Breast Cancer Mortality in Young Women in Brazil

Spatial and temporal analysis of breast cancer mortality in a state in northeastern Brazil

Breast cancer (BC) is the most common neoplasm, and its global burden has become one of the most important factors jeopardizing the health of the world population, especially women. The aim of this study was to analyze mortality trends and the spatial distribution of BC in women in the capital and state of Sergipe, aiming to contribute to the implementation and improvement of strategies for the prevention and health promotion of women with BC. Trends were calculated using the Joinpoint Regression Program 5.0.2. Spatial analyses were performed using the empirical Bayesian model, thematic maps were created using QGIS 3.10.7 and Moran's I indices were calculated using TerraView 4.2.2. Between 1996 and 2022, 1384 and 3128 BC deaths were recorded in the capital and state of Sergipe, respectively. The mortality trend increased in the age groups of 45-75+ for the state of Sergipe, while in the capital, we observed stability in all age groups. The highest AAPC was 4.6213, with a 95 % confidence interval (2.16; 7.14). Univariate global Moran's I analysis indicated spatial autocorrelation during the study period. A direct relationship was found between mortality rates and the more economically developed regions.

[Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019]

The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.

Mortality from Breast Cancer in Women under 50 Years of Age in Colombia

OBJECTIVE

 To calculate and analyze the mortality rates from breast cancer in women under 50 years of age in Colombia and to compare them with those of other countries in the region.

METHODS

 Based on data from the registry of deaths in 2018 and the results of the National Population and Housing Census of Colombia for the same year, specific mortality rates in women with breast cancer, specific mortality according to age group, standardized by age, proportional mortality, potential years of life lost, and years of life expectancy lost in women under 50 years of age who died from breast cancer were calculated. The mortality rate of regional countries was consulted on the Global Cancer Observatory webpage.

RESULTS

 In the group from 20 to 49 years, the specific mortality rate was higher in the age range from 45 to 49 years, with a rate of 23.42 × 100,000, a value that was above the specific mortality rate due to breast cancer in women in Colombia, 15.17 × 100.000. In the age range of 45 to 49 years, the potential years of life lost were 42.16. Of the 0.275 years of life expectancy lost by the population due to this neoplasia, women under 50 years of age represented 0.091 (33%). Colombia is the fifth in the rank of mortality in Latin American countries in this age group.

CONCLUSION

 Breast cancer in patients from 30 to 59 years is the number one cause for the decrease in life expectancy of women in Colombia. Women under 50 years of age represent one third of this decrease. This neoplasm is also the leading cause of mortality in women younger than 50 years in South America.

Effects of the COVID-19 pandemic on delays in diagnosis-to-treatment initiation for breast cancer in Brazil: a nationwide study

Background

Short period from diagnosis to breast cancer (BC) treatment initiation remains challenging for the public health system in Brazil, which may have been further affected by the coronavirus disease-2019 (COVID-19) pandemic. This study assessed BC diagnosis-to-treatment intervals (DTi) in Brazil and the possible effects of the COVID-19 outbreak on delays.

Methods

The Painel de Monitoramento de Tratamento Oncológico database was queried to obtain the number of Brazilian patients with a BC confirmed diagnosis and initiating cancer treatment in the pre-COVID-19 (2013-2019) and during the COVID-19 (2020-2021) periods, adopting a 60-day limit as timely treatment. A p-value of <0.05 was considered significant.

Results

A total of 315,951 cases were included (females: 99.3% and males: 0.7%), of which 251,667 and 64,284 records were computed before and during the COVID-19 years, respectively. Most patients failed to perform the first cancer treatment within 60 days (>60: 51.8%). We observed an upward trend in the number of BC treatments provided in the pre-COVID-19 years (r2 = 0.9575; p < 0.05), but the volume of treatments exhibited an average reduction of 24.6% yearly during the COVID-19 pandemic. The average DTi in days was 122.4, 122.5 and 122.3 in the total period studied, before and during the COVID-19 outbreak, respectively. The arrival of COVID-19 in Brazil increased the chances of treatment delay (OR = 1.043; p < 0.05) and inverted the proportion of early/advanced stages at BC diagnosis (55.8%/44.2%-48.4%/51.6%).

