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Vazquez FL, Coracin FL, Arantes KLBF, Ferigatto JL, Nascimento-Júnior AC, Barroso EM, Prata EM, Longatto-Filho A, Buexm LA, Tieghi-Neto V, Mauad EC, Warnakulasuriya S, Gama RR. An oral cancer screening program in Brazil: Analysis of seven years of outcome after its implementation in the suburban cities of São Paulo. Oral Oncol 2024; 154:106826. [PMID: 38733949 DOI: 10.1016/j.oraloncology.2024.106826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 04/22/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024]
Abstract
OBJECTIVE To describe the implementation of an oral cancer screening program at the Barretos Cancer Hospital (BCH) and present the outcome based on data obtained from 2014 to 2020. MATERIALS AND METHODS The residents of the Regional Health District of Barretos (DRS-V) were personally invited by community health agents or nurses, and among 13,973 people, 15,222 oral examinations were carried out over the years in 18 of its municipalities. Oral examinations were performed at the Mobile Dental Unit and at the Prevention Department of the BCH. Inclusion criteria were being 35 years of age or older, having a personal history of tobacco or alcohol consumption, or having a lesion in the oral cavity found by community health agent or self-reported, regardless of age or risk factors. RESULTS AND CONCLUSION The main result of our study was the stages of oral cancer among screen detected cases were smaller compared to cases in the hospital registry, in the state and in Brazil. Oral cancer detection rate per 1,000 oral examinations was 10.7.The early stages of oral cancer found by screening in primary care facilities or using mobile units suggest that, when organized, screening may improve the prognosis of oral cancer.
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Affiliation(s)
- F L Vazquez
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil.
| | - F L Coracin
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - K L B F Arantes
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - J L Ferigatto
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | | | - E M Barroso
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - E M Prata
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - A Longatto-Filho
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil; National Cancer Intitute (INCA), Washington Luís 35, Rio de Janeiro, RJ, Brazil
| | - L A Buexm
- National Cancer Intitute (INCA), Washington Luís 35, Rio de Janeiro, RJ, Brazil
| | - V Tieghi-Neto
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | - E C Mauad
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
| | | | - R R Gama
- Barretos Cancer Hospital, Antenor Duarte Vilela 1331, Barretos, SP, Brazil
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Mauad EC, Gomes UA, Gonçalves MA, Hidalgo GS, Almeida JRW, Boldrini D. Melanoma de Mucosa Oral, Genital e Anorretal. Rev Bras Cancerol 2022. [DOI: 10.32635/2176-9745.rbc.2000v46n2.3415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Entre 1970 e 1997, 411 pacientes com diagnóstico de melanoma foram atendidos no Hospital São Judas Tadeu de Barretos. Destes, 7 (1,7%) eram de mucosa e os respectivos prontuários foram analisados para este trabalho. Quanto à localização, eram anorretal; 2 eram vulvovaginal, e 1 localizava-se no palato; havia seis pacientes do sexo feminino e um masculino variando as idades de 31 a 81 anos (média = 61 anos). Apenas um paciente apresentou tumor localizado (está com quase 5 anos de sobrevida), 4 tinham doença regional (todos faleceram antes de 3 anos após o diagnóstico) e dois tinham metástases (óbitos ocorridos antes de um ano após diagnóstico). Os tratamentos variaram de conformidade com o estadiamento da doença. Os dados evidenciam o prognóstico ruim da moléstia, que se apresenta, usualmente em estádios avançados e, freqüentemente, com metástases.
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Yala A, Mikhael PG, Strand F, Lin G, Satuluru S, Kim T, Banerjee I, Gichoya J, Trivedi H, Lehman CD, Hughes K, Sheedy DJ, Matthis LM, Karunakaran B, Hegarty KE, Sabino S, Silva TB, Evangelista MC, Caron RF, Souza B, Mauad EC, Patalon T, Handelman-Gotlib S, Guindy M, Barzilay R. Multi-Institutional Validation of a Mammography-Based Breast Cancer Risk Model. J Clin Oncol 2021; 40:1732-1740. [PMID: 34767469 DOI: 10.1200/jco.21.01337] [Citation(s) in RCA: 61] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Accurate risk assessment is essential for the success of population screening programs in breast cancer. Models with high sensitivity and specificity would enable programs to target more elaborate screening efforts to high-risk populations, while minimizing overtreatment for the rest. Artificial intelligence (AI)-based risk models have demonstrated a significant advance over risk models used today in clinical practice. However, the responsible deployment of novel AI requires careful validation across diverse populations. To this end, we validate our AI-based model, Mirai, across globally diverse screening populations. METHODS We collected screening mammograms and pathology-confirmed breast cancer outcomes from Massachusetts General Hospital, USA; Novant, USA; Emory, USA; Maccabi-Assuta, Israel; Karolinska, Sweden; Chang Gung Memorial Hospital, Taiwan; and Barretos, Brazil. We evaluated Uno's concordance-index for Mirai in predicting risk of breast cancer at one to five years from the mammogram. RESULTS A total of 128,793 mammograms from 62,185 patients were collected across the seven sites, of which 3,815 were followed by a cancer diagnosis within 5 years. Mirai obtained concordance indices of 0.75 (95% CI, 0.72 to 0.78), 0.75 (95% CI, 0.70 to 0.80), 0.77 (95% CI, 0.75 to 0.79), 0.77 (95% CI, 0.73 to 0.81), 0.81 (95% CI, 0.79 to 0.82), 0.79 (95% CI, 0.76 to 0.83), and 0.84 (95% CI, 0.81 to 0.88) at Massachusetts General Hospital, Novant, Emory, Maccabi-Assuta, Karolinska, Chang Gung Memorial Hospital, and Barretos, respectively. CONCLUSION Mirai, a mammography-based risk model, maintained its accuracy across globally diverse test sets from seven hospitals across five countries. This is the broadest validation to date of an AI-based breast cancer model and suggests that the technology can offer broad and equitable improvements in care.
