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1.
Evid. actual. práct. ambul ; 22(3): e002023, nov. 2019.
Artigo em Espanhol | LILACS | ID: biblio-1046944

RESUMO

Al igual en otras partes del mundo, en Argentina la mortalidad específica por cáncer mamario disminuyó de forma sostenida entre 1996 y 2017. Es probable que en la actualidad la mamografía sea la herramienta más importante para detectar precozmente, evaluar y llevar un seguimiento de las personas con esta patología. Sin embargo existe mucha controversia acerca de los beneficios del tamizaje poblacional y de la realización de diagnósticos precoces de cáncer de mama. El propósito de esta revisión narrativa es brindar una mirada contraintuitiva, cuestionadora de los beneficios de esta práctica,ponderando también sus riesgos, escasamente visibilizados por las estrategias comunicacionales concordantes con el modelo deprevenir es mejor que curar y la lucha contra la historia natural del cáncer. (AU)


As in other parts of the world, in Argentina, breast cancer specific mortality declined steadily between 1996 and 2017. Mammography is currently the most important tool for early detection, evaluation and follow-up of people suffering fromthis disease. However, there is a controversy about the benefits of population screening and early diagnosis of breastcancer. The aim of this narrative review is to provide a counterintuitive, questioning view of the benefits of this practice, also weighing its risks, poorly visible through communication strategies consistent with the model of prevention is betterthan cureand the fight against the natural history of cancer. (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Mama/diagnóstico por imagem , Mamografia/efeitos adversos , Programas de Rastreamento/efeitos adversos , Argentina/epidemiologia , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/mortalidade , Neoplasias da Mama/prevenção & controle , Neoplasias da Mama/terapia , Mamografia/mortalidade , Mamografia/tendências , Saúde Pública , Tomada de Decisões
2.
Evid. actual. práct. ambul ; 22(3): e002018, nov. 2019. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1046953

RESUMO

En este comentario editorial, la autora repasa la controversia sobre la promoción del rastreo mamográfico del cáncer de mama en el contexto de las campañas de des-información durante el octubre rosa. (AU)


In this editorial comment, the author reviews the controversy over the promotion of mammographic screening of breastcancer in the context of misinformation campaigns during the pink October. (AU)


Assuntos
Humanos , Feminino , Adulto , Pessoa de Meia-Idade , Neoplasias da Mama/prevenção & controle , Mamografia/efeitos adversos , Programas de Rastreamento/efeitos adversos , Comunicação em Saúde/métodos , Serviços Preventivos de Saúde/tendências , Comunicação em Saúde/tendências , Prevenção Quaternária , Promoção da Saúde/tendências
5.
JAMA ; 322(9): 868-886, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31479143

RESUMO

Importance: Medications to reduce risk of breast cancer are effective for women at increased risk but also cause adverse effects. Objective: To update the 2013 US Preventive Services Task Force systematic review on medications to reduce risk of primary (first diagnosis) invasive breast cancer in women. Data Sources: Cochrane Central Register of Controlled Trials and Database of Systematic Reviews, EMBASE, and MEDLINE (January 1, 2013, to February 1, 2019); manual review of reference lists. Study Selection: Discriminatory accuracy studies of breast cancer risk assessment methods; randomized clinical trials of tamoxifen, raloxifene, and aromatase inhibitors for primary breast cancer prevention; studies of medication adverse effects. Data Extraction and Synthesis: Investigators abstracted data on methods, participant characteristics, eligibility criteria, outcome ascertainment, and follow-up. Results of individual trials were combined by using a profile likelihood random-effects model. Main Outcomes and Measures: Probability of breast cancer in individuals (area under the receiver operating characteristic curve [AUC]); incidence of breast cancer, fractures, thromboembolic events, coronary heart disease events, stroke, endometrial cancer, and cataracts; and mortality. Results: A total of 46 studies (82 articles [>5 million participants]) were included. Eighteen risk assessment methods in 25 studies reported low accuracy in predicting the probability of breast cancer in individuals (AUC, 0.55-0.65). In placebo-controlled trials, tamoxifen (risk ratio [RR], 0.69 [95% CI, 0.59-0.84]; 4 trials [n = 28 421]), raloxifene (RR, 0.44 [95% CI, 0.24-0.80]; 2 trials [n = 17 806]), and the aromatase inhibitors exemestane and anastrozole (RR, 0.45 [95% CI, 0.26-0.70]; 2 trials [n = 8424]) were associated with a lower incidence of invasive breast cancer. Risk for invasive breast cancer was higher for raloxifene than tamoxifen in 1 trial after long-term follow-up (RR, 1.24 [95% CI, 1.05-1.47]; n = 19 747). Raloxifene was associated with lower risk for vertebral fractures (RR, 0.61 [95% CI, 0.53-0.73]; 2 trials [n = 16 929]) and tamoxifen was associated with lower risk for nonvertebral fractures (RR, 0.66 [95% CI, 0.45-0.98]; 1 trial [n = 13 388]) compared with placebo. Tamoxifen and raloxifene were associated with increased thromboembolic events compared with placebo; tamoxifen was associated with more events than raloxifene. Tamoxifen was associated with higher risk of endometrial cancer and cataracts compared with placebo. Symptomatic effects (eg, vasomotor, musculoskeletal) varied by medication. Conclusions and Relevance: Tamoxifen, raloxifene, and aromatase inhibitors were associated with lower risk of primary invasive breast cancer in women but also were associated with adverse effects that differed between medications. Risk stratification methods to identify patients with increased breast cancer risk demonstrated low accuracy.


