Breast Cancer In Brazil Research Articles

Post pandemic reality in breast cancer in Brazil.

e22530 Background: After the coronavirus disease 2019 (COVID-19) pandemic, there was impact in breast cancer diagnosis all over the world but especially in low income countries. We aimed to evaluate the impact of COVID-19 pandemic on early diagnosis of breast cancer at an oncology center in southeast of Brazil. Methods: We extracted data on new breast cancer cases from Hospital Cancer Registry (RHC) of the Hospital Evangelico de Cachoeiro de Itapermirim in Espirito Santo/Brazil. Two intervals were compared: pre-COVID-19 (2019) and pos COVID-19 pandemic (2021) periods. Results: We had 224 new breast cancer cases in 2019 and 252 in 2021. There was an increase of 12,5 % new cases comparing the two years. In 2019 we had 23% of cases diagnosed in clinical stage (CS) I, 33% CS II, 15% CS III, 11% CS IV and 18% without information. In the year 2021 13% in CS I, 40% CS II, 20% CS III, 11% CS IV and 16% without CS information (table). In respect of age da median age at first diagnosis in 2019 was 61 years and in 2021 it was 56 years, demonstrating a decrease of age over the years. Conclusions: Breast cancer in Brazil was already a public health problem before the pandemic and it has aggravated. A substantial decrease in the number of patients with earlier stages of breast cancer at diagnosis was observed after COVID-19 pandemic. This studies demonstrates the need of efficient public policy to mitigate this problem. [Table: see text]

Care plan for breast cancer survivors: translation and validation

Objective: To translate, cross-culturally adapt and validate the content of the Treatment Summary and Survivorship Care Plan (TSSCP-S) for Brazilian breast cancer survivors. Methods: Methodological, quantitative study performed according to the steps of translation, compatibility and back-translation, construction of consensus of opinions in a group of experts for content validation, according to the Delphi technique and user evaluation. Results: The translated and cross-culturally adapted plan was evaluated by ten professionals, including nurses, physicians, psychologists, nutritionists and physical therapists with a degree, scientific production, knowledge and time working on the subject. Consensus was obtained in two rounds. The instrument presented a content validity coefficient of 83.3% in the second round of Delphi. In the evaluation of content, clarity, usefulness, cultural and socioecological responsiveness domains, agreement was 93.3%. The sociodemographic and clinical profile of users was heterogeneous, contributing to the necessary cultural adjustments, with a final consensus of 93.9%. Conclusion: The care plan was translated into Brazilian Portuguese, cross-culturally adapted and its contents were validated considering national health policies.

LncRNA-SNPs in a Brazilian Breast Cancer Cohort: A Case-Control Study.

Long noncoding RNAs (lncRNAs) are a class of non-coding RNAs that contain more than 200 nucleotides and exhibit a versatile regulatory capacity. Genomic alterations in lncRNAs have already been investigated in several complex diseases, including breast cancer (BC). BC is a highly heterogeneous disease and is the most prevalent cancer type among women worldwide. Single nucleotide polymorphisms (SNPs) in lncRNA regions appear to have an important role in BC susceptibility; however, little is known about lncRNA-SNPs in the Brazilian population. This study used Brazilian tumor samples to identify lncRNA-SNPs with a biological role in BC development. We applied a bioinformatic approach intersecting lncRNAs that are differentially expressed in BC tumor samples using The Cancer Genome Atlas (TCGA) cohort data and looked for lncRNAs with SNPs associated with BC in the Genome Wide Association Studies (GWAS) catalog. We highlight four lncRNA-SNPs-rs3803662, rs4415084, rs4784227, and rs7716600-which were genotyped in Brazilian BC samples in a case-control study. The SNPs rs4415084 and rs7716600 were associated with BC development at higher risk. These SNPs were also associated with progesterone status and lymph node status, respectively. The rs3803662/rs4784227 haplotype GT was associated with BC risk. These genomic alterations were also evaluated in light of the lncRNA's secondary structure and gain/loss of miRNA binding sites to better understand its biological functions. We emphasize that our bioinformatics approach could find lncRNA-SNPs with a potential biological role in BC development and that lncRNA-SNPs should be more deeply investigated in a highly heterogeneous disease population.

