65 (29%)NS- RRSO performed/recommended6/18 (33%)18/44 (41%)NS- RRS covered by NGOs0 (0%)11/37 (30%)0.022Current BC screening modality- Mammogram (MMG) ± US9 (41%)33 (65%)0.033- MRI ± MMG ± US9 (41%)6 (12%)- None3 (14%)1 (2%)- Unknown1 (5%)11 (22%)Follow BC screening recommendations- Yes19 (90%)37 (93%)NS- No2 (10%)3 (8%) Citation Format: Dione Aguilar, Alejandro Aranda-Gutierrez, Ana S Ferrigno, Jeffrey N Weitzel, Kathleen N Blazer, Danielle Castillo, Josef Herzog, Rosa Mejia, Nancy L Sada-Villarreal, Servando Cardona, Mauricio Canavati-Marcos, Margarita Garza-Montemayor, Cynthia Villarreal-Garza. Genetic cancer risk assessment and its impact on the uptake of cancer risk reduction strategies: The experience of a Mexican center [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-25.

Background: The PALB2 gene is recognized as one of the most clinically relevant moderate to high penetrance breast cancer (BC) predisposition genes. Its product, PALB2, plays a crucial role in the homologous recombination pathway as a partner and localizer of BRCA2. Previous studies have reported significant frequencies of germline PALB2 and BRCA2 pathogenic variants (PVs) in Hispanic populations. However, no study has yet compared the baseline clinicopathological features of Mexican BC patients who carry PVs in these closely related genes. Methods: Medical records of BC patients from two centers located in Monterrey, Mexico who underwent a next-generation sequencing panel for BC predisposition genes (APC, ATM, BRCA1, BRCA2, BRIP1, CHEK2, CDH1, CDKN2A, MLH1, MSH2, MSH6, MUTYH, NF1, PALB2, PMS2, PTEN, RAD50, RAD51C, RAD51D, TP53) based on NCCN recommendations were reviewed. Patients with germline PVs in PALB2 or BRCA2 were considered eligible. Fisher’s exact and Mann Whitney U tests were employed to evaluate differences between groups based on mutation status. Results: Between 2014 and 2019, a total of 8 PALB2 (1.8%) and 24 BRCA2 (5.5%) pathogenic mutation carriers were identified from 437 BC cases. Baseline clinicopathological features are shown in Table 1. Overall, no statistically significant differences were observed between groups. The most common germline PVs were c.2167_2168delAT, p.Met723fs, frameshift mutation for PALB2 (57% of cases) and c.274C>T, p.Gln92Ter, nonsense mutation for BRCA2 (30% of cases). Of note, one male BC case occurred in a PALB2 mutation carrier, representing 13% (1/8) of BC cases in this carrier group and the only male BC case (out of three) associated with a germline PV. Conclusion: This is the first report detailing the clinicopathological features of Mexican BC patients with germline PALB2 PVs. According to our findings, BC tumors in PALB2 mutation carriers share similar baseline characteristics with those diagnosed in BRCA2 mutation carriers. Long-term follow-up is required in order to determine if prognosis is similar between groups and to further solidify the clinical relevance of germline PALB2 PVs in the Mexican population. Baseline clinicopathological features of PALB2 and BRCA2 mutation carriers with BCPALB2 mutation carriersBRCA2 mutation carriersMedian age at diagnosis (years)3938Median body mass index (kg/m2)2326Family history of BCYes5 (63%)19 (79%)No3 (38%)5 (21%)Clinical stageI2 (25%)2 (8%)II5 (63%)11 (46%)III08 (33%)IV1 (13%)3 (13%)Histological typeIDC6 (75%)22 (92%)Non-IDC2 (25%)2 (8%)Histological gradeG11 (13%)5 (21%)G24 (50%)10 (42%)G33 (38%)6 (25%)Missing03 (13%)Molecular subtypeHR+/HER2-6 (75%)11 (46%)HR+/HER2+04 (17%)HR-/HER2+00HR-/HER2-2 (25%)9 (38%)LateralityUnilateral8 (100%)21 (88%)Bilateral03 (13%) Citation Format: Alejandro Aranda-Gutierrez, Ana S Ferrigno, Juan Carlos A. García Marrufo, Mariana Moncada-Madrazo, Analy Gomez-Picos, Cynthia Villarreal-Garza, Dione Aguilar. Clinicopathological features of PALB2 and BRCA2 mutation carriers with breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS16-29.

