Retrospective analysis of breast cancer prognosis among young and older women in a Brazilian cohort of 738 patients, 1985-2002

Invasive breast cancer (BC) is infrequent among women aged.5.40 years, however, the disease outlook in these younger patients is generally worse than among older women. The present study aimed to compare socio-demographic, clinical and pathological characteristics, and their association with long-term survival, between two random cohorts of young (<= 40 years) and older (50-69 years) Brazilian patients with BC. The cohort comprised of 738 randomly selected women who were diagnosed with BC at Barretos Cancer Hospital, Pio XII Foundation (Barretos, Brazil) between January 1985 and December 2002; the patients included young women (n=376) and older women (n=362). The current analysis suggested that BC in young women is associated with numerous pathological features of aggressiveness. Second cancer and bilateral BC were independent predictors of a poor outcome in the younger group. Furthermore, C-erB-2 was positively correlated with poor outcome in the older group, whereas estrogen receptor status and TNM stage were associated with disease prognosis in both groups. The overall survival rates of the two age groups were similar except when analyzed according the treatment period (1997-2002). Although patients aged <= 40 years harbored tumors with more aggressive clinicopathological characteristics, these characteristics were not independent predictors of overall survival. The present study indicates that medical advances associated with prevention of breast cancer may improve screening programs, which may therefore increase early diagnosis and subsequently lower mortality rates.The authors thank the Public Ministry of Labor (Research, Prevention and Education of Occupational Cancer) in Campinas, Brazil, and the Lions Club of Brazil for partial financial support of the present study and Dr. Vinicius de Lima Vazquez (Department of Skin cancer and Melanoma, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil) for assistance with the statistical analysis. The abstract was previously published in The Breast 23 (Suppl): S11, 2014.info:eu-repo/semantics/publishedVersio

Breast Units: unidades de diagnóstico e tratamento do câncer de mama

The concept of a globalized world is everywhere. In mastology the idea of organizing network services, with high technological and quality protocol is coming true. The European Society of Mastology, in 1998, began the process of registration of Breast Units, aiming to determine minimum parameters related to high level for diagnosis and treatment of breast cancer, with minimum quality criteria, susceptible to certification, and quality programs. There are currently 137 full members, 26 certified, distributed in 44 countries, mostly in Europe. In Brazil there are six centers, with only four full members, but no center has the EUSOMA certificate, since the absence of organized mammography screening according to the European quality standard. Likewise, aiming the formation and refinement of programs of minimum attendance, the American College of Surgeons, in 2005, initiated the organization of the National Accreditation Program of Breast Centers. Nowadays there are 28 standard programs with re-certification process every three years. The 365 centers have minimum parameters of quality and they also use programs related to the different medial specialties involved. In Brazil, there are 74 centers registered on the Brazilian Society of Mastology, but there are no regular certifications. The network organization of Breast Units, evaluated according to the technological organization, associated with quality control programs, grouped by certification and re-certification process are the goals to be considered in which the great beneficiary will be the woman.O conceito do mundo globalizado encontra-se por toda a parte. Na mastologia, a ideia de formação de rede de atendimento, associada a padrões tecnológicos e de alta qualidade, vem se solidificando. A Sociedade Europeia de Mastologia, em 1998, iniciou o processo de cadastramento de unidades mamá- rias, chamadas Breast Units, visando determinar parâmetros mínimos para as unidades de diagnóstico e tratamento do câncer de mama, com critérios de qualidade mínimos, passíveis de certificação, e programas de qualidade. Atualmente, são 137 membros completos, 26 certificados, distribuídos em 44 países, sendo a maioria na Europa. No Brasil, são seis centros, sendo apenas quatro plenos, não havendo nenhum centro com certificado, visto a ausência de rastreamento mamográfico organizado no padrão de qualidade europeu. Da mesma forma, visando a formação e aprimoramento de programas de atendimento mínimo, o Colégio Americano dos Cirurgiões iniciou, em 2005, a criação do National Accreditation Program of Breast Centers, sendo atualmente 28 programas padrão, com recertificação a cada 3 anos, em 365 centros, associados a programas de controle de qualidade regulamentados pelas especialidades envolvidas. No Brasil, existem 74 centros cadastrados na Sociedade Brasileira de Mastologia, porém não há certificações regulares. A formação de rede de unidades mamárias, escalonadas em função de sua complexidade tecnológica com programas de controle de qualidade, certificação e recertificação são metas que se devem considerar, nas quais a grande beneficiada será a mulher

