Brazilian Population Research Articles

Infodemic and sources of information about COVID-19 in a Brazilian population: what are the associated factors?

ABSTRACT Background: With the COVID-19 pandemic, social isolation, and information search have increased dramatically. This increased search for information about the Coronavirus, called infodemic, was greatly affected by fake news and information without scientific evidence. This article aimed to assess the infodemic amid the COVID-19 pandemic and its association with sociodemographic and pandemic-related variables, as well as describe the main sources from which people obtained information about COVID-19. Methods: A cross-sectional population-based study was performed in Criciúma, Brazil. All individuals aged 18 years or older, residing in the 607 households systematically selected, were invited to answer the questionnaire. Infodemic and sources to seek information about COVID-19 were evaluated, as well as sociodemographic and pandemic-related variables. Adjusted Poisson regression with robust variance was used to evaluate associations. Results: A total of 863 individuals participated in the study. The prevalence of infodemic was 22.1%, and television was the main source of information (58.9%). Three groups presented a higher prevalence of infodemic: older adults (PR: 1.65), individuals with low income (PR: 2.97), and those who had had contact with someone infected (PR: 2.20). Conclusions: The findings reflect how some groups are more exposed to infodemic, and underline the responsibility and importance of intersectoral actions for dissemination of information about COVID-19.

Gene - maltreatment interplay in adult ADHD symptoms: main role of a gene-environment correlation effect in a Brazilian population longitudinal study.

Childhood maltreatment correlates with attention-deficit/hyperactivity disorder (ADHD) in previous research. The interaction between ADHD genetic predisposition and maltreatment's impact on ADHD symptom risk remains unclear. We aimed to elucidate this relationship by examining the interplay between a polygenic score for ADHD (ADHD-PGS) and childhood maltreatment in predicting ADHD symptoms during young adulthood. Using data from the 2004 Pelotas (Brazil) birth cohort comprising 4231 participants, we analyzed gene-environment interaction (GxE) and correlation (rGE). We further explored rGE mechanisms through mediation models. ADHD symptoms were assessed at age 18 via self-report (Adult Self Report Scale - ASRS) and mother-reports (Strength and Difficulties Questionnaire - SDQ). The ADHD-PGS was derived from published ADHD GWAS meta-analysis. Physical and psychological child maltreatment was gauged using the Parent-Child Conflict Tactics Scale (CTSPC) at ages 6 and 11, with a mean score utilized as a variable. The ADHD-PGS exhibited associations with ADHD symptoms on both ASRS (β = 0.53; 95% CI: 0.03; 1.03, p = 0.036), and SDQ (β = 0.20; 95% CI: 0.08; 0.32, p = 0.001) scales. The total mean maltreatment score was associated with ADHD symptoms using both scales [(βASRS = 0.51; 95% CI: 0.26;0.77) and (βSDQ = 0.24; 95% CI: 0.18;0.29)]. The ADHD-PGS was associated with total mean maltreatment scores (β = 0.09; 95% CI: 0.01; 0.17; p = 0.030). Approximately 47% of the total effect of ADHD-PGS on maltreatment was mediated by ADHD symptoms at age 6. No evidence supported gene-environment interaction in predicting ADHD symptoms. Our findings underscore the significant roles of genetics and childhood maltreatment as predictors for ADHD symptoms in adulthood, while also indicating a potential evocative mechanism through gene-environment correlation.

Effects of 12 weeks of functional and resistance training on stress perception and sleep quality in Bra-zilian older people

The study investigated the effects of a 12-week functional and resistance training program on the perception of stress and sleep quality in Brazilian older people, involving 49 participants. The Perceived Stress in older adults and the Pittsburgh Sleep Quality Index (PSQI) was used. The training protocol included a general warm-up, resistance and functional training sessions, followed by a cool-down phase, held twice a week, lasting an average of 60 minutes over the 12 weeks. Data analysis was performed using the Kolmogorov-Smirnov test, bootstrapping, t-tests and Pearson correlation, with a significance level of p < 0.05. The results showed a significant reduction in sleep disturbance and total sleep quality score after the intervention. Men initially had lower stress and better sleep quality in some aspects compared to women, while older people between 60 and 69 years old had improvements in sleep quality in certain aspects before and after the intervention, compared to older people aged 70 and over. Furthermore, a positive correlation was observed between the perception of stress and several components of sleep quality, such as subjective quality, duration and total score. In short, the study demonstrated that the exercise program had varying impacts on sleep quality, but not on the perception of stress among the older people, highlighting a significant improvement in sleep quality after the intervention. Keywords: Aging. Exercise Therapy. Sleep Quality. Psychological stress. Physical education.

The Fundamental Right to Oral Health and Its Judicialization in The Brazilian State

