Survival of patients with operable breast cancer (Stages I-III) at a Brazilian public hospital--a closer look into cause-specific mortality

Changes in Invasive Breast Carcinomas after Neoadjuvant Chemotherapy Can Influence Adjuvant Therapeutic Decisions

PURPOSE

Neoadjuvant chemotherapy (NACT) can change invasive breast carcinomas (IBC) and influence the patients' overall survival time (OS). We aimed to identify IBC changes after NACT and their association with OS.

MATERIALS AND METHODS

IBC data in pre- and post-NACT samples of 86 patients were evaluated and associated with OS.

RESULTS

Post-NACT tumors changed nuclear pleomorphism score (p=0.025); mitotic count (p=0.002); % of tumor-infiltrating inflammatory cells (p=0.016); presence of in situ carcinoma (p=0.001) and lymphovascular invasion (LVI; p=0.002); expression of estrogen (p=0.003), progesterone receptors (PR; p=0.019), and Ki67 (p=0.003). Immunohistochemical (IHC) profile changed in 26 tumors (30.2%, p=0.050). Higher risk of death was significatively associated with initial tumor histological grade III (hazard ratio [HR], 2.94), high nuclear pleomorphism (HR, 2.53), high Ki67 index (HR, 2.47), post-NACT presence of LVI (HR, 1.90), luminal B-like profile (HR, 2.58), pre- (HR, 2.26) and post-NACT intermediate mitotic count (HR, 2.12), pre- (HR, 4.45) and post-NACT triple-negative IHC profile (HR, 4.52). On the other hand, lower risk of death was significative associated with pre- (HR, 0.35) and post-NACT (HR, 0.39) estrogen receptor-positive, and pre- (HR, 0.37) and post-NACT (HR, 0.57) PR-positive. Changes in IHC profile were associated with longer OS (p=0.050). In multivariate analysis, pre-NACT grade III tumors and pre-NACT and post-NACT triple negative IHC profile proved to be independent factors for shorter OS.

CONCLUSION

NACT can change tumor characteristics and biomarkers and impact on OS; therefore, they should be reassessed on residual samples to improve therapeutic decisions.

Breast cancer survival and the health system in Brazil: an analysis of public and private healthcare

Background

The incidence of breast cancer is increasing globally; however, survival outcomes vary and are lower in developing countries.

Methods

We analyzed the 5- and 10-year survival rates for breast cancer according to the type of healthcare insurance (public vs. private) in a referral center for cancer care in the Brazilian southeast region. This hospital-based cohort study included 517 women diagnosed with invasive breast cancer between 2003 and 2005. The Kaplan-Meier method was used to estimate the probability of survival, and the Cox proportional hazards regression model was used to assess prognostic factors.

Results

The 5- and 10-year breast cancer survival rates were as follows: private healthcare service survival rate of 80.6% (95% CI 75.0-85.0) and 71.5% (95% CI 65.4-77.1), respectively, and public healthcare service survival rate of 68.5% (95% CI 62.5-73.8) and 58.5% (95% CI 52.1-64.4), respectively. The main factors associated with the worst prognosis were lymph node involvement in both healthcare services and tumor size >2 cm only in public health services. The use of hormone therapy (private) and radiotherapy (public) was associated with the best survival rates.

Conclusions

The survival discrepancies found between health services can be explained mainly by the difference in the stage of the disease at the time of diagnosis, indicating inequalities in access to the early detection of breast cancer.

Ten-Year Survival of Breast Cancer in Iran: A National Study (Retrospective Cohort Study)

Purpose

This study aimed to estimate the 5- and 10-year survival rates of breast cancer in Iran.

Methods

This retrospective cohort study was performed in 2019 on breast cancer patients registered in the national cancer registry system of Iran during 2007-2014. The patients were contacted to collect their information and status (alive or dead). Age and pathological type of tumor were categorized into five groups, and the place of residence was divided into 13 regions. The Kaplan-Meier method and the Cox proportional hazards model were used for data analysis.

