Jane Rocha Duarte Cintra

Sobrevida de cinco anos e fatores prognósticos em coorte de pacientes com câncer de mama assistidas em Juiz de Fora, Minas Gerais, Brasil

O objetivo deste estudo foi analisar a sobrevida de cinco anos e os fatores prognosticos em mulheres com câncer invasivo da mama, submetidas a cirurgia e assistidas em Juiz de Fora, Minas Gerais, Brasil, com diagnostico da doenca entre 1998 e 2000. As variaveis analisadas foram: idade, cor, local de residencia, variaveis relacionadas ao tumor e ao tratamento. Foram estimadas as funcoes de sobrevida pelo metodo de Kaplan-Meier, e o modelo de riscos proporcionais de Cox foi utilizado para avaliacao prognostica. A sobrevida estimada foi de 81,8%. Tamanho tumoral e comprometimento de linfonodos axilares foram os fatores prognosticos independentes mais importantes, com risco de obito aumentado para mulheres com tamanho do tumor maior que 2,0cm (HR = 1,97; IC95%: 1,26-3,07) e com metastase para gânglios axilares (HR = 4,04; IC95%: 2,55-6,39). Tais achados enfatizam a importância do diagnostico e tratamento precoces. O acesso as acoes de rastreamento nos diversos niveis de assistencia, especialmente para o grupo considerado como de maior risco, deve ser uma prioridade para os gestores de saude no pais.

[Non-metastatic breast cancer specific-survival of patients after treatment with adjuvant chemotherapy].

OBJECTIVE Analyze the 5-year breast cancer specific-survival rate of women diagnosed with invasive non-metastatic disease, who as part of their primary treatment underwent surgery followed by adjuvant chemotherapy. METHODS Four hundred twenty eight patients diagnosed between 1998 and 2000 were recruited from all oncology services of the municipality of Juiz de Fora, MG, Brasil. Survival time was counted from the date of the histopathological diagnosis and the date of death due to breast cancer was considered the adverse event. Women alive until December 2005, the final date of the follow-up, were censored. For those who interrupt treatment, censor date was the last follow-up in the medical records. Kaplan-Meier survival curves were estimated, with the differences assessed by the log-rank test. RESULTS Mean age was 51.2 years, and most (72.6%) were Caucasian. Clinical Stages II (47.4%) and III (38.6%) predominated. Breast cancer specific five-year survival rate was 82.0%. A worst survival was observed among women with disease diagnostic before menopause (p=0.02), with tumor size greater than 2.0 cm (p=0.05), with lymph node involvement (p=0,000), in a more advanced disease stage (p=0.000), on a full adjuvant chemotherapy regimen (p=0.03), and who used hormone therapy (p=0.05). CONCLUSION This research allowed identification of the profile and disease survival of breast cancer patients who used adjuvant chemotherapy. These results stimulated the adoption of intensive strategies by the local health authorities for disease control and prevention in this population, emphasizing the increasing need of breast cancer screening, mainly for women considered as of high risk and the availability of timely treatment for all cases diagnosed.

Perfil imuno-histoquímico e variáveis clinicopatológicas no câncer de mama

OBJECTIVE: To describe the main characteristics of women with breast cancer, according to the immunohistochemical profile. METHODS: The population comprised a hospital cohort, consisting of women diagnosed with breast cancer between 2003 and 2005 (n = 601) and treated at a referral center for cancer care in Juiz de Fora, MG, Brazil. Only 397 women who had complete immunohistochemistry analysis were selected. To define the groups according to the immunohistochemical profile, the assessment of estrogen and progesterone receptors, Ki-67 cell proliferation index, and overexpression of human epidermal growth factor receptor 2 (HER2) was chosen. According to the different phenotypes, five subtypes were defined: luminal A, luminal B HER2 negative, luminal B HER2 positive, triple negative, and HER2 overexpression. RESULTS: Most patients were white (80.7%) and post-menopausal (64.9%), with a mean age of 57.4 years (± 13.5). At diagnosis, 57.5% had tumor size > 2.0 cm, and 41.7% had lymph node involvement. The most common subtypes were luminal B - HER2 negative (41.8%) and triple negative (24.2%). In the luminal A subtype, 72.1% of patients were post-menopausal, while the highest percentage of premenopausal women were observed in the luminal B - HER2 positive and triple negative subtypes (45.2% and 44.2%, respectively). A higher frequency of tumors > 2.0 cm and lymph node involvement was observed in triple negative and HER2 positive subtypes. CONCLUSION: This study allowed the distribution assessment of the main clinical and pathological characteristics and those related to health services in a cohort of Brazilian women with breast cancer, according to the immunohistochemical tumor subtypes.

