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The increased survival achieved with surgery and cancer treatments for breast cancer has led to a growing concern about fertility in young women, adversely affecting quality of life outcomes. Th e potential loss of fertility not only has a psychological but can also affect patients' treatment adherence or decisions, such as selection of treatments associated with a lower risk of infertility despite inferior outcomes. Our objective is to provide an overview of current knowledge about how systemic cancer treatments could impact the future fertility of breast cancer survivors The main hypothesis of how chemotherapy produce damage to the ovaries is a direct damage to the DNA of the oocytes, resulting in the activation of apoptosis and / or autophagy-related pathways. Alkylating agents as cyclophosphamide are the chemotherapeutic agents that are associated with the highest risk of gonadotoxicity; however, breast cancer patients are usually given combinations of chemotherapy drugs. Conversely, endocrine therapy, such as tamoxifen, does not appear to have a permanent effect on fertility but long-term use could lower oocyte quality due to patient aging. There is still not enough evidence about the effect on ovarian reserve for many biological therapies and for new drugs being used in the non-metastatic setting, and further research in this area is needed. Members of multidisciplinary teams in breast cancer should understand the impact on fertility of cancer treatments and the importance of an early referral of premenopausal patients to specialists in reproductive medicine to discuss all possible fertility preservation strategies.

Objective The aim of this study was to examine the effectiveness of a school-based gamification strategy to prevent childhood obesity. Methods Schools were randomized in Santiago, Chile, between March and May 2018 to control or to receive a nutrition and physical activity intervention using a gamification strategy (i.e., the use of points, levels, and rewards) to achieve healthy challenges. The intervention was delivered for 7 months and participants were assessed at 4 and 7 months. Primary outcomes were mean difference in BMI z score and waist circumference (WC) between trial arms at 7 months. Secondary outcomes were mean difference in BMI and systolic and diastolic blood pressure between trial arms at 7 months. Results A total of 24 schools (5 controls) and 2,197 students (653 controls) were analyzed. Mean BMI z score was lower in the intervention arm compared with control (adjusted mean difference -0.133, 95% CI: -0.25 to -0.01), whereas no evidence of reduction in WC was found. Mean BMI and systolic blood pressure were lower in the intervention arm compared with control. No evidence of reduction in diastolic blood pressure was found. Conclusions The multicomponent intervention was effective in preventing obesity but not in reducing WC. Gamification is a potentially powerful tool to increase the effectiveness of school-based interventions to prevent obesity.

Purpose Health emergency due to COVID-19 started in Uruguay on March 13, 2020; our mastology unit tried to ensure adequate oncological care, and protect patients from the virus infection and complications. Objective To assess the health care activities in the "peak" of the pandemic during 3 months. Materials and methods we collected data from the electronic health record. Results There were a total of 293 medical appointments from 131 patients (221 face-to-face), that decreased by 16.7% compared to the same period in 2019 (352 appointments). The medical appointments were scheduled to evaluate the continuity of systemic treatment or modifications (95 patients; 72.5%), follow-up (17; 12.9%), first-time consultation (12; 9.1%), and assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). New twenty treatments were initiated. Of the 14 patients that were on adjuvant/neoadjuvant CT, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte-colony-stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. Of the seven patients that were on palliative CT, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one and due to progression of the disease in the other patient). The ninety patients who were receiving adjuvant, neoadjuvant, or palliative criteria hormone therapy and/or anti-HER2 therapies, continued the treatment with no changes. Conclusions The evidence suggests that, although medical appointments decreased by approximately 17%, we could maintain healthcare activities, continued most of the treatments while the most modified was CT with G-CSF to avoid myelosuppression.

Male breast cancer (MBC) is a rare condition which, while sharing some similarities with breast cancer in women, has a unique disease profile of its own. Aim: To understand the characteristics of MBC and its management in Uruguay. Patients & methods: Retrospective observational study that included patients diagnosed with MBC. Results: 22 cases of MBC were found. The median age at diagnosis was 62.5 years. Symptoms included self-detected lump in 17 patients (77.3%) and nipple retraction in seven (22.7%). Ductal carcinomas of histological grade 2–3 were found in 20 patients (90.9%) and stage I–II disease was most commonly encountered (15 patients, 68.1%). Neoadjuvant chemotherapy, adjuvant chemotherapy, adjuvant radiotherapy and tamoxifen were offered to 16 (73%), 12 (54.5%), 17 (65.4%) and 20 (90.9%) patients, respectively. Conclusion: MBC behaves and is treated in many aspects like postmenopausal breast cancer. Further multi-institutional, prospective studies are needed for better understanding and management of male breast cancers.

Introduction: Sexual dysfunction from breast cancer and its various therapies is present in up to 60 % of the breast cancer patients. Sexuality remains a neglected issue; doctors often ignore it, claiming they lack the time, knowledge or expertise required to address it. Objectives: To evaluate the sexuality of breast cancer survivors’, inquire about the degree of interest in receiving help to resolve sexual dysfunctions related to the diagnosis and treatment of the disease and the level of satisfaction with the care received. Materials and methods: The subjects enrolled had an early breast cancer and were treated at the Mastology Unit of the Cancer Department of the Hospital de Clinicas. The study was approved by the hospital’s Ethics Committee. The selected questionnaire is the one used at the University of Chicago Medical Oncology Clinic. Mostof the 128 patients included were over 50 years old and had a sexual partner, 98 patients (76.5 %) had been sexually active within the last 12 months and 85 (86.7 %) reported having sexual problems. Results: Most patients (67/128, 68.3 %) responded that sexuality was important in their lives; 85 (86.6 %) were interested in receiving support to treat their sexual difficulties, and 72 (73.4 %) saw the feasibility of addressing them with a doctor. However, only 29 (29.6%) had sought medical help for that purpose, and most were unhappywith the care received. Seventy-nine patients (80.6 %) would be willing to participate in a program aimed at confronting their sexual problems. Conclusions: Our results reveal the need to address the sexual problems of patients diagnosed with and treated for breast cancer as part of their medical care. Future studies should focus on developing and evaluating the success of specific interventions in the management of these patients’ sexual dysfunction and ―even more importantly― designing strategies for its prevention.

