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Araújo Pereira Lisboa FC, Paulinelli RR, Campos Veras LP, Jubé Ribeiro LF, Pádua Oliveira LF, Sousa Rahal RM, Sousa AG, Freitas-Júnior R, Batista de Sousa J. Aesthetic results were more satisfactory after oncoplastic surgery than after total breast reconstruction according to patients and surgeons. Breast 2023; 71:47-53. [PMID: 37487426 PMCID: PMC10374858 DOI: 10.1016/j.breast.2023.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/09/2023] [Accepted: 07/11/2023] [Indexed: 07/26/2023] Open
Abstract
INTRODUCTION Patient satisfaction after breast cancer surgery has an impact on body image, sexual function, self-esteem, and quality of life and may differ from the perception of the attending physician. This study aimed to compare the aesthetic outcomes and satisfaction with conservative oncoplastic surgeries, mastectomies, and total breast reconstruction. METHODS We included 760 women diagnosed with invasive breast carcinoma or phyllodes tumors who returned at least 6 months after surgery or radiotherapy at two public hospitals and a private clinic between 2014 and 2022. Data was collected prospectively from patients and retrospectively from their medical records using a specific form after obtaining their informed consent. Aesthetic outcomes and quality of life were assessed using the BREAST-Q©, Harris Scale, and BCCT.core software. Data were evaluated using the SPSS statistical software. Statistical significance was set at p < 0.05. This study was approved by the hospital ethics committees. RESULTS A total of 405 (53.29%) partial and 355 (46.71%) total reconstructions were included. Patients who underwent partial reconstruction were older and had higher body mass index. Patients who underwent total reconstruction had larger tumors with advanced clinical and pathological stages. Clinical and surgical complications occurred more frequently in the total reconstruction group. A greater number of reparative surgeries and lipofilling procedures were required for total reconstruction. According to the BREAST-Q, the partial reconstruction group showed significantly higher levels of women's satisfaction with their breasts, the surgical outcomes, psychosocial and sexual well-being, provision of information, and the reconstructive surgeon. Only physical well-being was slightly higher in the total reconstruction group. In most cases, the results were rated good or excellent. Physicians considered partial reconstructions to have better results than total reconstructions, although this difference was not perceived by the BCCT.core software. CONCLUSION Women who underwent partial breast reconstruction had higher levels of satisfaction in several domains, lower frequency of complications, and required fewer surgeries to complete their reconstruction than women who underwent total reconstruction. Physicians were also more satisfied with the results of partial reconstructions.
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Affiliation(s)
| | - Régis Resende Paulinelli
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil; Breast and Gynecology Unit, Araújo Jorge Cancer Hospital, Goiás Cancer Combat Association, Brazil
| | | | | | | | - Rosemar Macedo Sousa Rahal
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Ruffo Freitas-Júnior
- Mastology Program, Department of Gynecology and Obstetrics, Federal University of Goiás, Goiânia, Goiás, Brazil; Breast and Gynecology Unit, Araújo Jorge Cancer Hospital, Goiás Cancer Combat Association, Brazil
| | - João Batista de Sousa
- Faculty of Medicine, University of Brasília - UnB, Distrito Federal, Brasília, Brazil
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Vieira RADC, Paulinellli RR, Rodrigues FFO, Moreira MAR, Caponero R, Pessoa EC, Rahal RMS, Facina G, de Freitas R. Criteria for selection and classification of studies in medical events. Rev Assoc Med Bras (1992) 2023; 69:e20220888. [PMID: 37075364 PMCID: PMC10176649 DOI: 10.1590/1806-9282.20220888] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/19/2022] [Indexed: 04/21/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. METHODS A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach's alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi's all-pairs comparisons. RESULTS A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01). CONCLUSION Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies.
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Affiliation(s)
- René Aloisio da Costa Vieira
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-Graduação em Tocoginecologia – Botucatu (SP), Brazil
| | | | | | | | | | - Eduardo Carvalho Pessoa
- Universidade Estadual Paulista “Júlio de Mesquita Filho”, Faculdade de Medicina de Botucatu, Programa de Pós-Graduação em Tocoginecologia – Botucatu (SP), Brazil
| | | | - Gil Facina
- Universidade Federal de São Paulo – São Paulo (SP), Brazil
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Rocha AFBM, Freitas-Junior R, Ferreira GLR, Rodrigues DCN, Rahal RMS. COVID-19 and Breast Cancer in Brazil. Int J Public Health 2023; 68:1605485. [PMID: 36938303 PMCID: PMC10020228 DOI: 10.3389/ijph.2023.1605485] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 02/24/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: This study aimed to evaluate COVID-19 effects on breast cancer screening and clinical stage at diagnosis in patients of 50-69 years of age receiving care within the public healthcare network (SUS) in 2013-2021 in Brazil and its macro-regions. Methods: This ecological study used Poisson regression to analyze trends in screening and staging. A secondary database was formed using SUS sources: outpatient data system of the SUS network and Oncology-Brazil Panel. Results: There was a reduction in screening, with an annual percent change of -5.9 (p < 0.022). The number of notified cases fell by 31.5% in 2020-2021 compared to 2018-2019. There was a 10.7% increase in the proportion of stage III/IV cases (p < 0.001) in 2020-2021 compared to 2013-2019, now surpassing the number of cases of early stage breast cancer. Conclusion: COVID-19 led to a reduction in breast cancer screening and an expressive increase in advanced tumors in users of the public healthcare network. Urgent interventions in public policies are required as the negative effects of the pandemic on the diagnosis/treatment of breast cancer are becoming apparent even earlier than expected.
