Estimativa 2018: Incidência de Câncer no Brasil

Therapeutic Potential of Chlorogenic Acid in Chemoresistance and Chemoprotection in Cancer Treatment

Chemotherapeutic drugs are indispensable in cancer treatment, but their effectiveness is often lessened because of non-selective toxicity to healthy tissues, which triggers inflammatory pathways that are harmful to vital organs. In addition, tumors' resistance to drugs causes failures in treatment. Chlorogenic acid (5-caffeoylquinic acid, CGA), found in plants and vegetables, is promising in anticancer mechanisms. In vitro and animal studies have indicated that CGA can overcome resistance to conventional chemotherapeutics and alleviate chemotherapy-induced toxicity by scavenging free radicals effectively. This review is a summary of current information about CGA, including its natural sources, biosynthesis, metabolism, toxicology, role in combatting chemoresistance, and protective effects against chemotherapy-induced toxicity. It also emphasizes the potential of CGA as a pharmacological adjuvant in cancer treatment with drugs such as 5-fluorouracil, cisplatin, oxaliplatin, doxorubicin, regorafenib, and radiotherapy. By analyzing more than 140 papers from PubMed, Google Scholar, and SciFinder, we hope to find the therapeutic potential of CGA in improving cancer therapy.

Lung cancer screening in Brazil: recommendations from the Brazilian Society of Thoracic Surgery, Brazilian Thoracic Association, and Brazilian College of Radiology and Diagnostic Imaging

Although lung cancer (LC) is one of the most common and lethal tumors, only 15% of patients are diagnosed at an early stage. Smoking is still responsible for more than 85% of cases. Lung cancer screening (LCS) with low-dose CT (LDCT) reduces LC-related mortality by 20%, and that reduction reaches 38% when LCS by LDCT is combined with smoking cessation. In the last decade, a number of countries have adopted population-based LCS as a public health recommendation. Albeit still incipient, discussion on this topic in Brazil is becoming increasingly broad and necessary. With the aim of increasing knowledge and stimulating debate on LCS, the Brazilian Society of Thoracic Surgery, the Brazilian Thoracic Association, and the Brazilian College of Radiology and Diagnostic Imaging convened a panel of experts to prepare recommendations for LCS in Brazil. The recommendations presented here were based on a narrative review of the literature, with an emphasis on large population-based studies, systematic reviews, and the recommendations of international guidelines, and were developed after extensive discussion by the panel of experts. The following topics were reviewed: reasons for screening; general considerations about smoking; epidemiology of LC; eligibility criteria; incidental findings; granulomatous lesions; probabilistic models; minimum requirements for LDCT; volumetric acquisition; risks of screening; minimum structure and role of the multidisciplinary team; practice according to the Lung CT Screening Reporting and Data System; costs versus benefits of screening; and future perspectives for LCS.

Antiproliferative Cancer Cell and Fungicidal Effects of Yellow and Red Araçá (Psidium cattleianum Sabine) Fruit Extract

Araçá is a native Brazil fruit, and has two morphological types, yellow and red; however, it is still little consumed by the population. Although there are few studies on the araçá fruit, some phytochemical propriety benefits have been described for this plant, such as antioxidant effects. To explore the benefits of araçá fruit, the physicochemical characteristics and in vitro toxicological effects of red and yellow araçá fruit were evaluated. In this work, the toxicity of araçá extracts in NIH/3T3 cell lines, the antiproliferative effects in cancer cell lines (C6, HT-29, and DU149), and the overall antifungal effects were evaluated. The irritant potential of araçá extracts was assessed by the HET-CAM test. The results demonstrated that the fruits are rich in fiber content and showed high phenols content. In addition, the araçá extracts had no present toxicity effects in cell lines; however, the red araçá extracts showed antiproliferative effects in HT-29 cancer cells at 50 mg/mL. The antifungal effects of araçá extract were promising in 23 isolates of Candida spp., and both araçá extracts showed no irritant effects. Therefore, this study demonstrated that red and yellow araçá fruit extract has promising biological and pharmacological effects that should be further explored.

Enhancing Skin Cancer Detection and Classification in Dermoscopic Images through Concatenated MobileNetV2 and Xception Models

One of the most promising research initiatives in the healthcare field is focused on the rising incidence of skin cancer worldwide and improving early discovery methods for the disease. The most significant factor in the fatalities caused by skin cancer is the late identification of the disease. The likelihood of human survival may be significantly improved by performing an early diagnosis followed by appropriate therapy. It is not a simple process to extract the elements from the photographs of the tumors that may be used for the prospective identification of skin cancer. Several deep learning models are widely used to extract efficient features for a skin cancer diagnosis; nevertheless, the literature demonstrates that there is still room for additional improvements in various performance metrics. This study proposes a hybrid deep convolutional neural network architecture for identifying skin cancer by adding two main heuristics. These include Xception and MobileNetV2 models. Data augmentation was introduced to balance the dataset, and the transfer learning technique was utilized to resolve the challenges of the absence of labeled datasets. It has been detected that the suggested method of employing Xception in conjunction with MobileNetV2 attains the most excellent performance, particularly concerning the dataset that was evaluated: specifically, it produced 97.56% accuracy, 97.00% area under the curve, 100% sensitivity, 93.33% precision, 96.55% F1 score, and 0.0370 false favorable rates. This research has implications for clinical practice and public health, offering a valuable tool for dermatologists and healthcare professionals in their fight against skin cancer.

Exploring regional disparities in lung cancer mortality in a Brazilian state: A cross-sectional ecological study

BACKGROUND

Lung cancer (LC) is one of the main causes of mortality in Brazil; geographic, cultural, socioeconomic and health access factors can affect the development of the disease. We explored the geospatial distribution of LC mortality, and associated factors, between 2015 and 2019, in Parana state, Brazil.