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Affiliation(s)
- Adam Yala
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA.,Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Peter G Mikhael
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA.,Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
| | - Fredrik Strand
- Breast Radiology Unit, Department of Imaging and Physiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Siddharth Satuluru
- Department of Computer Science, University of California Los Angeles, Los Angeles, CA
| | - Thomas Kim
- Department of Computer Science, Georgia Institute of Technology, Atlanta, GA
| | - Imon Banerjee
- Department of Biomedical Informatics, Emory University, Atlanta, GA
| | - Judy Gichoya
- Department of Radiology, Emory University, Atlanta, GA
| | - Hari Trivedi
- Department of Radiology, Emory University, Atlanta, GA
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Kevin Hughes
- Division of Surgical Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - David J Sheedy
- Analytics and Informatics Department, Novant Health, Winston-Salem, NC
| | - Lisa M Matthis
- Analytics and Informatics Department, Novant Health, Winston-Salem, NC
| | - Bipin Karunakaran
- Analytics and Informatics Department, Novant Health, Winston-Salem, NC
| | - Karen E Hegarty
- Digital Product and Services, Novant Health, Winston-Salem, NC
| | - Silvia Sabino
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, Brazil
| | - Thiago B Silva
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, Brazil
| | | | - Renato F Caron
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, Brazil
| | - Bruno Souza
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, Brazil
| | - Edmundo C Mauad
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, Brazil
| | - Tal Patalon
- Maccabitech, Maccabi Health Services, Tel Aviv, Israel
| | | | - Michal Guindy
- Department of Imaging, Assuta Medical Centers, Tel Aviv, Israel
| | - Regina Barzilay
- Department of Electrical Engineering and Computer Science, Massachusetts Institute of Technology, Cambridge, MA.,Jameel Clinic, Massachusetts Institute of Technology, Cambridge, MA
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Freedland AR, Muller RL, Hoyo C, Turner EL, Moorman PG, Faria EF, Carvalhal GF, Reis RB, Mauad EC, Carvalho AL, Freedland SJ. Implications of Regionalizing Care in the Developing World: Impact of Distance to Referral Center on Compliance to Biopsy Recommendations in a Brazilian Prostate Cancer Screening Cohort. Prostate Cancer 2021; 2021:6614838. [PMID: 34239732 PMCID: PMC8241493 DOI: 10.1155/2021/6614838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 06/09/2021] [Indexed: 11/18/2022] Open
Abstract
Given growing specialization in medical care, optimal care may require regionalization, which may create access barriers. We tested this within a large prostate cancer (PC) screening program in Brazil. In 2004-2007, Barretos Cancer Hospital prospectively screened men for PC throughout rural Brazil. Men with abnormal screen were referred for follow-up and possible biopsy. We tested the link between distance from screening site to Barretos Cancer Hospital and risk of noncompliance with showing up for biopsy, PC on biopsy and, among those with PC, PC grade using crude and multivariable logistic regression analysis. Among 10,467 men undergoing initial screen, median distance was 257 km (IQR: 135-718 km). On crude and multivariable analyses, farther distance was significantly linked with biopsy noncompliance (OR/100 km: 0.83, P < 0.001). Among men who lived within 150 km of Barretos Cancer Hospital, distance was unrelated to compliance (OR/100 km: 1.09, P=0.87). There was no association between distance and PC risk or PC grade (all P > 0.25). In Brazil, where distances to referral centers can be large, greater distance was related to reduced biopsy compliance in a PC screening cohort. Among men who lived within 150 km, distance was unrelated to compliance. Care regionalization may reduce access when distances are large.
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Affiliation(s)
- Alexis R. Freedland
- Department of Epidemiology, UCI School of Medicine, University of California, Irvine, CA, USA
| | - Roberto L. Muller
- Division of Urology, Center of Oncologic Research, Florianopolis, Santa Catarina, Brazil
| | - Cathrine Hoyo
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Elizabeth L. Turner
- Global Health Institute, Duke University, Durham, NC, USA
- Department of Biostatistics and Bioinformatics, Duke University Graduate School, Durham, NC, USA
| | - Patricia G. Moorman
- Department of Community and Family Medicine, Cancer Control and Population Sciences, Duke Cancer Institute, Durham, NC, USA
| | - Eliney F. Faria
- Division of Urologic Oncology and Laparoscopy, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Rodolfo B. Reis
- Division of Urology, Ribeirao Preto Medical School of Sao Paulo University (USP), Ribeirao Preto, São Paulo, Brazil
| | - Edmundo C. Mauad
- Department of Preventative Medicine, Barretos Cancer Hospital and Pio XII Foundation, Barretos, São Paulo, Brazil
| | - Andre L. Carvalho
- Research Support Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Stephen J. Freedland
- Division of Urology, Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Abstract
INTRODUCTION For the past 10 years, skin cancer has been the most frequent malignant neoplasm in Brazil and worldwide. Each year, there are more new cases of skin cancer than the combined incidence of cancers of the breast, prostate, lung and colon. There were an estimated 188 000 new cases of skin cancer in Brazil in 2016. The prevention department of Barretos Cancer Hospital (BCH) runs some prevention programs for cancer such as breast, prostate, cervical, oral, colon and skin cancers. The skin cancer prevention program comprises educational activities and medical assistance conducted at the hospital and at a mobile unit (MU). The objective of this study is to evaluate the use of the MU as part of a skin cancer prevention program, 10 years after the implementation of this prevention program, using an MU in remote areas of Brazil. METHODS The database of the BCH was used. These data refer to data collected by the BCH Prevention MU. A total of 45 872 patients with suspected skin cancer were evaluated at the MU from 2004 to 2013. Of these, 8954 surgical procedures (excisions and/or biopsy) were performed. RESULTS This study demonstrated a significant number of skin cancer cases diagnosed and treated by the MU. CONCLUSIONS This study showed that the MU positively contributes to the early diagnosis and treatment of skin cancer among populations residing in remote areas of Brazil.