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Affiliation(s)
- Aline Ferreira Bandeira Melo Rocha
- Postgraduate Program in Health Sciences, Federal University of Goiás, Goiânia, Brazil
- *Correspondence: Aline Ferreira Bandeira Melo Rocha,
| | - Ruffo Freitas-Junior
- Advanced Center for Breast Diagnosis (CORA), Federal University of Goiás, Goiânia, Brazil
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Gobbi H, Carvalho FM, Rahal RMS, Klôh MI, Pitol DL. Optimizing pathological assessment of breast cancer in Brazil: recommendations from a multidisciplinary working group on the tumor-tissue journey. Surg Exp Pathol 2022. [DOI: 10.1186/s42047-022-00121-x] [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: 11/07/2022] Open
Abstract
AbstractTimely and correct assessment of histopathological, immunohistochemical and molecular features of biopsy and surgical specimens is of paramount importance in the provision of care to patients with breast cancer, particularly in the current era of precision oncology. In order to ensure that tissue samples are obtained, processed, analyzed and reported in an optimal way, a concerted effort is required by institutions and individuals, taking into account state-of-the-art scientific and technical knowledge and circumventing logistic and operational constraints. This may be particularly challenging in some settings due to several sources of economic, structural, organizational and communication inefficiencies. In the current article, we present a brief review of breast cancer epidemiology and challenges in the disease diagnosis, especially in Brazil, and report the results of a multidisciplinary working group convened in May 2020 in an expert panel to identify and discuss the barriers and challenges related to the journey of breast cancer samples in Brazil. Following the identification of the issues, the working group also discussed and proposed recommendations for improving the journey and quality of breast cancer samples based on their professional experience and the current scientific literature, including guidelines of national and international health organizations (e.g. World Health Organization), consensus of medical societies and other published literature on the topic. We outline the most salient issues related to that journey in Brazilian public and private medical institutions, based on the experts’ clinical experience, since all of them are actively working at both sectors, and discuss current recommendations to address these issues aiming at mitigating and preventing preanalytical and analytical issues affecting diagnostic and therapeutic decisions. Such issues are grouped under four headings pertaining to education, communication, procedures in the operating room and sample transportation, and procedures in the pathology laboratory. Selected recommendations based on the current literature and discussed by the group of Brazilian experts are reviewed, which may mitigate the issues identified and optimize diagnostic and therapeutic decisions for patients with breast cancer, currently the most frequent malignant tumor worldwide and in Brazil. This paper has been submitted and published jointly, upon invitation and consent, in both the Surgical and Experimental Pathology and the Mastology journals.
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Nascimento S, Rahal RMS, Soares LR, de Souza Pimentel HJ, Kamimura TO, Freitas-Junior R. Publication rate of scientific papers presented at the largest event on breast cancer research in Latin America. Ecancermedicalscience 2021; 15:1259. [PMID: 34567244 PMCID: PMC8426010 DOI: 10.3332/ecancer.2021.1259] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Indexed: 11/25/2022] Open
Abstract
Purpose Medical congresses allow scientific production to be appropriately disseminated and discussed. However, most of the scientific papers presented at medical congresses do not go on to be published in indexed journals. The present study aimed to determine the publication rate of papers presented at the Brazilian Breast Cancer Symposium (BBCS) and trends associated with publication over that timeframe. Methods This was a retrospective, observational study evaluating scientific papers presented at the BBCS between 2012 and 2017. All the abstracts presented at the event within this timeframe were recorded. Next, a search for papers was made using online databases (BIREME/LILACS and MEDLINE/PubMed) and in the curricula of the authors on the Lattes Platform. Results Overall, 543 abstracts of papers presented at the BBCS between 2012 and 2017 were included. Of these, 112 (20.6%) had been published in an indexed journal, mostly in English (67.0%), in journals with an impact factor of 2.0–3.0 (21.4%) and ≥1 year after presentation at the event (75.9%). The factors associated with publication were: study conducted in a public institution (p = 0.01), oral or commented poster presentation (p > 0.001) and study concerning rehabilitation following breast cancer (p = 0.04). There was a downward trend in the rate of publication of articles over the years (p = 0.01). Conversely, the impact factor of the publications increased significantly between 2012 and 2017 (p = 0.04). Conclusion The publication rate of papers presented at the BBCS is low and remains consistent over the study period despite academic incentives and substantial awards.
