Presumed prevalence analysis on suspected and highly suspected breast cancer lesions in São Paulo using BIRADS criteria.

CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI), Institute of Diagnostic Imaging (IDI) and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR) criteria (Breast Imaging Reporting and Data System, BIRADS), the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS 4) and highly suspected (BIRADS 5) lesions increased with age, especially after the fourth decade. Accordingly, BIRADS 4 and BIRADS 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6% and it is similar to the prevalence of breast cancer observed in other populations.

Nipple-sparing mastectomy for breast cancer and risk reduction: oncologic or technical problem?

BACKGROUND: We evaluated the risks and benefits of nipple-sparing mastectomy in a multiinstitutional experience in the settings of risk-reducing surgery and breast cancer treatment. STUDY DESIGN: We analyzed data on 123 patients who had undergone nipple-sparing mastectomy with breast reconstruction for prophylaxis (n=55), treatment of breast cancer (n=41), or both (n=27) at four large centers. RESULTS: Median patient age was 45 years (range 22 to 70 years). There were 192 procedures (69 bilateral, 54 unilateral). Forty-four patients had invasive cancer; 20 had ductal carcinoma in situ (DCIS); 4 had phyllodes tumor. In all of these patients, the nipple tissue was cancer free on pathologic review. Median followup was 24.6 months (range 2.0 to 570.4 months). Local recurrence developed in two patients: one had DCIS in the upper-outer quadrant, with 71.8 months of followup; the other's cancer was invasive, in the upper-outer quadrant, with 6 months of followup. Distant metastasis developed in a third patient, who died 50 months after the procedure. Breast cancer developed in two patients after prophylactic mastectomy: one in the upper-outer quadrant at 61.8 months; one in the axillary tail at 24.4 months. No patients had recurrences in the nipple-areolar complex. Necrosis of the nipple was reported in 22 of 192 patients (11%) and it was judged minimal (less than one-third total skin of nipple) in 13 of 22 patients (59%). Overall cosmesis was judged by the patient and surgeon as good to excellent in the majority of patients. Level of satisfaction with cosmetic results was similar between prophylactic and treatment patients. CONCLUSIONS: The risk of local relapse was very low in our series of nipple-sparing mastectomies performed for DCIS or invasive cancer. Nipple-sparing mastectomy in the risk-reducing and breast cancer-treatment settings may be feasible in selected patients and should be the subject of additional prospective clinical trials.

Immediate effects of intraoperative evaluation of surgical margins over the treatment of early infiltrating breast carcinoma.

AIMS AND BACKGROUND: Local recurrences in patients submitted to conservative breast treatment for early infiltrating breast carcinomas occur in 5-10% of the cases and are caused mainly by inadequate local resection and remaining residual malignant tissue. The present study was carried out to analyze the effect of intraoperative evaluation of surgical margins and its influence on the immediate surgical management of patients with early breast carcinomas (T1-T2) scheduled to undergo quadrantectomy. METHODS: A total of 102 cases were studied. After a classical quadrantectomy, intraoperative evaluation of surgical margins was done by means of macroscopic, cytological and histopathologic analysis. The margins of the resected tissue were examined to assure they were clear or to orient a wider resection. RESULTS: In 64 cases (62.7%), the extent of the quadrant resection was considered adequate and the margins were clear. In 38 cases (37.3%), surgical margins were considered inadequate. An enlarged quadrantectomy was immediately performed in 33 patients (32.4%) and mastectomies in 5 (4.9%). CONCLUSIONS: Intraoperative evaluation of surgical margins frequently modifies the surgical management of patients who were initially prepared to be submitted to a quadrantectomy, indicating the need for further resection in the form of an enlarged quadrantectomy or mastectomy.

Prognostic effects of local recurrence after conservative treatment for early infiltrating breast carcinoma.

