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Hassan AT, Urban CDA, Facina G, Freitas-Junior R, Paulinelli RR, Biazus JV, de Oliveira VM, Vieira RADC. Training in oncoplastic surgery for mastologists. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e2024S119. [PMID: 38865539 PMCID: PMC11164266 DOI: 10.1590/1806-9282.2024s119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 11/30/2023] [Indexed: 06/14/2024]
Abstract
OBJECTIVE The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.
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Affiliation(s)
- Augusto Tufi Hassan
- Brazilian Society of Mastology, Executive Board – Rio de Janeiro (RJ), Brazil
- Clínica de Assistência à Mulher – Salvador (BA), Brazil
| | - Cicero de Andrade Urban
- Brazilian Society of Mastology, Executive Board – Rio de Janeiro (RJ), Brazil
- Brazilian Society of Mastology, Department of Oncoplastic Surgery – Rio de Janeiro (RJ), Brazil
- Hospital Nossa Senhora da Graça – Curitiba (PR), Brazil
| | - Gil Facina
- Brazilian Society of Mastology, Department of Oncoplastic Surgery – Rio de Janeiro (RJ), Brazil
- Universidade Federal de São Paulo – São Paulo (SP), Brazil
| | - Ruffo Freitas-Junior
- Brazilian Society of Mastology, Executive Board – Rio de Janeiro (RJ), Brazil
- Universidade Federal de Goiás, Complexo Oncológico de Referência do Estado de Goiás, Advanced Center for Diagnosis of Breast Disease – Goiânia (GO), Brazil
- Hospital de Câncer Araújo Jorge, Associação de Combate ao Câncer de Goiás – Goiânia (GO), Brazil
| | - Regis Resende Paulinelli
- Clínica de Assistência à Mulher – Salvador (BA), Brazil
- Hospital de Câncer Araújo Jorge, Associação de Combate ao Câncer de Goiás – Goiânia (GO), Brazil
| | - Jorge Villanova Biazus
- Clínica de Assistência à Mulher – Salvador (BA), Brazil
- Hospital das Clínicas de Porto Alegre – Porto Alegre (RS), Brazil
| | - Vilmar Marques de Oliveira
- Brazilian Society of Mastology, Executive Board – Rio de Janeiro (RJ), Brazil
- Clínica de Assistência à Mulher – Salvador (BA), Brazil
- Santa Casa de Misericórdia de São Paulo – São Paulo (SP), Brazil
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Mattar A, Hegg R, Tayar DO, Rocha M, Terzian ALB, Oliveira RW, Julian GS, Gebrim LH. Prognostic Factors and Survival Outcomes of Patients With Early HER2+ Breast Cancer Treated With Trastuzumab in a Brazilian Public Reference Center: A Real-World Study. Clin Breast Cancer 2023; 23:864-875.e7. [PMID: 37802752 DOI: 10.1016/j.clbc.2023.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/21/2023] [Accepted: 08/29/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Trastuzumab was introduced into the Brazilian public health care service for early breast cancer (BC) in 2012. This study describes the survival outcomes and prognostic factors related to early HER2+ BC treatment in a Brazilian reference cancer center. PATIENTS AND METHODS This were a retrospective, single-center, observational study of early HER2+ BC patients treated with trastuzumab in the (neo)adjuvant setting between 2012 and 2018 at Hospital Pérola Byington. Demographic, clinical, disease-free survival (DFS) and overall survival (OS) data were evaluated. Multivariate analysis was performed to assess independent prognostic factors. RESULTS One hundred seventy-six and 353 patients treated in the neoadjuvant and adjuvant setting were included, respectively. The 3- and 5-year OS rates were 79% and 56% for the neoadjuvant group and 97% and 92% for the adjuvant group, respectively. Node positivity at diagnosis predicted poor OS for both groups. In the neoadjuvant group, stage III disease at diagnosis, delayed surgery, and lack of pathological complete response (pCR) predicted poor prognosis. The 3- and 5-year DFS rates were 67% and 46% in the neoadjuvant group and 91% and 86% in the adjuvant group, respectively. Histological grade 2, stage III disease at diagnosis, and lack of pCR predicted poor DFS for the neoadjuvant group. For the adjuvant group, node positivity at diagnosis predicted poor DFS. CONCLUSION Our results reveal multiple clinical parameters affecting survival outcomes according to the treatment setting. Patients treated with neoadjuvant therapy have a poor prognosis since they present with more advanced disease, indicating the importance of early diagnosis and optimized treatment.