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Affiliation(s)
- Sergio Nascimento
- Faculty of Medicine, School of Medicine, The Federal University of Goiás, Rua 235 s/nº, Setor Leste Universitário, 74605050 Goiânia, GO, Brazil.,Advanced Center for Breast Diagnosis (CORA), Teaching Hospital, Federal University of Goiás, Primeira avenida s/nº, Setor Leste Universitário, 74605020 Goiânia, GO, Brazil.,School of Medicine, Alfredo Nasser University, Av Bela Vista, nº 26, Jardim Esmeraldas, 74905020 Aparecida de Goiânia, GO, Brazil.,https://orcid.org/0000-0003-1294-2524
| | - Rosemar Macedo Sousa Rahal
- Faculty of Medicine, School of Medicine, The Federal University of Goiás, Rua 235 s/nº, Setor Leste Universitário, 74605050 Goiânia, GO, Brazil.,Advanced Center for Breast Diagnosis (CORA), Teaching Hospital, Federal University of Goiás, Primeira avenida s/nº, Setor Leste Universitário, 74605020 Goiânia, GO, Brazil.,https://orcid.org/0000-0003-3619-0603
| | - Leonardo Ribeiro Soares
- Faculty of Medicine, School of Medicine, The Federal University of Goiás, Rua 235 s/nº, Setor Leste Universitário, 74605050 Goiânia, GO, Brazil.,Advanced Center for Breast Diagnosis (CORA), Teaching Hospital, Federal University of Goiás, Primeira avenida s/nº, Setor Leste Universitário, 74605020 Goiânia, GO, Brazil.,School of Medicine, Alfredo Nasser University, Av Bela Vista, nº 26, Jardim Esmeraldas, 74905020 Aparecida de Goiânia, GO, Brazil.,https://orcid.org/0000-0002-9448-6114
| | - Herik Jansen de Souza Pimentel
- School of Medicine, Alfredo Nasser University, Av Bela Vista, nº 26, Jardim Esmeraldas, 74905020 Aparecida de Goiânia, GO, Brazil.,https://orcid.org/0000-0002-4411-0397
| | - Tágara Oliveira Kamimura
- School of Medicine, Alfredo Nasser University, Av Bela Vista, nº 26, Jardim Esmeraldas, 74905020 Aparecida de Goiânia, GO, Brazil.,https://orcid.org/0000-0002-5053-1040
| | - Ruffo Freitas-Junior
- Faculty of Medicine, School of Medicine, The Federal University of Goiás, Rua 235 s/nº, Setor Leste Universitário, 74605050 Goiânia, GO, Brazil.,Advanced Center for Breast Diagnosis (CORA), Teaching Hospital, Federal University of Goiás, Primeira avenida s/nº, Setor Leste Universitário, 74605020 Goiânia, GO, Brazil.,https://orcid.org/0000-0003-4145-8598
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Rahal RMS, Rocha ME, Freitas-Junior R, Correa RDS, Rodrigues D, Martins E, Soares LR, Oliveira JC. Trends in the Incidence of Breast Cancer Following the Radiological Accident in Goiânia: A 25-Year Analysis. Asian Pac J Cancer Prev 2019; 20:3811-3816. [PMID: 31870126 PMCID: PMC7173397 DOI: 10.31557/apjcp.2019.20.12.3811] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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: 09/23/2019] [Indexed: 01/04/2023] Open
Abstract
Background: The largest radiological accident to occur in any urban area happened in Goiânia, Brazil, in 1987. One major concern regarding deleterious effects in the population was a possible increase in the breast cancer incidence. This study analyzed trends in the incidence of breast cancer over the 25-year period following the radiological accident. Methods: This ecological, population-based study was conducted to determine the incidence of breast cancer in female residents of Goiânia, Goiás, Brazil, between 1988 and 2012. The data were collected from the Goiânia population-based cancer registry. Crude and age-standardized incidence rates were calculated. The Joinpoint software program was used to calculate annual percent changes (APC) in the incidence of breast cancer. Results: Overall, 7,365 new cases of breast cancer were identified, with an annual crude incidence rate of 23.09/100,000 women in 1988 and of 71.65/100,000 women in 2012. The age-standardized incidence rate was 35.63/100,000 women in 1988 and 65.63/100,000 women in 2012. Analysis of the APC showed a significant annual increase of 4.8% in the incidence between 1988 and 2005 (p<0.0001) followed by stabilization in 2005-2012, with an APC of -3.5% (p=0.1). Conclusion: There was an increase in the incidence of breast cancer in the female residents of Goiânia, Goiás in the first 17 years of evaluation (1988-2004) followed by a period of stabilization until 2012. However, the trends in the incidence suggest a lack of association with the radiological accident.
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Affiliation(s)
- Rosemar Macedo Sousa Rahal
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
| | - Marina Elias Rocha
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
| | - Ruffo Freitas-Junior
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
| | | | - Danielle Rodrigues
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
| | - Edesio Martins
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
| | - Leonardo Ribeiro Soares
- Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goias, Goias, Brazil
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, da Silveira Corrêa R, Gouveia PA, Peixoto JE, Martins E, Soares LR. Temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service between 2008 and 2017. BMC Public Health 2019; 19:959. [PMID: 31319826 PMCID: PMC6637648 DOI: 10.1186/s12889-019-7278-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [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: 07/18/2018] [Accepted: 07/03/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND In Brazil, 70% of the population depends on the public healthcare system. Since early detection is considered crucial, this study aimed to evaluate temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service (SUS) according to the different regions of the country between 2008 and 2017. METHODS This ecological study analyzed data on breast cancer screening within the SUS for women aged 50-69 years. Coverage was calculated from the ratio between the number of screening tests conducted and the expected number for the target population. Joinpoint regression analysis was used to calculate annual percent changes (APC) in coverage. RESULTS Around 19 million mammograms were performed in 50-69-year old women within the SUS between 2008 and 2016. The estimated APC indicates that breast cancer screening coverage increased by 14.5% annually in Brazil between 2008 and 2012 (p < 0.01), with figures stabilizing between 2012 and 2017 as shown by an APC of - 0.4% (p = 0.3). In the five geographic regions of the country, the APC initially increased, then stabilized in the north, northeast and southeast and decreased in the south and Midwest. Of the 26 states, coverage increased in seven and remained stable in six. In the other 13, there was an initial increase followed by stabilization in 11, and a reduction in coverage in two. In the Federal District, coverage remained stable throughout the study period. CONCLUSION Evaluation of the temporal changes in breast cancer screening coverage provided under the Brazilian National Health Service revealed an initial increase, confirming that public policies were effective, although insufficient to ensure organized screening. There appears to be a lack of uniformity between the different regions and states and this situation is highlighted in the final 5-year period, with the APC reflecting stabilization of breast cancer screening coverage.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosemar Macedo Sousa Rahal
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Rosangela da Silveira Corrêa
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - Pollyana Alves Gouveia
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
| | - João Emílio Peixoto