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Affiliation(s)
| | - Edmundo C Mauad
- Barretos Cancer Hospital, Rua Antenor Duarte 1331, Barretos, SP, Brazil
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Silveira CEG, Carcano C, Mauad EC, Faleiros H, Longatto-Filho A. Cell phone usefulness to improve the skin cancer screening: preliminary results and critical analysis of mobile app development. Rural Remote Health 2019; 19:4895. [PMID: 30673294 DOI: 10.22605/rrh4895] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The high incidence of skin cancer in Brazil has resulted in an urgent need for more efficient methods of reducing the time between initial diagnosis and therapy. Such delays are significant in large countries like Brazil, where a considerable proportion of the population live in remote areas with limited access to specialized medical care. To address this problem the use of mobile phones as screening devices for suspicious skin lesions has been incorporated as long-distance teledermatology services. Digital photography is now a convenient ancillary option to minimize treatment delays caused by the distance between the specialist doctor and patients. The authors have developed a friendly mobile application and website to take high quality digital images of suspicious lesions, and to capture patient data easily and quickly to be analyzed by skin cancer professionals at another location. METHODS This was a prospective study of a population of 39 individuals monitored by routine skin cancer screening by the Cancer Prevention Department at Barretos Cancer Hospital during 2016. All patients were evaluated in the dermatology clinic, where a differential diagnosis was made based on the clinical information and direct examination of suspicious lesions. A second dermatologist assessed the same clinical information and digital images of all lesions captured by teledermatology, and provided an independent diagnostic opinion on the likelihood of the lesions being benign or suggestive of malignancy. The diagnostic efficiencies of teledermatology and standard dermatology were then compared to the histopathological findings of each biopsy as the diagnostic gold standard, and then statistical parameters of each approach were evaluated. RESULTS The lesions studied in this comparison were mostly found on the face (69%), followed by upper limbs (15%), scalp (8%), trunk (6%) and lower limbs (2%). Final histopathological analyses of the biopsies in the study group showed that 71% of lesions were malignant, with 32% being squamous cell carcinoma and 68% being classified as basal cell carcinoma, and 29% were considered benign lesions. The overall sensitivities of teledermatology in comparison to face-to-face evaluation in the clinic were similar (clinic, 80.0%; teledermatology, 80.8%). Other comparisons including accuracy (clinic, 78.9%; teledermatology, 79.5%); specificity (clinic, 76.9%; teledermatology, 76.9%); positive predictive value (clinic, 87.0%; teledermatology, 87.5%); and negative predictive value (clinic, 66.7.0%; teledermatology, 66.7%) all showed equivalence. The inter-observer kappa value between face-to-face examination and teledermatology showed excellent agreement at 0.958. CONCLUSION These preliminary findings indicate that the cell phone application developed to aid the diagnosis of skin cancer showed great potential and reliability, and can therefore be considered as an ancillary option in countries like Brazil, with isolated communities that have limited access to dermatology clinics.
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Affiliation(s)
| | - Cristiane Carcano
- Barretos Cancer Hospital, Street Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos - SP, 14784-400, Brazil
| | - Edmundo C Mauad
- Barretos Cancer Hospital, Street Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos - SP, 14784-400, Brazil
| | - Humberto Faleiros
- Barretos Cancer Hospital, Street Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos - SP, 14784-400, Brazil
| | - Adhemar Longatto-Filho
- Barretos Cancer Hospital, Street Antenor Duarte Villela, 1331 - Dr. Paulo Prata, Barretos - SP, 14784-400, Brazil
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7
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Fernandes GC, Michelli RAD, Galvão HCR, Paula AE, Pereira R, Andrade CE, Felicio PS, Souza CP, Mendes DRP, Volc S, Berardinelli GN, Grasel RS, Sabato CS, Viana DV, Mauad EC, Scapulatempo-Neto C, Arun B, Reis RM, Palmero EI. Prevalence of BRCA1/BRCA2 mutations in a Brazilian population sample at-risk for hereditary breast cancer and characterization of its genetic ancestry. Oncotarget 2018; 7:80465-80481. [PMID: 27741520 PMCID: PMC5348334 DOI: 10.18632/oncotarget.12610] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background There are very few data about the mutational profile of families at-risk for hereditary breast and ovarian cancer (HBOC) from Latin America (LA) and especially from Brazil, the largest and most populated country in LA. Results Of the 349 probands analyzed, 21.5% were BRCA1/BRCA2 mutated, 65.3% at BRCA1 and 34.7% at BRCA2 gene. The mutation c.5266dupC (former 5382insC) was the most frequent alteration, representing 36.7% of the BRCA1 mutations and 24.0% of all mutations identified. Together with the BRCA1 c.3331_3334delCAAG mutation, these mutations constitutes about 35% of the identified mutations and more than 50% of the BRCA1 pathogenic mutations. Interestingly, six new mutations were identified. Additionally, 39 out of the 44 pathogenic mutations identified were not previously reported in the Brazilian population. Besides, 36 different variants of unknown significance (VUS) were identified. Regarding ancestry, average ancestry proportions were 70.6% European, 14.5% African, 8.0% Native American and 6.8% East Asian. Materials and methods This study characterized 349 Brazilian families at-risk for HBOC regarding their germline BRCA1/BRCA2 status and genetic ancestry. Conclusions This is the largest report of BRCA1/BRCA2 assessment in an at-risk HBOC Brazilian population. We identified 21.5% of patients harboring BRCA1/BRCA2 mutations and characterized the genetic ancestry of a sample group at-risk for hereditary breast cancer showing once again how admixed is the Brazilian population. No association was found between genetic ancestry and mutational status. The knowledge of the mutational profile in a population can contribute to the definition of more cost-effective strategies for the identification of HBOC families.