METHODS AND FINDINGS

We obtained mortality (from the Brazilian Health Informatics Department) and population rates (from the Brazilian Institute of Geography and Statistics [IBGE]) in people over 40 years old, accessibility of oncology centers by municipality, disease diagnosis rate (from Brazilian Ministry of Health), the tobacco production rate (IBGE) and Parana Municipal Performance Index (IPDM) (from Parana Institute for Economic and Social Development). Global Moran's Index and Local Indicators of Spatial Association were performed to evaluate the spatial distribution of LC mortality in Parana state. Ordinary Least Squares Regression and Geographically Weighted Regression were used to verify spatial association between LC mortality and socioeconomic indicators and health service coverage. A strong spatial autocorrelation of LC mortality was observed, with the detection of a large cluster of high LC mortality in the South of Parana state. Spatial regression analysis showed that all independent variables analyzed were directly related to LC mortality by municipality in Paraná.

CONCLUSIONS

There is a disparity in the LC mortality in Parana state, and inequality of socioeconomic and accessibility to health care services could be associated with it. Our findings may help health managers to intensify actions in regions with vulnerability in the detection and treatment of LC.

A Recent Advancement in Nanotechnology Approaches for the Treatment of Cervical Cancer

BACKGROUND

Cervical cancer is one of the leading causes of female death, with a mortality rate of over 200,000 per year in developing countries. Despite a decrease in cervical cancer occurrences in developed countries over the last decade, the frequency of the disease in developing nations continues to rise at an alarming rate, particularly when it is linked to the human papillomavirus (HPV). With just a few highly invasive conventional therapies available, there is a clear need for novel treatment options such as nanotechnology-based chemotherapeutic drug delivery.

METHODS

Traditional anticancer therapy is limited by poor drug potency, non-specificity, unwanted side effects, and the development of multiple drug resistance (MDR), leading to a decrease in long-term anticancer therapeutic efficacy. An ideal cancer therapy requires a personalized and specialized medication delivery method capable of eradicating even the last cancer cell responsible for disease recurrence.

RESULTS

Nanotechnology provides effective drug delivery mechanisms, allowing it to serve both therapeutic and diagnostic purposes. Nanotechnology-based formulations are widely used to accurately target the target organ, maintain drug load bioactivity, preferentially accumulate the drug at the target location, and reduce cytotoxicity.

CONCLUSION

The key benefits of this drug delivery are that it improves pharmacological activity, solubility, and bioavailability and reduces toxicity in the target tissue by targeting ligands, allowing for new innovative treatment methods in an area that is desperately required. The goal of this review is to highlight possible research on nanotechnologybased delivery systems for cancer detection and treatment.

Overall survival analyses of female malignancies in Southern Brazil during 2008-2017: A closer look at breast, cervical and ovarian cancer

Background

The aim of this study was to report the overall survival and baseline factors associated with OS for breast, cervical and ovarian cancer in Florianópolis, Southern Brazil, a region with quality-of-life indicators comparable to high-income countries.

Methods

Cohort study was performed from probabilistic record linkage of the Mortality Information System and the Population-based cancer registry of Florianópolis. It was included breasts, cervical and ovarian cancer diagnosis during the period of 2008-2012 with a follow up of 60 months. Cox regression and Kaplan-Meier method were used for associations with overall survival and risk factors.

Findings

1857 cases of the three malignancies were included in the analysis. We identified 202 deaths in breast cancer subjects, 53 for cervical cancer and 51 for ovarian cancer. Metastatic disease at diagnosis was present in 31%, 9.6%, and 55% of the cases, respectively. Overall survival was statistically correlated with age, educational level and stage for breast cancer; age and stage for cervical cancer; age and stage for ovarian cancer.

Interpretation

Metastatic disease and age are the main prognostic factors for the malignancies studied, as they were associated with both overall survival and risk of death. Better screening and preventive tests for early diagnosis are needed.

Funding

Support of Research and Innovation in the State of Santa Catarina, Research Program for the Unified Health System (FAPESC/MS-DECIT/CNPQ/SES-SC-PPSUS); the Brazilian National Research Council (CNPq); and the Coordination for the Improvement of Higher Education Personnel (CAPES).

Five-year survival rate and prognostic factors in women with breast cancer treated at a reference hospital in the Brazilian Amazon

Breast cancer is the most prevalent malignant neoplasm and the leading cause cancer of death among women globally. In Brazil, survival rates vary according to the region and few studies have been conducted on breast cancer survival in less developed areas, such as the Amazon region. The aim of this study was to analyze the five-year survival rate and prognostic factors in women treated for breast cancer in the city of Belém in northern Brazil. A retrospective hospital-based cohort study was conducted (2007-2013). Sociodemographic, clinical/tumor, and treatment variables were obtained from the records at the Ophir Loyola Hospital. Survival analysis involved the Kaplan-Meier statistical method and Cox regression analysis was performed. The significance level was 5% (p <0.05). A total of 1,430 cases were analyzed. Mean survival time was 51.71 (± 17.22) months, with an estimated overall survival of 79.4%. In the multivariate analysis, referral from the public health care system, advanced clinical stage, lymph node involvement and metastasis were associated with worse prognosis and lower survival rate. Radiotherapy and hormone therapy were associated with increased survival. These findings can contribute to the development of regional strategies for early detection of breast cancer, reducing the incidence and mortality rates and increasing survival time.

Application of a Reflectance Confocal Microscopy Imaging Analysis Score for the Evaluation of Non-Melanogenic Changes in Male Photoaged Skin

The photoaging process is characterized by skin changes due to ultraviolet radiation exposure and is the principal environmental factor affecting skin aging. Reflectance confocal microscopy permits noninvasive skin imaging to understand how the photoaging process may change skin. Since men do not habitually use a sunscreen, the application of skin imaging techniques is important to understand the influence of sunlight on their skin health. The aim of this study was to develop a score based on RCM imaging analyses to evaluate the morphological and structural changes of the photoaged skin according to literature data. The score was applied in order to determine possible correlations between chronological aging and sunscreen use behavior among men. Thus, 40 men aged 18 to 50 years were recruited, images from the frontal region of their skin were obtained and the score was applied. It was observed that habits are more important than age for the skin photoaging process. Men with photoprotection habits showed overall better skin morphological and structural characteristics regardless of age, demonstrating that sun protection behavior is a major key factor in the understanding of photoaging, so that men should be encouraged to start the use of cosmetic products and to perform selfcare.