Objective: The objective of this study is to investigate the protection of the right to oral health as a fundamental human right, analyzing the legal demands on the subject, with the aim of understanding how the protection of oral health has occurred by the Brazilian Judiciary, as well as the parameters established by the courts. Theoretical Framework: The right to health, as a human right, was recognized for the first time in the 1948 Universal Declaration of Human Rights. It should be noted that human rights are indispensable for the debate regarding the guarantee of the right to qualified and safe oral health, with a direct relationship between general health, oral health and human dignity. Furthermore, the National Oral Health Policy of the Brazilian State, materialized in Law No. 14,572/2023, attributes to the Unified Health System (SUS) the competence to define the guidelines and standards for the physical and organizational structure of oral health services, serving as panel to reflect on its importance, which goes beyond the aesthetics of the smile, permeating essential aspects of the physical, mental and social health of human beings. Method: The methodology applied was the deductive method; As for the means of research, bibliographical methods were used, using doctrine, legislation and jurisprudence on the subject; Regarding the purposes, the research is understood as qualitative. Results and discussion: The results obtained revealed that, although oral health is a right constitutionally affirmed by the Brazilian State, given the implicit recognition as a social right in article 6 of the Magna Carta, the judicial route still stands out as an important instrument for its implementation. The need to implement greater protection, in practice, for oral health is evident, since, despite legislative developments to achieve this fundamental human right, there is a lack of concrete actions by the Executive Branch. Research Implications: The results of this work are of great relevance for the health of the Brazilian population, and the need to implement greater protection for oral health remains evident, since, despite legislative developments in Brazil and the world to expand the scope of this human right fundamental, there is a lack of concrete actions by the Executive Branch to implement social and economic policies guaranteed in art. 196 of the Federal Constitution. Originality/Value: This study contributes to the literature by demonstrating that the Judiciary, in the 21st century, continues to be constantly used as an alternative to implement the right to oral health, which demonstrates that this right still remains on the margins of general health and society. In this way, the jurisprudential survey carried out is of great relevance in the knowledge acquired that can contribute to the promotion of public policies aimed at oral health.

GENDER EMPOWERMENT: INTERFACE WITH GEOGRAPHIC SPACE AND SUSTAINABILITY

The objective of this work is to analyze empowerment based on gender and racial equality in Brazilian society. We have performed documental and quantitative research using data extracted from the Brazilian Institute of Geography and Statistics, Center of Educational, Cultural and Community Action Studies and Research and Union Socioeconomic Statistics and Studies Department databases. The data indicates that girls present greater age-grade distortion than boys, and the black population is at a disadvantage compared to the white population in higher education from ages 18 to 24. Black women are at a disadvantage in relation to black men, as white women are with white men in terms of inclusion in the Brazilian workforce and average salaries. In addition, they are under-represented in managerial positions, and there is a disadvantage in terms of gender in every state in Brazil. Black women suffer the most social inequality in the workforce. This study considers the criterion of race, because black people make up more than half of the Brazilian population. The female and racial geography, it points out that social and racial inequality is a compromising factor for achieving the goal of the 2030 Agenda.

Abstract PO5-11-10: Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy

Abstract Background: There is a significant scarcity of quality of life (QOL) data among the Brazilian population with breast cancer. This study aims to evaluate QOL in Brazilian women with early breast cancer treated with adjuvant endocrine therapy (ET) and to explore its relationships with patients’ clinical and social characteristics, type and duration of endocrine therapy and type of healthcare insurance. Methodology: Women with a history of early-stage estrogen-receptor positive invasive carcinoma of the breast on adjuvant endocrine therapy for at least 6 months were invited to participate of this study. QOL assessment was conducted using the EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires. Demographic and medical information were collected from medical records. Data collection performed using RedCap software. Qualitative variables were compared between groups using the Chi-square or exact Chi-square test and for quantitative variables the non-parametric Mann-Whitney test was used. Multivariable analysis was performed using Multiple linear regression models with Stepwise procedure. P < 0.05 was considered significant. Analyzes were performed in SAS 9.4. Results: From June 2021 to May 2023, a total of 461 women with ER+ early-stage breast cancer from 12 Brazilian institutions were included in this analysis. A total of 233 women (50.54%) were treated in private institutions. Mean age was 56.02 years (range 22-93), 47.69% were non-white and 38.7% were premenopausal. A total of 62.34% had prior lumpectomy, 43.1% had tumor stage II, 61.69% received prior chemotherapy and 15.18% were HER2 positive. Regarding ET, 45.2% were on aromatase inhibitors (AI), 40.61% on tamoxifen (TMX) and 14.19% on ovarian function suppression plus ET (OFS). Median duration of ET use was 2.78 years. From the adjustment of the multiple regression model, it was found that the variable patients with a higher educational level were a significant predictor for the Physical Functioning score (p < 0.0001). The Role Functioning score had the variables treatment in a private hospital (p = 0.0462) and a higher educational level (p = 0.0357) as significant predictors. The variables age > 60 years (p = 0.0006) and marital status: single (p = 0.0267) were significant predictors for the Emotional Functioning score. Cognitive Functioning was correlated with the variables age > 60 years (p < 0.0001) and treatment duration < 2 years (p = 0.0475). Social Functioning had significant predictors such as hormone therapy with AI (p = 0.0305) and hormone therapy with TMX (p = 0.0267) when compared to OFS, as well as treatment duration < 2 years (p = 0.0175). The variable age > 60 years was a predictor for the Fatigue score (p = 0.0233). The Pain score correlated with variables such as higher educational level (p = 0.0003) and treatment duration < 2 years (p = 0.0032). The variables treatment in a public hospital (p = 0.0066), age < 60 years (p = 0.0471), and treatment duration < 2 years (p = 0.0054) were predictors for a higher Arm Symptoms score. Regarding the Breast Symptoms score, the variables treatment in a public hospital (p = 0.0005), Caucasian ethnicity (p = 0.0006), radiation therapy (p = 0.0098), and treatment duration < 2 years (p = 0.0203) were predictors for the total score. Body Image correlated with variables such as age > 60 years (p = 0.0322), surgical approach: mastectomy (p = 0.0445), tumor size < 50mm (p = 0.0446), and radiation therapy (p = 0.0405). The Global health status score did not correlate with any variable. Conclusion: Lower educational level, age< 60 years, duration of ET less than 2 years had a significant impact in many domains of QOL. Radiotherapy was the treatment modality with more impact in QOL scores. The identification of modifiable factors related to QOL in this study provides valuable insights for the development of a customized intervention in Brazilian population. Citation Format: Danielle Santos, Cristiano Souza, Maria Cristina Magalhães, Daniela Pereira, Fernanda Moura, Sulene Oliveira, Anna Luiza Galvão, Bruno Souza, Amanda Castro, Monalisa Andrade, Andrea Shimada, Yuri Beckedorff, Carlos Paiva, Heloísa Resende, Angelica Rodrigues, Daniela Rosa, Daniele Assad-Suzuki, Romualdo Barroso-Sousa. Quality of life in Brazilian women with early breast cancer on adjuvant endocrine therapy [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-11-10.

