Mortality of Young Women due to Breast Cancer in Low, Middle and High-Income Countries: Systematic Literature Review and Meta-Analysis.

OBJECTIVE: To identify the difference in breast cancer mortality rates among young women according to countries' economic classification. METHODS: A systematic literature review included retrospective studies on breast cancer mortality rates in women aged 20 to 49 years. Databases used were PubMed, Web of Science, Scopus, and Virtual Health Library, with articles selected in English, Portuguese, and Spanish. The study selection and analysis were conducted by two pairs of researchers. Data from 54 countries were extracted, including 39 high-income, 12 upper-middle-income, and 3 lower-middle-income countries. A meta-analysis was performed with the quantitative data from two studies. RESULTS: Six articles met the inclusion criteria. Four were analyzed descriptively due to data diversity, and two were included in the meta-analysis. The pooled mortality rate for high-income countries was 10.2 per 100,000 women (95% CI: 9.8-10.6), while for upper-middle-income countries, it was 15.5 per 100,000 women (95% CI: 14.9-16.1). Lower-middle-income countries had a pooled mortality rate of 20.3 per 100,000 women (95% CI: 19.5-21.1). The decrease in mortality rates in high-income countries was statistically significant (p<0.05). CONCLUSION: Mortality rates for breast cancer among young women have decreased significantly in high-income countries but have increased in lower-income countries. This disparity underscores the impact of insufficient investment in preventive measures, health promotion, early diagnosis, and treatment on young women's mortality in lower-income countries.

Colorectal cancer mortality in women: trend analysis in Brazil and its regions and states.

OBJECTIVES: to analyze colorectal cancer mortality trends in women in Brazil and its regions and states. METHODS: ecological, time-series study with trend analysis of deaths caused by colorectal cancer in women in Brazil and its regions and states between 2008 and 2019. Polynomial regression was used to treat the data. RESULTS: 48,225 deaths of women caused by colorectal cancer were examined. There was an increasing mortality trend in Brazilian women, with regional differences that resulted from socioeconomic, political, and cultural inequalities. The South Region stood out with the highest rate (7.32) in 2008, which increased to 8.65 in 2019, followed by the Southeast Region, whose rates were 6.72 and 9.05 in 2008 and 2019, respectively. CONCLUSIONS: colorectal cancer mortality increased, which indicates the need to expand public policies oriented toward screening and early diagnosis of colorectal cancer in women.

Use and Applicability of the Gail Model to Calculate Breast Cancer Risk: A Scoping Review.

OBJECTIVE: To perform a scoping review of the applicability of the Gail model in different countries for different ethnicities. METHODS: The review was conducted based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist and search strategies based on the PICOS approach. The reviewed articles were included if they were published between 2013 and 2018 in English, Portuguese, or Spanish; were original articles available in full online; and described the use of the Gail model. The PubMed, Embase, and Web of Science data bases were searched. RESULTS: A total of 38 articles eligible for analysis were identified, of which 16 used the Gail model to assess breast cancer risk in women, eight analyzed the applicability of this tool in their population, seven compared the tool and/or modified it according to the specific risk factors of their population, and seven cited the model in determining eligibility for chemoprevention. CONCLUSION: The Gail model has different applicabilities Greater effectiveness and breast cancer risk are found in developed countries.

Colorectal cancer mortality in women: trend analysis in Brazil and its regions and states / Mortalidad por cáncer colorrectal en mujeres: análisis de tendencia en Brasil, Estados y Regiones / Mortalidade por câncer colorretal em mulheres: análise de tendência no Brasil, Estados e Regiões

ABSTRACT Objectives: to analyze colorectal cancer mortality trends in women in Brazil and its regions and states. Methods: ecological, time-series study with trend analysis of deaths caused by colorectal cancer in women in Brazil and its regions and states between 2008 and 2019. Polynomial regression was used to treat the data. Results: 48,225 deaths of women caused by colorectal cancer were examined. There was an increasing mortality trend in Brazilian women, with regional differences that resulted from socioeconomic, political, and cultural inequalities. The South Region stood out with the highest rate (7.32) in 2008, which increased to 8.65 in 2019, followed by the Southeast Region, whose rates were 6.72 and 9.05 in 2008 and 2019, respectively. Conclusions: colorectal cancer mortality increased, which indicates the need to expand public policies oriented toward screening and early diagnosis of colorectal cancer in women.

RESUMEN Objetivos: analizar las tendencias de mortalidad por cáncer colorrectal de mujeres en Brasil, Estados y Regiones. Métodos: estudio ecológico, de series temporales, con análisis de tendencia de decesos por cáncer colorrectal en mujeres, entre 2008 y 2019. Para análisis de tendencia se utilizó el modelo de regresión polinomial. Resultados: se analizaron 48.225 decesos de mujeres por cáncer colorrectal. Se observó tendencia creciente de mortalidad en las mujeres brasileñas, con diferencias regionales debidas a desigualdades de estándares socioeconómicos, políticos y culturales. Se manifiesta un aumento en la Región Sur, con tasa de 7,32 en 2008 incrementando a 8,65 en 2019, siguiéndole la Región Sudeste, con tasas de mortalidad de cáncer colorrectal de 6,72 y 9,05 en 2008 y 2019. Conclusiones: se observa aumento de tasas de mortalidad por cáncer colorrectal, demostrándose necesidad de incrementar las políticas públicas orientadas a estrategias de rastreo y diagnóstico precoz del cáncer colorrectal en mujeres.

