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Mexico: cancer statistics from IARC GlobalCan (2012)

Population in 2012: 116.1m
People newly diagnosed with cancer (excluding NMSC) / yr: 148,000
Age-standardised rate, incidence per 100,000 people/yr: 131.5
Risk of getting cancer before age 75:13.4%
People dying from cancer /yr: 78,700

Menu: Mexican Cancer Resources

Mexico: Cancer Organisations and Resources
Latest Research Publications from Mexico

Mexico: Cancer Organisations and Resources (6 links)

Latest Research Publications from Mexico

Salcedo-Hernández RA, Luna-Ortiz K, Lino-Silva LS, et al.
Conjunctival melanoma: survival analysis in twenty-two Mexican patients.
Arq Bras Oftalmol. 2014 May-Jun; 77(3):155-8 [PubMed] Related Publications
PURPOSE: To describe the cases of conjunctival melanoma (CM) and report the disease-free interval (DFI) and overall survival (OS).
METHODS: The charts of 22 patients who were admitted to two hospitals between 1985 and 2006 were reviewed for pertinent data, including demographics, site of involvement in the conjunctiva and sub-sites, surgical treatment, and adjuvant treatment.
RESULTS: There were 10 (45.45%) males and 12 (54.55%) females. Mean age was 52.3 years. In this group, 15 patients (68.1%) involved the bulbar conjunctiva, and 7 (31.9%) involved the palpebral conjunctiva. Of the 22 patients, 72.72% had a history of conjunctival melanosis. The average tumor size was 20.4 mm. Eight (36.36%) patients underwent orbital exenteration, 2 (9.06%) had enucleation, 5 (22.72%) had wide excision of the lesion followed by radiotherapy, 2 (9.06%) had orbital exenteration with neck dissection, and the remaining 5 patients (22.72%) were considered adequately treated only with wide excision. Eight (36.36%) patients received adjuvant treatment. Disease-free survival at 5 years was 51% and the overall survival at 5 and 10 years was 50% and 37%, respectively.
CONCLUSION: Conjunctival melanoma is a rare entity. Tumor behavior is aggressive, and the optimal treatment is surgery with adjuvant therapy.

Related: Melanoma

Bargallo JE, Lara F, Shaw-Dulin R, et al.
A study of the impact of the 21-gene breast cancer assay on the use of adjuvant chemotherapy in women with breast cancer in a Mexican public hospital.
J Surg Oncol. 2015; 111(2):203-7 [PubMed] Related Publications
BACKGROUND: The majority of breast cancer patients in Mexico are treated through the public health system and >80% receive adjuvant chemotherapy. The aim of this prospective study was to characterize the impact of the Oncotype DX assay on adjuvant therapy decision making and the confidence in those decisions amongst public sector physicians in Mexico.
METHODS: Ninety-eight consecutive patients with ER+, HER2-, stage I-IIIa, N0/N1-3 node-positive breast cancer from the Instituto Nacional de Cancerología were eligible for the study. The primary endpoint was the overall change in treatment recommendations after receiving the assay results.
RESULTS: Of 96 patients, 48% received a chemohormonal therapy recommendation prior to testing. Following receipt of results, treatment decisions changed for 31/96 (32%) patients, including 17/62 (27%) node-negative patients and 14/34 (41%) node-positive patients. The proportion of patients with a chemotherapy-based recommendation decreased from 48% pre- to 34% post-assay (P=0.024). 92% of physicians agreed that they were more confident in their treatment recommendation after ordering the assay.
CONCLUSIONS: These results suggest that use of the 21-gene assay in the Mexican public health system has a meaningful impact on adjuvant treatment recommendations that may reduce the overall use of chemotherapy.

Related: Breast Cancer

Ramírez-Garzón YT, Ávila O, Medina LA, et al.
Measurement of radiation exposure in relatives of thyroid cancer patients treated with (131)I.
Health Phys. 2014; 107(5):410-6 [PubMed] Related Publications
This work evaluates the radiological risk that patients treated with I for differentiated thyroid cancer could present to relatives and occupationally exposed workers. Recently, the International Atomic Energy Agency issued document K9010241, which recommends that patient discharge from the hospital must be based on the particular status of each patient. This work measures effective dose received by caregivers of patients treated with I at the Instituto Nacional de Cancerología, Mexico City. Thermoluminescent dosimeters were carried during a 15-d period by 40 family caregivers after patient release from hospital. Relatives were classified into two groups, ambulatory and hospitalized, according to the release mode of the patient, and three categories according to the individual patient home and transport facilities. Categories A, B, and C were defined going from most to least adequate concerning public exposure risk. Measurements were performed for 20 family caregivers in each group. The effective dose received by all caregivers participating in this study was found to be less than 5 mSv, the recommended limit per event for caregivers suggested by ICRP 103. In addition, 70 and 90% of ambulatory and hospitalized groups, respectively, received doses lower than 1 mSv. Caregivers belonging to category C, with home situations that are not appropriate for immediate release, received the highest average doses; i.e., 2.2 ± 1.3 and 3.1 ± 1.0 mSv for hospitalized and ambulatory patients, respectively. Results of this work have shown that the proper implementation of radiation protection instructions for relatives and patients can reduce significantly the risk that differentiated thyroid cancer patients treated with I can represent for surrounding individuals. The results also stress the relevance of the patient's particular lifestyle and transport conditions as the prevailing factors related to the dose received by the caregiver. Therefore, the patient's status should be the criterion used to decide his/her release modality. This work provides support to recommend the implementation of the "patient specific release criteria" in accordance with ICRP 94, IAEA Safety Report No. 63, and IAE document K9010241 A for patients treated with radiopharmaceuticals.