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Affiliation(s)
- Gabriela C Fernandes
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Henrique C R Galvão
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - André E Paula
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Rui Pereira
- Institute of Research and Innovation in Health, University of Porto, Porto, Portugal.,Institute of Molecular Pathology and Immunology at the University of Porto (IPATIMUP), Porto, Portugal
| | - Carlos E Andrade
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Paula S Felicio
- Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristiano P Souza
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Deise R P Mendes
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Sahlua Volc
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | | | - Rebeca S Grasel
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristina S Sabato
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Danilo V Viana
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Edmundo C Mauad
- Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Prevention Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Cristovam Scapulatempo-Neto
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Pathology Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Banu Arun
- MD Anderson Cancer Center, Houston, Texas, USA
| | - Rui M Reis
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Life and Health Sciences Research Institute (ICVS), Health Sciences School, University of Minho, Braga, Portugal.,ICVS/3B's-PT Government Associate Laboratory, Braga/Guimarães, Portugal
| | - Edenir I Palmero
- Center of Molecular Diagnosis, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Oncogenetics Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Molecular Oncology Research Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil.,Barretos School of Health Sciences, Dr. Paulo Prata-FACISB, São Paulo, Brazil
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Bitencourt AGV, Gama RRM, Graziano L, Negrão EMS, Sabino SMPS, Watanabe AHU, Guatelli CS, Souza JA, Mauad EC, Marques EF. Breast metastases from extramammary malignancies: multimodality imaging aspects. Br J Radiol 2017; 90:20170197. [PMID: 28485985 DOI: 10.1259/bjr.20170197] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Breast metastases from extramammary cancers are rare and usually related to poor prognosis. The extramammary tumours most frequently exhibiting breast metastases are melanoma, lymphomas, ovarian cancer, lung and neuroendocrine tumours, and sarcomas. Owing to the lack of reliable and specific clinical or radiological signs for the diagnosis of breast metastases, a combination of techniques is needed to differentiate these lesions from primary breast carcinoma or even benign breast lesions. Multiple imaging methods may be used to evaluate these patients, including mammography, ultrasound, MRI, CT and positron emission tomography CT. Clinical and imaging manifestations are varied, depend on the form of dissemination of the disease and may mimic primary benign and malignant breast lesions. Haematologically disseminated metastases often develop as a circumscribed mass, whereas lymphatic dissemination often presents as diffuse breast oedema and skin thickening. Unlike primary carcinomas, breast metastases generally do not have spiculated margins, skin or nipple retraction. Microlobulated or indistinct margins may be present in some cases. Although calcifications are not frequently present in metastatic lesions, they occur more commonly in patients with ovarian cancer. Although rare, secondary malignant neoplasms should be considered in the differential diagnosis of breast lesions, in the appropriate clinical setting. Knowledge of the most common imaging features can help to provide the correct diagnosis and adequate therapeutic planning.