Predicting the prevalence of type 2 diabetes in Brazil: a modeling study

AimsWe adopted a modeling approach to predict the likely future prevalence of type 2 diabetes, taking into account demographic changes and trends in obesity and smoking in Brazil. We then used the model to estimate the likely future impact of different policy scenarios, such as policies to reduce obesity.MethodsThe IMPACT TYPE 2 DIABETES model uses a Markov approach to integrate population, obesity, and smoking trends to estimate future type 2 diabetes prevalence. We developed a model for the Brazilian population from 2006 to 2036. Data on the Brazilian population in relation to sex and age were collected from the Brazilian Institute of Geography and Statistics, and data on the prevalence of type 2 diabetes, obesity, and smoking were collected from the Surveillance of Risk and Protection Factors for Chronic Diseases by Telephone Survey (VIGITEL).ResultsThe observed prevalence of type 2 diabetes among Brazilians aged over 25 years was 10.8% (5.2–14.3%) in 2006, increasing to 13.7% (6.9–18.4%) in 2020. Between 2006 and 2020, the observed prevalence in men increased from 11.0 to 19.1% and women from 10.6 to 21.3%. The model forecasts a dramatic rise in prevalence by 2036 (27.0% overall, 17.1% in men and 35.9% in women). However, if obesity prevalence declines by 1% per year from 2020 to 2036 (Scenario 1), the prevalence of diabetes decreases from 26.3 to 23.7, which represents approximately a 10.0% drop in 16 years. If obesity declined by 5% per year in 16 years as an optimistic target (Scenario 2), the prevalence of diabetes decreased from 26.3 to 21.2, representing a 19.4% drop in diabetes prevalence.ConclusionThe model predicts an increase in the prevalence of type 2 diabetes in Brazil. Even with ambitious targets to reduce obesity prevalence, type 2 diabetes in Brazil will continue to have a large impact on Brazilian public health.

Abstract PO4-25-11: Inconclusive Her2 by immunohistochemistry compared to in situ hybridization in breast cancer: a cross-sectional study

Abstract Introduction: Breast cancer stands as the most common malignancy diagnosed among women worldwide, with the Her2-positive subtype accounting for approximately 15% of the cases. The introduction of HER-targeted therapies has changed the natural history of this subtype, however, evaluating the Her2 status using immunohistochemistry (IHC), can yield inconclusive results in a significant percentage of cases, which requires the use of in situ hybridization techniques. The study of such cases has not been thoroughly explored, particularly in the brazilian population, and increasing interest in this subgroup of patients arises as the "Her2 low" category gathers evidence of clinical applicability. The present study aimed to assess the final Her2 status of samples with indeterminate IHC results and compare these findings with current literature. Methods: We conducted a cross-sectional study at the breast unit service of a private health network in the state of Minas Gerais, Brazil (Rede Mater Dei de Saúde). Breast tissue samples obtained over the past 5 years were analyzed, and specimens with inconclusive IHC results for Her2 were included in the study. Subsequently, the final Her2 status was determined through fluorescence in situ hybridization (FISH) test, or reanalysis in cases in which a new sample (surgical specimen) was obtained. Results: Among the initially identified 73 samples with indeterminate IHC results for Her2, a total of 15 patients were excluded due to lack of follow-up within the breast unit service. The final cohort consisted of 58 women aged between 28 and 71 years. Notably, approximately 91% of the patients exhibited positive hormone receptor tumors, whereas 9% displayed negative hormone expression. After reviewing the medical records, approximately 36% of the patients were classified as having a positive final Her2 status, while 62% had a negative final status. One patient had an inconclusive FISH result. Conclusion: The present study revealed that approximately 10% of the breast tissue samples included in the study yielded inconclusive results for Her2 by immunohistochemistry. Following FISH testing, the majority of these patients were reclassified into the negative final Her2 status category. The classification of most patients to what is known as the emerging "Her2 low" category, aligns with international publications, and highlights the clinical relevance of exploring this subset of breast cancer that gains relevance as advances provide prospects for targeted therapies. Table 1. Summarized results for the final Her2 status Absolute and percentage values for the final HER2 status in the study cohort Citation Format: Felipe Marcondes de Oliveira Coelho, Renata Capanema Saliba Franco, Enaldo Melo de Lima, Marco Antonio Dias, Anna Dias Salvador, Waldeir José de Almeida Junior, Julia Wanderley Rennó, José Tadeu Campos de Avelar. Inconclusive Her2 by immunohistochemistry compared to in situ hybridization in breast cancer: a cross-sectional study [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO4-25-11.

