Time to diagnosis and treatment for breast cancer in public and private health services

OBJECTIVE

To analyze the time to diagnosis and treatment for breast cancer and the associated factors, according to the type of care (public vs. private).

METHODOLOGY

Retrospective cohort study with 477 women diagnosed with breast cancer between 2014 and 2016. Data were collected in an oncology service in a municipality in Minas Gerais, in the 2018-2019 period. Analyzes were performed using the Kaplan-Meier method and Cox's proportional regression model.

RESULTS

The median time to diagnosis was 70 days, being shorter for women who discovered the disease through screening tests and who were diagnosed in early stages of the disease. The median time for treatment was 32 days, which was shorter for women assisted by private health service, with a high level of education and who were diagnosed in early stages.

CONCLUSIONS

Private care and facilitators of access to breast cancer care were associated with shorter waiting times.

Histological and Immunohistochemical Characteristics for Hereditary Breast Cancer Risk in a Cohort of Brazilian Women

OBJECTIVE

 The study aimed to characterize the clinical, histological, and immunohistochemical profile of women with invasive breast cancer, according to the risk for Hereditary Predisposition Breast and Ovarian Cancer Syndrome in a Brazilian population.

METHODS

 This is a retrospective study performed from a hospital-based cohort of 522 women, diagnosed with breast cancer treated at an oncology referral center in the Southeast region of Brazil, between 2014 and 2016.

RESULTS

 Among the 430 women diagnosed with invasive breast cancer who composed the study population, 127 (29.5%) were classified as at increased risk for hereditary predisposition to breast and ovarian cancer syndrome. There was a lower level of education in patients at increased risk (34.6%) when compared with those at usual risk (46.0%). Regarding tumor characteristics, women at increased risk had higher percentages of the disease diagnosed at an advanced stage (32.3%), and with tumors > 2cm (63.0%), with increased prevalence for both characteristics, when compared with those at usual risk. Furthermore, we found higher percentages of HG3 (43.3%) and K_i-67 ≥ 25% (64.6%) in women at increased risk, with prevalence being about twice as high in this group. The presence of triple-negative tumors was observed as 25.2% in women at increased risk and 6.0% in women at usual risk, with the prevalence of absence of biomarkers being 2.5 times higher among women in the increased risk group.

CONCLUSION

 From the clinical criteria routinely used in the diagnosis of breast cancer, the care practice of genetic counseling for patients at increased risk of hereditary breast cancer in contexts such as Brazil is still scarce.

Tempo para diagnóstico e tratamento do câncer de mama na assistência pública e privada

RESUMO Objetivo: Analisar o tempo para o diagnóstico e tratamento do câncer de mama e os fatores associados, segundo o tipo de assistência (pública vs. privada). Métodos: Coorte retrospectiva com 477 mulheres diagnosticadas com câncer de mama entre 2014-2016. Os dados foram coletados em um serviço de oncologia de um município de Minas Gerais, entre 2018-2019. As análises foram realizadas pelo método de Kaplan-Meier e pelo modelo de regressão de Cox. Resultados: O tempo mediano para diagnóstico foi de 70 dias, sendo menor para aquelas que descobriram a doença por exames de rastreamento e diagnosticadas em estádios iniciais. O tempo mediano para o tratamento foi de 32 dias, sendo menor para as mulheres assistidas pela rede privada, com alta escolaridade e diagnosticadas em estádios iniciais. Conclusões: Assistência na rede privada e facilitadores do acesso ao cuidado do câncer de mama associaram-se a menores tempos de espera.

USO DE MENSAGENS DE CELULAR PARA CESSAÇÃO DO TABAGISMO: REVISÃO SISTEMÁTICA

Formas inovadoras de tecnologias de comunicação, como a internet e o uso de celular, são cada vez mais utilizadas para ajudar fumantes a parar de fumar. O objetivo deste trabalho foi realizar uma revisão sistemática sobre o uso de mensagens de celular como forma de intervenção para pessoas que desejam parar de fumar. Pesquisas foram conduzidas nas bases de dados PubMed, Psychinfo, Scielo e Pepsic. Palavras-chave incluíram: [“tobacco use cessation” OR “tobacco use disorder”] AND [“intervention studies” OR “clinical trial” OR “evaluation studies”] AND [“text messaging”]. Os critérios de seleção dos estudos foram: 1) abordarem o tema mensagens de texto de celular para o tratamento do tabagismo; 2) ser um estudo clínico; 3) artigos científicos com textos completos disponíveis em bases de dados e 4) estar nos idiomas português, espanhol ou inglês. Entre os 23 estudos encontrados, sete preencheram os critérios de inclusão. Em seis dos sete estudos encontrados o envio de mensagens de celular foi a intervenção mais eficaz. Intervenções baseadas no envio de mensagens de celular são uma estratégia complementar ao tratamento do tabagismo que podem contribuir para a cessação tabágica. A inclusão de apenas três idiomas foi uma limitação dessa revisão.  

A review of smartphone apps for smoking cessation available in Portuguese

Smartphone apps are being developed as a complement to smoking cessation treatment. The current study aimed to analyze the content of available apps in Portuguese in two operational systems, Android and iOS. Fifty-one apps were found in iTunes and 600 in Google Play. Content evaluation included apps that focused on smoking cessation, with a total of 12 apps in iOS and 3 in Android. Each app was categorized according to its approach to smoking cessation and scored according to level of adherence to the Treating Tobacco Use and Dependence smoking cessation treatment guideline. Nine apps were classified as calendars, 8 as information tools, 6 as calculators, 3 as cigarette trackers, and 1 as hypnosis. The apps showed low level of adherence to the guideline, with a mean score of 12.8. We recommend that the available apps be revised and that future apps be developed using evidence-based practices for smoking cessation.