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Affiliation(s)
| | - Roberta R M Gama
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Luciana Graziano
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Erika M S Negrão
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Silvia M P S Sabino
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Anapaula H U Watanabe
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Camila S Guatelli
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Juliana A Souza
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
| | - Edmundo C Mauad
- 2 Department of Cancer Prevention, Radiology Division, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Elvira F Marques
- 1 Department of Imaging, AC Camargo Cancer Center, São Paulo, São Paulo, Brazil
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Possati-Resende JC, Fregnani JHTG, Kerr LM, Mauad EC, Longatto-Filho A, Scapulatempo-Neto C. The Accuracy of p16/Ki-67 and HPV Test in the Detection of CIN2/3 in Women Diagnosed with ASC-US or LSIL. PLoS One 2015; 10:e0134445. [PMID: 26230097 PMCID: PMC4521700 DOI: 10.1371/journal.pone.0134445] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 07/10/2015] [Indexed: 12/20/2022] Open
Abstract
The objective of this study was to compare the accuracies of double staining for p16/Ki-67 and the molecular test for high-risk HPV (hr-HPV) to identify high-grade cervical intraepithelial neoplasia (CIN2/CIN3) in women with cervical cytology of atypical squamous cells of undetermined significance (ASC-US) and low-grade squamous intraepithelial lesion (LSIL). Data were collected from 201 women who underwent cervical cytology screening in the Barretos Cancer Hospital and their results were categorized as ASC-US (n=96) or LSIL (n=105). All patients underwent colposcopy with or without cervical biopsy for diagnosis of CIN2/CIN3. The hr-HPV test (Cobas 4800 test) and immunocytochemistry were performed to detect biomarkers p16/Ki-67 (CINtec PLUS test). Two samples (1 ASC-US/1 LSIL) were excluded from the analysis due to inconclusive results of the histologic examination. There were 8 cases of CIN2/CIN3 among 95 women with ASC-US (8.4%), and 23 cases of CIN2/CIN3 among 104 women with LSIL (22.1%). In the group of women with ASC-US, the sensitivity and specificity in diagnosing CIN2/CIN3 were 87.5% and 79.5% for the HPV test and 62.5% and 93.1% for p16/Ki-67. Among women with LSIL, the sensitivity and specificity in the diagnosis of CIN2/CIN3 were 87% and 34.7% for the HPV test and 69.6% and 75.3% for immunocytochemistry. Superior performance was observed for p16/Ki-67 double staining, especially among women under 30 for whom the test had an area under the ROC curve of 0.762 (p<0.001). Both p16/Ki-67 double staining and the hr-HPV DNA test had similar performance in predicting high-grade cervical intraepithelial neoplasia among women with ASC-US. The best performance was observed in women aged >30 years. In younger women (≤30 years) with LSIL, p16/Ki-67 had greater accuracy in identifying precursor lesions. Among women >30 years diagnosed with LSIL, the two methods showed similar performance.
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Affiliation(s)
| | | | - Ligia M. Kerr
- Pathology Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Edmundo C. Mauad
- Cancer Prevention Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
| | - Adhemar Longatto-Filho
- Molecular Oncology Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Laboratory of Medical Investigation (LIM-14), School of Medicine, University of Sao Paulo, Sao Paulo, Brazil
| | - Cristovam Scapulatempo-Neto
- Pathology Department, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
- Molecular Oncology Center, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Silva TB, Oliveira CZ, Faria EF, Mauad EC, Syrjänen KJ, Carvalho AL. Development and validation of a nomogram to estimate the risk of prostate cancer in Brazil. Anticancer Res 2015; 35:2881-2886. [PMID: 25964571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
AIM To develop and validate a nomogram to estimate the probability of prostate cancer (PCa) in men undergoing opportunistic screening. PATIENTS AND METHODS This was a cross-sectional observational study on a cohort of men screened for PCa at the Barretos Cancer Hospital (BCH) between January 2004 and December 2007. Patients' data were collected from their charts and binary logistic regression analyses were performed to assess the power of various factor combinations as predictors of the PCa risk. RESULTS Out of the 1,313 screened men who underwent prostate biopsy, 553 (42.1%) had histopathological confirmation of PCa. The logistic regression analyses provided an area under the receiver operating characteristics (ROC) curve (AUC) of 0.737 (95% confidence interval (CI)=0.678-0.796) for the best predictor combination. A nomogram was constructed to estimate the individual risk for PCa prior to biopsy. CONCLUSION Our nomogram provides an easy and practical method, superior in performance to the traditional criteria, predicting the diagnosis of PCa with a reasonable accuracy.
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Affiliation(s)
- Thiago B Silva
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Cleyton Z Oliveira
- Teaching and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Eliney F Faria
- Department of Surgery/Urology, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Edmundo C Mauad
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, SP, Brazil
| | - Kari J Syrjänen
- Teaching and Research Institute, Barretos Cancer Hospital, Barretos, SP, Brazil Department of Clinical Research, Biohit HealthCare Plc., Helsinki, Finland
| | - André L Carvalho
- Department of Cancer Prevention, Barretos Cancer Hospital, Barretos, SP, Brazil
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Tobias-Machado M, Carvalhal GF, Freitas Jr. CH, Reis RBD, Reis LO, Nogueira L, Machado RD, Magnabosco W, Vieira RAC, Mauad EC, Carvalho AL, Faria EF. Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study. Int Braz J Urol 2013; 39:328-34. [DOI: 10.1590/s1677-5538.ibju.2013.03.05] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Accepted: 05/13/2013] [Indexed: 11/21/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - Eliney F. Faria
- Barretos Cancer Hospital (CHFjr, RDM, WM, RACV, ECM, ALC, EFF)
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Silva TB, Mauad EC, Carvalho AL, Jacobs LA, Shulman LN. Difficulties in implementing an organized screening program for breast cancer in Brazil with emphasis on diagnostic methods. Rural Remote Health 2013; 13:2321. [PMID: 23597169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
INTRODUCTION Breast cancer is the most common type of cancer among women, and the leading cause of cancer deaths worldwide. Among early detection methods, screening by mammography has been used in most developed countries as gold standard. The goal of this study was to evaluate the difficulties and opportunities in implementing breast cancer screening in Brazil, with an emphasis on the diagnostic methods used according to stage distribution. METHODS Between 2007 and 2009, 248 women were diagnosed with breast cancer in the Barretos region. Most of these were interviewed in their homes using a questionnaire with sociodemographic and preventive breast cancer screening questions. All other data were obtained from Barretos Cancer Hospital (BCH) medical records. RESULTS The screening program conducted by BCH was responsible for 46.1% of diagnosed cases, with 30.1% of these referred from the private system and 23.8% from the public system. Among asymptomatic women screened by the BCH Screening Program 70.8% had clinical stage 0-I disease, compared with 58.1% in the private and 50% in the public systems. Monthly breast self-examination was reported by 48.5% of the women. Clinical breast examinations were regularly performed by 88.9% of gynecologists in the private and 40.7% in the public health systems. Only 5.6% of the women reported difficulty in accessing mammography and this was most frequently due to fear of the disease or lack of knowledge about mammography in asymptomatic women. CONCLUSION This breast cancer screening program resulted in a substantial number of patients presenting with clinical stage (CS) 0-I disease. The success of this program was due to intensive community interventions, free mammography, and the availability of health care and mammography close to patients' homes.