Abstract PO2-08-03: Developing a polygenic risk score for precision prevention of estrogen receptor-positive (ER+)/HER2- breast cancer in Brazilian women

Abstract Polygenic risk scores (PRS) quantify the genetic risk of diseases based on risk alleles in genomic loci identified in genome-wide association studies (GWAS). As individuals of European ancestry are overrepresented in GWAS, PRS performance may vary in individuals of different ancestries. Brazil is the largest and most populated country in Latin America, with around 43% of admixed individuals, and data on breast cancer PRS performance for this population is lacking. We aimed to evaluate the performance of a breast cancer PRS with 313 SNPs generated with Europeans in Brazilian population. In this case-control study, we expect to include 1000 women age >= 18 years old with current or previous diagnosis of ER+/HER2- breast cancer. Germline DNA samples are genotyped with Illumina Infinium Global Screening Array-24 v3.0 chip. Controls are healthy woman previously genotyped with Global Screening Array-24 v1.0 chip. We selected the 313 SNPs PRS for ER+/HER2- breast cancer from PGS Catalog for evaluation. Quality control, imputation, PRS calculation and statistical analysis were performed in PLINK v2.0, Michigan server, PGS Catalog and R, respectively. We present the preliminary results for 1347 women (504 cases and 843 controls) included until March of 2023. After quality control and imputation, we calculated PRS for 1212 subjects (475 cases and 737 controls). Out of 313 SNPs, 211 were validated in our samples. For ER+/HER2- breast cancer, the odds ratio per SD of the 211-variant PRS (PRS211) was 1.363 (95% confidence interval [CI]: 1.211 to 1.537). Compared with women with average risk (40th-60th PRS percentile), women in the top 10% of PRS211 had a 1.623-fold increased risk (95% CI: 1.047 to 2.522). The area under the receiver operating characteristic curve of 0.581. Our preliminary results indicate that a PRS derived from European-ancestry population correlates with ER+/HER2- breast cancer in admixed Brazilian population, although with attenuated performance. Further work is needed to better characterize PRS risk stratification in admixed populations. Citation Format: Marina Candido Visontai Cormedi, Álison Luís Eburnêo Pereira, Fernanda Borchers Coeli-Lacchini, Sabrina Baroni, Lívia Mara Torres Bueno, Evelyn Ayumi Onga, Victor Girelli Piloto De Oliveira, Fabiana De Oliveira Buono, Aline Fares, Tatiana Strava Correa, Iasmin Alves Chirichela, Fernanda Peria, Romulado Barroso-Sousa, Rodrigo Santa Cruz Guindalini, Taisa Manuela Bonfim Machado Lopes, Rosimeire Aparecida Roela, Maria Aparecida Azevedo Koike Folgueira, Daniel Guimarães Tiezzi, Leandro Machado Colli, Liane Rapatoni. Developing a polygenic risk score for precision prevention of estrogen receptor-positive (ER+)/HER2- breast cancer in Brazilian women [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO2-08-03.

Abstract PO5-17-11: STRATIFICATION OF HIGH GENOMIC RISK IN THE GENETIC SIGNATURE OF 70 GENES (MAMMAPRINT™) IN REAL WORLD ANALYSIS (AGEMA-BRA)

Abstract INTRODUCTION – Although genetic signatures for breast cancer are used to de-escalate chemotherapy treatment, around half of the patients, according to several analyses, present high genomic risk and are conducted in the same way, regardless of the risk score found. The stratification into high risk 1 and high risk 2, proposed in the ISKY-2 cohort, sought to verify the possibility of selecting women with breast cancer who need to escalate the systemic treatment according to the score measured by the MammaPrint™ (MP). OBJECTIVE – To evaluate the outcomes of the AGMA-BRA cohort population (Mammaprint™ genetic signature in the brazilian population), analyzing the characteristics and behavior of patients stratified into high risk 1 (H1) and high risk 2 (H2) by the 70-gene genetic signature. METHODOLOGY – Retrospective study in the AGEMA-BRA cohort with high clinical and genomic risk. They were divided into high risk 1 (H1) with MP score between 0 and > -0.57 and high risk 2 (H2) with MP score ≤ -0.57; analyzing the epidemiological, anatomopathological, immunohistochemical (IHC) profiles and outcomes in the two populations. For the statistical evaluation, a descriptive analysis of the data with absolute and relative frequencies of the variables was performed. To verify the association between qualitative variables, the chi-square test was used. All analyzes were performed in the R 4.1.0 environment (R Core Team, 2021). The AGEMA-BRA study was approved by the ethics and research committee of the State University of Ponta Grossa (CAAE: 12194219.4.0000.0105). RESULTS – The AGEMA-BRA cohort comprises 953 patients with high clinical risk luminal breast cancer, of which 407 (42.7%) are at high genomic risk. After excluding cases that did not contain the necessary information, 176 records were analyzed, with an average follow-up of 40 months. The age group, tumor diameter and number of affected lymph nodes were similar. Statistical significance was observed when evaluating the histological grade where grade 3 was more frequent in cases with the highest risk MP score (H2) with 60% of the records (p. =0.039) (Table 1). As for the IHC analysis, the positivity of estrogen and progesterone receptors, and HER2 did not show statistical significance in the comparison between H1 and H2. In the Ki67 analysis, the comparison with expression >20% was more frequent in population H2 (76.4%) compared to H1 (48.2%) with p.=0.002. Metastasis-free survival (DMFS) was 96.4% for H1 and 95% for H2 (p.=0.269). CONCLUSIONS – The dichotomization of cases with MP score at high risk H1 and high risk H2 in the AGEMA-BRA cohort showed no difference in DMFS, inferring that this classification does not help in the management of these patients. The sample size and short follow-up for a disease that relapses later may have interfered with the result. More robust analysis of these two populations needs to be performed to confirm the presented data. Table 1 - Profile of high genomic risk AGEMA-BRA Citation Format: Fabio Mansani, Ruffo Freitas-Junior. STRATIFICATION OF HIGH GENOMIC RISK IN THE GENETIC SIGNATURE OF 70 GENES (MAMMAPRINT™) IN REAL WORLD ANALYSIS (AGEMA-BRA) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-11.

Abstract PO5-17-05: Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom?

