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da Luz Costa T, Dantas DB, de Campos Gomes F, Soares CO, Castelhano JR, Fonseca LC, Neves LMT, Figueiredo ERL, de Melo Neto JS. Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years. Int J Breast Cancer 2023; 2023:6665725. [PMID: 37936925 PMCID: PMC10627721 DOI: 10.1155/2023/6665725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023] Open
Abstract
Background Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at p < 0.05. Results Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) (p < 0.0001). Survival rates were longer in the southeast (70.3 ± 0.05) and south (70.6 ± 0.09) than in the north (63.98 ± 0.053) (p ≤ 0.001). Mortality increased with age after 32 years (p ≤ 0.001). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.
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Affiliation(s)
- Thalita da Luz Costa
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Diego Bessa Dantas
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Shafaee MN, Silva LR, Ramalho S, Doria MT, De Andrade Natal R, Cabello V, Cons L, Pavanello M, Zeferino LC, Mano MS, Linck RDM, Batista LS, Pedro EP, De Paula BH, Zuca-Matthes G, Podany E, Makawita S, Ann Stewart K, Tsavachidis S, Tamimi R, Bondy M, Debord L, Ellis M, Bines J, Cabello C. Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil. Oncologist 2022; 27:344-351. [PMID: 35348756 PMCID: PMC9074991 DOI: 10.1093/oncolo/oyac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes. Methods We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp’s Women’s Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death. Results One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death. Conclusion Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes. Impact Access to timely screening and diagnosis of breast cancer are priorities in these populations.
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Affiliation(s)
| | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maira Teixeira Doria
- Department of Obstetrics and Gynecology, Clinical Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rodrigo De Andrade Natal
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Victor Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Livia Cons
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marina Pavanello
- School of Women's and Children's Health, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Max S Mano
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Kelsey Ann Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | | | - Rull Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford Cancer Institute, Stanford, CA, USA
| | - Logan Debord
- Department of Dermatology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Jose Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Sá MFSD. Pink October and Breast Cancer in Brazil. REVISTA BRASILEIRA DE GINECOLOGIA E OBSTETRÍCIA 2021; 43:725-727. [PMID: 34784627 PMCID: PMC10183943 DOI: 10.1055/s-0041-1739451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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Barrios C, Freitas-Junior R, Martins S, Bines J, Del Pilar Estevez-Diz M, Caleffi M. Challenge of Incorporating New Drugs for Breast Cancer in Brazil: A Proposed Framework for Improving Access to Innovative Therapies. JCO Glob Oncol 2021; 7:474-485. [PMID: 33822641 PMCID: PMC8081546 DOI: 10.1200/go.20.00566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/27/2021] [Accepted: 02/16/2021] [Indexed: 01/23/2023] Open
Abstract
PURPOSE The objective of this review is to address the barriers limiting access to treatment of advanced metastatic breast cancer (mBC) in Brazil, specifically for patients in the public health care system, arguably those with the least access to innovation. MATERIALS AND METHODS A selected panel of Brazilian experts in BC were provided with a series of relevant questions to address in a multiday conference. During the conference, responses were discussed and edited by the entire group through numerous drafts and rounds of discussion until a consensus was achieved. RESULTS The authors propose specific and realistic recommendations for implementing access to new drugs in cancer care in Brazil. Moreover, in creating these recommendations and framework, the authors strive to address the most important barriers and impediments for technology incorporation. A feasible and specific multidisciplinary process is proposed, which is based on the collective participation of all involved stakeholders. CONCLUSION Given the current benefits and likely future developments, there is a great need to expand treatments for mBC not only in Brazil but also in most other countries in the world where access issues remain an unresolved demand. Adapting the current framework is essential for accomplishing this goal. The recommendations in this review can serve as a framework for adoption of new technologies in countries with limited resources.
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Affiliation(s)
- Carlos Barrios
- Grupo Oncoclínicas, Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Ruffo Freitas-Junior
- CORA, Advanced Center for Diagnosis of Breast Diseases, Federal University of Goias, Goiânia, Brazil
- Araujo Jorge Hospital of Associação de Combate ao Câncer em Goiás, Goiânia, Brazil
| | - Sandro Martins
- Medical Oncology Unit, University Hospital of Brasília/EBSERH, Brasília, Brazil
| | - Jose Bines
- Clínica São Vicente, Rio de Janeiro, Brazil
| | - Maria Del Pilar Estevez-Diz
- Instituto do Câncer do Estado de São Paulo/Faculdade de Medicina da Universidade de São Paulo, Onco Star Rede D'Or, São Paulo, Brazil
| | - Maira Caleffi
- Hospital Moinhos de Vento, Femama, Porto Alegre, Brazil
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de Souza BC, Dos Santos Figueiredo FW, de Alcantara Sousa LV, da Silva Maciel E, Adami F. Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014. BMC Womens Health 2020; 20:137. [PMID: 32605615 PMCID: PMC7325567 DOI: 10.1186/s12905-020-00995-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. Method Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. Results In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. Conclusion Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.
