Systematic Review of Nomograms Used for Predicting Pathological Complete Response in Early Breast Cancer.

Pathological complete response (pCR) is an important surrogate outcome to assess the effects of neoadjuvant chemotherapy (NAC). Nomograms to predict pCR have been developed with local data to better select patients who are likely to benefit from NAC; however, they were never critically reviewed regarding their internal and external validity. The purpose of this systematic review was to critically appraise nomograms published in the last 20 years (2010-2022). Articles about nomograms were searched in databases, such as PubMed/MEDLINE, Embase and Cochrane. A total of 1120 hits were found, and seven studies were included for analyses. No meta-analysis could be performed due to heterogeneous reports on outcomes, including the definition of pCR and subtypes. Most nomograms were developed in Asian centers, and nonrandomized retrospective cohorts were the most common sources of data. The most common subtype included in the studies was triple negative (50%). There were articles that included HER2+ (>80%). In one study, scholars performed additional validation of the nomogram using DFS and OS as outcomes; however, there was a lack of clarity on how such endpoints were measured. Nomograms to predict pCR cannot be extrapolated to other settings due to local preferences/availability of NAC. The main gaps identified in this review are also opportunities for future nomogram research and development.

Impact of the COVID-19 pandemic on the breast cancer early diagnosis program in Brazil.

During the COVID-19 pandemic, several screening exams were postponed, including mammograms. The aim of this study was to evaluate the impact of COVID-19 in mammographic screening in Brazil, considering 2015 to 2021. This was descriptive ecologic study based on the retrospective data of Brazil's mammographic screening program. A Brazilian national screening database (DATASUS - SISCAN (Cancer System Information)) was used as the data source, and the data in this database are publicly available for download and analysis. We report the number of screening rate from January 2015 to December 2021, using 2020 as reference year for COVID-19. From 2015 to 2021, 10,763,894 mammograms were performed and included in the analysis. Reductions of 39.6% and 13.3% were found in 2020 in 2021, respectively. During the pandemic's peak, the reduction was more pronounced, with maximum reductions of 82.4% in May 2020 and 34.8% in April 2021. There was an increase in the number of mammograms performed on high-risk patients from 11.2% in 2020 to 13.9% in 2021. This research demonstrated a decline in the breast cancer screening rate during the two years of the COVID-19 pandemic; this reduction will increase the burden of advanced breast cancer, potentially impacting morbidity and mortality related to this neoplasm.

Real-world evidence of neoadjuvant chemotherapy for breast cancer treatment in a Brazilian multicenter cohort: Correlation of pathological complete response with overall survival.

OBJECTIVES: We aimed to evaluate the pCR rate in patients receiving NAC for the treatment of breast cancer (BC) in a multicenter cohort in Brazil. Additionally, we aimed to use RWD to assess the impact of pCR on OS and DFS. METHODS: This was a retrospective, multicenter cohort study that included female patients over 18 years of age who were diagnosed with nonmetastatic breast cancer and received NAC. OS and DFS at five years were estimated by the Kaplan‒Meier method. Additionally, we conducted a multivariate analysis to identify factors that were significantly associated with pCR and OS. RESULTS: From 2011 to 2020, 1891 patients were included in the study, and 421 (22,3%) achieved pCR (ypT0 ypN0). Considering the presence of residual DCIS, pCR was achieved in 467 patients (23,5%). The pCR rate varied between the subtypes: HER-2+ (p = 0,016) and clinical stage IIIA and IIIB (p < 0,001). Among HER-2+ patients, those who received trastuzumab had a significantly higher pCR rate than those who did not receive trastuzumab (p < 0.0001). Similarly, patients with TNBC who received treatment with platinum-based regimens also showed higher pCR rates (p < 0.0001). OS was grouped according to pCR status, and the OS rate was 88,3% in the pCR group and 58.1% in the non-pCR group (p < 0.0001). The five-year DFS was 92.2% in the pCR group and 64.3% in the non-pCR group (p < 0.0001). CONCLUSION: The pCR rate and its prognostic value varied across BC subtypes. In our study, pCR could be used as a surrogate of favorable clinical outcome, as it was associated with higher OS and DFS rates.