Results

A total of 87,902 patients were diagnosed with breast cancer during the study, 22,307 of whom were followed-up. The 5- and 10-year survival rates of the patients were 80% and 69%, respectively. The mean age of the patients was 50.68 ± 12.76 years (median age, 49 years). About 2.3% of the patients were male. The 5- and 10-year survival rates were 69% and 50% in men, respectively. The highest survival rate was reported in the age group of 40-49 years, and the lowest rate was found in the age group of ≥70 years. Of all pathological types, 88% were found in the invasive ductal carcinoma group; the highest survival rate was reported in the noninvasive carcinoma group. The highest survival rate was reported in the Tehran region and the lowest in the Hamedan region. Based on the results, the Cox proportional hazards model, sex, age group, and pathological type were statistically significant differences.

Conclusion

This nationwide study performed on breast cancer patients indicated an improvement in the overall survival rate of these patients over the past years (the 5-year survival rate increased from 71% in 2011 to 80% in the present study), which might be attributed to advances in cancer management.

Outcomes of Oral and Oropharyngeal Squamous Cell Carcinoma Related to Healthcare Coverage: A Retrospective Cohort Study in Brazil

We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.

Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil

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.

Survival of south african women with breast cancer receiving anti-retroviral therapy for HIV

PURPOSE

Breast cancer outcomes in sub-Saharan Africa is reported to be poor, with an estimated five-year survival of 50% when compared to almost 90% in high-income countries. Although several studies have looked at the effect of HIV in breast cancer survival, the effect of ARTs has not been well elucidated.

METHODS

All females newly diagnosed with invasive breast cancer from May 2015-September 2017 at Charlotte Maxeke Johannesburg Academic and Chris Hani Baragwanath Academic Hospital were enrolled. We analysed overall survival and disease-free survival, comparing HIV positive and negative patients. Kaplan-Meier survival curves were generated with p-values calculated using a log-rank test of equality while hazard ratios and their 95% confidence intervals (CIs) were estimated using Cox regression models.

RESULTS

Of 1019 patients enrolled, 22% were HIV positive. The overall survival (95% CI) was 53.5% (50.1-56.7%) with a disease-free survival of 55.8% (52.1-59.3) after 4 years of follow up. HIV infection was associated with worse overall survival (HR (95% CI): 1.50 (1.22-1.85), p < 0.001) and disease-free survival (OR (95% CI):2.63 (1.71-4.03), p < 0.001), especially among those not on ART at the time of breast cancer diagnosis. Advanced stage of the disease and hormone-receptor negative breast cancer subtypes were also associated with poor survival.

CONCLUSION

HIV infection was associated with worse overall and disease-free survival. HIV patients on ARTs had favourable overall and disease-free survival and with ARTs now being made accessible to all the outcome of women with HIV and breast cancer is expected to improve.

Pilates and dance to patients with breast cancer undergoing treatment: study protocol for a randomized clinical trial - MoveMama study

Background

Breast cancer is a global public health issue. The side effects of the clinical treatment can decrease the quality of life of these women. Therefore, a healthy lifestyle is essential to minimize the physical and psychological side effects of treatment. Physical activity has several benefits for women with breast cancer, and Pilates solo and belly dancing can be an enjoyable type of physical activity for women with breast cancer undergoing clinical treatment. The purpose of this study is to provide a Pilates solo and a belly dance protocol (three times per week/16 weeks) for women undergoing breast cancer treatment and compare its effectiveness with that in the control group.

Methods

The participants will be allocated to either the intervention arm (Pilates solo or belly dance classes three times per week for 16 weeks) or a control group (receipt of a booklet on physical activity for patients with breast cancer and maintenance of habitual physical activity routine). The Pilates solo and belly dance classes will be divided into three stages: warmup and stretching, the main stage, and relaxation. Measurements of the study outcomes will take place at baseline; postintervention; and 6, 12, and 24 months after the end of the intervention (maintenance period). The data collection for both groups will occur with a paper questionnaire and tests covering general and clinical information. The primary outcome will be quality of life (EORT QLQ-C30 and EORT QLQ-BR23), and secondary outcomes will be physical aspects such as cardiorespiratory fitness (6-min walk test and cycle ergometer), lymphedema (sum of arm circumference), physical activity (IPAQ short version), disabilities of the arm (DASH), range of motion (goniometer test), muscular strength (dynamometer test) and flexibility (sit and reach test), and psychological aspects such as depressive symptoms (Beck Depression Inventory), body image (Body Image After Breast Cancer Questionnaire), self-esteem (Rosenberg), fatigue (FACT-F), pain (VAS), sexual function (FSFI), and sleep quality (Pittsburgh Sleep Quality Index).