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Affiliation(s)
- Beatriz Castro de Souza
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil.
| | | | - Luiz Vinicius de Alcantara Sousa
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
| | - Erika da Silva Maciel
- Universidade Federal do Tocantins, Campus Miracema. Avenida Lourdes Solino s/n°, Setor Universitário, Miracema, Tocantins, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
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Durán D, Monsalves MJ. [Spatial autocorrelation of breast cancer mortality in the Metropolitan Region, Chile: an ecological study]. Medwave 2020; 20:e7766. [PMID: 31999677 DOI: 10.5867/medwave.2020.01.7766] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/26/2019] [Indexed: 11/27/2022] Open
Abstract
Introduction Breast cancer is the most common malignancy in women worldwide and Chile, being the leading cause of female cancer death. A wide variation in mortality has been reported, with geographic clusters of higher risk. Objective To spatially analyze mortality from breast cancer in women in the Metropolitan Region in 2015. Methods Ecological study of location. We used death records in 2015 (C50 according to ICD10) and population projections of the Statistics Institute to estimate mortality rates. We calculated crude breast cancer mortality rates and standardized mortality ratios and performed a spatial epidemiological analysis of breast cancer mortality in women, estimating the global and local Moran I index to assess spatial autocorrelation. We present the results in maps according to the 2016 pre-census cartography. Results There were 622 deaths from breast cancer in the Metropolitan Region in 2015. The mean age was 66 years (SD: 15.5). 92.4% of deaths were registered in urban or central areas. However, the highest mortality rates were observed in peripherical districts. No global spatial autocorrelation was observed in the region (Morans I 0.007 p = 0.134). However, at the local level, four districts differ significantly from their neighbors. Conclusions The risk of dying from breast cancer in the Metropolitan Region of Chile is concentrated in women from peripherical communes. Four districts in the region present different risks from their neighboring districts. It is necessary to investigate local realities to prevent deaths from this pathology.
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Affiliation(s)
- Doris Durán
- Programa de Doctorado en Salud Pública, Escuela de Salud Pública, Facultad de Medicina, Universidad de Chile, Santiago, Chile; Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile. Address: Facultad de Medicina y Ciencia, Universidad San Sebastián, Lota 2465, Santiago 7510157, Chile. . ORCID: 0000-0001-6944-9410
| | - María José Monsalves
- Facultad de Medicina y Ciencia, Universidad San Sebastián, Santiago, Chile. ORCID: 0000-0002-5598-9851
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Stevanato KP, Pedroso RB, Iora P, dos Santos L, Pelloso FC, de Melo WA, de Barros Carvalho MD, Pelloso SM. Comparative Analysis between the Gail, Tyrer-Cuzick and BRCAPRO Models for Breast Cancer Screening in Brazilian Population. Asian Pac J Cancer Prev 2019; 20:3407-3413. [PMID: 31759366 PMCID: PMC7063010 DOI: 10.31557/apjcp.2019.20.11.3407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 10/16/2019] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To analyze the diagnostic accuracy of predictive models of breast cancer risk for the Brazilian population. METHOD A cross-sectional, study was conducted in a sample of 382 women aged 35-69 years who were users of the Unified Health System (SUS) residing in a municipality in southern Brazil. RESULTS The results showed that the Tyrer-Cuzick model had the highest mean risk values and estimates (proportion) for predicting the 5-year risk of breast cancer, reaching a maximum risk of ±1.63% in the 60-64 year age group. For the 90-year risk, a maximum risk of ±12.8% was predicted for the 50-54 year age group using this model. The 5-year risk calculated by the three tools increased progressively with increasing age, where the mean risk was ±0.8% in women aged 35-39 and reached ±1.50% in women aged 65-69. The 90-year risk declined with increasing age only in the Tyrer-Cuzick model, from ±10.8% to ±9%. The BRCAPRO model presented a greater sensitivity compared to the Gail and Tyrer-Cuzick models. And, the model that presented greater specificity was Gail. CONCLUSION The Tyrer-Cuzick model presented the highest risk estimates for 5 years and 90 years in the studied population, however, this data is not enough to validate this tool, since when analyzing the sensitivity and specificity the BRCAPRO and Gail have the highest values respectively.
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Affiliation(s)
| | | | | | - Lander dos Santos
- Master's Degree in Health Sciences of the Graduate Program in Health Sciences,
| | - Fernando Castilho Pelloso
- Lecturer at the Department of Medicine at Unicesumar University and Professor at the Department of Postgraduate Science in Health, State University of Maringá (UEM),
| | | | | | - Sandra Marisa Pelloso
- Lecturer at the Nursing Department of the Paraná State University, Paranavaí campus Brazil.