Assuntos
Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/prevenção & controle , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/uso terapêutico , Adulto , Área Sob a Curva , Inibidores da Aromatase/efeitos adversos , Neoplasias da Mama/genética , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Mutação , Guias de Prática Clínica como Assunto , Cloridrato de Raloxifeno/efeitos adversos , Cloridrato de Raloxifeno/uso terapêutico , Medição de Risco/métodos , Fatores de Risco , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Tamoxifeno/efeitos adversos
6.
JAMA ; 322(9): 857-867, 2019 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-31479144

RESUMO

Importance: Breast cancer is the most common nonskin cancer among women in the United States and the second leading cause of cancer death. The median age at diagnosis is 62 years, and an estimated 1 in 8 women will develop breast cancer at some point in their lifetime. African American women are more likely to die of breast cancer compared with women of other races. Objective: To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on medications for risk reduction of primary breast cancer. Evidence Review: The USPSTF reviewed evidence on the accuracy of risk assessment methods to identify women who could benefit from risk-reducing medications for breast cancer, as well as evidence on the effectiveness, adverse effects, and subgroup variations of these medications. The USPSTF reviewed evidence from randomized trials, observational studies, and diagnostic accuracy studies of risk stratification models in women without preexisting breast cancer or ductal carcinoma in situ. Findings: The USPSTF found convincing evidence that risk assessment tools can predict the number of cases of breast cancer expected to develop in a population. However, these risk assessment tools perform modestly at best in discriminating between individual women who will or will not develop breast cancer. The USPSTF found convincing evidence that risk-reducing medications (tamoxifen, raloxifene, or aromatase inhibitors) provide at least a moderate benefit in reducing risk for invasive estrogen receptor-positive breast cancer in postmenopausal women at increased risk for breast cancer. The USPSTF found that the benefits of taking tamoxifen, raloxifene, and aromatase inhibitors to reduce risk for breast cancer are no greater than small in women not at increased risk for the disease. The USPSTF found convincing evidence that tamoxifen and raloxifene and adequate evidence that aromatase inhibitors are associated with small to moderate harms. Overall, the USPSTF determined that the net benefit of taking medications to reduce risk of breast cancer is larger in women who have a greater risk for developing breast cancer. Conclusions and Recommendation: The USPSTF recommends that clinicians offer to prescribe risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, to women who are at increased risk for breast cancer and at low risk for adverse medication effects. (B recommendation) The USPSTF recommends against the routine use of risk-reducing medications, such as tamoxifen, raloxifene, or aromatase inhibitors, in women who are not at increased risk for breast cancer. (D recommendation) This recommendation applies to asymptomatic women 35 years and older, including women with previous benign breast lesions on biopsy (such as atypical ductal or lobular hyperplasia and lobular carcinoma in situ). This recommendation does not apply to women who have a current or previous diagnosis of breast cancer or ductal carcinoma in situ.


Assuntos
Inibidores da Aromatase/uso terapêutico , Neoplasias da Mama/prevenção & controle , Moduladores Seletivos de Receptor Estrogênico/uso terapêutico , Tamoxifeno/uso terapêutico , Adulto , Neoplasias da Mama/genética , Feminino , Genes BRCA1 , Genes BRCA2 , Humanos , Pessoa de Meia-Idade , Mutação , Cloridrato de Raloxifeno/uso terapêutico , Medição de Risco/métodos , Fatores de Risco
7.
Rev Bras Epidemiol ; 22: e190045, 2019 Sep 02.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31482984