Genetic Ancestry of 1127 Brazilian Breast Cancer Patients and Its Correlation With Molecular Subtype and Geographic Region

PurposeBreast cancer molecular subtypes show significant differences in different ethnic groups in the United States, but no study has evaluated genetic ancestry in breast cancer in Brazilian women. MethodsBreast cancer patients from distinct parts of Brazil were evaluated. Molecular subtypes were determined by immunohistochemistry. Genetic ancestry was evaluated using a panel of 46 AIMs (ancestry informative markers), which classified genetic ancestry as European, African, Asian, and Amerindian. PCR products were subjected to capillary electrophoresis and analyzed using GeneMapper 4.0 software. Ancestry was evaluated with Structure v.2.3.3 software. Ancestry was tested for correlations with geographic region and molecular subtype. The chi-square test and ANOVA with Bonferroni adjustment were applied. ResultsGenetic ancestry and clinical data were evaluated in 1127 patients. Higher rates of self-reported white ethnicity, European ancestry, and HER-2− luminal tumors were identified in the South region, which may influence age at diagnosis and result in a higher rate of early tumors. Conversely, higher rates of African ancestry in the North and Northeast regions, self-reported nonwhite ethnicity, HER-2+ tumors, and triple-negative tumors were noted. Triple-negative and HER-2+ tumors were associated with higher advanced and metastatic disease rates at diagnosis, with triple-negative tumors being more frequent in young women. ConclusionDifferences in genetic ancestry, self-reported ethnicity, and molecular subtype were found between Brazilian demographic regions. Knowledge of these features may contribute to a better understanding of age at diagnosis and the molecular distribution of breast cancer in Brazil.

BRCA1 and BRCA2 germline mutation analysis from a cohort of 1267 patients at high risk for breast cancer in Brazil

We determined the frequency and mutational spectrum of BRCA1 and BRCA2 in a series of patients at high risk for developing breast cancer from Brazil. A total of 1267 patients were referred for BRCA genetic testing, and no obligation of fulfilling criteria of mutation probability methods for molecular screening was applied. Germline deleterious mutations in BRCA1/2 (i.e., pathogenic/likely pathogenic variants) were identified in 156 out of 1267 patients (12%). We confirm recurrent mutations in BRCA1/2, but we also report three novel mutations in BRCA2, not previously reported in any public databases or other studies. Variants of unknown significance (VUS) represent only 2% in this dataset and most of them were detected in BRCA2. The overall mutation prevalence in BRCA1/2 was higher in patients diagnosed with cancer at age > 35years old, and with family history of cancer. The present data expand our knowledge of BRCA1/2 germline mutational spectrum, and it is a valuable clinical resource for genetic counseling and cancer management programs in the country.

COVID-19 and Breast Cancer in Brazil.

Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.

Abstract OT3-07-01: Real-World Data on First-line Treatment of HR-positive, HER2-negative, Metastatic Breast Cancer in Brazil (BRAVE Study/LACOG 0221)

