EDITORIALO n June 15 of the current year, the Brazilian Society of Mastology -Rio de Janeiro Region (SBM/RJ) promoted a discussion on public health policies in breast cancer at the VII International Symposium on Mastology -Rio (SIM Rio). There was a seminar addressing the barriers and strategies for the implementation of the guidelines for the early detection of breast cancer in Brazil.Strategies for the early detection of breast cancer and rapid access to treatment were discussed. Such factors are essential for the decrease in mortality and the increase in breast cancer survival rates. The event allowed for democratic participation, ensuring transparency and promoting learning opportunities for both interest groups and the audience, with the use of evidence-based knowledge.The event was attended by managers from all government levels, supporters from breast cancer-related technical areas, researchers interested in the translation processes of scientific knowledge, and the Brazilian and international civil society. Decisions considered urgent were exposed through common dialogue and points of convergence, transcending conflicts of interest. These decisions represent direct contributions to assist public health policies in breast cancer not only in Rio de Janeiro, but in the whole country.With this meeting, the SBM/RJ achieved its main objective, which was to promote integration and to show that together, we can develop outstanding and quality work. This quality is an attribute to be always sought in an organized, collective and synergistic way, unlike what is observed in the daily life of health services, in which individuals do what they consider most appropriate, but without the desired result.We have to strive to do the right thing at the right time and in the right way. Our actions are not to be seen as a punctual obligation or the fulfilling of a meaningless requirement. In relation to the seminar on barriers and strategies to implement the guidelines for the early detection of breast cancer in Brazil, I present the following considerations:Early detection of breast cancer requires the early diagnosis in women with symptoms of the disease and, in addition, may include screening asymptomatic women. Both efforts should consider the cultural context of the community in question, the resources available to support the program and the sustainability of those efforts over time 1 . Effective early detection programs may lead to decreased staging, which increases the proportion of breast cancers detected at an early stage, when treatment is most effective 1 . Noncommunicable diseases, such as cancer, are overcoming infectious diseases as one of the most pressing health care threats in low -and middle-income countries 2 . By 2025, 59% of all new cancer cases and 68% of deaths caused by cancer will occur in these countries 3 . Consequently, local health systems are struggling to respond to this change in this scenario 4 . Breast cancer represents a major public health problem in the world and in Brazil. In 2015, it w...
Este estudo avalia a introdução do Programa de Navegação do Paciente (PNP) em uma comunidade do município do Rio de Janeiro. Os objetivos são: estabelecer a viabilidade do PNP nesse contexto; identificar as barreiras ao rastreamento mamográfico; e assegurar cobertura mamográfica de 70% das mulheres recrutadas entre 50 e 69 anos. De março a setembro de 2018, foram recrutadas 678 mulheres com idade média de 58 anos da comunidade do Andaraí. O acompanhamento foi realizado pelo navegador de pacientes (NP) por telefone, e-mail e mensagens de texto. Doze por cento das mulheres recusaram-se a participar do PNP por razões culturais. As principais barreiras relatadas pelas mulheres foram: problemas do sistema com programação de cuidados de saúde (100%), problemas financeiros (64%), preocupações relacionadas à comunicação com a equipe médica (58%), medo (44%) e apoio social (14%). Foram obtidos 100% de satisfação com o PNP, e a meta de taxa de cobertura mamográfica foi superada, atingindo o percentual de 88%. O NP promoveu aumento na taxa de cobertura mamográfica, auxiliou na transmissão de informações de qualidade, reduziu o medo da mamografia e facilitou o acesso aos cuidados de saúde da mama. ABSTRACTThis study evaluates the Patient Navigation Program (Programa de Navegação do Paciente -PNP), which was introduced to a community in the municipality of Rio de Janeiro. The objectives were: to establish the viability of the PNP in this context; identify barriers to mammogram screening; and ensure mammogram coverage for 70% of women recruited between 50 and 69 years old. From March to September 2018, 678 women with an average age of 58 years old were recruited from the Andaraí community. Follow-up was performed through the patient browser (PB), by telephone, email and text messages. Twelve percent of women refused to participate in the PNP for cultural reasons. The main barriers reported by women were: systematic problems with health care programming (100%), financial problems (64%), concerns about communicating with medical staff (58%), fear (44%), and social support (14%). The PNP obtained 100% satisfaction, and the mammogram coverage rate goal was exceeded, reaching 88%. The PN promoted an increase in the rate for mammogram coverage, aided in the transmission of quality information, reduced individuals' fear of mammography, and facilitated access to breast health care.
Background: Patient Navigation Program (PNP) assists patients to reduce delays in diagnosis and treatment. A study was conducted on how PNP in Rio de Janeiro, Brazil, could promote adherence to the "Law of 60 Days", which states that all patients with cancer within the public system should start treatment within 60 days after diagnosis of cancer. Materials and Methods: From August 2017 to May 2018, 105 patients aged 33-80 years (mean 59 years) were recruited for Patient Navigator. Follow-up was by phone, email, or text message. PNP implemented at Rio Imagem was designed to: 1) collect important data on specific barriers, and 2) ensure that at least 70% of the patients recruited with breast cancer initiate treatment within the mandatory 60-days period. Results: Patients presented with stage 0 (4%), I-IIA (38%), IIB-IIIB (48%) and IV (5%). These included barriers to compliance with the law: fear and fatalistic thoughts (99%), financial burden (79%), uncoordinated health care (76%), attitudes towards providers (75%), duplicity of pre-treatment exams (52%), patient-provider communication (52%), transport (42%), scheduling (24%), and queues for surgical treatment (12%). PNP had 100% patient satisfaction and in 52% of the cases it helped the patients to start treatment within the period established by law. Conclusion: PNP in Rio did not reach the success rate a 70% to comply with the law, as intended (it reached 52%). However, the barriers that PN did not manage to overcome the lack of human resources and medical supplies, were informed to the health authorities and to the hospital managers.
Background: Preclinical evidence suggests that zoledronic acid (ZOL) works synergistically with chemotherapy by enhancing anti-tumor activity. ZOL blocks the mevalonate pathway and may indirectly interact with human epidermal growth factor receptor 2 (HER2) pathway activation. The clinical efficacy and biological rationale of chemotherapy plus anti-HER2 therapy and ZOL as a part of neoadjuvant therapy has not been previously tested. Patients and methods: We conducted a phase II clinical trial to evaluate the efficacy and safety of ZOL as part of a neoadjuvant treatment in patients with HER2-positive breast cancer (BC). The protocol consisted of four cycles of doxorubicin/cyclophosphamide with ZOL, followed by four cycles of docetaxel with trastuzumab and ZOL prior to surgery. The primary endpoint was the pathologic complete response (pCR) rate. Secondary endpoints were safety and the identification of clinicopathological characteristics associated with pCR. Results: A total of 71 patients with stage IIA to IIIB BC were included, with 60 eligible for the safety assessment and 58 for the efficacy analysis. Overall, the pCR rate was 42%, with higher rates in hormone receptor (HR)-positive tumors (40%), which contrasts with the results of pivotal trials. The most commonly observed grade 3 and 4 events were febrile neutropenia (grade 3, 20%; grade 4, 3%) and diarrhea (grade 3, 12%). Conclusions: The addition of ZOL as a repositioning drug in neoadjuvant treatment was an effective and well-tolerated therapy. This drug combination might overcome endocrine and anti-HER2 resistance. The higher pCR rates in the HR-positive subgroup deserve further translational investigation.
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