Cancer In Brazil Research Articles

Socioeconomic status and cancer survival in Brazil: Analysis of population data from the municipalities of Aracaju and Curitiba, 1996–2012

IntroductionThe association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available. ObjectivesThe objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR). MethodsUsing population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards. Results28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years) ObjectivesStudy the impact of socioeconomic factors on cancer survival in two Brazilian capitals. Methods: Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines. Results28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%. ConclusionThe results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s

Breast Cancer in Brazil: Screening Program and Surgical Approach

Breast cancer is the most common female cancer, and Screening mammography is a current strategy that reduces mortality among women. In Brazil, more recent data show an increasing number of mammograms but unequal geographic access to the exam nationwide. Breast surgery is essential to the current oncological treatment and management of breast cancer. Conservative breast techniques have been established as an effective treatment option; however, mastectomies are still widely used in Brazil. The increase in breast cancer screening programs nationwide should increase the number of breast-conserving surgeries over total mastectomies. However, these expectations may be compromised in developing countries such as Brazil, where there are relevant discrepancies in the public health system.

Epidemiology of laryngeal cancer in Brazil: Historical data from 2000 to 2019

IntroductionTo determine the incidence, morbidity, and mortality rate of laryngeal cancer in two decades and its epidemiological, clinical, and histological characteristics by sex in Brazil. MethodsThis ecological study used three reliable sources of secondary data: population- and hospital-based cancer registries and the national mortality database. All data available from 2000 to 2019 were considered. ResultsThe incidence of male laryngeal cancer decreased from 9.20 to 4.95 per 100,000 from 2000 to 2018, while mortality slightly decreased from 3.37 to 3.30 per 100,000 from 2000 to 2019. In the same period, the female incidence decreased from 1.26 to 0.48 per 100,000; however, mortality slightly increased from 0.34 to 0.36 per 100,000. Of 221,566 individuals with head and neck cancer, 27 % presented laryngeal cancer. The median age was 61 years (54−69), and most individuals were male (86.6 %), smokers (66.2 %), diagnosed with locally advanced cancer (66.7 %), and squamous cell carcinoma as the main histological type (93.2 %). Male tended to be older (p < 0.001), white (p < 0.001), smokers (p < 0.001), and present late treatment initiation (p < 0.001) and early death (p < 0.001) compared with female. ConclusionThe male laryngeal cancer affected mainly at productive age but with a decreased incidence, probably due to a reduction in smoking habit. However, mortality did not change, which may be explained by the late diagnosis and lack of access to radiotherapy.

Fertility preservation in women with cancer in Brazil: Infertility specialists' perceptions and attitudes.

e13676 Background: Oncofertility is a universal right and a global oncology priority. However, there is a lack of communication between infertility specialists and their clinical oncologists on topics relating to fertility preservation. The present study aims to evaluate the perceptions and attitudes of infertility specialists regarding fertility preservation in women with cancer in Brazil. Methods: An online questionnaire was sent to infertility specialists affiliated to the Brazilian Federation of Associations of Gynecology and Obstetrics (FEBRASGO, in the Portuguese acronym). Results: A total of 100 (30.9%) of 323 FEBRASGO infertility specialists responded, most located in the southern and southeastern Brazilian states. Experience in Human Reproduction ranged from one to 40 years (mean ± standard deviation: 15.5 ±10.2 years). Considering women with cancer in reproductive age in whom fertility preservation was indicated, 60.3% ±28.8% of them performed the procedure (ranging from 10 to 100%). Three main barriers to fertility preservation were appointed: cost (41%), knowledge and acceptance of medical oncologists (35%) and accessibility (9%). Most infertility specialists (58%) considered age above 40 years as the limit for fertility preservation in women with cancer. Breast and ovarian cancers, leukemia, and lymphoma were considered the most relevant types to be considered for fertility preservation, while lung, thyroid, gastric and brain. Conclusions: This is the first Brazilian study on specialists' impressions on cancer patient's access to fertility preservation. While most Brazilian cancer patients are treated in the public health system, most fertility specialists are in the private sector. Currently, the model of care is fragmented and a more integrated workflow between cancer and fertility experts is fundamental to improve fertility sparing access. Further studies are needed on the topic, also including clinical oncologists, hematologists, breast cancer specialists, and patients.

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]

Influence of the centralizing gastric cancer surgery on the health-related quality of life in Brazil.

