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Young women with breast cancer (YWBC) account for a variable proportion of patients diagnosed with breast cancer around the globe, with a higher prevalence in resource-limited settings than in high-income countries. This group represents a unique population that warrants special attention due to specific biological considerations and age-specific supportive care issues. This review aims to explore existing knowledge regarding YWBC’s needs, particularly in resource-restricted settings. To date, scarce information regarding the care of YWBC in resource-constrained countries is available, with most reports describing suboptimal care in terms of survivorship needs. Health care providers should implement actions to improve endocrine treatment adherence, referrals for fertility counseling and preservation, contraceptive use compliance, timely body image and sexual function interventions, comprehensive genetic risk assessments, and early quality of life and psychosocial health interventions. While high costs act as a barrier for optimal care in resource-limited settings, improving patient education represents a promising and cost-effective solution to improve patient care. Future research on developing tailored educational resources for YWBC in resource-limited settings should be considered a priority.

Stereotactic body radiation therapy (SBRT) has been shown to be safe and effective for delaying systemic treatment change among patients with metastatic renal cell carcinoma (mRCC). In this study, we sought to assess the genomic signatures of patients with mRCC who underwent SBRT for oligoprogression. A total of 30 patients with oligoprogressive disease were identified, the majority of whom had clear cell renal cell carcinoma (83.3%) and were receiving first-line treatment (53.3%). Genomic and transcriptomic sequencing were available in 20 and 16 patients, respectively. Duration of systemic treatment (DOT) was categorized as that prior (DOT[P]) and subsequent (DOT[S]) to radiation treatment. The median DOT(P) and DOT(S) were 15.1 and 18.3 mo, respectively, with a median DOT(S)/DOT(P) ratio of 1.4. Patients who had a DOT(S)/DOT(P) ratio of ≥1 had increased expression in pathways related to cell proliferation and development. In contrast, among patients with a ratio of ≤1, the reactive oxygen species pathway was enriched. This study highlights the potential role of genomics and transcriptomics to refine radiation treatment selection in patients with mRCC. PATIENT SUMMARY: In this study, we looked at mutations and genomic expressions among kidney cancer patients who responded better to stereotactic body radiotherapy. We found that enriched expression of certain pathways might play a role in response to radiotherapy.

Bertha Alejandra Martinez-Cannon,1,2 Andrea Castro-Sanchez,2 Regina Barragan-Carrillo,2 Sylvia de la Rosa Pacheco,1 Alejandra Platas,2,3 Alan Fonseca,2,3 Yoatzin Vega,2 Karen Bojorquez-Velazquez,3 Juan Enrique Bargallo-Rocha,2,3 Alejandro Mohar,3,4 Cynthia Villarreal-Garza1,2 1Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico; 2Joven & Fuerte: Programa para la Atencion e Investigacion de Mujeres Jovenes con Cancer de Mama, Mexico City, Mexico; 3Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico; 4Instituto de Investigaciones Biomédicas de la Universidad Nacional Autónoma de México, Mexico City, MexicoCorrespondence: Cynthia Villarreal-GarzaBreast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, Real San Agustin, 66278, San Pedro Garza Garcia, Nuevo Leon, MexicoEmail cynthiavg@gmail.comBackground: Breast cancer (BC) in young women is characterized by an unfavorable prognosis in hormone receptor-positive/HER2-negative tumors, which may be explained by low rates of tamoxifen adherence. In Mexico, up to 14% of all BC diagnoses occur in young women and no data on tamoxifen adherence has been reported.Objective: To estimate the rate of adherence to adjuvant tamoxifen in Mexican young women with BC (YWBC).Methods: A cross-sectional survey was conducted at the National Cancer Institute in Mexico City, among YWBC (≤ 40 years at diagnosis) receiving adjuvant tamoxifen. Adherence was measured subjectively, through self-reported surveys, and objectively, through medication possession ratio (MPR). Descriptive statistics were used to analyze sociodemographic characteristics. To compare associations between patients’ characteristics and adherence, Chi-square test was used for categorical variables and Student’s t-test or Mann–Whitney U-test for quantitative variables.Results: A total of 141 YWBC receiving adjuvant tamoxifen were included. Regarding subjective adherence, 95% expressed taking tamoxifen regularly, 70% reported missing 0 doses in the past 30 days, and 71.6% reported having adverse effects. Regarding objective adherence, 74.8% of patients had an MPR ≥ 80%. The association between subjective and objective adherence was statistically significant (p = 0.004). Subjective adherence was associated with not skipping tamoxifen doses when feeling worse. Objective adherence was associated with having a stable job, not skipping tamoxifen doses when feeling worse, taking additional medications, and time on tamoxifen treatment. Fifty-six percent considered the information on tamoxifen to be insufficient and 37% not understandable.Conclusion: In our study, high subjective and objective adherence rates to adjuvant tamoxifen were reported, although an important proportion of women reported high rates of adverse effects and not fully understanding the benefits of tamoxifen. Strategies to increase tamoxifen adherence may be even more important now that longer durations of treatment or further ovarian function suppression have become the standard of care in YWBC.Keywords: young women, breast cancer, tamoxifen, adherence, Mexico