Abstract Background: It is estimated that 50 thousand patients live with metastatic breast cancer (MBC) in Brazil. A recent Brazilian registry (LACOG 0312) on MBC demonstrated a median overall survival (OS) by breast subtype of 15 months for triple negative, 23 months for HER2 positive, and 42 months for Luminal tumors, which are very similar to developed countries except the HER2 positive group which have limited access to targeted agents in the public health system. Recently, CDK 4/6 inhibitors were approved for the treatment of HR+ HER2-negative MBC with an improvement in progression-free survival (PFS) and ribociclib and abemaciclib demonstrating benefit in OS over endocrine therapy alone, establishing the standard of care in first-line setting for this BC subtype. In Brazil, disparities exist in the incorporation of novel anticancer agents between public and private health systems limiting treatment options for patients with HR+ HER2- negative MBC in the public system, which covers most of the population. The BRAVE study aims to describe the patient journey and current patterns of care for HR+ HER2-negative MBC to identify possible gaps and how health insurance type influences treatment patterns in Brazil. Trial Design: This is an observational, retrospective cohort study. All patients diagnosed with mBC (either de novo or recurrent) in the period of January 2018 to December 2020 at participating centers will be included. Data will be collected from medical records. No interventions are proposed. Enrollment of a total of 300 patients (150 patients from public health care system and 150 patients from private health care system) is planned. ClinicalTrials.gov identifier: NCT05034393. Eligibility: Inclusion criteria: women ≥18 years old; histologically confirmed HR-positive HER2-negative invasive breast cancer; HR-positive, defined as 1% to 100% of tumor nuclei positive for ER and/or PgR as per ASCO/CAP Guideline 2020 or Allred score of ≥3; HER2-negative, defined as IHC result is 0/1+ or 2+ with ISH negative as per ASCO/CAP Guideline 2018; diagnosed with de novo or recurrent metastatic breast cancer between January 2018 and December 2020. Exclusion criteria: male BC; first-line treatment for mBC received through clinical trial. Specific Aims: Primary objective is to describe the first-line (1L) treatment of HR-positive, HER2-negative mBC in Brazil. Secondary objectives are to describe progression-free survival (PFS) in the 1L setting until month 24; describe and compare the 1L treatment of HR-positive, HER2-negative mBC and PFS until month 24 according to the health care coverage (public vs. private); describe timelines from symptoms, histopathological diagnosis, molecular test, and treatment; describe the mBC pathological characterization; describe frequency of diagnostic tests to define breast cancer molecular subtypes; describe the subsequent line of treatment and corresponding PFS; describe overall survival (OS); evaluate PFS and OS according to visceral vs. non-visceral metastatic disease, primary endocrine resistance vs. acquired endocrine resistance, de novo versus recurrent disease, public vs. private health system and pre vs postmenopausal status. Statistical Methods: No a priori sample size calculation was performed. The expected sample size of 150 patients in each group allows description of the proportion of patients using CDK 4/6 inhibitors with two-sided 90% confidence interval ranging from 53.4% to 66.6% when the expected proportion is 60% in the private health system. Present Accrual and Target Accrual: A total of 12 sites of 14 planned were activated. The first patient was enrolled on February 8, 2022. As of June 24, 2022, a total of 122 patients were enrolled, 86 from public and 36 from private health system. The target accrual of 300 patients is expected to be completed by November 2022. Results are expected to be presented by April 2023. Funding: Novartis. Acknowledgements: SAS. Citation Format: Gustavo Werutsky, Tomás Reinert, Daniela D. Rosa, Romualdo Barroso-Sousa, Heloísa Resende, Poliana A. Signorini, Juliana G. Martins Fagundes, Jose Marcio B. Figueiredo, Eduardo Cronemberger, Aline C. Vieira, Jorge Henrique Santos Leal, Luiza Nardin Weis, Ludmila Thommen, Rafaela G. Jesus, Gustavo Gössling, José Bines. Real-World Data on First-line Treatment of HR-positive, HER2-negative, Metastatic Breast Cancer in Brazil (BRAVE Study/LACOG 0221) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-07-01.

Abstract P4-07-48: Preliminary results of the FIRST (FreezIng bReaST cancer in Brazil) trial: a before-after study

Abstract Background: Image-guided tumor ablation is a non-surgical minimally invasive therapy available for the local treatment of carcinomas as an alternative to surgical treatment. However, studies evaluating this therapy in early breast cancer present variable success rates, raising the question of whether omitting surgery is permissible. Ongoing studies such as the Frost and Ice3 Trial may change the context of cryoablation in the treatment of early breast cancer. Objective: The main objective of this study is to assess the effectiveness of cryoablation in the local treatment of early breast cancer. The secondary objectives are to analyze the negative predictive value of magnetic resonance imaging (MRI) in predicting response to therapy and to assess ice ball size in relation to the largest tumor size. Methods: Non-randomized, single-arm, multicenter clinical study conducted in Brazil. The inclusion criteria will be patients with unifocal invasive breast carcinoma, tumors smaller than or equal to 2.5 cm, lesion visualized on ultrasound, and surgery indicated as the first treatment option. The exclusion criteria will be in situ ductal carcinoma, multifocal or multicentric tumors, clinical axillary involvement, lesion-to-skin distance of less than 5 mm, presence of distant metastasis, and neoadjuvant treatment. All patients will undergo local cryoablation treatment, which will be followed by conventional surgical treatment after an interval of 14 to 28 days. Imaging tests (mammography, ultrasound, and breast MRI) will be performed before and after cryoablation. Cryoablation effectiveness will be assessed through its success rate, defined as the absence of invasive or in situ malignant neoplastic cells in the surgical specimen. If the expected cryoablation success rate corroborates the 92% rate presented in the ACOSOG Z1072 study for patients without multifocal disease, this study will need at least 32 patients to verify if the technique is satisfactory (success rate &amp;gt; 70%) considering power of 95% and an alpha of 5%. The study was approved by the local ethics committee and registered in the Clinical Trials. Recruiting has started in 2020 and is expected to end in 2024. Results: Until now, eight patients have been included, all of them with invasive breast carcinoma of no special type, RH positive and HER 2 negative, histological grade 1 or 2. The mean age of the patients is 57 years, and the mean tumor size is 1.1 cm (0.5–1.8 cm). All patients underwent two cycles of 6-minute freezing and 4-minute thawing with only one cryoprobe coupled to the Argon and Helium gas system. The complete ablation rate was 87.5% (7 of 8 cases) and the ablation rate considering only absence of invasive lesion was 100%. In our study, only one patient had in situ focal ductal carcinoma in one margin. The mean ice ball size on ultrasound was 3.8 x the size of the breast lesion. The negative predictive value of breast MRI was 100%. Conclusions Cryoablation is a promising therapy and may be an alternative to surgical treatment in patients with early breast cancer. This study confirms that this ablative technique is feasible. However, the results of other ongoing studies need to confirm the role of cryoablation in breast cancer treatment. ClinicalTrials.gov Identifier: NCT05398497 Citation Format: Vanessa M. Sanvido, Silvio E. Bromberg, Antonio R. Junior, Bruna Mayumi T. Tachibana, Afonso Nazário. Preliminary results of the FIRST (FreezIng bReaST cancer in Brazil) trial: a before-after study [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P4-07-48.