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Affiliation(s)
- André Mattar
- Hospital Pérola Byington, São Paulo, SP, Brazil; Hospital da Mulher, São Paulo, SP, Brazil; Oncoclínicas São Paulo, São Paulo, SP, Brazil.
| | | | - Daiane O Tayar
- Roche Brazil, Rua Dr Rubens Gomes Bueno, São Paulo, SP, Brazil
| | - Mauricio Rocha
- Roche Brazil, Rua Dr Rubens Gomes Bueno, São Paulo, SP, Brazil
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Leme JC, Spinosa RMDO, Leal SO, Hirsch ABB, Lodovico A, Stramandinoli-Zanicotti RT, Kunkel ME, Moura FA. Development of low-cost and personalized external silicone breast prosthesis produced by additive manufacturing for women who have undergone mastectomy: A pilot study. Clin Biomech (Bristol, Avon) 2023; 110:106123. [PMID: 37866087 DOI: 10.1016/j.clinbiomech.2023.106123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/25/2023] [Accepted: 10/10/2023] [Indexed: 10/24/2023]
Abstract
BACKGROUND The aim of this study was to develop a low-cost and personalized method for external breast prosthesis production. METHODS The projected light method was used for the acquisition of the 3D geometry of the left breast of a healthy 29-year-old woman, 69 kg and 1.69 m. The 3D modeling software Blender was used to make the prosthesis model and mold with adjustments to the model's mesh, such as smoothing, assigning thickness, and creating the walls of the prosthesis mold. Two counter-molds were created. The pieces were manufactured on the 3D printer Stella Lite 3 using polylactic acid filament. Finally, the silicone was pigmented, and the mold was filled. FINDINGS Prototype 1 of the prosthesis was produced using a mold without a counter-mold, which resulted in a prosthesis of 495 g, considered heavy compared to traditional prostheses for the same breast size. To solve this issue, a counter-mold with pins was used to produce prototype 2 with a mass of 393 g, 20.6% lighter than prototype 1. Prototype 3 was made with a central-volume counter-mold and presented a mass of 355 g, a reduction of 28.3% compared to prototype 1. The definitive breast prosthesis was made with the pin counter-mold with a different silicone. It has nipple and areola pigmentation and a mass of 294 g, 25.2% lighter than prototype 2. INTERPRETATION The results suggest that the projected light method and additive manufacturing are potential tools for developing external breast prostheses, which may improve the health conditions and quality of life of mastectomized women.
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Affiliation(s)
- Juliane Cristina Leme
- Laboratory of Applied Biomechanics, Sport Sciences Department, State University of Londrina, Rod. Celso Garcia Cid, Km 380, Londrina, Brazil.
| | | | - Sandy Oliveira Leal
- Laboratory of Applied Biomechanics, Sport Sciences Department, State University of Londrina, Rod. Celso Garcia Cid, Km 380, Londrina, Brazil.
| | | | | | | | - Maria Elizete Kunkel
- Institute of Science and Technology, Federal University of São Paulo, R. Talim, 330, Sao Jose dos Campos, Brazil.
| | - Felipe Arruda Moura
- Laboratory of Applied Biomechanics, Sport Sciences Department, State University of Londrina, Rod. Celso Garcia Cid, Km 380, Londrina, Brazil.