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8
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Carvalho JB, Paes NA. Socioeconomic inequalities in breast cancer mortality in microregions of the Brazilian Northeast. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2019. [DOI: 10.1590/1806-93042019000200008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
Abstract Objectives: to evaluate the relation between the corrected mortality rates on breast cancer and the indicators of elderly women's living conditions in the Northeast micro-regions of Brazil . Methods: an ecological study was adopted in 2010 and 2015 for 188 micro-regions in the Northeast using structural equation modeling. The data on the population, deaths and indicators on living conditions were extracted from the IBGE, SIM/MS, and SISAP-Idoso (elderly), respectively. The under-registration of death data on breast cancer, badly defined death causes and garbage codes were corrected. The standardized mortality rates were calculated to permit time-space comparison. Results: the recovery of a considerable number of deaths was made possible to obtain a greater accuracy in the mortality rates estimation in micro-regions level. An increase in the mortality rates was observed at the time. The structural equation modeling presented a robust model with significance for some indicators on living conditions. The rates were higher in the micro-regions with lower percentage of illiterate elderly women, lower percentage of elderly women living in poverty, lower dependency ratio, and higher percentage of elderly women living at home with running water. Conclusions: the results showed an increased trend of elderly women dying of breast cancer in the region and with higher levels in the micro-regions with better indicators on living conditions.
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Freitas RD, Nunes RD, Martins E, Curado MP, Freitas NMA, Soares LR, Oliveira JC. Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study. ACTA ACUST UNITED AC 2018; 44:435-443. [PMID: 29019571 DOI: 10.1590/0100-69912017005003] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 05/11/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE to analyze the overall survival and prognostic factors of women with breast cancer in the city of Goiânia. METHODS this is a retrospective, cross-sectional, observational study that included women with malignant neoplasms of the breast identified by the Goiânia Population-based Cancer Registry. The variables studied were age at diagnosis, tumor size, staging, axillary lymph node involvement, tumor grade, disease extent, hormone receptors, and c-erb-B2 oncoprotein. We performed overall survival analyzes of five and ten years. RESULTS we included 2,273 patients in the study, with an overall survival of 72.1% in five years and 57.8% in ten years. In the multivariate analysis adjusted for tumor size, the factors that influenced the prognosis were axillary lymph nodes, histological grade, progesterone receptor, c erb B2, T staging and disease extension. CONCLUSION overall survival in ten years is below that observed in other countries, and possibly reflects what happens with the majority of the Brazilian population. The prognostic factors found in this population follow the same international patterns.
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Affiliation(s)
- Ruffo de Freitas
- - Federal University of Goiás (HC/UFG), Mastology Program, Clinics Hospital, Goiânia, GO, Brazil.,- Goiás Association to Cancer Combat (ACCG), Araújo Jorge Hospital, Goiânia, GO, Brazil
| | - Rodrigo Disconzi Nunes
- - Federal University of Goiás (HC/UFG), Mastology Program, Clinics Hospital, Goiânia, GO, Brazil
| | - Edesio Martins
- - Goiás Association to Cancer Combat (ACCG), Goiânia Population-based Cancer Registry, Goiânia, GO, Brazil
| | - Maria Paula Curado
- - International Prevention Research Institute (iPRI), Senior Research, Lyon, Auvergne-Rhône-Alpes, France.,- AC Camargo Cancer Center, AC Camargo Hospital, São Paulo, SP, Brazil
| | | | - Leonardo Ribeiro Soares
- - Federal University of Goiás (HC/UFG), Mastology Program, Clinics Hospital, Goiânia, GO, Brazil
| | - José Carlos Oliveira
- - Goiás Association to Cancer Combat (ACCG), Goiânia Population-based Cancer Registry, Goiânia, GO, Brazil
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Dave M, Dovales AC, Veiga LH, Peixoto JE, Pearce MS. Trends in mammography use in the Brazilian public healthcare system. J Cancer Policy 2018. [DOI: 10.1016/j.jcpo.2018.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Diagnosis and treatment pattern among rural and urban breast cancer patients in Southwest China from 2005 to 2009. Oncotarget 2018; 7:78168-78179. [PMID: 27556301 PMCID: PMC5363653 DOI: 10.18632/oncotarget.11375] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 08/13/2016] [Indexed: 02/05/2023] Open
Abstract
The incidence of all cancers in China is generally higher in urban areas; however, the mortality risk for affected patients is considerably higher in rural areas. We present a subanalysis investigating the differences in patient and disease characteristics, treatment patterns, and outcomes between rural and urban patients who were diagnosed with breast cancer at West China Hospital between 2005–2009. Baseline patient and disease characteristics were recorded, and patients were followed up for a minimum of 3 years, or until death. For this subanalysis, patients were stratified by their residential status (rural or urban). Of the 2252 patients in the cohort, 76.3% were from urban areas and 22.1% were from rural areas. Significant differences were observed in the prevalence of luminal A and human epidermal growth factor receptor 2-positive breast cancers among rural and urban patients. Estrogen receptor (ER)-positive patients were less likely to receive anti-ER therapy if they were from rural areas compared with urban areas; the use of aromatase inhibitors was also significantly lower for rural patients than urban patients. Univariate, multivariate, and Kaplan–Meier analyses all demonstrated that overall survival and progression-free survival were significantly lower for rural patients than urban patients.