Molecular docking of DS-3032B, a mouse double minute 2 enzyme antagonist with potential for oncology treatment development

BACKGROUND

It is known that p53 suppression is an important marker of poor prognosis of cancers, especially in solid tumors of the breast, lung, stomach, and esophagus; liposarcomas, glioblastomas, and leukemias. Because p53 has mouse double minute 2 (MDM2) as its primary negative regulator, this molecular docking study seeks to answer the following hypotheses: Is the interaction between DS-3032B and MDM2 stable enough for this drug to be considered as a promising neoplastic inhibitor?

AIM

To analyze, in silico, the chemical bonds between the antagonist DS-3032B and its binding site in MDM2.

METHODS

For molecular docking simulations, the file containing structures of MDM2 (receptor) and the drug DS-3032B (ligand) were selected. The three-dimensional structure of MDM2 was obtained from Protein Data Bank, and the one for DS-3032B was obtained from PubChem database. The location and dimensions of the Grid box was determined using AutoDock Tools software. In this case, the dimensions of the Grid encompassed the entire receptor. The ligand DS-3032B interacts with the MDM2 receptor in a physiological environment with pH 7.4; thus, to simulate more reliably, its interaction was made with the calculation for the prediction of its protonation state using the MarvinSketch^® software. Both ligands, with and without the protonation, were prepared for molecular docking using the AutoDock Tools software. This software detects the torsion points of the drug and calculates the angle of the torsions. Molecular docking simulations were performed using the tools of the AutoDock platform connected to the Vina software. The analyses of the amino acid residues involved in the interactions between the receptor and the ligand as well as the twists of the ligand, atoms involved in the interactions, and type, strength, and length of the interactions were performed using the PyMol software (pymol.org/2) and Discovery Studio from BIOVIA^®.

RESULTS

The global alignment indicated crystal structure 5SWK was more suitable for docking simulations by presenting the p53 binding site. The three-dimensional structure 5SWK for MDM2 was selected from Protein Data Bank and the three-dimensional structure of DS-3032B was selected from PubChem (Compound CID: 73297272; Milademetan). After molecular docking simulations, the most stable conformer was selected for both protonated and non-protonated DS-3032B. The interaction between MDM2 and DS-3032B occurs with high affinity; no significant difference was observed in the affinity energies between the MDM2/pronated DS-3032B (-9.9 kcal/mol) and MDM2/non-protonated DS-3032B conformers (-10.0 kcal/mol). Sixteen amino acid residues of MDM2 are involved in chemical bonds with the protonated DS-3032B; these 16 residues of MDM2 belong to the p53 biding site region and provide high affinity to interaction and stability to drug-protein complex.

CONCLUSION

Molecular docking indicated that DS-3032B antagonist binds to the same region of the p53 binding site in the MDM2 with high affinity and stability, and this suggests therapeutic efficiency.

RESILIENCE OF FAMILY CAREGIVERS OF CHILDREN AND ADOLESCENTS WITH CANCER AND ASSOCIATED FACTORS: MIXED METHOD STUDY

ABSTRACT Objective to analyze the relationship between resilience and associated factors (stress, minor psychiatric disorders and quality of life) of family caregivers with children and adolescents undergoing cancer treatment. Method mixed methods research, with sequential explanatory strategy, carried out with family caregivers of children and adolescents undergoing cancer treatment in a public hospital in the Rio Grande do Sul State, Brazil. Data collection took place from February to September 2018. The quantitative study was cross-sectional in nature, and the qualitative research was descriptive-exploratory. Participants included 62 family caregivers in the quantitative stage and 16 responded to semi-structured interviews. An instrument containing sociodemographic, economic, labor, health and resilience scales (CD-RISC-10-Br), minor psychiatric disorders (MPDs) (SRQ-20), quality of life (QOL) (WHOQO-Bref) and stress and semi-structured interview were applied. Descriptive and inferential statistics were used for quantitative data and content analysis for qualitative data. Results family caregivers had a moderate level of resilience (48.4%); high level of perceived stress (41%); suspicion for MPDs (45%). They presented satisfaction in the physical Qol domains (67.7%); psychological (62.9%); personal relationships (61.3%), and dissatisfaction in the environment domain (75.8%). The interviews reported for health changes that could trigger MPD, stress and changes in quality of life. Conclusion high level of stress; suspicion for MPD and low QoL, with the environment, were evidenced as associated factors for a lower level of resilience of family caregivers. The need to develop actions that strengthen resilience was percieved, as caregivers were essential for the effectiveness of the care plan for children and adolescents undergoing cancer treatment.

Perception of bonding and occupational stress in a multidisciplinary cancer patients health team

Abstract Cancer is the second leading cause of death in Brazil and one of the positive features in the care of cancer patients is the professional-patient bond; however, due to the complexity of the disease, these professionals may develop occupational stress. This study investigated the perception of the bond and occupational stress of professionals who deal with cancer patients. Forty professionals from the surgical clinic and onco-hematology service at a hospital answered a questionnaire about bonding and stress at work. The results showed a greater perception frequency of the therapeutic bond, the same type identified as ideal. The onco-hematology team exhibited higher scores than the surgical clinic team in the perception of the bond and of the ideal therapeutic bond. The average occupational stress level of the participants was 2.08 (moderate), with no difference between the two teams. The power of health work models that use the bond between health professionals and cancer patients as a care technology stands out.

