Desafios do rastreamento do câncer de mama / Challenges of breast cancer screening

A mamografia é o método de eleição para o rastreamento do câncer de mama, sendo o único que demonstra redução de mortalidade na população de risco habitual. A periodicidade de realização e a idade de início do rastreamento mamográfico são um tema controverso na literatura. Entretanto, dados no nosso país apontam para uma porção significativa de neoplasia de mamas em mulheres abaixo dos 50 anos. A Federação Brasileira das Associações de Ginecologia e Obstetrícia (Febrasgo), a Sociedade Brasileira de Mastologia (SBM) e o Colégio Brasileiro de Radiologia e Diagnóstico por Imagem (CBR) concordam que o rastreamento mamográfico deveria ser realizado, anualmente, por todas as mulheres a partir de 40 anos de idade. No Brasil, há uma distribuição desigual de mamógrafos nas várias regiões. As políticas de rastreamento devem considerar essa desigualdade. A grande maioria dos serviços no Brasil realiza rastreamento oportunístico para o câncer de mama. A implantação de rastreamento organizado por faixa etária e estratificação de risco pode otimizar os custos do sistema público de saúde. Pacientes de alto risco precisam ser rastreadas de forma diferente das pacientes de risco habitual. Essas pacientes precisam ter acesso à ressonância magnética das mamas e também iniciar seu rastreamento em idade mais precoce. O protocolo abreviado da ressonância magnética para rastreamento de pacientes de alto risco para câncer de mama pode melhorar a adesão e o acesso dessas pacientes ao programa de rastreamento. A ultrassonografia das mamas não é método de rastreamento isoladamente. Entretanto, ela tem seu papel como método complementar à mamografia e à ressonância magnética em cenários específicos, bem como em substituição à ressonância magnética em pacientes com contraindicação ao uso desse método. As mamas densas possuem baixa sensibilidade para o rastreamento por mamografia

Evaluation of the usability of a mobile application in early detection of pediatric cancer / Evaluación de la usabilidad de una aplicación móvil en la detección precoz de cáncer pediátrico / Avaliação da usabilidade de um aplicativo móvel para detecção precoce do câncer pediátrico

ABSTRACT Objective To evaluate the usability of a mobile application for early detection of pediatric cancer. Method A descriptive study, with a quantitative approach, evaluating the usability of the application "Fique Atento, pode ser câncer" by 19 oncology nurses at the Oswaldo Cruz University Hospital, Pernambuco, Brazil, using the validated System Usability Scale questionnaire. For analysis, Microsoft Excel and the support of the Statistical Package for the Social Sciences (SPSS) software were used. Results Through the application of the SUS questionnaire, the total value of the averages of all scores was 91.58%, the satisfaction rate was 88.6% and the efficiency rate 91.2%. Discussion The data demonstrated that the application has agreement and compliance with the principles of usability in the criteria of effectiveness, efficiency and user satisfaction. Final considerations The application brings an important contribution to expand the construction and validation of technological tools that align both theoretical and practical knowledge.

RESUMEN Objetivo Evaluar la usabilidad de una aplicación móvil para la detección precoz del cáncer pediátrico. Método Estudio descriptivo, con enfoque cuantitativo, evaluando la usabilidad de la aplicación "Fique atento, pode ser câncer" por 19 enfermeras de oncología del Hospital Universitario Oswaldo Cruz, Pernambuco, Brasil, utilizando el cuestionario de la Escala de Usabilidad del Sistema validado. Para el análisis de los datos se utilizó Microsoft Excel y el soporte del software Statistical Package for the Social Sciences (SPSS). Resultados Al aplicar el cuestionario SUS, el valor totals de los promedios de todos los puntajes fue del 91,58%, la tasa de satisfacción fue del 88,6% y la tasa de eficiencia del 91,2%. Discusión Los datos demostraron que la aplicación tiene concordancia y cumplimiento con los principios de usabilidad en los criterios de efectividad, eficiencia y satisfacción del usuario. Consideraciones finales La aplicación aporta un importante aporte para expandir la construcción y validación de herramientas tecnológicas que alinean conocimientos teóricos y prácticos.

RESUMO Objetivo Avaliar a usabilidade de um aplicativo móvel para detecção precoce do câncer pediátrico. Método Estudo descritivo, com abordagem quantitativa, de avaliação da usabilidade do aplicativo "Fique Atento, pode ser câncer" por 19 enfermeiros oncológicos do Hospital Universitário Oswaldo Cruz, Pernambuco, Brasil, utilizando o questionário validado System Usability Scale. Para análise dos dados utilizou-se o Microsoft Excel e o suporte do software Statistical Package for the Social Sciences (SPSS). Resultados Mediante a aplicação do questionário SUS, o valor total das médias de todos os scores foi de 91,58%, o índice de satisfação foi de 88,6% e o de eficiência 91,2%. Discussão Os dados demonstraram que o aplicativo possui concordância e conformidade com os princípios de usabilidade nos critérios de efetividade, eficiência e satisfação do usuário. Considerações finais: O aplicativo traz uma importante contribuição para ampliação da construção e validação de ferramentas tecnológicas que alinham o conhecimento teórico ao prático.

