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Fernandes JO, Machado BF, Cardoso-Filho C, Nativio J, Cabello C, Vale DB. Breast cancer survival after mammography dissemination in Brazil: a population-based analysis of 2,715 cases. BMC Womens Health 2023; 23:644. [PMID: 38049765 PMCID: PMC10696793 DOI: 10.1186/s12905-023-02803-4] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study aims to assess breast cancer survival rates after one decade of mammography in a large urban area of Brazil. METHODS It is a population-based retrospective cohort of women with breast cancer in Campinas, São Paulo, from 2010 to 2014. Age, vital status and stage were accessed through the cancer and mortality registry, and patients records. Statistics used Kaplan-Meier, log-rank and Cox's regression. RESULTS Out of the 2,715 cases, 665 deaths (24.5%) were confirmed until early 2020. The mean age at diagnosis was 58.6 years. Women 50-69 years were 48.0%, and stage I the most frequent (25.0%). The overall mean survival was 8.4 years (8.2-8.5). The 5-year survival (5yOS) for overall, 40-49, 50-59, 60-69, 70-79 years was respectively 80.5%, 87.7%, 83.7%, 83.8% and 75.5%. The 5yOS for stages 0, I, II, III and IV was 95.2%, 92.6%, 89.4%, 71.1% and 47.1%. There was no significant difference in survival in stage I or II (p = 0.058). Compared to women 50-59 years, death's risk was 2.3 times higher for women 70-79 years and 26% lower for women 40-49 years. Concerning stage I, the risk of death was 1.5, 4.1 and 8.6 times higher, and 34% lower, respectively, for stage II, III, IV and 0. CONCLUSIONS In Brazil, breast cancers are currently diagnosed in the early stages, although advanced cases persist. Survival rates may reflect improvements in screening, early detection and treatment. The results can reflect the current status of other regions or countries with similar health care conditions.
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Affiliation(s)
- Juliana O Fernandes
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Beatriz F Machado
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Cassio Cardoso-Filho
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Juliana Nativio
- Surveillance Section, Municipal Health Department, Campinas City Hall, Paço Municipal, Avenida Anchieta, nº 200, 13.015-904, Campinas, SP, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil.
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Solla Negrao EM, Cabello C, Conz L, Mauad EC, Zeferino LC, Vale DB. The impact of the COVID-19 pandemic on breast cancer screening and diagnosis in a Brazilian metropolitan area. J Med Screen 2023; 30:42-46. [PMID: 36071628 PMCID: PMC9922643 DOI: 10.1177/09691413221122055] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the performance of breast cancer screening and early diagnosis during the pandemic, compared to the pre-pandemic period.Setting: The public referral centre for screening in Campinas, São Paulo State, Brazil. METHODS This is an audit study of performance screening and diagnostic indicators. Two periods were analysed: 2019, the pre-COVID period, and 2020, the COVID period. All women who underwent mammography in these periods were included. Indicators were compared between periods, and the US Breast Cancer Surveillance Consortium benchmarks were used as a reference. RESULTS A comparison between the periods shows a reduction of 57.4% in screening and 4.4% in diagnosis using mammography. Cancer detection rate per 1000 screening mammograms dropped from 4.62 to 2.83 (p = 0.031), while it increased from 84.43 to 89.36 in diagnosis mammograms (p = 0.701), higher than the reference (34.4, p < 0.001). With regard to diagnosis, the proportion of minimal cancers was reduced (p = 0.005) and was lower than the reference (40.0%, p < 0.001), along with the proportion of node-negative invasive cancers (p < 0.001). The mean size of invasive tumours was similar in the two periods (32.50 mm and 33.40 mm, p = 0.808) but larger than the reference value (16.50 mm, p < 0.001). Recall rate was lower in the COVID period (22.55% vs. 27.37%, p = 0.015). CONCLUSION The COVID pandemic caused an overall decrease in breast screening and detection of breast cancer cases, although the reduction in number of diagnosis mammograms performed was minimal. Tumour mean size was large in both periods, the pandemic highlighting a previous profile of detection at an advanced stage.