Risk stratification by genomic signatures has been shown to improve prognostication and guide treatment decisions among patients with hormone-sensitive breast cancer. However, their role in young women has not been fully elucidated. In this review, a systematic search was conducted for published articles and abstracts from major congresses that evaluated the use of genomic signatures in young breast cancer patients. A total of 71 studies were analyzed, including 561,188 patients of whom 27,748 (4.9%) were young. Women aged ≤40 years were subjected to genomic testing at a similar rate to older women but had a higher proportion of intermediate- to high-risk tumors when classified by EndoPredict (p = 0.04), MammaPrint (p p

678 Background: Recent studies have suggested an association between the time-of-day of ICI infusions and disease outcomes, including progression free survival and overall survival, among patients with cancer. (Qian et al Lancet Oncology 2021). We sought to identify whether such an association exists in patients with mRCC receiving ICIs. Methods: Patients with mRCC treated with nivolumab alone, or in combination with ipilimumab, in either first- or second-line treatment were retrospectively identified. Patients who received

614 Background: Racial minorities experience intersecting forms of marginalization and suffer significant healthcare disparities. Prospective trials have shown similar outcomes with partial and radical nephrectomy among patients with localized RCC (Van Poppel et al Eur Urol 2011), and multiple studies suggest increasing use of the former technique (Breau et al Can J Urol 2020). We hypothesize that patients from minority groups, as well as those with non-private insurance, will have less access to this specialized procedure and therefore have a higher rate of radical nephrectomy. Methods: We utilized the California Office of Statewide Health Planning and Development (OSHPD) database that collects information from all inpatient admissions, emergency room visits and inpatient/outpatient procedures in the state. All patients undergoing nephrectomy (both partial and radical) were identified from Jan 1, 2012 to Dec 31, 2018 using CPT and ICD-9/10 codes to identify patients. Demographic data was collected with specific attention to race and payor status. Univariate and multivariate analyses were conducted to determine the association between demographic data and procedure type. Results: In total, 31,093 patients were identified; 57% were males, with a mean age of 58 years. Among these, 16,142 (51.9%), 8,645 (27.8%), 2,795 (9.0%), 2,032 (6.5%) and 1,479 (4.8%) were characterized as White, Hispanic, Asian, Black and other, respectively. Partial nephrectomy and radical nephrectomy were performed in 15,840 (50.9%) and 15,253 (49.1%) of patients. By race, partial nephrectomy was performed in 8,576 (53.1%), 4,107 (47.5%), 1,286 (46.0%), 1,124 (55.3%) and 747 (50.5%) of White, Hispanic, Asian, Black and other patients, respectively (p