RESILIÊNCIA DE CUIDADORES FAMILIARES DE CRIANÇAS E ADOLESCENTES COM CÂNCER E FATORES ASSOCIADOS: ESTUDO DE MÉTODOS MISTOS

RESUMO Objetivo analisar a relação entre resiliência e fatores associados (estresse, distúrbios psíquicos menores e qualidade de vida) de cuidadores familiares de crianças e adolescentes em tratamento oncológico. Método pesquisa de métodos mistos, com estratégia explanatória sequencial, realizado com cuidadores familiares de crianças e adolescentes em tratamento oncológico em um hospital público do interior do Rio Grande do Sul, Brasil. A coleta de dados ocorreu de fevereiro a setembro de 2018. O estudo quantitativo foi de natureza transversal e a pesquisa qualitativa teve caráter descritivo-exploratório. Participaram 62 cuidadores familiares na etapa quantitativa e 16 responderam as entrevistas semiestruturadas. Aplicaram-se instrumento contendo questões sociodemográficas, econômicas, laborais, de saúde e escalas de resiliência (CD-RISC-10-Br), distúrbios psíquicos menores (DPMs) (SRQ-20), qualidade de vida (QV) (WHOQO-Bref) e estresse e entrevista semiestruturada. Utilizou-se estatística descritiva e inferencial para os dados quantitativos e análise de conteúdo para os qualitativos. Resultados os cuidadores familiares possuíam nível moderado de resiliência (48,4%); alto nível de estresse percebido (41%); suspeição para distúrbios psíquicos menores (45%). Apresentaram satisfação nos domínios de qualidade de vida físico (67,7%); psicológico (62,9%); relações pessoais (61,3%), e insatisfação no domínio meio ambiente (75,8%). As entrevistas reportaram para alterações de saúde que poderiam desencadear distúrbios psíquicos menores, estresse e alterações na qualidade de vida. Conclusão alto nível de estresse; suspeição para distúrbios psíquicos menores e baixa qualidade de vida, com o meio ambiente, evidenciaram-se como fatores associados para um menor nível de resiliência dos cuidadores familiares. Percebeu-se a necessidade de desenvolver ações que fortalecessem a resiliência, pois os cuidadores foram essenciais para a efetividade do plano de cuidado de crianças e adolescentes em tratamento oncológico.

Diagnosis of Advanced Disease in Cases of Colorectal Cancer in a Developing Country

Objectives Colorectal cancer (CRC) is the second leading cause of cancer death in the world, with survival correlated with the extension of the disease at diagnosis. In many low-/middle-income countries, the incidence of CRC is increasing rapidly, while decreasing rates are observed in high-income countries. We evaluated the anatomopathological profile of 390 patients diagnosed with CRC who underwent surgical resection, over a six-year period, in the state of Paraíba, northeastern Brazil.

Results Adenocarcinomas accounted for 98% of the cases of primary colorectal tumors, and 53.8% occurred in female patients. The average age of the sample was 63.5 years, with 81.8% of individuals older than 50 years of age and 6.4% under 40 years of age. The most frequent location was the distal colon; pT3 status was found in 71% of patients, and pT4 status, in 14.4%. Angiolymphatic and lymph-node involvements were found in 48.7% and 46.9% of the cases respectively. Distant metastasis was observed in 9.2% of the patients. Advanced disease was diagnosed in almost half of the patients (48.1%). The women in the sample had poorly-differentiated adenocarcinomas (p = 0.043). Patients under 60 years of age had a higher rate of lymph-node metastasis (p = 0.044). Tumor budding was present in 27.2% of the cases, and it was associated with the female gender, the mucinous histological type, and the depth of invasion (pT3 and pT4).

Conclusions We conclude that the diagnosis of advanced disease in CRC is still a reality, with a high occurrence of aggressive prognostic factors, which results in a worse prognosis.

Use of Stingless Bee Propolis and Geopropolis against Cancer-A Literature Review of Preclinical Studies

Cancer is one of the major maladies affecting humankind and remains one of the leading causes of death worldwide. The investigation of the biological activities of stingless bee products, especially propolis and geopropolis, has revealed promising therapeutic properties, especially in the research on new antineoplastic agents. This literature review of preclinical trials, involving biological assays of antitumor activity and identification of the chemical composition of propolis and geopropolis of stingless bee species, describes the cytotoxicity in tumor lineages (breast, lung, ovarian, liver, mouth, pharynx, larynx, colon, stomach, colorectal, cervix, kidney, prostate, melanoma, human glioblastoma, canine osteosarcoma, erythroleukemia, human chronic myelocytic leukemia, and human promyelocytic leukemia) of propolis and geopropolis of 33 species of stingless bees. The chemical composition of propolis and geopropolis was identified, indicating that these belong to the chemical classes of phenolic acids, flavonoids, coumarins, benzophenones, anthraquinones, alkaloids, terpenes, steroids, saponins, fatty acids, and carbohydrates and are possibly responsible for the cytotoxicity in tumor cells. Apoptosis was one of the main mechanisms of cytotoxicity of extracts and substances isolated from stingless bee products. Although the results found are encouraging, other preclinical studies and clinical trials are essential for the discovery of new anticancer agents.

The Budget Impact of Monoclonal Antibodies Used to Treat Metastatic Colorectal Cancer in Minas Gerais, Brazil

INTRODUCTION

Biological medicines have increased the cost of cancer treatments, which also raises concerns about sustainability. In Brazil, three monoclonal antibodies (mAbs)-bevacizumab, cetuximab, and panitumumab-are indicated for the treatment of metastatic colorectal cancer (mCRC) but not currently funded by the Unified Health System (SUS). However, successful litigation has led to funding in some cases.

OBJECTIVE

Our objective was to evaluate the budgetary impact of including the mAbs bevacizumab, cetuximab, and panitumumab in standard chemotherapy for the treatment of mCRC within the SUS of Minas Gerais (MG), Brazil.