RESUMO

INTRODUCTION: The study assessed interobserver reliability in the classification of record pairs formed during probabilistic linkage of health-related databases, a key step in the methodology validation to be used in a larger on-going study on inequalities in the access to breast and cervical cancer control activities in Brazil (DAAC-SIS). METHODOLOGY: The RecLink software was used to link two databases of the Breast Cancer Control Information System (SISMAMA) in the state of Minas Gerais, Brazil: a reference database, which included 301 screening mammograms with probable benign diagnosis (BI-RADS 3 category) recorded in October 2010, and a database comprising 158,517 mammograms registered in 2011. Subsequently, the 215 pairs of records that were not assigned the maximum RecLink score were independently classified as being true or false by ten independent evaluators from four participating centers. RESULTS: The Kappa coefficient ranged from 0.87 to 1.00. Six evaluators were in perfect agreement with one or more evaluators from the other centers. The global Kappa was 0.96 (95% confidence interval - 95%CI 0.94 - 0.99). DISCUSSION: Assessment of interobserver reliability is key to ensuring the quality of the record linkage, and it should be routine practice in studies of this nature. The disclosure of such results contributes to transparency in the conduct of such studies and in the reporting of their findings. CONCLUSION: Interobserver reliability in this study was excellent, indicating satisfactory team consistency in the classification of record pairs.


Assuntos
Neoplasias da Mama/prevenção & controle , Sistemas de Informação em Saúde , Registro Médico Coordenado , Brasil , Bases de Dados Factuais , Feminino , Humanos , Mamografia , Variações Dependentes do Observador , Reprodutibilidade dos Testes , Integração de Sistemas
8.
JAMA ; 322(7): 666-685, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429902

RESUMO

Importance: Pathogenic mutations in breast cancer susceptibility genes BRCA1 and BRCA2 increase risks for breast, ovarian, fallopian tube, and peritoneal cancer in women; interventions reduce risk in mutation carriers. Objective: To update the 2013 US Preventive Services Task Force review on benefits and harms of risk assessment, genetic counseling, and genetic testing for BRCA1/2-related cancer in women. Data Sources: Cochrane libraries; MEDLINE, PsycINFO, EMBASE (January 1, 2013, to March 6, 2019, for updates; January 1, 1994, to March 6, 2019, for new key questions and populations); reference lists. Study Selection: Discriminatory accuracy studies, randomized clinical trials (RCTs), and observational studies of women without recently diagnosed BRCA1/2-related cancer. Data Extraction and Synthesis: Data on study methods, setting, population characteristics, eligibility criteria, interventions, numbers enrolled and lost to follow-up, outcome ascertainment, and results were abstracted. Two reviewers independently assessed study quality. Main Outcomes and Measures: Cancer incidence and mortality; discriminatory accuracy of risk assessment tools for BRCA1/2 mutations; benefits and harms of risk assessment, genetic counseling, genetic testing, and risk-reducing interventions. Results: For this review, 103 studies (110 articles; N = 92 712) were included. No studies evaluated the effectiveness of risk assessment, genetic counseling, and genetic testing in reducing incidence and mortality of BRCA1/2-related cancer. Fourteen studies (n = 43 813) of 8 risk assessment tools to guide referrals to genetic counseling demonstrated moderate to high accuracy (area under the receiver operating characteristic curve, 0.68-0.96). Twenty-eight studies (n = 8060) indicated that genetic counseling was associated with reduced breast cancer worry, anxiety, and depression; increased understanding of risk; and decreased intention for testing. Twenty studies (n = 4322) showed that breast cancer worry and anxiety were higher after testing for women with positive results and lower for others; understanding of risk was higher after testing. In 8 RCTs (n = 54 651), tamoxifen (relative risk [RR], 0.69 [95% CI, 0.59-0.84]; 4 trials), raloxifene (RR, 0.44 [95% CI, 0.24-0.80]; 2 trials), and aromatase inhibitors (RR, 0.45 [95% CI, 0.26-0.70]; 2 trials) were associated with lower risks of invasive breast cancer compared with placebo; results were not specific to mutation carriers. Mastectomy was associated with 90% to 100% reduction in breast cancer incidence (6 studies; n = 2546) and 81% to 100% reduction in breast cancer mortality (1 study; n = 639); oophorectomy was associated with 69% to 100% reduction in ovarian cancer (2 studies; n = 2108); complications were common with mastectomy. Conclusions and Relevance: Among women without recently diagnosed BRCA1/2-related cancer, the benefits and harms of risk assessment, genetic counseling, and genetic testing to reduce cancer incidence and mortality have not been directly evaluated by current research.