455 Background: Prior studies have described significant disparities in the selection of urinary diversion (UD) in patients with localized bladder cancer undergoing cystectomy. Although the choice of UD has not been shown to impact oncologic outcomes, continent urinary diversions (CUD) are associated with lower rates of in-hospital complications and mortality, but higher costs (Farber NJ et al. Bladder Cancer 2018). Male gender, White race, and higher income have been associated with proportionally higher rates of CUD than patients from other races or those without private insurance (Barocas DA et al. Cancer 2014 and Rios EM et al. Urology 2020). Utilizing the California Office of Statewide Health Planning and Development (OSHPD) database, we investigated potential barriers to CUD in patients with bladder cancer undergoing radical cystectomy. Methods: The current procedural terminology (CPT) and the international classification of diseases (ICD)-9/10 codes were used to identify patients with bladder cancer undergoing radical cystectomy from Jan 1, 2012, through Dec 31, 2018. Type of UD and demographic data such as race and payer status were collected. Univariate and multivariable analyses were conducted to determine the association between demographic variables and CUD use. Results: In total, 9,342 patients who underwent radical cystectomy were identified, of which 3,061 had UD status noted. Of these, 13.2% (404/3061) were continent and 86.2% (2,657/3061) were incontinent diversions. CUD use was significantly higher in White patients (14.1%; 320/2276) compared to Asian (12.8%; 24/187), Hispanic (9.5%; 30/316) or Black (5%; 6/119) patients (P=0.01). Use of CUD was significantly higher in patients with private insurance (23.2%; 167/721) compared to those with Medicare (10.2%; 207/2023) or indigent (MediCal/Medicaid; 8.6%; 23/269; p

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.

Background: Often, therapeutic decision-making in breast cancer (BC) patients is deeply influenced by age, with young women receiving highly aggressive systemic therapy, even when low clinical risk features are present. Currently, genomic signature studies have included a limited number of young patients, thus hindering their use in this population. Furthermore, significant data about their impact on clinical decision-making is lacking. Consequently, the medical community should strive to identify young patients who would not benefit from chemotherapy (CT). The aim of this prospective study was to determine the impact of the EndoPredict assay on adjuvant decision-making by a multidisciplinary team in premenopausal women. Patients and method: A total of 92 premenopausal women with hormone receptor-positive, HER2 negative, T1-T2, and N0-N1 BC have been included. Clinicopathological characteristics were recorded and each case presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Pearson chi-square was used to analyze differences between groups. Results: Median age at diagnosis was 43.5 years (y), with 68% being ≤ 45y. 28% had node-positive disease. Stage at diagnosis was: I (40%), IIA (36%), and IIB (23%). 11%, 72%, and 10% of tumors were low-, intermediate-, or high-grade, respectively. A total of 39 patients (46%) had a low-risk EPclin result. Notably, 61% of patients in the N0 group had a low-risk result compared to 9% with N1 status (p Change in CT decision was recorded in 14/85 patients (17%), with the greatest impact in CT reduction (table 1). Furthermore, 22/85 (26%) and 19/85 (22%) had a change in CT and anti-hormonal therapy regimen, respectively. Overall therapeutic compliance with EndoPredict results was 95%: 100% of patients with a high-risk EPclin received CT, while 87% with a low-risk result did not. Table 1.Pre- and Post-EndoPredict CT consensus Post-TestPost-Test No CTCTTotalPre-TestNo CT24 (28%)4 (5%)28 (33%)Pre-TestCT10 (12%)47 (55%)57 (67%) Total34 (40%)51 (60%)85 (100%) Conclusions: This is the first study that evaluates the EndoPredict assay effect in decision-making in a premenopausal BC patient cohort. The less overall therapy change observed, compared to previous studies, could be the result of a reliable clinical judgment for identifying high-risk patients, which represent a large proportion in this young group. Overall, the test's greatest impact was aiding the discrimination of patients that would not benefit from CT, thus avoiding unnecessary adverse effects. In conclusion, the EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a high rate of therapeutic compliance and a significant change in overall decision. Citation Format: Villarreal-Garza C, Deneken-Hernandez Z, Maffuz-Aziz A, Lopez-Martinez EA, Muñoz-Lozano JF, Barragan-Carrillo R, Peña-Curiel O, Moreno B, Ramos-Elias P, Diaz H, Bautista-Piña V. Change in therapeutic management after EndoPredict assay in a prospective decision impact study of Mexican premenopausal patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-08-54.