Does Pink October really impact breast cancer screening?

Objective: This study aims to evaluate the impact of the Pink October Campaign on the increase in mammographic screening in Brazil. Study design: Ecological observational study, based on retrospective data. Methods: Brazilian national screening database (DATASUS/SISMAMA/Information System on Breast Cancer) was used as a data source and is publicly available for download and analysis. We report screening numbers and outcome rates from January 2017 to December 2021 comparing statistically (ANOVA test, post-Tukey test), age groups, regions of Brazil, and the four quarters of the year. Results: During the study period, the average number of exams performed monthly over the five years was 137,400.117. An increase in the number of mammograms performed in October was identified, as well as in the two following months, respectively 33%, 39%, and 22%, with statistical significance (p = 0.000) in relation to the three quarters of the year. In addition, in the other months, we found values below the monthly average. Statistical difference was not found in the increase in mammograms considering age groups (p = 0.5) and different regions of the country (p = 0.6). Conclusions: This study showed an increase in mammographic screening in the three months following the Pink October Campaign, so we should intensify similar actions throughout the year and not just in October.

Comparative analysis between screening mammography performed in patients at usual risk and at high risk for breast cancer

Breast cancer is currently considered as a public health issue. To avoid late diagnosis, there is an attempt to use appropriate screening programs addressed to the early detection by testing the asymptomatic population in order to identify preclinical stage lesions. Methods: This is a retrospective, analytical, cross-sectional study of the notifications available in the cancer information system. The incidence of notifications from the reports of the BI-RADS™ notification system (Breast Imaging Reporting Data System) was compared between women at high and usual risk for breast cancer. Results: In the analyzed period, from 2013 to 2021, 16,065,383 screening mammographies were performed and notified in Brazil. Of these, 13,167,259 were performed in usualrisk women, whereas 2,898,124 were performed in high-risk women. To analyze the difference between reports of women at usual and high risk, the relative risk between them was calculated, as well as the necessary number to causa damage; the relative risk we found was of 0.5412 (95%CI 0.5341­0.5483) in B4 and relative risk of 0,433 (95%CI 0.4203­0.4462). As to the necessary number to cause damage, we observed 203 (95%CI 198­209) for B4 and 788 (95%CI 754­825) for B5. Despite the well-established need for breast cancer screening programs to reduce mortality, some aspects of screening do not have such a consensus. In this study, the incidence of reports that are suggestive of malignant breast lesions was higher among women at high risk.

Effects of clinical heterogeneity on Pregnancy-Associated Breast Cancer survival: a systematic review with meta-analysis

Pregnancy-associated breast cancer is defined as a diagnosis of breast cancer during pregnancy or within 1 year of childbirth. Current evidence shows that Pregnancy-associated breast cancer is associated with poor prognosis; however, no systematic review has summarized and explored how baseline characteristics could impact survival. We aimed to explore the impact of breast cancer characteristics on death and disease relapse. A systematic review with meta-analyses was conducted by searching articles in the main databases (Medline, Embase, and Cochrane) and congress abstracts. Summarized death and disease-free survival hazard ratios were recalculated, and all meta-analyses used a random-effects model. Heterogeneity was reported using the I2 method. A total of 7143 studies were identified and only 30 studies were included. Pregnancy-associated breast cancer is associated with a 96% (HR 1.96; 95%CI 1.58­2.35) higher risk of death and 82% (HR 1.82; 95%CI 1.45­2.20) risk of death or disease relapse in comparison to a population of non-pregnancy-associated breast cancer or nulliparous breast cancer. Through sensitivity analyses, we identified that clinical outcomes were impacted, possibly due to Ki-67 levels, poorly differentiated tumors, and triple-negative breast cancer frequency in the study. As relevant sources of inconsistencies, such clinical cancer-related characteristics should be better investigated as potential confounders for upcoming Pregnancy-associated breast cancer therapeutic strategies.