Assuntos
Neoplasias da Mama/genética , Genes BRCA1 , Genes BRCA2 , Aconselhamento Genético , Testes Genéticos , Mutação , Neoplasias Ovarianas/genética , Neoplasias da Mama/prevenção & controle , Neoplasias das Tubas Uterinas/genética , Neoplasias das Tubas Uterinas/prevenção & controle , Feminino , Predisposição Genética para Doença , Humanos , Neoplasias Ovarianas/prevenção & controle , Neoplasias Peritoneais/genética , Neoplasias Peritoneais/prevenção & controle , Medição de Risco
9.
JAMA ; 322(7): 652-665, 2019 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429903

RESUMO

Importance: Potentially harmful mutations of the breast cancer susceptibility 1 and 2 genes (BRCA1/2) are associated with increased risk for breast, ovarian, fallopian tube, and peritoneal cancer. For women in the United States, breast cancer is the most common cancer after nonmelanoma skin cancer and the second leading cause of cancer death. In the general population, BRCA1/2 mutations occur in an estimated 1 in 300 to 500 women and account for 5% to 10% of breast cancer cases and 15% of ovarian cancer cases. Objective: To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on risk assessment, genetic counseling, and genetic testing for BRCA-related cancer. Evidence Review: The USPSTF reviewed the evidence on risk assessment, genetic counseling, and genetic testing for potentially harmful BRCA1/2 mutations in asymptomatic women who have never been diagnosed with BRCA-related cancer, as well as those with a previous diagnosis of breast, ovarian, tubal, or peritoneal cancer who have completed treatment and are considered cancer free. In addition, the USPSTF reviewed interventions to reduce the risk for breast, ovarian, tubal, or peritoneal cancer in women with potentially harmful BRCA1/2 mutations, including intensive cancer screening, medications, and risk-reducing surgery. Findings: For women whose family or personal history is associated with an increased risk for harmful mutations in the BRCA1/2 genes, or who have an ancestry associated with BRCA1/2 gene mutations, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are moderate. For women whose personal or family history or ancestry is not associated with an increased risk for harmful mutations in the BRCA1/2 genes, there is adequate evidence that the benefits of risk assessment, genetic counseling, genetic testing, and interventions are small to none. Regardless of family or personal history, the USPSTF found adequate evidence that the overall harms of risk assessment, genetic counseling, genetic testing, and interventions are small to moderate. Conclusions and Recommendation: The USPSTF recommends that primary care clinicians assess women with a personal or family history of breast, ovarian, tubal, or peritoneal cancer or who have an ancestry associated with BRCA1/2 gene mutations with an appropriate brief familial risk assessment tool. Women with a positive result on the risk assessment tool should receive genetic counseling and, if indicated after counseling, genetic testing. (B recommendation) The USPSTF recommends against routine risk assessment, genetic counseling, or genetic testing for women whose personal or family history or ancestry is not associated with potentially harmful BRCA1/2 gene mutations. (D recommendation).


Assuntos
Neoplasias da Mama/genética , Genes BRCA1 , Genes BRCA2 , Aconselhamento Genético , Testes Genéticos , Mutação , Neoplasias Ovarianas/genética , Neoplasias da Mama/prevenção & controle , Neoplasias das Tubas Uterinas/genética , Feminino , Predisposição Genética para Doença , Humanos , Neoplasias Ovarianas/prevenção & controle , Neoplasias Peritoneais/genética , Medição de Risco
10.
Cancer Radiother ; 23(6-7): 778-783, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31378461

RESUMO

Randomized trials demonstrated similar overall survival between mastectomy and breast-conservative surgery followed by adjuvant radiation therapy. Breast-conservative surgery, with adjuvant radiation therapy, with or without neoadjuvant systemic therapy has become the standard of care for women with early or locally advanced breast cancer. Nevertheless, certain cardiac, lung or cutaneous toxicities may alter the long-term body image and the quality of life of a limited number of patients who consider having had "overtreatment" or treatment outside the best knowledge of science. In case of low-risk breast cancer, several trials have evaluated the carcinologic outcome in absence of radiation therapy after breast-conservative surgery. Local recurrences increased in case of breast-conservative surgery alone but without impact on overall survival. Multiple debates have emerged in order to select the most appropriate evaluation criteria. Finally, a large consensus has considered that reducing local recurrences is important but with modern technologies and after identifying patients of individual radiosensitivity. Indeed, in case of a low absolute risk of local recurrence, radiation therapy techniques have been developed to allow a focal treatment especially for patients with high risk of developing late effects. This kind of compromise takes into account the reduction risk of local recurrences but also the probability of developing radiation-induced cutaneous sequelae. In the same way, for patients considered at high risk of recurrence, the huge volumes need specific techniques to better cover the targets while protecting the surrounding critic organs such as heart and lung. Intensity-modulated radiation therapy and the local high boost may help to decrease local recurrences of these more extended and aggressive diseases while considering the individual radiosensitivity that paves the way of long-term sequelae. In this article, we detail a personalized approach of breast radiation therapy considering the absolute risk of local recurrences and the probability of radiation-induced toxicity appearance.