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Urban LABD, Chala LF, Bauab SDP, Schaefer MB, Dos Santos RP, Maranhão NMDA, Kefalas AL, Kalaf JM, Ferreira CAP, Canella EDO, Peixoto JE, de Amorim HLE, de Camargo Junior HSA. Breast cancer screening: updated recommendations of the Brazilian College of Radiology and Diagnostic Imaging, Brazilian Breast Disease Society, and Brazilian Federation of Gynecological and Obstetrical Associations. Radiol Bras 2017; 50:244-249. [PMID: 28894332 PMCID: PMC5586515 DOI: 10.1590/0100-3984.2017-0069] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objective To present the current recommendations for breast cancer screening in Brazil,
as devised by the Brazilian College of Radiology and Diagnostic Imaging, the
Brazilian Breast Disease Society, and the Brazilian Federation of
Gynecological and Obstetrical Associations. Materials and methods We analyzed scientific studies available in the Medline and Lilacs databases.
In the absence of evidence, the recommendations reflected the consensus of a
panel of experts. Recommendations Annual mammography screening is recommended for women 40-74 years of age.
Among women ≥ 75 years of age, annual mammography screening should be
reserved for those with an expected survival > 7 years. Complementary
ultrasound should be considered for women with dense breasts. Complementary
magnetic resonance imaging is recommended for women at high risk. When
available, an advanced form of mammography known as tomosynthesis can be
considered as a means of screening for breast cancer.
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Affiliation(s)
- Linei Augusta Brolini Dellê Urban
- Coordinator of the National Mammography Commission, Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Luciano Fernandes Chala
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Selma di Pace Bauab
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Marcela Brisighelli Schaefer
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Radiá Pereira Dos Santos
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Norma Medicis de Albuquerque Maranhão
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ana Lucia Kefalas
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - José Michel Kalaf
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Carlos Alberto Pecci Ferreira
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Ellyete de Oliveira Canella
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - João Emílio Peixoto
- Member of the National Mammography Commission, Representative of the Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR), São Paulo, SP, Brazil
| | - Heverton Leal Ernesto de Amorim
- Member of the National Mammography Commission, Representative of the Sociedade Brasileira de Mastologia (SBM), São Paulo, SP, Brazil
| | - Helio Sebastião Amâncio de Camargo Junior
- Member of the National Mammography Commission, Representative of the Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), Rio de Janeiro, RJ, Brazil
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13
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Freitas-Júnior R, Gagliato DM, Moura Filho JWC, Gouveia PA, Rahal RMS, Paulinelli RR, Oliveira LFP, Freitas PF, Martins E, Urban C, Lucena CÊM. Trends in breast cancer surgery at Brazil's public health system. J Surg Oncol 2017; 115:544-549. [PMID: 28168857 DOI: 10.1002/jso.24572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. METHODS Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05. RESULTS Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014. CONCLUSIONS We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Edesio Martins
- Clinical Hospital of the Federal University of Goias, Goiania, Brazil
| | - Cicero Urban
- Centro de Oncologia do Paraná, Curitiba, Brazil.,Positive University, Curitiba, Brazil
| | - Clécio Ênio Murta Lucena
- Santa Casa of Belo Horizonte, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
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Freitas-Junior R, Rodrigues DCN, Corrêa RDS, Peixoto JE, de Oliveira HVCG, Rahal RMS. Contribution of the Unified Health Care System to mammography screening in Brazil, 2013. Radiol Bras 2016; 49:305-310. [PMID: 27818544 PMCID: PMC5094819 DOI: 10.1590/0100-3984.2014.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To estimate the coverage of opportunistic mammography screening performed via
the Brazilian Sistema Único de Saúde (SUS, Unified Health Care
System), at the state and regional level, in 2013. Materials and Methods This was an ecological study in which coverage was estimated by determining
the ratio between the number of mammograms performed and the expected number
of mammograms among the population of females between 50 and 69 years of
age. The number of mammograms performed in the target population was
obtained from the Outpatient Database of the Information Technology
Department of the SUS. To calculate the expected number of mammograms, we
considered 58.9% of the target population, the proportion that would be
expected on the basis of the recommendations of the Brazilian National
Cancer Institute. Results In 2013, the estimated national coverage of mammography screening via the SUS
was 24.8%. The mammography rate ranged from 12.0% in the northern region to
31.3% in the southern region. When stratified by state, coverage was lowest
in the state of Pará and highest in the state of Santa Catarina (7.5%
and 35.7%, respectively). Conclusion The coverage of mammography screening performed via the SUS is low. There is
a significant disparity among the Brazilian states (including the Federal
District of Brasília) and among regions, being higher in the
south/southeast and lower in the north/northeast.