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Affiliation(s)
| | - Cesar Cabello
- Obstetrics and Gynecology Department,
University of Campinas, Campinas, Brazil
| | - Livia Conz
- Cancer Prevention Institute, Barretos
Cancer Hospital, Campinas, Brazil,Obstetrics and Gynecology Department,
University of Campinas, Campinas, Brazil
| | | | | | - Diama Bhadra Vale
- Obstetrics and Gynecology Department,
University of Campinas, Campinas, Brazil,Diama Bhadra Vale, State University of
Campinas, Obstetrics and Gynecology Department, Rua Alexander Fleming 101, CEP
13083-881, Campinas, Brazil.
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Negrao EMS, Cabello C, Conz L, Mauad EC, Zeferino LC, Vale DB. The COVID-19 Pandemic Impact on Breast Cancer Diagnosis: A Retrospective Study. Rev Bras Ginecol Obstet 2022; 44:871-877. [PMID: 35667376 PMCID: PMC9948273 DOI: 10.1055/s-0042-1749207] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE This study aimed to evaluate the diagnostic profile of breast cancer cases during the coronavirus disease 2019 (COVID-19) pandemic compared with the previous year. METHODS It is a retrospective study of cases diagnosed by a reference service in the public health system of Campinas, SP, Brazil. Two periods were analyzed: March to October 2019 (preCOVID period) and March to October 2020 (COVID-period). All women diagnosed during the periods were included. The Chi-Squared or Fisher exact and Mann-Whitney tests were used. RESULTS In the preCOVID and COVID periods, breast cancers were diagnosed, respectively, in 115 vs 59 women, and the mean ages at diagnosis were 55 and 57 years (p = 0.339). In the COVID period, the family history of breast cancer was more observed (9.6% vs 29.8%, p < 0.001), cases were more frequently symptomatic (50.4% vs 79.7%, p < 0.001) and had more frequently palpable masses (56.5% vs 79.7%, p = 0.003). In symptomatic women, the mean number of days from symptom to mammography were 233.6 (458.3) in 2019 and 152.1 (151.5) in 2020 (p = 0.871). Among invasive tumors, the proportion of breast cancers in stages I and II was slightly higher in the COVID period, although not significantly (76.7% vs 82.4%, p = 0.428). Also in the COVID period, the frequency of luminal A-like tumors was lower (29.2% vs 11.8%, p = 0.018), of triple-negative tumors was twice as high (10.1% vs 21.6%, p = 0.062), and of estrogen receptor-positive tumors was lower (82.2% vs 66.0%, p = 0.030). CONCLUSION During the COVID-19 pandemic, breast cancer diagnoses were reduced. Cases detected were suggestive of a worse prognosis: symptomatic women with palpable masses and more aggressive subtypes. Indolent tumors were those more sensitive to the interruption in screening.
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Affiliation(s)
| | - Cesar Cabello
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Livia Conz
- Cancer Prevention Institute, Hospital do Câncer de Barretos Barretos, SP, Brazil.,Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | | | - Luiz Carlos Zeferino
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Diama Bhadra Vale
- Obstetrics and Gynecology Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
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Shafaee MN, Silva LR, Ramalho S, Doria MT, De Andrade Natal R, Cabello V, Cons L, Pavanello M, Zeferino LC, Mano MS, Linck RDM, Batista LS, Pedro EP, De Paula BH, Zuca-Matthes G, Podany E, Makawita S, Ann Stewart K, Tsavachidis S, Tamimi R, Bondy M, Debord L, Ellis M, Bines J, Cabello C. Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil. Oncologist 2022; 27:344-351. [PMID: 35348756 PMCID: PMC9074991 DOI: 10.1093/oncolo/oyac050] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes. Methods We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp’s Women’s Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death. Results One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death. Conclusion Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes. Impact Access to timely screening and diagnosis of breast cancer are priorities in these populations.