- Brazilian Breast Cancer Research Network, Division of Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Edésio Martins
- Brazilian Breast Cancer Research Network, Faculdade Unida de Campinas, Goiânia, Goiás, Brazil
| | - Leonardo Ribeiro Soares
- Brazilian Breast Cancer Research Network, Advanced Center for Breast Diagnosis (CORA), School of Medicine, Federal University of Goiás, Primeira Avenida, s/n, Bloco II, Setor Universitário, Goiânia, Goiás, 74605-020, Brazil
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Rodrigues DCN, Freitas-Junior R, Rahal RMS, Correa RDS, Peixoto JE, Ribeiro NV, Ferreira NC, Soares LR. Difficult Access and Poor Productivity: Mammography Screening in Brazil. Asian Pac J Cancer Prev 2019; 20:1857-1864. [PMID: 31244310 PMCID: PMC7021592 DOI: 10.31557/apjcp.2019.20.6.1857] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Factors that may hamper access to mammographic screening in any given region include socioeconomic
limitations and the geographical distribution and quality of the mammography machines. This study evaluated access
to breast cancer screening within the Brazilian National Health Service (SUS), the geographical distribution of
mammography equipment and the number of mammograms performed in Brazil. Methods: This ecological study
evaluated the availability of mammography machines within the SUS, those available for Brazil as a whole, its macroregions,
states and the Federal District in 2016. The number of mammography machines required for breast cancer
screening was calculated and compared to the number of machines available. The expected number of mammograms was
compared with the actual number performed. Machines were georeferenced based on their location and the municipal
seat, according to healthcare region, with 60 km being defined as the maximum distance for an individual to travel for
a mammogram. Results: In 2016, there were 4,628 mammography machines in Brazil. Of these, 4,492 were in use
and 2,113 (47%) were available to the SUS. Considering the number of mammograms required as a function of the
number clinically indicated, 2,068 machines would be required for breast cancer screening in Brazil. The network of
machines available would be capable of producing 14,279,654 exams; however, only 4,073,079 exams were performed,
representing 29% of the total capacity of production in the country in 2016. Regarding the maximum distance of 60
km to access a mammogram, only relatively small areas of Brazil were found not to meet this indicator. Conclusion:
These results suggest that the difficulty of the Brazilian population in accessing breast cancer screening through the
SUS is not associated with the number of machines available or with the geographical location of the equipment but
rather with the insufficient number of mammograms performed.
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Affiliation(s)
- Danielle Cristina Netto Rodrigues
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Ruffo Freitas-Junior
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosemar Macedo Sousa Rahal
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - Rosangela da Silveira Correa
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
| | - João Emílio Peixoto
- Brazilian Network for Breast Research, Service for Quality Control in Ionizing Radiation, National Cancer Institute (INCA), Rio de Janeiro, RJ, Brazil
| | - Noely Vicente Ribeiro
- Institute of Social and Environmental Studies (IESA), Federal University of Goiás, Goiânia, Goiás, Brazil
| | | | - Leonardo Ribeiro Soares
- Brazilian Network for Breast Research, Advanced Breast Diagnosis Center (CORA), School of Medicine, Federal University of Goiás, Goiânia, Goiás, Brazil.
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Freitas Júnior RD, Becker TS, Rahal RMS, Paulinelli RR, Soares LR. Incisões cirúrgicas mamárias tratadas com 2-octilcianoacrilato versus sutura intradérmica com fio de nylon: ensaio clínico randomizado. Rev Col Bras Cir 2019; 46:e20192286. [DOI: 10.1590/0100-6991e-20192286] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Accepted: 08/10/2019] [Indexed: 12/25/2022] Open
Abstract
RESUMO Objetivo: avaliar o perfil de segurança e os resultados estéticos do 2-octilcianoacrilato versus sutura intradérmica com fio de nylon em cirurgias mamárias. Métodos: ensaio clínico randomizado, aberto, que avaliou a ocorrência de complicações, como deiscência, hematoma, infecção e reações alérgicas após o uso do 2-octilcianoacrilato ou do fio de nylon. Também foi analisado o tamanho das incisões, o tempo de fechamento da pele e o tempo cirúrgico total. O resultado estético foi avaliado após 40 e 180 dias da cirurgia, por meio da largura média da ferida operatória e por avaliação subjetiva conceitual (ótimo, bom, razoável ou ruim). Resultados: foram incluídas 79 pacientes, sendo 37 no grupo 2-octilcianoacrilato e 42 no grupo de sutura com fio de nylon. O estudo foi interrompido antes do término do recrutamento dos pacientes pela ocorrência de maior número de deiscências no grupo do adesivo (OR: 11,42; IC95%: 1,36-96,02; p=0,007). Em relação às demais complicações analisadas, ao tempo cirúrgico e ao resultado estético no pós-operatório, não se observaram diferenças significativas entre os grupos. A média do tamanho da ferida operatória foi maior no grupo do adesivo em relação ao grupo da sutura, mas não houve correlação entre o tamanho da ferida e o maior número de deiscências. Conclusão: o 2-octilcianoacrilato apresentou maior risco de deiscência em relação à sutura intradérmica, com resultados estéticos equivalentes.
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Freitas-Junior R, Ribeiro LFJ, Moreira MAR, Queiroz GS, Esperidião MD, Silva MAC, Pereira RJ, Zampronha RAC, Rahal RMS, Soares LR, dos Santos DL, Thomazini MV, de Faria CFS, Paulinelli RR. Complete axillary dissection without drainage for the surgical treatment of breast cancer: a randomized clinical trial. Clinics (Sao Paulo) 2017; 72:426-431. [PMID: 28793003 PMCID: PMC5525160 DOI: 10.6061/clinics/2017(07)07] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE: This randomized clinical trial evaluated the possibility of not draining the axilla following axillary dissection. METHODS: The study included 240 breast cancer patients who underwent axillary dissection as part of conservative treatment. The patients were divided into two groups depending on whether or not they were subjected to axillary drainage. ClinicalTrials.gov: NCT01267552. RESULTS: The median volume of fluid aspirated was significantly lower in the axillary drainage group (0.00 ml; 0.00 - 270.00) compared to the no drain group (522.50 ml; 130.00 - 1148.75). The median number of aspirations performed during conservative breast cancer treatment was significantly lower in the drainage group (0.5; 0.0 - 4.0) compared to the no drain group (5.0; 3.0 - 7.0). The total volume of serous fluid produced (the volume of fluid obtained from drainage added to the volume of aspirated fluid) was similar in the two groups. Regarding complications, two cases (2.4%) of wound dehiscence occurred in the drainage group compared to 13 cases (13.5%) in the group in which drainage was not performed, with this difference being statistically significant. Rates of infection, necrosis and hematoma were similar in both groups. CONCLUSION: Safety rates were similar in both study groups; hence, axillary dissection can feasibly be performed without drainage. However, more needle aspirations could be required, and there could be more cases of wound dehiscence in patients who do not undergo auxiliary drainage.