Related: Thyroid Cancer

Villarreal-Garza C, Alvarez-Gómez RM, Pérez-Plasencia C, et al.
Significant clinical impact of recurrent BRCA1 and BRCA2 mutations in Mexico.
Cancer. 2015; 121(3):372-8 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
BACKGROUND: Frequent recurrent mutations in the breast and ovarian cancer susceptibility (BRCA) genes BRCA1 and BRCA2 among Hispanics, including a large rearrangement Mexican founder mutation (BRCA1 exon 9-12 deletion [ex9-12del]), suggest that an ancestry-informed BRCA-testing strategy could reduce disparities and promote cancer prevention by enabling economic screening for hereditary breast and ovarian cancer in Mexico.
METHODS: In a multistage approach, 188 patients with cancer who were unselected for family cancer history (92 with ovarian cancer and 96 with breast cancer) were screened for BRCA mutations using a Hispanic mutation panel (HISPANEL) of 115 recurrent mutations in a multiplex assay (114 were screened on a mass spectroscopy platform, and a polymerase chain reaction assay was used to screen for the BRCA1 ex9-12del mutation). This was followed by sequencing of all BRCA exons and adjacent intronic regions and a BRCA1 multiplex ligation-dependent probe amplification assay (MLPA) for HISPANEL-negative patients. BRCA mutation prevalence was calculated and correlated with histology and tumor receptor status, and HISPANEL sensitivity was estimated.
RESULTS: BRCA mutations were detected in 26 of 92 patients (28%) with ovarian cancer, in 14 of 96 patients (15%) with breast cancer overall, and in 9 of 33 patients (27%) who had tumors that were negative for estrogen receptor, progesterone receptor, and human epithelial growth factor 2 (triple-negative breast cancer). Most patients with breast cancer were diagnosed with locally advanced disease. The Mexican founder mutation (BRCA1 ex9-12del) accounted for 35% of BRCA-associated ovarian cancers and 29% of BRCA-associated breast cancers. At 2% of the sequencing and MLPA cost, HISPANEL detected 68% of all BRCA mutations.
CONCLUSIONS: In this study, a remarkably high prevalence of BRCA mutations was observed among patients with ovarian cancer and breast cancer who were not selected for family history, and the BRCA1 ex9-12del mutation explained 33% of the total. The remarkable frequency of BRCA1 ex9-12del in Mexico City supports a nearby origin of this Mexican founder mutation and may constitute a regional public health problem. The HISPANEL mutation panel presents a translational opportunity for cost-effective genetic testing to enable breast and ovarian cancer prevention.

Related: Breast Cancer BRCA1 BRCA2 Ovarian Cancer

Ortega-Guerrero MA, Carrasco-Núñez G, Barragán-Campos H, Ortega MR
High incidence of lung cancer and malignant mesothelioma linked to erionite fibre exposure in a rural community in Central Mexico.
Occup Environ Med. 2015; 72(3):216-8 [PubMed] Related Publications
OBJECTIVE: To report the high incidence of lung cancer (LC) and malignant mesothelioma (MM) linked to environmental exposure to erionite fibres in a rural village of central Mexico.
METHODS: This is a retrospective survey of clinical and mortality records from the years 2000-2012, accompanied by an environmental survey for nine Group-1 lung and pleura carcinogenic agents listed by the International Agency for Research on Cancer (IARC).
RESULTS: Out of a total of 45 deaths between 2000 and 2012, 14 deaths correspond to different neoplasms of the lung, and at least four deaths to MM. The ages at diagnosis of MM were between 30 and 54 years. Annual age-standardised mortality rates per thousand due to LC and MM in the village (age >20 years) are 7.09 and 2.48 for males, and 4.75 and 1.05 for females, respectively. Erionite fibres were found in exposed rocks and soils, which can easily become airborne and be carried into streets and recreational areas near schools and homes. Other carcinogenic elements and minerals are found only in trace amounts, except for quartz dust and asbestos (chrysotile) cement sheeting, which are also present in the neighbouring villages.
CONCLUSIONS: These results indicate that environmental exposure to erionite is the main cause of the high rates of MM mortality in the Village of Tierra Blanca, supporting previous similar reports for people exposed to erionite fibres in villages in Turkey.

Related: Lung Cancer Mesothelioma

Chavarri-Guerra Y, St Louis J, Liedke PE, et al.
Access to care issues adversely affect breast cancer patients in Mexico: oncologists' perspective.
BMC Cancer. 2014; 14:658 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
BACKGROUND: Despite recently implemented access to care programs, Mexican breast cancer (BC) mortality rates remain substantially above those in the US. We conducted a survey among Mexican Oncologists to determine whether practice patterns may be responsible for these differences.
METHODS: A web-based survey was sent to 851 oncologists across Mexico using the Vanderbilt University REDCap database. Analyses of outcomes are reported using exact and binomial confidence bounds and tests.
RESULTS: 138 participants (18.6% of those surveyed) from the National capital and 26 Mexican states, responded. Respondents reported that 58% of newly diagnosed BC patients present with stage III-IV disease; 63% undergo mastectomy, 52% axillary lymph node dissection (ALND) and 48% sentinel lymph node biopsy (SLNB). Chemotherapy is recommended for tumors > 1 cm (89%), positive nodes (86.5%), triple-negative (TN) (80%) and HER2 positive tumors (58%). Trastuzumab is prescribed in 54.3% and 77.5% for HER2 < 1 cm and > 1 cm tumors, respectively. Tamoxifen is indicated for premenopausal hormone receptor (HR) positive tumors in 86.5% of cases and aromatase inhibitors (AI's) for postmenopausal in 86%. 24% of physicians reported treatment limitations, due to delayed or incomplete pathology reports and delayed or limited access to medications.
CONCLUSIONS: Even though access to care programs have been recently applied nationwide, women commonly present with advanced BC, leading to increased rates of mastectomy and ALND. Mexican physicians are dissatisfied with access to appropriate medical care. Our survey detects specific barriers that may impact BC outcomes in Mexico and warrant further investigation.

Related: Breast Cancer

Hicks EM, Litwin MS, Maliski SL
Latino men and familial risk communication about prostate cancer.
Oncol Nurs Forum. 2014; 41(5):509-16 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
PURPOSE/OBJECTIVES: To investigate how familial communication about prostate cancer (PCa) risk and screening affects sons of men with PCa.
RESEARCH APPROACH: Qualitative grounded theory.
SETTING: Southern California.
PARTICIPANTS: 17 Latino sons of PCa survivors.
METHODOLOGIC APPROACH: The team conducted semistructured interviews and follow-up interviews. Therefore, the sample includes 25 transcripts. Data were analyzed with a mix of a priori topical codes and grounded theory techniques.
FINDINGS: Sons were in need of information about familial risk and screening options. They became sensitized to PCa, desired information, and held protective intentions. Hopeful intentions came up against cultural taboos around sex, reproductive health, and intimacy that limited discussions between fathers and sons. Fathers were a valued source of information but play various roles, which affect sons' screening intentions. Open communication between father and son promoted awareness of screening and familial risk.
CONCLUSIONS: Uncertainty about familial risk and screening options, especially early detection strategies, was exacerbated by cultural taboos around PCa. Fathers could have been primary and credible advocates for shared decision making, but sons had difficulty learning from their fathers' experience.
INTERPRETATION: FINDINGS from the study can help inform community-based interventions with Latino families, help to culturally tailor health messaging, and sensitize clinicians to a group that needs concerted counseling about PCa risk and screening.

