Factors that Affect Performance of Clinical Breast Examination and Mammography Screening among Brazilian Women.

BACKGROUND: In the Brazilian health system, community health facilities consist of multidisciplinary teams that focus on family health, whereas health centers treat mainly illnesses of registered patients. In the present study we compared socio-economic factors and performance of mammography screening (MS) and clinical breast exam (CBE),  respectively, among women who used both types of public health service centers. METHODS: The present study included 180 women aged ≥40 years, who used different health service centers within the same municipal district. Of all 180 women, 110 (41.1%) and 70 (38.9%) used a health center and a community health facility. Logistic regression analysis was performed to calculate odds ratios (ORs) and confidence intervals (CIs) of variables. RESULTS: Regression modeling indicated that women who used the community health facility, performed annual MS 9.52 (OR= 0.105; 95%CI: 0.03- 0.36) times more often (p <0.001). In this model retirement and gynecological service use ≤ each second year, increased annual MS performance 8.16 (95%CI: 1.55- 54.32) and 7.78 (95%CI: 2.54- 23.79) times (p <0.001; p <0.001). Among 113 (62.8%) women who reported strong fear of MS, the chance of its performance was 35.71 (OR= 0.028; 95%CI: 0.02- 0.32) times decreased (p= 0.05). In a second model use of gynecological service ≤ each second year, increased chance of annual CBE performance 7.92 (95%CI: 3.25- 19.29) times (p <0.001). Women who used the community health facility performed annual and bi-annual CBE 2.90 (OR= 0.345; 95%CI: 0.14- 0.86) and 2.97 (OR= 0.337; 95%CI: 0.12- 0.92) times more often, compared to women who used the health center (p =0.030). CONCLUSIONS: Performance of MS and CBE varied both considerable among women who used different types of health service centers. Gynecological service use, fear and socioeconomic variables, additionally influenced regular performance of MS and CBE.

Performance of physical activity as a predictor of women's mammography screening attendance in a population of Northeast Brazil

Introduction: Despite the increasing incidence of breast cancer among women in Northeast Brazil, there have been no studies on the association between physical activity and attendance to mammography screening. Objective: This study of Brazilian women addressed socio-economic variables, physical activity, and knowledge about breast cancer and their impact on attendance to mammography screening. Methods: A cross-sectional quantitative study was conducted as an epidemiological evaluation. Data were obtained by interviewing 307 women in a public health center. Logistic regression analysis was applied to determine the odds ratio (ORs) and confidence intervals (CI) of variables. Results: Mean age of women was 49.79 (SD=8.63) years and 172 (56.0%) were between 40 and 49 years old. Women aged from 40 to 49 and ≥50 years who performed physical activity, had a 2.4-fold (95% CI: 1.13-5.04) and 10.6-fold (95% CI: 2.66-41.95) increased chance to attend MS every year (p=0.040; p<0.001). Women aged between 40 and 49 years with a low and middle income, had a 10.3-fold (OR=0.097; 95% CI: 0.02-0.53) and 13.2-fold (OR=0.076; 95% CI: 0.11 0.53) decreased chance to attend MS every second year (p=0.007). The MS attendance of women aged ≥50 years with basic education level was 13.3 (OR=0.075; 95% CI: 0.09-0.66) times decreased (p=0.010). Conclusion: Physical activity represented an important predictor of MS attendance of all women. The impact of income and education level, in contrast, depended strongly on the age group.

On a greedy approach for genome scaffolding.

BACKGROUND: Scaffolding is a bioinformatics problem aimed at completing the contig assembly process by determining the relative position and orientation of these contigs. It can be seen as a paths and cycles cover problem of a particular graph called the "scaffold graph". RESULTS: We provide some NP-hardness and inapproximability results on this problem. We also adapt a greedy approximation algorithm on complete graphs so that it works on a special class aiming to be close to real instances. The described algorithm is the first polynomial-time approximation algorithm designed for this problem on non-complete graphs. CONCLUSION: Tests on a set of simulated instances show that our algorithm provides better results than the version on complete graphs.

Treewidth-based algorithms for the small parsimony problem on networks.