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Affiliation(s)
- Ruffo Freitas-Junior
- PhD, Professor and Coordinator of the Breast Disease Program at the Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Danielle Cristina Netto Rodrigues
- PhD, Psychologist, Member of the Goiânia Breast Disease Research Network and Breast Disease Program at the Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Rosangela da Silveira Corrêa
- PhD, Senior Technologist for the Comissão Nacional de Energia Nuclear/Centro Regional de Ciências Nucleares do Centro-Oeste, Goiânia, GO, Brazil
| | - João Emílio Peixoto
- PhD, Medical Physicist, Consultant for the Ionizing Radiation Quality Control Sector of the Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
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Hu K, Lou L, Tian W, Pan T, Ye J, Zhang S. The Outcome of Breast Cancer Is Associated with National Human Development Index and Health System Attainment. PLoS One 2016; 11:e0158951. [PMID: 27391077 PMCID: PMC4938431 DOI: 10.1371/journal.pone.0158951] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 06/25/2016] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is a worldwide threat to female health with patient outcomes varying widely. The exact correlation between global outcomes of breast cancer and the national socioeconomic status is still undetermined. Mortality-to-incidence ratio (MIR) of breast cancer was calculated with the contemporary age standardized incidence and mortality rates for countries with data available at GLOBOCAN 2012 database. The MIR matched national human development indexes (HDIs) and health system attainments were respectively obtained from Human Development Report and World Health Report. Correlation analysis, regression analysis, and Tukey-Kramer post hoc test were used to explore the effects of HDI and health system attainment on breast cancer MIR. Our results demonstrated that breast cancer MIR was inversely correlated with national HDI (r = -.950; P < .001) and health system attainment (r = -.898; P < .001). Countries with very high HDI had significantly lower MIRs than those with high, medium and low HDI (P < .001). Liner regression model by ordinary least squares also indicated negative effects of both HDI (adjusted R2 = .903, standardize β = -.699, P < .001) and health system attainment (adjusted R2 =. 805, standardized β = -.009; P < .001), with greater effects in developing countries identified by quantile regression analysis. It is noteworthy that significant health care disparities exist among countries in accordance with the discrepancy of HDI. Policies should be made in less developed countries, which are more likely to obtain worse outcomes in female breast cancer, that in order to improve their comprehensive economic strength and optimize their health system performance.
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Affiliation(s)
- Kaimin Hu
- Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Lixia Lou
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Wei Tian
- Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Tao Pan
- Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Juan Ye
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
| | - Suzhan Zhang
- Cancer Institute, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang, China
- * E-mail:
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Strasser-Weippl K, Chavarri-Guerra Y, Villarreal-Garza C, Bychkovsky BL, Debiasi M, Liedke PER, Soto-Perez-de-Celis E, Dizon D, Cazap E, de Lima Lopes G, Touya D, Nunes JS, St Louis J, Vail C, Bukowski A, Ramos-Elias P, Unger-Saldaña K, Brandao DF, Ferreyra ME, Luciani S, Nogueira-Rodrigues A, de Carvalho Calabrich AF, Del Carmen MG, Rauh-Hain JA, Schmeler K, Sala R, Goss PE. Progress and remaining challenges for cancer control in Latin America and the Caribbean. Lancet Oncol 2016; 16:1405-38. [PMID: 26522157 DOI: 10.1016/s1470-2045(15)00218-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/03/2015] [Accepted: 08/04/2015] [Indexed: 12/22/2022]
Abstract
Cancer is one of the leading causes of mortality worldwide, and an increasing threat in low-income and middle-income countries. Our findings in the 2013 Commission in The Lancet Oncology showed several discrepancies between the cancer landscape in Latin America and more developed countries. We reported that funding for health care was a small percentage of national gross domestic product and the percentage of health-care funds diverted to cancer care was even lower. Funds, insurance coverage, doctors, health-care workers, resources, and equipment were also very inequitably distributed between and within countries. We reported that a scarcity of cancer registries hampered the design of credible cancer plans, including initiatives for primary prevention. When we were commissioned by The Lancet Oncology to write an update to our report, we were sceptical that we would uncover much change. To our surprise and gratification much progress has been made in this short time. We are pleased to highlight structural reforms in health-care systems, new programmes for disenfranchised populations, expansion of cancer registries and cancer plans, and implementation of policies to improve primary cancer prevention.