Related: Cancer Screening and Early Detection Prostate Cancer

López-Carrillo L, Hernández-Ramírez RU, Gandolfi AJ, et al.
Arsenic methylation capacity is associated with breast cancer in northern Mexico.
Toxicol Appl Pharmacol. 2014; 280(1):53-9 [PubMed] Related Publications
Exposure to environmental contaminants, dietary factors and lifestyles may explain worldwide different breast cancer (BC) incidence. Inorganic arsenic (iAs) in the drinking water is a concern in many regions, such as northern Mexico. Studies in several countries have associated the proportion of urinary monomethylarsenic (%MMA) with increased risks for many As-related diseases, including cancer. To investigate the potential relationships between the risk of BC and the capacity to methylate iAs, a hospital-based case-control study (1016 cases/1028 controls) was performed in northern Mexico. Women were directly interviewed about their reproductive histories. The profile of As metabolites in urine was determined by HPLC-ICP-MS and methylation capacity was assessed by metabolite percentages and indexes. Total urinary As, excluding arsenobetaine (TAs-AsB), ranged from 0.26 to 303.29μg/L. Most women (86%) had TAs-AsB levels below As biological exposure index (35μg/L). Women with higher %MMA and/or primary methylation index (PMI) had an increased BC risk (%MMA ORQ5vs.Q1=2.63; 95%CI 1.89,3.66; p for trend <0.001; PMI ORQ5vs.Q1=1.90; 95%CI 1.39,2.59, p for trend <0.001). In contrast, women with higher proportion of urinary dimethylarsenic (%DMA) and/or secondary methylation index (SMI) had a reduced BC risk (%DMA ORQ5vs.Q1=0.63; 95%CI 0.45,0.87, p for trend 0.006; SMI ORQ5vsQ1=0.42, 95%CI 0.31,0.59, p for trend <0.001). Neither %iAs nor total methylation index was associated to BC risk. Inter-individual variations in iAs metabolism may play a role in BC carcinogenesis. Women with higher capacity to methylate iAs to MMA and/or a lower capacity to further methylate MMA to DMA were at higher BC risk.

Related: Breast Cancer

Macías-Gómez NM, Gutiérrez-Angulo M, Leal-Ugarte E, et al.
MDR1 C3435T polymorphism in Mexican patients with breast cancer.
Genet Mol Res. 2014; 13(3):5018-24 [PubMed] Related Publications
We investigated whether the MDR1 C3435T polymorphism is associated with fibrocystic changes (FCC), infiltrating ductal breast cancer (IDBC), and/or clinical-pathological features of IDBC in Mexican patients. Samples from women who received surgical treatment in 2007 at the Centro Médico de Occidente (México) were included in the analysis. Genotyping was performed by polymerase chain reaction-restricted fragment length polymorphisms in 64 paraffin-embedded breast samples with IDBC, 64 samples with FCC, and 183 peripheral blood samples of healthy females designated as the healthy group (HG). The frequency of the T allele was 41, 45, and 52% for the FCC, IDBC, and HG samples, respectively. Significant differences were only found between the FCC and HG samples [odds ratio (OR) = 0.64, 95% confidence interval (CI) = 0.43-0.96; P = 0.032]. The prevalence of the T/T genotype was 8, 13, and 24% for FCC, IDBC, and HG samples, respectively. Again, statistical differences were only found between FCC and HG samples for the T/T genotype (OR = 0.28, 95%CI = 0.106-0.77; P = 0.009). Although the T allele and the T/T genotype were less frequent in the IDBC group than in the HG, the differences were not significant. Furthermore, no associations were found between the C3435T polymorphism and clinical-pathological features of the IDBC group. Both the FCC and IDBC groups had a high frequency of the C allele relative to the HG in this sample of women from Western Mexico.

Related: Breast Cancer

Macedo-Pérez EO, Morales-Oyarvide V, Mendoza-García VO, et al.
Long progression-free survival with first-line paclitaxel plus platinum is associated with improved response and progression-free survival with second-line docetaxel in advanced non-small-cell lung cancer.
Cancer Chemother Pharmacol. 2014; 74(4):681-90 [PubMed] Related Publications
PURPOSE: Paclitaxel and docetaxel are two taxanes approved for the treatment of non-small-cell lung cancer (NSCLC). However, there is limited evidence regarding the efficacy of docetaxel in NSCLC previously treated with a paclitaxel-platinum doublet (PP). The aim of our study was to evaluate the response to docetaxel in NSCLC patients with prior PP treatment.
METHODS: Patients with stage IV NSCLC treated with PP that presented disease progression and received docetaxel as second-line treatment were included. Demographics, clinical characteristics, EGFR mutation status, objective response (OR), overall survival (OS), progression-free survival (PFS), and PFS without chemotherapy after first line with PP were analyzed.
RESULTS: Sixty-three patients were evaluated. Median age was 58 years, 54% of patients were women, 53% were never-smokers, and 39% had EGFR mutations. OR and median PFS for PP were 36.5% and 6.7 months, respectively. OR and median PFS for docetaxel were 19% and 3.8 months, respectively. Patients with EGFR mutations had better response to docetaxel compared with wild-type patients (26 vs. 17%, p = 0.028). However, only long PFS (>6 months) to first-line PP was independently associated with a higher OR [RR 6.3, 95% CI (1.03-38.4), p = 0.046], and longer PFS [0.49 (0.25-0.9)] and OS [0.2 (0.06-0.7), p = 0.008] to second-line docetaxel compared with patients with short PFS (≤6 months) to PP.
CONCLUSIONS: Previous use of PP does not preclude a favorable response to docetaxel in NSCLC. Long PFS with PP may help select NSCLC patients who benefit from second-line docetaxel.