BACKGROUND: Phylogenetic reconstruction is one of the paramount challenges of contemporary bioinformatics. A subtask of existing tree reconstruction algorithms is modeled by the SMALL PARSIMONY problem: given a tree T and an assignment of character-states to its leaves, assign states to the internal nodes of T such as to minimize the parsimony score, that is, the number of edges of T connecting nodes with different states. While this problem is polynomial-time solvable on trees, the matter is more complicated if T contains reticulate events such as hybridizations or recombinations, i.e. when T is a network. Indeed, three different versions of the parsimony score on networks have been proposed and each of them is NP-hard to decide. Existing parameterized algorithms focus on combining the number c of possible character-states with the number of reticulate events (per biconnected component). RESULTS: We consider the parameter treewidth t of the underlying undirected graph of the input network, presenting dynamic programming algorithms for (slight generalizations of) all three versions of the parsimony problem on size-n networks running in times [Formula: see text], [Formula: see text], and [Formula: see text], respectively. Our algorithms use a formulation of the treewidth that may facilitate formalizing treewidth-based dynamic programming algorithms on phylogenetic networks for other problems. CONCLUSIONS: Our algorithms allow the computation of the three popular parsimony scores, modeling the evolutionary development of a (multistate) character on a given phylogenetic network of low treewidth. Our results subsume and improve previously known algorithm for all three variants. While our results rely on being given a "good" tree-decomposition of the input, encouraging theoretical results as well as practical implementations producing them are publicly available. We present a reformulation of tree decompositions in terms of "agreeing trees" on the same set of nodes. As this formulation may come more natural to researchers and engineers developing algorithms for phylogenetic networks, we hope to render exploiting the input network's treewidth as parameter more accessible to this audience.

Risk factors for breast cancer and their association with molecular subtypes in a population of Northeast Brazil.

BACKGROUND: The risk factors for breast cancer (BC) among women in Brazilian populations are poorly understood. To date, few Brazilian studies have addressed the potential association between risk factors and molecular BC subtypes. This case-control study aimed to identify risk factors for BC in a population of Northeast Brazil. METHODS: Data from 313 patients with invasive BC and 321 healthy controls were obtained from medical records from two cancer treatment centres and personal interviews. Of the 313 BC patients, 224 (71.6%) had reached menopause. The following distribution of subtypes was found among 301 patients: (1) Luminal A: 54 (17.9%); (2) Luminal B: 175 (58.1%); (3) HER2/neu: 29 (9.7%); and (4) triple-negative breast cancer (TNBC): 43 (14.3%). Odds ratios (ORs) and confidence intervals (CIs) were determined using regression analysis. RESULTS: Regression modelling indicated that family history, obesity (≥ 30.0 kg/m2), alcohol consumption and contraceptive use increased the overall risk of BC 1.78 (95% CI: 1.22-2.59), 1.69 (95% CI: 1.08-2.63), 2.21 (95% CI: 1.44-3.39) and 2.99 (95% CI: 2.09-4.28) times, respectively. After stratification for menopausal status, alcohol consumption increased the risk of BC 4.15 (95% CI: 2.13-8.11) times, and obesity, as a single variable, increased the risk of BC 2.02 (95% CI: 1.22-3.37) times, only among postmenopausal women. In a case-control analysis, the risk of TNBC and Luminal B breast cancer were 4.06 (95% CI: 1.58-10.42) and 1.87 times (95% CI: 1.13-3.11) higher, respectively, in obese women than in non-obese women. Furthermore, alcohol consumption increased the risk of Luminal A and B subtypes 7.08 (3.40-14.73) and 1.77 (1.07-2.92) times, respectively. CONCLUSION: Family history, contraceptive use, obesity and alcohol consumption increased the risk of BC. Obesity and alcohol consumption differentially increased risk of TNBC and Luminal molecular subtypes.