RESUMO Objetivos: analisar as tendências da mortalidade por câncer colorretal em mulheres no Brasil, Estados e Regiões. Métodos: estudo ecológico, de séries temporais, com análise de tendência dos óbitos por câncer colorretal de mulheres, no período de 2008 a 2019. Para análise de tendência, foi utilizado o modelo de regressão polinomial. Resultados: analisaram-se 48.225 óbitos de mulheres por câncer colorretal. Houve tendência crescente da mortalidade em mulheres brasileiras, com diferenças regionais, em razão das desigualdades nos padrões socioeconômicos, políticos e culturais. Destacando um aumento na Região Sul, com as maiores taxas, de 7,32 em 2008 para 8,65 em 2019, seguida pela Região Sudeste, com taxas de mortalidade por câncer colorretal de 6,72 e 9,05 em 2008 e 2019, respectivamente. Conclusões: observa-se um aumento das taxas de mortalidade por câncer colorretal, demonstrando a necessidade do incremento das políticas públicas direcionadas às estratégias de rastreamento e diagnóstico precoce do câncer colorretal em mulheres.

Impact of the Covid-19 Pandemic on Women's Health in Brazil.

PURPOSE: The aim is to verify the impact of the Covid-19 pandemic on women's healthcare and medical assistance in Brazil. PATIENTS AND METHODS: This exploratory cross-sectional study evaluated a non-probabilistic sample of women above 20 years old, carried out between August and September of 2020, through a snowball sampling using a Google Forms application. RESULTS: From a total of 2495 women, more than 70% have not been screened for cervical cancer (77.8% of 2244 women aged for screening), and more than 80% have not been screened for breast cancer (80.2% from 1325 women aged for mammography) during the pandemic. Also, 55.2% of the women did not undergo routine blood tests during the same period. The most frequent reasons for not performing screening and routine tests were: they were up to date; fear of contracting Covid-19; they decided to postpone it until after the end of the pandemic; they were unable to schedule the appointment at the healthcare center for whatever reason; and the healthcare center was only attending Covid-19 patients. Women with no comorbidities have performed significantly more mammograms and routine blood tests than women with comorbidities. In addition, women with comorbidities who were used to perform periodic medical follow-up have done it substantially more than women with no comorbidities during the pandemic. CONCLUSION: As observed, there was a significant decrease in women's access to the healthcare system during this pandemic. Many participants reported that they had not attended any screening tests, and some reasons included fear of getting infected and due to the public measures of social distancing. The consequences are late diagnoses and a worse prognosis. It might impact the healthcare systems around the world in the next few years. Further studies should be done to follow these consequences.

Fatores relacionados à adesão ao tratamento farmacológico por idosos na Atenção Primária à Saúde / Factors related to adhesion to pharmacological treatment by seniors in Primary Health Care

Objective: To identify factors related to adherence to pharmacological treatment by the elderly people in Primary Health Care.Method: It is a descriptive study developed with a team of the Family Health Strategy, in a municipality in northwestern Paraná. Data were collected in June and July 2018, through a questionnaire applied at home visit. Subsequently, the data were recorded, organized in spreadsheets and submitted to descriptive statistics.Results: Among the 118 elderly participants, 61.1% were female, 78.8% were between 60 and 69 years old, 59.3% had up to eight years of schooling, 12.2% had some physical disability, 9, 7% needed help to use medication, 60.1% were taking medication as prescribed, 12.1% had already used medication changed, 39.8% used 1 to 3 medications prescribed by the doctor, 50% reported Self-medication, 84.7% reported knowledge of the indication of all medications, 5.1% indicated that the greatest difficulty in adhering to treatment is that the medication is not provided free of charge. Conclusion: Given the factors highlighted by the participants as influential in adherence to drug treatment, it is necessary that professionals and managers jointly establish strategies to facilitate access to the necessary drugs for seniors.

Objetivo: identificar os fatores relacionados à adesão ao tratamento farmacológico por idosos na Atenção Primária à Saúde. Método: Estudo descritivo desenvolvido junto a uma equipe da Estratégia Saúde da Família, em um município do noroeste do Paraná. Os dados foram coletados nos meses de junho e julho de 2018, por meio de questionário aplicado no momento da visita domiciliar. Posteriormente, os dados foram registrados, organizados em planilhas e submetidos à estatística descritiva. Resultados: Dentre os 118 idosos participantes, 61,1% eram do sexo feminino, 78,8% tinham entre 60 e 69 anos, 59,3% possuíam até oito anos de estudo, 12,2% apresentavam alguma deficiência física, 9,7% necessitavam de auxílio para utilizar medicamentos, 60,1% faziam uso da medicação conforme prescrição médica, 12,1% já fez uso de medicamento trocado, 39,8%, utilizavam de 1 a 3 medicamentos prescritos pelo médico, 50% relataram automedicação, 84,7% relataram conhecimento da indicação de todos os medicamentos, 5,1% indicaram que a maior dificuldade para aderir ao tratamento é o medicamento não ser fornecido gratuitamente. Conclusão: Diante dos fatores destacados pelos participantes como influentes na adesão ao tratamento medicamentoso, torna-se necessário que profissionais e gestores estabeleçam conjuntamente estratégias para facilitar o acesso aos medicamentos necessários para os idosos.

Comparative Analysis between the Gail, Tyrer-Cuzick and BRCAPRO Models for Breast Cancer Screening in Brazilian Population.

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.