Background: Despite the disproportionately high-rates of breast cancer (BC) in young women in Mexico, cancer-control efforts have been predominantly aimed at improving oncological treatment, bypassing survivorship issues and supportive care for this group. The “Joven & Fuerte” cohort, the first supportive care and research program for young BC patients in Latin America, aims to describe and assess the burden of BC in young Mexican women. In this study, we focused on evaluating the association between quality of life (QoL) and anxiety, depression, and sexual functioning in young women with BC (≤ 40 years). Methods: This study included non-metastatic and non-recurrent patients belonging to the cohort's pilot phase. QoL was assessed with the EORTC QLQ-C30 global score. Patients were classified in the domains of anxiety and depression with the Hospital Anxiety and Depression Scale (HADS) as either probable case, doubtful case, or not a case. Sexual functioning was assessed with the Female Sexual Function Index (FSFI) and the sexual functioning and enjoyment domains of the EORTC QLQ-BR23. Assessments were performed at baseline, 6 months, 1 year, and 2 years. Pearson chi-square and analysis of variance (ANOVA) were used for analysis. Nominal unadjusted significance is reported with p Results: 73 out of 96 (76%) pilot phase patients met the inclusion criteria and had complete assessments up to 2 years follow-up. Global QoL was significantly worse for cases with anxiety and depression at baseline (means for non-cases, doubtful cases and cases, respectively: for anxiety, 81.09, 69.54, and 61.54, p Conclusion: This study confirmed an association between anxiety and/or depression and worse QoL at diagnosis of BC and after 6 months. Additionally, worse sexual function was significantly associated with the classification of case level anxiety. These findings support the current recommendation that physicians should regularly assess patients' psychosocial health and sexual functioning and provide prompt referral to corresponding supportive care services. Additional efforts must be conducted in low-resource settings, where sexual health and psychosocial care are not considered routine cancer treatment. Dedicated programs that promote multidisciplinary and supportive care services, such as “Joven & Fuerte”, should be incorporated into institutional health-care protocols to systematically address patients' emerging needs and improve QoL. Citation Format: Villarreal-Garza C, Platas A, Miaja M, Lopez-Martinez EA, Muñoz-Lozano JF, Fonseca A, Pineda C, Barragan-Carrillo R, Martinez-Cannon BA, Chapman J-AW, Goss PE, Bargallo-Rocha JE, Mohar A, Castro-Sanchez A. Effects of depression, anxiety, and sexual functioning on quality of life among young breast cancer patients in Mexico [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-17.

Background: The relationship between pregnancy and breast cancer (BC) risk is not fully understood. Most of the literature has described this interaction in terms of the age at first pregnancy and the number of full-term pregnancies. During the prospective accrual of the “Joven & Fuerte” young women with BC program in Mexico, we identified patients with pregnancy-associated BC (PABC) that experienced a short inter-pregnancy interval (SIPI) ( Objective: We aim to assess the occurrence of SIPI in patients with PABC, as well as describe their clinical features at presentation. Results: We included patients accrued in the “Joven & Fuerte” program from August 2014 and June 2018 at three Mexican cancer centers. A total of 375 patients ≤40 years-old with newly-diagnosed BC were assessed. 37 patients were diagnosed with PABC (10%), 21 during pregnancy and 16 after pregnancy. 6/37 (16%) patients with PABC experienced a SIPI, all diagnosed during pregnancy (28% of 21). The main clinicopathological features are described in the table 1. Table 1.Clinicopathological features of patients with PABC and SIPICaseAge at BC diagnosis (years)IPI (months)Pregnancy trimester at diagnosisStageBC subtype131183rdIIBNot available23262ndIIIAHR neg, HER2 pos337143rdIIAHR neg, HER2 pos436152ndIVHR pos, HER2 neg53142ndIIIAHR pos, HER2 neg63142ndIIICNot available Conclusion: According to the phenomena seen in this cohort of young BC patients, we hypothesize that SIPI may increase the incidence and/or modify the clinical outcomes of PABC. The evidence from clinical and laboratory data suggest that the mechanisms that could alter the interaction include, but are not limited to, the prolongation of the exposure to high concentrations of estrogens or their genotoxic metabolites, interaction with the effect of progesterone and other pregnancy-associated hormones on breast tissue, and immunologic factors. To date, to our knowledge there is no evidence about the effect of SIPI in PABC. Thus, research in this area should be encouraged, particularly in vulnerable women in limited-resource settings, where SIPI is, unfortunately, a common occurrence, and might represent a risk factor for BC/PABC. Citation Format: Diaz-Perez H, Del Toro-Mijares R, Lopez-Martinez EA, Muñoz-Lozano JF, Fonseca A, Platas A, Martinez-Cannon BA, Barragan-Carrillo R, Castro-Carrasco J, Limon-Gomez S, Villarreal-Garza C. Assessment of short inter-pregnancy interval in breast cancer diagnosed during pregnancy [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-10-10.