Prevenção do câncer de mama na Atenção Primária à Saúde: uma análise sobre a atuação de enfermeiros / Breast cancer prevention in Primary Health Care: an analysis on the performance of nurses

O câncer de mama (CM) é o tumor maligno que mais mata mulheres no mundo, sendo considerado um grave problema de saúde pública. Este artigo investiga as ações de enfermeiros atuantes na Atenção Primária à Saúde na prevenção do CM em Campina Grande-PB. Trata-se de um estudo descritivo-exploratório, de abordagem qualitativa, realizado com 10 enfermeiros que atuam em unidades básicas de saúde do referido município, por meio de entrevista semiestruturada. Os dados coletados foram analisados por meio da análise de conteúdo, com o auxílio do software Atlas.ti. Em seus resultados emergiram cinco categorias: Conhecimentos gerais sobre CM; Capacitação profissional e educação em saúde da população; Abordagem clínica do enfermeiro na prevenção do CM; Dificuldades na prevenção; Autoanálise da prática profissional. Entre estas, destacou-se a influência negativa da falta de capacitações para ajustamento das ações dos enfermeiros às diretrizes nacionais de prevenção do CM na Atenção Primária à Saúde.

Breast cancer is the malignant tumor that kills the most women worldwide, being considered a serious public health problem. This article investigates the actions of nurses working in Primary Health Care in the prevention of breast cancer in Campina Grande-PB. This is a descriptive-exploratory study, with a qualitative approach, carried out with 10 nurses who work in basic health units in that city, through semi-structured interviews. The collected data were analyzed through content analysis, with the help of the Atlas.ti software. Five categories emerged from their results: General knowledge about breast cancer; Professional training and health education for the population; Nurses' clinical approach to breast cancer prevention; Difficulties in prevention; Self-analysis of professional practice. Among these, the negative influence of the lack of training to adjust the nurses' actions to the national guidelines for the prevention of breast cancer in Primary Health Care was highlighted.

Haplotypes of single cancer driver genes and their local ancestry in a highly admixed long-lived population of Northeast Brazil.

Admixed populations have not been examined in detail in cancer genetic studies. Here, we inferred the local ancestry of cancer-associated single nucleotide polymorphisms (SNPs) and haplotypes of a highly admixed Brazilian population. SNP array was used to genotype 73 unrelated individuals aged 80-102 years. Local ancestry inference was performed by merging genotyped regions with phase three data from the 1000 Genomes Project Consortium using RFmix. The average ancestry tract length was 9.12-81.71 megabases. Strong linkage disequilibrium was detected in 48 haplotypes containing 35 SNPs in 10 cancer driver genes. All together, 19 risk and eight protective alleles were identified in 23 out of 48 haplotypes. Homozygous individuals were mainly of European ancestry, whereas heterozygotes had at least one Native American and one African ancestry tract. Native-American ancestry for homozygous individuals with risk alleles for HNF1B, CDH1, and BRCA1 was inferred for the first time. Results indicated that analysis of SNP polymorphism in the present admixed population has a high potential to identify new ancestry-associated alleles and haplotypes that modify cancer susceptibility differentially in distinct human populations. Future case-control studies with populations with a complex history of admixture could help elucidate ancestry-associated biological differences in cancer incidence and therapeutic outcomes.

Fatores de risco do câncer de próstata: estudo caso-controle no Nordeste do Brasil / Risk factors of prostate cancer: a case- control study in Northeast Brazil

Este estudo caso-controle teve como objetivo identificar os fatores que modificam o risco de câncer de próstata em pacientes de um hospital público da Paraíba. Dados de 91 pacientes e 91 controles saudáveis pareados por idade (± 5 anos) foram obtidos de prontuários médicos e entrevistas pessoais. A razão de chance e os intervalos de confiança foram determinados por meio de análise de regressão. Pacientes e controles tinham em média 69,56 (DP = 8,31) e 68,32 (DP = 7,68) anos (p = 0,297). Afrodescendentes e homens que já fumaram, tiveram um risco 4,150 e 3,939 vezes maior (p <0,001; p <0,001). A história familiar aumentou o risco 6,967 vezes (p <0,001). Ascendência africana, tabagismo e história familiar aumentaram o risco de câncer de próstata. As recomendações das autoridades de saúde em relação ao rastreamento do câncer de próstata poderiam se concentrar mais nos homens com esses fatores de risco.