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Affiliation(s)
- T B Silva
- Departamento de Prevenção, Barretos Cancer Hospital, Barretos, São Paulo, Brazil
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Fregnani JHTG, Scapulatempo C, Haikel RL, Saccheto T, Campacci N, Mauad EC, Longatto-Filho A. Could alarmingly high rates of negative diagnoses in remote rural areas be minimized with liquid-based cytology? Preliminary results from the RODEO Study Team. Acta Cytol 2012; 57:69-74. [PMID: 23221353 DOI: 10.1159/000343046] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Accepted: 08/29/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE It was the aim of this study to compare diagnostic performances of the BD SurePath™ liquid-based Papanicolaou test (LBC) and the conventional Papanicolaou test (CPT) in cervical samples of women from remote rural areas of Brazil. STUDY DESIGN Specimens were collected by mobile units provided by Barretos Cancer Hospital. This report evaluates the manual screening arm of the RODEO study. Of 12,048 women seen between May and December 2010, 6,001 were examined using LBC and 6,047 using CPT. RESULTS Comparative (LBC vs. CPT) outcomes were: all abnormal tests, 2.1 versus 1.0%; ASC-US (atypical squamous cells of unknown significance), 0.7 versus 0.1%; ASC-H (atypical squamous cells with possible high-grade squamous intraepithelial lesions) and AGC (atypical glandular cells), 0.4 versus 0.3%; LSIL (low-grade squamous intraepithelial lesions), 0.7 versus 0.3%; HSIL (high-grade squamous intraepithelial lesions), 0.4 versus 0.2%, and unsatisfactory, 0.03 versus 0.08%. The LBC arm detected significantly more lesions (ASC-US+) than CPT (p < 0.001); however, when we divided the diagnoses into two groups, ASC-H- (negative/ASC-US/LSIL) and ASC-H+ (ASC-H/AGC/HSIL), the difference was not statistically important (p = 0.213). CONCLUSIONS With inherent difficulties in patient recruitment and patient compliance with cancer screening, best test performance including human papillomavirus test capability are vitally necessary in Brazil's struggle to reduce cervical cancer.
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Faria EF, Carvalhal GF, dos Reis RB, Tobias-Machado M, Vieira RAC, Reis LO, Nogueira L, Machado RD, Freitas CH, Magnabosco WJ, Mauad EC, Carvalho AL. Use of low free to total PSA ratio in prostate cancer screening: detection rates, clinical and pathological findings in Brazilian men with serum PSA levels <4.0 ng/mL. BJU Int 2012; 110:E653-7. [PMID: 22892057 DOI: 10.1111/j.1464-410x.2012.11398.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
UNLABELLED What's known on the subject? and What does the study add? In spite of its low specificity, PSA is the most widely used screening test for prostate cancer (PCa), and is considered the main cause of the stage migration recently observed. The ratio of free to total PSA (%fPSA) has been shown to increase PSA accuracy in cancer detection; however, few screening studies have systematically evaluated its role in cancer detection rates in men with PSA levels <4.0 ng/mL and normal DRE. The present study supports a possible role of %fPSA as an adjunct to screening in men with total PSA 2.5-4.0 ng/mL and normal DRE, with a marked increase in cancer detection rates in a large Brazilian PCa screening study. We believe that %fPSA maybe a useful refinement to biopsy indications in men with low PSA levels. OBJECTIVE • To evaluate the role of the free to total prostate-specific antigen ratio (%fPSA) in identifying prostate cancer (PCa) in men with a prostate-specific antigen (PSA) level of 2.5-3.9 ng/mL and a normal digital rectal examination (DRE). PATIENTS AND METHODS • A prospective PCa screening study was conducted, which included 17571 men aged ≥ 45 years, across six Brazilian states, where men were recalled for further evaluation in the case of either a suspicious DRE and/or PSA ≥ 4.0 ng/mL, or PSA 2.5-3.9 ng/mL and %fPSA ≤ 15. • We evaluated the impact of a %fPSA ≤ 15 on cancer detection rates and the clinical and pathological stage of tumours in men with a normal DRE and PSA 2.5-3.9 ng/mL. RESULTS • When suspicious DRE and/or PSA ≥ 4.0 ng/mL were considered as criteria to prompt further evaluation, the cancer detection rate was 3.1%. When %fPSA ≤ 15 in men with total PSA levels of 2.5-3.9 ng/mL were considered as criteria, the PCa detection rate increased to 3.7%. Considering %fPSA ≤ 15 in men with PSA 2.5-3.9 ng/mL and normal DRE, the positive predictive value of biopsy was 31.1%. • Clinical stage was more favourable among men with PSA 2.5-3.9 ng/mL, normal DRE, and %fPSA ≤ 15 compared with men with normal DRE and PSA ≥ 4.0 ng/mL (P= 0.02). • Among those who underwent radical prostatectomy, pathological stage and the proportion of insignificant tumours were similar between men with PSA 2.5-3.9 ng/mL, normal DRE findings and %fPSA ≤ 15, and men with PSA ≥ 4.0 ng/mL. CONCLUSIONS • The use of %fPSA ≤ 15 as a biopsy indication in men with normal DRE and PSA 2.5-4.0 ng/mL in a PCa screening programme, increased cancer detection rates. Tumours in this subset of patients had similar pathological characteristics. • Using %fPSA ≤ 15 to indicate biopsy in men with PSA 2.5-3.9 ng/mL is a useful adjunct to PCa screening.