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4
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Andrade DAP, Veneziani AC, Paiva CE, dos Reis R, Filho CAF, Sanches AON, Barroso AWA, Paz ACMC, Kons GCDM, Preto DD, Budib MCB, Safro MA, Pinto GSF, Bilibio JP, Souza CDP. Discrepancies in breast cancer's oncological outcomes between public and private institutions in the southeast region of Brazil: a retrospective cohort study. Front Oncol 2023; 13:1169982. [PMID: 37441430 PMCID: PMC10333566 DOI: 10.3389/fonc.2023.1169982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 05/30/2023] [Indexed: 07/15/2023] Open
Abstract
Background Brazil is a middle-income country with inequalities in its healthcare system. The disparities between public and private services affect the diagnosis and treatment of patients with breast cancer. The aim of this study is to assess whether disease-free survival (DFS) and overall survival (OS) are different in public and private specialized centers. Patient and methods A retrospective cohort study with 1,545 breast cancer patients diagnosed from 2003 to 2011 at Barretos Cancer Hospital-BCH (public group, N = 1,408) and InORP Oncoclinicas (private group, N = 137) was conducted. A 1:1 propensity score matching (PSM) analysis was used to adjust the differences between the groups' characteristics (n = 137 in each group). Results The median age at diagnosis was 54.4 years. Estimated DFS rates at 1, 5, and 10 years were 96.0%, 71.8%, and 59.6%, respectively, at BCH and 97.8%, 86.9%, and 78%, respectively, at InORP (HR: 2.09; 95% confidence interval [CI], 1.41-3.10; p < 0.0001). Estimated OS rates at 1, 5, and 10 years were 98.1%, 78.5%, and 65.4%, respectively, at BCH and 99.3%, 94.5%, and 91.9%, respectively, at InORP (HR: 3.84; 95% CI, 2.16-6.82; p < 0.0001). After adjustment by PSM, DFS and OS results in 1, 3, and 5 years remained worse in the public service compared to the private service. Conclusion Patients treated in a public center have worse DFS and OS after a follow-up period of more than 5 years. These results were corroborated after carrying out the PSM.
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Affiliation(s)
- Diocésio Alves Pinto Andrade
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | - Carlos Eduardo Paiva
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
| | - Ricardo dos Reis
- Gynecologic Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Carlos Alberto Fruet Filho
- Clinical Oncology Department, InORP Oncoclínicas Group, Oncology Institute of Ribeirão Preto, Ribeirão Preto, Brazil
| | | | | | | | | | - Daniel D’Almeida Preto
- Clinical Oncology Department, Division of Urology, Barretos Cancer Hospital, Barretos, Brazil
| | | | | | | | | | - Cristiano de Pádua Souza
- Clinical Oncology Department, Division of Breast and Gynecologic, Barretos Cancer Hospital, Barretos, Brazil
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5
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Hassan RAM, Urban CDA, Dória MT, Spautz CC, Rabinovich I, Anselmi KF, Schunemann E, Kuroda F, Sobreiro BP, Lima RSD. Exposed Implant after Immediate Breast Reconstruction - Presentation and Analysis of a Clinical Management Protocol. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:690-698. [PMID: 34670304 PMCID: PMC10183878 DOI: 10.1055/s-0041-1735939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Infection and exposure of the implant are some of the most common and concerning complications after implant-based breast reconstruction. Currently, there is no consensus on the management of these complications. The aim of the present study was to review our cases and to present a clinical protocol. METHODS We conducted a retrospective review of consecutive patients submitted to implant-based breast reconstruction between 2014 and 2016. All patients were managed according to a specific and structured protocol. RESULTS Implant exposure occurred in 33 out of 277 (11.9%) implant-based reconstructions. Among these, two patients had history of radiotherapy and had their implant removed; Delayed reconstruction with a myocutaneous flap was performed in both cases. Signs of severe local infection were observed in 12 patients, and another 5 presented with extensive tissue necrosis, and they were all submitted to implant removal; of them, 8 underwent reconstruction with a tissue expander, and 2, with a myocutaneous flap. The remaining 14 patients had no signs of severe infection, previous irradiation or extensive tissue necrosis, and were submitted to primary suture as an attempt to salvage the implant. Of these, 8 cases (57.1%) managed to keep the original implant. CONCLUSION Our clinical protocol is based on three key points: history of radiotherapy, severe infection, and extensive tissue necrosis. It is a practical and potentially-reproducible method of managing one of the most common complications of implant-based breast reconstruction.