This case-control study aimed on the identification of factors that modified prostate cancer risk of patients in a public hospital of Paraíba. Data from 91 patients with prostate cancer and 91 age- matched (±5 years) healthy controls were obtained from medical records and personal interviews. Odds ratios (ORs) and confidence intervals (CIs) were determined using regression analysis. Patients and controls were on average 69.56 (SD= 8.31) and 68.32 (SD= 7.68) years old (p = 0.297). In a model of multiple regression analysis, Afrodescendants and men who ever smoked had a 4.150 and 3.939 times increased risk (p < 0.001; p < 0.001). Family history of first- degree relatives was associated with a 6.967 (p < 0.001) increased risk of prostate cancer. African ancestry, smoking and family history increased the risk of prostate cancer. Recommendations of health authorities regarding prostate cancer screening could stronger focus on men with these risk factors.

Risk of Colorectal Cancer in a Brazilian Population is Differentially Associated with the Intake of Processed Meat and Vitamin E.

The incidence and mortality rates of colorectal cancer (CRC) in Northeast Brazil are increasing. To study the association between CRC and diet, data were obtained from 64 patients with CRC and 123 sex- and age-matched controls. The dietary details were recorded using a validated food frequency questionnaire. Nutrient intake was calculated using Dietsys software (National Cancer Institute, Maryland, USA). In a binary logistic regression model of dietary components (model 1), the chance of CRC increased by 0.2% (odds ratio [OR] = 1.002; 95% confidence interval [CI]: 1.000-1.004) for each gram of processed meat intake per week (p < 0.010). Consumption of eggs decreased the chance by 0.1% per gram (OR = 0.999; 95% CI: 0.998-1.000; p < 0.050). The use of oil (including olive oil) for served food decreased the chance by 1.8% (OR = 0.982; 95% CI: 0.970-0.992) for each time consumed (p < 0.010). In a model of nutritional factors (model 2), intake of vitamin E decreased the chance by 16.8% (OR = 0.832; 95% CI: 0.725-0.940) for each milligram intake per week (p < 0.010). In model 1 and 2 smoking increased the chance of CRC by 10.294 (95%CI: 4.240-27.670) and 2.496 (95% CI: 1.425-3.566) times (p < 0.010; p < 0.010), respectively.

Socioeconomic Factors and Health Status Disparities Associated with Difficulty in ADLs and IADLs among Long-Lived Populations in Brazil: A Cross-Sectional Study.

OBJECTIVE: To evaluate the association between socioeconomic factors, health status, and Functional Capacity (FC) in the oldest senior citizens in a metropolis and a poor rural region of Brazil. METHOD: Cross-sectional study of 417 seniors aged ≥80 years, data collected through Brazil's Health, Well-being and Aging survey. FC assessed by self-reporting of difficulties in Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs). Chi-square tests and multiple logistic regression analyses were performed using "R" statistical software. RESULTS: Socioeconomic and demographic inequalities in Brazil can influence FC in seniors aged 80 years and older. Comparatively, urban long-lived people had a higher prevalence of difficulties for ADLs and rural ones showed more difficulties for IADLs. Among urban oldest seniors, female gender and lower-income were correlated with difficulties for IADLs. Among rural oldest seniors, female gender, stroke, joint disease, and inadequate weight independently were correlated with difficulties for ADLs, while the number of chronic diseases was associated with difficulties for IADLs. CONCLUSION: Financial constraints may favor the development of functional limitations among older seniors in large urban centers. In poor rural areas, inadequate nutritional status and chronic diseases may increase their susceptibility to functional decline.

Shorter delay to treatment by integrated diagnostic services and NGO-provided support among breast cancer patients in two Brazilian referral centres.

BACKGROUND: The diagnosis of breast cancer requires a complicated series of diagnostic exams. The present study addressed the delay of patients who used publicly and privately financed diagnostic services. Non-governmental organizations (NGOs) donated diagnostic mammograms and biopsies. DESIGN AND METHODS: Data from 304 patients were obtained from two Brazilian referral centres. In one referral centre (FAP), diagnostic mammography, clinic-histopathological exam and immunohistochemistry were outsourced, whereas in the other centre (HNL), these services were integrated. Cox regression, Kaplan-Meier analysis and non-parametric tests were used to compare variables and time intervals. RESULTS: If diagnostic mammography was financed privately and covered by private health insurance, the likelihood of a delay of >90 days between the first medical visit and the initiation of treatment decreased 2.15-fold (95%CI: 1.06- 4.36; p=0.033) and 4.44-fold (95%CI: 1.58-12.46; p=0.004), respectively. If the clinic-histopathological exam was outsourced (FAP) and publicly or privately financed, the median time between diagnostic mammography and the diagnostic result was 53 and 65 days in the integrated (HNL) and outsourced public system, compared to 29 days in the outsourced private system (p<0.050). The median time between the first medical visit and the diagnostic results of patients who were supported by NGOs, who financed their diagnostic services privately, and who used exclusively public diagnostic services was, respectively, 28.0, 48.5 and 77.5 days (p<0.050). CONCLUSION: Patients who used privately financed health services had shorter delays. Compared to outsourcing, the integration of the publicly financed clinic- histopathological exam diminished the delay. The support of patients by NGOs accelerated patient flow.