Background: The implementation of genetic cancer risk assessment (GCRA) has resulted in an increased identification of adult males with breast cancer (BC) predisposing mutations. However, its effect on adherence to cancer prevention strategies and the psychological impact of receiving a positive genetic test result have not been sufficiently explored in men. The aim of this study is to determine the impact of GCRA on men with BC predisposing mutations. Methods: Men aged ≥18 years that underwent genetic testing between 2017 and 2019 in a center located in Monterrey, Mexico were invited to answer a telephone survey in which clinical information was collected. In addition, a section with an adapted Multidimensional Impact of Cancer Risk Assessment (MICRA) was incorporated. Total MICRA score was determined as the mean of items 1-21. Furthermore, seven sections were analyzed separately: distress (items 1-4 and 7-8), uncertainty (items 9-12, 14-17 and 20), positive experiences (items 5-6 and 18-19), understanding choices (item 13), testing regret (item 21), worry about children (items 22-23) and worry about cancer (items 24-25). Differences between categorical variables were explored using Mann Whitney U tests. Results: A total of 31 patients were eligible for this study, of which 29 consented to participate. Of these, 15 were mutation carriers (8 BRCA1, 3 BRCA2, 2 ATM, 1 CHEK2 and 1 PALB2) with a median age of 45 years (range 20-71). Only one of the carriers surveyed had a personal history of BC. The median time elapsed from disclosure of positive carrier status to survey application was 13 months. Remarkably, 3/15 ignored their test result despite previous GCRA, and only 4/15 were able to identify the specific mutated gene. Most had disclosed their mutation status to close relatives (67%). Regarding psychological impact, 2/15 thought that their genetic test result had a significant impact in their life and 1/15 claimed that undergoing genetic testing generated feelings of anxiety or depression. In addition, two out of three childless carriers reported that their mutation status made them seriously doubt whether to have biological children. Notably, only 47% were aware about the mode of transmission of their mutation. Concerning medical support, 87% felt that the support offered by the medical team was sufficient, but only 60% considered that they had enough information about the implications of their carrier status. With respect to prevention strategies, 67% claimed to be unaware about the general recommendations according to their mutational status and age. Furthermore, 87% did not use sunscreen, 80% had never visited a dermatologist, 73% could not correctly identify suspicious signs for skin cancer, 8/11 (72%) of eligible patients did not perform routine breast self-exams, and 10/11 (91%) had not visited a physician for a clinical breast exam. In addition, 0/6 (0%) of the eligible patients had had a colonoscopy and 5/6 (83%) eligible patients had not undergone screening for prostate cancer. Concerning the MICRA score, patients with BC predisposing mutations had a higher total mean score than non-carriers (21.7 vs. 14.3; p=0.01), particularly due to the positive experiences subscale (11.5 vs. 5.4; p=0.01). Conclusion: Low awareness and poor adherence to recommended prevention strategies were found in male mutation carriers despite a high impact of GCRA in this group. Hence, efforts to elucidate the specific barriers that limit adherence to these strategies in men are warranted. MICRA scores. Results are shown as mean (standard deviation).Mutation carriers (n=15)Non-carriers (n=14)p valueTotal score21.7 (8.5)14.3 (7.8)0.008Distress subscale2.1 (4.0)1.1 (1.9)0.617Uncertainty subscale6.0 (6.3)5.6 (7.1)0.603Positive experiences subscale11.5 (5.2)5.4 (7.2)0.013Understanding choices item2.0 (2.2)2.1 (2.1)0.841Testing regret item0.1 (0.3)0.0 (0.0)0.779Worry about children section2.5 (3.1)3.7 (3.3)0.569Worry about cancer section5.0 (0.0)5.0 (0.0)>0.99 Citation Format: Ana S Ferrigno, Alejandro Aranda-Gutierrez, Mariana Moncada-Madrazo, Arantza Montemayor-Solis, Julia S Arango-Vasquez, Juan CA Garcia-Marrufo, Lourdes Martinez-Ordaz, Cynthia Villarreal-Garza, Dione Aguilar. Impact of genetic cancer risk assessment on males with breast cancer predisposing mutations [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-23.