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Affiliation(s)
| | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maira Teixeira Doria
- Department of Obstetrics and Gynecology, Clinical Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rodrigo De Andrade Natal
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Victor Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Livia Cons
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marina Pavanello
- School of Women's and Children's Health, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Max S Mano
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Kelsey Ann Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | | | - Rull Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford Cancer Institute, Stanford, CA, USA
| | - Logan Debord
- Department of Dermatology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Jose Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Shinzato JY, Serra KP, Eugeni C, Cabello C, Cardoso-Filho C, Zeferino LC. Potential Impact of the Z0011 Trial on the Omission of Axillary Dissection: A Retrospective Cohort Study. Rev Bras Ginecol Obstet 2021; 43:297-303. [PMID: 33784760 PMCID: PMC10183926 DOI: 10.1055/s-0041-1725052] [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: 10/21/2022] Open
Abstract
OBJECTIVE To evaluate the number of patients with early-stage breast cancer who could benefit from the omission of axillary surgery following the application of the Alliance for Clinical Trials in Oncology (ACOSOG) Z0011 trial criteria. METHODS A retrospective cohort study conducted in the Hospital da Mulher da Universidade Estadual de Campinas. The study population included 384 women diagnosed with early-stage invasive breast cancer, clinically negative axilla, treated with breast-conserving surgery and sentinel lymph node biopsy, radiation therapy, chemotherapy and/or endocrine therapy, from January 2005 to December 2010. The ACOSOG Z0011 trial criteria were applied to this population and a statistical analysis was performed to make a comparison between populations. RESULTS A total of 384 patients underwent breast-conserving surgery and sentinel lymph node biopsy. Of the total number of patients, 86 women underwent axillary lymph node dissection for metastatic sentinel lymph nodes (SNLs). One patient underwent axillary node dissection due to a suspicious SLN intraoperatively, thus, she was excluded from the study. Among these patients, 82/86 (95.3%) had one to two involved sentinel lymph nodes and met the criteria for the ACOSOG Z0011 trial with the omission of axillary lymph node dissection. Among the 82 eligible women, there were only 13 cases (15.9%) of lymphovascular invasion and 62 cases (75.6%) of tumors measuring up to 2 cm in diameter (T1). CONCLUSION The ACOSOG Z0011 trial criteria can be applied to a select group of SLN-positive patients, reducing the costs and morbidities of breast cancer surgery.
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Affiliation(s)
- Julia Yoriko Shinzato
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Katia Piton Serra
- Gynecology and Obstetrics Department, Faculdade São Leopoldo Mandic, Campinas, SP, Brazil
| | - Caroline Eugeni
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cesar Cabello
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Cassio Cardoso-Filho
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
| | - Luís Carlos Zeferino
- Gynecology and Obstetrics Department, Universidade Estadual de Campinas, Campinas, SP, Brazil
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da Silva LR, de Andrade CA, Brenelli F, Ramalho S, Reinert T, de Souza ABA, da Silva AER, de Paula Leite Kraft MB, de Vasconcelos VCA, Frasson AL, Torresan RZ, Cabello C, Ellis MJ, Zeferino LC. Real-world data on neoadjuvant endocrine therapy in ER-positive/HER2-negative breast cancer. Breast Cancer Res Treat 2021; 186:753-760. [PMID: 33543355 DOI: 10.1007/s10549-020-06076-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/28/2020] [Accepted: 12/23/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Neoadjuvant endocrine therapy (NET) has been shown to be effective in ER-positive/HER2-negative breast cancer in clinical trials. However, adoption in clinical practice is still limited. Real-world data may provide useful insights into effectiveness, toxicities and quality of care, potentially rendering clinical trial results to the real-world setting. Our purpose was to report real-world data of a cohort of postmenopausal patients submitted to NET. METHODS This prospective cohort study evaluated 146 postmenopausal female patients with ER-positive/HER2-negative breast cancer treated with NET at three tertiary hospitals between 2016 and 2018. Clinicopathological information were collected prospectively. Preoperative Endocrine Prognostic Index (PEPI) score was calculated for tumors submitted to at least 16 weeks of NET. RESULTS Median age was 67 years old, and 87.8% had stage I-II disease. Most tumors had histological grade II (76.1%). Median pretreatment Ki67 expression was 10%. Aromatase inhibitor was used in 99.5% of patients, and median treatment duration was 21.0 weeks. No tumor progressed during NET. Breast-conserving surgery was performed in the majority of patients (63.0%), as well as sentinel lymph-node biopsy (76.7%). Pathological complete response rate was 1.0%. 43 patients (29.5%) had PEPI score 0, and 26% had PEPI scores 4-5. Posttreatment Ki67 median expression was 3.0%, and only five tumors (3.4%) showed marked increase in Ki67 expression during treatment. Seven patients (4.8%) had HER2-positive residual disease, and were treated with adjuvant chemotherapy plus trastuzumab. CONCLUSIONS Our real-world data shows that NET is effective and safe in postmenopausal patients with ER-positive/HER2-negative breast cancer. Postmenopausal status and low-risk luminal tumor features (luminal A-like) should be used as selection criteria to ensure the best results with NET.
