Management of non-invasive tumours, benign tumours and breast cancer during the COVID-19 pandemic: recommendations based on a Latin American survey.

INTRODUCTION: The COVID-19 pandemic has changed health systems across the world, both in general hospitals and in oncology institutes or centres.For cancer specialists, particularly breast cancer (BC), the COVID-19 pandemic represents a combination of challenges since the hospital resources and staff have become more limited; this has obliged oncology specialists to seek a consensus and establish which patients with BC require more urgent attention and which patients can wait until there is a better control of this pandemic. The health system in Latin America has some special characteristics; in some of the countries, there are shortages which limit access to several specialities (surgery, clinical oncology and radiotherapy) in some regions. OBJECTIVE: After a systematic review of the most recent literature regarding the management of BC during the COVID-19 pandemic, the main objective is to understand the position of the different Latin American Societies of Mastology in terms of available alternatives for the treatment of BC. METHODS: After carrying out a comprehensive and exhaustive search of the most recent guides on the management of BC during the COVID-19 pandemic, the board members of the Latin American Federation of Mastology invited, via email, different specialists, all experts in BC care, to complete an anonymous survey online.The survey was distributed between 30 and 10 May 2020. The survey included 27 questions on four topics: demographic information, consultations, imaging and treatment of BC.The questionnaire was sent and then distributed to various health specialists including breast surgeons, clinical oncologists, radiation oncologists and radiologists via the Presidents of the different Latin American Societies of Mastology in 18 countries. The results are summarised as tallies based on the number of responses to each question. RESULTS: A total of 499 responses were received. The majority of the respondents were males (275 (55.11%)); 290 participants were over 45 years (58.11%).The questionnaire presented those surveyed with three possible answers (agree, disagree and neither agree nor disagree). The results reflect that there was consensus in the majority of situations presented. Only seven questions revealed disagreement among those responding. The results are presented as recommendations. CONCLUSION: The management of patients with BC presents unique challenges during the current world health situation produced by COVID-19 pandemic. Breast care specialists (surgical oncologists, breast care clinicians, clinical oncologists, radiation oncologists and radiologists) from 18 countries in Central and South America submitted through their responses and recommendations for the treatment of BC during the COVID-19 pandemic.

The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial.

BACKGROUND: This study evaluated the impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy. METHODS: Older breast cancer survivors were randomized into two groups: combined training: resistance + aerobic exercise program for nine months (n = 18) or control group (n = 18). Quality of life was assessed by the questionnaires SF36, EORTC QLQ-C30, and EORTC QLQ-BR23 at baseline, and at three, six, and nine months. The exercise group performed 40 min of resistance exercises on machines followed by 30 min of aerobic training on a treadmill 3x/wk. Repeated measures ANOVA was used to compare the groups over time. RESULTS: Significant time x group interactions and moderate to high effect sizes were found for physical functioning, physical health, bodily pain, general health perception, vitality, social functioning, fatigue, sleep disturbance, body image, and upset by hair loss, favoring the exercise group. CONCLUSION: This study demonstrated the potential benefits and high clinical relevance of exercise programs to improve quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy.

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.

Temporal variation of breast cancer surgical treatment in a university hospital in Brazil's Central West region.

OBJECTIVE: To assess the types of surgical treatments for breast cancer performed by the Mastology program of the Clinics Hospital, Federal University of Goiás (HC-UFG). METHODS: We conducted a cross-sectional, cohort study on the breast operations performed at HC-UFG from January 2002 to December 2009. We evaluated the surgical records for: surgical time and size, surgeon, type of operation, diagnosis, and type of anesthesia. The medical charts were researched for: pathology report of the tumor, lymph node involvement, primary tumor size, staging and performance of neoadjuvant therapies. We excluded operations for the removal of benign breast tumors. The temporal variation was analyzed using Poisson regression, considering the annual percentage change (APC). RESULTS: 403 operations were performed for breast cancer during the study period, with an average of 50.38 operations per year. The most common histological type was invasive ductal carcinoma (72.6%). The mean age of patients was 52 years, and 29% had disease in stages III and IV. The temporal trend revealed a significant increase in tumor size (p <0.01), the clinical stages III and IV (p = 0.01) and the use of neoadjuvant chemotherapy (p = 0.02). There was increase in mastectomies (APC = 9 cases/year, p = .04). There was no increase in cases of breast conservation treatments or of mastectomies with immediate reconstruction. CONCLUSION: In recent years, the HC-UFG has had an increased number of mastectomies as a result of increased incidence of locoregionally advanced breast cancer.