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Affiliation(s)
| | - Cícero de Andrade Urban
- Department of Post-graduation, Universidade Positivo, Curitiba, PR, Brazil.,Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
| | | | | | - Iris Rabinovich
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | | | - Eduardo Schunemann
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil.,Department of Obstetrics and Gynecology, Universidade Federal do Paraná, Curitiba, Paraná, PR, Brazil
| | - Flávia Kuroda
- Breast Unit, Hospital Nossa Senhora das Graças, Curitiba, PR, Brazil
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Challenges of microsurgery in the older patient in a private practice setting in Mexico City. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01888-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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7
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Bargallo-Rocha JE, Torres-Domínguez JA, Reynoso-Noverón N, Rivera-Corona J, Ramírez-Ugalde MT, Robles-Vidal CD, Perez-Quintanilla M, Aguilar-Villanueva S, Arellano-López S, Martínez-Said H, Soto-Perez-de-Celis E, Cabrera-Galeana P, Mohar A. Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2021; 47:1601-1605. [PMID: 33775488 DOI: 10.1016/j.ejso.2021.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 02/22/2021] [Accepted: 03/02/2021] [Indexed: 11/26/2022]
Abstract
Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009 period to 33% in the 2013-2016 period, with most of this increase occurring among women with early-stage disease (17-52%). Improving access to care and reducing the financial burden of breast cancer in developing countries may lead to an increased use of breast conserving surgery.
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Affiliation(s)
- Juan Enrique Bargallo-Rocha
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico; Programa de Atención a Pacientes Post-Mastectomía, Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Juan Alejandro Torres-Domínguez
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico; Programa de Atención a Pacientes Post-Mastectomía, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | | | - Milagros Perez-Quintanilla
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico; Programa de Atención a Pacientes Post-Mastectomía, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | - Selene Arellano-López
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Héctor Martínez-Said
- Servicio de Piel y Partes Blandas, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Programa de Atención a Pacientes Post-Mastectomía, Instituto Nacional de Cancerología, Mexico City, Mexico; Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Paula Cabrera-Galeana
- Servicio de Oncología Médica, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología y Universidad Nacional Autónoma de México, Mexico
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Cavalcante FP, Novita GG, Millen EC, Zerwes FP, Freitas Junior R. Breast reconstruction and coronavirus pandemic. J Plast Reconstr Aesthet Surg 2021; 74:644-710. [PMID: 33012691 PMCID: PMC7521206 DOI: 10.1016/j.bjps.2020.08.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
| | | | | | - Felipe Pereira Zerwes
- Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil.
| | - Ruffo Freitas Junior
- Advanced Center for Diagnosis and Treatment for Breast Cancer (CORA), Federal University of Goiás, Goiânia, Goiás, Brazil.