METHOD

A budget impact analysis of incorporating mAbs as first-line treatment of mCRC in MG was explored. The perspective taken was that of the Brazilian SUS, and a 5-year time horizon was applied. Data were collected from lawsuits undertaken between January 2009 and December 2016, and the model was populated with data from national databases and published sources. Costs are expressed in $US.

RESULTS

In total, 351 lawsuits resulted in funding for first-line treatment with mAbs for mCRC. The three alternative scenarios analyzed resulted in cost increases of 348-395% compared with the reference scenario. The use of panitumumab had a budgetary impact of $US103,360,980 compared with the reference scenario over a 5-year time horizon, and bevacizumab and cetuximab had budgetary impacts of $US111,334,890 and 113,772,870, respectively. The use of the anti-epidermal growth factor receptor (EGFR) mAbs (cetuximab and panitumumab) is restricted to the approximately 41% of patients with KRAS mutations, so the best cost alternative for incorporation would be the combination of panitumumab and bevacizumab, with a cost of approximately $US106 million.

CONCLUSION

These results highlight the appreciable costs for incorporating bevacizumab, cetuximab, and panitumumab into the SUS. Appreciable discounts are likely to be necessary before incorporation of these mAbs is approved.

Clinical verification of treatment planning dose calculation in lung SBRT with GATE Monte Carlo simulation code

PURPOSE

This study aims to use GATE/Geant4 simulation code to evaluate the performance of dose calculations with Anisotropic Analytical Algorithm (AAA) in the context of lung SBRT for complex treatments considering images of patients.

METHODS

Four cases of non-small cell lung cancer treated with SBRT were selected for this study. Irradiation plans were created with AAA and recalculated end to end using Monte Carlo (MC) method maintaining field configurations identical to the original plans. Each treatment plan was evaluated in terms of PTV and organs at risk (OARs) using dose-volume histograms (DVH). Dosimetric parameters obtained from DVHs were used to compare AAA and MC.

RESULTS

The comparison between the AAA and MC DVH using gamma analysis with the passing criteria of 3%/3% showed an average passing rate of more than 90% for the PTV structure and 97% for the OARs. Tightening the criteria to 2%/2% showed a reduction in the average passing rate of the PTV to 86%. The agreement between the AAA and MC dose calculations for PTV dosimetric parameters (V₁₀₀; V₉₀; Homogeneity index; maximum, minimum and mean dose; CI_Paddick and D_2cm) was within 18.4%. For OARs, the biggest differences were observed in the spinal cord and the great vessels.

CONCLUSIONS

In general, we did not find significant differences between AAA and MC. The results indicate that AAA could be used in complex SBRT cases that involve a larger number of small treatment fields in the presence of tissue heterogeneities.

Salivary cortisol concentrations in hematogy/oncology nurses on working days and days off

OBJECTIVE

to assess salivary cortisol concentrations in hematology/oncology nurses on working days and days off.

METHODS

a cross-sectional study carried out with 28 nurses from a university hospital. A sociodemographic, employment and health profile questionnaire was applied. For saliva collection, Salivette® tubes were used. Descriptive and analytical analysis was used.

RESULTS

there was no significant difference in cortisol concentrations between working days and days off (p>0.05). The high cortisol concentration was associated with not having children (0.621±0.340; p=0.046), not using medication (0.623±0.133; p=0.017) and birth control pills (0.556 ± 0.228; p=0.047) and intention to leave work (0.951±0.154; p=0.001). A positive correlation was identified between cortisol and absence from work due to health issues (0.72; p=0.05) and weight gain (0.935; p=0.02).

CONCLUSION

in general, cortisol concentration is within the reference parameters, with no significant difference in its secretion on working days and days off.

Polymorphisms of IL-4 and IL-4R are associated to some demographic characteristics of differentiated thyroid cancer patients but are not determinants of risk in the Brazilian population

BACKGROUND

IL-4 is known to present abnormal expression in thyroid tumors and SNPs in the IL-4 and its receptor IL-4R genes are associated to risk and mortality of various types of cancer.

METHODS

In order to evaluate their role in differentiated thyroid cancer (DTC), we investigated genetic frequencies of two IL-4 promoter SNPs (rs2070874 C>T, rs2243250 C>T) and four non-synonymous SNPs of the IL-4R gene (rs1805010 A>G, rs1805012 C>T, rs1805013 C>T, rs1801275 A>G) in 300 DTC patients matched to 300 controls. All patients were managed according to current guidelines and followed-up for a period of 12-252 months (69.20 ± 52.70 months).

RESULTS

Although none of the six investigated SNPs showed association with risk of DTC, rs1805010 was associated with age of diagnosis and the SNPs rs1805012 and rs1801275 were associated to gender. Further, in-silico analysis showed that all these three SNPs were able to cause decreased stability of the protein. We were not able to demonstrate any other association to clinical features of aggressiveness or to patients' prognosis.

CONCLUSIONS

These findings indicate that although genetic variants in IL-4 and IL-4R do not influence the risk or outcome of DTC patients, their influence on the behavior of thyroid tumors deserves further investigation.

Comparison of Automated Breast Ultrasound and Hand-Held Breast Ultrasound in the Screening of Dense Breasts

OBJECTIVE

 To compare hand-held breast ultrasound (HHBUS) and automated breast ultrasound (ABUS) as screening tool for cancer.

METHODS

 A cross-sectional study in patients with mammographically dense breasts was conducted, and both HHBUS and ABUS were performed. Hand-held breast ultrasound was acquired by radiologists and ABUS by mammography technicians and analyzed by breast radiologists. We evaluated the Breast Imaging Reporting and Data System (BI-RADS) classification of the exam and of the lesion, as well as the amount of time required to perform and read each exam. The statistical analysis employed was measures of central tendency and dispersion, frequencies, Student t test, and a univariate logistic regression, through the odds ratio and its respective 95% confidence interval, and with p < 0.05 considered of statistical significance.