Screening de lesiones orales malignas y potencialmente malignas en funcionarios de Universidad de Valparaíso y Universidad Viña del Mar durante los años 2016 - 2017 / Screening of malignant and potentially malignant oral lesions in employee of the University of Valparaíso and the University of Viña del Mar during 2016 - 2017

El objetivo de este estudio es determinar la prevalencia de lesiones orales malignas y potencialmente malignas (LPM) en funcionarios de la Universidad de Valparaíso y de Viña del Mar durante los años 2016 - 2017. Fueron citados 161 funcionarios, quienes accedieron a una encuesta que evaluaba factores de riesgo de cáncer oral (tabaco y alcohol) y si habían escuchado de la patología, sumado a un examen clínico. De los pacientes examinados, se diagnosticaron 121 lesiones de las cuales 2 fueron diagnosticadas como lesiones potencialmente malignas: Liquen plano y Leucoplasia, con una prevalencia de 1,7 %. El 50,3 % de los pacientes sabía de la existencia de cáncer oral. El Screening es una medida que permite dar a conocer a la población la existencia de cáncer oral y alertarlos sobre la importancia de su examen para su identificación de manera temprana.

The objective of this study is to determine the prevalence of malignant and potentially malignant oral lesions (PML) in University of Valparaíso and Viña del Mar employees, during the years 2016 - 2017. We cited 161 employees, who accessed a survey evaluating risk factors for oral cancer (tobacco and alcohol) and if they had heard of the disease. In addition, a clinical examination was carried out. Of the patients examined, 121 lesions were diagnosed, of which 2 were diagnosed as potentially malignant lesions: Lichen planus and Leukoplakia, with a prevalence of 1.6 %. 50.3 % of patients knew of the existence of oral cancer. Epidemiological designs are needed to better establish causality between risk factors and malignant or, potentially malignant lesions.

Prostate cancer screening in low- and middle- income countries: the Mexican case / Tamizaje para cáncer de próstata en países de bajos y medianos ingresos: el caso mexicano

Abstract: Prostate-specific antigen (PSA)-based early detection for prostate cancer is the subject of intense debate. Implementation of organized prostate cancer screening has been challenging, in part because the PSA test is so amenable to opportunistic screening. To the extent that access to cancer screening tests increases in low- and middle-income countries (LMICs), there is an urgent need to thoughtfully evaluate existing and future cancer screening strategies to ensure benefit and control costs. We used Mexico's prostate cancer screening efforts to illustrate the challenges LMICs face. We provide five considerations for policymakers for a smarter approach and implementation of PSA-based screening.

Resumen : El uso del Antígeno Prostático Específico (APE) para tamizaje para cáncer de próstata sigue siendo tema de amplio debate. La implementación de estrategias de tamiz organizado de cáncer de próstata ha sido un reto en parte porque la prueba de APE se presta para detección oportunista. A medida que aumenta el acceso a las pruebas de detección de cáncer en los países de ingresos bajos y medianos (PIBM), existe la necesidad urgente de evaluar cuidadosamente las estrategias actuales y futuras de detección oportuna de cáncer para garantizar su beneficio y controlar sus costos. Utilizamos los esfuerzos de tamizaje de cáncer de próstata de México para ilustrar los retos para PIBM. Ofrecemos cinco consideracio nes dirigidas a tomadores de decisión que permitan contar con estrategias racionales de implementación de tamizaje para cáncer de próstata basado en el uso de APE.

Barriers and innovative interventions for early detection of cervical cancer / Barreras e intervenciones innovadoras para la detección temprana del cáncer cervicouterino

Abstract: Cervical cancer has decreased significantly over the past 30 years in some countries. However, it remains among the leading causes of cancer deaths in low-income, and racial/ethnic minority women. Cervical cancer prevention technologies are not always available. Laboratories are often not well equipped to use them. HPV information has not been widely disseminated. WHO guidelines, and US and Latin American data provide context for strategies on effective interventions to reduce cervical cancer disparities. Systemic, personal and cultural barriers, combined with decision-making guidelines, and impactful messaging can accelerate reductions in cervical cancer health inequities in the Americas.

Resumen: El cáncer cervicouterino ha disminuido significativamente en los últimos 30 años, pero sigue siendo una de las principales causas de muerte entre mujeres de bajos recursos y minorías raciales/étnicas. Las tecnologías preventivas del cáncer cervicouterino no están siempre disponibles y los laboratorios no están siempre bien equipados para utilizarlas. La información sobre el VPH no ha sido difundida ampliamente. La OMS y datos de EEUU y Latinoamérica ofrecen estrategias para reducir el cáncer cervicouterino. El entendimiento de las barreras sistémicas, personales y culturales, dentro de un marco de toma de decisiones, y mensajes innovadores puede reducir las barreras asociadas con el cáncer cervicouterino en las Américas.