Conclusion

COVID-19 has imposed changes in BC care in Brazil, reducing the number of treatments provided by the Brazilian public health system, increasing the chances of delayed treatment initiation despite no differences in DTi averages being identified, and raising the proportion of advanced-stage diagnoses.

Clinical features and prognostic factors of breast cancer in young women: a retrospective single-center study

PURPOSE

This research aims to characterize the differences in clinical features and prognostic factors between younger and older breast cancer (BC) patients in China.

METHODS

All patients who were recently diagnosed with BC between January 1, 2015 and December 31, 2016 at Shanxi Province Cancer Hospital were recruited. We collected the epidemiological and clinical data as well as the follow-up information.

RESULTS

Out of the 1968 BC patients who met the criteria for analysis, 227 (11.53%) were under 40 years of age with a median age of 34 years at diagnosis. All patients were classified into the age < 40, age 40-59, and age ≥ 60 groups. There were significant differences in the histology, tumor size, T stage, grade, and human epidermal growth factor receptor-2 (HER-2) levels among the three groups (all P < 0.05). The 5-year overall survival (OS) rates were 86.34%, 89.58%, and 84.84% for the age < 40, age 40-59, and age ≥ 60 groups, respectively. The TNM stage was the only predictor of clinical outcome in all BC patients. The prognostic value of intrinsic subtypes for OS was different among the three groups.

CONCLUSION

Our study helped identify an age-related prognostic indicator of adverse events in BC patients and showed that young women with BC exhibited more aggressive clinical and pathological features. Our findings may facilitate clinical management and therapeutic interventions in young BC patients, especially in young women with a history of exposure to risk factors and age < 40 years.

First use of antineoplastic agents in women with breast cancer in the state of Rio de Janeiro, Brazil

Context: Breast cancer is the most common cancer, except for non-melanoma skin cancer, among women in Brazil and worldwide. Breast cancer treatment involves surgery, radiotherapy and chemotherapy, which is used in 70% of patients. This study analyzes the utilization of antineoplastic agents among women undergoing their first round of chemotherapy in Brazil's public health system (SUS) in the state of Rio de Janeiro. Methods: Data from the SUS Outpatient Information System's authorizations for high-complexity outpatient procedures (APACs) billed between January 2013 and December 2019 were extracted, and three datasets were created: all type 1 and type 2 APACs (including all chemotherapy procedures performed); all type 1 APACs; and first type 1 APACs (containing data only for the first round of breast cancer chemotherapy). Names of antineoplastic agents were standardized to enable the subsequent classification of therapy regimens, mitigating limitations related to data quality. Absolute and relative frequencies were used to describe sociodemographic, clinical and treatment characteristics, therapy regimen and supportive drugs. Results: We analyzed 23,232 records of women undergoing their first round of chemotherapy. There was a progressive increase in the number of procedures over time. Women were predominantly white, lived in the capital and close to the treatment center. Most had stage 3 cancer at diagnosis (50.51%) and a significant proportion had regional lymph node invasion (37.9%). The most commonly used chemotherapy regimens were TAC (docetaxel, doxorubicine, cyclophosphamide) (21.05%) and and cyclophosphamide (17.71%), followed by tamoxifen (15.65%) and anastrozole (12.94%). Supportive drugs were prescribed to 386 women and zoledronic acid was predominant (59.58%). Conclusion: The findings point to important bottlenecks and possible inequities in access to treatment and medicine utilization for breast cancer patients in Brazil. Efforts to improve breast cancer treatment and prevention should not only focus on interventions at the individual level but address the disease as a public health problem. The study focused on women undergoing their first round of treatment, providing valuable insight into patient and treatment characteristics to inform policy decisions.

Population-based temporal trends and ethnic disparity in breast cancer mortality in South Africa (1999-2018): Joinpoint and age-period-cohort regression analyses

Globally, breast cancer is the leading cause of cancer deaths, accounting for 15.5% of female cancer deaths in 2020. Breast cancer is also the leading cause of female cancers in South Africa. The rapid epidemiological transition in South Africa may have an impact on the trends in breast cancer mortality in the country. We therefore evaluated the trends in the breast cancer mortality in SA over 20 years (1999-2020).

