Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries.A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”.In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries.The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.
Breast cancer is the leading cause of cancer mortality in females worldwide. Studies based on gene expression profiles have identified different breast cancer molecular subtypes, such as luminal A and B cells, cancer cells that are estrogen receptor (ER) and/or progesterone receptor (PR) positive, human epidermal growth factor 2 (HER2)-enriched cells, cancer cells that exhibit an overexpression of the oncogene HER2, and triple-negative cells, cancer cells that are negative for ER, PR and HER2 expression. Immunohistochemistry is the most common type of method used for the identification of these molecular subtypes, through the identification of specific cell receptors. The present study aimed to evaluate the ER, PR and HER2 receptor expression in human breast cancer cell lines, and to classify the corresponding molecular subtype comparing two alternative methods. In the present study, a panel of human mammary carcinoma cell lines: BT-20; Hs578T; MCF-7; MCF-7/AZ; MDA-MB-231; MDA-MB-468; SKBR3; and T47D were used. Immunohistochemical and immunocytochemistry assays were used to characterize the breast cancer subtypes of these cell lines according to the expression of ER, PR and HER2 receptors. The results revealed the molecular characterization of this panel of breast cancer cell lines, using the differential expression of classical and clinically used markers in concordance with previous studies. In addition, these data are important for additional in vitro studies of these specific receptors.
BackgroundBreast conserving surgery (BCS) after neoadjuvant chemotherapy (NC) in patients with locally advanced breast cancer (LABC) is an infrequent procedure. In these patients the association with BCS and oncoplastic surgery (OS) is reported as a possible procedure in case-series, but there are limited case-control studies.MethodsA matched case-control study evaluated LABC submitted to NC and BCS. We evaluated 78 patients submitted to doxorubicin-cyclophosphamide regimen followed by paclitaxel regimen. The match case-control proportion was 2:1 and the patients were selected by tumor size, clinical T stage and year of diagnosis.Results52 underwent classic BCS and 26 OS. The average size tumor was 5.25 cm and 88.5% of the tumors were larger than 3 cm. The clinical and pathological group characteristics were similar, except the weight of surgical specimens (p = 0.004), and surgical margins (p = 0.06), which were higher in OS group. The rate of complete pathologic response was 26.9%. 97.4% received postoperative radiotherapy. At 67.1 months of follow up, 10.2% had local recurrence (LR) and 12.8% locoregional recurrence (LRR) and 19.2% died because disease progression. The overall survival at 60 months was 81.7%. After surgery the disease free-survival at 60 months was 76.5%. The was no difference between groups related to pathologic response (p = 0.42), LR (p = 0.71), LRR (p = 1.00), overall survival (p = 0.99) and disease specific survival (p = 0.87).ConclusionThis study corroborates the fact that OS is a safety procedure for LABC, offering the similar oncologic results observed in patients submitted to classic BCS.
ITADE allows extensive coverage areas, an early start of adjuvant treatment and it can be performed without requiring a reconstructive team.
Exclusive CRT approach is not safe to treat patients with low infiltrative rectal carcinoma.
BackgroundMicroRNAs (miRNAs) are small, non-coding RNA molecules involved in post-transcriptional gene regulation and have recently been shown to play a role in cancer metastasis. In solid tumors, especially breast cancer, alterations in miRNA expression contribute to cancer pathogenesis, including metastasis. Considering the emerging role of miRNAs in metastasis, the identification of predictive markers is necessary to further the understanding of stage-specific breast cancer development. This is a retrospective analysis that aimed to identify molecular biomarkers related to distant breast cancer metastasis development.MethodsA retrospective case cohort study was performed in 64 breast cancer patients treated during the period from 1998–2001. The case group (n = 29) consisted of patients with a poor prognosis who presented with breast cancer recurrence or metastasis during follow up. The control group (n = 35) consisted of patients with a good prognosis who did not develop breast cancer recurrence or metastasis. These patient groups were stratified according to TNM clinical stage (CS) I, II and III, and the main clinical features of the patients were homogeneous. MicroRNA profiling was performed and biomarkers related to metastatic were identified independent of clinical stage. Finally, a hazard risk analysis of these biomarkers was performed to evaluate their relation to metastatic potential.ResultsMiRNA expression profiling identified several miRNAs that were both specific and shared across all clinical stages (p ≤ 0.05). Among these, we identified miRNAs previously associated with cell motility (let-7 family) and distant metastasis (hsa-miR-21). In addition, hsa-miR-494 and hsa-miR-21 were deregulated in metastatic cases of CSI and CSII. Furthermore, metastatic miRNAs shared across all clinical stages did not present high sensitivity and specificity when compared to specific-CS miRNAs. Between them, hsa-miR-183 was the most significative of CSII, which miRNAs combination for CSII (hsa-miR-494, hsa-miR-183 and hsa-miR-21) was significant and were a more effective risk marker compared to the single miRNAs.ConclusionsWomen with metastatic breast cancer, especially CSII, presented up-regulated levels of miR-183, miR-494 and miR-21, which were associated with a poor prognosis. These miRNAs therefore represent new risk biomarkers of breast cancer metastasis and may be useful for future targeted therapies.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2407-14-739) contains supplementary material, which is available to authorized users.