Abstract Background: The precise location of the tumor site is essential for obtaining free margins and success of surgical treatment, reducing the rates of reoperation and local recurrences. Neoadjuvant chemotherapy (NAC) is a challenge for preoperative tumor localization, due to the different patterns of locoregional response, limitations related to imaging methods, and the possibility of a pathological complete response (pCR). In addition, there are several divergent approaches regarding preoperative axillary evaluation, lymph node marking methods and approaches when facing cN1. Thus, the knowledge and attitudes of the affiliated members of the Brazilian Society of Mastology (SBM) regarding breast and axilla marking were evaluated and a consensus regarding management and treatment was reached. Methods: This is an online survey conducted between June and December 2022. All 1.742 active mastologists affiliated to SBM were anonymously invited to participate in the study. The online form contained 28 objective questions, of which 22 were formulated on a Likert scale. These questions addressed several relevant aspects related to breast and axilla marking in the neoadjuvant setting. Responses that reached 70% agreement were considered consensual. Statistical analysis was performed using the SPSS program. Post hoc analysis was performed when appropriate and, in all analyses, the significance level of p < 0.05 was adopted. Results: A total of 468 mastologists answered the questionnaire (26.8%), with a predominance of professionals aged between 40-49 years (32.1%), male (50.4%), and residents of state capitals (63.9%). Most professionals were board-certified (84,8%), 87.7% for more than five years. The indication of tumor marking in the breast prior to NAC was consensual (96.4%) and the metal clip was the preferred method (69.7%). If available, the US-visible clip is preferred (86.5%). With respect to the marking of the breast and axilla prior to NAC, 93.3% of the mastologists considered relevant issues related to the techniques and materials. There was no consensus regarding the indication of pre-NAC histologically positive lymph node marking (49.8% disagree and 42.8% agree), however there was consensus that the clinical and imaging evaluation is insufficient for staging the axilla as N1 (71.6 %). The contraindication of breast and node marking in T4b tumors (71.2%) was consensual. There was consensus on the indication of sentinel lymph node biopsy (SLNB) for initially cN1 (92.3%) or cN2 (72.7%) tumors that became cN0 after NAC, with 67.5% opting for dual staining with technetium and patent blue. There was also consensus on the indication of axillary lymphadenectomy (89%) after NAC when double marking with technetium and patent blue for SLNB is not available. In addition, 41.0% of mastologists perform axillary lymphadenectomy when less than three lymph nodes are found in the SLNB. Among the 28 questions, consensus was reached on only 11 (39.3%); with some consensus variations according to age group, sex, geographic location of residence, place of professional activity (public or private), and professional experience. Conclusion: The indication of pre-NAC breast marking is consensual among Brazilian mastologists, although axillary nodal marking is not. There is a great divergence of attitudes among Brazilian surgeons in relation to the many issues related to pre-NAC breast and axilla marking, indicating the need to establish continuing education programs on the subject. Citation Format: Henrique Couto, Augusto Hassan, Dalton Steinmacher, Eduardo Pessoa, Eduardo Millen, Felipe Zerwes, Francisco Pimentel Cavalcante, Giuliano Tosello, Gustavo Badan, José Francisco, Leonardo Soares, Lucas Budel, Luciano Chala, Raquel Fernandes, Ruffo Freitas-Junior, Vilmar Oliveira, Vinicius Budel, Andre Mattar. Recommendations of a panel of experts from the Brazilian Society of Mastology on breast and axilla clipping: when, how and for whom? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-05.

Abstract PO5-17-10: PERFORMANCE AND OUTCOMES OF THE 70-GENES SIGNATURE (MAMMAPRINT™) IN A POPULATION WITH MIDDLE INCOME – REAL WORLD STUDY (AGEMA-BRA)

Abstract INTRODUCTION – Breast cancer remains the most frequent tumor in the female population and the fourth in mortality in the world population (GLOBOCAN 2020). With the aim of reducing mortality and at the same time de-escalating treatment, avoiding overtreatment, individualized therapy is increasingly being applied. The genomic signature of 70-genes, when stratifying patients into high and low risk of relapse, makes it possible to withdraw part of the cases of high clinical risk from chemotherapy treatment. However, the MINDACT study, which validated this signature, was carried out only in the European population, with no data on performance and outcomes in other populations with greater miscegenation. OBJECTIVE – To study the performance and outcomes of the 70-gene genomic signature (MammaPrint™) in a Brazilian population with a high ethnic miscegenation. METHODOLOGY – A retrospective cohort study was conducted in 953 women with breast cancer at high clinical risk, who underwent genomic analysis with the 70-gene platform (MammaPrint™), from January 2016 to December 2020. For the statistical evaluation, a descriptive analysis of the data with absolute and relative frequencies of the variables was performed. To verify the association between qualitative variables, the chi-square test was used. All analyzes were performed in the R 4.1.0 environment (R Core Team, 2021). Study approved by the Research Ethics Committee of the State University of Ponta Grossa (PR) - (CAAE: 12194219.4.0000.0105). RESULTS – The analysis of 955 cases from the AGEMABRA cohort (all at high clinical risk) showed 546 cases (57.2%) with low genomic risk and 409 cases (42.8%) with high genomic risk to MammaPrint™ (MP); when compared with data from the MINDACT study (46.2% low risk and 53.8% high risk) a significant difference was observed in the distribution for high and low risk in the two populations (p.< 0.001). After excluding patients with missing data, 409 cases of low- and high-risk MP were studied. The variables regarding age group, tumor diameter, number of affected lymph nodes, hormone receptors and HER2 overexpression showed no significant difference; within this same analysis, the tumor grade showed a higher incidence of grade 1 in the population with low genomic risk (6.6%) compared to high risk (2.9%) and grade 3 in high risk (13%) compared to low risk (5%) with p.< 0.001 (table 1). With an average follow-up of 40 months, the DMFS (disease metastatic free survival) found was 97.2%, being 97.8% for low risk and 96.2% for high risk (p.0.54). All patients with high-risk MP who progressed had used adjuvant chemotherapy, and all patients with low-risk MP who relapsed received only endocrine therapy. When compared to the MINDACT population, the AGEMA-BRA has more elderly patients, and smaller tumors with a lower histological grade (p.=< 0.001). CONCLUSION – The analysis of the Brazilian population submitted to the 70-gene genomic signature showed a greater proportional number of tumors with low genomic risk than in the test approval study, favoring its application with the aim of de-escalating systemic treatment in this population. Despite the low rate of disease progression in the AGEMA-BRA study, probably determined by the population with the best prognosis disease and the short follow-up, recurrence was similar in the high and low genomic risk groups, demonstrating the adequate selection of systemic therapy following the results of the MP. An increase in the sample size and longer follow-up are necessary to confirm the results found. Table 1. Characteristics of patients and tumor according to risk (AGEMA-BRA) Citation Format: Fabio Mansani, Ruffo Freitas-Junior. PERFORMANCE AND OUTCOMES OF THE 70-GENES SIGNATURE (MAMMAPRINT™) IN A POPULATION WITH MIDDLE INCOME – REAL WORLD STUDY (AGEMA-BRA) [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-17-10.