PURPOSE Trastuzumab has shown an overall survival (OS) benefit in patients with human epidermal growth factor receptor 2 (HER2)–positive breast cancer (BC), in both the adjuvant and the metastatic setting. We assessed the effectiveness of trastuzumab in patients treated in daily practice according to national treatment coverage protocols and compared our results with those reported by randomized clinical trials. These coverage protocols included patient selection criteria similar to those of those clinical trials and were developed by the Uruguayan National Resource Fund (FNR), the agency that has funded these prescriptions for more than a decade. PATIENTS AND METHODS We included all patients with HER2-positive BC treated with trastuzumab under FNR coverage approved between January 1, 2006, and December 31, 2016. The source of data was the FNR database, and primary outcome was OS, analyzed through Cox proportional hazards regression analysis. RESULTS A total of 1,944 women were included: 1,085 women (55.8%) were postmenopausal and 1,240 (63.7%) had HER2 and hormone receptor–positive BC. Trastuzumab was administered as adjuvant therapy to 1,233 patients (63.5%), of whom 154 also received it as a neoadjuvant treatment. Three hundred nineteen patients (16.4%) received trastuzumab for advanced disease. Five-year OS in the adjuvant setting was 86.4% (95% CI, 84.0% to 88.7%). The median survival of patients with advanced BC was 25.1 months (95% CI, 10.1 to 42.5 months). CONCLUSION Our survival results are not inferior to those reported in clinical trials, in both adjuvant and advanced settings. Importantly, these results support the relevance and the feasibility of treating patients in routine practice, following coverage protocols based on patient selection criteria and methods supported by positive clinical trials. In addition, these results favor quality and appropriate access to BC treatment in our country.

e12502 Background: After the government declared a health emergency due to COVID-19 on March, 2020, the Mastology Teaching Unit (UDAM) providing care to breast cancer patients tried to ensure adequate oncological care, and to protect patients from the virus infection and serious complications due to a possible state of immunosuppression. Towards this objective, the Department of Clinical Oncology developed guidelines with some treatment modifications. Objective: To assess the health care activities of the UDAM during the period considered as the “peak” of the pandemic, since its beginning to June 30, 2020. Methods: This is an observational study that collected data from the electronic clinical record system called Oncology Electronic Health Record (HCEO) during the aforementioned period. Results: There werea total of 293 medical appointments (221 in person), through which 131 patients were attended to. The number of medical appointments decreased by 16.7% compared to the same period in 2019 (352 appointments). Of the patients who were attended to during the “peak” period, 109 (83.2%) were on systemic onco-specific treatment and 22 (16.8%) were attended to for disease control. The medical appointments were scheduled to evaluate the continuity of treatment and treatment modifications if necessary (95 patients; 72.5%), for disease control (17; 12.9%), for first-time consultation (12; 9.1%) and to assess paraclinical studies (7; 5.3%). The patients were on hormone therapy (HT) (81 patients; 74%), chemotherapy (CT) (21; 19%), and anti-HER2 therapies (9; 8%). A total of 20 treatments were initiated, 14 with HT and 6 with CT. Of the 21 patients on CT, 14 (66.6%) were on adjuvant/neoadjuvant therapy. Of these, 9 (64.3%) continued with the same regimen with the addition of prophylactic granulocyte colony stimulating factors (G-CSF), and 5 (35.7%), who were receiving weekly paclitaxel, continued the treatment with no changes. The remaining 7 of 21 patients (33.3%) were on palliative CT. Of these, 2 (28.5%) continued the treatment with the addition of G-CSF, 3 (42.8%) continued with weekly capecitabine or paclitaxel with no treatment changes, and 2 (28.5%) changed their treatment regimen (a less myelosuppressive regimen was selected for one of them and this decision was due to the progression of the disease in the other patient). The 90 patients who were receiving adjuvant, neoadjuvant, or palliative criteria HT and/or anti-HER2 therapies, continued the treatment with no changes Conclusions: Although these are preliminary results, the available evidence suggests that, although medical appointments decreased by approximately 17%, the UDAM was able to maintain its healthcare activities and continued most of the treatments. The most modified treatment was CT, with the addition of prophylactic G-CSF, to avoid myelosuppression and potential complications from COVID-19 infection.

e13610 Background: In March 2020, a health emergency was decreed due to COVID-19 and this produced changes in the organization of health services. One of the objectives of the reorganization that took place was a reduction in face-to-face consultations (FTFC), and the promotion of telephone consultations (TC). Objective: Evaluate the effectiveness of TC and the level of satisfaction of patients attending the Mastology Unit using this method during the COVID health emergency. Methods: A prospective, cross-sectional study. A survey was used to assess the effectiveness of TC and the level of satisfaction with the method. Results: : Forty-two patients were surveyed, of which 69% were receiving adjuvant treatment and 14.2% palliative treatment. With regard to the effectiveness of TC, 76.1% of those surveyed had their appointment resolved by telephone; 78.6% of patients preferred to do the consultation by telephone; 97.6% believed that sufficient time was spent and that the timing of the appointment was appropriate. The responses showed a high degree of satisfaction with the care received. The medical care met the expectations of all patients, and 83.3% believed that once normalcy was restored, TC would be an option for their situation Conclusions: The TC method was evaluated with a high degree of satisfaction and allowed care to be maintained during the emergency. Although it is early to assess the healthcare impact of TC and the method's capacity to resolve issues, preliminary results show that it is a useful and valuable tool in clinical practice during periods of healthcare emergency.