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Affiliation(s)
- Leonardo Roberto da Silva
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Camila Annicchino de Andrade
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Fabrício Brenelli
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Susana Ramalho
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Tomás Reinert
- Centro de Pesquisa da Serra Gaúcha (CEPESG), Caxias do Sul, Brazil.,Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | - Ana Elisa Ribeiro da Silva
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Maria Beatriz de Paula Leite Kraft
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Vivian Castro Antunes de Vasconcelos
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Antônio Luiz Frasson
- Breast Cancer Center, Hospital São Lucas, Pontifical Catholic University of Rio Grande Do Sul (PUCRS), Porto Alegre, Brazil
| | - Renato Zochio Torresan
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Cesar Cabello
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil
| | - Matthew J Ellis
- Lester and Sue Smith Breast Cancer Center, Baylor College of Medicine, Houston, TX, USA
| | - Luiz Carlos Zeferino
- Faculty of Medical Sciences, Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), R Alexander Fleming 101-Cidade Universitária "Zeferino Vaz", Campinas, SP, 13083-881, Brazil.
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Spreafico FS, Cardoso-Filho C, Cabello C, Sarian LO, Zeferino LC, Vale DB. Breast Cancer in Men: Clinical and Pathological Analysis of 817 Cases. Am J Mens Health 2020; 14:1557988320908109. [PMID: 32618495 PMCID: PMC7492861 DOI: 10.1177/1557988320908109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/23/2020] [Accepted: 01/31/2020] [Indexed: 11/15/2022] Open
Abstract
The objective of the current study was to describe breast cancer cases in men according to age, stage, and histology, calculating risks compared to women. It is a retrospective cross-sectional study of all breast cancer cases of the Hospital Cancer Registry of São Paulo state, Brazil, 2000-2015. Variables were age, sex, stage, and histology. Absolute numbers and proportions, Mann-Whitney test and prevalence ratio with 95% confidence interval were used. The study included 93,737 cases, of which 817 were males. The mean age at diagnosis was 60.3 years in men and 56.2 years in women (p < .001). Stage II was the most common in both sexes (33.9% in men and 36.5% in women). Men had a higher frequency of stage III than women (PR 1.18, 95% CI 1.01-1.37). Stage 0 was significantly more common in women (PR 0.69, 95% CI 0.51-0.94). Ductal carcinoma and its variants were the most common histological types in both sexes (88.7% in men and 89.0% in women). Men had a higher frequency of rarer histological types such as papillary (PR 2.17, 95% CI 1.36-3.44) and sarcomas (PR 4.10, 95% CI 1.86-9.01). In conclusion, in men, breast cancer diagnosis occurred in more advanced ages and stages. Invasive ductal carcinoma was the primary histological type observed, although rarer types were more frequent.
