Training in oncoplastic surgery for mastologists

SUMMARY OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries.

Translation and Cross-Cultural Adaptation of the LYMPH-ICF Instrument for Lymphedema into Portuguese/Brazil / Traducción y adaptación transcultural al portugués/Brasil del instrumento LYMPH-ICF para linfedema / Tradução e adaptação transcultural para o português/Brasil do instrumento LYMPH-ICF para linfedema

ABSTRACT Objective: The aim of this study is to cross-culturally adapt the Lymphoedema Functioning, Disability and Health Questionnaire Lymphoedema (LYMPH-ICF) instrument into Brazilian Portuguese and conduct a pilot application (n = 10), without psychometric pretensions. Method: Methodological research was conducted, following the steps of translation, synthesis, back-translation, and evaluation by the expert committee. Two translators, two back-translators, and twelve professionals participated in the expert committee. A pretest was carried out with 10 patients with secondary lymphedema due to breast cancer. The degree of agreement was determined by the content validity coefficient. Results: It was necessary to modify 8 out of the 29 questions comprising the questionnaire, which exhibited idiomatic disagreement. However, despite these changes, there were no indications of impairments, as content reliability was achieved through a validity coefficient of 0.90. Final Considerations: The instrument was successfully translated and cross-culturally adapted for Brazil with a high level of agreement.

RESUMEN Objetivo: Realizar la adaptación transcultural del instrumento Cuestionario de Funcionamiento, Discapacidad y Salud del Linfedema (LYMPH-ICF) al portugués de Brasil y una aplicación piloto (n = 10), sin pretensiones psicométricas. Método: Investigación metodológica, siguiendo los pasos de traducción, síntesis, retrotraducción y evaluación por parte del comité de expertos. Participaron dos traductores, dos retrotraductores y doce profesionales para el comité de expertos. Se realizó una prueba piloto con 10 pacientes con linfedema secundario al cáncer de mama. Y el grado de concordancia se obtuvo mediante el coeficiente de validez de contenido. Resultados: Hubo necesidad de modificar 8 de las 29 preguntas que componen el cuestionario, las cuales mostraron discordancia idiomática. Sin embargo, a pesar de que se realizaron dichas modificaciones, no hubo indicación de perjuicios, ya que se alcanzó la confiabilidad del contenido mediante la obtención de 0,90 en el coeficiente de validez. Conclusiones: El instrumento fue traducido y adaptado transculturalmente para Brasil con un alto grado de concordancia.

RESUMO Objetivo: realizar a adaptação transcultural do instrumento Lymphoedema Functioning, Disability and Health Questionnaire Lymphoedema (LYMPH-ICF) para o português do Brasil e uma aplicação piloto (n = 10), sem pretensão psicométrica. Método: pesquisa metodológica, seguindo os passos de tradução, síntese, retrotradução e avaliação pelo comitê de especialistas. Participaram dois tradutores, dois retrotradutores e doze profissionais para o comitê de especialistas. Realizou-se o pré-teste com 10 pacientes com linfedema secundário ao câncer de mama. E o grau de concordância foi obtido pelo coeficiente de validade de conteúdo. Resultados: houve a necessidade de modificar 8 das 29 questões que compõem o questionário, as quais demonstraram discordância idiomática. Contudo, mesmo que tais alterações tenham sido realizadas, não houve indicação de prejuízos, já que foi alcançada a confiabilidade do conteúdo através da obtenção de 0,90 pelo coeficiente de validade. Considerações finais: o instrumento foi traduzido e adaptado transculturalmente para o Brasil com alto grau de concordância.

Criteria for selection and classification of studies in medical events

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. METHODS: A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach's alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi's all-pairs comparisons. RESULTS: A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01). CONCLUSION: Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies.