AIM: A study was carried out to determine whether local recurrence after quadrantectomy, axillary dissection and radiotherapy (QUART) affects the oncologic prognosis of patients with early infiltrating breast carcinoma. METHODS: A total of 149 patients were submitted to QUART between 1981 and 1990 and followed by an average period of 120.9 months (range, 16-213). Local recurrence was not observed in 132 cases (group 1) but was detected in 17 patients (group 2). RESULTS: In group 1, 39 cases (29.5%) presented distant metastases and 34 (25.8%) evolved to death. In group 2, 10 (51.8%) distant metastases and 9 deaths (52.9%) were verified. The survival curves estimated by the Kaplan-Meier method and analyzed by the logrank test were statistically different for distant metastases-free survival (P = 0.03) and for overall survival (P = 0.01). The relative risk in patients with post-QUART local recurrence for distant metastases was 2.09 and for death 2.34. CONCLUSIONS: It was concluded that post-QUART local recurrences are a poor prognostic factor in patients with early infiltrating breast carcinoma.

Programa Integrado de Controle do Câncer Mamário: experiência do Sistema Único de Saúde na região leste da cidade de São Paulo / Integrated Program Control of Breast Cancer: Public Health System experience in the east side of the city of São Paulo

Os autores discorrem sobre as dificuldades existentes no rastreamento mamográfico organizado e apresentam um modelo de gestão para atendimento integral do câncer de mama que vem sendo realizado na cidade de São Paulo, fruto da parceria do Hospital Alemão Oswaldo Cruz (HAOC) e da Escola de Ginecologia e Mastologia Prof. J. A. Pinotti (EGIMAJAP) com a Prefeitura da Cidade de São Paulo (Secretaria Municipal de Saúde) e com o Ministério da Saúde. A intersetorialidade do poder público e privado junto à comunidade contribuem para sustentabilidade de intervenções sanitárias com ampla aceitação social.

The authors discuss the difficulties in the organization of the mammographic screening and present a management model to comprehensive care of breast cancer which is being held in the city of São Paulo, the result of partnership of Oswaldo Cruz German Hospital, Prof J. A. Pinotti?s Gynecology and Mastology School (EGIMAJAP) with the Municipality of São Paulo and Ministry of Health. The intersectoral public and private power with the community contribute to the sustainability of health interventions with broad social acceptance

The influence of reduction mammaplasty techniques in synchronous breast cancer diagnosis and metachronous breast cancer prevention.

BACKGROUND: Although reduction mammaplasty (RM) is a well-described technique for cosmetic objectives, there are few reports regarding its bilateral application combined with oncologic breast surgery in patients with breast cancer. The purpose of this study is to analyze the role of RM in the contralateral breast (CB) synchronous cancer (SBC) incidence, the impact in risk reduction for metachronous breast cancer (MBC), the disease-free period, and overall survival METHODS: Patients were divided into 2 groups; group I: 114 pts submitted to oncologic surgery associated with immediate CB RM. Group II: 135 pts without CB RM. Mean time of follow-up was 51.5 months for both groups. Data regarding age, tumor size, histologic type and grade, clinical stage, and adjuvant therapy were collected RESULTS: Except for the CB RM, no differences were observed between the groups. In group I, the diagnosis of an occult, synchronic, and invasive carcinoma was noted in 1.8%, in situ in 2.6%, and MBC in 1.8%. In group II, MBC was observed in 6.7%. No difference was observed between the 2 groups (P = 0.062). The initiation of adjuvant therapy, the disease-free period, and overall survival were not influenced by the CB RM. CONCLUSION: CB RM is a reliable technique providing an opportunity for diagnosis of an occult SBC. There is evidence of reduction of MBC; however, a larger number of patients are necessary for significant conclusions. The technique should be considered in combination with immediate breast reconstruction. Success depends on patient selection and careful intraoperative management.

Presumed prevalence analysis on suspected and highly suspected breast cancer lesions in São Paulo using BIRADS® criteria

CONTEXT AND OBJECTIVE: Breast cancer screening programs are critical for early detection of breast cancer. Early detection is essential for diagnosing, treating and possibly curing breast cancer. Since there are no data on the incidence of breast cancer, nationally or regionally in Brazil, our aim was to assess women by means of mammography, to determine the prevalence of this disease. DESIGN AND SETTING: The study protocol was designed in collaboration between the Department of Diagnostic Imaging (DDI), Institute of Diagnostic Imaging (IDI) and São Paulo Municipal Health Program. METHODS: A total of 139,945 Brazilian women were assessed by means of mammography between April 2002 and September 2004. Using the American College of Radiology (ACR) criteria (Breast Imaging Reporting and Data System, BIRADS®), the prevalence of suspected and highly suspected breast lesions were determined. RESULTS: The prevalence of suspected (BIRADS® 4) and highly suspected (BIRADS® 5) lesions increased with age, especially after the fourth decade. Accordingly, BIRADS® 4 and BIRADS® 5 lesions were more prevalent in the fourth, fifth, sixth and seventh decades. CONCLUSION: The presumed prevalence of suspected and highly suspected breast cancer lesions in the population of São Paulo was 0.6 percent and it is similar to the prevalence of breast cancer observed in other populations.