Introduction In Mexico, there are considerable health system delays in the diagnosis and treatment initiation of women with breast cancer. Alerta Rosa is a navigation program in Nuevo Leon that aims to reduce barriers that impede the timely management of these patients. Patients and Methods Since December 2017, women who registered to receive medical evaluations by Alerta Rosa were stratified based on their clinical characteristics into three priority groups (“Red,” “Yellow,” and “Green”). According to the category assigned, patients were scheduled imaging studies and medical appointments with breast specialists on a preferential basis. Results Up until December 2019, 561 patients were scheduled for medical evaluations. Of them, 59% were classified as “Red,” 25% “Yellow,” and 16% “Green” priority. The median time from stratification to first medical evaluation was 4, 6, and 7 days, respectively (p = .003). Excluding those who had a prior breast cancer diagnosis, 21 patients were diagnosed by Alerta Rosa, with the initial “Red” priority classification demonstrating a sensitivity of 95% (95% confidence interval [CI], 75.1%–99.9%) and specificity of 42% (95% CI, 37.1%–47.1%) for breast cancer. The median time elapsed from initial patient contact to diagnosis and treatment initiation was 16 days and 39 days, respectively. The majority (72%) of patients were diagnosed at an early stage (0–II). Conclusion This patient prioritization system adequately identified women with different probabilities of having breast cancer. Efforts to replicate similar triage systems in resource-constrained settings where screening programs are ineffective could prove to be beneficial in reducing diagnostic intervals and achieving early-stage diagnoses. Implications for Practice Low- and middle-income countries such as Mexico currently lack the infrastructure to achieve effective breast cancer screening and guarantee prompt access to health care when required. To reduce the disease burden in such settings, strategies targeting early detection are urgently needed. Patient navigation programs aid in the reduction of health system intervals and optimize the use of available resources. This article presents the introduction of a triage system based on initial patient concern. Appointment prioritization proved to be successful at reducing health system intervals and achieving early-stage diagnoses by overcoming barriers that impede early access to quality medical care.

Background: Choosing the appropriate treatment for patients with early hormone receptor (HR)-positive and HER2-negative breast cancer (BC) remains a challenging process that must balance possible therapy benefits against potential side effects. Recent reports on premenopausal patients raise concerns about the safety of omitting chemotherapy (CT), and no consensus has been reached to define the use of these tools in the decision-making process. Thus, further research is needed to guide the use of genomic testing on this young group. Due to the limited data of the EndoPredict (EP) assay performance in premenopausal women, we aim to describe the follow-up results of a prospective cohort that utilized the EP assay to guide adjuvant treatment decision-making in this group of patients. Methods: Premenopausal women with HR-positive, HER2 negative, T1-T2, and N0-N1 BC who received adjuvant treatment guided by the results of the EP assay in two referral BC centers in Mexico were included. Clinicopathological and genomic characteristics were collected. Recurrence-free survival (RFS) and distant disease-free survival (DDFS) were evaluated using the Kaplan-Meier estimate. The Chi-squared and Log-rank tests were employed for group comparisons. Results: A total of 99 patients with a median age at diagnosis of 43 years (IQR 39-46) were analyzed. Most patients had T2 (54%), node-negative disease (72%), and low/intermediate-grade disease (85%). The distribution of clinical stages at diagnosis was: IA (38%), IB (2%), IIA (37%), IIB (22%). Regarding EPclin scores, 54% patients were categorized as high-risk while 47% had low-risk of distant recurrence. With respect to CT, 15% of patients in the low-risk group received CT compared to 100% in the high-risk category (p Clinicopathological characteristics of patients with recurrent disease.Age (y) at diagnosisStage (pT pN)GradeER (%)PR (%)Ki67 (%)EP resultEPclin scoreCTHTType of recurrence37IIA (T2 N0)29595N/ILow risk2.7NoTamoxifenLocal/regional43IA (T1c N0)2802010Low risk2.9NoTamoxifenLocal/regional45IA (T1c N0)21006020Low risk3.2NoTamoxifenLocal/regional42IIA (T2 N0)N/I1007040High risk3.9YesTamoxifenLocal/regional38IIA (T2 N0)2704040High risk4.2YesTamoxifenDistant35IIB (T2 N1)2604010High risk4.4YesTamoxifenDistant41IIB (T2 N1)2909070High risk5.1YesTamoxifen (after CT-induced ovarian failure)DistantER= Estrogen receptor status. PR= Progesteron receptor status. N/I= No information. Citation Format: Daniela Vazquez-Juarez, Bryan F Vaca-Cartagena, Andrea Becerril-Gaitan, Zuratzi Deneken-Hernandez, Ana S Ferrigno, Antonio Maffuz-Aziz, Edna A Lopez-Martinez, Regina Barragan-Carrillo, Jose F Muñoz-Lozano, Cynthia Villarreal-Garza. Follow-up of prospective cohort of Mexican premenopausal women with breast cancer who received guided adjuvant treatment with the EndoPredict assay [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-05-15.

