Acp Nazario

Abstract P6-05-02: Breast cancer increased risk on women using combined oral contraceptive

The most controversial aspect in relation to oral hormonal contraception is the risk of developing breast cancer. Knowledge of the factors that influence the proliferation of normal breast epithelium is essential to understanding carcinogenesis and proliferative activity can be assessed by various techniques, including the immunohistochemical analysis of Ki 67. In this work, we aim to compare the overall proliferative activity of breast after 3 cycles of combined oral contraceptive with a natural cycle and with that presented after only one cycle. Were selected 65 women attended in the period July 2006 to February 2007. These underwent excision of breast lump and breast tissue macroscopically regular adjacent to the node, lying this at least 1 cm. The patients were divided into two groups: group A, consisting of 20 women using three cycles of combined oral contraceptive consisting of 150 ug levonorgestrel and 30 ug of ethinyl estradiol, and the group B consisting of 35 women with natural cycles eumenorrheic , ie not used any hormonal medication. In the fourth month after initiation of use of the ACO, the group A patients were divided into four groups according to the use of the contraceptive. The A1 group (5 patients) in the first week; A2 (5 patients) in the second week; A3 (5 patients) in the third week and the A4 (5 patients), the break of the week . Results: The highest levels of Ki67 count occurred in the third (16.65%) and fourth week (16.56 %) similar to one another. Additionally, it is noted that the average pause week count was greater than the first week (10.25%) and of the second week (8.52%), which in turn were not distinct. When comparing the use of 3 cycles with 1 cycle, we found that there was no difference in Ki67 count levels by the time the first two weeks. However, note that the Ki67 levels were higher in women who used contraceptives for longer both in the third week as the week9s break. In conclusion, the proliferative activity of artificial cycle was significantly higher than the natural cycle, and after three cycles, showed higher rates of proliferation in the third and fourth weeks of the menstrual cycle, representing increased carcinogenesis and possible increased breast cancer risk. More studies including compensatory apoptosis must be considerer to confirm this hipothesis. Citation Format: Fenile R, Nazario ACP, Simoes CM. Breast cancer increased risk on women using combined oral contraceptive [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-05-02.

Abstract P2-12-03: Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life

Objective : To investigate the benefits of acupuncture in relation to the shoulder muscle strength and quality of life in women undergoing surgical treatment for breast cancer. Methods : Women with breast cancer, aged 18 years or more, with pain level ≥ 3 in the Visual Analog Scale in shoulder girdle or upper limb three months after surgery, were included in this prospective study. The patients were randomly divided into two groups and received weekly treatment for 10 sessions. Kinesiotherapy group (G1): treated with pre-defined standard kinesiotherapy, lasting 30 minutes. Group Acupuncture + Kinesiotherapy (G2): treated with the same Kinesiotherapy group protocol followed by another 30 minutes of acupuncture using pre-defined points. Acupuncture points used were as follows: CV 3, SP 9, ST 36, KD 7, LV 3, GB 21, LI 15, SJ 14, LU 5, LI 4, ST 38 and BL 60. Patients were evaluated at baseline, after five weeks and at the end of 10 weeks. Parameters studied were: clinical profile and socio-demographic data, muscle strength and quality of life. Results: 48 patients completed treatment, 24 in each group. Regarding shoulder muscle strength, all movements showed improvement and there was no statistical difference between groups. However, when analyzing intragroup changes, improvement of flexion and internal rotation were observed in G1 and increase of all movements were found in G2. Concerning EORTC, there was statistically significant difference between groups of pain symptom in the 5th session, with better score in patients of G2 in relation to G1. About EORTC intragroups results, G1 showed improvement in physical function, pain and insomnia; and G2 in performance roles, fatigue and pain. Conclusion : According to this prospective study, kinesiotherapy and acupuncture had a positive effect on the shoulder muscle strength and quality of life of patients. Keywords: 1. Breast cancer. 2. Rehabilitation. 3. Acupuncture. 4. Muscle Strength. 5. Quality of life. Citation Format: Giron PS, Haddad CA, Rizzi SL, Pinheiro TL, Luz RP, Nazario AP, Facina G. Prospective study of acupuncture in the rehabilitation of women undergoing surgical treatment of breast cancer in relation to the strength and quality of life [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-12-03.