Assuntos
Neoplasias da Mama/radioterapia , Medicina de Precisão/métodos , Lesões por Radiação/etiologia , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/patologia , Neoplasias da Mama/prevenção & controle , Fracionamento da Dose de Radiação , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/prevenção & controle , Órgãos em Risco/efeitos da radiação , Tolerância a Radiação , Medição de Risco , Carga Tumoral
11.
Aust N Z J Public Health ; 43(4): 334-339, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31268228

RESUMO

OBJECTIVE: To compare breast screening attendances of Indigenous and non-Indigenous women. METHODS: A total of 4,093 BreastScreen cases were used including 857 self-identified Indigenous women. Chi-squared analysis compared data between Indigenous and non-Indigenous women. Logistic regression was used for groupings based on visits-to-screening frequency. Odds ratios and 95% confidence intervals were calculated for associations with low attendance. RESULTS: Indigenous women were younger and had fewer visits to screening compared with non-Indigenous women. Non-English speaking was mainly associated with fewer visits for Indigenous women only (OR 1.9, 95%CI 1.3-2.9). Living remotely was associated with fewer visits for non-Indigenous women only (OR 1.3, 95%CI 1.1-1.5). Shared predictors were younger age (OR 12.3, 95%CI 8.1-18.8; and OR 11.5, 95%CI 9.6-13.7, respectively) and having no family history of breast cancer (OR 2.1, 95%CI 1.3-3.3; and OR 1.8, 95%CI 1.5-2.1, respectively). CONCLUSIONS: Factors associated with fewer visits to screening were similar for both groups of women, except for language which was significant only for Indigenous women, and remoteness which was significant only for non-Indigenous women. Implications for public health: Health communication in Indigenous languages may be key in encouraging participation and retaining Indigenous women in BreastScreen; improving access for remote-living non-Indigenous women should also be addressed.


Assuntos
Neoplasias da Mama/diagnóstico , Serviços de Saúde do Indígena/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Adulto , Neoplasias da Mama/etnologia , Neoplasias da Mama/prevenção & controle , Feminino , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Northern Territory/epidemiologia
12.
Medicine (Baltimore) ; 98(27): e16147, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31277115

RESUMO

BACKGROUND: As the most popular beverage in East Asia, green tea (GT) has various biological activities effects such as anti-mutation, anti-oxidation, and anti-tumor. In this study, we aimed to evaluate whether GT consumption could be an effective way to decrease the risk of breast cancer. METHODS: We had performed a systematic review and updated meta-analysis of published case-control studies to evaluate the association between GT intake and the risk of breast cancer. Searching strategies were performed by the following keywords "Breast cancer," "breast neoplasm," and "green tea," with derivations and different combinations. The following databases were searched: PubMed, Cochrane Library, EMBASE, Web of science, China National Knowledge Infrastructure, WanFang, and China Biology Medicine disc. Studies published in both English and Chinese were considered for inclusion. Risk of bias was assessed through the Newcastle-Ottawa Scale (NOS). All data were analyzed through using Review Manager 5.1 software. RESULTS: Fourteen studies fulfilled inclusion criteria for meta-analysis, yielding a total of 14,058 breast cancer patients and 15,043 control subjects. Individuals with the habit of drinking GT were found to have a negative association with the risk of future breast cancer (odds ratio 0.83; 95% confidence interval: 0.72-0.96) despite significant heterogeneity. In subgroup analyses, the negative correlation was still found in studies using registry-based controls, NOS grades ≥6 and the number of cases <500. CONCLUSIONS: GT consumption may have a decreased incidence of breast cancer despite significant heterogeneity. However, owing to the quality of available studies, more properly designed trials are warranted to clarify the association between GT consumption and breast cancer.


Assuntos
Neoplasias da Mama/prevenção & controle , Chá , Neoplasias da Mama/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos
13.
Public Health ; 173: 42-47, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31254676