The assessment of health-related quality of life (QoL) has improved the treatment of gastric cancer. Aiming to compare the influence of skilled surgeons in general hospitals versus specialized hospitals in cancer in Brazil, this study evaluated the relationship between quality of life and types of hospitals (general or cancer) in treating patients with gastric adenocarcinoma operated by surgeons with specific training in Surgical Oncology. This was a cross-sectional study involving 104 patients. Inferential analyses were used to compare two Brazilian general hospitals and a cancer center, evaluating scores of the SF-36 and FACT-Ga QoL questionnaires (Kruskal-Wallis test, Mann-Whitney test); gender, smoking, and Helicobacter pylori tests status (Pearson's Chi-Square test); ethnicity, alcoholism, location of the tumor in the stomach, Lauren's histological types, and type of surgery (Fisher's exact test), number of lymph nodes resected by Surgical Oncologists [Analysis of Variance (ANOVA) with a Fixed Factor], and comparative survival analysis (Log-Rank test). Patients treated at a cancer hospital had higher scores of the FACT-Ga (FACT-G total score, P=0.023; physical well-being, PWB, P=0.006; and functional well-being, FWB, P=0.011). The mean scores of the SF-36 questionnaire showed similar behavior but without reaching a significant difference. Patients operated by Surgical Oncologists at the cancer hospital had better scores in emotional well-being FACT-Ga domain (EWB, P=0.034 and P=0.047) compared to those operated by Surgical Oncologists in general hospitals. There was no significant difference in survival among the three hospitals (P=0.214). In this study, it was possible to suggest the relationship between QoL assessment scores with the centralization of care at specialized cancer hospital in the treatment of patients with gastric adenocarcinoma undergoing surgery with curative intent in Brazil.

Impact of the Covid-19 pandemic on the treatment of resectable liver neoplasms: A cross-sectional study from Brazil.

e22524 Background: By 2030, 10 million patients needing surgical oncology procedures will be from low and middle-income countries. Hepatocellular carcinoma is reported as the fifth most common cancer in men and the seventh in women worldwide. Surgical resection is the primary treatment option for patients with solitary hepatic tumors. The overload of health systems caused by the coronavirus pandemic has strongly affected Brazilian public healthcare (SUS), making the diagnosis of hepatocellular carcinoma difficult due to the lack of resources and professionals. Under these circumstances, we aimed to evaluate the impact of COVID-19 on the surgical treatment patterns for liver cancer performed by SUS during the peak of the COVID-19 pandemic. Methods: A retrospective study was conducted following the STROBE checklist. With data from DATASUS’s Hospital Information System; An agency of the Brazilian Ministry of Health; patients' identities are preserved and the conduction of any research with data from DATASUS is ethically approved. All hepatectomies from all hospitals were considered. Based on the PICO principle: People with liver cancer in Brazil from 2013 to 2021 (Population); hepatectomy (Interest); Brazilian region (Context), the study analyzes the absolute numbers of hepatectomies in oncology registered between January 2013 and December 2021 and compares it to the number of hepatic cancer diagnosis and deaths in the same period. Statistical analysis was performed on PAST, version 4.12, by applying ANOVA one way and Tukey’s test to assess the number of procedures compared over the years. Results: The total number of partial hepatectomies performed in SUS from 2013-2021 was 8,341, with an average of 695 procedures per year. In 2020, the number of hepatectomy surgeries decreased by 12.95% compared to 2019, going from 1,019 procedures in 2019 to only 887 in 2020. Decreases of 23.80%, 36.73%, 34.54%, and 23.59% in hepatectomies were reported in May, August, October, and December of 2020 compared to 2019. Despite the start of vaccinations in 2021, there was still a 6.67% decrease in hepatectomies compared to 2019. The total number of liver cancer diagnoses from 2013-2021 was 15,303, gradually increasing until 2021, when there was a 0.15% decrease in diagnoses when compared to the previous year. In 2020, the number of deaths decreased by 23.07%, from 65 in 2019 to 50 in 2020. However, in 2021, this number increased by 12%, to 56 deaths. Conclusions: The decrease in hepatectomies is apparent and may affect the prognosis of the patients who didn't have access to the health system during the Covid 19 pandemic. However, secondary delays in diagnosis could affect our observation. To deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning, and further research is needed to understand the impact of our observation on the outcome of patients.

Effect of the COVID-19 pandemic on radical prostatectomy: A Brazilian retrospective study.