Abstract P1-10-18: The use of hypofractionated radiotherapy for the treatment of women with early breast cancer in the Brazilian public health system may increase access to treatment: Cost effectiveness and budget impact analyses

Abstracts: 2016 San Antonio Breast Cancer Symposium; December 6-10, 2016; San Antonio, Texas OBJECTIVES: To evaluate the cost effectiveness and economic impact of increasing the use of hypofractionated radiotherapy for the treatment of women older than 50 years, with early breast cancer(stages I and II) within the Brazilian National Health System(SUS).METHODS:Several studies show no difference concerning efficacy and safety between hypofractionated and conventional radiotherapy for the treatment of women older than 50 years with stages I and II disease.We built a cost-effectiveness Markov model in Excel which quantifies the cost and the amount of photon beams linear accelerator time used for the treatment of patients using hypofractionated(2.67Gy/fraction) or conventional(2Gy/fraction).The time horizon is 5 years.The perspective of the study is the SUS.The effectiveness was measured as amount of hours saved using hypofractionated in relation to conventional radiotherapy.Costs related to treatment are from DATASUS,and considered the cost of planning the radiotherapy, of the check-film and the use of photon beams linear accelerator.The discount we applied was 5% for costs and benefits.We performed univariate and probabilistic sensitivity analyses. The treatment fraction time was set as 15 minutes. We also built, in Excel, a budget impact model to simulate the increasing adoption of hypofractionated radiotherapy instead of conventional radiotherapyin the treatment of Brazilian women older than 50 years with early breast cancer.The model compares hypofractionated radiotherapy(2.67Gy/fraction) with conventional radiotherapy(2 Gy/fraction).We determined the number of women over 50 years with stages 1 and 2 breast malignant neoplasm that underwent adjuvant radiotherapy in 2013 and 2014, and then projected these populations for the years 2016 to 2020.We considered the costs of planning the radiotherapy, using the photon beams linear accelerator, and performing the check-film.We considered a yearly increase of 20% in the adoption of hypofractionated radiotherapy for the years 2016 to 2019(2016 20%;2017 40%;2018 60%;2019 80% and 2020 90%).The treatment fraction time was set as 15 minutes. RESULTS: The use of hypofractionated radiotherapy at 5 years was able to decrease the number of hours of treatment(-21,835hours) and the total cost of treatment (-

Abstract P3-12-15: Effect of hypofractionated radiotherapy for the treatment of early stage breast cancer: Meta-analysis on efficacy and safety

11,790,229.64).The technology is cost saving.Based on the budget impact analysis, the annual incremental impact would be of -

Abstract P3-09-12: Effects of acupuncture on rehabilitation after breast cancer surgery - Preliminary results

243,202.65, -

Abstract P6-08-03: Incidence of winged scapula after breast cancer surgery with axillary dissection – Preliminary results

490,294.13, -

P5-13-06: Lipidomic Profile Predicts Pathologic Complete Response to Neoadjuvant Weekly Paclitaxel Treatment.

741,085.61, -

P5-07-06: Effect of Angiotensin-(1-7) and Angiotensin II on T47D Breast Cancer Cells in the Proliferation and cAMP Production.

995,388.73 and -

The Impact of Increasing the Use of Hypofractionated Radiotherapy for the Treatment of Women with Early Breast Cancer in A Developing Country

1,127,712.81 providing 3,378, 6.810, 10,294, 13,826 and 15,664 free hours of the linear accelerator for the years 2016, 2017, 2018, 2019 and 2020, respectively.These photon beams linear accelerator free hours may allow 613, 1,380, 2,306, 3,392 and 4,010 additional patients to have access to breast cancer treatment during the years of 2016 to 2020 respectively. CONCLUSIONS:Considering the conditions proposed in these models increasing the use of hypofractionation as a radiotherapy technique to treat women older than 50 years, with early breast cancer within seems to increase the system efficiency saving money, optimizing the treatment schedule and providing access to treatment for more patients. Citation Format: Andrade TRdM, Nazario ACP, Fonseca MCM. The use of hypofractionated radiotherapy for the treatment of women with early breast cancer in the Brazilian public health system may increase access to treatment: Cost effectiveness and budget impact analyses [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P1-10-18.