Abstract P5-04-02: Comparative analysis between screening mammography performed in patients at usual risk and patients at high risk for breast cancer in the early detection program for breast cancer in Brazil

Abstract Introduction: Breast cancer is currently considered a public health problem, being the most frequent in women in Brazil. In the past, and in places where screening programs are not very successful, the diagnosis was made during the clinical examination, being carried out late, which compromised the prognosis and survival of the patient. To avoid late diagnosis, an attempt is made to have the strategy of appropriate screening programs that make an early detection by applying the test to the asymptomatic population and identifying lesions in the pre-clinical stage. Objectives: To analyze the incidence of reports highly suggestive of malignancy in patients undergoing mammography in Brazil between 2013 and 2021. Methodology: A retrospective and analytical cross-sectional study of the notifications available in the cancer information system (SISCAN) was carried out. The incidence of report notifications by the Breast Imaging Reporting Data System (BI-RADS) classification system was compared between high-risk and normal-risk women for breast cancer. In addition to the information regarding the BI-RADS report, they were analyzed comparing epidemiological data between high-risk and normal-risk women. Other variables analyzed were the age group of the screened population and the size of the nodule according to the BI-RADS. Results: In the period analyzed from 2013 to 2021, 16,065,383 screening mammograms were performed and reported in Brazil. Of these, 13,167,259 mammograms were performed on women at normal risk, while 2,898,124 mammograms were performed on women reported as high risk. To analyze the difference between the reports in women at usual risk and those at high risk, the relative risk between them and the number necessary to cause harm was calculated, having found a relative risk of 0.5412 (CI 95 % 0.5341 - 0.5483) in B4 and a relative risk of 0.433 (95% CI 0.4203 - 0.4462). As for the number needed to deal damage, it was observed 203 (95% CI 198 - 209) for B4 and 788 (95% CI 754 - 825) for B5. Discussion: Although the need for breast cancer screening programs to reduce mortality is already well established, some aspects of screening do not have much consensus. In our study, as proposed in the literature, the incidence of reports suggestive of malignant breast lesions was higher in high-risk women. This finding may be consistent with the fact that women with risk factors are more likely to develop breast cancer than those with usual risk. Some studies show that exams from high-risk patients tend to be examined in greater detail, in order to have a higher false positive rate than low-risk patients, just as low-risk patients have a higher false negative rate. Conclusions: Our study showed an increased prevalence of reports suggestive of malignancy in high-risk patients when compared to usual-risk patients. Such findings may mean that high-risk patients have a higher prevalence of malignancy, but also that clinicians review the examinations of high-risk patients more carefully, increasing the rate of reports suggestive of malignancy in these patients. Reports of mammograms performed in the target population and in high-risk women in Brazil between 2013 and 2021 Risco relativo a depender do tamanho do nódulo e o laudo BI-RADS entre mulheres de alto risco e risco habitual Citation Format: MARCELO ANTONINI, GABRIEL D. PANNAIN, ODAIR FERRARO, REGINALDO G. COELHO LOPES, ANDRE MATTAR, JULIANA M. REAL. Comparative analysis between screening mammography performed in patients at usual risk and patients at high risk for breast cancer in the early detection program for breast cancer in Brazil [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-04-02.