Adopción e implementación del ofrecimiento de la autotoma VPH por agentes sanitarios en Jujuy, Argentina / Adoption and implementation of HPV self-collection sampling by CHWs in Jujuy, Argentina

Resumen: Objetivo: Evaluar la adopción e implementación en escala de la estrategia orientada a ofrecer puerta a puerta la autotoma de la prueba del virus del papiloma humano (AT-VPH), por parte de agentes sanitarios (AS), en Jujuy, Argentina. Material y métodos: Se aplicó una encuesta autoadministrada a 478 AS. Las dimensiones de adopción e implementación fueron evaluadas con el modelo RE-AIM. Resultados: Adopción: 81.8% de los AS ofreció la AT-VPH y 86.4% expresó gratificación con la estrategia. Implementación: los problemas encontrados fueron la demora en la entrega de tubos (61.3%) y resultados (70.0%); falta de recursos humanos (28.3%), y dificultades al obtener turnos para realizar el triage (26.1%). El principal obstáculo fue la sobrecarga de trabajo (50.2%), mientras que la capacitación (38.0%) y el listado de mujeres a contactar (28.7%) fueron los elementos facilitadores. Conclusiones: La adopción de la AT-VPH fue alta entre los AS. Deben reforzarse las estrategias programáticas para motivar a los AS y reducir su carga de trabajo al implementar la AT-VPH.

Abstract: Objective: To evaluate adoption and implementation of scaling up of HPV self-collection (SC) strategy offered door-to-door by Community Health Workers (CHWs) in Jujuy, Argentina. Materials and methods: A self-administered questionnaire was applied to 478 CHWs. RE-AIM model was used to evaluate adoption and implementation dimensions. Results: Adoption: 81.8% offered SC and 86.4% were satisfied with the strategy. Implementation: main problems were delays in the delivery of tubes (61.3%) and results (70.0%), lack of human resources (28.3%) and difficulties in obtaining an appointment for triage (26.1%). The main obstacle was the excessive workload of CHWs (50.2%). Training (38.0%) and the list of women to be offered the test (28.7%) were identified as facilitators. Conclusions: The adoption of SC strategy was high among CHWs. Program strategies should be strengthened to motivate and reduce the excessive workload of CHWs when implementing SC strategy.

Prática de exames de rastreio para câncer de mama e fatores associados - Inquérito de Saúde da Mulher em Uberaba MG, Brasil, 2014 / Breast cancer screening practice and associated factors: Women's Health Survey in Uberaba MG Brazil, 2014

Resumo Os objetivos deste estudo foram caracterizar o perfil socioeconômico e epidemiológico das mulheres em Uberaba, segundo a prática de exames de rastreio para câncer de mama, bem como verificar os fatores associados à prática. Pesquisa transversal de base populacional, parte do Inquérito de Saúde da Mulher em Uberaba MG. Coleta por entrevista domiciliar, referentes à questões socioeconômicas, epidemiológicas e prática de exames de rastreio para câncer de mama. Amostra foi composta por 1.520 mulheres acima de 20 anos. Após o processamento dos dados, foi realizada análise estatística com medidas de associação pelo teste Qui-Quadrado; regressão bivariada e multivariada de Poisson, significância de 5%. Os resultados demonstraram um perfil de prática de exames de rastreio para câncer de mama com mulheres de raça/cor branca (66%), escolaridade e renda per capita elevada, estado conjugal "em união" (67,5%), não chefes de família (64,4%) e não tabagistas (64,6%). Os fatores associados à maior prática dos exames foram a faixa etária de 40-49 e 50-69 anos (RP = 0,7 e 0,64), renda per capita maior que um salário mínimo (RP = 1,17) e fonte de pagamento da mamografia pública ou por plano de saúde (RP = 1,98 e 1,94). Conclui-se que existem fatores relacionados à prática de exames de rastreio na amostra estudada.

Abstract This study aimed to characterize women's socioeconomic and epidemiological profile in Uberaba according to the breast cancer screening practice and identify associated factors with this practice. This is a cross-sectional research part of the Women's Health Survey in Uberaba (MG). Data was collected by home interview, referring to socioeconomic and epidemiological issues and breast cancer screening practice, from a sample of 1,520 women above 20 years of age. After processing the data, we performed statistical analysis with measures of association by the Chi-square test, bivariate and multivariate Poisson regression, with a significance level of 5%. The results showed a profile of breast cancer screening practice with white women (66%), high schooling and per capita income, in common-law marriage (67,5%), non-heads of households (64,4%) and non-smokers (64,6%). Factors associated with higher practice were the age groups 40-49 and 50-69 years (PR = 0.7 and 0.64), per capita income higher than one minimum wage (PR = 1.17) and public or health plan mammography coverage (PR = 1.98 and 1.94). We can conclude that factors associated with breast cancer screening practice have been identified in the studied sample.