Immunohistochemical profile and clinical-pathological variables in breast cancer

OBJECTIVE To describe the main characteristics of women with breast cancer, according to the immunohistochemical profile. METHODS The population comprised a hospital cohort, consisting of women diagnosed with breast cancer between 2003 and 2005 (n = 601) and treated at a referral center for cancer care in Juiz de Fora, MG, Brazil. Only 397 women who had complete immunohistochemistry analysis were selected. To define the groups according to the immunohistochemical profile, the assessment of estrogen and progesterone receptors, Ki-67 cell proliferation index, and overexpression of human epidermal growth factor receptor 2 (HER2) was chosen. According to the different phenotypes, five subtypes were defined: luminal A, luminal B HER2 negative, luminal B HER2 positive, triple negative, and HER2 overexpression. RESULTS Most patients were white (80.7%) and post-menopausal (64.9%), with a mean age of 57.4 years (± 13.5). At diagnosis, 57.5% had tumor size > 2.0 cm, and 41.7% had lymph node involvement. The most common subtypes were luminal B - HER2 negative (41.8%) and triple negative (24.2%). In the luminal A subtype, 72.1% of patients were post-menopausal, while the highest percentage of premenopausal women were observed in the luminal B - HER2 positive and triple negative subtypes (45.2% and 44.2%, respectively). A higher frequency of tumors > 2.0 cm and lymph node involvement was observed in triple negative and HER2 positive subtypes. CONCLUSION This study allowed the distribution assessment of the main clinical and pathological characteristics and those related to health services in a cohort of Brazilian women with breast cancer, according to the immunohistochemical tumor subtypes.

Sobrevida por câncer de mama e iniquidade em saúde

O câncer de mama e a neoplasia mais frequente em mulheres e alguns estudos mostram desigualdades sociais na sua incidencia e sobrevida, o que e pouco estudado no Brasil. Para avaliar a iniquidade no seu prognostico, foi feito estudo de coorte hospitalar. O seguimento foi realizado por busca ativa nos registros medicos e Sistema de Informacao sobre Mortalidade, contato telefonico e consulta de situacao cadastral no Cadastro de Pessoas Fisicas. As funcoes de sobrevida foram estimadas pelo metodo de Kaplan-Meier e o modelo de riscos proporcionais de Cox foi utilizado para avaliacao prognostica. Foi estimada uma sobrevida especifica pela doenca de 76,3% (IC95%: 71,9-81,0) em 5 anos. As mulheres atendidas no servico publico tiveram pior prognostico (HR = 1,79; IC95%: 1,09-2,94), e tal efeito foi mediado, sobretudo, pelo estadiamento da doenca mais avancado no momento do diagnostico. Tais achados apontam para a existencia de desigualdades de acesso a acoes de rastreamento, com as mulheres de menor posicao socioeconomica tendo diagnostico mais tardio e consequentemente pior prognostico.Breast cancer is the most frequent neoplasm in women, and some studies have shown social inequalities in incidence and survival, which are poorly investigated in Brazil. To assess iniquity in prognosis, a hospital-based cohort study was carried out. Follow-up was made by active search in medical records and in the Mortality Information System, phone calls, and consultation on Individual Tax-Collection Record status. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed for prognostic assessment. Disease-specific survival was estimated at 76.3% (95%CI: 71.9-81.0) in 5 years. Women seen at public facilities had worse prognosis (HR = 1.79; 95%CI: 1.09-2.94), which was particularly due to the disease being diagnosed at a more advanced stage. These findings point to inequalities of access to screening actions, as women of lower social conditions with later diagnostic and therefore with worse prognostic.