Breast cancer screening in developing countries

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer

The impact of breast cancer screening among younger women in the Barretos Region, Brazil

To verify the impact of breast cancer screening in women aged 40-49 years in one region of Brazil

Localized Castleman's disease in the breast

AbstractINTRODUCTIONCastleman's disease (CD) is a rare disease with unknown etiology and is clinically associated with lymph nodes enlargement. Primary axillary localization of CD represents 2% of the cases. CD rarely occurs in the breasts.PRESENTATION OF CASEWe herein describe a rare case of CD that initially presented in the breast intramammary lymph node and demonstrated axillary adenopathy. Pathologic analysis showed the hyaline vascular form. The patient underwent axillary lymphadenectomy. The natural history was irregular because the localized CD progressed to a systemic form of CD. At 4.6years of follow-up a Hodgkin's lymphoma appeared.DISCUSSIONThis is the fourth published case of localized breast CD published. It is important to evaluate other clinical lymphadenopathies at the time of diagnosis, and computed tomography is important for disease evaluation and follow-up.CONCLUSIONPatients must undergo axillary lymphadenectomy when showing clinical symptoms. Irregular progression prompts new lymph node biopsy because of the potential presence of associated diseases

O valor da marcação tumoral prévia à quimioterapia neoadjuvante e sua relação com a resposta patológica e sua relação com o tratamento cirúrgico do carcinoma mamário localmente avançado.

Patients with locally advanced breast carcinoma are candidates for the neoadjuvant chemotherapy. The majority of them have partial response to treatment, i.e., reduction in tumor size; however, the rate of pathological complete response is of only 24%, even with the association of anthracycline and taxane. One benefit of the neoadjuvant chemotherapy is the possibility of breast-conserving surgery, and the challenge is the accurate assessment of the tumor response degree to treatment. Clinical response is determined by physical exam and imaging studies, which are not sufficient to predict accurately the tumor size or the pathological complete response in relation to the golden-standard test, which is the surgical histopathology. Moreover, it is necessary to consider that after the neoadjuvant chemotherapy there may be tumor fragmentation, originating multifocal lesions, which are difficult to be detected by imaging methods. In studies regarding neoadjuvant chemotherapy, there is no uniformity in the type of test used for clinical and pathological assessments of tumor response, and there is no exact description of the methodology used in the preoperative markup of the tumor bed, which is not always resected after the neoadjuvant chemotherapy. This is a fact that hinders the accurate assessment of response to the neoadjuvant chemotherapy. Therefore, the question is: under which circumstances a breast-conserving surgery after neoadjuvant chemotherapy is well indicated? This article has discussed the different ways of tumor marking, the evaluation of pathological response and its importance, especially considering breast-conserving treatment of locally advanced breast carcinoma.As pacientes com carcinoma de mama localmente avançado da mama são candidatas à quimioterapia neoadjuvante. A grande maioria delas apresenta resposta parcial ao tratamento, isto é, redução da dimensão do tumor. Entretanto, a taxa de resposta patológica completa é de apenas 24%, mesmo nos esquemas mais efetivos, como na associação de antraciclina com taxano. Um dos benefícios da quimioterapia neoadjuvante é a possibilidade da cirurgia conservadora da mama, e um dos desafios é avaliar com exatidão o grau de resposta tumoral ao tratamento. A resposta clínica é determinada por meio de exames físicos e de imagem, os quais não são suficientes para predizer com acurácia o tamanho do tumor ou a resposta patológica completa em relação ao exame padrão-ouro, que é o histopatológico da peça cirúrgica. Além disso, é necessário considerar que após a quimioterapia neoadjuvante pode ocorrer fragmentação do tumor, originando-se lesões residuais multifocais, de difícil detecção aos métodos de imagem. Em estudos sobre a quimioterapia neoadjuvante, observou-se que não há uniformidade no tipo de exame utilizado para a avaliação clinicopatológica da resposta tumoral; não há descrição exata sobre a metodologia utilizada na marcação pré-operatória do tumor, e nem sempre toda a área tumoral pré-quimioterapia neoadjuvante é ressecada, fato que dificulta a avaliação exata da resposta a este tipo de quimioterapia. Portanto, resta a dúvida: em quais circunstâncias a cirurgia conservadora da mama após a quimioterapia neoadjuvante está bem indicada? Neste artigo, discute-se as diferentes formas de marcação do tumor, a avaliação da resposta patológica e sua importância, principalmente quando se pretende realizar a cirurgia conservadora no carcinoma de mama localmente avançado

