Edesio Martins

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE: To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009. METHODS: This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates. RESULTS: Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC = 12%), Paraiba (APC = 11.9%), and Piaui (APC = 10.9%). CONCLUSION: Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels.

Cervical cancer mortality trends in Brazil: 1980-2009

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the countrys major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (-5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

Temporal evolution of breast cancer stages in a population-based cancer registry in the Brazilian central region

PURPOSE To analyze the temporal changes of breast cancer staging at diagnosis among women living in Goiânia, Goiás, Brazil, between 1989 and 2003. METHODS Retrospective and descriptive study in which the cases were identified from the Population-Based Cancer Registry of Goiânia for the period from 1989 to 2003. The variables studied were age, diagnostic method, topographic sublocation, morphology and breast cancer staging. Frequency analyses were carried out on the variables and means, and the medians for the age were determined. The SPSS(R) 15.0 software was used for statistical analyses. RESULTS A total of 3,204 breast cancer cases were collected. The mean age was 56 years (sd+/-16 years). With regard to clinical staging, 45.6% of the cases were found to be localized in the breast, with an increased rate of 19.25% between the first and the third five-year period (p<0.001; CI 95%=0.14-0.23) and 10.2% of cases were with distant metastases. However, a reduction of 17.74% for metastatic cases in the same interval (p<0.001 e CI 95%=0.14-21) was observed. The in situ case rate was 0.2% in 1989-1993 and increased to 6.2% in 1999-2003 (p<0.001, IC95%=4.9-7.4). CONCLUSION The diagnostic profile of breast cancer in the city of Goiânia is changing. Substantial increases in the number of early breast cancer cases are being found in relation to the number of advanced cases.

Incidence trend for breast cancer among young women in Goiânia, Brazil

CONTEXT AND OBJECTIVE It has been suggested that there has been a large increase in breast cancer incidence among young women over the last decade. The aim of this study was to describe the incidence of breast cancer among young women up to 39 years of age in Goiânia, between 1988 and 2003, and to compare this with other age groups. DESIGN AND SETTING Retrospective study using the database of the Population-based Cancer Registry of Goiânia, State of Goiás, Brazil. METHODS The incidence was calculated according to age groups: up to 39 years, 40 to 59 years and 60 years and over. Average annual percentage changes (AAPCs) were estimated for the different age groups using Poisson regression. RESULTS Over this period, 3,310 new cases were recorded. The standardized incidence was 2.89/100,000 in 1988 and increased to 6.37/100,000 in 2003 (R(2) = 0.52) for the group aged up to 39 years (p < 0.003). For the group from 40 to 59 years old, the incidence was 14.39/100,000 in 1988 and 41.70/100,000 in 2003 (R(2) = 0.85; p < 0.001). For the group aged 60 years and over, it was 17.62/100,000 and 28.49/100,000, respectively (R(2) = 0.67; p < 0.001). The AAPCs were 5.22%, 5.53% and 4.54% for the age groups up to 39, 40 to 59 and 60 years and over, respectively. CONCLUSIONS The incidence of breast cancer among young women in Goiânia has been increasing significantly, although this change was similar to the increase in other age groups.

Estudo descritivo dos casos de câncer de mama em Goiânia, entre 1989 e 2003

OBJETIVO: Descrever os casos de câncer de mama nas mulheres residentes em Goiânia no periodo 1989-2003. METODOS: Estudo retrospectivo, descritivo, que incluiu todos os casos de câncer de mama ocorridos nas moradoras de Goiânia, identificados pelo Registro de Câncer de Base Populacional de Goiânia (RCBPGO), no periodo de 1989 a 2003. As variaveis estudadas foram: idade, metodo de diagnostico, localizacao topografica, morfologia e extensao do câncer de mama. Foram utilizadas frequencias e taxas percentuais, alem da regressao de Poisson para determinacao da mudanca percentual anual (MPA). RESULTADOS: Foram identificados 3204 casos de câncer de mama. A localizacao topografica mais frequente foi o quadrante superior lateral (53,7%). O carcinoma ductal infiltrante (CDI) foi o mais frequente, com 2582 casos (80,6%), seguido pelo carcinoma lobular infiltrante (CLI), com 155 casos (4,8%). Houve aumento significante tanto do CDI quanto do CLI, sendo a MPA de 11,0 % e de 15,4%, respectivamente. A proporcao entre CDI e CLI nao foi influenciada pela idade (p=0,98). Quanto a extensao do tumor ao diagnostico, 45,6% dos casos eram localizados na mama, sendo que a MPA foi de 16,1% (IC= 12,4 a 20,0; p<0,001). Houve tendencia de reducao da MPA dos casos metastaticos (-3,8; IC= -8,6 a 1,2; p=0,12). CONCLUSAO: A localizacao topografica e o tipo histologico do câncer de mama, na cidade de Goiânia, seguem o padrao de outros paises. Os principais tipos morfologicos nao foram influenciados pela idade. Houve grande aumento de casos iniciais.