Programa multicéntrico de cribado de cáncer colorrectal en Chile / Results of a multicentric colorectal cancer screening program in Chile

Background: Colorectal Cancer Screening Programs (CRCSP) are widely accepted in developed countries. Unfortunately, financial restrictions, low adherence rate and variability on colonoscopy standardization hamper the implementation of CRCSP in developing countries. Aim: To analyze a multicentric pilot model of CRCSP in Chile. Material and Methods: A prospective model of CRCSP was carried out in three cities, from 2012 to 2015. The model was based on CRC risk assessment and patient education. Health care personnel were trained about logistics and protocols. The endoscopy team was trained about colonoscopy standards. A registered nurse was the coordinator in each center. We screened asymptomatic population aged between 50 and 75 years. Immunological fecal occult blood test (FIT) was offered to all participants. Subjects with positive FIT underwent colonoscopy. Results: A total of 12,668 individuals were enrolled, with a FIT compliance rate of 93.9% and 2,358 colonoscopies were performed. Two hundred and fifty high-risk adenomas and 110 cancer cases were diagnosed. One patient died before treatment due to cardiovascular disease, 74 patients (67%) underwent endoscopic resection and 35 had surgical treatment. Ninety one percent of patients had an early stage CRC (0-I-II). Among colonoscopy indicators, 80% of cases had an adequate bowel preparation (Boston > 6), cecal intubation rate was 97.7%, adenoma detection rate was 36.5%, and in 94.5% of colonoscopies, withdrawal time was adequate (> 8 min). Conclusions: This CRCS pilot model was associated to a high rate of FIT return and colonoscopy quality standards. Most CRCs detected with the program were treated by endoscopic resection.

Social determinants of health related to adhesion to mammography screening / Levantamiento de determinantes sociales de salud relacionados a la adhesión al examen mamógrafo / Levantamento de determinantes sociais de saúde relacionados à adesão ao exame mamográfico

ABSTRACT Objective: To identify proximal, intermediary and individual social determinants related to mammography adherence, according to the Social Determinants of Health model proposed by Dahlgren and Whitehead. Method: Correlational cross-sectional study, carried out with a sociodemographic and clinical data questionnaire and the Champion's Health Belief Model Scale, translated and adapted for use in Brazil. Data analyzed by multiple linear regression, from the domains scale, and sociodemographic and clinical variables were used as predictors. Results: The age group of 60-64 years (55.0%) was highlighted, 22 (55.0%) women had a stable partner; and 14 (65.0%) completed higher education. The domain with the greatest influence on adhesion to mammography was perceived barriers. Conclusion: The social determinants of health are directly related to the levels of adherence to the exam among women, as well as the perceived benefits, susceptibilities and barriers.

RESUMEN Objetivo: identificar determinantes sociales proximales, intermediarios y distales relacionados a la adhesión a la mamografía, según el modelo de determinantes sociales de salud, propuesto por Dahlgren y Whitehead. Método: estudio transversal correlacionado, realizado con la aplicación de un cuestionario de datos socio demográficos y clínicos y de Champion's Health BeliefModelScale, traducida y adaptada para el uso en Brasil. Datos analizados por regresión linear múltipla, a partir de los dominios de la escala, y usadas, como predictores, las variables socio demográficas y clínicas. Resultados: Se destacó el grupo de edad de 60-64 años (55,0%), 22 (55,0%) mujeres poseían pareja estable; y 14 (65,0%) concluyeron la enseñanza superior. El dominio con mayor influencia en la adhesión a la mamografía fue barreras notadas. Conclusión: Los determinantes sociales de salud tiene relación directa con los niveles de adhesión examen entre las mujeres, así como con los beneficios, las susceptibilidades y las barreras notadas.

RESUMO Objetivo: identificar determinantes sociais proximais, intermediários e distais relacionados à adesão à mamografia, segundo o modelo de determinantes sociais de saúde, proposto por Dahlgren e Whitehead. Método: estudo transversal correlacional, realizado com a aplicação de um questionário de dados sociodemográficos e clínicos e da Champion's Health Belief Model Scale, traduzida e adaptada para o uso no Brasil. Dados analisados por regressão linear múltipla, a partir dos domínios da escala, e usadas, como preditores, as variáveis sociodemográficas e clínicas. Resultados: destacou-se a faixa etária de 60-64 anos (55,0%), 22 (55,0%) mulheres possuíam companheiro fixo; e 14 (65,0%) concluíram o ensino superior. O domínio com maior influência na adesão à mamografia foi barreiras percebidas. Conclusão: os determinantes sociais de saúde têm relação direta com os níveis de adesão ao exame entre as mulheres, bem como com os benefícios, as suscetibilidades e as barreiras percebidas.