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Affiliation(s)
- Kathrin Strasser-Weippl
- Centre for Oncology and Hematology, Wilhelminen Hospital, Vienna, Austria; The Global Cancer Institute, Boston, MA, USA
| | - Yanin Chavarri-Guerra
- The Global Cancer Institute, Boston, MA, USA; Hemato-Oncology Department, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Cynthia Villarreal-Garza
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico; Departmento de Investigación y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Brittany L Bychkovsky
- Dana Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Marcio Debiasi
- Hospital Mae de Deus, Porto Alegre, Rio Grande do Sul, Brazil; Hospital Sao Lucas da PUCRS, Porto Alegre, Rio Grande do Sul, Brazil
| | - Pedro E R Liedke
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil; Instituto do Câncer Mãe de Deus, Porto Alegre, Rio Grande do Sul, Brazil
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Cancer Care in the Elderly Clinic, Instituto Nacional de Ciencias Médicas y Nutrición, Salvador Zubirán, Mexico City, Mexico
| | - Don Dizon
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Eduardo Cazap
- Sociedad Latinoamericana y del Caribe de Oncología Médica, Buenos Aires, Argentina
| | - Gilberto de Lima Lopes
- Medical Oncology, Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, São Paulo, Brazil; Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Diego Touya
- Department of Oncology, University of the Republic, Montevideo, Uruguay
| | | | - Jessica St Louis
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Caroline Vail
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Alexandra Bukowski
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA
| | - Pier Ramos-Elias
- Instituto de Cancerología, Centro de Cáncer de Mama, Tecnologico de Monterrey, Monterrey, Nuevo León, Mexico
| | - Karla Unger-Saldaña
- Cátedra CONACYT, Unidad de Epidemiología, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | | | - Mayra E Ferreyra
- Oncology Department, Maria Curie Hospital, Buenos Aires, Argentina
| | - Silvana Luciani
- Department of Noncommunicable Diseases and Mental Health, Pan American Health Organization, Washington, DC, USA
| | - Angelica Nogueira-Rodrigues
- Federal University, Minas Gerais, Brazil; EVA-Group Brasileiro de Tumores Ginecológicos, Brazilian Gynecologic Oncology Group, Bahia, Brazil
| | | | - Marcela G Del Carmen
- Division of Gynecologic Oncology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | - Jose Alejandro Rauh-Hain
- Vincent Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | - Raúl Sala
- Grupo Argentino de Investigación Clínica en Oncología-GAICO, Rosario, Santa Fe, Argentina
| | - Paul E Goss
- The Global Cancer Institute, Boston, MA, USA; Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA, USA; Harvard Medical School, Boston, MA, USA.
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Parreira VG, Meira KC, Guimarães RM. Socioeconomic differentials and mortality from colorectal cancer in large cities in Brazil. Ecancermedicalscience 2016; 10:614. [PMID: 26823683 PMCID: PMC4720492 DOI: 10.3332/ecancer.2016.614] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Indexed: 12/29/2022] Open
Abstract
The objective of this study was to compare the mortality pattern of colorectal cancer according to the social development profile of the large Brazilian cities. This was an ecological study that used as units of analysis Brazilian municipalities that were considered to be large (i.e. over 100,000 inhabitants). The social indicators adopted were obtained from the Atlas of Human Development in Brazil. Mortality data came from the Mortality Information System (MIS), represented by codes C18, C19, and C20. For data analysis, municipalities were characterised according to the indicator profile used by multivariate classification cluster analysis. It was observed that the Southeast, South, and Midwest regions concentrated over 90% of cities in the group of more developed municipalities, while the North and Northeast regions were represented by 60% of cities in the group of less developed municipalities. The mortality pattern of colorectal cancer in both groups was different, with a higher average mortality rate from colorectal cancer for populations living in cities from the more developed group (p = 0.02). The mortality rate from this cancer was shown to be directly proportional to the Municipal Human Developlemnt Index (MHDI) and inversely proportional to the inequality indicator (p < 0.001); therefore the highest means were observed among the municipalities with better socioeconomic conditions. It is important to consider social disparities to ensure equity in healthcare policy management.
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Affiliation(s)
| | - Karina Cardoso Meira
- Universidade Federal do Rio Grande do Norte, Escola de Enfermagem de Natal, Brazil
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18
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de Souza JA, Hunt B, Asirwa FC, Adebamowo C, Lopes G. Global Health Equity: Cancer Care Outcome Disparities in High-, Middle-, and Low-Income Countries. J Clin Oncol 2016; 34:6-13. [PMID: 26578608 PMCID: PMC5795715 DOI: 10.1200/jco.2015.62.2860] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Breakthroughs in our global fight against cancer have been achieved. However, this progress has been unequal. In low- and middle-income countries and for specific populations in high-income settings, many of these advancements are but an aspiration and hope for the future. This review will focus on health disparities in cancer within and across countries, drawing from examples in Kenya, Brazil, and the United States. Placed in context with these examples, the authors also draw basic recommendations from several initiatives and groups that are working on the issue of global cancer disparities, including the US Institute of Medicine, the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, and the Union for International Cancer Control. From increasing initiatives in basic resources in low-income countries to rapid learning systems in high-income countries, the authors argue that beyond ethics and equity issues, it makes economic sense to invest in global cancer control, especially in low- and middle-income countries.
