Human Papillomavirus vaccination coverage among the female population living in the state of Goiás, Brazil, 2014-2020: a time series study.

OBJECTIVE: To analyze the temporal trend of human papillomavirus (HPV) vaccination coverage among the female population aged 10 to 14 years, living in the state of Goiás, Brazil, between 2014 and 2022. METHODS: This was an ecological time series study using data from the Brazilian National Health System Information Technology Department (Departamento de Informática do Sistema Único de Saúde - DATASUS); the annual vaccination coverage rate was calculated based on the number of second doses administered; the trend of the rates was analyzed using the Prais-Winsten model. RESULTS: A total of 407,217 second doses of the quadrivalent HPV vaccine were administered to the female population aged 10-14 years, with annual vaccination coverage rates ranging from 12.3% (2019) to 30.0% (2015), and an annual percentage change (APC) of 0.7% (95%CI 0.9; 0.2; p-value = 0.030). CONCLUSION: In Góias state, the quadrivalent HPV vaccine coverage rate was below the national target (80%), showing a stationary trend in the time series.

Impact of the genomic signature of 70-genes for breast cancer in the public system and in supplementary health care in a country of medium socioeconomic development.

INTRODUCTION: The financial impact of breast cancer has been discussed due to its high incidence and the increased costs of systemic therapy and is even more relevant in countries with low and medium socioeconomic development. OBJECTIVE: To evaluate the financial viability of using the MammaPrint™ (MP) genetic signature in a public and private system in a country with a medium socioeconomic development index. MATERIAL AND METHOD: A pharmacoeconomic trial with a cost-benefit analysis evaluating the reduction in costs of chemotherapy, support drugs, and materials used during chemotherapy infusion in high-risk hormone receptor-positive (HR+) breast cancer patients submitted to analysis using the MammaPrint™ genetic signature. RESULTS: The value of using MammaPrint™ in the Unified Health System (SUS) would bring an additional cost of US$ 1,334.56 per patient in the over-50 age group. In private medicine, the use of MammaPrint™ in the same population would result in cost savings ranging from US$ 2,422.53 to US$ 9,989.95 per patient. CONCLUSION: The use of MP in RH + breast cancer patients with high clinical risk and low genomic risk in Brazil leads to significant savings in resources when applied to supplementary healthcare. In the SUS, reducing the costs of MP for large-scale use could make its application viable. These values need to be re-evaluated in each institution, using the methodology applied in the trial, adjusting according to costs, to obtain a result that reflects its reality.

Testosterone Deficiency in Hypertensive Men: Prevalence and Associated Factors. / Deficiência de Testosterona em Homens Hipertensos: Prevalência e Fatores Associados.

BACKGROUND: Testosterone deficiency (TD) is a prevalent condition in our midst and still very neglected. Arterial hypertension (AH) is one of the possible associated factors. OBJECTIVES: To determine the prevalence of TD in a hypertensive male population and the factors associated with its occurrence, such as age, time since hypertension diagnosis, number of antihypertensive classes, body mass index (BMI), diabetes, dyslipidemia, chronic kidney disease (CKD), positive symptoms of TD (positive ADAM questionnaire) and use of spironolactone. METHODS: Cross-sectional study with administration of the ADAM questionnaire, assessment of biochemical, clinical, and anthropometric data. Patients were stratified into DT and normal testosterone groups. Categorical variables were compared using the chi-squared test and continuous variables using the Mann-Witney test; variables with significance (p<0,05) were analyzed by multivariable linear regression. RESULTS: The prevalence of TD was 26.36%. There was an association between TD and body mass index (BMI) (p=0.0007) but there was no association with age (p=0.0520), time of hypertension diagnosis (p=0.1418), number of classes of antihypertensive drugs (p=0.732), diabetes (p=0.1112); dyslipidemia (p=0.3888); CKD (p=0.3321); use of spironolactone (p=0.3546) or positive ADAM questionnaire (p=0.2483). CONCLUSIONS: TD was highly prevalent and positively associated with BMI. Total testosterone (TT) declined by 8.44ng/dL with a one unit increase in BMI and dropped by 3.79ng/dL with a one-year increase in age.