Diretrizes para detecção precoce do câncer de mama no Brasil. II - Novas recomendações nacionais, principais evidências e controvérsias / Directrices para la detección precoz del cáncer de mama en Brasil. II - Nuevas recomendaciones nacionales, principales evidencias y controversias / Guidelines for early detection of breast cancer in Brazil. II - New national recommendations, main evidence, and controversies

Resumo: O câncer de mama é a principal causa de morte por câncer em mulheres no Brasil. As novas diretrizes para detecção precoce no Brasil foram elaboradas com base em revisões sistemáticas da literatura sobre riscos e possíveis benefícios de diversas estratégias de detecção precoce. O objetivo do presente artigo é apresentar as recomendações e atualizar a síntese de evidências, discutindo as principais controvérsias existentes. As recomendações para o rastreamento do câncer de mama (mulheres assintomáticas) foram: (i) recomendação contrária forte ao rastreamento com mamografia em mulheres com menos de 50 anos; (ii) recomendação favorável fraca ao rastreamento com mamografia em mulheres com idades entre 50 e 69 anos; (iii) recomendação contrária fraca ao rastreamento com mamografia em mulheres com idades entre 70 e 74 anos; (iv) recomendação contrária forte ao rastreamento com mamografia em mulheres com 75 anos ou mais; (v) recomendação favorável forte de que o rastreamento nas faixas etárias recomendadas seja bienal, quando comparada às periodicidades menores do que a bienal; (vi) recomendação contrária fraca ao ensino do autoexame das mamas para rastreamento; (vii) ausência de recomendação favorável ou contrária ao rastreamento com exame clínico das mamas; e (viii) recomendação contrária forte ao rastreamento com ressonância nuclear magnética, ultrassonografia, termografia ou tomossíntese, seja isoladamente, seja como complemento à mamografia. As recomendações para o diagnóstico precoce do câncer de mama (mulheres com sinais ou sintomas suspeitos) foram: (i) recomendação favorável fraca à implementação de estratégias de conscientização para o diagnóstico precoce do câncer de mama; (ii) recomendação favorável fraca ao uso de sinais e sintomas selecionados nas presentes diretrizes como critério de referência urgente para serviços de diagnóstico mamário; e (iii) recomendação favorável fraca de que toda a avaliação diagnóstica do câncer de mama, após a identificação de sinais e sintomas suspeitos na atenção primária, seja feita em um mesmo centro de referência.

Resumen: El cáncer de mama es la principal causa de muerte por cáncer en mujeres en Brasil. Las nuevas directrices para la detección precoz en Brasil fueron elaboradas basándose en revisiones sistemáticas de la literatura sobre riesgos y posibles beneficios de diversas estrategias de detección precoz. El objetivo del presente artículo es presentar las recomendaciones y actualizar la síntesis de evidencias, discutiendo las principales controversias existentes. Las recomendaciones para el tamizaje del cáncer de mama (mujeres asintomáticas) fueron: (i) fuerte recomendación contraria al tamizaje con mamografía en mujeres con menos de 50 años; (ii) baja recomendación favorable al tamizaje con mamografía en mujeres con edades entre 50 y 69 años; (iii) baja recomendación contraria al tamizaje con mamografía en mujeres con edades entre 70 y 74 años; (iv) fuerte recomendación contraria al tamizaje con mamografía en mujeres con 75 años o más; (v) fuerte recomendación favorable de que el tamizaje en las franjas etarias recomendadas sea bienal, cuando se compara con periodicidades menores a la bienal; (vi) baja recomendación contraria a la enseñanza del autoexamen de las mamas para tamizaje; (vii) ausencia de recomendación favorable o contraria al tamizaje con examen clínico de las mamas; y (viii) fuerte recomendación contraria al tamizaje con resonancia magnética nuclear, ultrasonografía, termografía o tomosíntesis, bien sea aisladamente, bien sea como complemento a la mamografía. Las recomendaciones para el diagnóstico precoz del cáncer de mama (mujeres con señales o síntomas sospechosos): (i) baja recomendación favorable a la implementación de estrategias de concienciación para el diagnóstico precoz del cáncer de mama; (ii) baja recomendación favorable al uso de señales y síntomas seleccionados en las presentes directrices como criterio de referencia urgente para servicios de diagnóstico mamario; y (iii) baja recomendación favorable de que toda la evaluación diagnóstica del cáncer de mama, tras la identificación de señales y síntomas sospechosos en la atención primaria, sea realizada en un mismo centro de referencia.