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Muller RL, Faria EF, Carvalhal GF, Reis RB, Mauad EC, Carvalho AL, Freedland SJ. Association between family history of prostate cancer and positive biopsies in a Brazilian screening program. World J Urol 2012; 31:1273-8. [PMID: 22820620 DOI: 10.1007/s00345-012-0904-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2012] [Accepted: 06/30/2012] [Indexed: 12/28/2022] Open
Abstract
PURPOSE To test the association between family history of prostate cancer (FH) and prostate cancer (PCa) risk in a large screening program in Brazil, as no conclusive study has yet investigated this. METHODS Between 2004 and 2007, 17,569 men were screened in 231 small municipalities using mobile screening units. Positive FH was defined as any relative having PCa among screened men. Men were biopsied if they had digital rectal examination suggestive of PCa or PSA >4.0 ng/mL or PSA of 2.5-4 ng/mL with percent free PSA ≤ 15 %. We analyzed the association between FH and PCa using multivariable logistic regression in the first screening round of the program. RESULTS Positive FH was present in 735 men (4.2 % of total), and they were younger, better educated and more likely to have had previous PCa screening (41.5 vs. 28.5 %; P < 0.001) compared to men with negative FH. FH status did not affect compliance rates in men recommended to undergo biopsy (P = 0.94). In first round, PCa was detected in 3.1 % of screened men (n = 552). In multivariable analysis, positive FH was associated with increased PCa risk (OR = 1.79; 95 % CI, 1.21-2.65; P = 0.003). However, Gleason scores (P = 0.78) or percent of positive cores (P = 0.32) among men with positive biopsies were similar, regardless of FH status. CONCLUSIONS In Brazil, men with positive FH were at increased PCa risk, which could not be explained by differential biopsy rates. This finding suggests that FH is also a true PCa risk factor in Brazil, a country with highly diverse population in terms of race, ethnicity, culture and socioeconomic status.
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Affiliation(s)
- Roberto L Muller
- Division of Urologic Surgery, Department of Surgery, Duke University Medical Center (DUMC), Box 2626, Durham, NC, 27710, USA,
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Faria EF, Carvalhal GF, Vieira RA, Silva TB, Mauad EC, Tobias-Machado M, Carvalho AL. Comparison of clinical and pathologic findings of prostate cancers detected through screening versus conventional referral in Brazil. Clin Genitourin Cancer 2011; 9:104-8. [PMID: 21843976 DOI: 10.1016/j.clgc.2011.06.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2011] [Revised: 05/11/2011] [Accepted: 06/02/2011] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Data regarding prostate cancer screening in Brazil are limited. We compared features of prostate cancers detected through screening versus those referred for treatment in Brazil. PATIENTS AND METHODS Group I included 500 of 13,754 men whose cancers were detected through screening, and Group II included 2731 men referred for treatment through the habitual public health system. We used Mann-Whitney and χ(2) tests to compare clinical and pathologic findings, considering significant any P < 0.05. RESULTS Median prostate-specific antigen (PSA) was lower among screened patients (5.5 ng/mL versus 10.0 ng/mL; P < 0.001). Of the screened patients, 170 (34%) had biopsy Gleason score ≥ 7, compared with 1265 (46.3%) in the referred group (P < 0.001). Lymph node metastases were suspected in 8.6% of the referred versus 3.2% of the screened men (P = 0.002). Distant metastases were more common in the referred men (9.3% vs. 3.0%; P < 0.001). Only 6.0% of the screened cancers were locally advanced at diagnosis (T3 or T4) versus 26.5% of the referred (P < 0.001). Screened patients had a higher proportion of localized tumors after surgery (67.7% vs. 54.2%; P = 0.002). Pathology Gleason scores were also lower among screened men (P < 0.01). Lymphadenectomies were performed in 166/636 men (26.1%). No nodal metastases were found in screened cancers (0/28; 0.0%), while 6/138 referred cancers (4.3%) presented nodal involvement (P = 0.3). CONCLUSION Clinical and pathologic characteristics of screen-detected cancers are more favorable than those of tumors diagnosed through the Brazilian health system.
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Affiliation(s)
- Eliney F Faria
- Division of Urology, Barretos Cancer Hospital, Antenor Duarte Villela 1331, Barretos, SP, Brazil.