Breast cancer survival and health iniquities

O câncer de mama e a neoplasia mais frequente em mulheres e alguns estudos mostram desigualdades sociais na sua incidencia e sobrevida, o que e pouco estudado no Brasil. Para avaliar a iniquidade no seu prognostico, foi feito estudo de coorte hospitalar. O seguimento foi realizado por busca ativa nos registros medicos e Sistema de Informacao sobre Mortalidade, contato telefonico e consulta de situacao cadastral no Cadastro de Pessoas Fisicas. As funcoes de sobrevida foram estimadas pelo metodo de Kaplan-Meier e o modelo de riscos proporcionais de Cox foi utilizado para avaliacao prognostica. Foi estimada uma sobrevida especifica pela doenca de 76,3% (IC95%: 71,9-81,0) em 5 anos. As mulheres atendidas no servico publico tiveram pior prognostico (HR = 1,79; IC95%: 1,09-2,94), e tal efeito foi mediado, sobretudo, pelo estadiamento da doenca mais avancado no momento do diagnostico. Tais achados apontam para a existencia de desigualdades de acesso a acoes de rastreamento, com as mulheres de menor posicao socioeconomica tendo diagnostico mais tardio e consequentemente pior prognostico.Breast cancer is the most frequent neoplasm in women, and some studies have shown social inequalities in incidence and survival, which are poorly investigated in Brazil. To assess iniquity in prognosis, a hospital-based cohort study was carried out. Follow-up was made by active search in medical records and in the Mortality Information System, phone calls, and consultation on Individual Tax-Collection Record status. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed for prognostic assessment. Disease-specific survival was estimated at 76.3% (95%CI: 71.9-81.0) in 5 years. Women seen at public facilities had worse prognosis (HR = 1.79; 95%CI: 1.09-2.94), which was particularly due to the disease being diagnosed at a more advanced stage. These findings point to inequalities of access to screening actions, as women of lower social conditions with later diagnostic and therefore with worse prognostic.

Disease-free survival in patients with non-metastatic breast cancer

INTRODUCTION Breast cancer is the second most common malignancy in the world and the one with highest incidence in the female population; it is also a major cause of death from cancer among women. OBJECTIVE To analyze the disease-free survival (DFS) at 5 years and prognostic factors in women with non-metastatic invasive breast cancer treated at a referral center for cancer care located in a medium-sized city in the Southeast of Brazil. METHOD Patients diagnosed with the disease between 2003 and 2005 and identified through the institutions cancer hospital records were analyzed. The follow-up of cases was carried out through hospital records, and complemented by search in the database of the Mortality Information System (SIM) as well as telephone contact. The variables analyzed were distributed in the following blocks: socio-demographic data, tumor-related characteristics, and treatment-related characteristics. Survival functions were calculated using the Kaplan-Meier method and the prognostic factors were analyzed based on Cox proportional hazard model. RESULTS The study showed a DFS at 5 years of 72% (95CI 67.6-75.9). The main variables independently associated with DFS were lymph node involvement, use of hormone therapy, and education level. CONCLUSION This study reinforces the importance of early diagnosis for DFS, pointing to the role of social aspects in this regard. The relevance of this research in the country is also highlighted, given the scarcity of studies on DFS in the Brazilian population.

Sobrevida de dez anos e fatores prognósticos para o câncer de mama na região Sudeste do Brasil

Introduction: Breast cancer is an important public health issue in many parts of the world. Thus, it shows relevant incidence and is considered one of the main causes of death from cancer among women. Objective: To analyze ten-year survival and prognostic factors in women with invasive breast cancer. Methods: The cohort was composed of 195 women assisted in an oncology referral center in the municipality of Juiz de Fora, state of Minas Gerais, Brazil, who were diagnosed with the disease in 2000 and 2001. Sociodemographic, tumoral, health service, and treatment-related characteristics were analyzed. The Kaplan-Meier method was used to estimate the survival functions and the Cox model of proportional hazards for the evaluation of prognostic factors. Results: The ten-year survival after diagnosis was of 56.3%. The major independent prognostic factors associated with increased risk of death were tumor size > 2.0 cm (hazard ratio - HR = 1.9; confidence interval - 95%CI 1.0 - 3.2) and presence of compromised lymph nodes (HR = 3.7; 95%CI 2.1 - 5.9). Conclusion: These findings reinforce the need of adopting actions that ensure access of the target population to the recommended diagnostic and therapeutic modalities, thus contributing to achieve earlier diagnosis and better survival rates.Introduction: Breast cancer is an important public health issue in many parts of the world. Thus, it shows relevant incidence and is considered one of the main causes of death from cancer among women. Objective: To analyze ten-year survival and prognostic factors in women with invasive breast cancer. Methods: The cohort was composed of 195 women assisted in an oncology referral center in the municipality of Juiz de Fora, state of Minas Gerais, Brazil, who were diagnosed with the disease in 2000 and 2001. Sociodemographic, tumoral, health service, and treatment-related characteristics were analyzed. The Kaplan-Meier method was used to estimate the survival functions and the Cox model of proportional hazards for the evaluation of prognostic factors. Results: The ten-year survival after diagnosis was of 56.3%. The major independent prognostic factors associated with increased risk of death were tumor size > 2.0 cm (hazard ratio - HR = 1.9; confidence interval - 95%CI 1.0 - 3.2) and presence of compromised lymph nodes (HR = 3.7; 95%CI 2.1 - 5.9). Conclusion: These findings reinforce the need of adopting actions that ensure access of the target population to the recommended diagnostic and therapeutic modalities, thus contributing to achieve earlier diagnosis and better survival rates.