RESUMO

OBJECTIVES: The aim of this analysis was to examine the association between public healthcare eligibility combined with private health insurance (PHI) status and the uptake of breast and prostate cancer screening services among middle and older age groups in Ireland. STUDY DESIGN: This is a cross-sectional analysis using The Irish Longitudinal Study on Ageing (TILDA). METHODS: The analysis included 6902 people aged 50 years and older who completed an in-house interview as part of TILDA. The interview collects information on a range of demographic, socio-economic, health and health service usage variables including the uptake of cancer screening services. An eligibility variable was created using information on public healthcare entitlement and PHI status. The association between eligibility and the uptake of two cancer screening services-mammogram and prostate-specific antigen (PSA) test-was examined using weighted multivariate logistic regression analysis. RESULTS: The uptake of a mammogram and PSA testing was significantly higher in those with PHI. This relationship held after controlling for a range of confounders including health and socio-economic status. CONCLUSIONS: More research is required to identify the reasons for the higher uptake of cancer screening services among those with PHI, given that insurance does not confer any advantages in accessing these services. It is possible that the higher uptake is explained by differential access to secondary care services between those with and without PHI. Consideration of the integrated nature of healthcare systems is essential when seeking to maximise the uptake of services (such as cancer screening) that potentially involve multiple parts of the healthcare system.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Neoplasias/diagnóstico , Antígeno Prostático Específico , Neoplasias da Próstata/diagnóstico , Idoso , Neoplasias da Mama/prevenção & controle , Estudos Transversais , Definição da Elegibilidade , Feminino , Humanos , Seguro Saúde , Irlanda , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Neoplasias/prevenção & controle , Neoplasias da Próstata/prevenção & controle , Classe Social , Fatores Socioeconômicos
14.
Plast Reconstr Surg ; 144(1): 1-9, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31246789

RESUMO

BACKGROUND: The increasing trend of women with unilateral breast cancer to electively undergo contralateral prophylactic mastectomy in addition to treatment of the index breast has been controversial. The authors set out to better frame the risks and benefits of contralateral prophylactic mastectomy in the treatment of unilateral breast cancer by evaluating outcomes of a large, consecutive cohort of patients. METHODS: An institutional review board-approved review of a single-surgeon (N.T.) experience (2013 to 2018) was conducted of all consecutive patients with unilateral breast cancer treated with mastectomy and immediate reconstruction. Patient characteristics, surgical pathologic results, and 30-day complications were assessed. Outcomes of patients with unilateral cancer who underwent unilateral mastectomy versus bilateral mastectomy (with one breast being contralateral prophylactic mastectomy) were compared. Logistic regression models evaluated various risk factors for potential associations with positive pathologic findings in the contralateral prophylactic mastectomy specimen and/or postoperative complications. RESULTS: Of 244 patients, 68 (27.9 percent) underwent unilateral mastectomy and 176 (72.1 percent) underwent contralateral prophylactic mastectomy. Surgical pathologic results of the prophylactic breast revealed occult ductal carcinoma in situ or invasive cancer in 13 patients (7.3 percent) and lobular carcinoma in situ in eight patients (4.6 percent). Incidence of complications was similar between groups [unilateral mastectomy, 19.12 percent (n = 13); contralateral prophylactic mastectomy, 13.07 percent (n = 23); p = 0.234]. CONCLUSIONS: Immediate reconstruction for unilateral mastectomy and contralateral prophylactic mastectomy have similar complication risk profiles, among patients as a whole and between individual breasts. These findings contribute to our understanding of the clinical impact prophylactic mastectomy and reconstruction may have on optimizing the counseling among extirpative surgeons, reconstructive surgeons, and patients. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.


Assuntos
Neoplasias da Mama/cirurgia , Carcinoma Ductal de Mama/cirurgia , Mamoplastia/métodos , Mastectomia/métodos , Transfusão de Componentes Sanguíneos/estatística & dados numéricos , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Cuidados Intraoperatórios/estatística & dados numéricos , Pessoa de Meia-Idade , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Risco , Retalhos Cirúrgicos/estatística & dados numéricos , Resultado do Tratamento
15.
Cancer Causes Control ; 30(8): 835-846, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31165965

RESUMO

PURPOSES: Dietary patterns have been found to be associated with the overall cancer risk and survival. However, the associations of healthy dietary patterns and breast cancer remain unclear. We aimed to conduct a meta-analysis of prospective cohort studies to estimate the pooled results of the association of healthy dietary patterns with breast cancer risk and survival. METHODS: PubMed, EMBASE, and Web of Science were searched for literature published until June 24th, 2018 that examined the associations between healthy dietary patterns and breast cancer risk and survival. Risk ratios (RRs) and 95% confidence intervals (CIs) were calculated by using a random-effects model for meta-analysis. RESULTS: There were 32 articles retrieved for the meta-analysis, with 27 for breast cancer risk and five for breast cancer survival. There was a statistically significant lower risk of breast cancer associated with healthy dietary patterns (RR = 0.93, 95% CI: 0.88, 0.98). Subgroup analysis results suggested that there was an inverse association between breast cancer risk and posterori-derived healthy patterns, but no statistically significant associations were found in other stratified subgroups (a priori-derived diet, study region, menopausal status, or breast cancer subtypes). Healthy dietary patterns were associated inversely with all-cause mortality (RR = 0.76, 95% CI: 0.63, 0.92); however, no association was found for breast cancer-specific mortality. CONCLUSIONS: The results suggested that healthy dietary patterns might be associated with a reduced risk of breast cancer and all-cause mortality among breast cancer patients. It could be clinically relevant to promote healthy dietary patterns for breast cancer prevention and improve survival among breast cancer patients.