FUNDAMENTO: A deficiência de testosterona (DT) é uma condição prevalente em nosso meio e ainda muito negligenciada. A hipertensão arterial (HA) é um de seus possíveis fatores associados. OBJETIVOS: Determinar a prevalência de DT em uma população masculina hipertensa e os fatores associados à sua ocorrência, como idade, tempo de diagnóstico de HA, número de classes de anti-hipertensivos, índice de massa corporal (IMC), diabetes, dislipidemia, doença renal crônica (DRC), sintomas positivos de DT (questionário ADAM positivo) e uso de espironolactona. MÉTODOS: Estudo transversal com aplicação do questionário ADAM, e avaliação de dados bioquímicos, clínicos e antropométricos. Os pacientes foram estratificados em grupos de DT e testosterona normal. As variáveis categóricas foram comparadas pelo teste do qui-quadrado e as variáveis contínuas pelo teste de Mann-Witney; as variáveis com significância (p<0,05) foram submetidas à regressão linear multivariada. RESULTADOS: A prevalência de DT foi de 26,8%. Houve associação entre DT e IMC (p=0,0007), mas não houve com idade (p=0,0520), tempo de diagnóstico de HA (p=0,1418), número de classes de anti-hipertensivos (p=0,0732), diabetes (p=0,1112); dislipidemia (p=0,3888); presença de DRC (p=0,3321); uso de espironolactona (p=0,3546) e questionário ADAM positivo (p=0,2483). CONCLUSÕES: A prevalência de DT foi alta e houve associação positiva com IMC. A testosterona total (TT) declinou 8,44 ng/dL com o aumento de 1 kg/m2 no IMC e caiu 3,79 ng/dL com o avanço em um ano na idade.

Breast cancer screening and diagnosis in older adults women in Brazil: why it is time to reconsider the recommendations.

Introduction: Breast cancer screening in women of 70 years of age or older remains controversial due to a lack of studies that include women of this age. Methods: This ecological study evaluated data from the Brazilian National Health Service (SUS) on breast cancer screening and staging in this age group compared to 50-69-year olds, for Brazil as a whole and for its geographical regions, between 2013 and 2019. A secondary database was obtained from the outpatient data system of the SUS's Informatics Department, the Brazil Oncology Panel, the Brazilian Institute of Geography and Statistics, the Supplementary Health Agency and the Online Mortality Atlas. Results: There was a marked reduction in screening in women ≥70 years of age (annual percent change [APC] -3.5; p < 0.001) compared to those of 50-69 years of age (APC-2.2; p = 0.010). There was a trend towards an increase in clinical staging, with a greater occurrence of stages III and IV in the ≥70 group (44.3%) compared to the women of 50-69 years of age (40.8%; p < 0.001). Conclusion: Considering the increasing age of the Brazilian population and the heterogeneity among older adults women, screening for the over-70s within the SUS merits greater debate insofar as the implementation of public policies is concerned.

Management of early-stage triple-negative breast cancer: recommendations of a panel of experts from the Brazilian Society of Mastology.

BACKGROUND: Triple-negative breast cancer (TNBC) is a heterogenous subtype involving different patterns of behavior and clinical course, demanding a complex, individualized sequence of treatment. The knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology regarding TNBC were evaluated and a consensus regarding management and treatment was reached. METHODS: Affiliates completed a survey involving 44 objective questions. In addition, a specialist meeting was held with 27 experts and 3 ad hoc consultants. The panelists completed the survey before and after brainstorming. Answers achieving 70% of agreement were considered consensual. The chi-square test was used to compare answers between panelists and affiliates and the Kappa coefficient to calculate agreement. RESULTS: Consensus among the panelists increased from 26 (59.1%) to 32 questions (72.7%) following brainstorming (p = 0.17), including 7/10 questions on systemic treatment. Among the affiliates, consensus was achieved for 24 questions (54.5%), resulting in moderate agreement (κ = 0.445). Neoadjuvant chemotherapy should be indicated for almost all cases (except cT1a-b N0) and should include platinum agents. When indicated, immunotherapy is part of the standard of care. The panel reaffirmed the concept of no ink on tumor as indicative of adequate margins and the possibility of sentinel lymph node biopsy for cN1 patients who become cN0 following neoadjuvant therapy. Controversies remain on combining immunotherapy with capecitabine/olaparib in pertinent cases. CONCLUSION: Expert consensus was achieved for > 70% of the questions, with moderate agreement between panelists and affiliates. Educational interventions on systemic breast cancer treatment affected decision-making in 60% of the questions.