The structure of first-cousin marriages in Brazil.

This paper deals with the frequency and structure of first-cousin marriages, by far the most important and frequent type of consanguineous mating in human populations. Based on the analysis of large amounts of data from the world literature and from large Brazilian samples recently collected, we suggest some explanations for the asymmetry of sexes among the parental sibs of first-cousin marriages. We suggest also a simple manner to correct the method that uses population surnames to assess the different Wright fixation indexes FIS, FST and FIT taking into account not only alternative methods of surname transmission, but also the asymmetries that are almost always observed in the distribution of sexes among the parental sibs of first-cousins.

Availability of Diagnostic Services and their Impact on Patient Flow in Two Brazilian Referral Centres of Breast Cancer Treatment.

BACKGROUND: System delay (SD) is a leading cause of advanced stage of disease and poor prognosis among Brazilian breast cancer patients. METHODS: Cox regression and Kaplan-Meier analysis were used to identify variables that contributed to SD among 128 breast cancer patients. Time intervals between first medical consultation and treatment initiation were compared among patients of two referral centres: Patients of a referral centre with outsourced (FAP), respectively, integrated (HNL) diagnostic services. RESULTS: Women who used a specialized private clinic at the beginning of patient flow had an 2.32 fold increased chance (95% CI: 1.17 - 4.60; p = 0.016) of hospital admission within 90 days after first medical consultation, compared to women who used a public health care provider (HCP). Of 73 and 34 patients of the FAP hospital and the HNL, respectively, 10 (13.7%) and 11 (32.5%) used one HCP prior to hospital admission (p = 0.000). The median time between first medical consultation and treatment initiation was 150 days. The median time between first medical consultation and hospital admission was 136.0 and 52.0 days for patients of the FAP hospital, respectively the HNL (p < 0.050). The median time between first medical consultation and diagnostic mammography was 36.5 and 23.0 days for patients from the FAP hospital and the HNL (p < 0.050). CONCLUSIONS: Usage of public diagnostic services was associated with increased SD, whereas the usage of private diagnostic services diminished it. The usage of a lower number of HCPs accelerated patient flow.

Breast Cancer Risk Perception and Mammography Screening Behavior of Women in Northeast Brazil.

Background: Previous studies suggest that education and income affect Brazilian women's breast cancer prevention behavior. The present study focused on the impact of perceived and estimated risk on mammography screening (MS) behavior. Materials and Methods: Information regarding socioeconomic variables and risk perception was obtained from 396 healthy women aged 40-79 years. Perceived comparative risk was measured on a seven-point Likert scale. A Breast Cancer Risk Assessment Tool of 5-year risk to develop breast cancer was used to determine objective risk. Estimated comparative risk was determined as categories of perceived risk relative to the objective risk. Regression analysis was applied to determine odds ratios (ORs) and confidence intervals (95% CIs) of variables. Results: Asked about the potential of MS to lower risk of death because of breast cancer, 215 (54.29%) responded that it does not lower risk. Women with low perceived comparative risk had a twofold (OR = 0.493; 95% CI: 0.24-1.00) decreased chance to participate in MS annually, compared with women with high-perceived comparative risk (p = 0.020). Women without family history had a 7.6-fold (OR = 0.132; 95% CI: 0.07-0.25) decreased chance of having a high-perceived comparative risk (p = 0.000). If compared with underestimation, the overestimation and accurate estimation of comparative risk tended to be associated with a decreased chance of MS attendance (p = 0.017). Regression modeling indicated that low educational level, no occupation, and no family history decreased the chance of women having MS (p = 0.040; p = 0.010; p = 0.022). Conclusions: Risk perception depended on family history. Present data did not indicate that overestimation, or accurate estimation of comparative risk, increased chance of MS attendance. Educational level, occupation status, and family history, instead, determined MS performance.