CONTEXTO E OBJETIVO: Os programas de rastreamento para câncer de mama são fundamentais para a detecção precoce da doença. A detecção precoce de lesões suspeitas é essencial para diagnóstico, tratamento e possível cura do câncer de mama. Como no Brasil não há dados nacionais ou regionais sobre a prevalência do câncer de mama, nosso objetivo foi avaliar mulheres através da mamografia para determinar a prevalência da doença no Brasil no período de abril de 2002 a setembro de 2004. TIPO DE ESTUDO E LOCAL: Este trabalho foi realizado com a colaboração do Departamento de Diagnóstico por Imagem (DDI), Instituto de Diagnóstico por Imagem e da Prefeitura da cidade de São Paulo. MÉTODOS: Um total de 139.945 mulheres brasileiras foram avaliadas através de mamografias no período de abril de 2002 a setembro de 2004. Utilizando o sistema Birads® ACR (Breast Imaging Reporting and Data System, American College), a prevalência de lesões suspeitas e altamente suspeitas foi determinada. RESULTADOS: A prevalência de lesões suspeitas (BIRADS® 4) e altamente suspeitas (BIRADS® 5) aumentou com a idade, especialmente após a quarta década. De acordo com isso, as lesões BIRADS® 4 e BIRADS® 5 são mais prevalentes nas quarta, quinta, sexta e sétima décadas de vida. CONCLUSÕES: A prevalência presumida de lesões suspeitas e altamente suspeitas de câncer de mama na população da cidade de São Paulo é 0,6 por cento e esta prevalência é similar a de outras populações observadas.

Influência da preservação de pele em cirurgia conservadora por câncer de mama sobre as taxas de recorrência local e a distância / Influence of skin sparing in conservative surgery for breast cancer on the rates of local and distant recurrence

OBJETIVO: avaliar a taxa de recorrência local, regional e a distância de nova técnica cirúrgica para tratamento conservador do câncer de mama de estádio inicial. A técnica é baseada na ressecção segmentar com dissecção axilar e preservação de pele por incisão periareolar única. MÉTODOS: cento e dezenove pacientes com câncer de mama de estádio I e II foram incluídas neste estudo. O grupo estudo foi constituído por 57 pacientes que se submeteram à cirurgia pela técnica proposta e 62 pacientes submetidas a quadrantectomia clássica constituíram o grupo controle. A radioterapia pós-operatória e o boost foram realizados em ambos os grupos. A média de seguimento foi de 50,1 meses para o grupo estudo e 51,2 para o grupo controle. As taxas de recidiva, sobrevida global e sobrevida livre de doença foram analisadas e comparadas entre os dois grupos. RESULTADOS: a taxa de recidiva local no período foi de 3,5 por cento para o grupo estudo e 4,8 por cento para o grupo controle. Não houve diferença significativa entre os grupos nas taxas de sobrevida livre de doença e sobrevida global. CONCLUSÕES: a técnica de ressecção segmentar com dissecção axilar por incisão única periareolar, preservando pele, näo mostrou diferença, em relação à quadrantectomia clássica, nas taxas de recidiva, sobrevida global e sobrevida livre de doença

Perspectivas da ultra-sonografia na deteccao e diagnostico do cancer de mama / Perspectives ultrasonographic in detection and diagnostic of breast cancer

O cancer de mama, segundo os ultimos dados epidemiologicos, ocupa o primeiro lugar em ocorrencia na mulher brasileira. Apesar da sua alta frequencia e do consequente impacto em diversos niveis do sistema de saude publica, os programas de rastreamento ainda estao longe de serem eficientes. A mamografia e o exame fisico das mamas sao o metodo de escolha no screening de mulheres assintomaticas. A ultra-sonografia vem gradativamente ocupando papel de destaque na investigacao de lesoes mamarias, particularmente no diagnostico. Este artigo apresenta as possibilidades do ultra-som como segunda linha de...