Discussion

In view of the high prevalence of breast cancer among women, the implementation of a specific protocol of Pilates solo and belly dancing for patients with breast cancer is important, considering the necessity to improve their physical and psychological quality of life. Pilates solo and belly dancing are two types of physical activity that involve mental and physical concentration, music, upper limb movements, femininity, and social involvement. An intervention with these two physical activities could offer options of supportive care to women with breast cancer undergoing treatment, with the aim being to improve physical and psychological quality of life.

Trial registration

ClinicalTrials.gov, NCT03194997. Registration date 12 August 2017. Universal Trial Number (World Health Organization), U1111-1195-1623.

Factors influencing delay in symptomatic presentation of breast cancer in Brazilian women

The aim of this study was to evaluate delays in the presentation of symptomatic breast cancer in women (time interval between the perception of their first sign or symptom until the first medical appointment) and its risk factors. A cohort study composed of patients with breast cancer (symptomatic) admitted to an oncological centre in the city of Rio de Janeiro, Brazil was performed. The patients were interviewed during their first hospital visit. To assess time interval as a continuous variable, the median and interquartile ranges (IQR) were calculated. The outcome comprised delay in breast cancer presentation when time from the first sign or symptom perception to the first medical appointment was ≥90 days. A descriptive analysis was performed. The association between independent variables (epidemiological, social and demographic data, related to individual healthcare, clinical and current disease) and the outcome (delay in symptomatic presentation) was assessed by a univariate analysis applying odds ratios (OR). Associations with p < .20 in the univariate analysis were included in the multiple logistic regression model. Variables with a p < .05 were retained in the final model. A total of 388 women were included. The median time was of 41 days (interquartile range - IQR: 13.2-130.0); 34.3% delayed presentation at ≥ 90 days. After adjustment, the variables associated with a delay in presentation were frequency of gynaecological examination of over than 1 year (OR: 2.59, 95% CI: 1.67-4.05), no family history of breast cancer (OR: 1.96, 95% CI: 1.15-3.35), and income lower than the minimum wage (OR: 1.62, 95% CI: 1.03-2.55). A higher score in tangible support (OR: 0.98; 95% CI: 0.96-0.99) was associated with a lesser chance of delay in presentation. Thus, delay in presentation was associated with social barriers, access to health service, health information and individual factors.

[Survival rate of 10 years among women with breast cancer: a historic cohort from 2000-2014]

Breast cancer is a public health problem due to its high incidence, morbidity and mortality. The analysis of survival for this disease contributes to the description of behavior and prognostic factors. The scope of this article is to investigate survival for 10 years after diagnosis and the prognostic factors of women with breast cancer admitted to the Unified Health System Mastology Service in Joinville, State of Santa Catarina, between 2000 and 2014. A historical cohort study with data from the medical records and death certificates of 1,321 women, of whom 471 were considered eligible under the minimum follow-up criteria of 10 years (n = 288), and/or death before this period (n = 183). Survival analysis using the Kaplan-Meier model, the Log-Rank test and the Cox regression model was conducted. Overall survival at 10 years was 41% (CI 95%, 36.1%-45.0%). The risk of 10-year mortality stratified by tumor staging was higher among women with lymphatic invasion and staging II, and staging III, at 60 years or older. The findings suggest that the presence of lymphatic invasion, advanced age and intermediate/advanced staging of the disease can be considered indicators of a worse prognosis for breast cancer.

Modeling risk assessment for breast cancer in symptomatic women: a Saudi Arabian study

Background

Despite the continuing increase in the breast cancer incidence rate among Saudi Arabian women, no breast cancer risk-prediction model is available in this population. The aim of this research was to develop a risk-assessment tool to distinguish between high risk and low risk of breast cancer in a sample of Saudi women who were screened for breast cancer.

Methods

A retrospective chart review was conducted on symptomatic women who underwent breast mass biopsies between September 8, 2015 and November 8, 2017 at King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Results

A total of 404 (63.8%) malignant breast biopsies and 229 (36.2%) benign breast biopsies were analyzed. Women ≥40 years old (aOR: 6.202, CI 3.497–11.001, P=0.001), hormone-replacement therapy (aOR 24.365, 95% CI 8.606–68.987, P=0.001), postmenopausal (aOR 3.058, 95% CI 1.861–5.024, P=0.001), and with a family history of breast cancer (aOR 2.307, 95% CI 1.142–4.658, P=0.020) were independently associated with an increased risk of breast cancer. This model showed an acceptable fit and had area under the receiver-operating characteristic curve of 0.877 (95% CI 0.851–0.903), with optimism-corrected area under the curve of 0.865.