Abstract PO5-21-02: Breast cancer screening based on physical breast examination: ITABERAÍ randomized trial

Abstract Introduction: Approximately 70% of the Brazilian population depends on the public healthcare system (Sistema Único de Saúde - SUS). However, only 16% of SUS users have access to mammography for breast cancer screening, which necessitates the evaluation of new strategies to reduce mortality from the disease, including expanding physical breast examination (PBE) by non-medical professionals. Within the primary healthcare network, the Community Health Agent (CHA) is a technical-level professional who performs activities through home visits. The primary objective of this study is to evaluate the effectiveness of screening actions based on PBE performed by CHA in reducing advanced tumors (Stage III and IV) and breast cancer mortality rates. Secondary objectives include comparing the number of breast cancer diagnoses between the groups, establishing the overdiagnosis rate, comparing cancer-specific survival, comparing overall survival, comparing the number of diagnostic procedures, assessing the interval between the first symptom and diagnosis, evaluating the interval between diagnosis and the start of treatment, and comparing the financial cost of diagnosis and treatment for breast cancer patients. Trial design: Multicenter, phase III, prospective, randomized clinical trial. The target population comprises women aged 40 years or older and users of SUS. The randomization process will be carried out based on the spatial analysis of each participating center, using sociodemographic information on women from each macroregion to verify the homogeneity of data between groups. Intervention: After randomization, CHA in each group underwent training at different times. CHA in the CG received guidance on breast cancer screening and prevention according to Ministry of Health recommendations, while CHA in the IG received the same guidance and participated in theoretical and practical training for PBE (only female professionals). Variables and data collection: An application was developed to be installed on mobile devices, which the CHA used during home visits. The graphical interface of the application was developed in Dart/Flutter. For the backend, Python programming language was used along with the Flask framework to create the Application Programming Interface (API) responsible for the communication between the database and the application. The MySQL software was used for the relational database. The variables used for building the application included sociodemographic data, lifestyle habits, medical history, information on previous examinations, and physical breast examination. Statistical analysis: For the analyses, the database will be exported to the REDCap (Research Electronic Data Capture) platform. The calculations were defined to detect a reduction in severe cases and mortality (10% and 20%, respectively). For this purpose, a sample power of 80% and a Type I error of 5% were adopted after adjusting for intraclass correlation and sampling effect (0.032 and 1.892, respectively). The calculations were estimated using nQuery software (version 9.1). For the city of Itaberaí, a population of 1,894 women was estimated in each group, resulting in a total of 3,788. Present and target accrual: The trial was activated in December 2022, and as of June 30th, 2023, 2,467 patients had been accrued. The study will last for 16 years, and the first data analyses will be conducted in 2024. Registration and ethical aspects: The trial is registered in ReBEC (Brazilian register): RBR-39vm2nd. Contact information: Prof. Dr. Ruffo Freitas-Junior, Federal University of Goiás, ruffojr@terra.com.br. Citation Format: Ruffo Freitas-Junior, Danielle Rodrigues, Rosangela Corrêa, Leonardo Soares. Breast cancer screening based on physical breast examination: ITABERAÍ randomized trial [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-21-02.

Assessment of childhood dyslipidemia in the Brazilian population: Study based on the database of a large support laboratory in the state of Minas Gerais

Assessment of childhood dyslipidemia in the Brazilian population: Study based on the database of a large support laboratory in the state of Minas Gerais

Fourteen-year trends in overweight, general obesity, and abdominal obesity in Amazonian indigenous peoples.

Available data show that the epidemiological profile of most indigenous Brazilian populations is characterized by the coexistence of long-standing health problems (high prevalence of infectious and parasitic diseases, malnutrition, and deficiency diseases, such as anemia in children and women of reproductive age), associated with new health problems, especially those related to obesity (hypertension, type 2 diabetes mellitus and dyslipidemia). Based on this scenario, this study analyzed the nutritional profile of the adult population of seven indigenous peoples from the Brazilian Amazon in the years 2007 and 2021. A total of 598 adults individuals were analyzed in 2007 (319 women and 279 men) and 924 in 2021 (483 women and 441 men), from seven indigenous peoples located in the state of Pará, who were assisted during health actions carried out in 2007 and in 2021. Body mass index classification used the World Health Organization criteria for adults: low weight, < 18.5kg/m2; normal weight, ≥ 18.5 and < 25kg/m2); overweight, ≥ 25 and < 30kg/m2, and obesity, ≥ 30kg/m2. A waist circumference (WC) < 90cm in men and < 80cm in women was considered normal. The data revealed heterogeneous anthropometric profiles, with a low prevalence of nutritional changes in the Araweté, Arara and Parakanã peoples, and high proportions of excess weight and abdominal obesity in the Kararaô, Xikrin do Bacajá, Asurini do Xingu and Gavião peoples, similar to or even higher than the national averages. Different stages of nutritional transition were identified in the indigenous peoples analyzed, despite apparently having been subjected to the same environmental pressures that shaped their nutritional profile in recent decades, which may indicate different genetic susceptibilities to nutritional changes. The evidence shown in this study strongly suggests the need to investigate in greater depth the genetic and environmental factors associated with the nutritional profile of Brazilian indigenous peoples, with assessment of diet, physical activity and sociodemographic and socioeconomic variables that enable the development of appropriate prevention and monitoring measures.