Methods

Joinpoint regression analyses of the trends in crude and age-standardized mortality rates (ASMR) of breast cancer among South African women were conducted from 1999 to 2018 using mortality data from Statistics South Africa. Age-period-cohort regression analysis was then conducted to evaluate the independent effect of age, period, and cohort on breast cancer mortality, and analysis was stratified by ethnicity.

Results

The mortality rate of breast cancer (from 9.82 to 13.27 per 100,000 women) increased at around 1.4% per annum (Average Annual Percent Change (AAPC): 1.4%, 95% CI:0.8-2.0, P-value< 0.001). Young women aged 30-49 years (1.1%-1.8%, P-value< 0.001) had increased breast cancer mortality. The risk of breast cancer mortality increased among successive birth cohorts from 1924 to 1928 but decreased among recent cohorts born from 1989 to 1993. In 2018, the breast cancer mortality rate among Blacks (9.49/100,000 women) was around half of the rates among the non-Blacks. (Coloreds: 18.11 per 100,000 women; Whites: 17.77/100,000 women; Indian/Asian: 13.24 per 100,000 women).

Conclusions

Contrary to the trends in high- and middle-income countries, breast cancer mortality increased in South Africa especially among young women. Breast cancer prevention programs should be intensified and should also target young women. The marked disparity in ethnic burden of breast cancer should be considered during planning and implementation of interventions.

Cytotoxic Cyclotides from Anchietea pyrifolia, a South American Plant Species

Cyclotides are mini-proteins with potent bioactivities and outstanding potential for agricultural and pharmaceutical applications. More than 450 different plant cyclotides have been isolated from six angiosperm families. In Brazil, studies involving this class of natural products are still scarce, despite its rich floristic diversity. Herein were investigated the cyclotides from Anchietea pyrifolia roots, a South American medicinal plant from the family Violaceae. Fourteen putative cyclotides were annotated by LC-MS. Among these, three new bracelet cyclotides, anpy A-C, and the known cycloviolacins O4 (cyO4) and O17 (cyO17) were sequenced through a combination of chemical and enzymatic reactions followed by MALDI-MS/MS analysis. Their cytotoxic activity was evaluated by a cytotoxicity assay against three human cancer cell lines (colorectal carcinoma cells: HCT 116 and HCT 116 TP53^-/- and breast adenocarcinoma, MCF 7). For all assays, the IC₅₀ values of isolated compounds ranged between 0.8 and 7.3 μM. CyO17 was the most potent cyclotide for the colorectal cancer cell lines (IC₅₀, 0.8 and 1.2 μM). Furthermore, the hemolytic activity of anpy A and B, cyO4, and cyO17 was assessed, and the cycloviolacins were the least hemolytic (HD₅₀ > 156 μM). This work sheds light on the cytotoxic effects of the anpy cyclotides against cancer cells. Moreover, this study expands the number of cyclotides obtained to date from Brazilian plant biodiversity and adds one more genus containing these molecules to the list of the Violaceae family.

Prognostic Factors and Models for Elderly (≥70 Years Old) Primary Operable Triple-Negative Breast Cancer: Analysis From the National Cancer Database

BACKGROUND

Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer. In the elderly (≥70 years old) primary operable (T_1-3N_0-1M₀) TNBC, individualized treatment modalities for this population are pivotal and important, but limited studies are explored.

METHODS

The clinicopathological features of elderly primary operable TNBC patients were retrospectively selected from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015. Kaplan-Meier curves were used to show the survival patterns in the different subgroups. Multivariate Cox analysis was used to identify independent risk factors in the 3-, 5-, and 7- year overall survival (OS) and cancer-specific survival (CSS) in this subpopulation. The predictive model was further developed and validated for clinical use.