RESULTS

 A total of 440 patients were evaluated. Regarding lesions, HHBUS detected 15 (7.7%) BI-RADS 2, 175 (89.3%) BI-RADS 3, and 6 (3%) BI-RADS 4, with 3 being confirmed by biopsy as invasive ductal carcinomas (IDCs), and 3 false-positives. Automated breast ultrasound identified 12 (12.9%) BI-RADS 2, 75 (80.7%) BI-RADS 3, and 6 (6.4%) BI-RADS 4, including 3 lesions detected by HHBUS and confirmed as IDCs, in addition to 1 invasive lobular carcinoma and 2 high-risk lesions not detected by HHBUS. The amount of time required for the radiologist to read the ABUS was statistically inferior compared with the time required to read the HHBUS (p < 0.001). The overall concordance was 80.9%. A total of 219 lesions were detected, from those 70 lesions by both methods, 126 only by HHBUS (84.9% not suspicious by ABUS) and 23 only by ABUS.

CONCLUSION

 Compared with HHBUS, ABUS allowed adequate sonographic study in supplemental screening for breast cancer in heterogeneously dense and extremely dense breasts.

Serum fatty acid synthase levels and n-3 fatty acid intake in patients with breast cancer

PURPOSE

Fatty acid synthase (FASN) is a key enzyme in fatty acid biosynthesis that is usually over-expressed in patients with breast cancer, but its relationship with the patient's dietary habit is not clear. A higher intake of n-3 polyunsaturated fatty acids is related to reduced breast carcinogenesis in vitro and in vivo. The aim of this study was to clinically investigate the association between serum FASN levels and fatty acid intake in women newly diagnosed with breast cancer.

METHODS

In a case-control cross-sectional study, with 18 breast cancer patients and 29 controls, we evaluated nutritional status, dietary intake, and serum FASN levels. Statistical analyses were carried out with parametric and non-parametric tests, according to the sample's normality distribution.

RESULTS

The mean age of breast cancer group (n = 18) and control group (n = 29) was 46.8 ± 9.7 y and 44.4. ± 8.6 y, respectively. Mean serum concentration of FASN in breast cancer group was significantly higher (132.51 ± 95.05 ng/mL) than in control group (36.88 ± 20.87 ng/mL) (p < 0.0001). Among breast cancer group, serum FASN levels of premenopausal women were significantly higher than those of postmenopausal women (p = 0.026). There was no significant difference between the early and late disease stages in regard to serum FASN levels in breast cancer group. Mean nutrient intake was similar and n-3 docosahexaenoic acid intake was low in both groups. We observed no association regarding fatty acid intake and serum FASN levels.

CONCLUSION

These data suggest that dietary n-3 fatty acid has no association with serum FASN levels among newly diagnosed breast cancer patients.

Epidemiological profile of people with intestinal ostomy at a referral center

Objective: to describe the epidemiological and clinical profile of people with intestinal stoma. Methods: documentary research, carried out in a reference center for people with disabilities in northeastern Brazil. Data collection was performed from December 2018 to February 2019, through a review of medical records. Results: there was a predominance of males (56.6%), average of 56.7 years, 41.4% married, 22.0% had incomplete elementary school, 27.9% had an income of 2 to 3 minimum wages, 47.1% were retired and 53.4% lived in the capital. Neoplasia was the main cause of stoma (62.2%) and colostomies corresponded to 84.4%, of which 38.3% were definitive. 60.3% had complications and 54.4% of them corresponded to periestomal dermatitis. Conclusion: people with intestinal colostomy were male, elderly, married, retired, with low schooling and definitive stoma due to neoplasia. Knowing the profile is essential to plan the reception, assist the treatment and rehabilitation of people with intestinal stoma.

Perfil epidemiológico de pessoas com estomias intestinais de um centro de referência

Objetivo: descrever o perfil epidemiológico e clínico de pessoas com estomias intestinais. Método: pesquisa documental realizada em um centro de referência para pessoas com deficiência no Nordeste do Brasil. A coleta de dados foi realizada de dezembro de 2018 a fevereiro de 2019, por meio de revisão de prontuários. Resultados: houve predomínio do sexo masculino (56,6%), média de 56,7 anos, 41,5% casados, 22% tinham ensino fundamental incompleto, 27,9% tinham renda de dois a três salários mínimos, 47,1% eram aposentados e 53,4% residiam na capital. A neoplasia foi a principal causa de confecção da estomia (62,2%) e as colostomias corresponderam a 84,2%, das quais 38,3% eram definitivas. Houve complicações em 60,3% e 54,4% dessas complicações corresponderam à dermatite periestomal. Conclusão: as pessoas com colostomia intestinal eram do sexo masculino, idosas, casadas, aposentadas, com baixa escolaridade e estomia definitiva por neoplasia. Conhecer o perfil é fundamental para planejar o acolhimento, direcionar o tratamento e a reabilitação das pessoas com estomia intestinal.

Attendance for diagnostic colposcopy among high-risk human papillomavirus positive women in a Brazilian feasibility study

OBJECTIVE

To investigate factors associated with colposcopy attendance in HPV-positive women in São Paulo, Brazil.

METHODS

We analyzed data from a prospective cohort of women positive for high-risk HPV (hr-HPV) undergoing cervical cancer screening in primary care services in São Paulo, Brazil. Non-pregnant women attending routine screening between December 2014 and March 2016 were offered an hr-HPV test, and those testing positive and aged 25 years or older were invited for colposcopy. Sociodemographic information was recorded at study enrollment. We compared variables between women who did and did not attend colposcopy within a logistic regression framework.

RESULTS

Of 1537 hr-HPV-positive women, 1235 (80.4%) attended for colposcopy, with a median time from primary test to colposcopy of 132 days. Younger age (P<0.001) and concurrent negative cytology results (P=0.025) were associated with lower attendance. Women registered at units providing both the primary test and colposcopy were more likely to attend than those at units making external referrals (788/862 [91.4%] versus 447/675 [66.2%], P<0.001).