Task force of the Brazilian Society of Otology — evaluation and management of peripheral facial palsy

ObjectiveTo review key evidence-based recommendations for the diagnosis and treatment of peripheral facial palsy in children and adults. MethodsTask force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on peripheral facial palsy were eligible for inclusion. The American College of Physicians’ guideline grading system and the American Thyroid Association’s guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions. ResultsThe topics were divided into 2 main parts: (1) Evaluation and diagnosis of facial palsy: electrophysiologic tests, idiopathic facial palsy, Ramsay Hunt syndrome, traumatic peripheral facial palsy, recurrent peripheral facial palsy, facial nerve tumors, and peripheral facial palsy in children; and (2) Rehabilitation procedures: surgical decompression of the facial nerve, facial nerve grafting, surgical treatment of long-term peripheral facial palsy, and non-surgical rehabilitation of the facial nerve. ConclusionsPeripheral facial palsy is a condition of diverse etiology. Treatment should be individualized according to the cause of facial nerve dysfunction, but the literature presents better evidence-based recommendations for systemic corticosteroid therapy.

The role of edible mushrooms in the Brazilian diet: a comprehensive analysis

Purpose This study aims to examine the role of edible mushrooms in the Brazilian diet, considering their strategic significance in meeting nutritional goals within sustainable development. Despite their potential in the nutrition of the Brazilian population, significant knowledge gaps still exist. To address this, the authors formulated this study into five main sections: the consumption of edible mushrooms in Brazil, the factors influencing the consumption, the occurrence of edible mushrooms in Brazil, the nutritional contribution of mushrooms consumed in Brazil and sustainable mushroom production in Brazil. Design/methodology/approach The authors compiled current literature to develop this viewpoint paper using systematic review, systematic search and narrative review search methods. Findings Mushrooms are sporadically consumed in Brazil, primarily by the urban population, with challenges in estimating the most used species. Social, economic and cultural factors, health considerations and reduced meat consumption influence mushroom consumption behavior. While Pleurotus ostreatus, Lentinula edodes and Agaricus bisporus are primary species, ethnomycological studies highlight a more diverse consumption among traditional indigenous communities. Brazil hosts approximately 133 wild mushroom species safe for human consumption. Some can be sustainably cultivated using substrates derived from agricultural and urban waste, offering high-protein, high-fiber, low-fat foods with bioactive compounds holding antioxidant and prebiotic potential. Originality/value To the best of the authors’ knowledge, no previous study has investigated how edible mushrooms contribute to the food and nutrition of the Brazilian population. This study emphasizes the crucial role of edible mushrooms in preserving Brazil’s cultural heritage, contributing to food and nutritional security and enhancing the overall diet quality.

Using Portuguese BRCA pathogenic variation as a model to study the impact of human admixture on human health

BackgroundAdmixture occurs between different ethnic human populations. The global colonization in recent centuries by Europeans led to the most significant admixture in human history. While admixture may enhance genetic diversity for better fitness, it may also impact on human health by transmitting genetic variants for disease susceptibility in the admixture population. The admixture by Portuguese global exploration initiated in the 15th century has reached over 20 million of Portuguese-heritage population worldwide. It provides a valuable model to study the impact of admixture on human health. BRCA1 and BRCA2 (BRCA) are two of the important tumor suppressor genes. The pathogenic variation (PV) in BRCA is well determined to cause high risk of hereditary breast and ovarian cancer. Tracing the distribution of Portuguese BRCA PV in Portuguese-heritage population will help to understand the impact of admixture on cancer susceptibility in modern humans. In this study, we analyzed the distribution of the Portuguese-originated BRCA variation in Brazilian population, which has high degree Portuguese-heritage.MethodsBy comprehensive data mining, standardization and annotation, we generated a Portuguese-derived BRCA variation dataset and a Brazilian-derived BRCA variation dataset. We compared the two BRCA variation datasets to identify the BRCA variants shared between the two populations.ResultsThe Portuguese-derived BRCA variation dataset consists of 220 BRCA variants including 78 PVs from 11,482 Portuguese cancer patients, 93 (42.2%) in BRCA1 and 127 (57.7%) in BRCA2. Of the 556 Portuguese BRCA PV carriers carrying the 78 PVs, 331 (59.5%) carried the three Portuguese-BRCA founder PVs of BRCA1 c.2037delinsCC, BRCA1 c.3331_3334del and BRCA2 c.156_157insAlu. The Brazilian-derived BRCA variation dataset consists of 255 BRCA PVs from 7,711 cancer patients, 136 (53.3%) in BRCA1 and 119 (46.6%) in BRCA2. We developed an open database named dbBRCA-Portuguese (https://genemutation.fhs.um.edu.mo/dbbrca-portuguese/) and an open database named dbBRCA-Brazilian (https://genemutation.fhs.um.edu.mo/dbbrca-brazilian) to host the BRCA variation data from Portuguese and Brazilian populations. We compared the BRCA PV datasets between Portuguese and Brazilian populations, and identified 29 Portuguese-specific BRCA PVs shared between Portuguese and Brazilian populations, 14 in BRCA1 including the Portuguese founder BRCA1 c.3331_3334del and BRCA1 c.2037delinsCC, and 15 in BRCA2 including the Portuguese founder BRCA2 c.156_157insAlu. Searching the 78 Portuguese BRCA PVs in over 5,000 ancient human genomes identified evolution origin for only 8 PVs in Europeans dated between 37,470 and 3,818 years before present, confirming the Portuguese-specificity of Portuguese BRCA PVs; comparing the 78 Portuguese BRCA PVs Portuguese, 255 Brazilian BRCA PVs, and 134 African BRCA PVs showed little overlapping, ruling out the possibility that the BRCA PVs shared between Portuguese and Brazilian may also be contributed by African.ConclusionOur study provides evidence that the admixture in recent human history contributed to cancer susceptibility in modern humans.

