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

Incidence trend of five main causes of cancer, in greater Cuiabá, Mato Grosso, Brazil, 2000 to 2016

OBJECTIVE

To analyze the incidence trend of the five main causes of cancer, according to sex and age, in Greater Cuiabá, in the state of Mato Grosso, from 2000 to 2016.

METHODS

Incidence information was obtained from the Population-Based Cancer Registry, referring to the municipalities Cuiabá and Várzea Grande (RCBP - Cuiabá). Crude incidence rates were calculated and the five main types of cancer were selected: for males, prostate (C61), lung (C33-34), colorectal (C18-21), stomach (C16) and oral cavity cancer (C00-10); and for females, breast (C50), cervix (C53), colorectal (C18-21), lung (C33-34) and thyroid gland cancer (C73). Age-adjusted rates were calculated by the direct method, using the world population as reference. Trends were estimated using the Joinpoint method and evaluated by Annual Percent Change (APC) and Average Annual Percent Change (AAPC). The Joinpoint Regression Program software, version 8.3.6.1, was used.

RESULTS

During the period, there was a decreasing trend of lung (AAPC=-2.2; 95%CI -4.0--0.3) and stomach cancer (AAPC=-5.2; 95%CI -7.7--2.6) in men, and of cervix cancer (AAPC=-7.2; 95%CI -9.0--5.3) in women, and increasing for breast (AAPC=2.8; 95%CI 0.2-5.5) and thyroid cancer (AAPC=8.3; 95%CI 4.6-12.2).

CONCLUSION

In Greater Cuiabá, we found a downward incidence trend among elderly men for prostate, lung and stomach cancer. Women are affected at younger age groups, with an upward trend for breast cancer and downward trend for cervix cancer.

Tendência da incidência dos cinco principais tipos de câncer na Grande Cuiabá, 2000 a 2016

RESUMO: Objetivo: Analisar a tendência da incidência das cinco principais causas de câncer, segundo sexo e faixa etária, na Grande Cuiabá, no estado de Mato Grosso, no período 2000 a 2016. Métodos: As informações da incidência foram obtidas no Registro de Câncer de Base Populacional referente aos municípios Cuiabá e Várzea Grande. Foram calculadas as taxas de incidência brutas e selecionados os cinco principais tipos de câncer: para o sexo masculino foram próstata (C61), pulmão (C33–34), colorretal (C18–21), estômago (C16) e cavidade oral (C00–10) e para o sexo feminino foram mama (C50), colo do útero (C53), colorretal (C18–21), pulmão (C33–34) e glândula tireoide (C73). As taxas foram padronizadas pelo método direto, utilizando-se população mundial como referência. As tendências foram estimadas pelo método de regressão joinpoint, segundo sexo e faixa etária, e avaliadas por meio da variação percentual anual (annual percent change — APC) e da variação percentual média anual (average annual percent change — AAPC). Utilizou-se o software Joinpoint Regression Program, versão 8.3.6.1. Resultados: No período, verificou-se tendência decrescente do câncer de pulmão (AAPC=-2,2; intervalo de confiança 95% [IC95%] −4,0–-0,3) e estômago (AAPC=-5,2; IC95% −7,7–-2,6), nos homens, e colo do útero (AAPC=-7,2; IC95% −9,0–-5,3), nas mulheres, e crescente para mama (AAPC=2,8; IC95% 0,2–5,5) e tireoide (AAPC=8,3; IC95% 4,6–12,2). Conclusão: Na Grande Cuiabá, verificou-se tendência decrescente da incidência entre homens idosos para próstata, pulmão e estômago. Mulheres são acometidas em idades mais jovens, com tendência crescente para mama e decrescente para colo do útero.

Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis

Background:

The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. One major concern regarding deleterious effects in the population was a possible increase in the breast cancer incidence. This study analyzed trends in the incidence of breast cancer over the 25-year period following the radiological accident.