Assuntos
Neoplasias da Mama/epidemiologia , Dieta , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Estudos Prospectivos , Fatores de Risco
16.
Gynecol Oncol ; 154(2): 374-378, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31160070

RESUMO

OBJECTIVE: Describe clinical characteristics and risk reducing strategies utilized among women with a BRCA mutation who lived to age 75 and above. METHODS: A retrospective study of women with BRCA mutations identified from 1995 to 2015 in a California health care system. From a database of 1189 women, 69 participants were identified who lived to age 75 or older. Demographic and clinical characteristics were recorded, as well as cancer history and risk-reducing strategies utilized. Descriptive and bivariate analyses were used to analyze the cohort. RESULTS: The median age of the cohort at study entry was 78 (IQR: 76-84) and the median age at time of genetic testing was 73 (IQR 68-79). Fifty (72%) women had a prior history of breast cancer and 27 (39%) had a history of ovarian cancer. Three of 19 (16%) women with no history of breast cancer elected to undergo a risk-reducing mastectomy (RRM) after their positive genetic test. Among 30 women with ovaries still in place, 14 (47%) underwent a risk-reducing salpingo-oophorectomy (RRSO); six were age 70 or older at the time of surgery. Four (6%) women in the cohort developed BRCA-related cancer after testing, one developed breast cancer and three developed pancreatic cancer. CONCLUSIONS: Most women with BRCA mutations surviving beyond age 75 received their genetic test result at an older age and had a history of BRCA-related cancer. Women continued surveillance and risk reducing surgeries at an older age. Pancreatic cancer was the most common new cancer diagnosed in older BRCA mutation carriers.


Assuntos
Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/genética , Testes Genéticos/estatística & dados numéricos , Neoplasias Ovarianas/genética , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Feminino , Humanos , Mastectomia , Mutação , Neoplasias Ovarianas/epidemiologia , Neoplasias Ovarianas/prevenção & controle , Ovariectomia , Estudos Retrospectivos
17.
Am Soc Clin Oncol Educ Book ; 39: e22-e33, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099634

RESUMO

Observational evidence has consistently linked excess adiposity and inactivity to increased breast cancer risk and to poor outcomes in individuals diagnosed with early-stage, potentially curable breast cancer. There is less information from clinical trials testing the effect of weight management or physical activity interventions on breast cancer risk or outcomes, but a number of ongoing trials will test the impact of weight loss and other lifestyle changes after cancer diagnosis on the risk of breast cancer recurrence. Lifestyle changes have additional benefits beyond their potential to decrease primary or secondary breast cancer risk, including improvements in metabolic parameters, reduction in the risk of comorbidities such as diabetes and heart disease, improvement of physical functioning, and mitigation of side effects of cancer therapy. Despite these myriad benefits, implementation of lifestyle interventions in at-risk and survivor populations has been limited to date. This article reviews the evidence linking lifestyle factors to breast cancer risk and outcomes, discusses completed and ongoing randomized trials testing the impact of lifestyle change in primary and secondary breast cancer prevention, and reviews efforts to implement and disseminate lifestyle interventions in at-risk and breast cancer survivor populations.


Assuntos
Manutenção do Peso Corporal , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/prevenção & controle , Exercício , Neoplasias da Mama/etiologia , Ensaios Clínicos como Assunto , Dieta , Detecção Precoce de Câncer , Feminino , Humanos , Estilo de Vida , Obesidade/complicações , Obesidade/epidemiologia , Prevenção Primária , Vigilância em Saúde Pública , Medição de Risco , Prevenção Secundária
18.
Am Soc Clin Oncol Educ Book ; 39: 61-74, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099663

