El cáncer de mama es la neoplasia más común en mujeres a nivel mundial, al igual que en nuestro país. Sin embargo, en México, existen diferencias que son importantes de identificar e individualizar para mejorar los desenlaces de las mujeres que padecen esta enfermedad, por lo que el objetivo de esta 8ª revisión del consenso es el de proveer una guía nacional actualizada, basada en la mejor evidencia científica, ajustada a la heterogeneidad de nuestro sistema de salud y a las necesidades y coberturas terapéuticas existentes. Se reconoce mundialmente que el tratamiento del cáncer de mama es multimodal y requiere de un grupo multidisciplinario que ayude a tomar las mejores decisiones terapéuticas, por lo que las conclusiones de este consenso proveen de la mejor evidencia para guiar los tratamientos quirúrgico, con radioterapia y sistémico, basados en las características de la paciente, del tumor y del sistema de salud. Finalmente en esta edición se hace un especial hincapié en la necesidad de realizar un diagnóstico preciso tempranamente e iniciar el tratamiento indicado de manera rápida, ya que se ha comprobado que el retraso en el mismo afecta negativamente la tasa de sobrevida.Palabras clave: Consenso de Colima. Consenso cáncer mamario. Guías cáncer mamario. México. AbstractBreast cancer is the most common neoplasm in women worldwide, as well as in our country. However, in Mexico there are differences that are important to identify and individualize in order to improve the outcomes of women suffering from this disease. Thus, the purpose of this 8 th consensus review is to provide a national updated guideline, based on the best scientific evidence, and adjusted to the heterogeneity of our health system and to the existing needs and therapeutic coverage.

Background: Adherence to BCCPG improves clinical outcomes for patients with breast cancer. However, implementation of international BCCPG may not be feasible in low- and middle-income countries (LMICs) due to limitations in resources and personnel. A potential solution for this issue is developing national/regional guidelines considering local healthcare contexts. In Mexico, the National Consensus on Diagnosis and Treatment of Breast Cancer (known as the Colima Consensus, http://consensocancermamario.com) is considered the national BCCPG, and it is updated bi-yearly since 1994. The aim of this study was to evaluate physicians’ uptake of the Colima Consensus recommendations, and to identify barriers and attitudes that may impact adherence. Methods: A cross-sectional, 30-item survey exploring attitudes towards the Colima Consensus, as well as barriers limiting adherence to its recommendations, was e-mailed to Consensus attendees, members of the Mexican Society of Oncology, and of the Mexican Mastology Association, with answers collected over 3 weeks. Descriptive statistics, including means, medians, and standard deviations were used to analyze the participants’ sociodemographic characteristics, attitudes, and perceived barriers. X2 tests were used to evaluate associations between physicians’ characteristics/attitudes and adherence. Results: Among 1553 physicians invited to participate, 320 (21%) answered the survey, of which 25 (8%) were unaware of the Colima Consensus. Two hundred ninety-five participants completed the entire survey and were included in this analysis. Fifty-six percent were male, 65% were age 30-49, 44% practiced in Mexico City, and 8% were foreign. Regarding specialty, 26% were surgical oncologists, 14% medical oncologists, and 10% radiation oncologists. Over half of respondents (57%) worked in both public and private practice, while 19 and 23% worked only in public or private practice, respectively. Sixty-two percent had access to a multidisciplinary breast cancer team. Eighty-five percent reported using the Colima Consensus to guide clinical decision making and 77% adhered to its recommendations in most/all cases. Forty-two percent used the Colima Consensus as their only guideline reference. Surgical oncologists were more likely than medical oncologists to use the Colima Consensus as their only guideline reference (29 vs. 12%, p<0.01). The most commonly reported barriers to adherence were lack of resources (51%) and logistical issues (31%). Physicians working without a dedicated multidisciplinary breast cancer team were significantly more likely to report a lack of resources as a barrier than those with a multidisciplinary team (63 vs. 43%, p<0.01). No differences were found in other barriers according to participants’ characteristics. Regarding attitudes towards the Colima Consensus, 88% agreed/strongly agreed that it was a valuable teaching tool, 88% considered it a trustworthy source of information, and 89% believed it led to improved quality of care. Seventy-six percent of the participants agreed/strongly agreed that the Consensus’ recommendations were free of bias and 58% considered that its use led to reduced costs of care. Conclusions: Initial results of our study show high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion of physicians using it as their main guideline reference. Lack of resources and logistical issues were the main barriers hampering implementation of recommendations, particularly for physicians working without a multidisciplinary breast cancer team. Our results highlight the relevance of local BCCPG and of multidisciplinary collaborations, and suggest a need for the creation of stratified recommendations for various healthcare settings and resources. Citation Format: Bertha Alejandra Martinez-Cannon, Enrique Soto-Perez-de-Celis, Aura A. Erazo Valle-Solis, Claudia Arce Salinas, Enrique Bargallo Rocha, Veronica Bautista Piña, Ma. Guadalupe Cervantes Sanchez, Christian Haydee Flores Balcazar, Maria del Carmen Lara Tamburrino, Ana Lluch Hernandez, Antonio Maffuz Aziz, Victor Manuel Perez Sanchez, Adela Poitevin Chacon, Efrain Salas Gonzalez, Laura Torrecillas Torres, Vicente Valero, Yolanda Villaseñor Navarro, Jesus Cardenas Sanchez. Physicians’ attitudes and perceived barriers to adherence to national breast cancer clinical practice guidelines (BCCPG) in Mexico [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-17-05.