Adesão à Terapia Hormonal Adjuvante com Tamoxifeno e Anastrozol utilizando ARMS-12 e MMAS-4 / Adherence to Adjuvant Hormone Therapy with Tamoxifen and Anastrozole using ARMS-12 and MMAS-4 / Adherencia a la Terapia Hormonal Adyuvante con Tamoxifeno y Anastrozol utilizando ARMS-12 y MMAS-4

Introdução: Entre os cânceres de mama, aproximadamente 75% das mulheres são receptores hormonais positivos, sendo estas mais propensas a responderem à hormonioterapia com anastrozol e tamoxifeno. Apesar de eficazes, apresentam taxas significativas de não adesão. Objetivo: Avaliar a adesão à terapia hormonal adjuvante com tamoxifeno e anastrozol em pacientes atendidos nos Ambulatórios da Mastologia e de Quimioterapia do Hospital São Paulo entre os anos de 2019 e 2020. Método: Estudo transversal com 102 mulheres, realizado entre os meses de setembro de 2019 e março de 2020. A adesão à terapia hormonal adjuvante foi avaliada utilizando-se as escalas Morisky Medication Adherence Scale (MMAS-4) e Adherence to Refills and Medications Scale of 12 items (ARMS-12). Resultados: A média de idade foi de 61,5 anos (59,3-63,6). Entre as pacientes, 27,7% faziam uso de tamoxifeno e 72,3% de anastrozol. Relataram desconforto em relação ao uso do medicamento 84,4%, sendo as ondas de calor (42,2%) e as dores articulares (55,9%) os mais frequentes. A escala de ARMS>12 foi pontuada por 79,2%; cerca de 90% das mulheres pontuaram a MMAS-4 até dois pontos, porém não houve diferença significativa entre os tipos de hormônios utilizados para escalas de adesão (p=0,815 e p=0,489). Conclusão: A adesão à hormonioterapia observada foi relativamente baixa, independentemente da endocrinoterapia, podendo essas pacientes estarem em risco de inadequação quanto à resposta clínica

Introduction: Among breast cancers, approximately 75% of women are hormone receptors-positive, and these are more likely to respond to hormone therapy with anastrozole and tamoxifen. Although effective, they have significant rates of non-adherence. Objective: To evaluate adherence to adjuvant hormone therapy with tamoxifen and anastrozole in patients consulted at the Mastology and Chemotherapy Outpatient Clinic of Hospital São Paulo between 2019 and 2020. Method: Cross-sectional study carried out with 102 women between September 2019 and March 2020. Adherence to hormone therapy was evaluated using the Morisky Medication Adherence Scale (MMAS-4) and Adherence to Refills and Medications Scale of 12 items (ARMS-12). Results: The mean age was 61.5 years (59.3-63.6). Among the patients, 27.7% used tamoxifen and 72.3%, anastrozole. 84.4% of them reported discomfort in using the medication, the most frequent were hot flashes (42.2%) and joint pain (55.9%). 79.2% scored the ARMS>12 scale, about 90% of the women scored MMAS-4 up to 2 points, but there was no significant difference between the types of hormones used for adhesion scales (p=0.815 to p=0.489). Conclusion: Adherence to hormone therapy was relatively low, regardless of the hormone used, and these patients may be at risk of inadequate clinical response

Introducción: Entre los cánceres de mama, aproximadamente el 75% de las mujeres son receptores hormonales positivos, y estas son más propensas a responder a la terapia hormonal con anastrozol y tamoxifeno. Aunque son eficaces, tienen tasas significativas de no adherencia. Objetivo: Evaluar la adhesión a la terapia hormonal adyuvante con tamoxifeno y anastrozol en pacientes atendidas en las Clínicas Ambulatorias de Mastología y Quimioterapia del Hospital São Paulo entre 2019 y 2020. Método: Este es un estudio transversal realizado con 102 mujeres entre septiembre de 2019 y marzo de 2020. La terapia hormonal adjunta se evaluó utilizando las escalas Morisky Medication Adherence Scale (MMAS-4) e Adherence to Refills and Medications Scale of 12 items (ARMS-12). Resultados: La edad media fue de 61,5 años (59,3-63,6). Entre las pacientes, el 27,7% utilizaron tamoxifeno y el 72,3% anastrozol. El 84,4% de ellas reportaron molestias en relación con el uso del medicamento, siendo los más frecuentes los sofocos (42,2%) y el dolor articular (55,9%). 79,2% puntuaron la escala ARMS>12, alrededor del 90% de las mujeres obtuvieron MMAS-4 hasta dos puntos, pero no hubo diferencia significativa entre los tipos de hormonas utilizadas para escalas de adhesión (p=0,815 a p=0,489). Conclusión: La adherencia de la terapia hormonal observada fue relativamente baja, independientemente de la hormona utilizada, y estas mujeres pueden estar en riesgo de respuesta clínica inadecuada