Methods:

This ecological, population-based study was conducted to determine the incidence of breast cancer in female residents of Goiânia, Goiás, Brazil, between 1988 and 2012. The data were collected from the Goiânia population-based cancer registry. Crude and age-standardized incidence rates were calculated. The Joinpoint software program was used to calculate annual percent changes (APC) in the incidence of breast cancer.

Results:

Overall, 7,365 new cases of breast cancer were identified, with an annual crude incidence rate of 23.09/100,000 women in 1988 and of 71.65/100,000 women in 2012. The age-standardized incidence rate was 35.63/100,000 women in 1988 and 65.63/100,000 women in 2012. Analysis of the APC showed a significant annual increase of 4.8% in the incidence between 1988 and 2005 (p<0.0001) followed by stabilization in 2005-2012, with an APC of -3.5% (p=0.1).

Conclusion:

There was an increase in the incidence of breast cancer in the female residents of Goiânia, Goiás in the first 17 years of evaluation (1988-2004) followed by a period of stabilization until 2012. However, the trends in the incidence suggest a lack of association with the radiological accident.

Triple-negative breast cancer: the reality in Chile and in Latin America

Breast cancer is the leading cause of cancer death among women worldwide. While triple-negative breast cancer is less common among various sub-types of breast cancer, it tends to affect younger women and is more aggressive, having a higher rate of early recurrence and mortality compared to other sub-types. We know about the association between triple-negative breast cancer and BRCA mutations, which are highly prevalent in founding populations of European origin, but the true prevalence of these mutations in Latin American populations is unknown. There is also very little information about the demographic and epidemiological aspects of triple-negative breast cancer in Latin America, which we will try to summarise in this article. In addition, we will try to provide a brief introduction to the most common recommendations for treating this histological class in Latin America.

Impact of sex, body mass index and initial pathologic diagnosis age on the incidence and prognosis of different types of cancer

Cancer represents a significant challenge for humankind, as early diagnosis and treatment are difficult to achieve. To systemically investigate the effect of sex, body mass index (BMI) and age on cancer incidence and prognosis, the data from 14,504 cases of cancer were downloaded from The Cancer Genome Atlas (TCGA). BMI was used to categorize each person as underweight, normal weight, overweight or obese. Two‑ and five‑year survival rates were applied to estimate the prognosis for each cancer type. All data were statistically analyzed. We identified that males were more susceptible to lung, liver and skin cancer when compared with females, whereas females were more susceptible to thyroid, breast and adrenal cortex cancer. High BMI (>25) was positively associated with the occurrence of cancer, although patients with high BMI at the time of initial diagnosis had higher two/five‑year survival rates. The survival rates for cancer were positively correlated with the age at initial pathologic diagnosis. Some types of cancer were associated with particularly young ages of onset, including adrenocortical carcinoma, cervical and endocervical cancers, brain lower grade glioma, pheochromocytoma and paraganglioma, testicular germ cell tumors and thyroid carcinoma. Hence, the early diagnosis and prognosis for these cancers need to be improved. In conclusion, sex, BMI and age are associated with the incidence and survival rates for cancers. These results could be used to supplement precision and personalized medicine.

Prognostic factors and overall survival of breast cancer in the city of Goiania, Brazil: a population-based study

OBJECTIVE

to analyze the overall survival and prognostic factors of women with breast cancer in the city of Goiânia.

METHODS

this is a retrospective, cross-sectional, observational study that included women with malignant neoplasms of the breast identified by the Goiânia Population-based Cancer Registry. The variables studied were age at diagnosis, tumor size, staging, axillary lymph node involvement, tumor grade, disease extent, hormone receptors, and c-erb-B2 oncoprotein. We performed overall survival analyzes of five and ten years.

RESULTS

we included 2,273 patients in the study, with an overall survival of 72.1% in five years and 57.8% in ten years. In the multivariate analysis adjusted for tumor size, the factors that influenced the prognosis were axillary lymph nodes, histological grade, progesterone receptor, c erb B2, T staging and disease extension.

CONCLUSION

overall survival in ten years is below that observed in other countries, and possibly reflects what happens with the majority of the Brazilian population. The prognostic factors found in this population follow the same international patterns.