Relação do Índice de Massa Corporal e Linfedema Secundário a tratamento cirúrgico do Câncer de Mama: estudo retrospectivo / Relationship of Body Mass Index and Secondary Lymphedema to Surgical Treatment of Breast Cancer: a retrospective study

INTRODUÇÃO: O câncer de mama é a neoplasia mais incidente na população feminina brasileira, sendo o linfedema uma de suas principais complicações cirúrgicas. OBJETIVO: Verificar a relação do índice de massa corpóreo e o desenvolvimento do linfedema no pós-operatório de câncer de mama, sua relação com o tipo de tratamento e ao tempo pós-cirúrgico. MATERIAIS E MÉTODOS: Foram levantados prontuários de 59 mulheres no período de maio de 2008 a fevereiro de 2009 utilizando dados da anamnese; exame físico; perimetria, volume estimado; relatos, sintomas e dados em prontuário. A análise foi feita por meio de médias e desvios padrões para as variáveis quantitativas e qualitativas (absoluta e relativa) e para verificação dos fatores de risco foi utilizado o Teste t de Student e Teste Qui-quadrado de Pearson com nível de significância de 5%. RESULTADOS: A frequência de linfedema foi de 47,5%, sendo que 40,7% eram obesas. Observou-se diferença significativa entre os grupos de linfedema e IMC (p=0,002). Nota-se ainda diferença significativa entre linfedema no grupo sem radioterapia de axila (p=0,003) e associação entre o tempo pós-cirúrgico e linfedema (p=0,006), sendo maior após 6 meses de cirurgia. CONCLUSÃO: Existe correlação entre obesidade e desenvolvimento do linfedema. Os tipos de tratamento parecem não ter influenciado o seu desenvolvimento e quanto mais tempo decorrido pós- cirurgia, maior o risco do seu aparecimento.

INTRODUCTION: Breast cancer is the most common neoplasm in the Brazilian female population, with lymphedema being one of its main surgical complications. OBJECTIVE: To verify the relationship between the body mass index and the development of lymphedema in the postoperative period of breast cancer, its relationship with the type of treatment received and the time elapsed from the surgery. MATERIALS AND METHODS: Medical records of 59 women were collected from May 2008 to February 2009 using data from anamnesis, physical exam; perimetry, estimated volume; reports, symptoms, and notes in medical records. The analysis was performed using means and standard deviations for the quantitative and qualitative variables (absolute and relative) and to verify the risk factors used, the Student's t-test and Pearson's chi-square test with a 5% significance level (0.05). RESULTS: The frequency of lymphedema was 47.5%, with 40.7% being obese. There was a significant difference between the groups of lymphedema and BMI (p=0.002). There is also a significant difference between lymphedema in the group without axillary radiotherapy (p=0.003) and an association between post-surgical time and lymphedema (p=0.006), being greater after six months of surgery. CONCLUSION: There is a correlation between obesity and the development of lymphedema. The types of treatment do not seem to have influenced their development, and the longer the surgery has elapsed, the greater the risk of their appearance.

Influence of breast cancer subtype on pathological complete response

Objective: To compare the rates of pathological complete response (pCR) after treatment with neoadjuvant chemotherapy, in the different subtypes of breast cancer in patients followed at the Mastology Service of Hospital do Servidor Público Estadual. Methods: Descriptive and retrospective study, in which medical records of 213 patients diagnosed with breast cancer and submitted to neoadjuvant chemotherapy were reviewed, from February 2011 through January 2018. Histological data collected were: hormone receptors, hyperexpression of HER-2, grade, histological type and clinical data: age of the patient at diagnosis, tumor size and clinical stage at diagnosis and after chemotherapy, and rate of pCR. Results: The mean age of patients at diagnosis was 53.97 years. Forty-six patients (21,6%) had pCR, 77 (36.1%) were grade 2 and 136 (63.9%) were grade 3. Regarding cancer subtype, 29 patients (13.6%) were reported to have pure HER2 subtype, 48 patients (22.5%) corresponded to Luminal A subtype, 51 (23.9%) to Luminal B, and 66 patients (31.0%) were characterized as Triple Negative, while only 17 patients (7.9%) had Luminal B HER. Conclusion: The subtypes Pure HER 2 and Luminal B had the highest pCR rates.