Background: In March 2020, a health emergency was decreed due to COVID-19 and this produced changes in the organization of health services. One of the objectives of the reorganization that took place was a reduction in face-to-face consultations (FTFC), and the promotion of telephone consultations (TC). Objective: Evaluate the effectiveness of TC and the level of satisfaction of patients attending the Mastology Unit using this method during the COVID health emergency. Methods: A prospective, cross-sectional study. A survey was used to assess the effectiveness of TC and the level of satisfaction with the method. Results: Forty-two patients were surveyed, of which 69% were receiving adjuvant treatment and 14.2% palliative treatment. With regard to the effectiveness of TC, 76.1% of those surveyed had their appointment resolved by telephone;78.6% of patients preferred to do the consultation by telephone;97.6% believed that sufficient time was spent and that the timing of the appointment was appropriate. The responses showed a high degree of satisfaction with the care received. The medical care met the expectations of all patients, and 83.3% believed that once normalcy was restored, TC would be an option for their situation. Conclusions: The TC method was evaluated with a high degree of satisfaction and allowed care to be maintained during the emergency. Although it is early to assess the healthcare impact of TC and the method's capacity to resolve issues, preliminary results show that it is a useful and valuable tool in clinical practice during periods of healthcare emergency. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.

Introduction: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. Materials and Methods: A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. Results: This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. Conclusions: Consistent with international reports, most respondents had a risk factor. Among the group of respondents aged over 50 years, most underwent mammographic and clinical surveillance at least biennially. Although it is only possible to formulate conclusions about the surveyed women because of the study design, the obtained data further our understanding of the epidemiological profile of the Uruguayan population, which can contribute to prevention practices.

e12537 Background: To estimate the prevalence of Trastuzumab (TTZ) induced cardiotoxicity in Uruguayan women diagnosed with early HER – 2 positive breast cancer (BC) over a period of ten years, treated under the financial coverage of the National Resource Fund (FNR). Methods: A prospective descriptive observational study based on the analysis of an anonymized database provided by the FNR of Uruguayan HER-2 positive early BC patients treated with TTZ between 2006 and 2016. Variables analyzed included: age, menopausal status, stage, presence of cardiovascular risk factors, use or not of anthracyclines, left ventricular ejection fraction prior and during treatment, and temporary or permanent suspension of treatment. Statistical analysis was performed using SPSS Statistics version 25. The variables were assessed through the use of measures of central tendency, dispersion, contingency tables and proportions. To analyze the relationship between the different variables, the Chi-Square test of independence was performed. Results: The analysis included 1401 patients diagnosed with HER-2 + stage I to III breast cancer who received adjuvant TTZ. The mean age at diagnosis was 52.45 years. The prevalence of cardiotoxicity in evaluable patients (1065 pts) was 20.3%. The proportion of patients who had symptomatic heart failure was 3% (32 pts) and in those who discontinued treatment for asymptomatic cardiac toxicity managed to resume trastuzumab prevalence was 92.6 %. About 9,7 % (21 pts) of patients had drop of left ventricular ejection fraction (LVEF) below 50%, whilst 10% drop of LVEF below their baseline levels were found in 75% of patients (162 pts) There is significant difference in the risk of cardiotoxicity according to the type of chemotherapy (anthracycline containing vs non-anthracycline based) (Chi-square = 3.9, p-value < 0.005). There was no evidence of a relationship between cardiovascular risk factors and the development of cardiotoxicity as well there was no evidence between sequential or concurrent use of TTZ with chemotherapy. Conclusions: The prevalence of cardiotoxicity in this study was similar to that reported internationally. The majority of patients did not develop cardiac toxicity and those who presented it did so asymptomatically and reversibly.

e12542 Background: Sexual dysfunction from breast cancer and its various therapies is present in up to 60% of the breast cancer patients. Sexuality remains a neglected issue; doctors often ignore it, claiming they lack the time, knowledge or expertise required to address it. Objectives: To evaluate the sexuality of breast cancer survivors, inquire about the degree of interest in receiving help to resolve sexual dysfunctions related to the diagnosis and treatment of the disease and the level of satisfaction with the care received. Methods: One hundred twenty eigth patients with early breast cancer treated at the Mastology Unit of the Hospital de Clínicas were enrrolled. The study was approved by the hospital’s Ethics Committee. The selected questionnaire is the one used at the University of Chicago Medical Oncology Clinic. Results: Most patients were over 50 years old (96 patients) and had a sexual partner (87 patients), 98 patients (76.5%) had been sexually active within the last 12 months and 85 (86.7%) reported having sexual problems. Moreover, most patients (67/128, 68.3%) responded that sexuality was important in their lives; 85 (86.6%) were interested in receiving support to treat their sexual difficulties, and 72 (73.4%) saw the feasibility of addressing them with a doctor. However, only 29 (29.6%) had sought medical help for that purpose, and most were unhappy with the care received. Seventy-nine patients (80.6%) would be willing to participate in a program aimed at confronting their sexual problems. Conclusions: Our results reveal the need to address the sexual problems of patients diagnosed and treated for breast cancer as part of their medical care. Future studies should focus on developing and evaluating the success of specific interventions in the management of these patients’ sexual dysfunction and - even more importantly - designing strategies for its prevention.