Abstract: Breast cancer is the leading cause of cancer mortality in Brazilian women. The new Brazilian guidelines for early detection of breast cancer were drafted on the basis of systematic literature reviews on the possible harms and benefits of various early detection strategies. This article aims to present the recommendations and update the summary of evidence, discussing the main controversies. Breast cancer screening recommendations (in asymptomatic women) were: (i) strong recommendation against mammogram screening in women under 50 years of age; (ii) weak recommendation for mammogram screening in women 50 to 69 years of age; (iii) weak recommendation against mammogram screening in women 70 to 74 years of age; (iv) strong recommendation against mammogram screening in women 75 years or older; (v) strong recommendation that screening in the recommended age brackets should be every two years as opposed to shorter intervals; (vi) weak recommendation against teaching breast self-examination as screening; (vii) absence of recommendation for or against screening with clinical breast examination; and (viii) strong recommendation against screening with magnetic resonance imaging, ultrasonography, thermography, or tomosynthesis alone or as a complement to mammography. The recommendations for early diagnosis of breast cancer (in women with suspicious signs or symptoms) were: (i) weak recommendation for the implementation of awareness-raising strategies for early diagnosis of breast cancer; (ii) weak recommendation for use of selected signs and symptoms in the current guidelines as the criterion for urgent referral to specialized breast diagnosis services; and (iii) weak recommendation that every breast cancer diagnostic workup after the identification of suspicious signs and symptoms in primary care should be done in the same referral center.

O conhecimento de mulheres sobre os métodos para prevenção secundária do câncer de mama / Women's knowledge of methods for secondary prevention of breast cancer

Resumo Objetivou-se avaliar o conhecimento das mulheres sobre métodos de rastreamento do câncer de mama. Estudo de base populacional com mulheres de 18 anos ou mais em Rio Grande, entre abril e novembro de 2011. Entrevistadoras aplicavam questionário pré-codificado em todas as mulheres do domicílio selecionado. Construiuse um modelo para cada forma de rastreamento (autoexame das mamas, mamografia e exame clínico), analisados por regressão de Poisson. Das 1596 mulheres entrevistadas, 1355 referiram o autoexame, 456, a mamografia e, apenas 191, o exame clínico da mama, realizado por um profissional de saúde, como importantes para a prevenção do câncer de mama. As mulheres brancas, e com 11 anos ou mais de escolaridade, tiveram maior probabilidade de referirem a mamografia e o exame clínico como métodos de rastreamento. Para esses dois desfechos, também se observou uma tendência linear, sendo que a probabilidade de referir uma dessas formas de rastreamento se incrementou na medida em que aumentaram os quartis de renda. O estudo aponta para a necessidade de maior esclarecimento da população sobre os métodos de prevenção, evitando, assim, o diagnóstico tardio. Evidenciou-se que as mulheres não brancas e as de baixa escolaridade e renda, demonstraram menos conhecimentos sobre os métodos de exame clínico e mamografia.

Abstract The objective of this study was to evaluate women's knowledge of methods for screening breast cancer. The study was done on a population of women aged 18 or over in the city of Rio Grande between April and November 2011. Interviewers used questionnaires on all of the women at selected households. Models were developed for every type of screening (self-examination of breasts, mammography, and clinical exams) that were analyzed through the use of Poisson regression. Out of the 1596 women interviewed, 1355 reported self-examination, 456, mammography, and only 191, clinical examination of the breast, performed by a health professional, as important for the prevention of breast cancer. White women with 11 years or more worth of schooling had a greater probability of having mammography exams and clinical examinations as methods for screening. We noted, linked to the aforementioned, that there was a linear tendency whereby there was a greater probability for those with high incomes to undergo one of the above interventions. The study noted that there was a need for more detailed information aimed at the population on prevention methods in order to avoid late diagnosis. We noted that non-white women with little education and on low incomes showed less knowledge of clinical examination methods and mammographies.

Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies / Fatores de risco do câncer de mama e o conhecimento sobre a doença: revisão integrativa de estudos Latino Americanos

Abstract 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.

Resumo Esta revisão teve por objetivo comparar a literatura Latino-Americana sobre o conhecimento da neoplasia mamária e seus fatores de risco. Foram selecionados 47 estudos, dos quais 27 eram sobre o risco de desenvolver câncer de mama e 20 sobre o conhecimento ou a consciência sobre a doença. Os estudos sobre fatores de risco eram principalmente do tipo caso-controle e sua maioria estava no idioma Inglês. Já as pesquisas sobre conhecimento eram, sobretudo, do tipo transversal e foram publicadas nos idiomas Português e Espanhol. As pesquisas sobre conhecimento destacaram o diagnóstico precoce da neoplasia mamária, e o autoexame da mama foi o método de detecção mais abordado (N = 14). Por outro lado, os estudos sobre fatores de risco avaliaram, principalmente, sobrepeso (N = 14), historia familiar (N = 13), baixa paridade (N = 12) e curto período de amamentação (N = 10). Fatores socioeconômicos, como a renda e o nível educacional tiveram efeitos variáveis e afetaram também o conhecimento das mulheres sobre fatores de risco e detecção precoce. Os resultados da pesquisa indicaram que os estudos sobre fatores de risco do câncer de mama apresentaram melhor delineamento metodológico e fundamentação teórica, comparado com os estudos sobre conhecimento que foram na maioria dos casos descritivos.