PHYLLODES TUMORS OF THE BREAST: A RETROSPECTIVE EVALUATION OF CASES FROM THE HOSPITAL DO SERVIDOR PÚBLICO ESTADUAL DE SÃO PAULO / Tumor filoides de mama: avaliação retrospectiva de casos do Hospital do Servidor Público Estadual de São Paulo

Objective: To evaluate the clinical and pathological characteristics of phyllodes tumors, and to identify possible associated risk factors for relapses among patients from the Breast Surgery Department of the Hospital do Servidor Público Estadual of São Paulo (HSPE-SP). Methods: Retrospective, descriptive study of data from 52 patients, between 1976 and 2013. The following data were collected: age, tumor size, histological type, surgical margins, type of surgery performed, relapses and amount of time before relapse. Results: The mean age of the patients was 45.7 years old, the mean size of the tumor was 7.8 cm. A mastectomy was performed on 12 patients, and the others underwent a wide excision. Benign phyllodes tumors were found in 30 patients, and the others were found as follows: 11 with borderline tumors and 11 with malign phyllodes tumors. There was no statistical relevance with regard to the relapses and the characteristics evaluated. Conclusion: The sample studied has similar clinical and pathological characteristics as described in the scientific literature, with the mean age at diagnosis being 45 years old, the mean tumor size, 7.8 cm. The majority found were benign phyllodes tumors and 33% were from relapses. There was no statistical significance between the evaluated variables and the risk for relapse.

Objetivo: Avaliar as características clínicas e patológicas do tumor filoides e identificar fatores relacionados com risco de recidivas em pacientes acompanhadas no ambulatório de Mastologia do Hospital do Servidor Público Estadual de São Paulo (HSPE-SP). Método: Estudo retrospectivo descritivo de dados de 52 pacientes, entre 1976 e 2013, dentre os quais: idade, tamanho do tumor, tipo histológico, margens cirúrgicas, tipo de cirurgia, recidivas e tempo para recidiva. Resultados: A idade média das pacientes foi 45,7 anos. O tamanho médio do tumor foi de 7,8 cm. O tratamento em 12 pacientes foi a mastectomia, e as demais 40 a excisão ampla. O tipo histológico encontrado em 30 pacientes foi tumores benignos, 11 malignos e 11 de variedade borderline. Após o seguimento médio de 53,93 meses, observaram-se 17 recidivas. Não houve relevância estatística entre a recorrência local e as variáveis avaliadas. Conclusões: A amostra avaliada tem características clínicas e patológicas condizentes com a literatura, com média de idade de 45 anos, tamanho do tumor de 7,8 cm, sendo encontrados na maioria tumor filoides benigno e 33% de recidivas. Não houve significância estatística entre características avaliadas e o risco de recidiva.

Genetic polymorphism of GSTM1 in women with breast cancer and interact with reproductive history and several clinical pathologies.

Due to the conflicting results regarding the association between breast cancer and the GSTM1 null mutation, our aim was to research this association in a Brazilian population and correlations with smoking, reproductive history and several clinical pathologies. A case-control study was performed on 105 women with breast cancer and 278 controls. Extraction of DNA was accomplished according to the protocol of the GFX kit and polymorphism analysis by the PCR technique. The control and experimental groups were compared and statistical analysis assessed by X2 or Fisher's exact test. The deletion in the GSTM1 gene in the breast cancer group had a prevalence of 32 (30.4%) individuals with the presence of null mutation. In the control group, the null mutation was present in 104 (37.4%) women. Upon comparison of the two groups, no statistically significant difference of the GSTM1 gene was observed, with an odds ratio (OR) of 0.74, 95%, confidence interval (CI) 0.45 - 1.20, p = 0.277. The results conclusively show that single gene GSTM1 polymorphisms do not confer a substantial risk of breast cancer to its carriers. Furthermore, in this study no correlation was found between GSTs and smoking, reproductive history and several clinical pathologies with respect to cancer risk.