Conclusion

The prediction model developed in this study has a high ability in predicting increased breast cancer risk in our facility. Combining information on age, use of hormone therapy, postmenopausal status, and family history of breast cancer improved the degree of discriminatory accuracy of breast cancer prediction. Our risk model may assist in initiating population-screening programs and prompt clinical decision making to manage cases and prevent unfavorable outcomes.

Survival rates of breast cancer and predictive factors: a hospital-based study from western Amazon area in Brazil

Abstract Breast cancer survival in Latin America countries is below Central European countries. Hospital-based breast cancer survival studies in western Amazon, Brazil, are lacking. This article aims to estimate hospital-based breast cancer survival in Rio Branco, Acre, and predictor factors. Hospital-based cohort study of all women diagnosed with breast cancer (2007-2012) was proceeded. Information were obtained from medical reports, and follow-up was until 2013. One-, 2- and 5- years breast cancer specific-survival were estimated by Kaplan-Meier method. Crude and adjusted Harzards Ratios (HR) were estimated by proportional Cox regression model. One-, 2-, and 5-year overall breast cancer survival were 95.5%, 83.7%, and 87.3% respectively. Surgery combined to radiotherapy significantly affected 1-, 2-, and 5-year survival (99%, 94%, and 90.6%, respectively) as compared to other treatments (77%,57.1%, and 37.5%, respectively). Comparing to surgery combined to radiotherapy treatment, surgery alone increased the risk of death, independently of age and stage (HR = 7.23;95%CI:2.29-22.83). In Rio Branco, Acre, 5-year breast cancer survival is similar to more developed areas in Brazil. Surgery combined to radiotherapy was independently associated to a lower risk of death as compared to surgery alone and other treatment.

5-Year Survival Rates and Prognostic Factors in Patients with Synchronus and Metachronus Breast Cancer from 2010 to 2015

Introduction:

Currently breast (BC) cancer is a serious medical problem in all countries of the world. Survival depends on many factors. The present study focused on 5-year survival and its related factors in patients with BC in Iran. Material and methods. The present analytical retrospective study was performed (from March 2010 until March 2015) on patients with BC followed for at least 6 months. The main variables assessed were tumor size, grade of lymph node involvement, metastasis, stage, history, human epidermal growth factor receptor expression, and tumor origin. Analysis of survival was accomplished using the Kaplan- Meier method.

Results:

Some 351 (80.2%) of the total of 438 individuals had unilateral and 87(19.8%) had bilateral cancer, 28 (35.6%) of the latter being synchronous and 56(64.4%) metachronous. Mean duration of follow-up was 47.44±28.19 months, during which 61 (17.3%) patients with unilateral and 18 with bilateral cancer eventually died. The 5-year survival rate in patients with unilateral BC was significantly higher than those with bilateral BC (Log-rank Test chi2= 3.11, p=0.032). In addition, with metachronous cases, the survival rate was 64.2% in comparison with 51.6% for synchronous BCs. Survival rate was significantly (p value =0.038) higher with metachronous than with synchronous cancers (Log-rank Test chi2=3.54, p=0.038). The highest survival rate was reported for BCs originating from lobule tissue and the lowest rate examples of interstitial tissue origin (Log-rank Test chi2=11.54, p=0.0001). Patients with earl stage lesions (M1) survived longer than with other stages (Log-rank Test chi2= 9.55, p=0.001).

Conclusion:

In this study, most women with BC had a positive family history and were married. The 5-year survival rate was lower with advanced stages of cancer. According to our findings, survival rates might improve if patients undergo screening and diagnosis is made at an early stage of the disease.