This cross-sectional survey study evaluates the specific concerns of and high hesitancy rate toward COVID-19 vaccination among women with breast cancer in Mexico.

e12560 Background: Young women with breast cancer (YWBC) have worse survival outcomes compared to their older counterparts. Even though a higher recurrence rate has been previously documented in this population, there is still limited information regarding the timing, prevalence and type of disease recurrence. This study aims to describe the patterns of early recurrence in Mexican YWBC. Methods: Women aged ≤40 years at diagnosis, accrued in the Joven & Fuerte prospective cohort, with stage I-III BC and having at least a 2-year follow-up were analyzed. Recurrence-free survival (RFS) and overall survival (OS) at 2 years were evaluated using the Kaplan-Meier estimate. Log-rank and Fisher’s exact tests were employed for group comparisons; the Cox regression method was used to identify factors associated with RFS and OS. Results: A total of 210 patients with a median age at diagnosis of 36 years (range: 21-40) were analyzed. Most patients were diagnosed with stage II (50%) and III (39%). Distribution according to molecular subtype was: 50% HR+/HER2-, 26% TNBC, 17% HR+/HER2+, and 7% HR-/HER2+. In total, 31 (15%) patients experienced early disease recurrence. The two BC subtypes with the highest recurrence rate were TNBC (12/54; 22%) and HR+/HER2+ (6/35; 17%), followed by HR+/HER2- (12/106; 11%) and HR-/HER2+ (1/15; 7%). Stage at diagnosis was associated with a higher risk of recurrence (stage III: 21/82 (68%); stage II: 10/94 (32%); p= 0.003). Of the total recurrences, 23% were locorregional and the remaining 77% were distant metastases. The most common sites of distant metastases were lung (46%), bone (38%) and central nervous system (33%). Notably, 50% of distant recurrences affected multiple organs. Overall, RFS at 2 years was 85.2% (95%CI 79.7-89.4). In the univariate analysis, age ( < 35 v ≥35), type of surgery (conservative v mastectomy) and BMI ( < 25 v ≥25 kg/m²) were not significantly associated with RFS. In a multivariate model, node involvement (HR = 2.76; p= 0.044), not receiving chemotherapy (HR = 3.86; p= 0.024) and TNBC (HR = 2.47; p= 0.035) were independently associated with worse RFS. The OS found in this cohort was 92.9% (95%CI 88.4-95.6). In a multivariate model, TNBC (HR = 3.71; p= 0.029) and stage III at diagnosis (HR = 5.55; p= 0.008) were associated with worse OS. Conclusions: This cohort of YWBC experienced a low RFS at 2 years. As previously reported, patients with node involvement and TNBC faced a greater risk of early recurrence. Noteworthy, a high prevalence of distant metastases was observed, with half of them involving > 1 site. Future studies are warranted to elucidate the factors associated with early recurrence in YWBC. In addition, the incorporation of new treatment strategies is urgently needed to improve disease outcomes in this group.