RESUMO

The field of germline genetic testing for breast cancer (BC) risk has evolved substantially in the last decade. The introduction of multigene panel testing (MGPT) led to an urgent need to understand the cancer risk associated with several genes included in the panels. Although the research on understanding the cancer risk associated with mutations in several genes continues, there is also a need to understand the modifying effects of race and ethnicity, family history, and BC pathology on the prevalence of germline mutations and associated BC risk. Furthermore, polygenic risk scores (PRSs) to predict BC risk in patients with or without germline mutations in cancer-predisposition genes are now available for clinical use, although data on the clinical utility of PRSs are lacking. In patients with advanced BC associated with BRCA1/2 mutation, olaparib and talazoparib are now approved for treatment. In addition, molecular profiling studies are being used to clarify the BC tumor biology in mutation carriers to identify potential therapeutic options. In this article, we discuss these advances in the field of germline genetic testing and highlight current limitations and implications for clinical care.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/etiologia , Predisposição Genética para Doença , Mutação em Linhagem Germinativa , Biomarcadores Tumorais , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/prevenção & controle , Feminino , Testes Genéticos , Humanos , Estadiamento de Neoplasias , Medicina de Precisão , Prevalência , Vigilância em Saúde Pública , Medição de Risco , Fatores de Risco
19.
BMC Public Health ; 19(1): 503, 2019 May 03.
Artigo em Inglês | MEDLINE | ID: mdl-31053073

RESUMO

BACKGROUND: The negative impact of cervical and breast cancers in low and lower-middle income countries are worsening, and, along with other non-communicable diseases, occur disproportionately in these resource-limited economies. Most preventive approaches to these cancers require government funding, but few countries with the most at-risk population can afford government-sponsored universal vaccination, screening, diagnostic and treatment programmes, which, along with socioeconomic issues, contribute to the poor outcomes in these mostly developing countries. An urgent need exists, therefore, to find an effective, affordable, cost-effective, culturally-acceptable and sustainable way of reducing these cancers. This paper advocates a re-thinking in the current preventive campaigns. MAIN BODY: Using evidence provided by recently-published papers, a case is made for enlightenment campaigns to primarily target teenagers (boys and girls) in high schools of developing countries. Inclusions into the schools' academic curricula are the recommended approach, given that both cancers take hold on populations within that age bracket. This approach, if adopted, may be the only accessible, affordable and realistic approach that gives millions of women in low and lower-middle income countries the chance at survival. Empowering them early instils the self-awareness and confidence necessary for young adults to take charge of their own health. The acquired knowledge, in turn, helps them adopt positive attitudes and preventive behaviours that will, ultimately, prolong their lives. CONCLUSION: The recommended approach offers governments and concerned stakeholders an evidence-based option that allows them to deliver cost-effective and sustainable life-saving interventions, while hoping to get around the bottlenecks that limit the large scale implementation of other effective but capital-intensive strategies.


Assuntos
Neoplasias da Mama/prevenção & controle , Países em Desenvolvimento , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Neoplasias da Mama/economia , Análise Custo-Benefício , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Pobreza/estatística & dados numéricos , Neoplasias do Colo do Útero/economia , Vacinação
20.
Int J Clin Oncol ; 24(9): 1105-1110, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31055694

RESUMO

BACKGROUND: This study aimed to identify the clinical background and treatment outcomes of risk-reducing salpingo-oophorectomy (RRSO) in Japan for women with hereditary breast and ovarian cancer (HBOC). METHODS: In the present retrospective observational study, we examined the Japanese HBOC Consortium's (JHC) database. This database contains 11,711 probands who received BRCA genetic testing, or their relatives, with any cancer in 2433 pedigrees. This study was supported by the registration committee of the JHC. RESULTS: We analyzed 488 individuals diagnosed with HBOC, of which 153 (31.4%) underwent RRSO. Of the latter patients, 88 carried BRCA1 mutation (B1); 62 carried BRCA2 mutation (B2); and 3 carried both mutations. During a mean follow-up period of 2.6 years (range 0-12.6), one patient developed a primary peritoneal cancer (PPC). Clinical background comparison for individuals who underwent RRSO vs. those > 45 years of age who did not undergo RRSO revealed that significant factors were represented by B1 (p < 0.0001); child bearing (p < 0.00001); and breast cancer history (p < 0.01). However, family history of ovarian cancer and menopause status were not significantly different. CONCLUSION: Over 30% HBOC's in Japan underwent RRSO. In Japan, individuals with breast cancer history and B1 generally underwent RRSO, whereas those who did not bear a child mostly avoided RRSO.


Assuntos
Neoplasias da Mama/prevenção & controle , Neoplasias Ovarianas/prevenção & controle , Salpingo-Ooforectomia , Adulto , Idoso , Grupo com Ancestrais do Continente Asiático , Proteína BRCA1/genética , Proteína BRCA2/genética , Neoplasias da Mama/genética , Feminino , Seguimentos , Humanos , Menopausa , Pessoa de Meia-Idade , Mutação , Neoplasias Ovarianas/genética , Linhagem , Neoplasias Peritoneais/etiologia , Estudos Retrospectivos , Comportamento de Redução do Risco
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