71 Background: Transgender people experience intersecting forms of marginalization and suffer significant healthcare disparities. There is evidence that healthcare providers are insufficiently equipped to provide adequate healthcare to this population. Hormone-replacement therapy for trans-women requires blockade of androgen production and estrogen supplementation, which increases the risk of breast cancer (BC) compared to cis-males. Also, trans-women without gender-affirming mastectomy should undergo BC screening (BCS). We seek to explore the knowledge and attitudes among physicians regarding current strategies for breast cancer screening in trans-women and men. Methods: We adapted an online 15-item survey exploring knowledge and attitudes among physicians on strategies for BCS in trans people. The first 6-items evaluated attitudes, and the last 9-items knowledge. We conducted a pilot phase to assess physicians' understanding before the final data collection and adjusted it after corrections. Participants were invited through social media and directly peer-to-peer in June 2022. Descriptive statistics and Chi-square test were used for statistical analysis using SPSS ver. 26. Results: A total of 165 participants completed the survey, 96 (58.2%) self-identified as male, 66 (40%) female, and 2 (1.2%) non-binary gender with a mean age of 30 years (23 – 60 years). Most participants were residents and fellows (70.3%), and 29.7% were attendings. Overall, only 7.3% of participants felt confident in their knowledge of BCS in trans-people, 55.2% felt that had an inadequate preparation regarding transgender health during medical school and 86.1 and 83% agreed that it should be thoroughly addressed during medical school and residency, respectively. Regarding knowledge, 10.9% recognized that BC risk is different between trans- and cis-women, 9.7% identified that trans-women had a lower BC risk, and 77% answered that transgender people have insufficient access to health services. Finally, as for specific BC screening strategies, only 49.1% correctly identified BCS strategies for trans-women, 61.2% correctly answered the recommended age to start BCS in trans-women, 40.6% the periodicity for BCS, and 63% identified the correct recommendation for BCS trans-men without a gender-affirming mastectomy. Conclusions: Current physician knowledge regarding BCS strategies in the transgender population is limited. Nonetheless, respondents identified transgender health as an area of opportunity that might be addressed with widespread information. These findings reinforce that education of healthcare providers is required to end health inequalities faced by this diverse group of patients.

Young women with cancer comprise a special population of patients who experience cancer and oncologic care in a unique way. Recent progress in diagnostic and therapeutic approaches has transformed the landscape of clinical oncology practice. This perspective addresses novel therapies, and some of the main challenges that oncologists face when providing care for young patients in the era of next-generation sequencing and tissue-agnostic approaches through the use of targeted therapies for diverse malignancies.

Background In Mexico, up to 15% of breast cancer (BC) patients are 40 years or younger. Therefore, fertility preservation and pregnancy after cancer treatment are major concerns in this population. However, no data are available regarding Mexican physicians' knowledge and attitudes toward these issues. Objective The objective of the study was to describe physicians' attitudes, knowledge, and perceived barriers toward fertility preservation among young women with BC (YWBC) in a developing country. Methods A cross-sectional study was conducted among physicians attending the 2016 Mexican Society of Oncology (SMeO) Annual Meeting or affiliated to SMeO. Chi-squared tests were used to assess factors associated with a higher likelihood of disclosing infertility risks, discussing fertility preservation methods, referring to specialists, and effective counseling. Results Of the 314 participants, 83% reported a high sense of responsibility about informing treatment-related infertility risks, 58% always informed patients about those risks, 38% always discussed fertility preservation procedures, 52% always referred interested patients to fertility specialists, and 24% wrongly considered pregnancy and GnRH analogs detrimental in YWBC. Barriers for discussing fertility preservation were costs, lack of specialists, and prognosis. Conclusions It is crucial to promote physicians' knowledge and to endorse policies to overcome barriers obstructing universal access to fertility preservation for YWBC in Mexico.