Abstract P3-05-13: INFLUENCE OF METABOLIC SYNDROME ON OVERALL SURVIVAL (OS), DISEASE FREE SURVIVAL (DFS) AND INVASIVE FREE SURVIVAL (IFV) IN A COHORT OF PATIENTS TREATED FOR BREAST CANCER IN BRAZIL

Abstract Introduction: Metabolic syndrome can be defined as a set of conditions - central obesity (waist circumference), elevated blood pressure, reduced HDL cholesterol, increased triglycerides and glucose intolerance - which is known to be associated with a higher risk in the development of cardiovascular disease and type 2 diabetes. It affects approximately 30% of the population of women over 50 years of age. In view of the risk factors described above, it is important to seek, in addition to the screening recommended by the Ministry of Health (a mammogram every two years in women aged 50 to 69 years), ways to reduce the risk of breast cancer with regard to to behavioral factors. Practicing the maintenance of adequate weight and physical activities can contribute to the reduction of this pathology. Therefore, even in the pathophysiology of breast cancer, its relationship with the metabolic syndrome is seen, which is often the cause - and even consequence - women treated for breast cancer seem to have an additional risk of metabolic syndrome, resulting from excess adiposity. and effect of treatments. Objectives: To evaluate the relationship between metabolic syndrome at the diagnosis of breast cancer and overall survival, disease-free survival and invasive disease-free survival. Methodology: Retrospective longitudinal observational study of the cohort type carried out in the Mastology sector of the Gynecology and Obstetrics Service of the Hospital do Servidor Público Estadual de São Paulo “Francisco Morato Oliveira. We evaluated the rates of local recurrence, distant metastases and overall survival of patients with malignant breast cancer in each group. Results: From January 2017 to December 2020, 375 patients underwent surgical treatment for breast cancer at the Hospital do Servidor Público Estadual, of which 25 were excluded due to loss of follow-up, 10 due to incomplete data and 5 due to diagnosis of metastases. Thus, 335 patients were eligible for the study, with a mean age of 63.4 ± 1.4 years, and a mean follow-up time of 48 ± 1.4 years. Metabolic syndrome (MS) is present in 109 (32 .5%) patients, while 226 (67.5%) do not have MS. Regarding the characteristics of prognostic factors, that is, KI 67, molecular classification and staging, in table 3 we can observe that patients with metabolic syndrome have a very similar distribution, while those without MS have a KI 67 ≥ 14% in 62.4% of the patients. patients with a significant difference. The molecular profile in MS patients is 39.4% Luminal A patients and 42.5% Luminal B patients without MS, with a significant difference in distribution. Regarding clinical staging, patients with MS have initial clinical stage I and IIA in 54.1%, and advanced stage IIB 20.2% III 25.7%, while patients without MS have initial clinical stage 65%, advanced stage IIB 11.1%m III 23.9, results with a significant difference. When we evaluated the presence of obesity as a factor of worsening of prognostic factors, we did not find significant differences. We evaluated the temporal outcomes of overall survival, disease-free survival, and invasive disease-free survival. The overall sample survival was 37.3 years with a CI 1.1 years, disease-free survival was 35.9 years with a CI 1.2 years, and invasive disease-free survival was 36.9 years with CI 1,3 years. When we compared these outcomes with the presence of MS, we observed a significant difference in all outcomes. Conclusions: The presence of MS at diagnosis does not worsen overall survival, disease-free survival or invasive disease-free survival. Overall Survival (OS) for Breast Cancer and Metabolic Syndrome Overall Survival (OS) for Breast Cancer and Metabolic Syndrome Disease Free Survival (DFS) for Breast Cancer and Metabolic Syndrome Disease Free Survival (DFS) for Breast Cancer and Metabolic Syndrome Invasive Free Survival (IFS) for Breast Cancer and Metabolic Syndrome Invasive Free Survival (IFS) for Breast Cancer and Metabolic Syndrome Citation Format: MARCELO ANTONINI, AMANDA LEAL GUIMARAES, FERNANDA GRACE BAUk RICHTER, ODAIR FERRARO, REGINALDO G. COELHO LOPES, JULIANA M. REAL, ANDRE MATTAR. INFLUENCE OF METABOLIC SYNDROME ON OVERALL SURVIVAL (OS), DISEASE FREE SURVIVAL (DFS) AND INVASIVE FREE SURVIVAL (IFV) IN A COHORT OF PATIENTS TREATED FOR BREAST CANCER IN BRAZIL [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-05-13.