CONCLUSION

Non-attendance for colposcopy may limit the success of future screening programs based on hr-HPV testing in Brazil. Transfer of colposcopy services to primary care is a simple and effective facilitator of attendance.

Comparison between Two Methods to Evaluate Function in Postoperative Breast Cancer Survivors

INTRODUCTION

Treatment for breast cancer can cause adverse effects such as pain and reduced upper limb function which can affect activities of daily living. The Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire is the most used tool for evaluating function in breast cancer survivors. However, some specific aspects have raised discussions about its restricted coverage, which can generate several biases.

OBJECTIVE

To determine if DASH scores differed when assessed before and after task-oriented training (TOT) at 3 and 6 months after breast cancer surgery.

DESIGN

Prospective cohort study.

SETTING

Institutional study of 22 women assessed at 3 and 6 months after breast cancer surgery.

MAIN OUTCOME MEASURES

The DASH questionnaire and TOT assessment. Two correlation tests were performed: Spearman's correlation between the total score of the two DASH scores (pre- and post-TOT) and the Kendall's tau correlation between each of the items.

RESULTS

There was a moderate and excellent correlation between final DASH scores, pre- and post-TOT, at both 3 and 6 months postoperatively. However, when assessed individually, most of the DASH items were poorly correlated. There was also no agreement between the total DASH scores pre- and post-TOT as assessed by Bland-Altman plots.

CONCLUSION

Both the DASH and TOT are considered useful in clinical practice to assess upper limb function, although the use of TOT in some of the DASH items may reduce memory bias and improve skills estimation.

Time trends and age-period-cohort analysis of cervical cancer mortality rate in Brazil

BACKGROUND

Cervical cancer (CC) is a common preventable and curable disease that may lead to death. Our aim was to describe the patterns of time trends in CC mortality rates among women in Brazil from 1980 to 2017, and identify the influence of age, period and birth cohort (APC) stratified by region (North NR, Northeast NER, Southeast SER, South SR, Center-Western region CWR).

METHODS

We performed a time-series analysis using secondary data bases. Crude (MR) and WHO age-standardized CC mortality rates (aMR) were estimated per 100,000 women. We evaluated time trends using permutation joinpoint regression models (JP) and APC models to estimate the effect of APC on MR.

RESULTS

The JP analysis showed a temporal decrease in all regions, except the NR, which had an annual percentage increase of 0.44 (95%CI 0.2 - 0.7). MR in the NR was 2 to 4 times higher than in the other regions. We observed steady increases in MR with age in the NR and NER. A plateau after age 40 was observed in SER, SR, and CWR. The NR and NER MR ratio stabilized around the year 2000. Birth cohort effect showed decreasing MR ratio from 1900 to 1970 for all regions, except the NR, which showed increasing MR rate from older to more recent cohorts.

CONCLUSION

We showed relevant differences in cervical MR by region, which may reflect inequality in access to primary and secondary prevention as well as treatment, particularly in the NR.

Awareness towards an increasing concern during pregnancy: maternal and perinatal outcomes of women with cancer

BACKGROUND

Increased incidence of cancer in women of childbearing age and improvements on treatment for preserving fertility have led to higher frequency of pregnancy during or after cancer treatment.

OBJECTIVE

This study aimed to describe maternal and perinatal outcomes associated with cancer and pregnancy and, as a secondary analysis, to compare outcomes of women with active disease and with remission before pregnancy.

STUDY DESIGN

We performed a retrospective study of women followed up at a referral center owing to a history of cancer or cancer diagnosed during pregnancy. Data on sociodemographic information, obstetrical history, types of neoplasia, treatments offered, antenatal follow-up, and maternal and perinatal outcomes were retrieved from medical chart review. A descriptive analysis was performed and a comparison among women with active and nonactive disease was performed using Student t-test and chi-square test.

RESULTS

A total of 66 women were included in a 5-year period. The most frequent types of cancer were breast (33%), hematologic (21%), brain (11%), cervical (9%), and ovarian (5%) cancers. There were 39 participants (59%) who had active disease and 26 who received oncological treatment during pregnancy, and 23 (34.8%) had a vaginal delivery. There were 4 women who needed intensive care unit admission postpartum. A total of 18 (29.5%) deliveries were at term, most newborns (59%) with adequate weight for gestational age and only 1 had Apgar score lower than 7 in the fifth minute of life. There was 1 stillbirth. The active invasive cancer during pregnancy group showed a higher rate of preterm birth and lower birthweight with significant statistical difference (P=.03 and P<.01, respectively).

CONCLUSION

Breast cancer was the most frequent type of cancer in our cohort. Most deliveries were preterm, with adequate birthweight. Women with active cancer are more likely to have a preterm childbirth and newborns with lower birthweight.

Clinical profile of individuals with bisphosphonate-related osteonecrosis of the jaw: an integrative review

BACKGROUND

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) is still the most prevalent type of osteonecrosis with clinical relevance. In Brazil, bisphosphonate use is high but there is a lack of epidemiological studies on BRONJ.

OBJECTIVE

To determine the clinical profile of BRONJ in a Brazilian population through an integrative review.

DESIGN AND SETTING

Integrative review of BRONJ in a Brazilian population.

METHODS

Cases and clinical research on Brazilians with BRONJ between 2010 and 2019, indexed in PubMed/MEDLINE, Scopus, Web of Science and LILACS were reviewed. Age, sex, type and time of bisphosphonate intake, administration route, related diseases, region of the BRONJ, diagnostic criteria, staging, triggering factor and type of treatment were analyzed.

RESULTS

Fifteen articles on 128 subjects were included. Most patients were women (82.03%); the mean age was 63 years. Intravenous zoledronic acid was mostly used (62.50%), for breast cancer treatment (46.87%). The main localization of BRONJ was the mandible (54.68%), associated mainly with tooth extractions (45.98%). The diagnostic criteria were clinical (100%) and radiographic (89.06%), mostly in stage II (68.08%). The surgical treatments were sequestrectomy (37.50%) and platelet-rich plasma (PRP) (36.71%). Microbial control was done using chlorhexidine (93.75%) and infection control using clindamycin (53.90%).