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Affiliation(s)
- Ruffo Freitas-Junior
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
- *Corresponding author. E-mail:
| | | | | | - Geraldo Silva Queiroz
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | | | - Rubens José Pereira
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | - Rosemar Macedo Sousa Rahal
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
| | - Leonardo Ribeiro Soares
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
| | | | - Maria Virginia Thomazini
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
| | | | - Régis Resende Paulinelli
- Gynecology and Breast Unit, Hospital Araújo Jorge, Goiás Anticancer Association, Goiânia, GO, BR
- Breast Program, Department of Gynecology and Obstetrics, School of Medicine, Federal University of Goiás, Goiânia, GO, BR
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Freitas-Júnior R, Gagliato DM, Moura Filho JWC, Gouveia PA, Rahal RMS, Paulinelli RR, Oliveira LFP, Freitas PF, Martins E, Urban C, Lucena CÊM. Trends in breast cancer surgery at Brazil's public health system. J Surg Oncol 2017; 115:544-549. [PMID: 28168857 DOI: 10.1002/jso.24572] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [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: 12/22/2016] [Accepted: 01/07/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES To analyze time trend patterns in Breast Cancer (BC) surgeries performed at Brazil's Public Health System, known as SUS from 2008 to 2014. METHODS Ecological study of time series, based on the database system from SUS. Information on surgical procedures performed for BC treatment was collected. Analysis of the absolute number of surgeries was performed using Poisson Regression through Jointpoint Regression, and the trends were calculated through the annual percentage change (APC), with a confidence interval (CI) of 95%, and statistical significance when P < 0.05. RESULTS Data analysis from 193.596 breast surgeries revealed a reduced number of simple mastectomies (APC -4.4%; CI -7.4 to -1.4; P < 0.05); stable trends in radical mastectomy with lymphadenectomy (APC -1.0%; CI -2.4 to 0.5; P = 0.1) and breast conserving surgery (APC 0.4%; CI -1.6 to 2.4; P = 0.6). Also, we observed a reduced number of axillary lymphadenectomy dissection (APC -16.8%; CI -26.8 to -5.4; P < 0.05); increased trends in breast reconstruction with implants after 2011 (APC 9.1%; CI 0.1-18.8; P < 0.05) and with flaps after 2012 (APC 61.3%; CI 41.3-84.0; P < 0.05). The overall rate of patients with breast reconstruction increased from 15% in 2008 to 29.2% in 2014. CONCLUSIONS We found a significant increase in breast reconstruction in public health system in Brazil, and also a reduction in simple mastectomy and axillary lymphadenectomy.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Edesio Martins
- Clinical Hospital of the Federal University of Goias, Goiania, Brazil
| | - Cicero Urban
- Centro de Oncologia do Paraná, Curitiba, Brazil.,Positive University, Curitiba, Brazil
| | - Clécio Ênio Murta Lucena
- Santa Casa of Belo Horizonte, Faculty of Medical Sciences of Minas Gerais, Belo Horizonte, Brazil
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Freitas-Junior R, Rodrigues DCN, Corrêa RDS, Peixoto JE, de Oliveira HVCG, Rahal RMS. Contribution of the Unified Health Care System to mammography screening in Brazil, 2013. Radiol Bras 2016; 49:305-310. [PMID: 27818544 PMCID: PMC5094819 DOI: 10.1590/0100-3984.2014.0129] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective To estimate the coverage of opportunistic mammography screening performed via
the Brazilian Sistema Único de Saúde (SUS, Unified Health Care
System), at the state and regional level, in 2013. Materials and Methods This was an ecological study in which coverage was estimated by determining
the ratio between the number of mammograms performed and the expected number
of mammograms among the population of females between 50 and 69 years of
age. The number of mammograms performed in the target population was
obtained from the Outpatient Database of the Information Technology
Department of the SUS. To calculate the expected number of mammograms, we
considered 58.9% of the target population, the proportion that would be
expected on the basis of the recommendations of the Brazilian National
Cancer Institute. Results In 2013, the estimated national coverage of mammography screening via the SUS
was 24.8%. The mammography rate ranged from 12.0% in the northern region to
31.3% in the southern region. When stratified by state, coverage was lowest
in the state of Pará and highest in the state of Santa Catarina (7.5%
and 35.7%, respectively). Conclusion The coverage of mammography screening performed via the SUS is low. There is
a significant disparity among the Brazilian states (including the Federal
District of Brasília) and among regions, being higher in the
south/southeast and lower in the north/northeast.