e17101 Background: Prostate cancer is reported as the most common cancer in Brazilian men. Prostatectomy (RP) is fundamental for a better prognosis and outcome. The overload of health systems caused by the coronavirus pandemic has strongly affected surgical care in Brazilian public healthcare (SUS), making the diagnosis of prostate cancer more difficult due to the lack of resources and professionals available. Under these circumstances, we aimed to evaluate the impact of COVID-19 on the surgical treatment patterns for prostate cancer performed by SUS during the peak of the COVID-19 pandemic. Methods: A retrospective cross-sectional study was conducted using the STROBE checklist and secondary data from the Hospital Information System of DATASUS, a Ministry of Health agency. The study analyzes the absolute numbers of prostatectomies in oncology registered between January 2013 and October 2022, updated by December 15, 2022. Based on the PICo principle: People with prostate cancer in Brazil from 2013 to 2022 (Population); prostatectomy (Interest); Brazilian region (Context), the study compared the number of cancer diagnoses in the same period. Statistical analysis was performed by applying ANOVA one way to assess the number of procedures compared over the years. Results: In Brazil, on SUS, between January 2013 and October 2022, there were 31,716 RPs, with an annual average of 2,883 procedures. The total number of prostate cancer surgeries decreased by 27.20% in 2020, going from 3,499 procedures in 2019 to 2547 in the following year. There was a 43.02%, 38.87%, 35.77%, and 35.03% decrease in July, October, May, and August, respectively, compared to 2019. Despite vaccination in 2021, prostatectomies decreased by 22.32% compared to 2019. From 2013 to 2022, there were 293,308 prostate cancer diagnoses, with a 71% increase from 2017 to 2019, a 25% decrease from 2019 to 2020, and a 5% increase in 2021. The results show that the total of deaths in prostatectomies is 142. In 2019, 10 deaths were reported on SUS, and that number increased to 13 in 2020, 16 in 2021, and 18 in 2022, showing a progressive increase after the pandemic. Conclusions: The decrease in the number of RP is apparent and may impact the prognosis of the patients who were unable to access the health system during the COVID-19 pandemic. It is fundamental to know the amount of damming from those surgeries to propose measures to prevent adverse outcomes. For all to receive safe, cost-effective, and timely cancer surgery, it is crucial that surgical procedures are a central component of both global and national cancer control plans.

Analysis of the clinical, epidemiological and mortality profile of Gastric Cancer in Brazil

Introduction: Gastric cancer is one of the most prevalent, both in women and in men, worldwide, including in Brazil, being considered a condition that causes more morbidity and mortality. Objective: To describe the clinical, epidemiological and mortality profile of gastric cancer in Brazil from 2010 to 2020, as well as the prevalence and risk factors involved in the development of this disease. Methodology: To prepare the study, a bibliographic survey was carried out, through research in the LILACS, Scielo and MEDLINE databases, using descriptors. Strings were made with the words using the Boolean operator (AND): gastric cancer AND epidemiology AND morbidity and mortality AND public health. Results: Morbimortality was higher for gastric cancer in men, predominantly aged over 60 years, white. It was found that gastric cancer had the highest number of cases registered in the year 2019 (32,876 cases) and a significant drop in the year 2020 (12,495 cases). The southeast region of the country was the one that obtained the highest number of diagnoses, on the other hand, the northeast region was the one that least diagnosed this disease. The risk factors most described in the literature are: H. pylori infection; eating habits; excess salt in food and genetic factors. Conclusion: We can infer that gastric cancer remains a serious public health problem in Brazil, and it is important to restructure strategies adopted for prevention and early diagnosis in all states and regions in order to optimize the treatment of the disease in order to enable its cure and improve patients' quality of life.

Cancer per Economic Activity at Brazil’s Southeast Region: Benefits Granted by the Brazilian Social Security System

Introduction: Despite the economic importance of the Region, there are still few studies in the literature about occupational cancer in Brazil’s Southeast Region. Objective: Compare the distribution of cancer-related benefits granted by the Brazilian Social Security System (RGPS) by economic activity of the insured individual, between 2008 and 2014, at Brazil’s Southeast Region. Method: The proportions of cancer-related accidental (work-related) and social security (general) benefits granted, according to the economic activity of the insured individual (bank cashier, salesperson, transport and freight worker, railway worker, industrial worker, sailor, public servant, rural worker, and blank) were calculated. Results: Cancer represented 3.07% (271,086) of the benefits granted for all causes. Commercial and rural activities showed the largest proportions of cancer-related benefits granted in all States. For both activities, breast and prostate cancers were the main locations that justified the approval of social security benefits, and other malignant skin neoplasms were the main locations for accidental benefits. Conclusion: The disproportionality between the number of cancer-related social security and accidental benefits granted suggests an error in many benefits, disfavoring accidental benefits. The improvement of the anamneses of the worker by the medical expert, with the use of additional documents, can aid the establishment of the causal link between the professional activity and the cancer developed, granting accidental benefits when this link exists. Moreover, surveillance strategies to boost the implementation of actions to prevent occupational cancer are still necessary at that Region.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

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.