e12624 Background: Obesity (BMI ≥30 kg/m2) and breast cancer (BC) are two major public health concerns worldwide. Obesity has been linked with aggressive clinicopathological features and inferior survival rates in patients with BC, regardless of molecular subtype. In addition, obesity has been associated with decreased pathological complete response (pCR) rates in some BC cohorts. However, the impact of obesity on pCR rates in different BC molecular subtypes is still a subject of debate. This study aims to explore the impact of obesity on pCR rates in women with different BC subtypes in a public health-care center. Methods: Medical records of women diagnosed with primary BC between 2009 and 2020 in a center in Monterrey, Mexico were reviewed. Patients with stage II or III at diagnosis treated with neoadjuvant chemotherapy (NAC) were considered eligible. Associations between variables were examined using Fisher's exact test of independence, employing logistic regression to calculate odds ratios (OR) when appropriate. Results: A total of 559 patients with a median age at diagnosis of 48 years (range 25-85) were included. Patients were diagnosed with stages II (37%) and III (63%). The most common molecular subtype was HR+/HER2- (49%), followed by TNBC (25%), HR-/HER2+ (15%), and HR+/HER2+ (11%). Regarding BMI, a significant proportion of patients was either overweight (34%) or obese (47%). In this cohort, a total of 134 (24%) patients achieved pCR following NAC with anthracycline- and/or taxane-containing regimens. pCR rates by subtype were as follows: HR-/HER2+ (41%), TNBC (34%), HR+/HER2+ (31%), and HR+/HER2- (13%). A significant association between pCR rates and molecular subtype was found (p

e12622 Background: Immunologic biomarkers such as tumor infiltrating lymphocytes (TILs) and programmed death ligand-1 (PD-L1) can provide prognostic information in breast cancer (BC) patients. Specifically, a high TILs level has been associated with pathologic complete response and enhanced disease-free survival (DFS). Furthermore, PD-L1 positivity has been associated with worse DFS and overall survival (OS). However, the interaction of both biomarkers as well as its association with survival outcomes in specific BC subtypes is still a subject of ongoing research. Methods: Medical records of women diagnosed with primary BC between 2013 and 2015 in a center in Monterrey, Mexico were reviewed. Eligible patients had at least 1 year of follow-up, stages I-III at diagnosis, and available tissue for TILs and PD-L1 assessment. PD-L1 positivity was defined as the presence of PD-L1 in ≥1% of tumor-infiltrating immune cells using the VENTANA SP142 assay. Classification of TILs into low ( < 30%) and high (≥30%) levels was performed for analytical purposes. Clinicopathological features were compared with Fisher’s exact tests and logistic regression models, as appropriate. The Kaplan-Meier method was used to calculate recurrence-free survival (RFS), and associations between variables were explored with log-rank or Cox regressions. Results: A total of 195 patients were included. Overall, 12.3% of BC biopsy specimens showed positivity to PD-L1 (8.3% [11/132] in HR+/HER2-, 5.9% [2/34] in HER2+, and 38% [11/29] in TNBC; p < 0.001). PD-L1 positivity was significantly associated with ER-negative status (OR 3.1; p = 0.013), high TILs (OR 5.7; p < 0.001), and high Ki67 expression (HR 12.5; p < 0.001). The median follow-up for the entire cohort was 61 months (95%CI 58-63). RFS in the PD-L1- group was significantly superior to the PD-L1+ group (85% vs. 66% at 5 years; p = 0.021). In a multivariate Cox model, PD-L1 positivity (HR 3.3), low TILs (HR 3.4), advanced stage (HR 2.8), and high histological grade (HR 2.5) were all independent prognostic factors for worse RFS. Based on these results, we further classified our cohort into four prognostic profiles based on PD-L1 and TILs status. The low TILs/PD-L1+ group experienced an inferior RFS than low TILs/PD-L1- patients (45% vs. 85% at 5-years; p-value < 0.001), while no difference was observed in the high TILs groups. Notably, when analyzing HR+/HER2- patients only, a similar statistical difference was observed between low TILs/PD-L1+ and low TILs/PD-L1- groups (HR 5.4, p = 0.009). Conclusions: In our cohort, PD-L1 positivity together with low TILs identified a subset of BC patients with a worse RFS. Interestingly, patients with HR+/HER2- BC fared worse in the low TILs/PD-L1+ subcategory than in the low TILs/PD-L1- group. Future studies are warranted to explore the prognostic value of categorizing patients based on TILs and PD-L1 status in different BC subtypes.