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Affiliation(s)
- Ruffo Freitas-Junior
- PhD, Professor and Coordinator of the Breast Disease Program at the Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Danielle Cristina Netto Rodrigues
- PhD, Psychologist, Member of the Goiânia Breast Disease Research Network and Breast Disease Program at the Faculdade de Medicina da Universidade Federal de Goiás (UFG), Goiânia, GO, Brazil
| | - Rosangela da Silveira Corrêa
- PhD, Senior Technologist for the Comissão Nacional de Energia Nuclear/Centro Regional de Ciências Nucleares do Centro-Oeste, Goiânia, GO, Brazil
| | - João Emílio Peixoto
- PhD, Medical Physicist, Consultant for the Ionizing Radiation Quality Control Sector of the Instituto Nacional de Câncer (INCA), Rio de Janeiro, RJ, Brazil
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de Morais FD, Freitas-Junior R, Rahal RMS, Gonzaga CMR. Sociodemographic and clinical factors affecting body image, sexual function and sexual satisfaction in women with breast cancer. J Clin Nurs 2016; 25:1557-65. [DOI: 10.1111/jocn.13125] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2015] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ruffo Freitas-Junior
- Department of Obstetrics and Gynecology; Hospital das Clínicas of the Federal University of Goiás (UFG); Goiânia Brazil
| | - Rosemar Macedo Sousa Rahal
- Department of Obstetrics and Gynecology; Hospital das Clínicas of the Federal University of Goiás (UFG); Goiânia Brazil
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Freitas R, Siqueira LB, Carrijo ENDA, Lacerda RP, Paulinelli RR, Rahal RMS, Oliveira LFP. Temporal variation of breast cancer surgical treatment in a university hospital in Brazil's Central West region. Rev Col Bras Cir 2014; 40:180-5. [PMID: 23912363 DOI: 10.1590/s0100-69912013000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 08/28/2012] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To assess the types of surgical treatments for breast cancer performed by the Mastology program of the Clinics Hospital, Federal University of Goiás (HC-UFG). METHODS We conducted a cross-sectional, cohort study on the breast operations performed at HC-UFG from January 2002 to December 2009. We evaluated the surgical records for: surgical time and size, surgeon, type of operation, diagnosis, and type of anesthesia. The medical charts were researched for: pathology report of the tumor, lymph node involvement, primary tumor size, staging and performance of neoadjuvant therapies. We excluded operations for the removal of benign breast tumors. The temporal variation was analyzed using Poisson regression, considering the annual percentage change (APC). RESULTS 403 operations were performed for breast cancer during the study period, with an average of 50.38 operations per year. The most common histological type was invasive ductal carcinoma (72.6%). The mean age of patients was 52 years, and 29% had disease in stages III and IV. The temporal trend revealed a significant increase in tumor size (p <0.01), the clinical stages III and IV (p = 0.01) and the use of neoadjuvant chemotherapy (p = 0.02). There was increase in mastectomies (APC = 9 cases/year, p = .04). There was no increase in cases of breast conservation treatments or of mastectomies with immediate reconstruction. CONCLUSION In recent years, the HC-UFG has had an increased number of mastectomies as a result of increased incidence of locoregionally advanced breast cancer.
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Affiliation(s)
- Ruffo Freitas
- Faculdade de Medicina, Universidade Federal de Goiás-UFGO, Goiânia, Goiás State, Brazil.
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Rodrigues DCN, Freitas-Junior R, Corrêa RDS, Peixoto JE, Tomazelli JG, Rahal RMS. Performance of diagnostic centers in the classification of opportunistic screening mammograms from the Brazilian public health system (SUS). Radiol Bras 2013. [DOI: 10.1590/s0100-39842013000300008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To evaluate the performance of diagnostic centers in the classification of mammography reports from an opportunistic screening undertaken by the Brazilian public health system (SUS) in the municipality of Goiânia, GO, Brazil in 2010. Materials and Methods The present ecological study analyzed data reported to the Sistema de Informação do Controle do Câncer de Mama (SISMAMA) (Breast Cancer Management Information System) by diagnostic centers involved in the mammographic screening developed by the SUS. Based on the frequency of mammograms per BI-RADS® category and on the limits established for the present study, the authors have calculated the rate of conformity for each diagnostic center. Diagnostic centers with equal rates of conformity were considered as having equal performance. Results Fifteen diagnostic centers performed mammographic studies for SUS and reported 31,198 screening mammograms. The performance of the diagnostic centers concerning BI-RADS classification has demonstrated that none of them was in conformity for all categories, one center presented conformity in five categories, two centers, in four categories, three centers, in three categories, two centers, in two categories, four centers, in one category, and three centers with no conformity. Conclusion The results of the present study demonstrate unevenness in the diagnostic centers performance in the classification of mammograms reported to SISMAMA from the opportunistic screening undertaken by SUS.
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Freitas-Junior R, Correa RS, Peixoto JE, Rodrigues DCN, Rahal RMS. Abstract P3-02-13: ANALYSIS OF INFRASTRUCTURE FOR MAMMOGRAPHY SCREENING IN THE STATE OF GOIAS, BRAZIL, 2010. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p3-02-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Objective: Assess the infrastructure for mammography screening in the state of Goiás, Brazil, taking into consideration the quality of the image generated by the equipment and the dose received by the patients, according to the type of technology (conventional and digital mammography).
Methods: Cross-sectional study in which the observational units were the diagnostic imaging services that were in operation in 2010. In an in loco visit, we collected information on the equipment and performed tests to assess quality of the image, accuracy values for tube tension, quality of X-ray beam, and dose at the simulator entrance. The percentage of mammography equipments in conformity with the parameters evaluated was calculated, and the mean glandular tissue dose (Dg) was estimated based on the dose at the simulator entrance. To assess quality of the image and the radiation dose, we used a standard breast simulator (5.3 cm thickness and 50% glandular tissue).
Results: In 2010, 102 services were in operation, using 106 equipments. Among these, 100 (94.3%) – 64 conventional and 36 digital mammography equipments – had their performance and dose assessed. The visualization of fibers (p = 0.044) and the dose at the simulator entrance (p = 0.042) were the parameters that presented differences between the types of technology.
The mean dose at the simulator entrance was 9.75 mGy (± 2.46) in conventional and 14.93 mGy (± 8.39) in digital equipments (p < 0.001); 12% of the conventional and 50% of the digital equipments presented Dg above the limit established by the European guidelines.