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Simoes Correa-Galendi J, Del Pilar Estevez Diz M, Stock S, Müller D. Economic Modelling of Screen-and-Treat Strategies for Brazilian Women at Risk of Hereditary Breast and Ovarian Cancer. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2021; 19:97-109. [PMID: 32537695 PMCID: PMC7790767 DOI: 10.1007/s40258-020-00599-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
BACKGROUND Clinical evidence supports the use of genetic counselling and BRCA1/2 testing for women at risk for hereditary breast and ovarian cancer. Currently, screen-and-treat strategies are not reimbursed in the Brazilian Unified Healthcare System (SUS). The aim of this modelling study was to evaluate the cost effectiveness of a gene-based screen-and-treat strategy for BRCA1/2 in women with a high familial risk followed by preventive interventions compared with no screening. METHODS Adopting the SUS perspective, a Markov model with a lifelong time horizon was developed for a cohort of healthy women aged 30 years that fulfilled the criteria for BRCA1/2 testing according to the National Comprehensive Cancer Network (NCCN) guideline. For women who tested positive, preventive options included intensified surveillance, risk-reducing bilateral mastectomy and bilateral salpingo-oophorectomy. The Markov model comprised the health states 'well', 'breast cancer', 'death' and two post-cancer states. Outcomes were the incremental costs per quality-adjusted life-year (QALY) and the incremental costs per life-year gained (LYG). Data were mainly obtained by a literature review. Deterministic and probabilistic sensitivity analyses were performed to assess the robustness of the results. RESULTS In the base case, the screen-and-treat strategy resulted in additional costs of 3515 Brazilian reais (R$) (US$1698) and a gain of 0.145 QALYs, compared with no screening. The incremental cost-effectiveness ratio (ICER) was R$24,263 (US$21,724) per QALY and R$27,258 (US$24,405) per LYG. Applying deterministic sensitivity analyses, the ICER was most sensitive to the probability of a positive test result and the discount rate. In the probabilistic sensitivity analysis, a willingness to pay of R$25,000 per QALY gained for the screen-and-treat strategy resulted in a probability of cost effectiveness of 80%. CONCLUSION Although there is no rigorous cost-effectiveness threshold in Brazil, the result of this cost-effectiveness analysis may support the inclusion of BRCA1/2 testing for women at high-risk of cancer in the SUS. The ICER calculated for the provision of genetic testing for BRCA1/2 approximates the cost-effectiveness threshold proposed by the World Health Organization (WHO) for low- and middle-income countries.
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Affiliation(s)
- Julia Simoes Correa-Galendi
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Sao Paulo, SP, Brazil.
| | - Maria Del Pilar Estevez Diz
- Insituto Do Cancer Do Estado de Sao Paulo, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, SP, Brazil
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Sao Paulo, SP, Brazil
| | - Dirk Müller
- Institute for Health Economics and Clinical Epidemiology, The University Hospital of Cologne (AöR), Sao Paulo, SP, Brazil
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10
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Groth AK, Closs Ono MC, Weihermann V, Brasil Bastos LZ, de Santana Rezende TM, de Zorzi Dalke DB, Borssuk Ferreira CI. A Picture of Breast Reconstruction in a Public Oncology Hospital in Latin America: A Ten-Year Experience. Eur J Breast Health 2020; 16:244-249. [PMID: 33062963 DOI: 10.5152/ejbh.2020.5848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 08/16/2020] [Indexed: 11/22/2022]
Abstract
Objective Breast cancer is the most frequent malignant tumor among women worldwide, with the sole exception of non-melanoma skin cancer. Currently, one of the most common treatments in Brazil is modified radical mastectomy, which, although effective, leads to both physical and psychological complications. In this context, breast reconstruction seeks to restore the functional and psychosocial health of women. This study aims to investigate the characteristics of breast reconstructions after mastectomy by comparing immediate and delayed reconstructions. Materials and Methods This is a retrospective observational study, which was performed by analyzing the electronic medical records of the Erasto Gaertner Hospital in Curitiba, Brazil, from between January 2007 and December 2017. Results After applying exclusion criteria, we analyzed a total of 268 medical records from January 2010 to December 2017. The most frequent histological type was invasive ductal carcinoma. Patients treated after 2014 had a higher number of immediate reconstructions, and the most commonly used method was alloplastic reconstruction using expanders (66.5%). There was no significant difference in the frequency of immediate or late complications between patients who opted for immediate or delayed reconstructions. The most common immediate complication was surgical wound dehiscence, and the use of neoadjuvant chemotherapy was not associated with a higher rate of complications in immediate reconstructions. Conclusion The current preference is for immediate reconstructions with breast tissue expanders in combination with chemotherapy, which follows a trend in Brazil and worldwide that has been identified in the literature. Finally, the growth in immediate reconstructions with no associated increase in complications demonstrates the effectiveness of this practice.