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Affiliation(s)
- Jonas A de Souza
- Jonas A. de Souza, The University of Chicago Medical Center and Bucksbaum Institute for Clinical Excellence; Bijou Hunt, Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL; Fredrick Chite Asirwa, Indiana University School of Medicine, Indianapolis, IN, and Moi University School of Medicine, Eldoret, Kenya; Clement Adebamowo, Institute of Human Virology and Greenebaum Cancer Center, School of Medicine, University of Maryland; Gilberto Lopes, Johns Hopkins University School of Medicine, Baltimore, MD, and Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, Sao Paulo, Brazil
| | - Bijou Hunt
- Jonas A. de Souza, The University of Chicago Medical Center and Bucksbaum Institute for Clinical Excellence; Bijou Hunt, Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL; Fredrick Chite Asirwa, Indiana University School of Medicine, Indianapolis, IN, and Moi University School of Medicine, Eldoret, Kenya; Clement Adebamowo, Institute of Human Virology and Greenebaum Cancer Center, School of Medicine, University of Maryland; Gilberto Lopes, Johns Hopkins University School of Medicine, Baltimore, MD, and Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, Sao Paulo, Brazil
| | - Fredrick Chite Asirwa
- Jonas A. de Souza, The University of Chicago Medical Center and Bucksbaum Institute for Clinical Excellence; Bijou Hunt, Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL; Fredrick Chite Asirwa, Indiana University School of Medicine, Indianapolis, IN, and Moi University School of Medicine, Eldoret, Kenya; Clement Adebamowo, Institute of Human Virology and Greenebaum Cancer Center, School of Medicine, University of Maryland; Gilberto Lopes, Johns Hopkins University School of Medicine, Baltimore, MD, and Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, Sao Paulo, Brazil
| | - Clement Adebamowo
- Jonas A. de Souza, The University of Chicago Medical Center and Bucksbaum Institute for Clinical Excellence; Bijou Hunt, Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL; Fredrick Chite Asirwa, Indiana University School of Medicine, Indianapolis, IN, and Moi University School of Medicine, Eldoret, Kenya; Clement Adebamowo, Institute of Human Virology and Greenebaum Cancer Center, School of Medicine, University of Maryland; Gilberto Lopes, Johns Hopkins University School of Medicine, Baltimore, MD, and Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, Sao Paulo, Brazil
| | - Gilberto Lopes
- Jonas A. de Souza, The University of Chicago Medical Center and Bucksbaum Institute for Clinical Excellence; Bijou Hunt, Sinai Urban Health Institute, Mount Sinai Hospital, Chicago, IL; Fredrick Chite Asirwa, Indiana University School of Medicine, Indianapolis, IN, and Moi University School of Medicine, Eldoret, Kenya; Clement Adebamowo, Institute of Human Virology and Greenebaum Cancer Center, School of Medicine, University of Maryland; Gilberto Lopes, Johns Hopkins University School of Medicine, Baltimore, MD, and Centro Paulista de Oncologia and Oncoclinicas do Brasil Group, Sao Paulo, Brazil.
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Song QK, Wang XL, Zhou XN, Yang HB, Li YC, Wu JP, Ren J, Lyerly HK. Breast Cancer Challenges and Screening in China: Lessons From Current Registry Data and Population Screening Studies. Oncologist 2015; 20:773-9. [PMID: 26001390 DOI: 10.1634/theoncologist.2014-0351] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 03/02/2015] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND As one of its responses to the increasing global burden of breast cancer (BC), China has deployed a national registration and BC screening campaign. The present report describes these programs and the initial results of these national BC control strategies, highlighting the challenges to be considered. MATERIALS AND METHODS The primary BC incidence and prevalence data were obtained from the Chinese National Central Cancer Registry. MapInfo software was used to map the geographic distribution and variation. The time trends were estimated by the annual percentage of change from 2003 to 2009. The description of the screening plans and preliminary results were provided by the Ministry of Health. RESULTS Chinese cancer registries were primarily developed and activated in the East and Coastal regions of China, with only 12.5% of the registries located in West China. Geographic variation was noted, with the incidence of BC higher in North China than in South China and in urban areas compared with rural areas. Of great interest, these registries reported that the overall BC incidence has been increasing in China, with an earlier age of onset compared with Western countries and a peak incidence rate at age 50. In response to this increasing incidence and early age of onset, BC screening programs assessed 1.46 million women aged 35-59 years, using clinical breast examinations and ultrasound as primary screening tools between 2009 and 2011. The diagnostic rate for this screening program was only 48.0/10(5) with 440 cases of early stage BC. Early stage BC was detected in nearly 70% of screened patients. Subsequently, a second-generation screening program was conducted that included older women aged 35-64 years and an additional 6 million women were screened. CONCLUSION The cancer registration system in China has been uneven, with a greater focus on East rather than West China. The data from these registries demonstrate regional variation, an increasing BC incidence, and an early age of onset. The 2009 to 2011 BC screening program targeting women aged 35-59 years had a low detection rate that resulted in a second-generation screening program that extended the cohort size and ages screened to 35-64 years. IMPLICATIONS FOR PRACTICE Cancer registration has been active in China for decades; however, a national survey of registries has not been routinely reported. This study used MapInfo to describe the reported data and found asymmetric registration activities, geographic variations in breast cancer (BC) burdens, and an increasing incidence with a peak at age 50. The initial Chinese BC screening programs focused on a relatively young population of women aged 35-59 years and had a low detection rate, but 69.7% of patients had early stage BC. Older women were included in the second-generation screening programs, and an additional 6 million women were screened. Consideration of regional variations and age is necessary to optimize the efficiency and utility of BC screening in China, with the ultimate goal to reduce BC mortality.