Differential Impact of Education Level, Occupation and Marital Status on Performance of the Papanicolaou Test among Women from Various Regions in Brazil

Background: In Brazil, little is known regarding the underlying causes of differences among populations regarding socio-economic variables that affect women's cervical cancer screening behavior. The present study focused on socio-economic variables that affect women's performance of the Papanicolaou test, comparing two distinct Brazilian populations. Methods: We collected data regarding performance of the Papanicolaou test and socio-economic variables from 559 women in Mato Grosso do Sul (MS), in the Central East region, and 338 women in Paraíba (PB), in the Northeast region of Brazil. Nominal logistic regression modeling was performed to identify independent variables for both groups of data. Results: Of the women interviewed from MS and PB, 116 out of 599 (19.37%) and 94 out of 338 (27.81%), respectively, had not performed the Papanicolaou test within the last three years (p = 0.025). Low educational level characterized 570 (95.16%) and 203 (60.06%) of women from MS and PB, respectively (p = 0.000). Women in PB who had a low educational level and were unemployed had a 2.96-fold (OR = 0.338; 95% CI: 0.121 - 0.939) and 2.40-fold (OR = 0.416; 95% CI: 0.199 - 0.869) lower chance, respectively, to have performed the Papanicolaou test ≥ three times, or once within the last three years (p = 0.029; p = 0.014). The chance of women in MS who did not live in a stable relationship to have performed the test ≥ three times was 1.79-fold (OR = 0.560; 95% CI: 0.348 ­ 0.901) lower compared to women who reported a stable relationship (p = 0.039). Conclusions: High educational level, employment, and having a stable interpersonal relationship positively associated with performance of the Papanicolaou test among women in PB and MS. Despite having predominantly a low educational level, women in MS performed the Papanicolaou test more frequently than those in PB.

Women's knowledge about risk factors of breast cancer in a Brazilian community.

Knowledge about risk factors for breast cancer was identified as an important variable that affects women's avoidance behavior and their screening performance. The present study assessed women's knowledge about risk factors and associated socio-economic variables. Data from 417 women aged 20-86 years were obtained in Caicó, Rio Grande do Norte, Brazil. In agreement with the recognition of 26 potential risk factors and prevention behaviors, two groups with good (N = 203) and poor (N = 214) knowledge were formed, respectively. Having a close relative with cancer remained the unique significant variable in the adjusted model. Women without any close relative with cancer, were 1.54 (95% confidence interval [CI] 1.036-2.288) times as likely to have poor knowledge, compared to women who had a close relative with cancer (p = 0.033). Other socio-economic variables, including income, employment status and educational level had no significant association with knowledge (p = 0.450, p = 0.914, p = 0.639, respectively). Of 417 women, 302 (72.42%), 339 (81.29%), and 309 (74.10%), respectively, did not identify "physical inactivity," "overweight after menopause," and "no breastfeeding of children" as risk factors. Knowledge could help to avoid risk factors and motivate prevention behavior. Information about risk factors should be disseminated in health campaigns.

Increased Risk of Penile Cancer among Men Working in Agriculture

Background: Previous Brazilian studies have indicated that working in agriculture could lead to an increased risk of penile cancer. The present descriptive study aimed at establishing a possible association between penile cancer and agricultural occupation. Materials and methods: Data on a total of 103 penile cancer patients were obtained from medical records of two reference centres for cancer treatment in the state of Paraíba, Northeast Brazil. Information about sexual behaviour was obtained in interviews for 48 cases. Results: Of 103 patients 38 and 52 were illiterate and had not completed graduation, respectively, and 60 earned less than twice the minimum wage. All together, 72 (70%) worked in agriculture and 39 confirmed involvement in application of agrochemicals. A history of phimosis was noted for 42 (69%) out of 61 patients and 40 (59%) out of 68 ever smoked. Pathological signs of HPV infection were detected in 45 (70%) out of 64 patients. Of the 48 interviewed patients, 27 (56%) confirmed sexual contact with prostitutes and eight (19%) out of 43 had sex with animals. Conclusions: Data confirmed the presence of several risk factors for penile cancer, like phimosis, smoking, HPV infection and promiscuous sexual behaviour. The high number of Brazilian agricultural workers with penile cancer was unexpected if compared with other professional groups. Future studies should focus on this group of men and elucidate possible reasons for their increased risk.

