Introduction: The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres. For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions. Objective: After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC. Methods: After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online. The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC. The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question. Results: A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%). The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations. Conclusion: The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.

Risk stratification of patients with early stage breast cancer may support adjuvant chemotherapy decision‐making. This review details the development and validation of six multi‐gene classifiers, each of which claims to provide useful prognostic and possibly predictive information for early stage breast cancer patients. A careful assessment is presented of each test's analytical validity, clinical validity, and clinical utility, as well as the quality of evidence supporting its use.

The survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2- patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.

Cementing of a casing string or liner is always considered a crucial phase of the well construction process. The difference with the other phases, is that once cement has been mixed and pumped in the well, there is a limited amount of time for operators to take decisions for troubleshooting or surpassing any obstacles encountered, before cement is no longer pumpable, as at such point, decisions become exponentially costlier, and can even result in the loss of the well, or sidetrack. Steps to mitigate these risks involve extensive pre-planning to identify all possible risk scenarios, and prepare mitigation, elimination and correction methods. Another step is to count with appropriate equipment, backup equipment, and contingency procedures ready to be implemented if required. Decisions such as how much more volume should be pumped if plug bump is not seen, or if volume count should be reset when dart latch is seen, should be reviewed in advance, as a decision-making process cannot take place when the event is seen, as the timeframe to take these decisions are too narrow. Cementing a liner in a deepwater scenario increases the risks during the operation. Inaccuracies for volume counting during displacement are increased, and in situations when there is a small liner, and the displacement volume is greatly larger than the slurry volume, increases inaccuracies even further. Free-fall of cement is also increased, as a heavier slurry is being displaced throughout a longer interval, until it U-turns at the shoe and is finally placed on the annular space. This also increases the risk of not seeing the dart latch with the plug, not being able to reset the volume count to a more precise volume. The cementing phase of the 4.5" liner for the Deepwater Total Moho-Nord Albian Project, presented these risks due to the short 4.5" liner interval. The liner interval can be as short as 450 mts of liner length, equivalent to 10 m3 of cement slurry) in comparison with the TOL depth (average 4,100 m MD, equivalent to over 50 m3 of displacement). The risks were increased as the project relies on plug bump to set a series of annular inflatable packers to help seal the formation from water influxes. This meant that if the theoretical volume was pumped and the plug did not bump at the time, displacement had to stop, and the packers could not be inflated. Rotation, which often helps cement placement, was also not an option in this project, as T&D analysis proved that there was a high risk to exceed the torque limit of the liner connections. All these risks combined, made the cementing operation of the 4.5" liner of the Albian project, one of the most complex and crucial parts of the well operation.

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