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Affiliation(s)
| | | | - Cesar Cabello
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | - Luis Otávio Sarian
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
| | | | - Diama Bhadra Vale
- Obstetrics and Gynecology Department,
State University of Campinas, Brazil
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Reinert T, Ramalho S, de Vasconcelos VCA, Silva LR, da Silva AER, de Andrade CA, Kraft MBDPL, Coelho GP, Mandelli J, Binotto M, Cabello C, de Paiva Silva GR, Bines J, Barrios CH, Ellis MJ, Graudenz MS. ESR1 Mutations Are Not a Common Mechanism of Endocrine Resistance in Patients With Estrogen Receptor-Positive Breast Cancer Treated With Neoadjuvant Aromatase Inhibitor Therapy. Front Oncol 2020; 10:342. [PMID: 32309212 PMCID: PMC7145981 DOI: 10.3389/fonc.2020.00342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 12/10/2019] [Accepted: 02/27/2020] [Indexed: 12/31/2022] Open
Abstract
Introduction: Mutations in the ESR1 gene (ESR1m) are important mechanisms of resistance to endocrine therapy in estrogen receptor–positive (ER+) metastatic breast cancer and have been studied as a potential therapeutic target, as well as a predictive and prognostic biomarker. Nonetheless, the role of ESR1m as a possible mechanism of primary endocrine resistance, as well as whether it also occurs in tumors that are resistant to ET administered in early-stage disease as (neo)adjuvant, has not been adequately studied. In this study, we evaluated the prevalence of ESR1m in tumor samples from patients with ER+ breast cancer resistant to neoadjuvant aromatase inhibitor therapy. Methods: We followed a prospective cohort of patients with ER+ HER2– stages II and III breast cancer treated with neoadjuvant endocrine therapy (NET). Tumor samples from patients with a pattern of primary endocrine resistance [defined as a Preoperative Endocrine Prognostic Index (PEPI) score of ≥4] were identified and analyzed for the presence of ESR1m. Results: One hundred twenty-seven patients were included in the cohort, of which 100 (79%) had completed NET and underwent surgery. Among these patients, the PEPI score ranged from 0 to 3 in 70% (70/100), whereas 30% (30/100) had a PEPI score of 4 or more. Twenty-three of these patients were included in the analysis. ESR1 mutations were not identified in any of the 23 patients with early-stage ER+ breast cancer resistant to NET. Discussion: Growing evidence supports the notion that there are different mechanisms for primary and secondary endocrine resistance. Our study suggests that ESR1 mutations do not evolve rapidly and do not represent a common mechanism of primary endocrine resistance in the neoadjuvant setting. Therefore, ESR1m should be considered a mechanism of acquired endocrine resistance in the context of advanced disease. Further research should be conducted to identify factors associated with intrinsic resistance to ET.
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Affiliation(s)
- Tomás Reinert
- Postgraduate Program in Medical Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil.,Centro de Pesquisa da Serra Gaucha (CEPESG), Caxias Do Sul, Brazil.,Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Elisa Ribeiro da Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila Annicchino de Andrade
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Jovana Mandelli
- Diagnose Patologia e Biologia Molecular, Caxias Do Sul, Brazil
| | - Monique Binotto
- Centro de Pesquisa da Serra Gaucha (CEPESG), Caxias Do Sul, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Geisilene Russano de Paiva Silva
- Laboratory of Molecular and Investigative Pathology - LAPE, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - José Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Matthew J Ellis
- Lester and Sue Smith Breast Cancer Center, Baylor College of Medicine, Houston, TX, United States
| | - Marcia Silveira Graudenz
- Postgraduate Program in Medical Sciences, Universidade Federal Do Rio Grande Do Sul (UFRGS), Porto Alegre, Brazil
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Teixeira SRC, de Camargo Júnior HSA, Cabello C. Background parenchymal enhancement: behavior during neoadjuvant chemotherapy for breast cancer and relationship with a pathological complete response. Radiol Bras 2020; 53:95-104. [PMID: 32336824 PMCID: PMC7170574 DOI: 10.1590/0100-3984.2019.0057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 11/21/2022] Open