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Affiliation(s)
- Qing-Kun Song
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Xiao-Li Wang
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Xin-Na Zhou
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Hua-Bing Yang
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Yu-Chen Li
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Jiang-Ping Wu
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Jun Ren
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
| | - Herbert Kim Lyerly
- Beijing Key Laboratory of Therapeutic Cancer Vaccine, Capital Medical University Cancer Center, Beijing Shijitan Hospital, Beijing, People's Republic of China; Duke University Medical Center, Durham, North Carolina, USA
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20
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Lucato MT, Freitas-Junior R, Moreira MA, Bernardes-Junior JR, Pinto SA, Paulinelli RR, Soares LR. Effect of tamoxifen and raloxifene on the proliferative activity of the breast epithelium in premenopausal women. CLINICAL MEDICINE INSIGHTS-ONCOLOGY 2015; 9:25-30. [PMID: 25861235 PMCID: PMC4360847 DOI: 10.4137/cmo.s22456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To compare the effects of tamoxifen and raloxifene on the proliferative activity of normal breast tissue in premenopausal women as measured by Ki-67/MIB-1 expression. STUDY DESIGN A total of 48 women with benign breast nodules and a recommendation for surgical removal of the lesion took part in this study. They were randomized to use tamoxifen or raloxifene for 22 days, after which they were submitted to surgery. During the surgical procedure, a 1-cm fragment of normal breast tissue was removed to study Ki-67 expression. RESULTS The mean percentage ratios between immunolabeled and non-labeled cells were 2.02 ± 1.09 and 3.13 ± 3.23 for the tamoxifen and raloxifene groups, respectively. There was no statistically significant difference between the tamoxifen (n = 16) and raloxifene (n = 14) groups in relation to the immunohistochemical analysis of Ki-67 (P = 0.205). CONCLUSION The results of this study showed no difference between tamoxifen and raloxifene with respect to the potential of these drugs to reduce the proliferative activity of the normal breast epithelium in premenopausal women.
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Gonzaga CMR, Freitas-Junior R, Curado MP, Sousa ALL, Souza-Neto JA, Souza MR. Temporal trends in female breast cancer mortality in Brazil and correlations with social inequalities: ecological time-series study. BMC Public Health 2015; 15:96. [PMID: 25886146 PMCID: PMC4331144 DOI: 10.1186/s12889-015-1445-7] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/20/2015] [Indexed: 11/17/2022] Open
Abstract
Background Breast cancer is the most common cause of death from cancer in women in less developed regions. Therefore, the objective of this study was to provide data on the temporal trends in female breast cancer mortality between 1990 and 2011 and to evaluate its association with the social inequalities present in Brazil. Methods Breast cancer mortality data and estimates for the resident population were obtained from the Brazilian National Health Service database for the 1990–2011 period. Age-standardized mortality rates were calculated (20–39, 40–49, 50–69 and ≥70 years) by direct standardization using the 1960 standard world population. Trends were modeled using joinpoint regression model and linear regression. The Social Exclusion Index and the Human Development Index were used to classify the 27 Brazilian states. Pearson’s correlation was used to describe the association between the Social Exclusion Index and the Human DeveIopment and the variations in mortality rates in each state. Results Age-standardized mortality rates in Brazil were found to be stable (annual percent change [APC] = 0.3; 95% CI: −0.1 – 0.7) between 1994 and 2011. Considering the Brazilian states, significant decreases in mortality rates were found in Rio Grande do Sul, Rio de Janeiro and São Paulo. Increases in mortality rates were most notable in the states of Maranhão (APC = 11.2; 95 %CI: 5.8 – 16.9), Piauí (APC = 9.8; 95% CI: 7.6 – 12.1) and Paraíba (APC = 9.3; 95% CI: 6.0 – 12.8). There was a statistically significant correlation between Social Exclusion Index and a change in female breast cancer mortality rates in the Brazilian states between 1990 and 2011 and between Human Development Index and mortality between 2001 and 2011. Conclusions Female breast cancer mortality rates are stable in Brazil. Reductions in these rates were found in the more developed states, possibly reflecting better healthcare.
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Affiliation(s)
| | - Ruffo Freitas-Junior
- Department of Obstetrics and Gynecology, Federal University of Goiás (UFG), Goiânia, Brazil. .,, Alameda das Rosas, 533, Setor Oeste, 74110-060, Goiânia, GO, Brazil.
| | - Maria-Paula Curado
- Health Sciences, Federal University of Goiás (UFG), Goiânia, Brazil. .,Hospital Araújo Jorge, Goiás Anticancer Association (ACCG), Goiânia, Brazil. .,International Prevention Research Institute (IPRI), Lyon, France.
| | | | | | - Marta Rovery Souza
- Institute of Tropical Pathology and Public Health, Federal University of Goiás (UFG), Goiânia, Brazil.
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