Trends in incidence of breast cancer among women under 40 in Asia

BACKGROUND

The aim of this study was to evaluate trends in incidence of breast cancer in women less than 40 years in Asia.

MATERIALS AND METHODS

Registered cases of female breast cancer age less than 40 years and corresponding person years were ascertained from the CI5plus for 10 registries in Asia for the duration of 1970- 2002. Cases were categorized into three age groups: 16-40, 16-29, and 30-40. The 16-40 age group was adjusted to world age population structure. Joinpoint regression analysis was conducted to determine the annual percent of change (APC) and the average annual percent of change (AAPC) for each age group.

RESULTS

A total of 23,661 cases of breast cancer occurred in the 10 registries during the 32 years (1970-2002) of follow-up. The overall age adjusted (16-40 group) breast cancer incidence rate increased from 2.28-4.26 cases per 100,000 population corresponding to an AAPC of 2.6% (95%CI 2.1, 3.0). The trend in incidence for the age group 16-29 increased from 0.45-1.07 corresponding to an AAPC of 2.8% (95%CI 1.9, 3.7). In age group 30 to 40, the incidence ranged from 13.3 in year 1970 to 24.8 in year 2002 corresponding to an AAPC of 2.7% (95% CI 2.3, 3.1). There were two statistically significant changing points in the regression line for the age groups 30-40 and 16-40: one point in the year 1975 with an APC of 6.1 (5.1, 7.1), and the other in 1985 with an APC of 0.4% (0.01, 0.8).

CONCLUSIONS

Our study proved that: 1) the incidence of breast cancer in young women has increased in Asian population during the study period; 2) the rate of increase was very high during the period of 1980-1990.

[Mammogram screening for breast cancer and associated factors in the South of Brazil: a based-population survey]

The purpose of this study was to identify factors associated with annual mammogram screening in women 40 to 69 years of age in Florianópolis, Santa Catarina State, Brazil. Data were obtained from two population studies with independent samples, one with adult women and the other with elderly women, in 2009-2010. Prevalence rates for annual mammogram screening were estimated by crude and adjusted Poisson regression. Overall prevalence of annual mammograms in adult women was 43.5% (95%CI: 38.8-48.2) and was higher in women with private health insurance. In elderly women, prevalence was 38.3% (95%CI: 34.0-42.6), with the following associated factors: marital status (married/with partner), schooling (> 5 years), and highest income quartile. Mammogram screening should be independent of socioeconomic status and age in order to reduce mortality from breast cancer.

Breast cancer in young women in Latin America: an unmet, growing burden

BACKGROUND

Breast cancer (BC) is the leading cause of malignancy-related deaths among women aged ≤ 45 years. There are unexplored and uncertain issues for BC in this particular group in Latin America. The aim of this study is to evaluate BC incidence and mortality among young women and related clinicopathological and survivorship aspects in this region.

MATERIALS AND METHODS

Data were obtained from Globocan 2008 and the International Agency for Research on Cancer's Cancer Incidence in Five Continents series plus databases. We requested collaboration from the 12 different national cancer institutes in Latin America through SLACOM, the Latin American and Caribbean Society of Medical Oncology, and conducted a systematic literature review to obtain local data regarding the prevalence of BC among young women and their characteristics, outcomes, and survivorship-related issues.

RESULTS

BC incidence and mortality proportions for Latin American women aged <44 years were higher when compared with those of developed countries (20% vs. 12% and 14% vs. 7%, respectively). We found only a few Latin American series addressing this topic, and prevalence varied between 8% and 14%. Stage II and III disease, high histological grade, and triple-negative and HER2 BC were features frequently observed among young Latin American BC patients.

CONCLUSION

The rising incidence and mortality of BC in young Latin American women is a call to action in the region. It is necessary to monitor the epidemiological and clinical data through reliable cancer registries and to consider the implementation of protocols for education of patients and health professionals. This unmet, growing burden must be considered as a top priority of the national programs in the fight against BC, and models of specialized units should be implemented for this particular group of patients to provide better care for this emergent challenge.