World Voice Day 2023

World Voice Day 2023 Robert T. Sataloff (bio) CARE OF THE PROFESSIONAL VOICE Each year, the journal of singing publishes an issue highlighting World Voice Day. The journal is committed to collaborating with the American Academy of Otolaryngology—Head and Neck Surgery (AAO-HNS), the Voice Foundation, and other organizations to support World Voice Day. This article is modified periodically and republished before World Voice Day (April 16th) in order to remind people to prepare to participate in its commemoration. This topic has been discussed previously by the author and others (see References). All singing and acting teachers, physicians, speech-language pathologists, nurses, voice patients, and others who care for and about the voice, should work together to raise awareness of the importance of the voice and of developments in voice care. Some years ago, the World Health Organization (WHO) recognized a particularly high rate of laryngeal cancer in Brazil. In April, 1989, the Executive Committee of the Sociedade Brasileira de Laringologia e Voz (Brazilian Association of Laryngology and Voice), a multidisciplinary society that includes physicians, speech-language pathologists and singing teachers, proposed April 16th as “Voice Day.” Later, that idea was transformed to a national voice week, and even a voice month in some locations. Soon, other societies around the world recognized the importance of public education about voice; and the European Laryngological Association (www.elsoc.org), the American Academy of Otolaryngology-Head and Neck Surgery (AAOHNS) (www.entnet.org), the Voice Foundation (www.voicefoundation.org), the American Laryngological Association (ALA) (www.alahns.org), American Bronchoesophagological Association (www.abea.net), the National Association of Teachers of Singing (www.nats.org), and other organizations began collaborating to establish an annual celebration of voice. The AAO-HNS recognized this event in 2002, and the name World Voice Day was adopted. World Voice Day was celebrated in the United States for the first time on April 16, 2003, supported by the AAO-HNS, the Voice Foundation, the American Laryngological Association, the National Association of Teachers of Singing, and numerous other societies and organizations. A summary of the evolution of World Voice Day can be found on the website of the AAO-HNS, at World-Voice-Day.org, and in a 2007 editorial by Svec and Behlau. Typically, World Voice Day activities include lectures, concerts, educational programs, clinical voice screenings, and media events scheduled to take place on and around April 16th. Web-based educational initiatives may be found through the AAO-HNS, Voice Foundation and World-Voice-Day.org websites, and elsewhere. Laryngologists, speech-language pathologists, [End Page 483] nurses, singers, singing teachers, actors, acting teachers and others organize celebratory events in cities throughout the world. Voice professionals are bound together by a commitment to expand public appreciation of and knowledge about the human voice, and to raise awareness about the importance of good voice health and education. For example, in Philadelphia, Voice Foundation World Voice Day events have included a PECO Crown Lights display visible throughout much of the city, singing performances, and lectures on voice care, readings for children at venues such as libraries, stand-up comedy performances, cabaret events, and other activities. Extensive events honoring World Voice Day take place each year in Lisbon, Portugal, under the auspices of Professor Mario Andrea; in the Detroit area under the guidance of Dr. Adam Rubin; in Pittsburgh with Dr. Libby Smith; in San Francisco with Drs. Clark Rosen and VyVy Young; in Los Angeles under the guidance of Dr. Michael Johns; in Cleveland through Dr. Michael Benninger; in Paris with Dr. Jean Abitbol; in Beirut under the supervision of Dr. Abdul Hamdan; and in many other cities. In addition to the physician-led events, the National Association of Teachers of Singing supports World Voice Day actively, and many events throughout the United States are organized by singing teachers, as well as by speech-language pathologists and other voice professionals. Future activities are likely to be even more expansive. Many will be coordinated through the relatively new ad hoc World Voice Day planning committee, notable for its broad international representation. The group’s initial meeting was held in Erlangen, Germany, on July 4, 2012; and the organization is committed to sharing...

Benefícios acidentários e previdenciários concedidos a portadores de câncer no Brasil, 2008-2014

Abstract This article aims to describe the distribution of cancer among the benefits granted by the General Social Security Registry, from 2008 to 2014, in Brazil. Ecological study using data given by the National Social Security Institute. The proportion of accidental (work-related) and social security (general) benefits granted by cancer in Brazil was determined, among the benefits granted for all causes, and a spatial analysis was conducted to assess the geographical distribution of these proportions, with the states Brazilians as a unit of analysis. Cancer was the reason for granting 533,438 benefits (2.9% of the total benefits granted for all causes), with a predominance of females in social security benefits (53.7%) and males in accidental benefits (71.6 %). The highest proportions of social security benefits for cancer occurred in North and Midwest regions. In 19 of the 26 Brazilian states (including all states in the southern region) and in the Federal District, there was no granting of accident benefits for cancer. The analysis of the occurrences of cancer that generated benefit concessions suggests a disproportionality in granting of social security benefits in relation to accident workers, mainly in North, Northeast and South regions of Brazil.