Prevalence of xerostomia in women during breast cancer chemotherapy / Prevalencia de la xerostomía en mujeres durante la quimioterapia por cáncer de mama / Prevalência da xerostomia em mulheres durante a quimioterapia por câncer de mama

ABSTRACT Objective: To identify the prevalence of xerostomia in women undergoing chemotherapy for breast cancer. Method: Prospective cohort with 27 women who underwent up to 16 sessions of intravenous chemotherapy. Data collection was performed at the outpatient clinic of a university hospital in the city of São Paulo, where two forms were applied before the start of treatment and the Xerostomia Inventory before and after each chemotherapy session. Results: Complaints of dry mouth were present in 48.1% of women before chemotherapy, and they were approximately 28 times more likely to develop dry mouth during treatment. It was observed that the use of antiemetics contributed to the occurrence of xerostomia, and the anti-ulcerous were presented as a protective factor. Conclusion: The study identified both a high prevalence of xerostomia regardless of the chemotherapy used and the need to create protocols to improve the quality of life of these patients.

RESUMEN Objetivo: Identificar la prevalencia de la xerostomía en las mujeres en tratamiento quimioterápico por cáncer de mama. Método: Cohorte prospectiva con 27 mujeres que realizaron hasta 16 sesiones de quimioterapia endovenosa. La recogida de datos ha sido realizada en el ambulatorio de un hospital universitario en la ciudad São Paulo, donde han sido aplicados dos formularios antes del inicio del tratamiento y el Xerostomia Inventory antes y después de cada sesión de quimioterapia. Resultados: La queja de boca seca estuvo presente en 48,1% de las mujeres antes de la quimioterapia, y ellas tuvieron aproximadamente 28 veces más chance de desarrollar la xerostomía durante el tratamiento. Se observó que el uso de antieméticos contribuyó para la ocurrencia de xerostomía, y los antiulcerosos se presentaron como factor de protección. Conclusión: El estudio identificó tanto una alta prevalencia de xerostomía independientemente de la quimioterapia empleada cuanto la necesidad de la creación de protocolos visando a la mejoría de la calidad de vida de esas pacientes.

RESUMO Objetivo: Identificar a prevalência da xerostomia nas mulheres em tratamento quimioterápico por câncer de mama. Método: Coorte prospectiva com 27 mulheres que realizaram até 16 sessões de quimioterapia endovenosa. A coleta de dados foi realizada no ambulatório de um hospital universitário na cidade de São Paulo, onde foram aplicados dois formulários antes do início do tratamento e o Xerostomia Inventory antes e após cada sessão de quimioterapia. Resultados: A queixa de boca seca esteve presente em 48,1% das mulheres antes da quimioterapia, e elas tiveram aproximadamente 28 vezes mais chance de desenvolver a xerostomia durante o tratamento. Observou-se que o uso de antieméticos contribuiu para a ocorrência de xerostomia, e os antiulcerosos se apresentaram como fator de proteção. Conclusão: O estudo identificou tanto uma alta prevalência de xerostomia independentemente da quimioterapia empregada quanto a necessidade da criação de protocolos visando à melhoria da qualidade de vida dessas pacientes.

Plagiarism in scientific publications

Plagiarism in scientific publications is a topic of fundamental importance and rarely addressed in the literature. It is associated with ethical issues that go beyond research itself, a fact that values the discussion on the topic. The concept, the main types of plagiarism, ethical relationships, preventive methodologies aiming to minimize their occurrence, diagnostic methodologies, and potential penalties involved are discussed. Every researcher and team involved in publishing articles should be aware of the importance and relevance of not plagiarizing, since being cautious about it is essential to build a solid curriculum on the part of the researcher, and credibility on the part of scientific journals.