Polytomous Rasch Analyses of Surgeons' Decision-Making on Choice of Procedure in Endoscopic Lumbar Spinal Stenosis Decompression Surgeries.

With the growing prevalence of lumbar spinal stenosis, endoscopic surgery, which incorporates techniques such as transforaminal, interlaminar, and unilateral biportal (UBE) endoscopy, is increasingly considered. However, the patient selection criteria are debated among spine surgeons. This study used a polytomous Rasch analysis to evaluate the factors influencing surgeon decision-making in selecting patients for endoscopic surgical treatment of lumbar spinal stenosis. A comprehensive survey was distributed to a representative sample of 296 spine surgeons. Questions encompassed various patient-related and clinical factors, and responses were captured on a logit scale graphically displaying person-item maps and category probability curves for each test item. Using a Rasch analysis, the data were subsequently analyzed to determine the latent traits influencing decision-making. The Rasch analysis revealed that surgeons' preferences for transforaminal, interlaminar, and UBE techniques were easily influenced by comfort level and experience with the endoscopic procedure and patient-related factors. Harder-to-agree items included technological aspects, favorable clinical outcomes, and postoperative functional recovery and rehabilitation. Descriptive statistics suggested interlaminar as the best endoscopic spinal stenosis decompression technique. However, logit person-item analysis integral to the Rasch methodology showed highest intensity for transforaminal followed by interlaminar endoscopic lumbar stenosis decompression. The UBE technique was the hardest to agree on with a disordered person-item analysis and thresholds in category probability curve plots. Surgeon decision-making in selecting patients for endoscopic surgery for lumbar spinal stenosis is multifaceted. While the framework of clinical guidelines remains paramount, on-the-ground experience-based factors significantly influence surgeons' selection of patients for endoscopic lumbar spinal stenosis surgeries. The Rasch methodology allows for a more granular psychometric evaluation of surgeon decision-making and accounts better for years-long experience that may be lost in standardized clinical guideline development. This new approach to assessing spine surgeons' thought processes may improve the implementation of evidence-based protocol change dictated by technological advances was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the International Society for Minimal Intervention in Spinal Surgery (ISMISS), the Mexican Spine Society (AMCICO), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Society (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS).

Comparative Analysis of Learning Curve, Complexity, Psychological Stress, and Work Relative Value Units for CPT 62380 Endoscopic Lumbar Spinal Decompression vs Traditional Lumbar Spine Surgeries: A Paired Rasch Survey Study.

Effective 1 January 2017, single-level endoscopic lumbar discectomy received a Category I Current Procedural Terminology (CPT) code 62380. However, no work relative value units (RVUs) are currently assigned to the procedure. An international team of endoscopic spine surgeons conducted a study, endorsed by several spine societies, analyzing the learning curve, difficulty, psychological intensity, and estimated work RVUs of endoscopic lumbar spinal decompression compared with other common lumbar spine surgeries. A survey comparing CPT 62380 to 10 other comparator CPT codes reflective of common spine surgeries was developed to assess the work RVUs in terms of learning curve, difficulty, psychological intensity, and work effort using a paired Rasch method. The survey was sent to 542 spine specialists. Of 322 respondents, 150 completed the survey for a 43.1% completion rate. Rasch analysis of the submitted responses statistically corroborated common knowledge that the learning curve with lumbar endoscopic spinal surgery is steeper and more complex than with traditional translaminar lumbar decompression surgeries. It also showed that the psychological stress and mental and work effort with the lumbar endoscopic decompression surgery were perceived to be higher by responding spine surgeons compared with posterior comparator decompression and fusion surgeries and even posterior interbody and posterolateral fusion surgeries. The regression analysis of work effort vs procedural difficulty showed the real-world evaluation of the lumbar endoscopic decompression surgery described in CPT code 62380 with a calculated work RVU of 18.2464. The Rasch analysis suggested the valuation for the endoscopic lumbar decompression surgery should be higher than for standard lumbar surgeries: 111.1% of the laminectomy with exploration and/or decompression of spinal cord and/or cauda equina (CPT 63005), 118.71% of the laminectomy code (CPT 63047), which includes foraminotomy and facetectomy, 152.1% of the hemilaminectomy code (CPT 63030), and 259.55% of the interlaminar or interspinous process stabilization/distraction without decompression code (CPT 22869). This research methodology was endorsed by the Interamerican Society for Minimally Invasive Spine Surgery (SICCMI), the Mexican Society of Spinal Surgeons (AMCICO), the International Society For Minimally Invasive Spine Surgery (ISMISS), the Brazilian Spine Society (SBC), the Society for Minimally Invasive Spine Surgery (SMISS), the Korean Minimally Invasive Spine Surgery (KOMISS), and the International Society for the Advancement of Spine Surgery (ISASS). This study provides an updated reimbursement recommendation for endoscopic spine surgery. Level 3.