Abstract
Objective To evaluate background parenchymal enhancement (BPE) and its characteristics, as well as its behavior before and after neoadjuvant chemotherapy (NAC), in both breasts of patients with unilateral breast cancer. Materials and Methods This was a retrospective, cross-sectional observational study involving a consecutive sample of women with invasive breast cancer who underwent breast magnetic resonance imaging (MRI) between July 2007 and July 2017, as well as undergoing dynamic contrast-enhanced MRI before and after NAC. In both breasts, we evaluated the BPE in accordance with the Breast Imaging Reporting and Data System. We applied logistic regression analysis, and values of p < 0.05 were considered significant. Results We evaluated 150 women. The mean age was 45.2 years (range, 20-74 years). The variables correlating independently with a high pre-NAC BPE, in the affected and contralateral breasts, were being under 50 years of age (odds ratio [OR] = 6.55; 95% confidence interval [95% CI]: 2.32-18.46, for both breasts) and a post-NAC BPE reduction (OR = 17.75; 95% CI: 4.94-63.73 and OR = 18.47; 95% CI: 5.19-66.49, respectively). Conclusion Patients with invasive unilateral breast cancer who have a high pre-NAC BPE in both breasts tend to be under 50 years of age and to show a post-NAC reduction in BPE.
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Affiliation(s)
- Sandra Regina Campos Teixeira
- Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (Caism-Unicamp), Campinas, SP, Brazil.,CDE - Diagnóstico por Imagem, Campinas, SP, Brazil
| | | | - Cesar Cabello
- Centro de Atenção Integral à Saúde da Mulher da Universidade Estadual de Campinas (Caism-Unicamp), Campinas, SP, Brazil
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Reinert T, Ramalho S, Vasconcelos VCA, Silva LR, Silva AER, Andrade CA, Kraft MBPL, Coelho GP, Mandelli J, Binotto M, Cabello C, Silva GRP, Bines J, Barrios CH, Ellis MJ, Graudenz MS. Abstract P2-11-08: ESR1 mutations are not a mechanism of primary resistance to aromatase inhibitors in ER-positive breast cancer treated with neoadjuvant endocrine therapy. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-11-08] [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
Introduction: Mutations in the ESR1 gene (ESR1m) are important mechanisms of resistance to endocrine therapy (ET) in estrogen receptor-positive (ER+) advanced breast cancer and have been recognized as a prognostic and predictive biomarker as well as a potential therapeutic target. ESR1m prevalence has been described as 9-45% in cohorts of ET-resistant metastatic tumors in a variety of publications. We recently reported a prevalence of 25% in a cohort of ER+ breast cancer patients with visceral metastasis. However, the role of ESR1m as a mechanism of resistance to ET used in early-stage disease is not well studied. Neoadjuvant endocrine therapy (NET) is being increasingly explored, not only to allow less extensive surgery but also as a scientific tool, exploring biomarkers to predict outcomes. The preoperative endocrine prognostic index (PEPI) combining Ki67 score, ER Allred score, tumor size, and nodal status after NET is a surrogate of endocrine sensitivity and can identify a subgroup of patients with primary resistance to ET. In this study, we evaluated the prevalence of ESR1m in tumor samples from patients with ER+ breast cancer that were primarily resistant to neoadjuvant aromatase inhibitor (AI) therapy. Methods: We followed a prospective cohort of postmenopausal patients with ER+ HER2- stages II-III breast cancer treated with neoadjuvant endocrine therapy (NET). Patients were treated with anastrozole for a recommended period of at least three months. Tumor samples from patients with a pattern of primary endocrine-resistant tumors (defined as a PEPI Score higher than 3) were selected and analyzed for the presence of ESR1m. ESR1m were evaluated in formalin-fixed paraffin-embedded (FFPE) breast cancer tissue using real-time quantitative polymerase chain reaction (RT-qPCR). Mutations in codons 380, 537, and 538 of the ESR1 gene were analyzed. Results: 127 patients were included in the cohort, of which 100 (79%) had completed NET and had surgery. Among these patients, the PEPI Score ranged from 0 to 3 in 70% (70/100), and 30% (30/100) had a PEPI Score of 4 or more and were selected. 