Objective To evaluate the change in adjuvant therapeutic decision in a cohort of young women with breast cancer discussed by a multidisciplinary team, before and after EndoPredict testing. Patients and methods 99 premenopausal women with hormone receptor-positive, HER2-negative, T1-T2, and N0-N1 breast cancer were included. Clinicopathological characteristics were recorded and cases were presented in a multidisciplinary tumor board. Consensual therapeutic decisions before and after EndoPredict results were registered. Medical records were reviewed at six-month follow-up to determine physicians’ adherence to therapeutic recommendations. Pearson chi-square and McNemar’s tests were used to analyze differences between groups and changes in treatment recommendations, respectively. Results Median age at diagnosis was 43 years. The most frequent tumor size was pT2 (53.5%) and 27% of patients had 1–3 positive lymph nodes. 46% of patients had a low-risk EPclin result. Nodal status and tumor grade were significantly associated with EPclin result (p < .00001 and p = .0110, respectively), while Ki67 levels and age ≤40 years were not. A change in chemotherapy decision was registered in 19.2% of patients (p = .066), with the greatest impact in de-escalation (9% net reduction). A change in chemotherapy or endocrine therapy regimen was suggested in 19% and 20% of cases, respectively, after EPclin results were available. A significant difference was found in the median EPclin score between patients with a low- vs. high-intensity chemotherapy and endocrine therapy regimen recommendation (p = 0.049 and p = 0.0001, respectively). Tumor board treatment recommendation adherence with the EndoPredict result was 95% and final treatment adherence to EPclin result was 93%. Conclusions The EndoPredict test successfully assisted the clinical decision-making process in premenopausal patients, with a clinically significant change in overall decision-making, with the greatest impact seen in chemotherapy reduction, and a high rate of therapeutic adherence.

Background: Delay in diagnosis and treatment initiation of breast cancer (BC) has been associated with advanced stages and poor outcome. In developed countries, age has not been solely reported as an independent predictor of diagnosis delay. In Mexico, median time since tumor detection to treatment initiation is about 7 months, but young women are underrepresented in these studies. We aim to describe time intervals related to diagnosis in Mexican young women with BC (YWBC). Methods: Newly diagnosed YWBC were invited to participate as part of this prospective cohort. Patient accrual began in November 2014 at two public cancer centers in Mexico. Patients completed self-report surveys including questions regarding mode of detection, time from first symptom to medical appointment (patient interval) and time from first symptom to diagnosis (total interval). Pearson chi-square tests were used to examine the effects of patient and clinical characteristics on patient interval and clinical stage. Results: 96 YWBC with median age at diagnosis of 35 y (range 21-40) were enrolled in our pilot phase. 82.3% had tumor detected by self or partner. 62.5% of YWBC were diagnosed as locally advanced disease (IIB-IIIC). Median tumor size was 3.5 cm (0.5-12.0), with node involvement in 66.7%. 53.1% of YWBC had a patient interval of 12 months, 39.6% reached a total interval >12 months. Patient interval and clinical stage were not significantly associated with occupation, education, marital status, current partner or method of detection. N(%)TimePatient intervalTotal interval12 months13 (13.5)38 (39.6)No symptoms0 (0.0)3 (3.1)NA22 (22.9)5 (5.2)Method of Detection Patient/Partner detected tumor79 (82.3)Clinical detection0 (0.0)Image detected9 (94)NA8 (8.3)Clinical stage 02 (2.1)IA13 (13.5)IB1 (1.0)IIA14 (14.6)IIB17 (17.7)IIIA28 (29.2)IIIB8 (8.3)IIIC7 (7.3)IV6 (6.2) Conclusions: In this cohort, most patients had a greater total delay than previously reported in Mexico, possibly attributed to long health-system intervals, which could contribute to worse outcomes in YWBC. The prospective nature of this study allows the recollection of biologic characteristics, treatment scheme and adherence to treatment, to determine their impact on clinical outcome besides diagnosis delay. “Joven & Fuerte”, the first dedicated program for the care of young breast cancer patients in Latin America, aims to develop YWBC-tailored interventions to early diagnose or “downstage” BC among young women by endorsing patient navigation, increasing general population awareness and improving providers' knowledge in low-middle income countries, such as Mexico. Citation Format: Castro-Sanchez A, Barragan-Carrillo R, Miaja M, Platas A, Martinez Cannon BA, Fonseca A, Vega Y, Bukowski A, Chapman J-A, Goss P, St. Louis J, Bargallo-Rocha JE, Mohar A, Peña-Curiel O, Villarreal-Garza CM. Delay in diagnosis of breast cancer in Mexican young women: Report of the “Joven y Fuerte” prospective cohort pilot phase [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-09.