Internet Search Trends on Breast Cancer Between 2017 and 2021 in Brazil: an Infoveillance Investigation

Introduction: Internet users frequently search for information on health issues. The behavior of Internet users may be related to health contexts experienced in their communities, reflecting unmet demands. Objective: To analyze the interest of Internet users on breast cancer in Brazil between 2017 and 2021. Method: An infodemiological study was carried out using the relative search volume (ranging from 0 to 100) for the term “câncer de mama” (breast cancer) in Brazil, retrieved from the Google Trends tool. The annual relative search volume was compared with a non-parametric approach and significance value (p) of 5%. Results: Except between 2019 and 2020 (p-value&gt;0.05), there was a significant increase in Internet searches for the term “câncer de mama” in Brazil (all p-values &lt;0.05). The peak of interest (relative search volume=100) was found in October 2020. Internet users who searched for the term “câncer de mama” often searched for signs and symptoms of breast cancer. Conclusion: The interest of Internet users on breast cancer has increased in recent years in Brazil.

Frequência e fatores associados ao atraso para o tratamento do câncer de mama no Brasil, segundo dados do PAINEL-Oncologia, 2019-2020

to analyze treatment delay and the flow of care for women with breast cancer in Brazil in 2019 and 2020. this was a follow-up study of breast cancer cases available from the Oncology Panel; a chi-square test and multilevel logistic regression were performed in order to analyze the explanatory variables associated with delay (greater than 60 days) in starting treatment. 22,956 cases (54.5%) with delay in treatment were identified in 2019 and 17,722 (48.7%) in 2020; the Southeast region (54.6%) had the greatest proportion of delay; delay was greater when treatment was provided outside the municipality of residence and lower in 2020 compared to 2019; most outward flows were to the capital cities in the same Federative Units of residence. strategies to reduce cancer treatment delay and optimize health care networks in the Federative Units should be prioritized.

Ancestry and self-reported race in Brazilian breast cancer women.

This study aimed to evaluate the association between self-reported race/color and ancestry in Brazilian patients with breast cancer. This was an observational, transversal, epidemiological study, evaluating race and ancestry in 1,127 patients with breast cancer. For genetic ancestry, a 46-AIM-INDEL panel was used. The ancestral profile was evaluated with the Structure v.2.3.3 software. Descriptive statistics were performed. To assess differences between race and ancestry, an analysis of variance with Bonferoni adjustment was used. The race distribution was 77.7% white, 17.6% brown, 4.1% black, 0.4% yellow, and 0.3% cafuse. The African ancestry proportion was significantly (p<0.001) more evident in black [0.63±0.21 (0.17-0.96)], followed by brown [0.25±0.16 (0.02-0.70)], and less frequent in white skin color. The European ancestry proportion was significantly (p<0.001) higher in white [0.72±0.17 (0.02-0.97)], followed by brown [0.57±0.19 (0.12-0.92)], yellow [0.27±0.31 (0.12-0.620], and black [0.24±0.19 (0.02-0.72)]. The Asiatic ancestry proportion is significantly (p<0.001) higher in yellow [0.48±0.51 (0.04-0.93)]. The Amerindian ancestry proportion frequency was the least frequent in all groups, and cafuse patients did not express differences between all race groups. The brown race group presented differences in African and European ancestry. Although we found many similarities between white European ancestry, black African ancestry, and yellow Asian ancestry, there is great miscegenation between patients. Although they can be labeled as having one race, they do present many ancestral genes that would allow their inclusion in another race group.

Criteria for selection and classification of studies in medical events.

The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach's alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi's all-pairs comparisons. A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01). Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies.

Time interval between diagnosis to treatment of breast cancer and the impact of health insurance coverage: a sub analysis of the AMAZONA III Study (GBECAM 0115)

Breast cancer (BC) is the most common type of cancer among women in Brazil. Evidence shows that delayed treatment onset is associated with increased mortality. This study aimed to evaluate median days between diagnosis and treatment and factors associated with delayed start of treatment (> 60days after diagnosis): stage, treatment received, subtype, epidemiological characteristics, and type of healthcare coverage. This analysis included 1709 stage I-III BC patients from AMAZONA III, a prospective, observational study, diagnosed from January 2016 to March 2018 in 22 centers in Brazil. The median number of days from diagnosis to beginning of first oncologic treatment was 46days (IQR 28-75) overall, 43days (IQR 25-75) for stage I disease, 49days (IQR 28-81) for stage II, and 44days (IQR 30-68) for stage III, (p = 0.1180). According to first treatment received, diagnosis-to-treatment interval was 43days (IQR 29-65) for neoadjuvant chemotherapy and 48days (IQR 26-81) for surgery. Diagnosis-to-treatment interval was higher in women treated in the public system versus the private system (56 vs. 34days, p < 0.0001). Patients in the public system had an increased odds of delayed treatment initiation (OR 4.74 95% CI 3.09-7.26, p < .0001). The longer interval from diagnosis to treatment in the public system was independent of clinical stage, type of treatment (systemic vs surgery first), subtype and region of the country. By characterizing the delays in care delivery, our study will aid stakeholders to better design interventions and allocate resource to improve timely treatment for breast cancer in Brazil. gov Identifier: NCT02663973, registered on January, 26th, 2016.