Conclusion: The infrastructure for mammography screening in the state of Goias, Brazil, in 2010 presented acceptable quality standard according to international guidelines. However, the radiation doses were heterogeneous between the two types of technology, with a predominance of higher doses in digital equipments.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P3-02-13.
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Affiliation(s)
- R Freitas-Junior
- Federal University of Goias, Goiania, Goias, Brazil; Comissão Nacional de Energia Nuclear, Goiania, Goias, Brazil; National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil
| | - RS Correa
- Federal University of Goias, Goiania, Goias, Brazil; Comissão Nacional de Energia Nuclear, Goiania, Goias, Brazil; National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil
| | - J-E Peixoto
- Federal University of Goias, Goiania, Goias, Brazil; Comissão Nacional de Energia Nuclear, Goiania, Goias, Brazil; National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil
| | - DCN Rodrigues
- Federal University of Goias, Goiania, Goias, Brazil; Comissão Nacional de Energia Nuclear, Goiania, Goias, Brazil; National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil
| | - RMS Rahal
- Federal University of Goias, Goiania, Goias, Brazil; Comissão Nacional de Energia Nuclear, Goiania, Goias, Brazil; National Cancer Institute of Brazil, Rio de Janeiro, RJ, Brazil
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Freitas R, Freitas NMA, Curado MP, Martins E, Silva CMB, Rahal RMS, Queiroz GS. Incidence trend for breast cancer among young women in Goiânia, Brazil. SAO PAULO MED J 2010; 128:81-4. [PMID: 20676574 PMCID: PMC10938973 DOI: 10.1590/s1516-31802010000200007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Revised: 09/08/2009] [Accepted: 02/22/2010] [Indexed: 11/21/2022] Open
Abstract
CONTEXT AND OBJECTIVE It has been suggested that there has been a large increase in breast cancer incidence among young women over the last decade. The aim of this study was to describe the incidence of breast cancer among young women up to 39 years of age in Goiânia, between 1988 and 2003, and to compare this with other age groups. DESIGN AND SETTING Retrospective study using the database of the Population-based Cancer Registry of Goiânia, State of Goiás, Brazil. METHODS The incidence was calculated according to age groups: up to 39 years, 40 to 59 years and 60 years and over. Average annual percentage changes (AAPCs) were estimated for the different age groups using Poisson regression. RESULTS Over this period, 3,310 new cases were recorded. The standardized incidence was 2.89/100,000 in 1988 and increased to 6.37/100,000 in 2003 (R(2) = 0.52) for the group aged up to 39 years (p < 0.003). For the group from 40 to 59 years old, the incidence was 14.39/100,000 in 1988 and 41.70/100,000 in 2003 (R(2) = 0.85; p < 0.001). For the group aged 60 years and over, it was 17.62/100,000 and 28.49/100,000, respectively (R(2) = 0.67; p < 0.001). The AAPCs were 5.22%, 5.53% and 4.54% for the age groups up to 39, 40 to 59 and 60 years and over, respectively. CONCLUSIONS The incidence of breast cancer among young women in Goiânia has been increasing significantly, although this change was similar to the increase in other age groups.
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Affiliation(s)
- Ruffo Freitas
- Goiás Mastology Research Network, Goiânia, Goiás, Brazil.
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Freitas-Júnior RD, Paulinelli RR, Rahal RMS, Moreira MAR, Oliveira ELCD, Aiko KF, Approbato MS. Estudo experimental comparando o uso do 2-octil cianoAcrilato ao nylon 4-0 na sutura da pele. Rev Col Bras Cir 2008. [DOI: 10.1590/s0100-69912008000300011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Comparar o 2-octil cianoacrilato com o fio de "nylon" no fechamento da pele em ratos. MÉTODOS: Vinte e cinco ratos da linhagem Wistar, foram submetidos à incisão de 3 cm de cada lado do abdome. A síntese foi feita utilizando em um dos lados o "nylon" 4.0, pontos intradérmicos, e do outro o 2-octil cianoacrilato. Após sete dias, o fio foi removido e as incisões, analisadas quanto às complicações. Após 40 dias, o resultado da cicatriz foi avaliado. Os ratos foram sacrificados, as cicatrizes foram ressecadas, fixadas e enviadas ao patologista, sem informação sobre qual o método utilizado. RESULTADOS: Houve dois óbitos durante a anestesia e um tardio. O tempo de operação foi de 136 segundos com a cola e 176 segundos, com o "nylon" (P=0,003). Dentre as 50 operações realizadas, as complicações foram: um hematoma com cada método (P=0,80), quinze deiscências da cola contra 11 do "nylon" (P=0,20), sete cicatrizes de aspecto ruim ou razoável da cola contra quatro do "nylon" (P=0,30), três infecções na cola contra duas (P=0,40). Ao exame patológico, a mediana da largura da cicatriz foi de 1.119 micra com a cola e 1.800 com o "nylon" (P=0,40). A espessura foi de 1.795 contra 1.705 micra (P=0,40). CONCLUSÃO: O 2-octil cianoacrilato apresentou o mesmo aspecto cicatricial, a mesma resistência e as mesmas complicações que a sutura com o "nylon" 4.0, porém permitindo redução no tempo cirúrgico.