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Affiliation(s)
- Anne Karoline Groth
- Erasto Gaertner Hospital, Department of Plastic and Reconstructive Surgery, Curitiba/Paraná, Brazil.,Positivo University, Medical School, Curitiba/Paraná, Brazil
| | - Maria Cecilia Closs Ono
- Erasto Gaertner Hospital, Department of Plastic and Reconstructive Surgery, Curitiba/Paraná, Brazil.,Federal University of Paraná, Medical School, Curitiba/Paraná, Brazil
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11
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Mazuquin B, Sunemi MMDO, E Silva MPP, Sarian LOZ, Williamson E, Bruce J. Current physical therapy care of patients undergoing breast reconstruction for breast cancer: a survey of practice in the United Kingdom and Brazil. Braz J Phys Ther 2020; 25:175-185. [PMID: 32605886 DOI: 10.1016/j.bjpt.2020.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 03/12/2020] [Accepted: 05/25/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND In both the United Kingdom (UK) and Brazil, women undergoing mastectomy should be offered breast reconstruction. Patients may benefit from physical therapy to prevent and treat muscular deficits. However, there are uncertainties regarding which physical therapy program to recommend. OBJECTIVE The aim was to investigate the clinical practice of physical therapists for patients undergoing breast reconstruction for breast cancer. A secondary aim was to compare physical therapy practice between UK and Brazil. METHODS Online survey with physical therapists in both countries. We asked about physical therapists' clinical practice. RESULTS 181 physical therapists completed the survey, the majority were from Brazil (77%). Respondents reported that only half of women having breast reconstruction were routinely referred to physical therapy postoperatively. Contact with patients varied widely between countries, the mean number of postoperative sessions was 5.7 in the UK and 15.1 in Brazil. The exercise programs were similar for different reconstruction operations. Therapists described a progressive loading structure over time: range of motion (ROM) was restricted to 90° of arm elevation in the first two postoperative weeks; by 2-4 weeks ROM was unrestricted; at 1-3 months muscle strengthening was initiated, and after three months the focus was on sports-specific activities. CONCLUSION Only half of patients having a breast reconstruction are routinely referred to physical therapy. Patients in Brazil have more intensive follow-up, with up to three times more face-to-face contact with a physical therapist than in the UK. Current practice broadly follows programs for mastectomy care rather than being specific to reconstruction surgery.
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Affiliation(s)
- Bruno Mazuquin
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom.
| | | | | | - Luís Otávio Zanatta Sarian
- Centre for Integral Attention to Women's Health, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Esther Williamson
- Nuffield Department of Orthopedics Rheumatology and Musculoskeletal Sciences, University of Oxford, United Kingdom
| | - Julie Bruce
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, United Kingdom
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12
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Freitas-Junior R, Ferreira-Filho DL, Soares LR, Paulinelli RR. Oncoplastic Breast-Conserving Surgery in Low- and Middle-Income Countries: Training Surgeons and Bridging the Gap. CURRENT BREAST CANCER REPORTS 2019. [DOI: 10.1007/s12609-019-00317-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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13
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van Bommel A, Spronk P, Mureau M, Siesling S, Smorenburg C, Tollenaar R, Vrancken Peeters MJ, van Dalen T. Breast-Contour-Preserving Procedure as a Multidisciplinary Parameter of Esthetic Outcome in Breast Cancer Treatment in The Netherlands. Ann Surg Oncol 2019; 26:1704-1711. [PMID: 30830541 PMCID: PMC6510878 DOI: 10.1245/s10434-019-07265-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Indexed: 01/02/2023]
Abstract
BACKGROUND The rate of breast-conserving surgery (BCS) is used as an esthetic outcome parameter, while other treatments contribute also, such as neoadjuvant chemotherapy (NAC) enabling BCS or immediate breast reconstruction (IBR). This study explores these efforts to preserve the patient's breast contour. PATIENTS AND METHODS All patients who underwent surgery for invasive breast cancer in The Netherlands between January 2011 and December 2015 were selected from the Dutch national breast cancer audit (n = 61,309). The breast-contour-preserving procedures (BCPP) rate was defined as the rate of primary BCS, BCS after NAC, or mastectomy with IBR. BCPP rates were calculated and compared by year of diagnosis, age categories, and individual hospitals. RESULTS The rate of primary BCS remained stable (53%) while the BCPP rate increased from 63% in 2011 to 71% in 2015 due to an increase in patients receiving BCS after NAC and mastectomy with IBR. Primary BCS rates increased with age (from 17% in patients aged < 30 years to 63% in patients aged 60-69 years), while the proportion of patients undergoing mastectomy with IBR decreased from 44% in patients < 30 years to 1% in patients ≥ 70 years. The BCPP rate was similar for all age groups except for patients > 70 years. BCPP rates varied between the different hospitals in The Netherlands, ranging from 47 to 88%. CONCLUSIONS The chance of preserving the breast contour for patients with breast cancer has increased substantially over recent years. BCPP provides a comprehensive parameter of esthetic outcome of breast cancer surgery.