Related: Non-Small Cell Lung Cancer Cisplatin Lung Cancer Paclitaxel Docetaxel EGFR

Arechavaleta-Velasco F, Cuevas-Antonio R, Dominguez-Lopez P, et al.
Matrix metalloproteinase-8 promoter gene polymorphisms in Mexican women with ovarian cancer.
Med Oncol. 2014; 31(8):132 [PubMed] Related Publications
Increased levels of matrix metalloproteinase-8 (MMP-8) have been associated with tumor grade and stage in ovarian cancer. Also, it has been reported that higher concentrations of this enzyme in fluid from malignant ovarian cysts compared with benign ovarian cysts. However, no genetic analysis has been conducted yet to assess the contribution of MMP-8 polymorphisms in ovarian cancer. Thus, this study was performed to investigate the frequencies of MMP-8 genotypes in Mexican women with ovarian cancer. MMP-8 promoter genotypes were examined in 35 malignant ovarian tumors, 51 benign tumors, and 37 normal ovary tissues. Two single nucleotide polymorphisms were selected and characterized using polymerase chain reaction-restriction fragment length polymorphism analysis. The chi-square test was used to calculate statistical significance. Haplotype analysis was performed using the SNPstats web tool. Of the two polymorphisms, only the MMP-8 -799 T/T genotype was significantly associated with an increased risk of ovarian cancer (OR 3.78, 95 % CI 1.18-12.13). The Kaplan-Meier analysis for this polymorphism showed that patients with the T/T genetic variant had a tendency toward significant worse overall survival compared with patients with the C/C + C/T genotypes. Haplotype analysis revealed no significant differences in haplotype distribution between benign ovarian tumors, malignant ovarian cancer, and controls. This study suggests that MMP-8 promoter gene polymorphism -799 T/T is significantly associated with an increased risk of ovarian cancer in Mexican women.

Related: Ovarian Cancer Polymorphisms

Penaranda E, Molokwu J, Hernandez I, et al.
Attitudes toward self-sampling for cervical cancer screening among primary care attendees living on the US-Mexico border.
South Med J. 2014; 107(7):426-32 [PubMed] Related Publications
BACKGROUND: Hispanic women living along the US border with Mexico have one of the highest cervical cancer mortality rates in the nation, owing in part to lower rates of screening. The barriers to screening in this population include lack of access to care and fear of and embarrassment about the pelvic examination. Screening for oncogenic or high-risk human papillomavirus during cervical cytology has been added to screening recommendations. A novel method for human papillomavirus testing is self-sampling, in which women collect their own cervicovaginal samples. There is lack of information about the acceptability of self-sampling as an alternative to cytology for cervical cancer screening in women living along the US-Mexico border.
METHODS: We conducted five focus groups with women between the ages of 30 and 65 who were primary care patients of clinics along the US-Mexico border. We used constructs from different health behavioral theories as a framework for the interview guide.
RESULTS: A total of 21 women participated in the focus groups, 80% of whom were Hispanic; mean age was 53.4 (standard deviation 7.9). More than one-third (38%) of the participants had not undergone a Papanicolaou test in the last 3 years. Women identified the perceived benefits of self-sampling as ease, convenience, practicability, less embarrassment, and need for child care as compared with a Papanicolaou test. The main barrier to self-sampling was concern about not performing the test correctly.
CONCLUSIONS: In this qualitative study, we found positive attitudes toward self-sampling among women living along the US border with Mexico. Further research is needed to evaluate interventions that address women's low levels of self-efficacy to perform the test and to evaluate the effectiveness of self-sampling in increasing cervical cancer screening rates.

Related: Cancer Screening and Early Detection USA Cervical Cancer

Starks D, Arriba LN, Enerson CL, et al.
Mexican Cervical Cancer Screening Study II: 6-month and 2-year follow-up of HR-HPV women treated with cryotherapy in a low-resource setting.
J Low Genit Tract Dis. 2014; 18(4):333-7 [PubMed] Related Publications
OBJECTIVE: To determine the efficacy and tolerance of cryotherapy in a visual inspection with acetic acid (VIA) triage protocol after primary human papillomavirus (HPV) screening in a low-resource setting.
MATERIALS AND METHODS: This continuous series conducted over 2 years enrolled nonpregnant, high-risk HPV (HR-HPV)-positive women between the ages of 30 and 50 years, who resided in the state of Michoacán, Mexico, and had a history of no Pap smear screening or knowledge of Pap smear results within the last 3 years. These women were initially enrolled in the Mexican Cervical Cancer Screening Study II (MECCS II) trial and were treated with cryotherapy after VIA triage. They subsequently followed up at 6 months and 2 years for repeat VIA, colposcopy, and biopsy.
RESULTS: A total of 291 women were treated with cryotherapy, of whom 226 (78%) followed up at 6 months. Of these 226 women, 153 (68%) were HR-HPV-negative; there were no findings of cervical intraepithelial neoplasia grade 2 (CIN2) or worse. The remaining 73 women (32%) were HR-HPV-positive; of these women, 2 had CIN2 and 3 had CIN3. Only 137 women followed up at 2 years. Of these 137 women, 116 were HR-HPV-negative and 21 were HR-HPV-positive. Of the 21 women positive for HR-HPV, 9 had negative biopsy results, 11 had CIN1, and 1 had no biopsy. The clearance rate of HR-HPV was 83% (95% confidence interval: 0.78-0.87). There were no biopsy findings of CIN2 or worse at 2 years. Before cryotherapy, of the 226 women, 15 (6.6%) were positive for endocervical curettage (ECC) and 5 (2.2%) were referred for surgical management. Of these 15 ECC-positive women, 10 (67%) followed up at 6 months and it was shown that no patient was ECC positive at that time point. Moreover, of the 15 ECC-positive women, 11 (73%) followed up at 2 years and it was shown that no patient was ECC positive at that time point. In our study, VIA had a false-positive rate of 5%.
CONCLUSIONS: Cryotherapy was an effective, acceptable, and well-tolerated means of treating cervical dysplasia in a low-resource setting.