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Mauad EC, Silva TB, Latorre MRDO, Vieira RAC, Haikel RL, Vazquez VL, Longatto-Filho A. Opportunistic screening for skin cancer using a mobile unit in Brazil. BMC Dermatol 2011; 11:12. [PMID: 21645347 PMCID: PMC3123636 DOI: 10.1186/1471-5945-11-12] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 06/06/2011] [Indexed: 11/10/2022]
Abstract
Background Skin cancer is the most common malignancy in the white population worldwide. In Brazil, the National Cancer Institute (INCA) estimates that in 2010 there will be 119,780 and 5,930 new cases of non-melanoma skin cancer and melanoma, respectively. The aim of this study was to evaluate the use of a mobile unit in the diagnosis and treatment of skin cancer in several poor regions of Brazil. Methods The diagnosis of skin cancer was accomplished through active medical screening in the prevention Mobile Unit (MU) of Barretos Cancer Hospital (BCH). The study population consisted of patients examined in the MU between 2004 and 2007, and their suspicious lesions were subjected to histopathological evaluation. Data were collected prospectively from standardized forms and analyzed. Results During the screening, 17,857 consultations were carried out. A total of 2012 (11.2%) cases of skin cancer were diagnosed. The predominant histological type reported was basal cell carcinoma (n = 1,642 or 81.6%), followed by squamous cell carcinoma (n = 303 or 15.1%), Bowen's disease (n = 25 or 1.2%), malignant melanoma (n = 23 or 1.1%), basosquamous cell carcinoma (n = 3 or 0.1%), miscellaneous lesions (12 or 0.6%), and metatypical carcinoma (n = 4 or 0.2%). Only 0.6% of lesions were stage III. There were no stage IV non-melanoma skin lesions, as well as no melanomas stages III and IV, found. Conclusions It was observed that the MU can be a useful tool for early skin cancer diagnosis and treatment. This program probably is important, especially in developing countries with inadequate public health systems and social inequality.
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Affiliation(s)
- Edmundo C Mauad
- Barretos Cancer Hospital-Pio XII Foundation, São Paulo, Brazil.
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Mauad EC, Nicolau SM, Moreira LF, Haikel RL, Longatto-Filho A, Baracat EC. Adherence to cervical and breast cancer programs is crucial to improving screening performance. Rural Remote Health 2009; 9:1241. [PMID: 19778158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Cervical and breast cancer are the most common malignancies among women worldwide. Effective screening can facilitate early detection and dramatically reduce mortality rates. The interface between those screening patients and patients most needing screening is complex, and women in remote areas of rural counties face additional barriers that limit the effectiveness of cancer prevention programs. This study compared various methods to improve compliance with mass screening for breast and cervical cancer among women in a remote, rural region of Brazil. METHODS In 2003, a mobile unit was used to perform 10,156 mammograms and Papanicolaou smear tests for women living in the Barretos County region of São Paulo state, Brazil (consisting of 19 neighbouring cities). To reach the women, the following community outreach strategies were used: distribution of flyers and pamphlets; media broadcasts (via radio and car loudspeakers); and community healthcare agents (CHCAs) making home visits. RESULTS The most useful intervention appeared to be the home visits by healthcare agents or CHCAs. These agents of the Family Health Programme of the Brazilian Ministry of Health reached an average of 45.6% of those screened, with radio advertisements reaching a further 11.9%. The great majority of the screened women were illiterate or had elementary level schooling (80.9%) and were of 'poor' or 'very poor' socioeconomic class (67.2%). CONCLUSIONS Use of a mobile screening unit is a useful strategy in developing countries where local health systems have inadequate facilities for cancer screening in underserved populations. A multimodal approach to community outreach strategies, especially using CHCAs and radio advertisements, can improve the uptake of mass screening in low-income, low-educational background female populations.
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Affiliation(s)
- Edmundo C Mauad
- Barretos Cancer Hospital - Department of Cancer Screening, São Paulo, Brazil.
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Abstract
OBJECTIVE The purpose of this study was to determine the possibility of providing a cervical screening facility to a poor population. METHODS A cross-sectional study was conducted in the period from December 1994 to December 1997, with 1384 women from the poor districts of Barretos, São Paulo and three other neighbouring cities. Performed by a nurse, the programme included door-to-door interviews and cervical screening. The Papanicolaou smears were taken either at the community centre or at home using a portable gynaecological table transportable by bicycle, developed by the Institution. RESULTS From 1384 interviewed women, 1044 (75.4%) agreed to undergo the examination and 499 (47.8%) had never had the test or had not had it repeated within the last 3 years. Among 1044 examined women, seven cases of carcinoma 'in situ', one invasive squamous cell carcinoma (stage IB) and two polyps were found. CONCLUSIONS This study shows that programmes of cancer prevention in poor populations can be as successful as those carried out in more developed countries by taking advantage of innovations in the delivery of care.
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Affiliation(s)
- Edmundo C Mauad
- Department of Clinical Oncology, Fundação Pio XII, Barretos and Faculdade de Medicina de Ribeirão Preto (USP), Ribeirão Preto, São Paulo, Brazil
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Abstract
To establish the short-term and long-term results of current treatment of irritable bowel syndrome (IBS), 104 patients were studied prospectively. All patients were treated similarly and the results were assessed after a few weeks and then after at least 5 years. IBS can be diagnosed more easily than has been suggested--72% of this series were correctly diagnosed by their referring doctor, and only 12% required radiological studies to exclude organic disease. The response to treatment was considerably better than expected, possibly because of the more aggressive use of high-fibre diets and bulking agents. Thus, 85% of patients were rendered virtually symptom-free in the short term, and 68% were still virtually symptom-free 5 years later. The response to treatment was better in men than in women, in those with constipation than with diarrhoea, when the symptoms had initially been triggered by an episode of acute diarrhoea, and in patients with a relatively short history. With a few simple investigations, sympathetic explanation, and appropriate treatment, most patients with IBS have a good prognosis.
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