Temporal variation of breast cancer surgical treatment in a university hospital in Brazil's Central West region

OBJECTIVE

To assess the types of surgical treatments for breast cancer performed by the Mastology program of the Clinics Hospital, Federal University of Goiás (HC-UFG).

METHODS

We conducted a cross-sectional, cohort study on the breast operations performed at HC-UFG from January 2002 to December 2009. We evaluated the surgical records for: surgical time and size, surgeon, type of operation, diagnosis, and type of anesthesia. The medical charts were researched for: pathology report of the tumor, lymph node involvement, primary tumor size, staging and performance of neoadjuvant therapies. We excluded operations for the removal of benign breast tumors. The temporal variation was analyzed using Poisson regression, considering the annual percentage change (APC).

RESULTS

403 operations were performed for breast cancer during the study period, with an average of 50.38 operations per year. The most common histological type was invasive ductal carcinoma (72.6%). The mean age of patients was 52 years, and 29% had disease in stages III and IV. The temporal trend revealed a significant increase in tumor size (p <0.01), the clinical stages III and IV (p = 0.01) and the use of neoadjuvant chemotherapy (p = 0.02). There was increase in mastectomies (APC = 9 cases/year, p = .04). There was no increase in cases of breast conservation treatments or of mastectomies with immediate reconstruction.

CONCLUSION

In recent years, the HC-UFG has had an increased number of mastectomies as a result of increased incidence of locoregionally advanced breast cancer.

Histological profile and age at diagnosis of breast and ovarian tumors: A register-based study in Espirito Santo, Brazil

Breast and ovarian cancers are important public health problems in Brazil. However, in various locations in the Brazilian territory these types of cancer remain poorly characterized. Therefore, this study aimed to compare data collected from the Pathology Services of two Oncology Reference Hospitals in Espirito Santo state (Brazil) with the data in previous Brazilian studies. Histological type frequency and age at diagnosis of breast and ovarian tumors between 2001-2004 and 2009-2010 were analyzed. Tumor size, histological grade, lymph node status, hormone receptor status [estrogen (ER) and progesterone receptors (PR)] as well as HER2 and Ki-67 marker status were obtained for the cases of infiltrating ductal carcinomas of the breast during the period 2009-2010. Categorical variables were described by their absolute and/or relative frequencies, while quantitative variables were expressed as the mean ± standard deviation and median, using 95% confidence intervals. Chi-square tests were performed to examine whether or not the studied variables differed by age at the time of diagnosis. Malignant breast tumors (1,758) and 119 malignant ovarian tumors were examined. Mean ages for malignant breast and ovarian tumors were 53.59 and 52.98 years, respectively. An increased tumor frequency in the age group of ≤35 years was observed for other malignant tumors of the breast during the period of 2009-2010, compared to 2001-2004. When considering only infiltrating ductal carcinomas with immunohistochemistry records available, there were 82.1% (133 cases) of ER⁺/PR⁺ tumors, 1.9% (3 cases) of ER^-/PR^-/HER2 3⁺ and 16.04% (26 cases) of ER^-/PR^-/HER2^- tumors. The findings of this study demonstrated detailed information concerning breast and ovarian tumor behavior in the Espirito Santo state (Brazil), allowing for a precise comparison with other populations (Brazilian or international), which may be helpful in the planning of prevention and treatment strategies.

Breast cancer in young women in Latin America: an unmet, growing burden

Breast cancer (BC) is the leading cause of malignancy-related deaths among women aged ≤45 years. There are unexplored and uncertain issues for BC in this particular group in Latin America. The aim of this study is to evaluate BC incidence and mortality among young women and related clinicopathological and survivorship aspects in this region.

MATERIALS AND METHODS

Data were obtained from Globocan 2008 and the International Agency for Research on Cancer's Cancer Incidence in Five Continents series plus databases. We requested collaboration from the 12 different national cancer institutes in Latin America through SLACOM, the Latin American and Caribbean Society of Medical Oncology, and conducted a systematic literature review to obtain local data regarding the prevalence of BC among young women and their characteristics, outcomes, and survivorship-related issues.