Biópsia do linfonodo sentinela para o câncer de mama com anestesia local

Introduction: The technique of sentinel lymph node biopsy (SLB) is the gold standard method to predict the axilar status for breast cancer. However, the intraoperative evaluation of the sentinel lymph node has disadvantages. Some services, attempting to minimize these disadvantages, have begun to carry out the sentinel lymph node biopsy under local anesthesia. The aim of this prospective study is to demonstrate our experience in the sentinel lymph node biopsy, which was carried out under local anesthesia, and this procedure’s feasibility. Methods: This is a prospective study that targets the patients enrolled in the Hospital de Câncer de Barretos, suffering from breast cancer. The patients underwent sentinel lymph node biopsy under local anesthesia from January to November, 2009, according to the established protocol. Results: From January to December, 2009, 41 research procedures were performed of the sentinel lymph node under local anesthesia. During the procedure under local anesthesia, the dissected average was 2.4 (0-5) lymph nodes. In four cases, the result of the resected pathological lymph nodes was positive; in one case for macrometastases; and the remaining three for micrometastases. In all patients, the procedure was performed uneventfully, using doses of anesthetic below their toxic levels. All patients survived without any complications intra- or postoperatively. Conclusion: The sentinel lymph node biopsy under local anesthesia is a feasible procedure that brings little discomfort to the patient, and should be indicated whenever possible. It has many advantages, when comparing with the technique under general anesthesia.Introdução: A técnica da biópsia do linfonodo sentinela (BLS) é considerada padrão-ouro como método preditor do comprometimento axilar para o câncer de mama. Entretanto, a avaliação perioperatória do linfonodo sentinela tem desvantagens. Tentando minimizar as desvantagens, alguns serviços começaram a realizar a pesquisa do linfonodo sentinela sob anestesia local. O objetivo principal deste trabalho prospectivo é demonstrar nossa experiência na pesquisa do linfonodo sentinela, realizada sob anestesia local, e demonstrar a viabilidade deste procedimento. Métodos: Trata-se de um estudo prospectivo que tem como alvo as pacientes matriculadas na Fundação Pio XII – Hospital de Câncer de Barretos, as quais são portadoras de carcinoma da mama. As pacientes foram submetidas à biópsia do linfonodo sentinela sob anestesia local, no período de janeiro a novembro de 2009, conforme protocolo estabelecido. Resultados: No período de janeiro a dezembro de 2009, foram realizados 41 procedimentos da pesquisa de linfonodo sentinela sob anestesia local. Durante o procedimento sob anestesia local, a média dissecada foi de 2,4 (0-5) linfonodos. Em quatro casos, o resultado anatomopatológico dos linfonodos ressecados foi positivo; houve um caso para macrometástases e três restantes para micrometástases. Em todos os pacientes, o procedimento foi realizado sem intercorrências, utilizando-se de doses de anestésicos muito inferiores aos seus níveis tóxicos. Todos os pacientes evoluíram sem qualquer tipo de complicação intra ou pós-operatória. Conclusão: A pesquisa do linfonodo sentinela sob anestesia local é um procedimento factível que traz pouco desconforto para o paciente, devendo ser indicado sempre que possível. Apresenta inúmeras vantagens, comparando-se com a técnica sob anestesia geral