Related: Cervical Cancer

Salinas-Martínez AM, Flores-Cortés LI, Cardona-Chavarría JM, et al.
Prediabetes, diabetes, and risk of breast cancer: a case-control study.
Arch Med Res. 2014; 45(5):432-8 [PubMed] Related Publications
BACKGROUND AND AIMS: Although underlying mechanisms have been described to account for the association between prediabetes and diabetes with breast cancer, reported results have been inconsistent. We undertook this study to determine whether prediabetes and diabetes are risk factors for breast cancer in Mexican women with no family history of breast cancer in the mother, daughters, or sisters.
METHODS: A case-control study was carried out during 2011-2013. "Case" referred to patients with a histopathological diagnosis of breast cancer (incident and primary cases) (n = 240); "controls" were those with a BI-RADS 1 or 2 mammography result (n = 406). Categorization of prediabetes and diabetes was based on self-reporting or fasting glucose and glycated hemoglobin blood sampling results. Reproductive and sociodemographic data were collected by interview. Odds ratios (ORs) and 95% confidence intervals (CI) were calculated using multivariate unconditional binary logistic regression analysis.
RESULTS: Prediabetes increased the risk of breast cancer in postmenopausal women (adjusted OR 2.08, 95% CI 1.10-3.96) as did diabetes (adjusted OR 2.85, 95% CI 1.55-5.26). A history of diabetes preceding breast cancer by ≥7 years and <7 years were both associated with an increased risk for breast cancer (adjusted OR 2.80, 95% CI 1.40-5.60 and 3.00, 95% CI 1.50-5.90, respectively).
CONCLUSIONS: This is the first study in Mexico evaluating prediabetes and diabetes as breast cancer risk factors in women with no first-degree relatives with breast cancer. Our findings suggest that women with prediabetes and diabetes should be considered a more vulnerable population for early breast cancer detection.

Related: Breast Cancer

Cervantes CA, Botero MA
Average years of life lost due to breast and cervical cancer and the association with the marginalization index in Mexico in 2000 and 2010.
Cad Saude Publica. 2014; 30(5):1093-102 [PubMed] Related Publications
The objective of this study was to calculate average years of life lost due to breast and cervical cancer in Mexico in 2000 and 2010. Data on mortality in women aged between 20 and 84 years was obtained from the National Institute for Statistics and Geography. Age-specific mortality rates and average years of life lost, which is an estimate of the number of years that a person would have lived if he or she had not died prematurely, were estimated for both diseases. Data was disaggregated into five-year age groups and socioeconomic status based on the 2010 marginalization index obtained from the National Population Council. A decrease in average years of life lost due to cervical cancer (37.4%) and an increase in average years of life lost due breast cancer (8.9%) was observed during the period studied. Average years of life lost due to cervical cancer was greater among women living in areas with a high marginalization index, while average years of life lost due to breast cancer was greater in women from areas with a low marginalization index.

Related: Breast Cancer Cervical Cancer

Floriano-Sanchez E, Rodriguez NC, Bandala C, et al.
CYP3A4 expression in breast cancer and its association with risk factors in Mexican women.
Asian Pac J Cancer Prev. 2014; 15(8):3805-9 [PubMed] Related Publications
BACKGROUND: In Mexico, breast cancer (BCa) is the leading type of cancer in women. Cytochrome P450 (CYP450) is a superfamily of major oxidative enzymes that metabolize carcinogens and many antineoplastic drugs. In addition, these enzymes have influence on tumor development and tumor response to therapy. In this report, we analyzed the protein expression in patients with BCa and in healthy women. Links with some clinic-pathological characteristic were also assessed.
MATERIALS AND METHODS: Immunohistochemical analyses were conducted on 48 sets of human breast tumors and normal breast tissues enrolled in Hospital Militar de Especialidades de la Mujer y Neonatologia and Hospital Central Militar, respectively, during the time period from 2010 to 2011. Informed consent was obtained from all participants. Statistical analysis was performed using χ2 or Fisher exact tests to estimate associations and the Mann Whitney U test for comparison of group means.
RESULTS: We found a significant CYP3A4 overexpression in BCa stroma and gland regions in comparison with healthy tissue. A significant association between protein expression with smoking, alcoholism and hormonal contraceptives use was also observed. Additionally, we observed estrogen receptor (ER) and progesterone receptor (PR) positive association in BCa.
CONCLUSIONS: We suggest that CYP3A4 expression promotes BCa development and can be used in the prediction of tumor response to different treatments. One therapeutic approach may thus be to block CYP3A4 function.

Related: Breast Cancer

Ortiz-Mendoza CM, de-la-Fuente-Vera TA, Pérez-Chávez E
Metabolic syndrome in Mexican women survivors of breast cancer: a pilot study at a general hospital.
Med Arch. 2014; 68(1):19-21 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
INTRODUCTION: According to developed countries' studies, in breast cancer survivors there is a high prevalence of metabolic syndrome; however, in Mexico data is lacking about this issue.
GOAL: To explore if metabolic syndrome occurs in Mexican women survivors of breast cancer.
MATERIAL AND METHODS: At a second-level general hospital, women with breast cancer with a surviving > 2 years were studied. The analysis involved their demographic and anthropometric features, blood pressure measurement, time of surviving, besides fasting blood levels of lipids and glucose.
RESULTS: The sample consisted of 100 women; 42% were obese (body mass index > or = 30 kg/m2). The sample's mean age was 60 years with a mean surviving time of 6.5 years. Their mean glucose level was 122 mg/dL and triglycerides 202 mg/dL. There were 33% with blood pressure > or = 130/85mm Hg or diagnosis of hypertension. Fifty-seven percent had glucose > 99 mg/dL or diagnosis of diabetes mellitus, and 58% had triglycerides > 149 mg/dL. Metabolic syndrome occurred in 57% of obese women.
CONCLUSION: Our results suggest that metabolic syndrome occurs in more than 50% of obese Mexican women survivors of breast cancer.