Based on the GRADE system, a group of specialists in Medical Oncology from ISSSTE produced a set of recommendations for the systemic treatment of advanced lung cancer —specifically non-small cell lung cancer and small-cell lung cancer— with immunotherapy, chemotherapy with or without antiangiogenic agents. Regarding the diagnosis, extension studies and lung grades are analyzed. Likewise, basic pathology, molecular biology, and imaging features are described to determine the treatment protocols for advanced lung cancer with actionable mutations or biomarkers related to domains such as actionable mutations, anaplastic lymphoma kinase, and reactive oxygen species (ROS1). The recommendations comprise the most important clinical issues: immunotherapy in lung cancer, first-line treatment for non-small cell lung cancer, non-squamous (wild-type) metastatic cancer, second-line immunotherapy regimes, chemotherapy without first-line immunotherapy for adenocarcinoma, firstline chemotherapy with antiangiogenic agents, as well as the characteristics a patient should present to be a candidate to receive immunotherapy. Dosages are stated in the different treatment protocols; the chemotherapy regimes for unresectable, locally-advanced lung cancer are being reviewed, as well as for ECOG 0-1 until ECOG 2, limited and extended stages. Even though there is no consensus on certain topics, this document includes clear guidelines whose aim is standardizing the criteria, and that will be subject to be reviewed and updated.

e18669 Background: Adherence to BCCPG improves outcomes for patients with breast cancer. However, the implementation of international BCCPG may not be feasible in low- and middle-income countries, and a potential solution may be developing BCCPG adapted to local contexts. The National Consensus on Diagnosis and Treatment of Breast Cancer ( Colima Consensus, http://consensocancermamario.com) is the Mexican BCCPG. This study aimed at evaluating physicians’ uptake of the Colima Consensus and identifying barriers impacting adherence. Methods: A cross-sectional, 30-item survey exploring adherence, barriers, and attitudes towards the Colima Consensus was e-mailed to Consensus attendees and members of the Mexican Society of Oncology and Mexican Mastology Association. Answers were collected between 06/21-09/21. Descriptive statistics, univariate, and multivariate analysis were used to analyze the associations between participants’ characteristics, adherence, attitudes, and barriers. Results: Among 1553 physicians invited to participate, 439 (28%) completed the survey. Fifty-four percent were male, 66% were age 30-49 years, and 39% practiced in Mexico City. Twenty-six percent were surgical, 13% medical, and 10% radiation oncologists. Ninety-two percent reported using the Consensus to guide decision-making, 78% adhered to its recommendations, 89% agreed with its recommendations, and 94% believed it was applicable to their clinical practice. Regarding attitudes towards the Consensus, 90% agreed/strongly agreed with it being a good educational tool, 89% a reliable source of information, and 90% thought it improved quality of care. The most common barriers to adherence were lack of resources (54%) and logistical problems (29%). Physicians working with a multidisciplinary team were less likely to cite lack of resources as reason for non-adherence (p < 0.01). Forty percent reported using the Consensus as their only BCCPG. Surgical oncologists (p < 0.01), those practicing in public hospitals (p < 0.01), in institutions with local BCCPG (p < 0.01), with ≤5 new patients/month (p < 0.01), and not involved in research (p < 0.01) were more likely to use the Consensus as their only BCCPG. In multivariate analysis, being a surgical oncologist (OR 3.26, p < 0.01) and working in a public hospital (OR 2.12, p < 0.01) increased the odds of using the Consensus as the only BCCPG. Conclusions: We show high levels of adherence and positive attitudes towards the Colima Consensus, with a significant proportion using it as their main BCCPG. Lack of resources and logistical issues were the main barriers to adherence. Our results highlight the relevance of local BCCPG and suggest a need for the creation of stratified recommendations adapted to various healthcare settings.