Neurectomia pre-sacra laparoscopica: revisao e experiencia pessoal / Laparoscopic presacral neurectomy: review and personal experience

A neurectomia pre-sacra tem mostrado ser uma alternativa terapeutica cirurgica em diversos casos de dor pelvica cronica. Quando persiste o quadro doloroso, apesar da instituicao de todo tratamento clinico e cirurgico padrao, em algumas formas de dismenorreia primaria ou secundaria, na endometriose ou processo inflamatorio pelvico cronico; a possibilidade de realizarmos um procedimento, preferencialmente pela videolaparoscopia, de desnervacao pelvica deve ser considerado. Em nossa experiencia pessoal, nem todas realizadas pela laparoscopia, o indice de sucesso foi de 79,6 porcento. As complicacoes, quando surgem, podem ser plenamente solucionadas sem aumentos maior da morbidade. Ha necessidade, entretanto, do conhecimento do cirurgiao em...

Biópsia mamária assistida a vácuo (mamotomia) guiada por ultra-som: apresentação clínicopatológica de 26 casos / Vacuum-assisted biopsy under ultrasonographic guidance: clinicopathologic study of 26 cases

Os programas de rastreamento do câncer de mama fizeram com que um enorme número de lesões não-palpáveis fosse identificável mamograficamente, necessitando de estudo. Após o diagnóstico de uma lesão não-palpável, ela será categorizada dentro dos critérios do Breast Imaging Reporting and Data System (Bi-Rads), sendo necessária uma verificação citoistológica. A possibilidade de aplicação de propedêutica minimamente invasiva, como punção aspirativa com agulha fina (PAAF), biópsia com agulha grossa (core-biópsia) ou biópsia assistida a vácuo (mamotomia), tem norteado as pesquisas relacionadas à conduta frente a estas lesões. Quinze mulheres atendidas na Clínica Ginecológica do Hospital das Clínicas da FMUSP e 11 na Clínica Prof. José Aristodemo Pinotti (SP) submeteram-se à mamotomia sob orientação da ultra-sonografia. Todas possuíam nódulos sólidos não-palpáveis, visualizados pela ultra-sonografia, com tamanho igual ou menor a 25 mm, indeterminados ou suspeitos. Das 26 biópsias obtidas pela mamotomia não houve nenhum caso de material insuficiente para diagnóstico. Não ocorreram complicações entre as pacientes submetidas a essa propedêutica, as quais toleraram bem o procedimento. Foram detectados um caso de carcinoma ductual in situ e um caso de hiperplasia ductual atípica, submetidos à biópsia cirúrgica. Os demais casos tiveram a imagem total ou parcialmente retirada e diagnóstico histológico benigno, compatível com a imagem. Nossos dados iniciais, com o uso da mamotomia guiada por ultra-som, mostraram excelentes resultados quanto a amostragem representativa de tecido da lesão, acurácia do diagnóstico, conforto e nível de dor.

The breast cancer screening programs all over the world showed a lot of nonpalpable lesions demonstrated at the mammogram which need cyto-histologic exam. The possibility of using a minimally invasive method such as a FNA (fine needle aspiration), core biopsy or vacuum-assisted biopsy has oriented the research upon the management in these lesions. Fifteen patients at the Gynecological Clinic of the São Paulo Medical School, of São Paulo University (FMUSP), and eleven at Clinic Prof. José Aristodemo Pinotti (SP) underwent vacuum assisted biopsy under ecographic guidance. All of them had nonpalpable solid nodules, seen at ultrasonography smaller than 25mm, indeterminate or suspicious. The tissue was enough for histological diagnostic of the lesions in all the 26 cases, without complications. The patients did not complain during the exam. There were two cases of atypia: one ductal in situ carcinoma and one atypical ductal hyperplasia, submitted to surgical biopsy. All of the remaining cases had the image entirely or partially excised and a benign diagnosis compatible with the image. The use of ultrasound guidance for the vacuum assisted biopsy in the palpable and nonpalpable nodules showed excellent data in the preliminary results referring to accuracy of the diagnosis, comfort and tissue sampling.