Natalia Camejo: Asistente del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Cecilia Castillo: Prof. Adj. del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Andrea Shiavone: Asistente del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Ana Laura Alfonso: Oncólogo Médico. Servicio Medico Integral (SMI), Uruguay.-- Dahiana Amarillo: Postgrado del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Franco Xavier: Oncólogo Médico, Cooperativa Asistencial Médica de Rivera (CASMER), Uruguay.-- Gabriel Krygier: Prof. Agdo. del Servicio de Oncología Clínica, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Lucia Delgado: Prof. Directora del Servicio de Oncología Clínicas, Hospital de Clínicas, Facultad de Medicina, Universidad de la República. Uruguay.-- Contacto: ncam3@yahoo.com El cáncer de mama (CM) en el hombre (CMM) es una entidad poco frecuente. Si bien tiene algunas semejanzas con el CM femenino, es una patología con un perfil propio. El objetivo del estudio consiste en conocer las características del CMM y su manejo en nuestro medio. Materiales y métodos: estudio retrospectivo que incluyó pacientes diagnosticados de CMM en tres centros del Uruguay en un período de 15 años. Resultados: se incluyeron 12 pacientes; la mediana de edad fue 68 años; un tercio de ellos tenían antecedentes familiares (AF). Características clínico patológicas: todos los tumores fueron carcinomas ductales con grado histológico (GH) 2-3, ¼ se hallaban en estadio (E) I, la mitad (6) en EII, 6 tuvieron metástasis axilares, 2/3 fueron receptores de estrógeno (RE) / receptores de progesterona (RP) +. Se definieron 3 subtipos biológicos: I) HER2- RE/RP+: 2/3 de los pacientes; II) HER2+: 1/6; y III) triple negativo: 1/6. Todos los pacientes con enfermedad localizada fueron sometidos a mastectomía y la mayoría recibieron tratamiento con quimioterapia (QT). La totalidad de quienes presentaron enfermedad localizada RE/RP+ recibieron hormonoterapia adyuvante con buena adherencia y tolerancia. Dos de los once pacientes tratados con criterio radical recayeron en la evolución; el resto permanece en controles o tratamiento sin evidencia de recaída. Conclusión: presentamos una serie de pacientes con CMM, con un perfil similar al reportado en la literatura. La edad de presentación fue superior a la del CM femenino, y la mayoría fueron RE/RP +, HER 2-; sin embargo, en esta serie los pacientes se presentaron en estadio localizado y con tumores de alto grado en una proporción mayor a lo descrito en la literatura. Breast cancer (BC) in men (MBC) is an uncommon clinical entity. Even though it shares some similarities with female BC, it has a distinctive profi le. The objective of this study is to identify the characteristics of MBC and learn how it is managed in our setting. Materials and methods: retrospective study including patients diagnosed with MBC in three centers in Uruguay for a period of 15 years. Results: 12 patients were enrolled; the median age was 68 years; a third of whom had a family history (FH). Clinical and pathological characteristics: all of the tumors were ductal carcinomas of histological grade (HG) 2-3, 1/4 were stage (S) I, half (6) were SII, 6 had axillary metastases, 2/3 were estrogen receptor (ER) / progesterone receptor (PR) +. Three biological subtypes were defi ned: I) HER2- ER/PR+: 2/3 of patients; II) HER2+: 1/6; and III) triple-negative: 1/6. All patients with localized cancer underwent a mastectomy and most were treated with chemotherapy (CHT). All of those who presented with localized, ER/PR+ cancer received adjuvant hormone therapy, with good adherence and toleran ce. Two of the eleven patients treated with radical surgery recurred during evolution; the rest remain in follow-up or treatment without evidence of recurrence. Conclusion: we presented a series of patients with MBC, with a profi le similar to the one reported in the literature. Age at presentation was higher than that of female BC, and most were ER/PR +, HER 2-. However, patients in this series presented with breast cancer in the localized stage and high-grade tumors in a higher proportion than is described in the literature. O câncer de mama (CM) em homens (CMM) é uma entidade clínica incomum. Embora tenha algumas semelhanças com o CM feminino, é uma patologia com o seu próprio perfil. O objetivo deste estudo foi conhecer as características do CMM e seu manejo no nosso meio. Materiais e métodos: estudo retrospectivo com pacientes com diagnóstico de CMM em três centros do Uruguai em um período de 15 anos. Resultados: foram incluídos 12 pacientes; a mediana da idade foi 68 anos; um terço deles tinha ante cedentes familiares (AF). Características clínico-patológicas: todos os tumores foram carcinomas ductais de grau histológico (GH) 2-3, 1/4 estavam no estágio (E) I, a metade (6) no EII, 6 apresentaram metástases axilares, 2/3 foram receptores de estrogênio (RE) / receptores de progesterona (RP) +. Foram defi nidos 3 subtipos biológicos: I) HER2- RE/RP+: 2/3 dos pacientes; II) HER2+: 1/6 ; e III) triplo-negativo: 1/6. Todos os pacientes com doença localizada foram submetidos a mastectomia e a maioria receberam tratamento com quimioterapia (QT). A totalidade dos que apresentaram doença localizada RE/RP+ recebeu hor monioterapia adjuvante com boa adesão e tolerância. Dois dos onze pacientes tratados com critério radical recaíram na evolução; o resto permanece sob monitoramento ou tratamento sem evidência de recaída. Conclusão: apresentamos uma série de pacientes com CMM, com um perfi l semelhante ao descrito na literatura. A idade de apresentação foi maior do que para o CM feminino, e a maioria foram RE/RP +, HER 2-; entretanto, os pacientes desta série apresentaram-se com estágio localizado e tumores de alto grau em uma proporção maior do que a descrita na literatura.