Monitoring the profile of cervical cancer in a developing city.

BACKGROUND: Medical records are frequently consulted to verify whether the treatment and guiding principles were correct. Determine incidence and mortality trends of in situ and invasive neoplasms of the uterine cervix, in the period 1988-2004 in Goiânia, Brazil. METHODS: The incident cases were identified through the Population-Based Cancer Registry of Goiânia. Population data were collected from census data of the Brazilian Institute of Geography and Statistics. For mortality analysis, data were extracted from the Mortality Information System. The Poisson Regression was utilized to determine the annual incidence and mortality rates. RESULTS: A total of 4446 cases of in situ and invasive neoplasms of the uterine cervix were identified. No significant reductions were verified in invasive cervical cancer rates (p=0.386) during the study period, while in situ carcinomas presented an annual increasing trend of 13.08% (p<0.001). A decreasing trend was observed for mortality (3.02%, p=0.017). CONCLUSION: No reduction was observed for the incidence of invasive cancer of the uterine cervix; however, increasing trends were verified for in situ lesions with a consequent reduction in mortality rates. These increasing trends may be the result of recently-implemented screening programs or due to improvements in the notification system.

Prevalence of breast cancer in the city of Goiânia, Goiás, Brazil, between 1988 and 2002.

CONTEXT AND OBJECTIVE: Studies have shown increased prevalence rates for breast cancer, relating to higher incidence, longer survival and breast cancer prevention programs among populations. The aim here was to analyze the annual prevalence of breast cancer in Goiânia over a 15-year period. DESIGN AND SETTING: This was a cross-sectional study on women with breast cancer diagnosed in Goiânia, Goiás, Brazil, from 1988 to 2002. METHODS: The breast cancer cases were identified in the database of the Population-Based Cancer Registry of Goiânia. The 15-year period was stratified into three five-year periods. The cases were followed up for five years, and the mortality database was used to exclude deaths. The population of the official census was used as the denominator for rate calculations. RESULTS: The coefficient of breast cancer prevalence in Goiania was 22.87/100,000 in 1988 and 220.22/100,000 women in 2002. The analyses for periods showed that in the first period, the rate was 19.39/100,000 and that it was 44.79/100,000 in the last period. For the fifteen years analyzed, the prevalence rate for breast cancer was 127.24/100,000 women. The annual percentage change was 27.07 (P < 0.001; 95% confidence interval, CI: 20.79-33.67) from 1988 to 1992 and 9.39 (P < 0.001; 95% CI: 8.52-10.25) from 1992 to 2002. CONCLUSION: There was an increase in the breast cancer prevalence rate in the city of Goiânia between 1988 and 2002, possibly relating to the improvement in the screening and treatment of breast cancer.

Incidence trend for breast cancer among young women in Goiânia, Brazil.

CONTEXT AND OBJECTIVE: It has been suggested that there has been a large increase in breast cancer incidence among young women over the last decade. The aim of this study was to describe the incidence of breast cancer among young women up to 39 years of age in Goiânia, between 1988 and 2003, and to compare this with other age groups. DESIGN AND SETTING: Retrospective study using the database of the Population-based Cancer Registry of Goiânia, State of Goiás, Brazil. METHODS: The incidence was calculated according to age groups: up to 39 years, 40 to 59 years and 60 years and over. Average annual percentage changes (AAPCs) were estimated for the different age groups using Poisson regression. RESULTS: Over this period, 3,310 new cases were recorded. The standardized incidence was 2.89/100,000 in 1988 and increased to 6.37/100,000 in 2003 (R(2) = 0.52) for the group aged up to 39 years (p < 0.003). For the group from 40 to 59 years old, the incidence was 14.39/100,000 in 1988 and 41.70/100,000 in 2003 (R(2) = 0.85; p < 0.001). For the group aged 60 years and over, it was 17.62/100,000 and 28.49/100,000, respectively (R(2) = 0.67; p < 0.001). The AAPCs were 5.22%, 5.53% and 4.54% for the age groups up to 39, 40 to 59 and 60 years and over, respectively. CONCLUSIONS: The incidence of breast cancer among young women in Goiânia has been increasing significantly, although this change was similar to the increase in other age groups.