Microarray-based analysis of whole-genome DNA methylation profiling in early detection of breast cancer

Emerging evidence indicated that changes in DNA methylation early in breast cancer (BC) development might be clinically relevant for therapeutic decisions. Through analysis of whole-genome gene expression microarray and DNA methylation microarray, we explored genes with abnormal DNA methylation in BC for early detection. Firstly, human BC tissues and adjacent non-cancerous tissues were collected from nine BC patients. Gene expression microarray sequencing was conducted for identifying differentially expressed genes and DNA methylation microarray sequencing for differentially methylated genes in BC. Differentially expressed genes and methylated genes in BC were further explored using the Cancer Genome Atlas database. The correlation between DNA methylation and gene expression was illustrated by multiple comparisons. In other 60 clinical samples, methylation specific polymerase chain reaction (PCR) and reverse transcription quantitative PCR were applied for the methylation of HOXA4 and IGF1 genes in BC and adjacent non-cancerous tissues. In total, 1680 upregulated genes and 1249 downregulated genes were determined in BC. Chromosome 16 and 17 showed more differentially methylated genes, and DNA methylation level was increased in BC tissues in each gene region. Chromosome 19 showed more differentially methylated genes, and DNA methylation level was increased in BC tissues in the exoniensis 1, untranslated region-5 and transcriptional start site 200 gene regions. In other 60 clinical samples, HOXA4 and IGF1 in BC tissues presented increased DNA methylation and decreased gene expression in BC. MCF7 cells treated with RG108 showed decreased HOXA4 and IGF1 expressions. It was estimated that HOXA4 and IGF1 were identified with increased DNA methylation and decreased gene expression in BC, which may serve as biomarkers in early BC detection.

Outcome of Patients With Breast Cancer Treated in a Private Health Care Institution in Brazil

PURPOSE

Middle-income countries like Brazil often have a dichotomous health care system in which patients may be treated in either public or private institutions that differ substantially in terms of level of access to diagnostic and therapeutic procedures.

PATIENTS AND METHODS

This was a prospective, observational study to assess real-world data in 1,230 female patients with breast cancer who were treated in a private health care institution between 2012 and 2016 in Brazil.

RESULTS

Breast cancer in these patients mostly was diagnosed at early (79.0% stages I or II) or locally advanced (16.1% stage III) stages. The primary tumor was resected in 89.0% of cases, most often through breast-conserving surgery (55.1%). Patients with locally advanced disease received more aggressive therapy (eg, higher rates of mastectomy, axillary dissection and chemotherapy use) than patients with early-stage disease. The estimated 2-year overall survival (OS) was 95.3%. Survival was significantly longer among patients with stage I or II disease (2-year OS, 97.9% and 97.5%, respectively) than those with stage III or IV disease (89.4% and 69.5%, respectively; P < .01). Tumor grade was also correlated with OS in the overall cohort ( P = .05); triple-negative status was only prognostic for patients with stage III disease ( P < .01).

CONCLUSION

The data provided aid understanding of the current scenario of breast cancer presentation and treatment in the Brazilian private health care system and may serve as a foundation to guide resource allocation. Our results reinforce the need to pursue adequate access to cancer care in low- and middle-income countries to optimize patient outcome.

Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study

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.

Breast cancer screening in Brazil. Barriers related to the health system

Objective:

Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil.

Method:

We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study.

Results:

The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services.

Conclusion:

There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

Five-year disease-free survival among stage II-IV breast cancer patients receiving FAC and AC chemotherapy in phase II clinical trials of Panagen

BACKGROUND

We report on the results of a phase II clinical trial of Panagen (tablet form of fragmented human DNA preparation) in breast cancer patients (placebo group n = 23, Panagen n = 57). Panagen was administered as an adjuvant leukoprotective agent in FAC and AC chemotherapy regimens. Pre-clinical studies clearly indicate that Panagen acts by activating dendritic cells and induces the development of adaptive anticancer immune response.

METHODS

We analyzed 5-year disease-free survival of patients recruited into the trial.

RESULTS

Five-year disease-free survival in the placebo group was 40 % (n = 15), compared with the Panagen arm - 53 % (n = 51). Among stage III patients, disease-free survival was 25 and 52 % for placebo (n = 8) and Panagen (n = 25) groups, respectively. Disease-free survival of patients with IIIB + C stage was as follows: placebo (n = 6)-17 % vs Panagen (n = 18)-50 %.

CONCLUSIONS

Disease-free survival rate (17 %) of patients with IIIB + C stage breast cancer receiving standard of care therapy is within the global range. Patients who additionally received Panagen demonstrate a significantly improved disease-free survival rate of 50 %. This confirms anticancer activity of Panagen.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02115984 from 04/07/2014.