Associacao entre cancer de mama e disfuncoes da tireoide / Association between breast cancer and the thyroid disease

Os autores, atraves de revisao de literatura, descrevem as relacoes existentes entre a tireoide e glandula mamaria. Mulheres em uso de tamoxifeno podem apresentar elevacoes nas globulinas carreadoras de tiroxina. A ocorrencia de...

Core biopsy guiada por ultra-sonografia: resultados do nucleo de resolucao do Servico de Mastologia da Faculdade de Medicina da Universidade de Sao Paulo / Core biopsy guided by ultrassonography: results from the nucleous of resolution of the Service of Senology of Medical School of Sao Paulo University

O Nucleo de Resolucao de Mastologia visa reduzir o numero de biopsias cirurgicas em lesoes mamarias, baseando-se na complementacao ultra-sonografica e nas biopsias por true cut dirigidas. Metodos: as pacientes admitidas com lesoes mamarias verificadas pela mamografia foram submetidas...

A revelacao do diagnostico do cancer de mama: aspectos eticos / The revelation of the diagnosis of breast cancer: ethical aspects

Avaliar a forma de revelacao do diagnostico de cancer, em pacientes portadoras de cancer de mama atendidas no...

Mastite lupica como diagnostico diferencial do cancer de mama / Lupus mastitis as differential diagnosis of breast cancer

O lupus eritematoso e uma das mais frequentes doencas do tecido conjuntivo. O acometimento pode ser unicamente cutaneo ate sistemico. Atinge preferencialmente...

Novas perspectivas minimamente invasivas no tratamento cirúrgico do câncer de mama / New minimally invasive perspectives in the surgical treatment of the breast cancer

No último século foram realizadas significativas e progressivas mudanças no tratamento do câncer de mama. A ablação minimamente invasiva do tumor primário é possível com uma variedade de técnicas. Alternativas à cirurgia tradicional para conservação da mama incluem a excisão por estereotaxia, a criocirurgia, a ablação a laser e a ablação por radiofreqüência guiada por ultra-sonografia. Os autores descrevem as evidências atuais destas técnicas

Efeito da recidiva local pós-QUART no prognóstico oncológico das pacientes com carcinoma invasor inicial de mama / Effect local recurrence after conservative treatment on the prognosis of patients with initial infiltrative breast carcinoma

Este trabalho foi realizado com o objetivo de investigar se a recidiva local (RL), depois de quadrantectomia, dissecçäo axilar e radioterapia (QUART) para tratamento do carcinoma invasor inicial de mama, afeta o prognóstico das pacientes. Foram analisados 149 casos tratados por QUART entre 1981 e 1990, seguidos por 120,9 meses em média (16 a 213), que determinaram a formaçäo de dois grupos: 1) 132 casos que näo desenvolveram RL; e 2) 17 casos nos quais detectou-se RL. No grupo 1 ocorreram 39 (29,5 por cento) pacientes com metástase à distância e 34 (25,8 por cento) óbitos; no grupo 2, 10 (58,8 por cento) e 9 (52,9 por cento), respectivamente. As curvas de sobrevida estimadas pelo método de Kaplan-Meier analisadas pelo teste estatítico "log-rank" mostraram diferença estatística significante para a sobrevida livre de metástase à distância (p=0,03) e para sobrevida global (p=0,01). Calculou-se para pacientes com RL o risco relativo de 2,09 para metástase à distância e de 2,34 pa óbito. Conclui-se que a RL pós-QUART agrava o prognóstico oncológico das pacientes

Manutencao da fertilidade na paciente com cancer ginecologico estadio inicial / Maintenance of fertility in patients with gynecologycal cancer early stages

O diagnostico de cancer, em qualquer estadio que se apresente, resulta sempre em inumeros questionamentos sobre seu prognostico, morbidade e sobrevida. Muitas vezes promove a depressao e perda definitiva ou temporaria de inumeros projetos de vida. Quando este diagnostico e feito em mulheres na idade reprodutiva, sem prole constituida, temos mais um fator agravante no universo do manejo do cancer. Apresentamos, neste estudo de revisao, os recentes trabalhos publicados que abordam a...