Background: In Mexico, approximately 30% of young women with breast cancer (YWBC) are childless and >40% express concern about infertility risk secondary to cytotoxic treatment. However, only 30% of patients recall being disclosed by their physician of such risk. The aim of this study was to characterize and analyze the caregivers' behavior, attitudes and knowledge towards fertility preservation in YWBC in a limited resource setting, such as Mexico. Materials and Methods: A 20-item survey was designed and validated by an expert panel, which was answered by participants of the annual meeting of the Mexican Society of Oncology 2016, as well as by physicians affiliated to the same association via web. Pearson chi-square tests were used to assess factors associated with the likelihood of disclosure of infertility risk, discussion about methods of fertility preservation and referral to a reproductive health specialist. Results: The participants' demographic characteristics are displayed in Table 1 and are associated with the main areas of interest in Table 2. Characteristics%Age ≤40y56>40y44Gender Male69Female31Specialty Medical36Surgical53Other12Clinical Practice Public26Private9Both65Knowledge safety subsequent pregnancy Fair64Not fair36Knowledge safety ovulation inductors Fair38Not fair62Knowledge safety GnRH analogues Fair37Not fair63 Inform about infertility riskInform about preservation strategiesRefer to a specialist %p%p%pAge ≤40y56.5 46.2 54.9 >40y44.5.8653.8.00845.1.72Gender Male67.6 73.1 65.4 Female32.4.7226.9.14934.5.24Specialty Medical30.2 31.1 28.4 Surgical57.7 57.7 60.5 Other12.1.579.2.4211.1.18Clinical practice Public19.8 12.6 19.8 Private19.8 21.0 15.4 Both60.4.0266.4.00264.8.51Sense of responsibility Low-Middle8.8 5.0 8.0 High91.2 The caregivers' most influential factor in all areas was their self-reported sense of responsibility on disclosing patients about infertility risk. Those physicians that inform patients about infertility risk are statistically more likely to discuss fertility preservation strategies and to refer to a reproductive health specialist. As for the main barriers for fertility preservation, costs were the most frequently mentioned (29.6%), followed by lack of specialists (11.2%), and patient's prognosis according to clinical stage (11.2%). Conclusions: This represents the first Latinamerican study evaluating the YWBC's caregivers' attitudes and practices towards fertility preservation, as well as their general knowledge concerning oncofertility issues. The fact that only one third of the enquired physicians were aware of the safety of ovulation inductors and use of GnRH analogues in YWBC is striking, which may translate into worse survivorship care. Furthermore, physicians reported that access barriers were the most prevalent factors that hindered appropriate referral. Health-care providers play a major role in the timely detection of the patient's interest in future offspring, thus it is crucial to promote knowledge about this relevant topic and endorse policies that can provide universal access to assisted reproductive technologies. Citation Format: Villarreal-Garza CM, Barragan-Carrillo R, Bargallo-Rocha JE, Peña-Curiel O, Martinez-Cannon BA, Platas A, Torres J, Mohar A, Rivera S, Garcia-Valdovino VJ, Garcia-Leon GA, Castro-Sanchez A. Physician knowledge and attitudes towards fertility preservation in Mexican young breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-11-09.

Despite the high rates of breast cancer among young Mexican women, their special needs and concerns have not been systematically addressed. To fulfill these unsatisfied demands, we have developed “Joven & Fuerte: Program for Young Women with Breast Cancer in Mexico,” the first program dedicated to the care of young breast cancer patients in Latin America, which is taking place at the National Cancer Institute of Mexico and the two medical facilities of the Instituto Tecnologico y de Estudios Superiores de Monterrey. The program was created to optimize the complex clinical and psychosocial care of these patients, enhance education regarding their special needs, and promote targeted research, as well as to replicate this program model in other healthcare centers across Mexico and Latin America. From November 2013 to February 2017, the implementation of the “Joven & Fuerte” program has delivered specialized care to 265 patients, through the systematic identification of their particular needs and the provision of fertility, genetic, and psychological supportive services. Patients and families have engaged in pedagogic activities and workshops and have created a motivated and empowered community. The program developed and adapted the first educational resources in Spanish dedicated for young Mexican patients, as well as material for healthcare providers. As for research, a prospective cohort of young breast cancer patients was established to characterize clinicopathological features and psychosocial effects at baseline and during follow-up, as a guide for the development of specific cultural interventions addressing this vulnerable group. Eventually, it is intended that the program’s organization and structure can reach national and international interactions and serve as a platform for other countries.