e12028 Background: BRCA1 is one of the main susceptibility genes for breast cancer (BC). While BRCA1 mutations are rare in sporadic tumors, loss or reduction of gene expression have been reported in approximately 30-50% of sporadic BCs in the general population. From the molecular point of view, there is no clear characterization of these tumors in young women and we have found no studies reporting the rate of under-expression of BRCA1 in women with sporadic BC under 40 years of age. Objective: to assess the tumor expression of BRCA1 using immunohistochemistry (IHC) and its prognostic value in Uruguayan women diagnosed with BC before the age of 40 years. Methods: IHQ was used to analyze the tumor expression of BRCA1 in paraffin-embedded tumor samples of 40 BC patients diagnosed before the age of 40 between 01/01/2006 and 12/31/2012. The optimization and determination of the BRCA1 protein by IHC was centralized. The antibodies used were anti BRCA1 MS110 monoclonal antibodies against the N-terminal end and GLK-2 against the C-terminal end (amino acids 1839-1863). Expression was considered positive when >10% of the cells had nuclear and/or cytoplasmic labeling. Overall survival (OS) and disease free survival (DFS) were calculated; the curves were developed using the Kaplan-Meier method and the difference in survival was evaluated through the log rank test. Results: the average age of the 40 patients included was 36 years; 8 patients (20%) had significant family history of BC or ovarian cancer. The distribution by stage (S) was as follows: SI: 9 patients (22.5%); SII: 20 patients (50%); SIII: 10 patients (25%), and SIV: 1 patient. Regarding the biological profile: 17 patients (42.5%) were HER2- and ER/PR+, 13 (32.5%) were HER2+ and the remaining 10 patients (25%) were classified as triple negative. The 5-year OS and DFS were 73% and 60% respectively. The expression of BRCA1 with GLK-2 was ≤10% in 16 of the 40 patients included (40%). The 5-year OS and DFS for patients with ≤10% expression was 56% vs. 85% for patients with >10% (p = 0.015) and 40% vs. 72% (p = 0.034) respectively. The expression of BRCA1 by MS110 was ≤10% in 11 of the 40 patients included (27.5%). No statistically significant differences were found in the 5-year OS or DFS based on the expression of this marker. Conclusions: Decreased BRCA1 tumor expression as assessed by IHC using GLK-2 was found in 40% of young patients included and was associated with unfavorable prognosis.

e12026 Background: Adjuvant HT in Hormone Receptors (HR) + BC increases overall survival (OS). Adherence to therapy is a complex and multifaceted issue that can alter outcomes; however, not much of it is known abouth this in routine clinical practice. Methods: This was a retrospective study that enrolled patients treated with HT because of HR+ BC (stages I-III) at the BC unit in the 2002-2012 period. Methods: The proportion remaining on endocrine therapy was analysed by Kaplan-Meier curve. Univariate analysis (log rank test) was used to identify the factors that might independently impact on such discontinuation. The study was approved by the Ethics Committee of the Hospital de Clínicas. Results: 139 (73.1%) of the 190 patients enrolled were postmenopausal; their median age being 61 years. Most patients were single or divorced or widowed (121, 63.7%) and resided in the capital (125, 65.7%). Most tumors (166, 87.3%) were ductal carcinomas and most presented at a low histological grade: HG 2-3: 112 (58.9%). The distribution by stage was: SI: 63 (33.1%); SII: 82 (43.1%); SIII 39 (20.5%); S0 6 (3.1%). At the end of their first, second, third, fourth and fifth years of treatment; 95.3%, 87.9%, 80.6%, 76.4% and 69.5% of the patients still adhered, respectively. Adherence was not associated with either age (p = 0.687), menopausal status (p = 0.449), marital status (p = 0.221), origin (p = 0.5640), or stage (p = 0.168). The patients who received combined HT (tamoxifen followed by AI) adhered better than those who received one drug alone (p = 0.017). Conclusions: we assessed the adherence to HT in real life and found that it was reduced by 30.5% in 5 years, despite patients were well informed about the well-known benefit in terms of OS, of being a well-tolerated treatment and of being provided for free. These results are similar to or even better than those reported in several international studies. Further investigation is needed to understand why patients interrupt HT. We need to work harder to increase compliance, given the potential impact this may have on the patients’ OS.

An increased folate intake may be beneficial in deficient populations. However, in women with adequate levels it may not deliver additional benefits while it may increase the risk for some forms of cancer. A systematic literature review of benefits or risks of folate in the development of breast cancer was performed using MEDLINE, systematic review of selected articles and references of the selected articles looking specifically at serum folate levels, dietary folate intake or total folate intake and the risk of developing breast cancer. Fourteen case-control studies, fourteen cohort studies, seven case-control nested studies, two randomized trials and two meta-analyses were selected for analysis based on pre-established criteria. The reviewed evidence does not support the hypothesis that higher intakes of dietary folate reduce the risk for breast cancer. Some studies showed a higher risk of breast cancer in populations exposed to high folate intake post fortification, especially when folic acid is used. The results support the need to be cautious and to limit the exposure of women to high intakes of folic acid, especially in countries with mandatory food fortification.

e18789Background: In clinical trials, trastuzumab (TTZ) has shown an overall survival benefit (OS) in patients with HER-2 positive breast cancer (BC), both in the adjuvant and in the metastatic set...