Related: Breast Cancer

Sampieri CL, Mora M
Gastric cancer research in Mexico: a public health priority.
World J Gastroenterol. 2014; 20(16):4491-502 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
This study aimed review studies conducted on Mexican patients diagnosed with gastric cancer and/or diseases associated with its development, in which at least one Mexican institute has participated, and to assess their contributions to the primary and secondary prevention of this disease. A search of the Medline database was conducted using the following keywords: gastric/stomach cancer, Mexico. Studies of the Mexican population were selected in which at least one Mexican Institute had participated and where the findings could support public policy proposals directed towards the primary or secondary prevention of gastric cancer. Of the 148 studies found in the Medline database, 100 were discarded and 48 were reviewed. According to the analysis presented, these studies were classified as: epidemiology of gastric cancer (5/48); risk factors and protectors relating to gastric cancer (9/48); relationship between Helicobacter pylori and pathologies associated with gastric cancer and the development of the disease (16/48); relationship between the Epstein-Barr virus and pathologies associated with gastric cancer and the development of the disease (3/48); molecular markers for the development of diseases associated with gastric cancer and gastric cancer (15/48). Mexico requires a program for the prevention and control of gastric cancer based on national health indicators. This should be produced by a multidisciplinary committee of experts who can propose actions that are relevant in the current national context. The few studies of gastric cancer conducted on the Mexican population in national institutes highlight the poor connection that currently exists between the scientific community and the health sector in terms of resolving this health issue. Public policies for health research should support projects with findings that can be translated into benefits for the population. This review serves to identify national research groups studying gastric cancer in the Mexican population.

Related: Stomach Cancer Gastric Cancer

Niëns LM, Zelle SG, Gutiérrez-Delgado C, et al.
Cost-effectiveness of breast cancer control strategies in Central America: the cases of Costa Rica and Mexico.
PLoS One. 2014; 9(4):e95836 [PubMed] Article available free on PMC after 01/02/2016 Related Publications
This paper reports the most cost-effective policy options to support and improve breast cancer control in Costa Rica and Mexico. Total costs and effects of breast cancer interventions were estimated using the health care perspective and WHO-CHOICE methodology. Effects were measured in disability-adjusted life years (DALYs) averted. Costs were assessed in 2009 United States Dollars (US$). To the extent available, analyses were based on locally obtained data. In Costa Rica, the current strategy of treating breast cancer in stages I to IV at a 80% coverage level seems to be the most cost-effective with an incremental cost-effectiveness ratio (ICER) of US$4,739 per DALY averted. At a coverage level of 95%, biennial clinical breast examination (CBE) screening could improve Costa Rica's population health twofold, and can still be considered very cost-effective (ICER US$5,964/DALY). For Mexico, our results indicate that at 95% coverage a mass-media awareness raising program (MAR) could be the most cost-effective (ICER US$5,021/DALY). If more resources are available in Mexico, biennial mammography screening for women 50-70 yrs (ICER US$12,718/DALY), adding trastuzumab (ICER US$13,994/DALY) or screening women 40-70 yrs biennially plus trastuzumab (ICER US$17,115/DALY) are less cost-effective options. We recommend both Costa Rica and Mexico to engage in MAR, CBE or mammography screening programs, depending on their budget. The results of this study should be interpreted with caution however, as the evidence on the intervention effectiveness is uncertain. Also, these programs require several organizational, budgetary and human resources, and the accessibility of breast cancer diagnostic, referral, treatment and palliative care facilities should be improved simultaneously. A gradual implementation of early detection programs should give the respective Ministries of Health the time to negotiate the required budget, train the required human resources and understand possible socioeconomic barriers.

Related: Breast Cancer Cancer Screening and Early Detection Trastuzumab (Herceptin)

Eguía-Aguilar P, Pérezpeña-Díazconti M, Benadón-Darszon E, et al.
Reductions in the expression of miR-124-3p, miR-128-1, and miR-221-3p in pediatric astrocytomas are related to high-grade supratentorial, and recurrent tumors in Mexican children.
Childs Nerv Syst. 2014; 30(7):1173-81 [PubMed] Related Publications
PURPOSE: Astrocytomas are the most frequent type of tumor of the central nervous system in children. Hence, it is important to describe markers that may improve our understanding of their behavior. Mature microRNAs (miRNAs) may be such biological markers. They are small molecules of RNA that regulate gene expression post-transcriptionally. Due to their importance in cancer, the objective of the present study was to determine the profile of expression of precursor and mature forms of miR-124-3p, miR-128-1, and miR-221-3p using RT-qPCR in pediatric samples.
METHODS: A total of 57 astrocytomas embedded in paraffin were selected. As controls, the study included 13 samples of normal brain tissue.
RESULTS: Three of eight miRNAs were selected after a preliminary screening. All the miRNAs showed higher levels of expression in normal brain tissue. The expression of miR-124-3p and miR-128-1 decreased in astrocytomas than in normal brain tissue in all grades (p < 0.05 in both cases), and this reduction was most evident in GIV (407- and 1,469-fold, respectively); however, the expression of the precursor forms pre-miR-128-1 and pre-miR-221 was higher in GIV (3.5-fold) than in GI. The levels of miR-128-1 were higher in infratentorial tumors than in supratentorial cases (p = 0.006). Finally, the expression of miR-221-3p was higher in non-recurrent tumors and live patients (p = 0.0185 and p = 0.0004, respectively).
CONCLUSIONS: The low expression of these miRNAs may constitute a potential marker of astrocytomas that correlates with localization, possibly due to alterations in the maturation processes of these miRNAs that produced low mature forms in patients with recurrent pediatric astrocytomas.