Background: Young women with breast cancer (YWBC) comprise a group of patients with unique biopsychosocial characteristics with a special perception of needs throughout their disease and survivorship. Contexts marked by restricted allocations and economic constraints might further aggravate the struggle of these patients living within limited resource settings and can demand added requirements for them and their families. Objective: To analytically explore the existing knowledge regarding the needs of YWBC in low- and middle- income countries (LMICs). Methods: We conducted a thorough literature review of scientific journal databases available in Spanish and English containing information on YWBC in LMICs. Results: We did not find any publications exclusively assessing this topic in resource-limited settings. We looked for data on the different types of YW need from studies in the region that assessed the needs of breast cancer (BC) patients in general and described in their findings the particularities of young patients. Young BC patients described within the literature present a variety of needs. Those reported most frequently as unmet were related to information needs and psychological counseling, practical and physical assistance, and social and spiritual support. Conclusions: Published literature on the subject - particularly in Latin America - is extremely scarce. This offers an area of opportunity for conducting further research in this topic that would help improve health professional training and establish health policies in favor of YWBC.

e18854Background: Quality of life (QoL) has been reported to be lower in young women with breast cancer (YWBC). However, in limited resource settings with a high prevalence of YWBC, such as Mexico,...

e21714 Background: Compared to other regions, the burden of breast cancer (BC) in Mexico is disproportionately borne by younger women. Yet, their particular needs and concerns have remained understudied, including treatment-related sexual adverse effects. We aim to assess the sexual function and satisfaction in Mexican young women with BC undergoing treatment. Methods: This is a prospective sexual assessment study in BC patients of the pilot phase of the Joven y Fuerte Mexican cohort (N=96). Sexual health was assessed using the Female Sexual Function Index (FSFI) and the Sexual Satisfaction Inventory (SSI) at two points in time: baseline (BL) and 6-months follow-up (6-FU). FSFI and SSI scores lower than 26.55 and 111, respectively, were defined as sexual morbidity. Differences between proportions of BL and 6-FU were examined with Pearson chi-square test. Matched t-tests were used to test for differences in the domains of the FSFI and in the SSI total score. Results: 70 women completed the FSFI at both time points and 69 the SSI. Our results showed a high percentage of sexual dysfunction among Mexican women at BL and 6-FU (61.4% and 74.3%, respectively, p

e12003 Background: Young age has been associated with significantly increased risk of breast cancer (BC) death among women with luminal BC. One contributing factor might be the low rate of tamoxifen (TMX) adherence previously reported in this young group. Given that in Mexico a disproportionate rate of BC is diagnosed among YW, information regarding TMX adherence is particularly relevant. Our study's aim was to report TMX adherence in Mexican YW and its associated determinants. Methods: Consecutive patients ≤40y at diagnosis at the National Cancer Institute in Mexico City, under TMX treatment, completed a multiple-choice survey regarding the use and attitudes about hormonal therapy and adherence. Data of TMX disposal was collected from the pharmacy’s records, and the medication possession ratio (MPR) was calculated; an MPR ≥80% was considered adherent. Results: 135 YW with a median age at diagnosis of 35.7y (24-40) were included. 77% were undergraduate, 28% unpaired and 33% childless. Median follow-up was 26 months. 95% of patients reported a regular TMX intake: 70% did not miss any doses, while 25% missed 1-6 doses a month. Only 45% considered that the information received regarding TMX therapy was sufficient and for 37% was incomprehensive. 43% thought TMX significantly reduced their recurrence-risk and 60% strongly believed that they needed to be on TMX treatment. 73% of women reported adverse effects, being menopausal symptoms the most frequent, but only 27% were worried about the treatment long-term effects. From the 99 patients with a pharmacy record, 73% had an MPR > 80%. No significant factor was statistically associated with TMX adherence. Conclusions: Although Mexican YW and pharmacy data surprisingly sustained higher rates of TMX adherence compared to previous data, still a significant proportion of patients were non-adherent. Two-thirds of our patients reported having adverse effects, which might contribute to late TMX discontinuation. Since the newer recommendations of double hormonal blockade could lead to higher withdrawal rates of endocrine therapy in YW, adherence should be emphasized and closely monitored. Accordingly, hormonal treatment adherence should be a key component in the medical assessment of young luminal BC patients.