Are All Views with and without Displacement Maneuver Necessary in Augmentation Mammography? Putting Numbers Into Perspective.

OBJECTIVE: Augmentation implants pose a challenge for radiologists. Displacing the implant allows slightly more breast tissue to be visualized than the standard compression views. The objective of this study was to verify the agreement between craniocaudal (CC) views and CC with implant displacement (CC-ID), mediolateral oblique (MLO) and MLO-ID and the inter- and intraobserver agreement of mammographic images for finding abnormal images. METHODS: The main outcomes [BI-RADS® normal=1,2; abnormal=3,4,5)] were analysed by 3 readers (reader1; reader 2, 1st round, reader 2, 2nd round) in 360 women with breast implants. Comparison between CC/CC-ID and MLO/MLO-ID, and degree of agreement for mammographic images between researchers were made using Kappa index. Proportions were calculated using a 95% confidence interval (95%CI). RESULTS: A total of 87 abnormal findings were identified by reader 2, 2nd round. Abnormal findings were observed in CC-ID=18.8% (68 out of 360; 95%CI=15.1%-23.2%) compared to CC=10.8% (39 out of 360; 95%CI=8%-14.4%, k=0.49); in MLO=10.5% (38 out of 360; 95%CI=7.7%-14.1%) compared to MLO-ID=15.8% (57 out of 360; 95%CI=12.4%-19.9%, k=0.55). The CC-ID was the view that singly identified more abnormal findings (20 out of 87; 23%; 95%CI=15.4% to 32.8%) and the CC was the view that least detected abnormal findings (1 out 87; 95%CI=0.2% to 6.2%). The inter- and intraobserver agreement between readers views was 0.67 and 0.74 respectively. CONCLUSIONS: In women with breast augmentation implants, all views are necessary to identify breast tissue abnormalities. In our sample, the inter- and intraobserver agreement were "substantial".

Real-world data on metastatic breast cancer in Goiânia, Brazil: a 17-year analysis (1995­2011)

Introduction: Most of the data on metastatic breast cancer (MBC) originate from hospital-based studies or controlled trials involving specific populations and controlled treatments. In this respect, few population-based studies have analyzed the profile of MBC in low- and middle-income countries. Objective: To describe the epidemiological profile of women with de novo MBC using data from a population-based cancer registry (PBCR). Methods: An ecological study conducted in a PBCR in Goiânia, Brazil, for the 1995­2011 period. Women with MBC at diagnosis were included and the standardized incidence rate and annual percent change (APC) over the period were calculated. The women's clinical and demographic characteristics and data on diagnosis and treatment were analyzed. Results: Overall, 5,289 cases of breast cancer were registered in the Goiânia PBCR, 277 (5.2%) at metastatic stage. The adjusted incidence was 8.9/100,000 in 1995 and 6.04/100,000 in 2011 (APC: 1.1; p=0.6). Most of the patients (70.3%) were receiving care within the public healthcare system and the mean age at diagnosis was 54.7±14.5 years. Additional data for a subpopulation of 156 patients were identified at the city's two main treatment centers. According to immunohistochemistry, 53 women (67.1%) had hormone receptor-positive cancer. Of these, 14.0% (6/43) received endocrine therapy as first-line systemic treatment and 48.5% (17/35) as second-line treatment. A comparison of clinical data between the 1995­2003 and 2004­2011 periods revealed no significant differences in age, histological grade, locoregional staging, the presence of symptoms at diagnosis, or in treatment. Conclusion: This study population of women with MBC consisted predominantly of locally advanced tumors and the luminal-like subtype. The incidence rate of MBC in Goiânia did not change over the 17-year period. Most cases received chemotherapy as firstline systemic treatment irrespective of the tumor phenotype.