Frequência e fatores preditivos relacionados a metástase linfática em câncer gástrico precoce

BACKGROUND The standard treatment of gastric cancer still has high morbidity and mortality in western populations. Groups of patients with negligible risk of lymph node metastasis may benefit from less invasive treatments. Data regarding the frequency and predictive factors related to lymphatic metastasis in early gastric cancer are rare. AIM To perform the analysis of frequency and predictive factors related to lymphatic metastasis in patients with early gastric cancer treated in a tertiary center in Brazil. METHODS Nine hundred and twenty three patients underwent gastrectomy for gastric adenocarcinoma at the hospital. Of these, 126 had early tumors and were included in the analysis. Clinical and pathological related findings and lymphatic metastasis were evaluated. RESULTS Lymph node metastases were observed in 7.8% of patients with mucosal tumors and 22.6% of submucosal tumors. The presence of ulceration, Lauren histologic type, tumors larger than 50 mm, submucosal invasion, and presence of lymphatic or vascular invasion were significant factors in univariate analysis. The presence of ulceration, lesions larger than 50 mm, infiltration of the submucosal layer and lymphatic invasion were factors independently related to lymphatic metastasis in multivariate analysis. CONCLUSION Ulceration, lesions larger than 50 mm, infiltration of the submucosal layer and lymphatic invasion are independent risk factors related to lymphatic metastasis in early gastric cancer.

Alterações venosas e linfáticas em mulheres com linfedema após linfadenectomia axilar no tratamento do câncer de mama

PURPOSE To evaluate changes in the venous axillary-subclavian and lymphatic systems of women with lymphedema after axillary lymphadenectomy for breast cancer treatment. METHODS This was a case series involving 11 women with unilateral upper limb lymphedema after axillary lymphedenectomy for the treatment of breast cancer. The study was carried out in the Mastology Program of the Clinical Hospital of the Federal University of Goiás, Goiânia, GO, during the period between March 2010 and March 2011. Doppler velocimetry ultrasonography was used to detect the presence of venous changes in the subclavian and axillary veins. Lymphatic changes were evaluated by lymphoscintigraphy in both upper limbs. Fishers exact test was used for the comparison between limbs. RESULTS Subclavian vein flow volume in the upper limb with lymphedema was significantly different from that in the contralateral limb (p<0.001), 54.6% of the women had increased flow. In the axillary vein, 45.4% had increased flow and 45.4% had decreased flow, with a statistically significant difference (p<0.01) between limbs. Compared to the contralateral limb, significant lymphatic changes (p<0.05) were also found in the vessel route (not visualized), number of lymphatic vessels (none), axillary lymph nodes (absent) and dermal reflux (present). In the contralateral upper limb without lymphedema, no venous or lymphatic alterations were encountered. CONCLUSION The women subjected to axillary lymphadenectomy for the treatment of breast cancer presented both venous and lymphatic changes in the upper limb with lymphedema.

Trends in breast cancer surgery at Brazil's public health system

To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazils Public Health System, known as SUS from 2008 to 2014.

Monitoring the profile of cervical cancer in a developing city.

BackgroundMedical records are frequently consulted to verify whether the treatment and guiding principles were correct. Determine incidence and mortality trends of in situ and invasive neoplasms of the uterine cervix, in the period 1988–2004 in Goiânia, Brazil.MethodsThe incident cases were identified through the Population-Based Cancer Registry of Goiânia. Population data were collected from census data of the Brazilian Institute of Geography and Statistics. For mortality analysis, data were extracted from the Mortality Information System. The Poisson Regression was utilized to determine the annual incidence and mortality rates.ResultsA total of 4446 cases of in situ and invasive neoplasms of the uterine cervix were identified. No significant reductions were verified in invasive cervical cancer rates (p = 0.386) during the study period, while in situ carcinomas presented an annual increasing trend of 13.08% (p < 0.001). A decreasing trend was observed for mortality (3.02%, p = 0.017).ConclusionNo reduction was observed for the incidence of invasive cancer of the uterine cervix; however, increasing trends were verified for in situ lesions with a consequent reduction in mortality rates. These increasing trends may be the result of recently-implemented screening programs or due to improvements in the notification system.

Trends in oncoplastic breast surgery and breast reconstruction over the past 35 years

In an attempt to optimize the balance between the risk of local recurrence and the cosmetic outcome in breast cancer surgery, new surgical procedures that combine the principles of surgical oncology and plastic surgery have been introduced in recent years. There has been an exponential increase in the number of scientific publications in general, but this increase has been pronounced in the fields of oncology and breast reconstruction. Our aim is to evaluate trends in the publication of papers on oncoplastic surgery and breast reconstruction over a 35-year period, according to the type of surgery, the specialty, the study design and the geographical region in which the study was conducted. A search was conducted of the PubMed database for studies published between 1981 and 2015 using the following keywords: “reconstructive breast cancer surgery” and “oncoplastic breast cancer”. The search included all types of study design. The database was constructed to include on the general characteristics evaluated in the study, information on the population evaluated and information on outcomes. The Joinpoint and SPSS software programs were used to conduct the statistical analysis. The growth rate of publications was analyzed based on the annual percent change with Pearson’s correlation coefficient (R) and the respective 95% confidence intervals being calculated. Comparisons among categories were analyzed based on overlapping confidence intervals or on statistically significant P < .05 for nonparametric tests (Mann–Whitney U, Kruskal–Wallis). A total of 2357 abstracts were analyzed, 1378 met the inclusion criteria. The annual percent change was 14.5 over the whole period: 25.4 between 1983 and 1993 and 12.0 between 1993 and 2015 (Figure 1 and Table 1). Overall, 943 of the papers were written by plastic surgeons, 365 by breast surgeons, and 16 by radiologists (Table 1). The number of studies on oncoplastic surgery also