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Dorantes-Acosta E, Medina-Sanson A, Jaimes-García Y, López-Martínez B
Clinical features and treatment outcomes of pediatric acute promyelocytic leukemia in a Mexican pediatric hospital.
Rev Invest Clin. 2013 Sep-Oct; 65(5):392-8 [PubMed] Related Publications
INTRODUCTION: Acute promyelocytic leukemia (APL) is a distinct type of acute myeloid leukemia (AML) characterized by chromosomal translocations involving the retinoid acid receptor α (RARA) gene on chromosome 17. APL is a relatively rare blood disease that is highly curable with current treatment strategies; however, patient outcomes are heterogeneous in countries with limited resources. Promyelocytic leukemia accounts for 20-25% of all AML cases in Latin American countries.
MATERIAL AND METHODS: We conducted a study from July 2007 to July 2012 and applied the IC-APL2006 protocol. This case study reports the results from eleven patients with AML M3 (five males and six females). In all cases, the diagnoses were made by aspirating bone marrow and evaluating the t(15:17) or t(11:17) transcript. In eight cases, the molecular biology-based diagnostics for the PLM-RARa transcript were positive, and they were negative in two cases. One patient was positive for the PLZF-RARa transcript.
RESULTS: The mean WBC at the time of diagnosis was 10.1 x 10(9)/L, and the mean platelet count was 17.1 x 10(9)/L. The mean percentage of abnormal promyelocytes in the bone marrow aspirates was 68%. Of the eleven patients, four presented with disseminated intravascular coagulation. All of the patients began treatment with transretinoic acid (ATRA) (45 mg/m(2)/day), which led to 4 cases of ATRA syndrome. There were 2 relapses, and the patient died in one case. The remaining ten patients were alive after the median follow-up period of 33.6 months (range from 11 to 60 months).
CONCLUSION: The authors report on a series of cases involving pediatric patients with AML M3 seen at a single institution; the patients were stratified and treated with a standard protocol to obtain satisfactory results. Although the number of patients is limited, the health outcomes are relevant. To our knowledge, this is the first series of pediatric APL patients in Mexico who were treated with the IC-APL2006 protocol.

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Villarreal-Calderon R, Luévano-González A, Aragón-Flores M, et al.
Antral atrophy, intestinal metaplasia, and preneoplastic markers in Mexican children with Helicobacter pylori-positive and Helicobacter pylori-negative gastritis.
Ann Diagn Pathol. 2014; 18(3):129-35 [PubMed] Related Publications
Chronic inflammation and infection are major risk factors for gastric carcinogenesis in adults. As chronic gastritis is common in Mexican children, diagnosis of Helicobacter pylori and other causes of gastritis are critical for the identification of children who would benefit from closer surveillance. Antral biopsies from 82 Mexican children (mean age, 8.3 ± 4.8 years) with chronic gastritis (36 H pylori+, 46 H pylori-) were examined for gastritis activity, atrophy, intestinal metaplasia (IM), and immunohistochemical expression of gastric carcinogenesis biomarkers caudal type homeobox 2 (CDX2), ephrin type-B receptor 4 (EphB4), matrix metalloproteinase 3 (MMP3), macrophage migration inhibitory factor (MIF), p53, β-catenin, and E-cadherin. Atrophy was diagnosed in 7 (9%) of 82, and IM, in 5 (6%) of 82 by routine histology, whereas 6 additional children (7%) (3 H pylori+) exhibited aberrant CDX2 expression without IM. Significant positive correlations were seen between EphB4, MMP3, and MIF (P<.0001). Atrophy and follicular pathology were more frequent in H pylori+ biopsies (P<.0001), whereas IM and CDX2 expression showed no significant correlation with H pylori status. Antral biopsies demonstrating atrophy, IM, and/or aberrant CDX2 expression were seen in 21.95% (18/82) of the children, potentially identifying those who would benefit from closer surveillance and preventive dietary strategies. Biomarkers CDX2, EphB4, MMP3, and MIF may be useful in the workup of pediatric gastritis.

Denova-Gutiérrez E, Hernández-Ramírez RU, López-Carrillo L
Dietary patterns and gastric cancer risk in Mexico.
Nutr Cancer. 2014; 66(3):369-76 [PubMed] Related Publications
Multiple epidemiological studies have evaluated the relationship between diet and gastric cancer (GC), focusing on individual foods and nutrients. However, some studies have estimated the association between dietary patterns and GC risk. To identify the dietary patterns of residents of Mexico City and to assess the association of these patterns with GC, a population-based case-control study with 248 histologically confirmed GC cases and 478 controls paired by age and sex was carried out. The dietary patterns were characterized from 22 food groups through factorial analysis. Three major dietary patterns were identified. Pattern 1 was characterized by the consumption of vegetables, fruits, and white meat; subjects in the highest quintile of this pattern had a lower GC risk than those in the lowest quintile [odds ratio (OR(Q5 vs. Q1)) = 0.43; 95% confidence interval (95%CI): 0.24-0.77; P trend = 0.010]. A comparison between the extreme quintiles of the third pattern (which included major consumption of refined grains and desserts), resulted in the following: OR(Q5 vs. Q1) = 4.80; 95%CI: 2.56-8.98; P-trend < 0.001). Additionally, we found no significant association between the second pattern (characterized by high consumption of Mexican food) and GC risk. This is the first study of associations between dietary patterns and GC in Mexico to confirm that GC risk is lower in individuals with healthy dietary patterns.

Related: Stomach Cancer Gastric Cancer

Sánchez-Lezama AP, Cavazos-Arroyo J, Albavera-Hernández C
Applying the Fuzzy Delphi Method for determining socio-ecological factors that influence adherence to mammography screening in rural areas of Mexico.
Cad Saude Publica. 2014; 30(2):245-58 [PubMed] Related Publications
In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

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Lazcano-Ponce E, Lőrincz AT, Torres L, et al.
Specimen self-collection and HPV DNA screening in a pilot study of 100,242 women.
Int J Cancer. 2014; 135(1):109-16 [PubMed] Related Publications
Since cervical cancer remains common in Mexico despite an established cytology screening program, the Ministry of Health recently introduced pilot front-line HPV testing into the Mexican cervical cancer screening program (CCSP). Here, we present the key field performance metrics of this population-based study. High-risk HPV DNA (hrHPV) testing was conducted on self-collected vaginal specimens from 100,242 women aged 25-75 years residing in Morelos State. All hrHPV positive women and a random sample of 3.2% (n = 2,864) of hrHPV negative participants were referred for colposcopic examination. The main disease endpoint of interest was cervical intraepithelial neoplasia grade 2 or higher (CIN2+). We calculated relative risk, positive predictive value and negative predictive value adjusted for screening test verification bias. The overall prevalence of hrHPV was 10.8% (95% CI 10.6-11.0). Women positive for hrHPV had a relative risk of 15.7 for histologically detectable CIN2+. The adjusted positive predictive value of the hrHPV test was 2.4% (95% CI 2.1-2.7); whereas the adjusted negative predictive value was 99.8% (95% CI 99.8-99.9). These findings suggest that large-scale vaginal hrHPV testing in a middle-income country can identify women at greater risk of advanced cervical abnormalities in a programmatically meaningful way but care is warranted to ensure that disease not detectable at colposcopy is kept to a minimum. PASS shows areas that need improvement and sets the stage for wider use of hrHPV screening of self-collected vaginal specimens in Mexico.

