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<.00195.5<.00192.0<.001Inform about infertility risk      Always--94.1 64.8 Not always--5.9<.00135.2.013 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.

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 <6 months, but roughly 27.1% had a total interval <6 months. While only 13.5% had a patient interval >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 interval<1 month29 (30.2)7 (7.3)1-3 months18 (18.8)9 (9.4)4-6 months4 (4.2)10 (10.4)7-12 months10 (10.4)24 (25.0)>12 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 Breast cancer represents the most common malignancy in Latin America, and since 2006 it is the cancer type with the highest incidence among Mexican women. Providing multidisciplinary high-quality care for the growing population of patients with breast cancer represents a challenge to low and middle-income countries, which have limited economic resources and limited health staff and facilities. Since 2007, Seguro Popular insurance program has provided coverage for the treatment of women with breast cancer, including surgery, radiotherapy, chemotherapy, endocrine therapy and Her2-targeted treatments; before this program up to 50% of the Mexican population did not have healthcare coverage, and had to pay out of pocket for cancer care. Unfortunately, due to financial constraints, this does not include other interventions which may be relevant, such as supportive care and reconstructive surgery. National Cancer Institute of Mexico (INCan) is a part of the Mexican federal government and as such provides care to uninsured individuals with all types of malignancies, including breast cancer. Since the start of Seguro Popular insurance program (2007), INCan has provided oncological care to over 5,000 women with breast cancer. In 2012, INCan received a grant from the federal government (P017 Reproductive Health and Gender Equality in Health Grant) in order to establish the “Post-Mastectomy Program” (PMP), which aimed providing free patient navigation, supportive care and breast reconstruction for women after mastectomy. Starting on july 2016, derived from PMP, it was possible the setting of a Same-Day Surgery Facility (SDSF) at INCan: two small, fully equipped operation rooms with a small recovery area; and the hiring of 4 nurses and 2 anesthesiologists, adding all this to the one main operation room already set for breast cancer surgery. This allowed an increase in all kind of breast cancer surgery: conservative surgery, mastectomy with sentinel lymph node and breast reconstruction procedures. One of this rooms was assigned to breast reconstructive surgeries. Material and Methods Data were retrospectively collected from a 5 year period, 30 months before SDSF and 30 months after SDSF. Before SDSF an average 66.4 (54-73) of breast reconstruction surgeries were done by six month period, total of 332 breast reconstruction surgeries. After implementation of SDSF an average of 124 (107-138) by six month period, with a total 621 surgeries, which represents an 87% increase in breast reconstruction procedures for the same time period. Conclusion Same day surgery has been proven before to be safe in breast cancer surgery and in breast reconstructive surgery when co-morbidities are accounted for. This work shows that implementation of Same-Day Surgery could be a tool to increase the offer of breast reconstruction in economically restrained systems, in early or experienced breast reconstruction programs in developing economies, and even in developed ones. In our experience, this approach achieved an 87% increase in breast reconstruction procedures, in a 30 month period, which allowed us to benefit more women and offer them a better quality of life. Citation Format: Bargalló-Rocha JE, Gutiérrez-Zacarías LM, Maciel-Miranda A, Figueroa-Padilla J, Drucker-Zertuche M, Esparza-Arias N, Elizalde-Méndez A, Cabrera-Galeana PA. Same-day surgery impact on breast reconstruction program in a public healthcare system: An affordable booster [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 P5-16-09.

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<0.05. 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<.001; and for depression, 75.63, 64.17, and 55.00, p=0.01) and depression at 6 months (76.55, 66.67, and 35.42, respectively, p<.001). Classification of case level anxiety was associated with FSFI morbidity during the first year (baseline, p=0.03; 6 months, p=0.09; 1 year, p=0.04). There was no significant association between case level depression and FSFI morbidity in the first 2 years. Neither anxiety nor depression was generally associated with significantly different BR23 sexual functioning or sexual enjoyment; however, a sporadic association was observed between anxiety and BR23 sexual functioning at 6 months (p=0.04). 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.

Introduction: Information seeking is critical for the decision making of individuals undergoing cancer diagnosis and treatment. The information needs of breast cancer (BC) patients and whether they use online resources to obtain it are largely unknown, particularly in developing countries with scarce educational resources and poor Internet access. Additionally, the influence of age on the use of online BC resources has not been explored. In this study, we aim to describe the information needs of BC patients in Mexico, and to analyze the difference in such needs between age groups. Patients and Methods: A cross-sectional survey was conducted from March to May 2015 amongst women with BC undergoing treatment or follow-up at the National Cancer Institute in Mexico City. Demographic data (age, place of residence, occupation and level of education), Internet use and access (e-mail, social networks, tablet and/or smartphone use) and need of information sources (printed and online materials) were collected. Patients were asked which particular aspects of BC they would like to see highlighted in online educational resources. Patients were divided into three age groups (≤ 40 years [y], 41-64 y and ≥ 65 y). Chi-square test was used for comparison between group characteristics, and Student's t test to detect differences in information needs between groups. Results: 325 patients were invited, 15 refused to answer and 310 provided completed surveys. Median age was 47 y (19-87), 220 (72.6%) were housewives, and 181 (58.4%) had less than undergraduate education. 163 (52.6%) had Internet access, 139 (45%) had e-mail, 133 (43%) had a social network profile and 178 (57.6%) owned a smartphone/tablet. Regarding information needs, 94.5% (n = 241) believed printed materials should be available, while 93.2% (n = 287) thought online resources would be useful and 78% (n = 241) expressed the desire to have an online forum with other patients. Women ≤ 40 y were more likely to have Internet access (p < 0.0001), e-mail account (p < 0.0001), social network profiles (p < 0.0001) and tablets/smartphones (p < 0.0001). Although there was no difference in the perceived need for printed materials between age groups (p = 0.26), women ≥ 65 y were less likely to believe online resources would be useful (90.8 vs. 97.3%; p = 0.01). 21.6% (n = 67) of patients mentioned diet and exercise as the most important aspect they would like to see in a website, followed by survivorship (19.7%; n = 61), and treatment (14.5%; n = 45). Women ≤ 40 y were significantly more interested in learning about the adverse effects of treatment than their older counterparts (12.4 vs. 3%; p < 0.001). There was no difference between age groups regarding other aspects of perceived information needs. Conclusions: Despite having a poor educational background and low rates of Internet access, almost all the surveyed women were interested in obtaining online BC information, regardless of age. Perceived information needs and preferences do not differ greatly between age groups, although young women are more likely to want information about adverse effects. Supplying patients with appropriate and accessible online educational resources addressing their information needs is essential, and healthcare providers should strive to accomplish this goal. Citation Format: Villarreal-Garza C, Platas A, Bargalló-Rocha JE, Aguilar-González CN, Ortega-Leonard LV, Martínez-Cannon BA, Ramos-Elías P, Soto-Perez-de-Celis E. Information needs and Internet use of breast cancer patients in Mexico. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-09-08.