Survival Study of Triple-Negative and Non–Triple-Negative Breast Cancer in a Brazilian Cohort

Objective: To analyze the clinical, pathological, and sociodemographic aspects between triple-negative breast cancer (TNBC) and non-TNBC in a Brazilian cohort and identify potential prognostic factors. Methods: This hospital-based retrospective cohort study included 447 women with breast cancer treated at referral centers in Southeastern Brazil. Overall and disease-free survival were compared; prognostic factors were evaluated. Results: Triple-negative breast cancer corresponded to 19.5% of breast cancer diagnosis and was more prevalent among nonwhite and less educated women. The patients with TNBC tended to present with stage III cancer, high p53 expression, lymphocytic infiltration, and multifocality and treated with radical surgery and chemotherapy. The 5-year overall and disease-free survival were 62.1% and 57.5% for TNBC and 80.8% and 75.3% for non-TNBC, respectively (P < .001). The TNBC recurrence was associated with multicentricity, whereas lymph node involvement increased the risk of both recurrence and death. Non-TNBC worse clinical course was associated with nonwhite ethnicity, lower education level, lymph node involvement, and advanced stage. Conclusions: Triple-negative breast cancer exhibited a more aggressive behavior, earlier and more frequent recurrence, and worse survival compared with non-TNBC. While biological and social variables were associated with poorer prognosis in non-TNBC, only lymph node involvement and multicentricity were correlated with worse clinical outcomes in TNBC.

Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais

Os objetivos foram investigar a associacao entre raca/cor e a sobrevivencia em 10 anos de mulheres com câncer de mama e o papel do estadiamento como mediador. Coorte hospitalar com 481 mulheres com câncer invasivo de mama, diagnosticadas entre 2003 e 2005. Foram feitas comparacoes entre mulheres brancas e negras quanto as caracteristicas sociodemograficas e ao estadiamento, usando o teste qui-quadrado, e a sobrevivencia em 10 anos, usando os metodos de Kaplan-Meier e regressao de Cox. Foram estimados para a variavel raca/cor efeitos diretos e indiretos, mediados pelo estadiamento, com ajuste para a condicao social da area de residencia e idade, utilizando o modelo de respostas potenciais (contrafactual) e regressao multipla de Cox. As mulheres negras residiam em setores censitarios de menor renda, eram usuarias do setor publico em maior proporcao e foram diagnosticadas com estadiamentos mais avancados. A sobrevivencia especifica em 10 anos foi de 64,3% (IC95%: 60,0; 68,9), com diferenca significativa entre brancas (69,5%; IC95%: 64,8; 74,6) e negras (44%; IC95%: 35,2; 55,1). Nos modelos multiplos, ajustados para renda e idade, as negras tiveram pior prognostico (HR = 2,09; IC95%: 1,76; 2,51), e a proporcao mediada pelo estadiamento foi de 40% (IC95%: 37; 42). Ha disparidade racial na sobrevivencia do câncer de mama em 10 anos, mediada principalmente pelo estadiamento mais avancado da doenca nas mulheres negras. Isso aponta para a necessidade de ampliar a cobertura e a qualidade do programa de rastreamento dessa doenca e facilitar o acesso ao diagnostico e tratamento precoces, com vistas a reducao da iniquidade racial.