The role of N-methyl-D-aspartate receptors (NMDArs) in pain sensation was initially uncovered in 1987 when the hyperexcitability of spinal cord dorsal horn nociceptive neurons evoked by C-fiber stimulation was found to be blocked by spinal delivery of NMDAr antagonist. Since then, many studies have focused on the role of central NMDArs in pain sensation. It is now apparent that peripheral NMDArs also play a role not only in the initiation but also in the maintenance of chronic pain states, particularly those following peripheral nerve injuries. Peripheral NMDArs are an attractive target for treating chronic pain, because under normal (nonpainful) stimulation NMDArs in dorsal root ganglia (DRG) neurons do not activate; in addition, some of the NMDArs isoforms are predominantly expressed in DRG neurons, and NMDArs have various regulatory sites that are isoform-dependent. This article concentrates on reviewing the possible role of peripheral NMDArs in initiating and maintaining chronic pain states. Of particular interest is the role of NMDArs not only on peripheral DRG neurons but also on their surrounding glia, since neuronal-glial interactions have been shown to contribute to injury-evoked neuronal hyperexcitability. Drugs that would target selectively peripheral NMDArs would improve treatment of chronic pain states. This review is divided into 5 sections: NMDAr structure and function; the role of peripheral NMDArs in pain perception; modulation of NMDArs during pain states; modulation of NMDAr activity by Substance P; and role of glia in DRG neuronal hyperexcitability.

ObjectiveTo analyse the relationship between serum folate (SF), vitamin B12 and impaired cognitive function in the Chilean elderly.DesignWe analysed the relationships between impaired cognitive function and age, SF (µg/l) and vitamin B12 (pg/ml) with Student’s t test, as well as between impaired cognitive function and gender, educational level, residence area, diabetes and hypertension with the χ2 test. Multiple logistic regressions with interactions were estimated to assess the impact of SF on impaired cognitive function according to these methods.SettingChile.SubjectsOlder adults (>65 years, n 1051), drawn from representative households of a national prevalence study, assessed using the Modified Mini Mental Status Examination (MMMSE). Individuals with altered MMMSE scores (≤13 points) were sequentially assessed using the Pfeffer Functional Activities Questionnaire (PFAQ).ResultsMultivariate models using the MMMSE demonstrated an increased risk of impaired cognitive function for seniors who had hypertension, diabetes and higher vitamin B12 levels. SF and its square (SF2) were statistically significant, indicating that this predictor of impaired cognitive function displays a U-shaped distribution. The interaction between SF and vitamin B12 was not statistically significant. Models using the MMMSE plus PFAQ suggested that urban residence decreased the risk of impaired cognitive function, whereas male gender, older age, vitamin B12 levels and hypertension increased this risk. The variables SF and SF2 and the SF × vitamin B12 interaction were statistically significant (P12 levels. When SF was low, a one-unit increase in SF (1 µg/l) diminished the risk. When SF was elevated, a further increase in SF raised the risk, especially at low vitamin B12 levels.ConclusionsThe relationship between folate, vitamin B12 and impaired cognitive function warrants further study.

Background: Celiac disease (CD) is an immune-mediated enteropathy triggered by the ingestion of gluten in genetically susceptible individuals. Its prevalence in Europe and the USA is 0.5 to 1%. Aim: To analyze epidemiological aspects and degree of compliance with gluten-free diet (GFD) among Chilean individuals with CD. Material and Methods: Subjects with confirmed or suspected CD were invited to answer an online survey published on the web at www.fundacionconvivir.cl. The answers were reinforced with a telephone interview. Results: The survey was answered by 1212 subjects (79% females). Median age at diagnosis was 25.8 years (range 1 to 84 years), with a bimodal curve with two peaks at less than 3 years and at 20 to 40 years of age. The diagnosis was made only by serologic markers in 9%, only by intestinal biopsy in 17.5%, and by a combination of both methods in 70%o. Conditions associated with CD were reported by 30%> of subjects and 20%> had relatives with CD. The GFD was strictly adhered to by 70%>, occasionally by 27%> and never by 3%>. Seventy five percent of subjects with a strict adherence to GFD had a favorable clinical response compared with 42%> of those with incomplete or lack of adherence (odds ratio 4.0, 95%> confidence intervals 2.8-5.7p < 0.01). Conclusions: In 30% of respondents, the diagnosis of CD was not confirmed according to international guidelines that require serology and duodenal biopsy. One third of subjects recognized a poor compliance with GFD. Those with a strict adherence to it had a more favorable clinical course. However, 25%> did not experience a clinical improvement despite a strict GFD, a finding which requires further study.

Endoscopic ultrasound (EUS) provides relevant information when an ampullary or periampullary tumor is suspected. Early detection, T and N staging and Fine Needle Aspiration plus cithologic confirmation, are some of the expected benefits. Exclusion of benign findings like choledocholithiasis or chronic pancreatitis is also important. A correct understanding of the complex ampullary and periampullary anatomy is needed. Knowledge of the individual clinical history and other previous diagnostic images all contribute to a successful EUS examination. Radial and lineal EUS images are uniquely detailed and, at the moment, it seems to be the best way to exclude or confirm malignant or benign findings. We propose a procedural algorithm, including EUS, for suspected ampullary or periampullary tumors. This review summarizes the vast amount of information to be found spread in the literature, and recognizes this small anatomic area as the origin for a clinical entity with proper clinical presentation, proper imaging and proper therapeutic resolutions. The benefits of performing EUS for its study are highlighted.

Neuroendocrine tumors are uncommon, including VIPoma that produces vasoactive intestinal polypeptide. We report a 45-year-old female presenting with a history of diarrhea lasting three months. An abdominal CAT scan showed a solid tumor in the body of the pancreas. A fine needle aspiration biopsy of the tumor was compatible with a neuroendocrine tumor. The patient was subjected to a partial pancreatectomy, excising a 4 cm diameter tumor. The pathological study was compatible with a neuroendocrine carcinoma. There was no regional lymph node involvement. During the postoperative period the results of serum vasoactive intestinal polypeptide were received. These were 815.9 pg/ml before surgery and normalized after the operation.