Increase in cervical adenocarcinoma rate in Goiânia, GO, Brazil.

AIM: To analyze the incidence and mortality trends of cervical adenocarcinoma in Goiânia, Brazil. METHODS: The cases were identified from the database of the Population-based Cancer Registry of Goiânia. The primary site was confirmed from the medical files. For all variables studied, frequencies and linear and polynomial logistic regressions were calculated. The Statistical Package for the Social Sciences and Excel softwares were used. RESULTS: Cervical adenocarcinoma accounted for 7.02% of all cancer cases, between 1998 and 2002. The mean age was 44 years for the in situ form and 52 years for the invasive form, and the age group with the highest incidence was from 45 to 49 years. Adenocarcinoma not otherwise specified (68.1%) and stage I were most frequent. The standardized rate incidence increased from 1.47 per 100,000 to 2.84 per 100,000 in 1988 and 2002, respectively (R = 0.424 and P = 0.008). The mortality rates due to cervical adenocarcinoma were 0.89 per 100,000 in 1988 and 0.51 per 100,000 in 2002. CONCLUSIONS: An increasing incidence of cervical adenocarcinoma was observed in Goiânia, although the mortality rate remained stable.

[Knowledge and practice of breast self-examination in Goiânia]. / Conhecimento e prática do auto-exame de mama.

OBJECTIVE: To ascertain frequency of women in a hospital sample in Goiânia, Brazil, who know about and carry out breast-self examination (BSE) as well as the factors associated to knowledge and practice of this diagnostic method. METHODS: A descriptive study was carried out aiming to identify factors potentially associated to BSE in a sample of 2,073 women. Data was collected using a standardized questionnaire of age, education level, origin, parity, civil status, income and breastfeeding antecedents of the women. RESULTS: 75% of women knew about BSE and 51% practiced it. A multivariate analysis yielded the following odds ratios: BSE knowledge was 4.2 times higher among housewives than women working away from home; 2.1 times higher among those aged 30 years or older; 2.1 times higher in those with 5 years or more of schooling, 1.98 times higher among those living in the Greater Goiânia Region, 1.4 times higher among those with 2 children or more, and 1.68 times higher among those with an income above 2 minimum wages. In relation to BSE practice, it was 1.7 times more frequent among housewives and among those 30 year or older, 1.8 times more frequent among those with more years of schooling and 1.2 more frequent among women with an income above 2 minimum wages. CONCLUSION: The majority of women knew about BSE, and half of them, practiced it. Less knowledge and less frequent practice of BSE was more often detected in poorer women, those with less health information and awareness about the usefulness of this method for early breast cancer detection.

[Discomfort and pain during mammography]. / Desconforto e dor durante realização da mamografia.

INTRODUCTION: Mammography is the most important method for early detection of breast cancer, however, patients frequently complain of discomfort and pain. OBJECTIVE: Evaluate how often discomfort and pain are felt during mammography and identify factors that may be associated to these complaints. METHODS: A prospective study including 2,164 patients recruited from public (996) and private (1,168) health services was carried out. After the imaging procedure, patients quantified pain using a linear analogical scale. Discomfort was qualitatively evaluated by multivariate analysis. RESULTS: Discomfort was reported by 90% of the patients, and of these 12% rated the sensation as intense or intolerable. Only 2% of the women in the study group did not feel any pain during the procedure. Factors associated to pain were: age, use of birth control methods (BCM), previous mastalgia and patients from the private health sector. Discomfort was independently associated to the service where the procedure was performed (OR = 2.50 IC 1.64-5.17) and to previous mastalgia (OR = 3.15 IC 1.96-7.12). When asked about a repeat mammography, 98% of the patients said they would comply. CONCLUSION: Young women (< 50 years), BCM users, mastalgia patients and women who were using the services of a private clinic felt more intense pain and discomfort during mammography.