Association between age and survival in a cohort of Brazilian patients with operable breast cancer

Whether age is an independent prognostic factor in breast cancer is a matter of debate. This is a retrospective cohort study of 767 breast cancer patients, stages I-III, treated at the Hospital das Clínicas, Minas Gerais Federal University, Belo Horizonte, Minas Gerais State, Brazil, from 2001 to 2008, aiming to study the relationship between age and survival. We included variables related to patients, tumors, and types of treatment. Different sets of Cox models were used for survival analysis. Hazard ratios (HR) and 95%CI were calculated. The relationship between age and breast cancer survival did not change substantially in any of them. In the model that accounted for all variables, women aged 70 and older (HR = 1.51, 95%CI: 1.04-2.18), and 35 or younger (HR = 1.78, 95%CI: 1.05-3.01) had shorter cancer specific survival than patients aged between 36 and 69. In addition, older age, having at least one comorbidity, and being white were associated with a higher risk of dying from other causes. In conclusion, shorter breast cancer survival is expected among the youngest and oldest patients.

CDKN2A (p14(ARF)/p16(INK4a)) and ATM promoter methylation in patients with impalpable breast lesions

Early detection of breast cancer increases the chances of cure, but the reliable identification of impalpable lesions is still a challenge. In spite of the advances in breast cancer detection, the molecular basis of impalpable lesions and the corresponding circulating biomarkers are not well understood. Impalpable lesions, classified by radiologists according to the Breast Imaging Reporting and Data System in the categories 3 and 4, can be either benign or malignant (slow growing or aggressive). In this article, we report the DNA methylation pattern in CDKN2A (p14(ARF)/p16(INK4a)) and in ATM gene promoters from 62 impalpable lesions, 39 peripheral blood samples, and 39 saliva samples, assessed by methylation-specific polymerase chain reaction method. ATM showed the greatest percentage of methylation in DNA from lesions (benign and malignant), blood (even with p16(INK4a)), and saliva, followed by p16(INK4a) and p14(ARF). Among the malignant cases, ATM promoter was the most hypermethylated in lesion DNA and in blood and saliva DNAs, and p14(ARF), the least. The highest percentage of p16(INK4a) methylation was found in the blood. Finally, our data are relevant because they were obtained using impalpable breast lesions from patients who were carefully recruited in 2 public hospitals of Rio de Janeiro.

Accuracy of a probabilistic record-linkage methodology used to track blood donors in the Mortality Information System database

The probabilistic record linkage (PRL) is based on a likelihood score that measures the degree of similarity of several matching variables. Screening test results for different diseases are available for the blood donor population. In this paper, we describe the accuracy of a PRL process used to track blood donors from the Fundação Pró-Sangue (FPS) in the Mortality Information System (SIM), in order that future studies might determine the blood donor's cause of death. The databases used for linkage were SIM and the database made up of individuals that were living (200 blood donors in 2007) and dead (196 from the Hospital das Clinicas de São Paulo that died in 2001-2005). The method consists of cleaning and linking the databases using three blocking steps comparing the variables "Name/Mother's Name/ Date of Birth" to determine a cut-off score. For a cut-off score of 7.06, the sensitivity and specificity of the method is 94.4% (95%CI: 90.0-97.0) and 100% (95%CI: 98.0-100.0), respectively. This method can be used in studies that aim to track blood donors from the FPS database in SIM.

Factors related to survival rates for breast cancer patients

This study is to analyze the relationship between clinical parameters and prognosis and survival rates of breast cancer patients. A total of 1541 cases of breast cancer were retrospectively reviewed with respect to clinical parameters and the correlation with prognosis and survival rates. Among these patients, follow-up investigation was performed for 1381 cases. Clinical parameters including disease sites (the lesion quadrant), incidences, the number of axillary lymph node metastasis, maximum diameter of tumor, tumor regional lymph node metastasis (TNM) stages, pathological types were investigated. The estrogen receptor, progesterone receptor, Human Epidermal Growth Factor Receptor-2 levels were correlated with long term disease-free survival. Lymph node metastases, tumor diameter, TNM stage, and hormone receptor status are correlated with survival rates of breast cancer patients.