Criteria for evaluating studies at scientific medical events

Medical journals value the quality of studies. Scientific events are spaces for discussion in the face of scientific advances, innovation and consensus. In them, space is opened for the presentation of clinical studies, translational studies, experience reports and videos, with the best-designed studies being selected and awarded. The lack of clear criteria allows for differences in assessments, making it difficult to place value on situations associated with research. In order to improve quality, it is necessary to evaluate ethics, the hierarchy of scientific evidence (methodology), the study design, the originality, the relevance, and the linearity of the material presented. The present study aims to discuss these points, presenting proposals to be used in the evaluation of clinical studies, translational studies, case reports and videos in scientific medical events.

Effects of anastrozole on Ki-67 antigen expression in the vaginal epithelium of female rats in persistent estrus

OBJECTIVES: Aromatase inhibitors are the first-choice drugs for the treatment of hormone sensitive breast cancer. However, in addition to the scarcity of studies, there are controversies about their effects on vaginal epithelial cell proliferation in rats, especially those in persistent estrus. METHODS: To investigate vaginal epithelial cell proliferation by Ki-67 antigen expression, persistent estrus was induced in 42 randomly selected rats. These rats were randomly divided into 2 groups: group I (control, n=21), which received 0.1 mL of propylene glycol (vehicle) daily, and group II (experimental, n=21), which received 0.5 mg/kg or 0.125 mg/day of anastrozole diluted with 0.1 mL of propylene glycol. RESULTS: Light microscopy showed a higher concentration of cells with brown Ki-67 stained nuclei in the control compared to the experimental group. The mean percentage of Ki-67 stained nuclei per 500 cells in the vaginal epithelium was 68.64±2.64 and 30.46±2.00 [mean±standard error of the mean (SEM)] in the control and experimental groups, respectively (p<0.003). CONCLUSION: This study showed that anastrozole, at the dose and treatment duration selected, significantly decreased cell proliferation in the vaginal mucosa of the rats in persistent estrus.

Prevalence of xerostomia in women during breast cancer chemotherapy / Prevalencia de la xerostomía en mujeres durante la quimioterapia por cáncer de mama / Prevalência da xerostomia em mulheres durante a quimioterapia por câncer de mama

ABSTRACT Objective: To identify the prevalence of xerostomia in women undergoing chemotherapy for breast cancer. Method: Prospective cohort with 27 women who underwent up to 16 sessions of intravenous chemotherapy. Data collection was performed at the outpatient clinic of a university hospital in the city of São Paulo, where two forms were applied before the start of treatment and the Xerostomia Inventory before and after each chemotherapy session. Results: Complaints of dry mouth were present in 48.1% of women before chemotherapy, and they were approximately 28 times more likely to develop dry mouth during treatment. It was observed that the use of antiemetics contributed to the occurrence of xerostomia, and the anti-ulcerous were presented as a protective factor. Conclusion: The study identified both a high prevalence of xerostomia regardless of the chemotherapy used and the need to create protocols to improve the quality of life of these patients.

RESUMEN Objetivo: Identificar la prevalencia de la xerostomía en las mujeres en tratamiento quimioterápico por cáncer de mama. Método: Cohorte prospectiva con 27 mujeres que realizaron hasta 16 sesiones de quimioterapia endovenosa. La recogida de datos ha sido realizada en el ambulatorio de un hospital universitario en la ciudad São Paulo, donde han sido aplicados dos formularios antes del inicio del tratamiento y el Xerostomia Inventory antes y después de cada sesión de quimioterapia. Resultados: La queja de boca seca estuvo presente en 48,1% de las mujeres antes de la quimioterapia, y ellas tuvieron aproximadamente 28 veces más chance de desarrollar la xerostomía durante el tratamiento. Se observó que el uso de antieméticos contribuyó para la ocurrencia de xerostomía, y los antiulcerosos se presentaron como factor de protección. Conclusión: El estudio identificó tanto una alta prevalencia de xerostomía independientemente de la quimioterapia empleada cuanto la necesidad de la creación de protocolos visando a la mejoría de la calidad de vida de esas pacientes.