RESUMOO rastreamento para o câncer de mama ou a realização regular do exame de mamografi a é uma realidade em países desenvolvidos. A enfermagem atua de diferentes maneiras neste processo, tendo importante papel no enfrentamento das barreiras relacionadas com a não adesão ao rastreamento; porém, sua efetividade é pouco comprovada, havendo limitado número de estudos clínicos sobre o tema. Realizou-se revisão integrativa sobre o tema na PubMed e na literatura latino-americana LILACS, avaliando estudos clínicos controlados que comprovassem a efetividade das ações de enfermagem, utilizando as palavras-chave rastreamento para o câncer de mama, enfermagem e estudos clínicos. Na PubMed foram identifi cadas 110 publicações sobre o tema, das quais 18 estudos clínicos apresentando as ações de enfermagem. Não se identifi cou nenhum estudo na LILACS. A presente revisão mostrou a efetividade da enfermagem no contexto do rastreamento do câncer de mama, apresentando novas perspectivas de atuação profi ssional, dentro de um contexto multidisciplinar de qualifi cação de ações relacionadas à saúde da mulher. Descritores: Neoplasias da Mama; Programas de Rastreamento; Papel do Profi ssional de Enfermagem; Enfermeira Oncológica; Ensaio Clínico. ABSTRACTMammographic breast cancer screening is a fact in developed countries. Nursing acts in different ways in this process, having an important role in the barriers related to non-adherence to screening, but its effectiveness is little proven, with limited number of clinical trials about this topic. An integrative review of the literature in PubMed and LILACS (Latin American Literature) was conducted, aiming to evaluate controlled clinical trials about nurse´s role in breast cancer screening. It was used the key words breast cancer screening, clinical trials and nurse. From 110 publications in PubMed, 18 were clinical trials and showed the nurse´s role in breast cancer screening. None publication was observed in LILACS database. This review shows the effectiveness of nursing in breast cancer screening, presenting new nurse´s role in the multidisciplinary team that qualify actions related to women´s health. Key words: Breast Neoplasms; Mass Screening; Nurse´s Role; Oncologic Nursing; Clinical Trial. RESUMENLa detección del cáncer de mama por mamografía es un hecho en los países desarrollados. Enfermería actúa de diferentes maneras en este proceso, asumiendo un papel importante en los obstáculos relacionados con la falta de adherencia a los exámenes. A pesar de su importancia, existe un número limitado de ensayos clínicos sobre este tema. Se realizó una revisión integrada de la literatura en PubMed y LILACS (Literatura Latinoamericana), evaluando ensayos clínicos sobre el papel de la enfermera en el rastreamento del cáncer de mama. Utilizó-se las palabras clave detección del cáncer de mama, enfermería y estudios clínicos. De 110 publicaciones en PubMed, 18 eran ensayos clínicos que mostraron el papel de la enfermera en la detección del cáncer de mama, pero ninguna publicación estaba present...
Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40-69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn't done de mammography in their lives and these women were principally from low socio-economic status (OR=2.99), low education (OR=3.00). The best strategies to include these women were mobile unit (OR=1.43) and Family Health Program (OR=1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.
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