Clinical quality assurance in breast cancer screening and diagnosis: a warning regarding mammographic positioning

This study aimed to evaluate the clinical image quality of mammograms performed in users of the Brazilian Unified Health System (SUS) referred to a tertiary hospital. Methods: A prospective study assessed mammograms from women referred to a specialist breast center in Goiânia, Goiás, Brazil, between May and October 2017. Scans performed in the preceding 6 months, either screening or diagnostic, were included in the study. Clinical quality was determined from 40 variables related to patient identification, technical performance, the equipment, radiological findings, reporting of results, and breast positioning. Scans performed in the public and private healthcare networks were compared regarding mammographic positioning. Results: Overall, 4,560 variables associated with the clinical quality of the images were evaluated in scans from 114 women with a mean age of 50.6 years. A total of 660 (14.47%) inadequacies were found, 443 (67.12%) of which were related to breast positioning. The most common errors were as follows: pectoral muscle could not be seen in 86.8% of scans in the craniocaudal view and inframammary angle could not be seen in 79.8% of scans in the mediolateral oblique view. Considering the breast-positioning criteria evaluated in the mediolateral oblique view, there was a greater risk of the breast not being centrally positioned with the nipple in profile (RR 4.66; 95%CI 1.05−20.62; p=0.02) and of nonvisualization of the retro-areolar area (RR 4.14; 95%CI 0.92−18.66; p=0.04) in the exams performed in the private compared to the public network.

Prognostic Role of PD-L1 Expression in Invasive Breast Cancer: A Systematic Review and Meta-Analysis.

Programmed death ligand 1 (PD-L1) has been investigated in various types of cancer; however, the role of PD-L1 expression in breast cancer remains controversial. We performed a systematic review and meta-analysis to assess the association of PD-L1 expression with clinicopathological variables, overall survival (OS), and disease-free survival (DFS) in invasive breast cancer. A total of 965 articles were included from CINAHL, Embase, PubMed, and Scopus databases. Of these, 22 studies encompassing 6468 cases of invasive breast cancer were included in the systematic review, and 15 articles were included in the meta-analysis. PD-L1 expression was associated with age ≥ 50 years, lymph node status-negative, progesterone receptor-negative, Ki67 ≥ 20%, and human epidermal growth factor receptor 2 (HER2)-negative. PD-L1 positivity was associated with worse OS (hazard ratio, HR, 2.39; 95% confidence interval, CI, 1.26-3.52; p =< 0.000); however, there was no significant improvement in DFS (HR 0.17; 95% CI -0.12-0.46; p =< 0.252). PD-L1 positivity was significantly associated with the clinicopathological characteristics of favorable and unfavorable prognoses. However, the final clinical outcome was associated with lower OS and had no significant association with DFS.

Publication rate of scientific papers presented at the largest event on breast cancer research in Latin America.

PURPOSE: Medical congresses allow scientific production to be appropriately disseminated and discussed. However, most of the scientific papers presented at medical congresses do not go on to be published in indexed journals. The present study aimed to determine the publication rate of papers presented at the Brazilian Breast Cancer Symposium (BBCS) and trends associated with publication over that timeframe. METHODS: This was a retrospective, observational study evaluating scientific papers presented at the BBCS between 2012 and 2017. All the abstracts presented at the event within this timeframe were recorded. Next, a search for papers was made using online databases (BIREME/LILACS and MEDLINE/PubMed) and in the curricula of the authors on the Lattes Platform. RESULTS: Overall, 543 abstracts of papers presented at the BBCS between 2012 and 2017 were included. Of these, 112 (20.6%) had been published in an indexed journal, mostly in English (67.0%), in journals with an impact factor of 2.0-3.0 (21.4%) and ≥1 year after presentation at the event (75.9%). The factors associated with publication were: study conducted in a public institution (p = 0.01), oral or commented poster presentation (p > 0.001) and study concerning rehabilitation following breast cancer (p = 0.04). There was a downward trend in the rate of publication of articles over the years (p = 0.01). Conversely, the impact factor of the publications increased significantly between 2012 and 2017 (p = 0.04). CONCLUSION: The publication rate of papers presented at the BBCS is low and remains consistent over the study period despite academic incentives and substantial awards.

Chemotherapy negatively impacts body composition, physical function and metabolic profile in patients with breast cancer.