CONCLUSIONS

BRONJ had higher prevalence in Brazilian women receiving treatment for breast cancer and osteoporosis. The mandible was the region most affected with a moderate stage of BRONJ, particularly when there were histories of tooth extraction and peri-implant surgery. Sequestrectomy with additional drugs and surgical therapy was the treatment most accomplished.

Cytotoxic Effect of Prodigiosin, Natural Red Pigment, Isolated from Serratia marcescens UFPEDA 398

Prodigiosin is a secondary metabolite, with red pigmentation, produced by Serratia marcescens. Red pigment is a natural alkaloid whose chemical structure has three pyrrole rings. Prodigiosin has been described for several biological activities, including antitumor, inducing apotosis in T and B lymphocytes. This work aimed to evaluate the cytotoxic activity of prodigiosin in NCHI-292, HEp-2, MCF-7 and HL-60 tumor cell lines. The red pigment was isolated from Serratia marcescens UFPEDA 398 biomass whose fractions were previously separated by column chromatography, purified, identified and further characterized by GC-MS and compared with the computerized library of m/z values. The pigment corresponded to prodigiosin with maximum absorption at 534 nm, molecular weight 323 and structural formula C20H25N3O. During the prodigiosin purification process a purple absorbance fraction at 272.65 nm was also observed. Significant cytotoxic effects of prodigiosin were evidenced for NCHI-292, Hep-2, MCF-7 and HL-60 tumor cell lines. The isolated purple fraction had no cytotoxic effect (IC50 11.3 µg/mL) when compared to prodigiosin (IC50 3.4 µg/mL) for the tumor cell lines studied. The MCF-7 strain was slightly more pigment resistant (IC50 5.1 µg/mL). Therefore, further studies will be needed to elucidate the antitumor mechanisms of prodigiosin action against tumor strains from flow cytometry tests. However, although these data are preliminary, it was evidenced that prodigiosin showed cytotoxic activity in tumor cell lines suggesting promising antitumor properties. In this sense, future studies on the cytotoxic and genotoxic effects of prodigiosin produced by S. marcecsens UFPEDA 398 are suggested.

Clinical and epidemiological aspects of children and adults with intestinal stoma of the Bahia-Brazil reference center

Objective: To characterize children and adults with intestinal stoma in relation to sociodemographic and clinical aspects of the State Reference Center of Bahia. Method: This is a cross-sectional descriptive research, with a quantitative approach and a convenience sample of 43 patients that met the inclusion criteria. The data were collected through an interview and evaluation of the stoma and skin, around and analyzed by descriptive statistics, with frequency and percentage distribution. Results: There was a predominance of males, aged between 40 and 59 years old, unmarried, with incomplete elementary education, family income of a minimum wage, having colorectal cancer and firearm trauma as responsible for the stoma. It emphasized the occurrence of temporary descending colostomy, use of a drainable device, a single piece, with a cut-off, with a cut greater than the diameter of the stoma, presence of dermatitis. Stomatal hygiene and device switching were performed independently. Conclusion: The results of the study indicated a need to reassess the strategies used in specialized care, with emphasis on educational actions aimed at self-care and greater participation of the user in the program, aiming at their rehabilitation and improvement in quality of life.

Perfil de crianças e adultos com estomia intestinal do centro de referência da Bahia-Brasil

Objetivo: Identificar o perfil de crianças e de adultos com estomia atendidos em um Centro Estadual de Referência do Estado da Bahia. Método: Trata-se de pesquisa descritiva transversal, com abordagem quantitativa, com amostra de conveniência de 43 pacientes que atenderam aos critérios de inclusão. Os dados foram coletados por meio de entrevista e avaliação da estomia e pele ao redor, analisados por estatística descritiva, com distribuição de frequência e percentual. Resultados: Houve predomínio do sexo masculino, idade de 40 a 59 anos, solteiros, com ensino fundamental incompleto, renda familiar de um salário mínimo, tendo o câncer colorretal e trauma por arma de fogo como responsáveis pela estomia. Destacou-se a ocorrência da colostomia descendente temporária, uso de dispositivo drenável, peça única, recortável, com recorte maior que o diâmetro da estomia, presença de dermatite. A higienização da estomia e troca do dispositivo eram realizadas de forma independente pela maioria. Conclusão: Os resultados do estudo indicaram necessidade de reavaliar as estratégias utilizadas na assistência especializada com ênfase nas ações educativas voltadas ao autocuidado e maior participação do usuário no programa, objetivando sua reabilitação e melhoria na qualidade de vida.

Environmental Exposure to Pesticides and Breast Cancer in a Region of Intensive Agribusiness Activity in Brazil: A Case-Control Study

Background: Breast cancer is a serious public health problem and is the second most prevalent cancer type in the world. The purpose of this article is to evaluate the association between pesticide use and breast cancer in a region of intense agribusiness activity in the state of Mato Grosso, Brazil. Methods: A case-control study was conducted on women living in the city of Rondonópolis, in the south of Mato Grosso state. There were 85 cases of women with confirmed breast cancer and 266 controls who were randomly selected from primary health care users. Bivariate and stratified analyses were performed. Multiple logistic regression was then performed, keeping in the final model the factors with a significance level lower than or equal to 0.05 or considered important according to apriori biological criteria. Results: In the final model, living near cropland with pesticides (OR: 2.37; CI: 95% 1.78–3.16) and women aged over 50 years who experienced early menarche (OR: 2.08; CI: 95% 1.06–4.12) had a higher risk of developing breast cancer compared to control subjects. Conclusion: This study highlights the importance of exposure to pesticides as an environmental risk factor for the development of breast cancer among women.