Valor prognóstico do grau histológico (GH), grau nuclear (GN) e índice mitótico (IM) para pacientes com carcinoma da mama estádios II e III com linfonodos axilares comprometidos / Prognostic value of histological and nuclear grades and mitotic index for patients with stages II and III breast carcinoma with positive axillary lymph nodes

Avaliar o grau histológico (GH), grau nuclear (GN) e índice mitótico (IM) como fatores prognósticos para metástase em pacientes com carcinoma da mama, estádios clínicos II e III com linfonodos axilares comprometidos. Métodos: Cinquenta e três pacientes foram submetidas a tratamento cirúrgico primário, através de mastectomia radical (Halsted) ou radical modificada (Patey), à quimioterapia e à radioterapia em parede torácica e fossa supraclavicular. O esquema quimioterápico compreendeu fluoracil, adriamicina e ciclofosfamida para pacientes com 50 anos ou menos; fluoracil, metrotrexate e ciclofosfamida para pacientes com mais de 50 anos. A presença de doença sistêmica foi, inicialmente, descartada e todas essas pacientes foram avaliadas por período mínimo de cinco anos ou até o aparecimento de metástases. O GH foi determinado através do método deScarf-Bloom-Richardson modificado, o GN pelo método de Black modificado e o IM em dez campos de grande aumento (CGA) na periferia do tumor. Resultados: Das 53 pacientes, 27 (50,9 por cento) apresentaram metástases à distância. Destas, 18,5 por cento eram portadoras de tumores GH I (5/27); 14,8 por cento GH II (4/27) e 66,7 por cento GH III (18/27). Vinte seis (49,1 por cento) pacientes não apresentaram metástases. Destas, 38,4 por cento foram classificadas como grau I (10/26), 15,4 por cento como grau II (4/26) e 46,2 por cento como grau III (12/26). O estudo do GN demonstrou que, das pacientes com metástases, 3,7 por cento (1/27) apresentavam tumor grau I, 22,2 por cento (6/27) tumores grau II e 74,1 por cento (20/27) tumorescom grau III. Das sem metástases, 19,2 por cento (5/26) foram grau I, 34,6 por cento (9/26) grau II e 46,2 por cento (12/26) tumores grau III. Em relação ao IM, das pacientes com metástases, 14,8 por cento (4/27) apresentavam até cinco mitoses em 10 CGA, 25,9 por cento (7/27) seis a dez mitoses e 59,3 por cento (16/27) mais de dez mitoses. Em relação às sem metástases, 38,5 por cento(10/26) apresent...

Polimorfismo do gene do receptor de progesterona ( PROGINS ) em mulheres com câncer de mama: estudo caso-controle / Polymorphism in genes of the progesterone receptor ( PROGINS ) in women with breast cancer: a case-control study

OBJETIVOS: analisar a correlação entre o polimorfismo PROGINS e o câncer de mama. MÉTODOS: estudo caso-controle desenvolvido entre abril e outubro de 2004 com o pareamento de 50 mulheres com diagnóstico histopatológico de carcinoma de mama e 49 mulheres saudáveis. A inserção Alu de 306 pares de base no intron G do gene do receptor da progesterona denominada PROGINS foi detectada por meio de reação em cadeia da polimerase e analisada em gel de agarose 2 por cento corado com brometo de etídio. Os grupos controle e experimental foram comparados, por meio de programa estatístico Epi-Info 6.0, quanto aos genótipos e às freqüências alélicas, utilizando-se o teste do chi2. RESULTADOS: em relação ao PROGINS encontramos uma prevalência na população estudada de 62 (62,6 por cento) indivíduos homozigotos selvagens, 35 (35,3 por cento) de heterozigotos e dois (2,1 por cento) casos com a presença da mutação. Não foi evidenciada diferença significante em relação ao polimorfismo PROGINS, quando comparados os casos e controles, seja com relação à homozigose (62 vs 65,3 por cento), heterozigose (36 vs 34,6 por cento) ou à presença de mutação (2,0 vs 2,1 por cento), com p de 0,920 (OR=1,01), 0,891 (OR=1,06) e 0,988 (OR=1,10), respectivamente. CONCLUSÕES: os resultados mostraram que o polimorfismo PROGINS não conferiu risco substancial de câncer de mama em seus portadores

Genetic polymorphism of GSTM1 in women with breast cancer and interact with reproductive history and several clinical pathologies