RESUMO Objetivo: Identificar a prevalência da xerostomia nas mulheres em tratamento quimioterápico por câncer de mama. Método: Coorte prospectiva com 27 mulheres que realizaram até 16 sessões de quimioterapia endovenosa. A coleta de dados foi realizada no ambulatório de um hospital universitário na cidade de São Paulo, onde foram aplicados dois formulários antes do início do tratamento e o Xerostomia Inventory antes e após cada sessão de quimioterapia. Resultados: A queixa de boca seca esteve presente em 48,1% das mulheres antes da quimioterapia, e elas tiveram aproximadamente 28 vezes mais chance de desenvolver a xerostomia durante o tratamento. Observou-se que o uso de antieméticos contribuiu para a ocorrência de xerostomia, e os antiulcerosos se apresentaram como fator de proteção. Conclusão: O estudo identificou tanto uma alta prevalência de xerostomia independentemente da quimioterapia empregada quanto a necessidade da criação de protocolos visando à melhoria da qualidade de vida dessas pacientes.

Breast cancer in the health insurance system of Jundiaí: data on 105 patients / Câncer de mama no sistema de saúde suplementar de Jundiaí: dados de 105 pacientes

Introduction: The data related to breast cancer's epidemiology in Brazil are heterogenous, reflecting the country's socioeconomic inequalities. Significant number of cases of this disease are attended through the health insurance system, but data on these cases is poorly disseminated. Objective: To evaluate epidemiological data on breast cancer from patients attended through the health insurance system in the municipality of Jundiaí, São Paulo. Methods: This was a retrospective study conducted through reviewing the medical files of 105 patients diagnosed with breast cancer, who were attended between January 2014 and December 2015. The information gathered included: age, clinical staging, histological type, immunohistochemical profile, surgical treatment and adjuvant treatment. Results: The study included 105 patients with breast cancer who were treated exclusively within the health insurance system of Jundiaí. The patients' mean age was 50.8 years. We observed that 13 patients (12.3%) were diagnosed with ductal carcinoma in situ (stage 0), 43 (40.9%) with stage I, 34 (32.3%) with stage II, 11 (10.4%) with stage III and 2 (1.9%) with stage IV. Conservative surgery was performed on 76 patients (72.3%), while 29 (27.7%) underwent mastectomy. Among the latter, immediate reconstruction was performed in 82.7% (24) of the cases. Conclusion: The high rates of early diagnosis and conservative surgery show that screening for breast cancer within the health insurance system of the municipality of Jundiaí, has been effective. Accessible mammography and the socioeconomic level of the population seem to be the main factors responsible for the obtained findings.

Introdução: Os dados referentes à epidemiologia do câncer de mama no Brasil são heterogêneos, reflexo da desigualdade socioeconômica do país. A medicina suplementar possui número relevante de casos da doença, porém estes são pouco divulgados. Objetivo: Avaliar os dados epidemiológicos do câncer de mama em pacientes atendidas pela saúde suplementar no município de Jundiaí, SP. Método: Estudo retrospectivo por meio da revisão do prontuário médico de 105 pacientes com diagnóstico de câncer de mama atendidas entre janeiro de 2014 e dezembro de 2015. As informações coletadas incluíram: idade, estadiamento clínico, tipo histológico, perfil imuno-histoquímico, tratamento cirúrgico e adjuvante. Resultados: O estudo incluiu 105 pacientes com câncer de mama, tratadas exclusivamente no sistema de saúde suplementar de Jundiaí. A idade média das pacientes foi de 50,8 anos. Observamos que 13 (12,3%) pacientes foram diagnosticadas com carcinoma ductal in situ (estádio 0), 43 (40,9%) no estádio I, 34 (32,3%) no estádio II, 11 (10,4%) no estádio III, e 2 (1,9%) no estádio IV. A cirurgia conservadora foi realizada em 76 (72,3%) pacientes, das quais 29 (27,7%) foram submetidas à mastectomia. Nessas pacientes, a reconstrução imediata foi realizada em 82,7% (24) dos casos. Conclusão: A elevada taxa de diagnósticos precoces, assim como de cirurgias conservadoras, revela rastreamento eficaz para o câncer de mama na saúde suplementar do município de Jundiaí. A acessibilidade à mamografia e o nível socioeconômico da população parecem ser os principais responsáveis pelos achados obtidos