RESULTS

BC incidence and mortality proportions for Latin American women aged <44 years were higher when compared with those of developed countries (20% vs. 12% and 14% vs. 7%, respectively). We found only a few Latin American series addressing this topic, and prevalence varied between 8% and 14%. Stage II and III disease, high histological grade, and triple-negative and HER2 BC were features frequently observed among young Latin American BC patients.

CONCLUSION

The rising incidence and mortality of BC in young Latin American women is a call to action in the region. It is necessary to monitor the epidemiological and clinical data through reliable cancer registries and to consider the implementation of protocols for education of patients and health professionals. This unmet, growing burden must be considered as a top priority of the national programs in the fight against BC, and models of specialized units should be implemented for this particular group of patients to provide better care for this emergent challenge.

Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS)

Objective To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010. Materials and Methods The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS® category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance. Results Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity. Conclusion The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.

A review of breast cancer care and outcomes in Latin America

This review presents an overview of breast cancer care, burden, and outcomes in Latin America, as well as the challenges and opportunities for improvement. Information was gleaned through a review of the literature, public databases, and conference presentations, in addition to a survey of clinical experts and patient organizations from the region. Breast cancer annual incidence (114,900 cases) and mortality (37,000 deaths) are the highest of all women's cancers in Latin America, and they are increasing. Twice as many breast cancer deaths are expected by 2030. In Peru, Mexico, Colombia, and Brazil, diagnosis and death at younger ages deprives society of numerous productive years, as does high disease occurrence in Argentina and Uruguay. Approximately 30%-40% of diagnoses are metastatic disease. High mortality-to-incidence ratios (MIRs) in Latin America indicate poor survival, partly because of the late stage at diagnosis and poorer access to treatment. Between 2002 and 2008, MIRs decreased in all countries, albeit unevenly. Costa Rica's change in MIR outpaced incidence growth, indicating impressive progress in breast cancer survival. The situation is similar, although to a lesser extent, in Colombia and Ecuador. The marginal drops of MIRs in Brazil and Mexico mainly reflect incidence growth rather than progress in outcomes. Panama's MIR is still high. Epidemiological data are scattered and of varying quality in Latin America. However, one could ascertain that the burden of breast cancer in the region is considerable and growing due to demographic changes, particularly the aging population, and socioeconomic development. Early diagnosis and population-wide access to evidence-based treatment remain unresolved problems, despite progress achieved by some countries.

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.

Descriptive study of breast cancer cases in Goiânia between 1989 and 2003

OBJECTIVE

To describe cases of breast cancer in women living in Goiânia from 1989-2003.

METHODS

We conducted a retrospective, descriptive stud, which included all cases of breast cancer occurring in residents of Goiânia, identified by the Population-Based Cancer Registry of Goiânia (RCBPGO) in the period from 1989 to 2003. The variables were: age, method of diagnosis, topographic location, morphology and extent of breast cancer. We used frequencies and percentage rates, and Poisson regression to determine the annual percentage change (APC).

RESULTS

We identified 3204 cases of breast cancer. The most frequent topographic location was the superior-lateral quadrant (53.7%). Infiltrating ductal carcinoma (IDC) was the most frequent, with 2582 cases (80.6%), followed by infiltrating lobular carcinoma (ILC), with 155 cases (4.8%). There was a significant increase of both the IDC and the ILC, with APCs of 11.0% and 15.4%, respectively. The ratio between IDC and ILC was not influenced by age (p = 0.98). As for tumor extent at diagnosis, 45.6% were located in the breast, and the APC was 16.1% (CI = 12.4 to 20.0, p <0.001). There was a trend of APC reduction of metastatic cases (-3.8, CI = -8.6 to 1.2, p = 0.12).

CONCLUSION

The topographical location and histological type of breast cancer in the city of Goiania followed the pattern of other countries. The main morphological types were not influenced by age. There was a large increase in initial cases.