Differential Association of the Lifestyle-Related Risk Factors Smoking and Obesity with Triple Negative Breast Cancer in a Brazilian Population

Background: A longer lifespan and changing lifestyle-related and reproductive risk factors have led to an increased incidence of breast cancer in Brazil. There have been few studies about associations of specific risk factors with molecular subtypes of the disease. The aim of the present study was to identify factors that modulate the risk of triple negative breast cancer. Materials and Methods: A case-case analysis was performed. Data for 236 breast cancer patients from two reference centres in North-eastern Brazil were applied to assess the association of risk factors with triple negative breast cancer relative to the luminal A subtype. Molecular subtypes were defined by expression status of hormone receptors and amplification of HER2. Nominal logistic regression was used to estimate odds ratios and to generate a model of independent variables. Results: Smoking and body mass index were differentially associated with likelihood of triple negative breast cancer compared to the Luminal A subtype (p= 0.013; p= 0.004): Women who ever smoked some time in their lives were 4.016 (OR= 0.249; CI 95%: 0.09- 0.71) times less likely to have triple negative breast cancer. Obese and overweight patients, respectively, were 4.489 (CI 95%: 1.32- 15.28) and 1.340 (CI 95%: 0.38- 4.69) times more likely to have triple negative breast cancer. Conclusions: Case-case analysis with the Luminal A subtype as the reference group indicated that smoking and body mass index are differentially associated with risk of triple negative breast cancer.

Resolution and reconciliation of non-binary gene trees with transfers, duplications and losses.

Summary: Gene trees reconstructed from sequence alignments contain poorly supported branches when the phylogenetic signal in the sequences is insufficient to determine them all. When a species tree is available, the signal of gains and losses of genes can be used to correctly resolve the unsupported parts of the gene history. However finding a most parsimonious binary resolution of a non-binary tree obtained by contracting the unsupported branches is NP-hard if transfer events are considered as possible gene scale events, in addition to gene origination, duplication and loss. We propose an exact, parameterized algorithm to solve this problem in single-exponential time, where the parameter is the number of connected branches of the gene tree that show low support from the sequence alignment or, equivalently, the maximum number of children of any node of the gene tree once the low-support branches have been collapsed. This improves on the best known algorithm by an exponential factor. We propose a way to choose among optimal solutions based on the available information. We show the usability of this principle on several simulated and biological datasets. The results are comparable in quality to several other tested methods having similar goals, but our approach provides a lower running time and a guarantee that the produced solution is optimal. Availability and Implementation: Our algorithm has been integrated into the ecceTERA phylogeny package, available at http://mbb.univ-montp2.fr/MBB/download_sources/16__ecceTERA and which can be run online at http://mbb.univ-montp2.fr/MBB/subsection/softExec.php?soft=eccetera . Contact: celine.scornavacca@umontpellier.fr. Supplementary information: Supplementary data are available at Bioinformatics online.

Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies.

The aim of this integrative review was to compare Latin American literature about risk and knowledge on breast cancer. Of 47 studies selected, 20 were about knowledge or awareness and 27 about risk of breast cancer. English was the dominant language in studies about risk, whereas studies about knowledge were mainly written in Spanish or Portuguese. Studies about knowledge were all cross- sectional, whereas case- control studies dominated authors' interest about risk of breast cancer. Studies about knowledge were mainly focused on early detection of the disease and the most common study objective was breast self- examination (N = 14). In contrast, few studies about risk of breast cancer focused on early detection (N = 5). Obesity and overweight (N = 14), family history (N = 13), decreased parity (N = 12), and short breastfeeding duration (N = 10) were among the most frequent identified risk factors. Socio- economic factors such as income and educational level had variable effects on breast cancer risk and affected also knowledge of women about risk factors and early detection. Present results indicated that studies about risk of breast cancer were more often based on a better sound analytical background, compared to studies about knowledge, which were mostly descriptive.