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Affiliation(s)
- Annnelotte van Bommel
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands. .,Dutch Institute for Clinical Auditing, Leiden, The Netherlands.
| | - Pauline Spronk
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | - Marc Mureau
- Department of Plastic and Reconstructive Surgery, Erasmus MC Cancer Institute, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sabine Siesling
- Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Health Technology and Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Carolien Smorenburg
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Rob Tollenaar
- Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.,Dutch Institute for Clinical Auditing, Leiden, The Netherlands
| | | | - Thijs van Dalen
- Department of Surgery, Diakonessenhuis Utrecht, Utrecht, The Netherlands
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14
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Figueroa-Padilla J, Soto-Perez-de-Celis E, Maciel-Miranda A, Vargas-Salas D, Santamaria E, Esparza-Arias N, Gutiérrez-Zacarías LM, Cabrera-Galeana P, Bargalló-Rocha E. Implementation of a microsurgical breast reconstruction program in Mexico. Microsurgery 2018; 38:831-833. [PMID: 30462855 DOI: 10.1002/micr.30383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 09/10/2018] [Indexed: 11/09/2022]
Affiliation(s)
- Johnatan Figueroa-Padilla
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Soto-Perez-de-Celis
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico.,Department of Geriatrics, Instituto Nacional de Ciencias Medicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Alejandro Maciel-Miranda
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Daniela Vargas-Salas
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Eric Santamaria
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Nereida Esparza-Arias
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Luz M Gutiérrez-Zacarías
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Paula Cabrera-Galeana
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Enrique Bargalló-Rocha
- Post-Mastectomy Program, Department of Breast Tumors, Instituto Nacional de Cancerología, Mexico City, Mexico
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15
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van Maaren MC, Strobbe LJA, Koppert LB, Poortmans PMP, Siesling S. Nationwide population-based study of trends and regional variation in breast-conserving treatment for breast cancer. Br J Surg 2018; 105:1768-1777. [DOI: 10.1002/bjs.10951] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 04/06/2018] [Accepted: 06/21/2018] [Indexed: 12/20/2022]
Abstract
Abstract
Background
Landmark trials have shown breast-conserving surgery (BCS) combined with radiotherapy to be as safe as mastectomy in breast cancer treatment. This population-based study aimed to evaluate trends in BCS from 1989 to 2015 in nine geographical regions in the Netherlands.
Methods
All women diagnosed between 1989 and 2015 with primary T1–2 N0–1 breast cancer, treated with BCS or mastectomy, were identified from the Netherlands Cancer Registry. Crude and case mix-adjusted rates of BCS were evaluated and compared between nine Dutch regions for two time intervals: 1989–2002 and 2003–2015. The annual percentage change in BCS per region over time was assessed by means of Joinpoint regression analyses. Explanatory variables associated with the choice of initial surgery were evaluated using multivariable logistic regression.