Due to the conflicting results regarding the association between breast cancerand the GSTM1 null mutation, our aim was to research this associationin a Brazilian population and correlations withsmoking, reproductive history and several clinical pathologies. A case-control study was performed on 105 women with breast cancer and 278 controls. Extraction of DNA was accomplished according to the protocol of the GFX© kit and polymorphism analysis by the PCR technique. The control and experimental groups were compared and statistical analysis assessed by Xy or Fisher's exact test. The deletion in the GSTM1 gene in the breast cancer group had a prevalence of 32 (30.4 percent) individuals with the presence of null mutation. In the control group, the null mutation was present in 104 (37.4 percent) women. Upon comparison of the two groups, no statistically significant difference of the GSTM1 gene was observed, with an odds ratio (OR) of 0.74, 95 percent, confidence interval (CI) 0.45 - 1.20, p = 0.277. The results conclusively show that singlegene GSTM1 polymorphisms do not confer a substantial risk of breastcancer to its carriers. Furthermore, in this study no correlation was found between GSTs andsmoking, reproductive history and several clinical pathologies with respect to cancer risk.

Citologia aspirativa no carcinoma da mama / Aspirative cytology of breast carcinoma

O presente estudo visou avaliar a eficiência da citologia oncótica, obtida através de punçäo aspirativa com agulha fina, em pacientes portadoras de neoplasia mamária maligna, diagnosticada clínica e/ou radiologicamente e confirmada por exame histológico. Tal procedimento revelou-se método de execuçäo simples, pouco dispendioso e presuntivo de malignidade em 78,4% dos casos nas quais se obteve material suficiente para o estudo citológico

Tumor filodes (Cistossarcoma filodes) / Phyllodes Tumor (Cystosarcoma Phyllodes)

Objetivo: analisar o comportamento clínico, a conduta terapêutica e o seguimento de 23 casos de tumor filodes. Método: Foi realizada análise retrospectiva de 23 prontuários de pacientes com diagnóstico histopatológico de tumor filodes no período de 1976 a 1992. Resultados: A relaçäo tumor filodes / fibroadenoma foi de 1:19. A faixa etária predominante foi de 41 a 50 anos, com 11 casos (47,8 por cento). As variedades histológicas que predominaram foram as benignas e as fronteiriças (borderlines) ocorrendo 10 casos de cada (43,4 por cento). Em relaçäo ao tratamento, 15 pacientes (65,2 por cento) submeteram-se a tumorectomia e 8 pacientes (34,8 por cento), à mastectomia. Houve 9 casos (39,1 por cento) de recidivas locais, ocorrendo 1 óbito por caquexia após a terceira recidiva. Houve 4 recidivas em 10 variedades benignas (40 po cento) e igual número nas fronteiriças (borderlines), enquanto nas malignas ocorreu uma em 3 casos (33,3 por cento); com relaçäo ao tratamento cirúrgico ocorreram 3 recidivas em 8 pacientes mastectomizadas (37,5 por cento) e em 15 pacientes com tumorectomia (40 por cento). As recidivas predominaram na faixa etária menor que 40 anos, com 3 em 5 casos (60 por cento). A maioria das recidivas (66,7 por cento) ocorreu até 25 meses após o tratamento cirúrgico inicial. Conclusöes: 1. A variedade histógica e o tipo de tratamento cirúrgico näo influenciaram no aparecimento das recidivas. 2. A amioria das recidivas ocorreu até 24 meses após o tratamento cirúrgico inicial, exigindo, pacientes na faixa etária menor que 40 anos (60,0 por cento) pode se dever a ressecçäo insuficiente (enucleraçäo), visando a melhor resultado estético

Câncer da mama localmente avançado (T3 e T4): tratamento por radioterapia e mastectomia simples / Locally advanced breast cancer (T3 and T4): treatment with radiotherapy and simple mastectomy

Säo analisados os resultados obtidos no tratamento de 193 pacientes com carcinoma avançado da mama, isto é, estádios III (174 casos) e IV (19 casos). Todas as pacientes foram submetidas a radioterapia radical e, seis semanas após, a mastectomia simples. A quimioterapia foi efetuada em 53 enfermos pelo CMF (12 séries) e a ooforectomia em 52. Foi obtido 45% de sobrevivência de cinco anos, sendo que as pacientes que receberam quimioterapia tiveram maior intervalo livre de doença