10562 Background: Breast cancer (BC) is the most common cause of cancer-related death and morbidity among young women in Latin America. This group has a higher prevalence of advanced disease stages at diagnosis compared to their older counterparts. Thus, strategies aimed at detecting BC at early stages are imperative. Breast self-examination (BSE) remains a useful strategy for BC detection, especially in women who do not routinely undergo screening with imaging studies. This study aims to evaluate factors related with BSE practice in Mexican young women with BC and assess its association with earlier disease stages. Methods: Women aged ≤40 newly diagnosed with BC from 2014 to 2020 at three cancer referral centers in Mexico accrued in the Joven & Fuerte cohort were included and asked to complete a socio-demographic survey. Fisher’s exact and Mann-Whitney U tests were used to evaluate associations between BSE and socio-demographic characteristics, as well as disease stages. Results: A total of 554 patients with a median age at diagnosis of 36 years (range: 19-40) were analyzed. Most patients (65%) were married or in a domestic partnership, and the majority were housewives (63%). Regarding educational background, 64% had completed at least high school, and up to 84% had a monthly income < 11,600 Mexican pesos (US$ 581). Overall, 85% of patients had public insurance, 6% had private insurance, and 9% were uninsured. The distribution of clinical stages at diagnosis was: 0 (2%), I (11%), II (45%), III (32%), and IV (10%). BC detection methods were: 85% by self/partner exam, 11% by an imaging study, and 4% by a healthcare professional. A total of 443 (80%) patients practiced BSE, of which 50% did it on a monthly basis, 18% every 2-3 months, and the remaining 12% every 4-12 months. Notably, a higher educational level (≥ high school v ≤ middle school) was positively associated with BSE practice (RR: 1.28; 95%CI 1.06-1.54; p= 0.005). No significant association was found between BSE and age (≤35 v > 35), marital status (in a relationship v no), occupation (housewive v other), monthly income ( < 11,600 v ≥11,600) or medical coverage (public/uninsured v private). Patients that performed BSE were more likely to be diagnosed with early BC (stages 0-II) compared to those that did not (61% v 45%; p= 0.003). No association was found between BSE frequency and stage at diagnosis. Noteworthy, patients with private insurance were more likely to be diagnosed with stages 0-II compared to those with public or no insurance (80% v 56%; p= 0.007). Conclusions: The significant association between BSE and earlier stages at diagnosis found in this study highlights the need to raise awareness and promote this practice among young women with the objective of downstaging BC diagnoses. Public health interventions such as educational and social media campaigns that aim to improve the correct practice of BSE might be particularly useful in settings with inadequate screening programs.

Vascular endothelial growth factor (VEGF) is well established as the main agent responsible for vascular leakage and angiogenesis in the diabetic retina. While VEGF can have positive effects on hyperglycemia stressed retinal tissues, it also plays a role in events progressing to the oxygen- stressed, i.e. hypoxic, diabetic retina. Some VEGF makes its way to the retina from systemic sources and some is produced locally within the eye. Hyperglycemia, oxidants, inflammation, and advanced glycation end-products are all stimulants to VEGF production, both in the hypoxic and the pre-hypoxic retina. Endothelial cells, pericytes, Müller cells, microglia, astrocytes, retinal pigment epithelium and neurons have all been known to produce VEGF at some point in retinal development or in disease. Excessive VEGF production in the early diabetic retina can lead to retinal exposure or mechanisms which exacerbate further damage. While Müller cells are likely the most significant producer of VEGF in the pre-hypoxic retina, other VEGF producing cells may also play a role due to their proximity to vessels or neurons. Study of the release of VEGF by retinal cells in hyperglycemia conditions, may help identify targets for early treatment and prevent the serious consequences of diabetic retinopathy.