Results
A total of 202 934 patients were included, 82 200 treated in 1989–2002 and 120 734 in 2003–2015. During 1989–2002, the mean rate of BCS was 50·6 per cent, varying significantly from 39·0 to 71·7 per cent between the nine regions. For most regions, a marked rise in BCS was observed between 2002 and 2003. During 2003–2015, the mean rate of BCS increased to 67·4 per cent, but still varied significantly between regions from 58·5 to 75·5 per cent. A significant variation remained after case-mix correction.
Conclusion
This large nationwide study showed that the use of BCS increased from 1989 to 2015 in the Netherlands. After adjustment for explanatory variables, a large variation still existed between the nine regions. This regional variation underlines the need for implementation of a uniform treatment and decision-making strategy.
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Affiliation(s)
- M C van Maaren
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
| | - L J A Strobbe
- Department of Surgical Oncology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - L B Koppert
- Department of Surgical Oncology, Erasmus Medical Centre Cancer Institute, Rotterdam, The Netherlands
| | - P M P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France
| | - S Siesling
- Department of Research, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
- Department of Health Technology and Services Research, Faculty of Behavioural, Management and Social Sciences, Technical Medical Centre, University of Twente, Enschede, The Netherlands
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16
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Soares LR, Freitas-Junior R. The impact of mammography screening on the surgical treatment of breast cancer. Breast J 2018; 24:1138. [PMID: 30062863 DOI: 10.1111/tbj.13093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 05/07/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Leonardo Ribeiro Soares
- Program of Mastology, Department of Obstetrics and Gynecology, Teaching Hospital, Federal University of Goiás (UFG), Goiás, Brazil
| | - Ruffo Freitas-Junior
- Program of Mastology, Department of Obstetrics and Gynecology, Teaching Hospital, Federal University of Goiás (UFG), Goiás, Brazil
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17
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Sirohi B, Chalkidou K, Pramesh CS, Anderson BO, Loeher P, El Dewachi O, Shamieh O, Shrikhande SV, Venkataramanan R, Parham G, Mwanahamuntu M, Eden T, Tsunoda A, Purushotham A, Stanway S, Rath GK, Sullivan R. Developing institutions for cancer care in low-income and middle-income countries: from cancer units to comprehensive cancer centres. Lancet Oncol 2018; 19:e395-e406. [PMID: 30102234 DOI: 10.1016/s1470-2045(18)30342-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 04/26/2018] [Accepted: 04/26/2018] [Indexed: 12/27/2022]
Abstract
Global cancer centres operate across different sizes, scales, and ecosystems. Understanding the essential aspects of the creation, organisation, accreditation, and activities within these settings is crucial for developing an affordable, equitable, and quality cancer care, research, and education system. Robust guidelines are scarce for cancer units, cancer centres, and comprehensive cancer centres in low-income and middle-income countries. However, some robust examples of the delivery of complex cancer care in centres in emerging economies are available. Although it is impossible to create an optimal system to fit the unique needs of all countries for the delivery of cancer care, we summarise what has been published about the development and management of cancer centres in low-income and middle-income countries so far and highlight the need for clinical and political leadership.
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Affiliation(s)
| | - Kalipso Chalkidou
- Imperial College London, London UK; Centre for Global Development, London, UK
| | | | | | - Patrick Loeher
- Indiana University Medical Center, Indianapolis, IN, USA
| | - Omar El Dewachi
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | - Tim Eden
- University of Manchester, Manchester, UK
| | - Audrey Tsunoda
- Hospital Erasto Gaertner, Instituto de Oncologia do Paraná and Universidade Positivo, Curitiba, Brazil
| | - Arnie Purushotham
- Tata Trusts, Mumbai, India; King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
| | | | - Goura K Rath
- All India Institute of Medical Sciences, New Delhi, India
| | - Richard Sullivan
- King's Health Partners Comprehensive Cancer Centre and Institute of Cancer Policy, School of Cancer Sciences, Kings College London, London, UK
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