Background: In the phase III IMpassion130 trial, combining atezolizumab with first-line nanoparticle albumin-boundpaclitaxel for advanced triple-negative breast cancer (aTNBC) showed a statistically significant progression-free survival (PFS) benefit in the intention-to-treat (ITT) and programmed death-ligand 1 (PD-L1)-positive populations, and a clinically meaningful overall survival (OS) effect in PD-L1-positive aTNBC. The phase III KEYNOTE-355 trial adding pembrolizumab to chemotherapy for aTNBC showed similar PFS effects. IMpassion131 evaluated first-line atezolizumabepaclitaxel in aTNBC. Patients and methods: Eligible patients [no prior systemic therapy or 12 months since (neo)adjuvant chemotherapy] were randomised 2:1 to atezolizumab 840 mg or placebo (days 1, 15), both with paclitaxel 90 mg/m 2 (days 1, 8, 15), every 28 days until disease progression or unacceptable toxicity. Stratification factors were tumour PD-L1 status, prior taxane, liver metastases and geographical region. The primary endpoint was investigator-assessed PFS, tested hierarchically first in the PD-L1-positive [immune cell expression 1%, VENTANA PD-L1 (SP142) assay] population, and then in the ITT population. OS was a secondary endpoint. Results: Of 651 randomised patients, 45% had PD-L1-positive aTNBC. At the primary PFS analysis, adding atezolizumab to paclitaxel did not improve investigator-assessed PFS in the PD-L1-positive population [hazard ratio (HR) 0.82, 95% confidence interval (CI) 0.60-1.12; P ¼ 0.20; median PFS 6.0 months with atezolizumabepaclitaxel versus 5.7 months with placeboepaclitaxel]. In the PD-L1-positive population, atezolizumabepaclitaxel was associated with more favourable unconfirmed best overall response rate (63% versus 55% with placeboepaclitaxel) and median duration of response (7.2 versus 5.5 months, respectively). Final OS results showed no difference between arms (HR 1.11, 95% CI 0.76-1.64; median 22.1 months with atezolizumabepaclitaxel versus 28.3 months with placeboe paclitaxel in the PD-L1-positive population). Results in the ITT population were consistent with the PD-L1-positive population. The safety profile was consistent with known effects of each study drug. Conclusion: Combining atezolizumab with paclitaxel did not improve PFS or OS versus paclitaxel alone. ClinicalTrials.gov: NCT03125902.

PURPOSE Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973 ). METHODS The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson’s χ2 test. RESULTS Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married ( P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis ( P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2–positive, luminal B, and triple-negative subtypes. CONCLUSION Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.

Objective. To analyse effects of resistance training (RT) in breast cancer survivors (BCS) and how protocols and acute variables were manipulated. Methods. Search was made at PubMed, Science Direct, and LILACS. All articles published between 2000 and 2016 were considered. Studies that met the following criteria were included: written in English, Spanish, or Portuguese; BCS who have undergone surgery, chemotherapy, and/or radiotherapy; additional RT only; analysis of muscle performance, body mass composition (BMC), psychosocial parameters, or blood biomarkers. Results. Ten studies were included. PEDro score ranged from 5 to 9. Rest interval and cadence were not reported. Two studies reported continuous training supervision. All reported improvements in muscle strength, most with low or moderate effect size (ES), but studies performed with high loads presented large ES. Five described no increased risk or exacerbation of lymphedema. Most studies that analysed BMC showed no relevant changes. Conclusions. RT has been shown to be safe for BCS, with no increased risk of lymphedema. The findings indicated that RT is efficient in increasing muscle strength; however, only one study observed significant changes in BMC. An exercise program should therefore consider the manipulation of acute and chronic variables of RT to obtain optimal results.

Tel/Fax: (62) RESUMO OBJETIVO. Determinar a prevalência e fatores associados ao conhecimento e prática do auto-exame das mamas (AEM) em amostra hospitalar de Goiânia. MÉTODOS. Realizou-se estudo descritivo sobre os fatores potencialmente associados ao conhecimento e prática do AEM numa coorte de 2073 pacientes. Usou-se entrevista estruturada, sendo as variáveis estudadas: idade, escolaridade, procedência, paridade, estado civil, renda familiar e amamentação. RESULTADOS. Observou-se que 75% das mulheres conheciam e 51% praticavam o AEM. Análise multivariada permitiu a obtenção das seguintes razões de chance: conhecimento do AEM entre donas de casa foi 4,2 vezes maior que entre as que trabalham fora; 2,1 vezes maior entre as acima de 30 anos; 2,1 vezes maior entre as com cinco ou mais anos de escolaridade; 1,98 vez maior entre as originárias da Grande Goiânia; 1,4 vez maior entre as com dois ou mais filhos; 1,68 vez maior entres aquelas com renda maior que dois salários mínimos. Em relação à realização do AEM, esta foi 1,7 vez mais freqüente nas donas de casa; 1,7 vez mais relatada nas maiores de 30 anos; 1,8 vez mais entre as originárias da Grande Goiânia; 1,8 vez mais freqüente naquelas com maior escolaridade; e 1,2 vez mais nas mulheres com renda superior a dois salários mínimos. CONCLUSÃO. A maioria das pacientes refere conhecer o auto-exame, e metade menciona praticá-lo. As camadas da população mais carentes de informação e conscientização sobre a importância dessa técnica na detecção precoce do câncer de mama apresentam alta taxa de desconhecimento e não o praticam. INTRODUÇÃOApesar de que não se tenha demonstrado que os ensaios com treinamento, na realização do auto-exame das mamas, reduzam a mortalidade por câncer de mama 1,2 , há evidências de que as medidas destinadas à redução do estadiamento ao diagnóstico tendem a produzir um grande benefício generalizado em termos da sobrevida das pacientes e dos custos do tratamento 3 . Mesmo alguns pesquisadores tendo encontrado uma associação entre a freqüência da realização do auto-exame e o diagnóstico da neoplasia mamária em estágios iniciais 4,5 , a influência desse método na sobrevida continua pouco clara 1,5 . Alguns autores sustentam o fato de que lesões descobertas pelo auto-exame tendem a ser menores (aproximadamente 0,6 cm em média) do que aquelas encontradas de maneira acidental. Infelizmente, como menos de 50% das mulheres da população em geral realizam o auto-exame periodicamente, até o momento, parece não haver uma diminuição na taxa de mortalidade com o uso sistemático do auto-exame 1 . Embora a mamografia persista sendo apontada pelas normas de especialistas como o método diagnóstico de eleição para o câncer de mama em programas populacionais de rastreamento da doença devido a seu impacto na mortalidade 6,7 , o exame clínico das mamas e o autoexame constituem componentes importantes das atividades de rotina em países com acesso a mamografia, bem como para uma educação em saúde voltada para o cuidado geral das mamas em todos os países 8 . NoBra...

The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.