Evaluation of body image, quality of life, tactile sensitivity and pain in women with breast cancer submitted to surgical intervention

SUMMARY Breast cancer is one of the most common types of tumor in the world and the most common among women. There are several treatments for breast cancer; however, the condition often can be accompanied by severe complications in a woman's life. OBJECTIVE: o evaluate and compare body image perception, quality of life, tenderness, and pain in women with breast cancer during preoperative and postoperative periods of 30, 60 and 90 days. MATERIALS AND METHODS: We conducted a prospective longitudinal study. The patients answered the questionnaire "How I relate to my own body", EORTC QLQ-C30 and EORTC QLQ-BR23. We assessed upper limb and breast sensitivity with an esthesiometer. Patients were questioned about the presence and level of pain on a scale of 0 to 10. RESULTS: For body image, it was possible to observe a significant difference between pre and postoperative at 30 days. There were changes in some areas of the EORTC QLQ C30 and EORTC QLQ BR23 questionnaires, such as arm and breast symptoms, social function, constipation, sexual function and satisfaction, among others. For evaluation of breast and axilla sensitivity and assessment of pain, all postoperative periods showed significant differences when compared to the preoperative period. The sensitivity of the inner region of the arm presented no significant change. CONCLUSION: The difference found in the study shows that evaluations on all scales should be done in several periods, using a proper treatment for the changes and individuality of each patient.

RESUMO O câncer de mama é um dos tipos mais comuns de tumores no mundo e o tipo mais comum entre as mulheres. Existem tratamentos severos para o câncer de mama, no entanto, em muitos casos, podem ser acompanhados por complicações sérias para a vida da mulher. OBJETIVO: Avaliar e comparar a percepção da imagem corporal, a qualidade de vida, a sensibilidade e a dor em mulheres com câncer de mama nos períodos pré-operatório e pós-operatório de 30, 60 e 90 dias. MÉTODOS: Foi realizado um estudo longitudinal prospectivo. Os pacientes responderam ao questionário "Como me relaciono com meu próprio corpo", o EORTC QLQ-C30 e o EORTC QLQ-BR23. Fizemos uma avaliação da sensibilidade do membro superior e da mama com um estesiômetro. Os pacientes foram questionados sobre a presença de dor e seu nível em uma escala de 0 a 10. RESULTADOS: Para a imagem corporal, foi possível observar uma diferença significativa entre o pré e pós-operatório de 30 dias. Mostrou mudanças em algumas áreas dos questionários EORTC QLQ C30 e EORTC QLQ BR23, como sintomas de braço e mama, função social, constipação e função sexual e satisfação, entre outros. Para avaliação da sensibilidade mamária e axilar e avaliação da dor, todos os períodos de pós-operatório apresentaram diferenças significativas quando comparados ao período pré-operatório. A sensibilidade da região interna do braço não apresentou mudanças significativas. CONCLUSÃO: A diferença encontrada no estudo mostra que as avaliações em todas as escalas devem ser feitas em vários períodos, utilizando um tratamento adequado que enfrente as mudanças e a individualidade de cada paciente.

Leiomyoma of the breast parenchyma: a case report and review of the literature

ABSTRACT INTRODUCTION: Benign tumors are often seen in breast screening examinations. However, the differential diagnosis is not always simple because of radiological similarity between the different benign lesions. CASE REPORT: We present a rare case report of leiomyoma of the breast parenchyma in a 68-year-old asymptomatic patient. The mammographic and ultrasonographic findings were similar to those observed in benign lesions. CONCLUSION: The histopathological diagnosis requires careful differentiation from lesions that have smooth muscle proliferation, especially leiomyosarcoma. The most commonly performed treatment is resection of the lesion with free margins. Although breast leiomyoma is rare, it should be considered among the differential diagnoses for breast nodules of benign appearance. Resection with safety margins proved to be the only treatment needed.