Espinalioma de lengua: informe de un caso clínico / Tongue spinalioma. clinical case report

Objetivos: concientizar sobre la importancia de la consulta estomatológica y educar en la autodetección de lesiones facultativamente cancerizables. Caso clínico: paciente con antecedentes traumáticos locales de larga data, producidos por piezas dentarias con bordes filosos, obturaciones desbordantes y el consumo de tabaco, factores predisponentes e incidentes en el desencadenamiento de la lesión neoplásica. Conclusión: el caso presentado pone en evidencia las deficientes medidas de prevención primaria y la falta de acciones conducentes a la práctica de autoevaluaciones orales periódicas.

Aim: To raise awareness about the importance of pathology consultation and patient education in self detection of potentially cancerous lesions. Clinical case: We report the case of a patient with along history of local traumatisms generated by tooth lesions with sharp edges, over contoured restorations and tobacco consumption, all of which are considered risk factors in the generation of neoplasic processes. Conclusion: The case that is reported shows lack of useof primary preventive and self detections conducts that could prevent the development of cancerous lesions.

Detección precoz de cáncer pulmonar con tomografía computarizada de tórax en pacientes con enfermedad pulmonar obstructiva crónica tabáquica / Early detection of lung cancer using computed tomography among patients with chronic obstructive pulmonary disease

Background: Chest computed tomography (CT) scan may improve lung cancer detection at early stages in high risk populations. Aim: To assess the diagnostic performance of chest CT in early lung cancer detection in patients with chronic obstructive pulmonary disease (COPD). Patients and Methods: One hundred sixty one patients aged 50 to 80 years, active or former smokers of 15 or more pack-years and with COPD were enrolled. They underwent annual respiratory functional assessment and chest computed tomography for three years and were followed for five years. Results: Chest CT allowed the detection of lung cancer in nine patients (diagnostic yield: 5.6%). Three cases were detected in the initial CT and six cases in follow-up scans. Most patients were in early stages of the disease (6 stage Ia and 1 stage Ib). Two patients were diagnosed at advanced stages of the disease and died due to complications of cancer. Two thirds of patients had nonspecific pulmonary nodules on the initial chest CT scan (100 patients, 62%). Seventy four percent had less than three nodules and were of less than 5 mm of diameter in 57%. In 92% of cases, these were false positive findings. In the follow-up chest CT, lung nodules were detected in two thirds of patients and 94% of cases corresponded to false positive findings. Conclusions: Chest CT scans may detect lung cancer at earlier stages in COPD patients.

Arterial blood and end-tidal concentrations of sevoflurane during the emergence from anesthesia in gynecologic patients

OBJECTIVE: The end-tidal concentration of inhalation anesthetics is a clinical indicator for predicting the emergence from anesthesia. This study was conducted to assess the relationship between arterial blood and end-tidal sevoflurane concentrations during emergence. METHODS: Thirty-two female American Society of Anesthesiologists physical status I-II patients receiving general anesthesia for elective gynecologic surgery were included. A fixed dose of 3.5% inspiratory sevoflurane in 6 L min-1 oxygen was maintained until the end of surgery. At 20 and 10 minutes before and 0, 5, 10, 15, and 20 minutes after discontinuing sevoflurane, as well as at the time of eye opening by verbal command, defined as awakening, 1 ml arterial blood was obtained to measure its sevoflurane concentration by gas chromatography. Simultaneous inspiratory and end-tidal concentrations of sevoflurane were detected by an infrared analyzer and tested by Bland-Altman agreement analysis. RESULTS: The arterial blood concentrations of sevoflurane were similar to the simultaneous end-tidal concentrations during emergence: 0.36% (0.10) and 0.36% (0.08) sevoflurane at awakening, respectively. The mean time from discontinuing sevoflurane to eye opening was 15.8 minutes (SD 2.9, range 10-26) and was significantly correlated with the duration of anesthesia (52-192 minutes) (P = 0.006) but not with the body mass index or total fentanyl dose. CONCLUSION: The mean awakening arterial blood concentration of sevoflurane was 0.36%. The time to awakening was prolonged in accordance with the anesthetic duration within 3 hours. With well-assisted ventilation during emergence, the sevoflurane end-tidal concentration was nearly equal to its arterial blood concentration, which could be a feasible predictor for awakening. .

Rare renal metastases from differentiated thyroid carcinoma: early clinical detection and treatment based on radioiodine / Metástases renais raras de carcinoma diferenciado da tireoide: detecção clínica precoce e tratamento com radioiodoterapia