Background: Autoimmune pancreatitis is a special form of chronic pancreatitis, more common in men and usually presenting as obstructive jaundice or abdominal pain. It may be associated with other immunological disorders and sometimes it is possible to find positive serological markers. Typical images show pancreatic enlargement with focal or diffuse stenosis of the pancreatic duct but sometimes it presents as a focal pancreatic mass that is difficult to differentiate from pancreatic carcinoma. Aim: To report ten cases of autoimmune pancreatitis. Material and Methods: Retrospective review of clinical records of 10 patients aged 26 to 56 years (six males) with autoimmune pancreatitis. Results: The clinical presentation was obstructive jaundice in six cases, acute pancreatitis in two, persistent increase in serum amylase and Upase in one, and permanent abdominal pain and weight loss in one. On imaging studies, a circumscribed mass was founded in six patients. An endoscopic retrograde colangiopancreatography was performed in four patients showing an abnormal pancreatic duct in all. Six patients were operated and tissue for pathological study was obtained in five, showing inflammatory infiltration. Vive patients were treated with steroids with a good clinical response. Conclusions: Autoimmune pancreatitis must be borne in mind in the differential diagnosis of pancreatic lesions.

143 Background: To evaluate the incidence, severity and outcome of Trastuzumab-induced cardiotoxicity in HER2 positive Uruguayan breast cancer (BC) patients. Methods: Retrospective observational analysis of HER2 positive BC patients who were treated with Trastuzumab (TTZ) from January 2007 to December 2013 at two Uruguayan centers. Cardiac monitoring included physical examination and assessment of left ventricular ejection fraction (LVEF) by echocardiography that was evaluated before TTZ administration and every 12 weeks thereafter during the duration of therapy. Cardiovascular risk factors analyzed were: obesity (BMI ≥ 30 kg/m2), hypertension, diabetes, sedentary lifestyle and high cholesterol. Results: Sixty nine female patients were found in the databases of our institutions. Median age was 48 years (range: 27-73). Stage at diagnosis was as detailed: 19 % EI, 46 % EII, 29 % EIII and 4 % EIV. Eighty nine percent of patients received adjuvant TTZ , 4 % neoadjuvant TTZ and 7 % received it as a palliative therapy. Thirty patients (43, 5%) had at least one cardiovascular risk factors: 26% hypertension, 16% obesity, 9% sedentary lifestyle, and 4% high cholesterol. Median number of TTZ cycles was 15. Cycles were administered every 3 weeks at standard dose. Nineteen patients (27%) developed cardiotoxicity, of whom 12 had a transient suspension because of a reversible fall in LVEF, 2 had a irreversible reduction in LVEF, and 5 had a symptomatic heart failure. Eighty-nine percent of our patients (62 patients) completed treatment and the rest had a definitive suspension due to a irreversible reduction in LVEF or symptomatic heart failure. Most patients that developed cardiotoxicity (15 out of 19) had cardiovascular risk factors and also most of them (16 out of 19) had received anthracyclines before TTZ. Conclusions: Cardiotoxicity incidence was similar to the incidence reported in the literature and when it was present, in most cases was transient, asymptomatic, and reversible.

e11547 Background: To investigate the frequency, clinical pathological characteristics and prognosis of young women with breast cancer (BC) less than 40 years old and estimate disease free survival...

We discuss the clinical presentation and course of the disease of a 25-year-old male who had gastro-in-testinal (GIT) symptoms secondary to retroperitoneal lymph node proliferation of a germ-cell tumour of the testis. The pathology evaluation of the orchiectomy specimen classified it as a burned-out tumour of the testis, given the lack of tumour elements and the presence of typical scarring tissue. Biological issues leading to tumour regression are discussed, as well.

The effect of 100 mg IM of vitamin B12, monthly, during 4 months, over anemia in premature infants was evaluated. A controlled, randomized and blinded study in 55 less than 33 weeks of gestational age babies was conduced. There was no differences in hematologyc evolution neither growth in both studied groups. The number of transfusion was significatively lower in both groups than those reported in other studies.

e21064 Background: Breast cancer (BC) is an heterogeneous disease and the most common cause of cancer death in Uruguayan women. HER2 and hormone receptors (HR) tumor expression define BC subtypes w...

e11622 Background: Hereditary BC can have a distinct phenotype and behavior in comparison to sporadic BC. The aim of the present study was to investigate if there is any difference in the age at diagnosis, disease extension and biological profile in BC patients (pts) with or without a significant family history of BC. Methods: We retrospectively reviewed clinical charts of BC pts, stage 0- III who had surgery between March 2006 and March 2008. We included pts with known estrogen receptor (ER), progesterone receptor (PR) and HER2 status. The family history was obtained from the clinical charts and confirmed by a telephone interview with a standardized questionnaire. A significant family history of BC was defined by the presence of one of the following criteria: (1) 3 or more BC cases among close relatives, at least one diagnosed before 50 years (2) 2 BC cases among close relatives, at least one diagnosed before 50 years and one of the following: bilateral BC, ovarian cancer diagnosed in the family, male BC, father´s inheritance, Ashkenazi Jewish ancestry Results: 435 pts were identified, with available data on ER/PR and HER2 status in 197 pts. Family history was evaluated in 136 pts (69%) and was classified as significant in 18 (13.2%). Between pts with and without a significant family history of BC cancer there were no difference in the proportion of pts < 50 years old at diagnosis (0.36 vs. 0.39), T3/T4 tumours (0.08 vs. 0.11), axillary node positivity (0.55 vs 0.66), ER/PR+ (0.77 vs. 0.72), HER2 + (0.11 vs. 0.11) and triple negative tumors (0.19 vs 0.17). Conclusions: our data does not show any difference in the main prognostic and predictive factors between operable BC pts with and without a significant family history of BC. These findings are concordant with previous published data about a greater prevalence of BRCA2 mutations in Uruguayan families. No significant financial relationships to disclose.