Mammographic density among indigenous women in forested areas in the state of Amapá, Brazil: a cross-sectional study / Densidade mamográfica em mulheres indígenas de áreas da floresta do estado do Amapá, Brasil: estudo transversal

ABSTRACT CONTEXT AND OBJECTIVE: There is no register of breast cancer cases among indigenous populations in Brazil. The objective here was to evaluate the association of clinical and demographic characteristics with mammographic density among indigenous women. DESIGN AND SETTING: Cross-sectional analytical study conducted in indigenous territories in the state of Amapá, Brazil. METHODS: Women were recruited from three indigenous territories and underwent bilateral mammography and blood collection for hormonal analysis. They were interviewed with the aid of an interpreter. Mammographic density was calculated using computer assistance, and was expressed as dense or non-dense. RESULTS: A total of 137 indigenous women were included in this study, with an average age of 50.4 years, and an average age at the menarche of 12.8 years. Half (50.3%) of the 137 participants had not reached the menopause at the time of this study. The women had had an average of 8.7 children, and only two had never breastfed. The average body mass index of the population as a whole was 25.1 kg/m2. The mammographic evaluation showed that 82% of women had non-dense breasts. The clinical characteristics associated with mammographic density were age (P = 0.0001), follicle-stimulating hormone (FSH) (P < 0.001) and estrogen levels (P < 0.01). CONCLUSIONS: The majority of the indigenous women had non-dense breasts. Age, menopausal status and FSH and estrogen levels were associated with mammographic density.

RESUMO CONTEXTO E OBJETIVO: Não há registro de casos de câncer de mama em populações indígenas no Brasil. O objetivo foi avaliar a associação de características clínicas e demográficas com a densidade mamográfica em mulheres indígenas. TIPO DE ESTUDO E LOCAL: Estudo transversal, analítico, realizado em territórios indígenas no estado do Amapá, Brasil. MÉTODOS: Mulheres foram recrutadas de três territórios indígenas e submetidas a mamografia bilateral e a coleta de sangue para análise hormonal. As participantes foram entrevistadas com a ajuda de um intérprete. A densidade mamográfica foi calculada com assistência de computador, e expressa como densa ou não densa. RESULTADOS: 137 mulheres foram incluídas no estudo, com média de 50,4 anos e média de idade à menarca de 12,8 anos. Metade (50,3%) das 137 participantes não havia entrado na menopausa no momento do estudo. As mulheres tinham em média 8,7 filhos, e duas nunca haviam amamentado. O índice de massa corpórea médio da população como um todo foi de 25,1 kg/m2. A análise mamográfica mostrou que 82% das mulheres tinham mamas não densas. As características clínicas associadas com a densidade mamográfica foram idade (P = 0.0001), hormônio folículo-estimulante (FSH, P < 0,001) e níveis de estrogênio (P < 0,01). CONCLUSÕES: A maioria das indígenas tinha mamas não densas. Idade, status menopausal e níveis de estrógeno e FSH foram associados com a densidade mamográfica.

Expression of estrogen and progesterone receptors in astrocytomas: a literature review

Gliomas are the most common type of primary central nervous system neoplasm. Astrocytomas are the most prevalent type of glioma and these tumors may be influenced by sex steroid hormones. A literature review for the presence of estrogen and progesterone receptors in astrocytomas was conducted in the PubMed database using the following MeSH terms: “estrogen receptor beta” OR “estrogen receptor alpha” OR “estrogen receptor antagonists” OR “progesterone receptors” OR “astrocytoma” OR “glioma” OR “glioblastoma”. Among the 111 articles identified, 13 studies met our inclusion criteria. The majority of reports showed the presence of estrogen and progesterone receptors in astrocytomas. Overall, higher tumor grades were associated with decreased estrogen receptor expression and increased progesterone receptor expression.

Breast cancer: news in diagnosis and treatment / Câncer de mama: novidades no diagnóstico e no tratamento

SUMMARY The authors discuss the main innovations in the diagnosis and treatment of breast cancer, particularly in diagnostic imaging and screening, and in locoregional and systemic therapies.

RESUMO Os autores discutem as principais novidades no diagnóstico e no tratamento do câncer de mama, particularmente no diagnóstico por imagem, no rastreamento e nas terapêuticas locorregional e sistêmica.