BACKGROUND: Evidence suggests that chemotherapy (CT) leads to unfavorable outcomes on nutritional and metabolic profile; however, this is poorly understood. OBJECTIVE: To evaluate the impact of CT on body composition, bone mineral density (BMD), insulin resistance, lipid markers related to atherosclerotic cardiovascular diseases in women recently diagnosed with breast cancer according to menopausal status. METHODS: This is a prospective study that enrolled women newly diagnosed with stage II-III breast cancer (2014-18). Body composition were measured by dual-energy x-ray absorptiometry. Blood samples were collected to assess lipid profile, insulin resistance and sensitivity, visceral adiposity index and lipid accumulation product were calculated. Dietary intake, physical activity and function were also evaluated at the time of breast cancer diagnosis and after CT completion. RESULTS: Ninety-nine women (40.4% in the premenopausal stage) aged 51 ± 1 years took part in this study. CT duration was 197 ± 27 days and main regimen was anthracyclines with taxanes (88.9%). CT was associated with an increase in total and central adiposity, insulin resistance, and all lipid-related markers, and a decrease in appendicular lean mass index, BMD and HDL-c concentration. Premenopausal women experienced greater unfavorable outcomes on adiposity markers and BMD compared to postmenopausal women (p < 0.01). No changes were observed in dietary intake and physical activity after CT. CONCLUSIONS: Breast cancer CT negatively impacted body composition and metabolic profile. Premenopausal women experienced greater unfavorable impact on adiposity markers and BMD.

Breast cancer staging in population-based registries: an alert to the quality of information

Objective: To discuss the practical difficulties associated with breast cancer staging, especially in the context of populationbased cancer registries (PBCR). Methods: This is a short communication that discusses the importance and temporal evolution of breast cancer staging, as well as the limitations and new challenges associated with this process. Results: This study discusses the importance and temporal evolution of breast cancer staging, as well as the limitations and new challenges associated with this process. Minimal divergences in physical examination and disagreements in imaging tests can classify the patient in a higher or lower stage of the disease. In some population-based registries, up to 20% of the information regarding the clinical stage of breast cancer may be mistaken. Conclusion: We highlight the necessity for continuing education and constant training for all professionals involved in the breast cancer epidemiological context. The utilization of new technologies can help standardize the information and reduce the divergences related to cancer staging registry.

Nipple-sparing mastectomy in normal breast: consequence of simulation and disease anxiety

Diagnosis in psychiatry is a thorough and potentially artificial process. In this letter, we discuss this diagnostic process in the context of a young patient who underwent nipple-sparing mastectomy after falsifying a breast biopsy report revealing invasive ductal carcinoma. The secondary pathology revision was also forged by the patient and confirmed the diagnosis. The patient was summoned by the Service's board and admitted the falsification of breast cancer reports. After evaluation at the Psychiatric Service, changes in vital mood, psychosis, delusional activity and obsessive-compulsive symptoms were ruled out. In view of the growing demand for prophylactic mastectomy observed worldwide, similar cases may become more frequent.

Knowledge of basic attention professionals about prevention and early detection of breast cancer in the state of Goiás

The role of Basic Health Care (BHC) professionals is essential in the primary and secondary prevention of breast cancer. The aim of this study was to characterize BHC professionals in the Health Regions of a federative unit and to assess their knowledge about breast cancer. This was a prospective study carried out with BHC professionals from the state of Goiás. Phase 1 ­ Preparation of material and training of the team. Phase 2 ­ Agreement of actions between executing team and coordination of health regions. Phase 3 ­ Presentation of project at the collegiate meeting. Phase 4 ­ Qualification of BHC professionals with different learning methods and application of questionnaires, evaluating the contribution of the action. A total of 1,133 professionals were included; mean age was 36.3 years, and they were predominantly women (87.6%), working as community health agents (59.2%) and at public service (76.3%). Only 53.8% of professionals identified the female sex as a risk factor for breast cancer, while 90% identified family history as an important factor for the development of the disease. Important changes in physical examination that can occur in patients with the disease, such as skin retraction, skin bulging and nipple injury, were mentioned as a risk factor only by 35.3%, 31.3% and 39.7%, respectively. BHC professionals who participated in the project had less than ten years of professional experience and significant restrictions of knowledge about primary and secondary prevention of breast cancer. They still experience difficulties in accessing mammography and specialized care.

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study.

BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

Evaluation of ionizing radiation as a risk factor for the incidence of breast cancer: long-term analysis after the cesium-137 accident in Goiânia, Brazil. An ecological study

ABSTRACT BACKGROUND: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. OBJECTIVE: To evaluate the association between breast cancer incidence and ionizing radiation levels. DESIGN AND SETTING: Ecological study among residents of the city of Goiânia, Brazil. METHODS: The central region of Goiânia, with seven major sources of contamination from cesium-137, was defined as the study area. The addresses of women diagnosed with breast cancer were identified between 2001 and 2010. The data were geographically referenced and, using census data, the annual averages of crude incidence rates were estimated. The existence of clusters of new cases was ascertained by means of the Moran index. Correlations of radiometric measurements with the incidence were assessed using unconditional linear regression. RESULTS: A total of 4,105 new cases were identified, of which 2,233 were in the study area, and of these, 1,286 (57.59%) were georeferenced. The gross rates of total and referenced cases were 102.91 and 71.86/100,000 women, respectively. These were close to the average for Brazilian state capitals, which is 79.37/100,000 women. The cluster analysis showed slight correlations in three small sets of census tracts, but these were far from the sources of contamination. The scatter plot of points and the R2 value close to zero indicated that there was no association between the variables. CONCLUSION: This study reinforces the hypothesis that the ionizing radiation levels to which women living in Goiânia are now exposed to are not associated with the onset of new cases of breast cancer.

Publication rate of abstracts on breast cancer presented at different scientific events in Brazil

Introduction: Medical congresses allow scientific production to be appropriately disseminated and discussed. However, most of the scientific papers presented at medical congresses do not go on to be published in indexed journals. The present study aimed to characterize the abstracts presented at three different congresses on breast cancer held in Brazil, and to determine the publication rate of these three events. Methods: Observational, retrospective study, where the observation unit consisted of the scientific papers presented at the Brazilian Congress of Mastology (CBM), Jornada Paulista de Mastologia (JPM) and Brazilian Breast Cancer Symposium (BBCS) in 2017. Initially, we recorded all the abstracts of works presented at the event. Subsequently, the works were searched in digital databases (BIREME/LILACS and MEDLINE/PubMed) and in the respective resumes of the authors on the Lattes platform. Results: The study included 266 abstracts of scientific papers presented in the three selected events, of which 21 (7.9%) were published in an indexed journal. Most of these studies were conducted predominantly in public institutions (71.1%), located in the State of São Paulo (30.5%) and were presented in the form of a poster (77.8%). The publication rate from the BBCS, CBM and JPM was 13.4, 5.4 and 3.4%, respectively (p = 0.03). Considering the published articles, there was no difference in journal impact factor between the congresses (p = 0.49). "Mastology" was the journal that received the largest number of publications (n = 8; 38.1%). Conclusion: In 2017, less than 10% of the abstracts on breast cancer presented at Brazilian congresses were published in an indexed journal. Among the main specialty events in the country, the Brazilian Breast Cancer Symposium has a significantly higher publication rate.

Vitiligo as a Köebner phenomenon after oncoplastic breast surgery

The Köebner phenomenon is characterized by the appearance of several types of dermatological lesions after traumatic stimulation. The triggering of this phenomenon after breast surgery is uncommon and usually associated with psoriatic lesions. The aim of this study was to describe two cases of vitiligo as the initial manifestation of Köebner phenomenon after breast oncoplastic surgery. Case 1: female, 41 years old, no history of dermatological pathologies, presenting with tubular carcinoma in the right breast. Quadrantectomy and sentinel lymph node biopsy were performed, followed by reconstruction with mammoplasty. Later, the patient started on tamoxifen and underwent radiotherapy, without complications. Thirty days after treatment, the patient presented progressive depigmentation of the areola-papillary complex. Topical treatment was started with dermatological ointment tacrolimus monohydrate and, after one year, the condition was completely resolved. Case 2: 52-yearold woman with previous history of vitiligo on the face, with complete clinical response after dermatological treatment. She was diagnosed with ductal carcinoma in situ on the left breast and underwent quadrantectomy, by means of mammoplasty using the round block technique. Afterwards, she underwent radiotherapy and started tamoxifen. Four years after the surgery, she developed dyschromia in the ipsilateral periareolar region and was diagnosed with vitiligo. Local dermopigmentation was offered, but the patient opted for an expectant conduct and clinical follow-up. To our knowledge, this is the first description of Köebner phenomenon after breast oncoplastic surgery. In these cases, the therapeutic approach must be multidisciplinary and count on the assessment of multiple clinical and individual parameters.