Brazilian breast cancer patient-reported outcomes: What really matters for these women.

Patient-Reported Outcomes (PRO) are directly reported by the patient without interpretation of the patient's response by a clinician or anyone else and pertains to the patient's health, quality of life, or functional status associated with health care or treatment. It can provide patients' perspectives regarding treatment benefit and harm beyond survival and are often the outcomes of most importance to patients. This study aims to describe and analyze outcomes reported by Brazilian women diagnosed with breast cancer and rank the most important attributes for these patients. Observational descriptive study composed of exploratory interviews followed by online questionnaires applied to a convenience sample of women diagnosed with breast cancer. Twelve women were interviewed to explore the main outcomes and preferences about their treatments, such as the most common side effects and the most impacted aspects of life after diagnosis and BC treatment. Psychological, emotional, and sexual impacts were frequently described as impacted aspects. Fifty-three women, from all the five Brazilian regions, answered the online questionnaire. Following an order of importance ranking, the following outcomes were chosen, respectively: overall survival, progression-free survival; and quality of life. The treatment effects that were considered less important, among this sample, were pain and adverse events. Thinking about expanding the therapeutic quality of users, it is essential to take into account the experiences of patients. PRO is a trend in current research to achieve this goal, in order to influence the decisions of HTA agencies about the importance of valuing outcomes that affect patients' lives.

Impact of the COVID-19 Pandemic on Cancer Staging: An Analysis of Patients With Breast Cancer From a Community Practice in Brazil.

A nationwide lockdown was enforced in Brazil starting in March 2020 because of the COVID-19 pandemic when cancer screening activities were reduced. In this study, we evaluated the impact of the COVID-19 pandemic on breast cancer (BC) diagnosis. We extracted data from the medical records of patients age older than 18 years who were diagnosed with BC and started treatment or follow-up in private oncology institutions in Brazil between 2018 and 2021. The primary objective was to compare the stage distribution during the COVID-19 pandemic (2020-2021) with a historical prepandemic control cohort (2018-2019). Early BC was defined as stage I-II and advanced disease as stage IV. We collected data for 11,753 patients with an initial diagnosis of BC, with 6,493 patients in the pandemic (2020-2021) and 5,260 patients in the prepandemic period (2018-2019). We observed a lower prevalence of early-stage BC (63.6% v 68.4%) and a higher prevalence of advanced-stage BC (16.9 v 12.7%), after the onset of the pandemic (both P < .01). This pattern was similar for both estrogen receptor-positive/human epidermal growth factor receptor 2-negative and human epidermal growth factor receptor 2-positive tumors: significantly decreased in the early stage from 69% to 67% and 68% to 58%, respectively, and a considerable increase in advanced-stage disease from 13% to 15% and 13% to 20%, respectively. For triple-negative BC, there was a significantly higher percentage of patients with advanced-stage disease during the pandemic (17% v 11%). Overall, age 50 years or older and postmenopausal status were associated with a greater risk of advanced stage at diagnosis during the pandemic period. We observed a substantial increase in the number of cases of advanced-stage BC in Brazil during the COVID-19 pandemic.

Temporal trends in social security benefits for female breast cancer in Brazil.

The aim of this study was to assess temporal trends in disability benefits for breast cancer awarded to women by Brazil's National Social Security Institute. We conducted a time-series analysis of disability benefit incidence rates between 2007 and 2018 using joinpoint regression and data from the Unified Benefits Information System (SUIBE) and open access social security system database. The age-adjusted incidence rate increased by 6.7% per year between 2015 and 2018 after a period of stability between 2007 and 2014. The number of benefits granted to women aged 20-49 increased, on average, by 3.4% per year, showing a marked rise from 2015 to 2018 (10.4% per year). The findings highlight that breast cancer is an important cause of sick leave among female workers and that the incidence of the disease is growing in younger economically active women, reinforcing the importance of early referral to the Social Security Professional Rehabilitation Program to help workers return to work and readapt to working life.