Mortality, Disease-Free Survival, and Local Recurrence in Hypofractionated Radiotherapy for the Treatment of Early-Stage Breast Cancer: A Meta-Analysis

Objectives: To evaluate the short and long term effect of hypofractionated radiotherapy on efficacy and safety in women with early stage breast cancer that underwent breast-conserving surgery. Methods: We searched in Embase, Medline, Cochrane Library, and Lilacs for randomized controlled trials comparing conventional unconventional fractioning. Two reviewers obtained data independently and disagreements were solved by consensus. We measured the effect of fractioning within 5 years and after 5 years of treatment by means of the relative risk (RR) obtained from a meta-analytic random effects model comparing unconventional and conventional fractioning in relation to local, loco-regional and distant recurrence, mortality, disease-free survival (number of patients with disease-related events), ischemic heart disease, rib fractures and lung fibrosis. Results: We included five medium/ high quality studies totalizing 7.802 women. Unconventional fractioning does not change within 5 years and after 5 years, respectively: (1) local recurrence RR 0.90 (95% CI 0.68 to 1.18; P = 0.44) and RR 0.98 (95% CI 0.83 to 1.17; P = 0.86); (2) locoregional recurrence RR 0.99 (95% CI 0.71 to 1.36; P = 0.84) and RR 0.97 (95% CI 0.77 to 1.23; P = 0, 79); (3) distant recurrence (RR) 1.04 (95% CI 0.73 to 1.46; P = 0.84) and RR 1.02 (95% CI 0.79 to 1.32; P = 0 , 88); (4) mortality RR 0.89 (95% CI 0.77 to 1.05; P = 0.16) and RR 0.96 (IC 95% from 0.89 to 1.08; P = 0.48); (5) disease-free survival RR 0.96 (95% CI 0.78 to 1.18; P = 0.69) and RR 0.96 (95% CI 0.84 to 1.09, P = 0, 49); (6) cardiac ischemia (radiotherapy in both breasts) RR 0.73 (95% CI 0.34 to 1.57; P = 0.42) and RR 0.61 (95% CI 0.33 to 1.15; P = 0.13); (7) cardiac ischemia (radiotherapy only in the left breast) RR de 0.84 (95% CI; 0.21 to 3,.7; P= 0.80) and RR de 0.72 (95% CI, 0.28 to 1.86; P= 0.49); (8) rib fractures RR 1.02 (95% CI 0.25 to 4.20; P = 0.98) and RR 1.08 (95% CI 0.26 to 4.53; P = 0, 91); (9) pulmonary fibrosis RR 2.42 (95% CI 0.50 to 11.71, P = 0.27) and RR 3.16 (95% CI 0.89 to 11.21, P = 0.07). In a subanalysis, removing the fractioning not recommended by ASTRO, unconventional fractioning increases the occurrence of pulmonary fibrosis after 5 years RR 4.17 (95% CI, 1.05 to 16.56; P = 0.04). In another sub-analysis to verify the possible influence of tumor-bed radiation boost we observed that unconventional fractioning increases disease-free survival within 5 years RR 0.82 (95% CI, 0.69 to 0.97; P = 0.02), decreases distant recurrence after 5 years of the treatment RR 0.80 (95% CI, 0.66 to .96; P = 0.02) but increases the occurrence of pulmonary fibrosis after 5 years RR 4.17 (95% CI, 1.05 to 16.56; P = 0.04). Conclusion: Hypofractioning does not affect, neither in the short nor in the long term, the ocorrence of local, locoregional and distant recurrence, disease-free survival and mortality, of ischemic heart disease, pulmonary fibrosis and ribs fracture in women with early stage breast cancer that underwent breast-conserving surgery. Citation Format: Nazario ACP, Andrade TRdM, Segreto HRC, Segreto RA, Fonseca MCM. Effect of hypofractionated radiotherapy for the treatment of early stage breast cancer: Meta-analysis on efficacy and safety. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-12-15.