RESULT

Between 2010 and 2015 years, a total of 4,761 elderly primary operable TNBC patients were enrolled for the study, with a mean age of 76 years and a median follow-up of 56 months. The multivariate Cox analysis showed that age (increased per year: hazard ratio (HR) = 1.05), race (Asian/Pacific Islander and American Indian/Alaska Native, HR = 0.73), differentiation grade (grade II: HR = 2.01; grade III/IV: HR = 2.67), larger tumor size (T_1c: HR = 1.83; T₂: HR = 2.78; T₃: HR = 4.93), positive N stage (N_1mi: HR = 1.60; N₁: HR = 1.54), receiving radiation therapy (HR = 0.66), and receiving adjuvant chemotherapy (HR = 0.61) were the independent prognostic factors for OS, and a similar prognostic pattern was also determined in CSS. Besides, two nomograms for predicting the 3-, 5-, and 7-year OS and CSS in this population were developed with a favorable concordance index of 0.716 and 0.746, respectively.

CONCLUSION

The results highlight that both radiation and adjuvant chemotherapy are significantly associated with favorable long-term OS and CSS probability in elderly primary operable TNBC patients. Based on the determined independent prognostic factors, the novel nomograms could assist the oncologists to make individualized clinical decisions for the subpopulation at different risks.

Risk Factors, Prognostic Factors, and Nomogram for Distant Metastasis in Breast Cancer Patients Without Lymph Node Metastasis

Background

Lymph node negative (N0) breast cancer can be found coexisting with distant metastasis (DM), which might consequently make clinicians underestimate the risk of relapse and insufficient treatment for this subpopulation.

Methods

The clinicopathological characteristics of N0 breast cancer patients from the Surveillance, Epidemiology, and End Results (SEER) database between January 2010 and December 2015 were retrospectively reviewed. Multivariate logistic and Cox analyses were used to identify independent risk factors in promoting DM and the 1-, 3-, and 5- year cancer-specific survival (CSS) in this subpopulation.

Result

Seven factors including age (<40 years), tumor size (>10 mm), race (Black), location (central), grade (poor differentiation), histology (invasive lobular carcinoma), and subtype (luminal B and Her-2 enriched) were associated with DM, and the area under curve (AUC) was 0.776 (95% CI: 0.763-0.790). Moreover, T1-3N0M1 patients with age >60 years at diagnosis, Black race, triple-negative breast cancer subtype, no surgery performed, and multiple DMs presented a worse 1-, 3-, and 5-year CSS. The areas under the ROC for 1-, 3-, and 5- year CSS in the training cohort were 0.772, 0.741, and 0.762, respectively, and 0.725, 0.695, and 0.699 in the validation cohort.

Conclusion

The clinicopathological characteristics associated with the risk of DM and the prognosis of female breast cancer patients without lymph node metastasis but with DM are determined. A novel nomogram for predicting 1-, 3-, 5- year CSS in T1-3N0M1 patients is also well established and validated, which could help clinicians better stratify patients who are at a high-risk level for receiving relatively aggressive management.

Cancer-Specific Survival Outcome in Early-Stage Young Breast Cancer: Evidence From the SEER Database Analysis

BACKGROUND

Young women with breast cancer are determined to present poorer survival compare with elderly patients. Therefore, identifying the clinical prognostic factors in young women with early-stage (T_1-2N_0-1M₀) breast cancer is pivotal for surgeons to make better postoperative management.

METHODS

The clinicopathological characteristics of female patients with early-stage breast cancer from the Surveillance, Epidemiology, and End Results program between Jan 2010 and Dec 2015 were retrospectively reviewed and analyzed. Univariate and multivariate Cox regression analyses were used to determine the potential risk factors of cancer-specific survival in young women with early-stage breast cancer. The nomogram was constructed and further evaluated by an internal validation cohort. The Kaplan-Meier survival curves were used to estimate cancer-specific survival probability and the cumulative incidence.

RESULTS

Six variables including race, tumor location, grade, regional lymph node status, tumor subtype, and size were identified to be significantly associated with the prognosis of young women with early-stage breast cancer during the postoperative follow-up. A nomogram for predicting the 3-, 5- year cancer-specific survival probability in this subpopulation group was established with a favorable concordance index of 0.783, supported by an internal validation cohort with the AUC of 0.722 and 0.696 in 3-, 5- year cancer-specific survival probability, respectively.

CONCLUSIONS

The first predictive nomogram containing favorable discrimination is successfully established and validated for predicting the 3-, 5- year cancer-specific survival probability in young women with early-stage breast cancer during the postoperative follow-up. This model would help clinicians to make accurate treatment decisions in different clinical risk population.