9559 Background: Kaposi’s sarcoma is the most common malignancy among HIV patients and is considered to be one of the AIDS defining conditions. This abstract illustrates our 10 year experience with the treatment of 32 Kaposi’s sarcoma HIV patients with the same therapeutic approach. Methods: Between 04/95 and 03/05 we recruited 32 previously untreated patients that were diagnosed with Kaposi’s sarcoma and treated at the Servicio de Oncologia Clinica (Universitary Clinicas Hospital) in Montevideo. All of them received the same iv polychemotherapy plan (Adriamycin 10mg/m2, Bleomycin 10 U/m2 and Vincristine 1.4 mg/m2, every two weeks until tumor progression or severe toxicity). Results: 21 of the patients were good risk ones and the remaining 11 were poor risk patients (AIDS Clinical Trials Group staging classification). CD4 levels varied from 6 to 780/ml and the viral load ranges were 240 to 89000 copies. The patients received an average of 10.2 (4–21) polychemotherapy cycles. Grade 3–4 myelotoxicity was reported in 5 patients delaying the onset of the subsequent cycles. Grade 2 neurotoxicity was seen in 7 patients after 4, 5, 6, 8, 10, 11 and 13 cycles of ABV, changing vincristine for vinblastine (4mg/m2 every two weeks) in these patients. All the patients achieved a partial response with improvements in CD4 levels and viral load. 13/32 patients experienced a relapse (3–29 months after last chemotherapy cycle). 3 patients were retreated with paclitaxel 135 mg/m2 with 2/3 new partial responses of shorter duration. 5 patients received 4 additional ABV cycles achieving a new partial response. 5 patients refused further treatment dying due to progressive disease. One relapsed patient developed a second malignancy (High grade Non Hodgkin lymphoma) dying three months later. Conclusions: These data suggest that ABV regimen is still an effective treatment option for HIV-Kaposi’s sarcoma, specially in the undeveloped countries in which the cost of other better internationally approved options (liposomal doxorubicin and daunorubicin) makes them unaccesible for the majority of the population. No significant financial relationships to disclose.

Therapeutic Gastrointestinal Endoscopy in Pediatric Patients Carmen G. Rostion, Cecilia Castillo, Roque Saenz, Carlos Harz, Carlos Reyes, Raul Prieto, Eduardo Valdivieso, Hugo Richter, Claudio Navarrete Introduction: Pediatric gastrointestinal disorders, occasionally require interventional gastrointestinal endoscopy procedures, to solve congenital or acquired clinical conditions. Its use has increased considerably, due to the development of new and better technological resources and cares, usually extrapolated not only from diagnostic, but also therapeutic endoscopic resources in adult population. Biliary atresia, pancreatic cystic fibrosis, Hirschprung disease and congenital disorders (imperforated anus and esophageal atresia v.g), demand new diagnostic and therapeutic skills. Aim: To evaluate our cumulative experience, in minimally invasive treatment among children. Patients and Method: We present a consecutive series of therapeutic endoscopic procedures in pediatric population (0 to 15 years) recruited from January 2003 to November 2005., in our Unit located at Santiago Chile. After informed consent was obtained from parents, under general anesthesia or titrated sedation with propofol, the endoscopic procedure was performed, utilizing pediatric Olympus instruments. Clinical and endoscopic data, were collected using an Epi Info 2002 computerized database, which includes besides photo images and video-records. Results: 82 therapeutic endoscopic procedures, among 75 patients (40 women and 35 men), aged between 0 and 15 years, refered from Primary Care Hospitals, were done. ERCP in 22 cases (2 liver transplant patients), 12 percutaneous gastrostomies, 8 endoscopic treatment of esophageal varices (6 band ligations and 2 variceal sclerosis), esophageal dilatation in 8 cases (1 achalasia and 7 benign estenosis), intra gastric baloon in 4 obese patients, 6 colonic polypectomies (juvenile polyps). APC in 3 cases of congenital tracheoesophageal fistulae, 3 foreign bodies extraction only, (this procedure is usually performed in the urgency department), positioning of nasoyeyunal tube in 3 cases, endoscopic drainage of 2 gastro-duodenal duplications and 1 pancreatic pseudocyst. 73 patients did well. One patient had recurrence of the tracheoesophageal fistulae, after application of APC and went to surgery. There was a casualty, as consequence of air embolism. Discussion: Minimally invasive gastrointestinal endoscopy procedures appear like complex interventions, but they are becoming a necessary therapeutic resource in the pediatric population. We present our experience in highly selected pediatric patients, referred to our Unit from several Primary Care Hospitals. 97,5% of the cases were solved endoscopically. There was a casualty in this series.

7568 Background: Uveal melanoma is the most common primary malignant intraocular tumor in adults (70%). They generally occur sporadically and familiy uveal melanoma only accounts for 0.6 % of patients. Methods: Data was collected from 63 patients assisted at six different institutions in Montevideo, Uruguay, during a 20-year period. Diagnosis was histopathologically confirmed in 55/63(87%) patients. Radical surgery (predominately enucleation) was performed in 54/63(86%) patients. Other treatment options included orbit excenteration, braquitherapy, and proton beam therapy. 25/63 (40%) developed distant metastasis, mainly in the liver. Results: The mean age at diagnosis was 59 years old. The most common symptom was decreased visual acuity in 50/63 (77%). Three patients had extrascleral extension of the tumor and presented with pigmented lesions. There was a statistical significant correlation between tumors of mixed and epithelioid type and survival (p