Objective : The aim of this study was to explore the clinical characteristics of renal metastatic cancer, the methods for its detection by radioiodine (131I), and the response to 131I treatment in fourteen patients with renal metastases from differentiated thyroid carcinoma (DTC).Subjects and methods : DTC patients (n = 2,955) that received treatment with 131I were retrospectively analyzed. Scans (131I-WBS, 31I-SPECT/CT and/or 18F-FDG-PET/CT) were performed after an oral therapeutic dose of 131I. Therapeutic efficacy was evaluated based on changes in Tg and anatomical imaging changes at renal lesions.Results : Among these 14 patients, 11 had avidity for 131I, but three patients did not accumulate 131I after 131I treatment. In the 11 131I-positive renal lesions, 10 cases were detected by 131I-SPECT/CT combined with another imaging modality and one case by 131I-WBS combined with ultrasonography (US). In the three 131I-negative renal lesions, two cases were detected by 18F-FDG-PET/CT and one case by computed tomography (CT). In 11 patients with 131I-avid renal metastases, Serum Tg levels in 81.82% (9/11) patients showed a gradual decline, and 18.18% (2/11) of the patients showed a significant elevation. There was no marked difference in serum Tg before the last 131I treatment (Z = 0.157; p = 0.875). Only one patient presented partial response, eight patients exhibited stable disease, and renal metastases progressed in two patients showing progressive disease. No patients reached complete response.Conclusion : 131I-SPECT/CT, combined with another imaging modality after 131I-WBS, can contribute to the early detection of renal metastases of DTC. 131I therapy is a feasible and effective treatment for most DTC renal metastases with avidity for 131I. Arq Bras Endocrinol Metab. 2014;58(3):260-9.

Objetivo : O objetivo deste estudo foi analisar as características clínicas de metástases renais, os métodos para sua detecção por radioiodo (131I) e a resposta ao tratamento com 131I em 14 pacientes com metástases renais de carcinoma diferenciado da tireoide (DTC).Sujeitos e métodos Pacientes com DTC (n = 2.955) que receberam tratamento com 131I foram analisados retrospectivamente. 131I-PCI, 31I-SPECT/CT e/ou 18F-FDG-PET/CT foram feitos após uma dose terapêutica oral de 131I. A eficácia terapêutica foi baseada nas alterações da Tg e nas imagens anatômicas das lesões renais.Resultados : Dos 14 pacientes, 11 apresentaram lesões ávidas por 131I, mas três pacientes não acumularam 131I depois do tratamento com 131I. Nas 11 lesões renais positivas para 131I, 10 casos foram detectados por 131I-SPECT/CT combinado com outra modalidade de exame de imagem e um caso por 131I-WBS combinado com US. Nas três lesões renais negativas para 131I, dois casos foram detectados por 18F-FDG-PET/CT e um caso por tomografia computadorizada (TC). Em 11 pacientes com metástases renais ávidas por 131I, os níveis séricos de Tg em 81,82% (9/11) dos pacientes mostraram um declínio gradual e 18,18% (2/11) apresentaram uma elevação significativa. Não houve diferenças marcadas na Tg sérica antes do último tratamento com 131I (Z = 0,157; p = 0,875). Apenas um paciente apresentou resposta parcial, oito pacientes apresentaram doença estável e as metástases renais progrediram em dois pacientes que apresentaram doença progressiva. Nenhum dos pacientes apresentou resposta completa.Conclusão : 131I-SPECT/CT, combinada com outra modalidade de diagnóstico por imagem após 131I-PCI, pode contribuir para a detecção precoce de metástases renais de DTC. O tratamento ...

Biomarkers for screening of lung cancer and pre-neoplastic lesions in a high risk Chilean population

BACKGROUND: The mortality of lung cancer (LC), increases each year in the world, in spite of any advances, in development of new drugs to advance stages of LC. The high incidence of LC has been associated with smoking habit, genetic diversity and environmental pollution. Antofagasta region has been reported to have the highest LC mortality rate in Chile and its inhabitants were exposed to arsenic in their drinking water in concentrations as high as 870 µg/L. Non-invasive techniques such as biomarkers (Automatic Quantitative Cytometry: AQC and DR70) and Auto Fluorescence Bronchoscopy (AFB) might be potentially useful as a supplementary diagnostic approach and early detection. Early detection is one of the most important factors to intervene and prevent cancer progression in LC. This is a work of an ongoing prospective bimodality cancer surveillance study in high risk LC volunteers. Enrolment was done in subjects from Antofagasta and Metropolitan regions. In addition, we enrolled subjects who were suspected of having lung cancer. AQC, DR70 and AFB were used as tools in the detection of pre-neoplastic (PNL) and neoplastic lesions (NL). RESULTS: Half of the samples, classified as suspicious by AFB, were confirmed as metaplasia or dysplasia by histopathology. For LC, DR70 showed a higher sensitivity (95.8%) and specificity (91.9%) than AQC. However, for PNL AQC showed a higher sensitivity (91.9%) than DR70 (27.3%), although both with low PPV values. As a pre screener, both biomarkers might be employed as complementary tools to detect LC, especially as serially combined tests, with a sensitivity of 60% and a PPV of 65.2%. Additionally, the use of parallel combined tests might support the detection of PNL (sensitivity 91.2%; PPV 49.1%). CONCLUSION: This work adds information on cellular and molecular biomarkers to complement imaging techniques for early detection of LC in Latin America that might contribute to formulate policies concerning screening of LC. Supported by INNOVA-CORFO, Chile.