Related: Cancer Screening and Early Detection Cervical Cancer

Anaya-Ruiz M, Vallejo-Ruiz V, Flores-Mendoza L, Perez-Santos M
Female breast cancer incidence and mortality in Mexico, 2000-2010.
Asian Pac J Cancer Prev. 2014; 15(3):1477-9 [PubMed] Related Publications
The objective of this study was to investigate the recent incidence and mortality trends for breast cancer in Mexican females. Data between 2000 and 2010 from the Department of Epidemiology of the Ministry of Health, and International Agency for Research on Cancer (IARC) were analyzed. Age-standardized rates (ASRs) and annual percent changes (APCs) were calculated. The absolute incidence and mortality rates of breast cancer increased: 3,726 and 4,615 in 2000 to 8,545 and 4,966 in 2010, respectively. Incidence increased over time in all age groups tested, the 60-64 age group had the highest ASR (57.4 per 100,000 women in 2010), while the 20-44 age group had the lowest ASR (12.3 in 2010). The results show that incidence of breast cancer has increased in Mexico during last one decade, especially among older women, while the downturn observed in mortality mainly reflects improved survival as a result of earlier diagnosis and better cancer treatment.

Related: Breast Cancer

Peñarrieta-de Córdova I, Barrios FF, Gutierrez-Gomes T, et al.
Self-management in chronic conditions: partners in health scale instrument validation.
Nurs Manag (Harrow). 2014; 20(10):32-7 [PubMed] Related Publications
AIMS: This article describes a study that aimed to validate the Self-care in Chronic Conditions Partners in Health Scale instrument in the Mexican population. The instrument has been validated in Australia for use as a screening tool by primary healthcare professionals to assess the self-care skills and abilities of people with a chronic illness.
METHODS: Validation was conducted using baseline data for 552 people with diabetes, hypertension and cancer aged 18 or older who were users of healthcare centres in Tampico, Tamaulipas, Mexico.
RESULTS: Results show high reliability and validity of the instrument and three themes were identified: knowledge, adherence, and dealing with and managing side effects.
CONCLUSION: The findings suggest the scale is useful as a generic self-rated clinical tool for assessing self-management in a range of chronic conditions, and provides an outcome measure for comparing populations and change in patient self-management knowledge and behaviour. The authors recommend validating the scale in other Latin-American settings with more research into the effect of gender on self- management.

Related: Cancer Prevention and Risk Reduction

Comrnejo-Juárez P, Espinosa-Altamirano A, Ibarra-del-Río M, et al.
Cystic echinococcosis: a disease mimicking cancer in a non-endemic country report of two cases.
West Indian Med J. 2013; 62(3):266-9 [PubMed] Related Publications
Echinococcosis is a parasitic disease that involves dogs as definitive host and sheep as intermediate host. Humans become infected incidentally through fecal-oral contact, particularly in the course of playful and close contact with an infected dog. Mexico is considered a region that is virtually free of cystic echinoccocosis. This manuscript describes two cases that were referred to a tertiary-care oncology hospital with a diagnosis of cancer. In one case, the presumptive diagnosis was liver cancer because abdominal ultrasonography revealed a low-density mass in the right hepatic lobe. Drainage was performed and cytologic examination of the fluid showed multiple Echinococcus cyst as well as prostoscolex. The case was resolved with percutaneous drainage and administration of albendazole for two months. In the second case, the patient was referred with a diagnosis of disseminated cervical cancer A cyst was identified in the upper right lung lobe; a diagnostic puncture was performed showing an Echinococcus cyst. This resolved solely with two months of albendazole administration.

Related: Liver Cancer Cervical Cancer

Jaime-Pérez JC, Brito-Ramirez AS, Pinzon-Uresti MA, et al.
Characteristics and clinical evolution of patients with acute myeloblastic leukemia in northeast Mexico: an eight-year experience at a university hospital.
Acta Haematol. 2014; 132(2):144-51 [PubMed] Related Publications
BACKGROUND/OBJECTIVE: Acute myeloid leukemia (AML) is the most common acute leukemia in adults. We documented the characteristics and results of treatment of patients with AML at a single reference center.
METHODS: Patients diagnosed with AML between June 2003 and July 2011 at a university hospital in northeast Mexico were studied. Overall survival (OS) and event-free survival (EFS) were determined, and risk factors were analyzed with respect to their influence on prognosis.
RESULTS: A total of 132 AML patients were included. Median age was 32 years. Complete remission (CR) was achieved by 55% of patients. CR was achieved by 65.1% of patients <60 years (n = 109), compared to 8.7% of those >60 years (n = 23; p < 0.001). In all, 39% of patients >60 years suffered an early death, compared to 14.7% of those <60 years (p < 0.001). OS for patients with AML was 35%, whereas EFS was 32%. On multivariate analysis, patients >60 years had a lower OS and EFS (p < 0.001). A total of 28% of patients received a transplant, and they had high er OS and EFS. Conclusions: Our patients were considerably younger and had remarkably lower survival rates than reported for other populations; those >60 years had a higher early death rate, and fewer of these patients achieved CR.

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Rodríguez-Acosta ED, Esquivel-Pedraza L, Saeb-Lima M, et al.
Borderline tuberculoid leprosy mimicking mycosis fungoides.
Skinmed. 2013 Nov-Dec; 11(6):379-81 [PubMed] Related Publications
A 65-year-old unemployed man, originally from Michoacán and currently living in Toluca, state of Mexico, presented for medical consultation for disseminated dermatosis in all body segments. The condition was limited to the head and neck, was bilateral and symmetrical, and was characterized by infiltrated and confluent erythematous-edematous plates of diverse diameter covering 90% of the upper and lower extremities (Figure 1). The ailment had 2 years' evolution and a progressive course. The patient was diagnosed in private practice as having atopic dermatitis. After exacerbation of symptoms, he was treated with deflazacort and hydroxychloroquine with no improvement. Results from lesion biopsies revealed sarcoidal granulomas and the patient was therefore referred to the dermatology department at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán for further study and treatment with the presumptive diagnosis of mycosis fungoides vs sarcoidosis.

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