e12510 Background: Among premenopausal women with breast cancer (BC), adherence to endocrine therapy (ET) has often been reported suboptimal due to age-related adverse effects, lack of understandable information and inadequate social support. The current increased use of ovarian function suppression (OFS) may lead to even lower adherence rates in this group due to its high adverse effects profile. This study aims to assess the extent to which premenopausal patients comply with ET and to identify factors that hinder optimal adherence in Mexico. Methods: Women aged ≤50 years with primary stage I-III hormone receptor-positive BC receiving adjuvant ET for ≥1year were invited to fill a survey regarding their attitude towards ET and self-reported adherence. Fisher’s exact test was used to explore associations between categorical variables. This study was funded by AstraZeneca Mexico. Results: From Sep 2019 to Jan 2020, 127 patients with a median age of 45 years (range: 25-50) were included. Most had at least high school education (64%) and were unemployed (61%). ET distribution was: 69% tamoxifen (TMX) alone; 2% TMX switch to aromatase inhibitor (AI); 29% OFS plus TMX/AI. All patients recognized ET as a necessary part of their treatment and 97% believed it reduced their recurrence risk, yet 14% considered they had not received enough information about ET. Adverse effects were reported by 98%, predominantly hot flashes (82%), arthralgias (59%) and fatigue (58%). A statistically significant higher proportion of patients treated with a switch strategy or OFS experienced hot flashes, headache, insomnia, decreased libido and dyspareunia than those with TMX alone. Only 59% claimed their physician had taken measures to reduce these symptoms. Overall, 93% reported complete ET adherence. Nonetheless, 22% of them subsequently acknowledged missing 1-6 doses in the last month, the most common reasons being forgetfulness (78%), adverse effects (27%) and unwillingness to take the medication (11%). Unemployed patients were more likely to report daily compliance than students/employees (79% vs 60%; p = 0.02). No significant differences in adherence were found according to other factors, including type of ET. Conclusions: Premenopausal Mexican women self-report remarkably high rates of ET adherence. However, a considerable proportion misses ≥1 doses/month, with forgetfulness as the most common cause particularly in students/employees. Interventions aimed at reminding this group to take their ET and managing adverse effects could be crucial to improve adherence and, consequently, disease outcomes.

e19064 Background: Alerta Rosa is a navigation program in Nuevo Leon, Mexico that aims to reduce delays in breast cancer (BC) diagnosis and treatment initiation irrespective of healthcare coverage. Via a call center, a navigator registers each patient’s initial concern and schedules a medical evaluation. This study aimed to assess the implementation of a triage system to guide appointment prioritization for undiagnosed BC patients with abnormal breast findings or imaging studies. Methods: Women that contacted Alerta Rosa were stratified according to their clinical characteristics into three priority groups. Asymptomatic women seeking check-up information were classified as low-priority (“Green”), those with nonspecific symptoms (e.g. mastalgia) or indeterminate image studies (BIRADS 0) as intermediate-priority (“Yellow”), and patients with suspicious symptoms (i.e. palpable mass, nipple retraction or bloody discharge), abnormal image studies (BIRADS 3-5) or an established BC diagnosis as high-priority (“Red”) for an appointment. The triage system’s ability to detect undiagnosed BC was evaluated against the number of patients per category in whom BC was later confirmed. Differences in time from initial contact to first medical evaluation were explored with an independent t-test. Results: From December 2017 to 2019, 561 women with a median age of 44 years (range: 8-89) contacted Alerta Rosa. 369 (66%) reported breast symptoms, 92 (16%) sought check-up information, 68 (12%) had an indeterminate/abnormal image study and 32 (6%) had received a BC diagnosis and wanted a second opinion. Accordingly, 16% of patients were classified as “Green”, 25% “Yellow” and 59% “Red”. The median time from stratification to medical evaluation was 4 days for the “Red” group and 7 days for those in other categories ( p= 0.003). A total of 558 appointments were scheduled, of which 441 (79%) were attended. Excluding those who had received a prior BC diagnosis, 20/299 patients from the “Red” group had BC confirmed (6.7%) compared to 1/138 patient from the “Yellow” (0.7%) and none from the “Green” categories. Therefore, the “Red” category achieved a sensitivity of 95.2% (CI95%: 76.2-99.9%) and specificity of 53.8% (CI95%: 49.3-58.3%) for BC. Conclusions: The triage system adequately identified women with different probabilities of having BC. Thus, the implementation of a stratification system could help identify high risk patients in limited-resource settings where screening programs are ineffective and efforts to prioritize access to medical attention is crucial to achieve early-stage diagnoses.