Characterization of genetic predisposition to molecular subtypes of breast cancer in Brazilian patients.

Introduction BRCA1 and BRCA2 germline pathogenic variants (GPVs) account for most of the 5-10% of breast cancer (BC) that is attributable to inherited genetic variants. BRCA1 GPVs are associated with the triple negative subtype, whereas BRCA2 GPVs are likely to result in higher grade, estrogen-receptor positive BCs. The contribution of other genes of high and moderate risk for BC has not been well defined and risk estimates to specific BC subtypes is lacking, especially for an admixed population like Brazilian.ObjectiveThe aim of this study is to evaluate the value of a multigene panel in detecting germline mutations in cancer-predisposing genes for Brazilian BC patients and its relation with molecular subtypes and the predominant molecular ancestry.Patients and methodsA total of 321 unrelated BC patients who fulfilled NCCN criteria for BRCA1/2 testing between 2016-2018 were investigated with a 94-genes panel. Molecular subtypes were retrieved from medical records and ancestry-specific variants were obtained from off-target reads obtained from the sequencing data.ResultsWe detected 83 GPVs in 81 patients (positivity rate of 25.2%). Among GPVs, 47% (39/83) were identified in high-risk BC genes (BRCA1/2, PALB2 and TP53) and 18% (15/83) in moderate-penetrance genes (ATM, CHEK2 and RAD51C). The remainder of the GPVs (35% - 29/83), were identified in lower-risk genes. As for the molecular subtypes, triple negative BC had a mutation frequency of 31.6% (25/79), with predominance in BRCA1 (12.6%; 10/79). Among the luminal subtypes, except Luminal B HER2-positive, 18.7% (29/155) had GPV with BRCA1/2 genes contributing 7.1% (11/155) and non-BRCA1/2 genes, 12.9% (20/155). For Luminal B HER2-positive subtype, 40% (16/40) had GPVs, with a predominance of ATM gene (15% - 6/40) and BRCA2 with only 2.5% (1/40). Finally, HER2-enriched subtype presented a mutation rate of 30.8% (4/13) with contribution of BRCA2 of 7.5% (1/13) and non-BRCA1/2 of 23% (3/13). Variants of uncertain significance (VUS) were identified in 77.6% (249/321) of the patients and the number of VUS was increased in patients with Asian and Native American ancestry.ConclusionThe multigene panel contributed to identify GPVs in genes other than BRCA1/2, increasing the positivity of the genetic test from 9.6% (BRCA1/2) to 25.2% and, considering only the most clinically relevant BC predisposing genes, to 16.2%. These results indicate that women with clinical criteria for hereditary BC may benefit from a multigene panel testing, as it allows identifying GPVs in genes that directly impact the clinical management of these patients and family members.

Public procurement of antineoplastic agents used for treating breast cancer in Brazil between 2013 and 2019

BackgroundBreast cancer is the most common cancer among women in Brazil and the country’s public health care system is the main care provider. Timely treatment can increase the chance of cure, prevent metastasis and improve quality of life. Effective public procurement of antineoplastic agents can therefore improve access to drug therapy. This study investigates patterns in the procurement of selected antineoplastic agents used for treating breast cancer by public bodies and avoidable expenditure on these drugs between January 2013 and December 2019.MethodsWe selected antineoplastic agents used for adjuvant or preoperative chemotherapy listed in the 2018 Breast Cancer Diagnosis and Treatment Guidelines and included in category L of the WHO Anatomical Therapeutic Chemical classification system. We analyzed regular purchases of antineoplastic agents registered in the Integrated General Services Administration System (SIASG), considering purchased quantity, unit price, date of purchase and procuring entity. Prices were inflation-adjusted to July 2019 based on the National Consumer Price Index.ResultsA total of 10 antineoplastic agents were selected. Trastuzumab and tamoxifen accounted for the largest share of total spending and largest volume of purchases, respectively. The Ministry of Education was the largest purchaser in volume terms of all the drugs studied, except trastuzumab 440 mg, where the category “Other Institutions” accounted for most purchases, and vinorelbine 20 mg, where the Ministry of Health made most purchases. The category “Other Institutions” accounted for the largest share of total spending. Total avoidable expenditure was R$99,130,645. Prices paid for medicines and avoidable expenditure were highest in the Ministry of Defense.ConclusionsThe differences observed in the performance of different categories of buyers as to amounts purchased and prices practiced for antineoplastic agents could be reduced by employing strategies to expand the centralization of purchases, resulting in expanded access to breast cancer medicines in the public sector.