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Cardoso AA, Paulinelli RR, Freitas-Júnior R, Rahal RMS, Jacinto TF. Análise comparativa da técnica da incisão em duplo círculo com as técnicas com incisão periareolar e transareolomamilar de correção cirúrgica da ginecomastia. Rev Bras Ginecol Obstet 2007. [DOI: 10.1590/s0100-72032007000900005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Freitas R, Fiori WF, Ramos FJDF, Godinho E, Rahal RMS, de Oliveira JG. Desconforto e dor durante realização da mamografia. Rev Assoc Med Bras (1992) 2006; 52:333-6. [PMID: 17160308 DOI: 10.1590/s0104-42302006000500021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [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: 07/25/2005] [Accepted: 10/18/2005] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION Mammography is the most important method for early detection of breast cancer, however, patients frequently complain of discomfort and pain. OBJECTIVE Evaluate how often discomfort and pain are felt during mammography and identify factors that may be associated to these complaints. METHODS A prospective study including 2,164 patients recruited from public (996) and private (1,168) health services was carried out. After the imaging procedure, patients quantified pain using a linear analogical scale. Discomfort was qualitatively evaluated by multivariate analysis. RESULTS Discomfort was reported by 90% of the patients, and of these 12% rated the sensation as intense or intolerable. Only 2% of the women in the study group did not feel any pain during the procedure. Factors associated to pain were: age, use of birth control methods (BCM), previous mastalgia and patients from the private health sector. Discomfort was independently associated to the service where the procedure was performed (OR = 2.50 IC 1.64-5.17) and to previous mastalgia (OR = 3.15 IC 1.96-7.12). When asked about a repeat mammography, 98% of the patients said they would comply. CONCLUSION Young women (< 50 years), BCM users, mastalgia patients and women who were using the services of a private clinic felt more intense pain and discomfort during mammography.
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Affiliation(s)
- Ruffo Freitas
- Serviços de Ginecologia e Mama e de Radiologia da Associação de Combate ao Câncer em Goiás.
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Freitas-Júnior R, Oliveira ELC, Pereira RJ, Silva MAC, Esperidião MD, Zampronha RAC, Ribeiro LFJ, Queiroz GS, Jorge EA, Rahal RMS, Ferro JE, Paulinelli RR, Barbosa SFC. Modified radical mastectomy sparing one or both pectoral muscles in the treatment of breast cancer: intra and postoperative complications. SAO PAULO MED J 2006; 124:130-4. [PMID: 17119688 DOI: 10.1590/s1516-31802006000300004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Accepted: 05/30/2006] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVE Modified radical mastectomy is widely utilized in breast cancer treatment. However, no prospective comparison has yet been made between the Madden technique (preservation of the pectoralis minor muscle) and the Patey technique (resection of this muscle). The aim of this work was to compare these two modified radical mastectomy techniques, by analyzing their degrees of difficulty and complications. DESIGN AND SETTING Randomized trial at the Breast Unit of Hospital Araújo Jorge, Goiás; and Faculdade de Medicina da Universidade Federal de Goiás. METHODS 430 patients with breast cancer with an indication for modified radical mastectomy were included in the program, of whom 426 patients were available for analysis (225 allocated to Patey and 201 to Madden). The chi-squared and Student t tests were used for analysis. RESULTS The patients demographics were well balanced between the two groups. The mean duration of the surgical procedures was 105 (+/- 29.9) and 102 minutes (+/- 33), for the Patey and Madden groups, respectively (p = 0.6). Hospitalization duration was 2.3 days for both groups. The mean number of lymph nodes resected was 20.3 (+/- 7.6) for Patey and 19.8 (+/- 8.1) for Madden (p = 0.5). There were no differences in terms of vascular or nerve sections, hematomas or infections. The surgeons reported the same degree of difficulty for the two methods. CONCLUSION The removal of the pectoralis minor muscle did not influence any of the variables studied. Therefore, either technique can be performed, at the surgeon's discretion.
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Affiliation(s)
- Ruffo Freitas-Júnior
- Breast Unit of Hospital Araújo Jorge, Associação de Combate ao Câncer em Goiás, Department of Gynecology and Obstetrics, Faculdade de Medicina, Universidade Federal de Goiás.
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Abstract
The aim of this study was to identify the aerobic and the anaerobic microorganisms which can be related to duct ectasia. The patients were divided into two groups. Group 1 comprised 100 patients with coloured nipple discharge (duct ectasia group), and Group 2 (the control group) was composed of 50 patients without nipple discharge. The culture media used were BHI-PRAS, blood agar, mannitol agar and MacConkey agar. There was a high frequency of bacterial growth in the two groups: 85% in Group 1 and 88% in Group 2. The most prevalent bacteria were Staphylococcus aureus and Staphylococcus epidermidis. There was a statistically significant higher rate of smokers in the duct ectasia group compared with the control group, 25 (25%) patients vs. 5 (10%), respectively (p = 0.03). These findings allow us to put forth the hypothesis that the genesis of duct ectasia may be a non-infectious inflammatory process.
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Affiliation(s)
- R M S Rahal
- Medical School, Institute of Tropical Pathology and Public Health, Goiania, Brazil
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Abstract
Duct ectasia consists of dilation of the mammary ducts and is clinically manifested as nipple discharge, which is more commonly multiductal, bilateral, and colored. To identify clinical factors that might be related to duct ectasia. A case-control study was carried out on a population of 150 patients divided into two groups. Group 1 (the experimental group) comprised 100 patients with multiductal, bilateral, and colored nipple discharge, clinically representing the nipple secretion of duct ectasia. Group 2 (the control group) was composed of 50 patients without nipple discharge. The odds ratio of duct ectasia was three times higher for current smokers (p=0.04). Likewise, smokers from the duct ectasia group had smoked for a longer time (median 25 months) compared to smokers from the control group (median 15 months) (p=0.02). Parity, history of abortion or termination, breast-feeding, hormonal contraceptive use, and history of breast abscess did not increase the risk for duct ectasia. The group of women with duct ectasia was associated with current tobacco smoking.
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Affiliation(s)
- Rosemar Macedo Sousa Rahal
- Breast Unit, Department of Gynecology and Obstetrics, Medical School of the Goiás Federal University, Goiania, Brazil
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