23 patients were included in the analysis (6 did not consent or were lost to follow-up, and one was HER2-positive). Patients characteristics are summarized in Table 1. The median duration of NET was 22 weeks. All samples of tumor tissue from the surgical specimens after NET were evaluable. Quantification of DNA extraction and reference gene cycle threshold values confirmed that the material was adequate for the analysis. We compared these findings with a study from our group using the same methodology in patients with advanced disease where ESR1 mutations were detected in 25% (n=32) of patients with visceral metastasis of ER+ breast cancer resistant to endocrine therapy. ESR1 mutations were not identified in any of the 23 patients with early-stage ER+ breast cancer resistant to NET (p 0.01, Fisher´s exact test) Discussion: Growing evidence supports the notion that there are different mechanisms of primary and secondary endocrine resistance. Our study suggests that ESR1 mutations do not evolve rapidly and do not represent a common mechanism of primary endocrine resistance in the neoadjuvant setting. Therefore, ESR1m should be considered a mechanism of acquired endocrine resistance in the context of advanced disease. Further research should be conducted to identify factors associated with intrinsic resistance to ET.
Citation Format: Tomas Reinert, Susana Ramalho, Vivian CA Vasconcelos, Leonardo R Silva, Ana Elisa R Silva, Camila A Andrade, Maria Beatriz PL Kraft, Guilherme P Coelho, Jovana Mandelli, Monique Binotto, Cesar Cabello, Geisilene RP Silva, Jose Bines, Carlos H Barrios, Matthew J Ellis, Marcia S Graudenz. ESR1 mutations are not a mechanism of primary resistance to aromatase inhibitors in ER-positive breast cancer treated with neoadjuvant endocrine therapy [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-11-08.
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Affiliation(s)
- Tomas Reinert
- 1Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
| | - Susana Ramalho
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Vivian CA Vasconcelos
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Leonardo R Silva
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Ana Elisa R Silva
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Camila A Andrade
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | | | | | - Jovana Mandelli
- 3DIagnose Patologia e Biologia Molecular, Caxias do Sul, Brazil
| | - Monique Binotto
- 4Centro de Pesquisa da Serra Gaucha (CEPESG), Caxias do Sul, Brazil
| | - Cesar Cabello
- 2Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, Brazil
| | - Geisilene RP Silva
- 5Laboratory of Molecular and Investigative Pathology – LAPE, Faculty of Medical Sciences, State University of Campinas (UNICAMP, Campinas, Brazil
| | - Jose Bines
- 6Instituto Nacional do Câncer (INCA-HCIII), Rio de Janeiro, Brazil
| | - Carlos H Barrios
- 7Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Matthew J Ellis
- 8Lester and Sue Smith Breast Cancer Center – Baylor College of Medicine, Houston, TX
| | - Marcia S Graudenz
- 1Postgraduate Program in Medical Sciences, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Abstract
Abstract
Introduction: The Oncotype DX was associated to 14% of adjuvant chemotherapy administration to Hormonal Receptor positive (HR+) and HER2 negative, T1N0 or T2N0 breast cancer patients at Tailor X trial recently published (RS>25)
Objective: To describe the adjuvant chemotherapy administration to a Brazilian public hospital for HR+ HER2 negative, T1N0 or T2N0 breast cancer patients. And the estimate the cost effectivity of Oncotype DX in our low income scenary.
Materials and Methods:This retrospective cross-sectional study was conducted at the Oncology Division of the Women's Hospital - CAISM of the State University of Campinas (UNICAMP), Brazil. All patient data were found from the hospital records from 2007 to 2009. It was included T1N0 and T2N0 HR+/HER2 negative breast cancer patients. Patients submitted to neoadjuvant treatment were excluded.
We calculate the final cost of different types of chemotherapy used and the potential impact to oncotype DX introduction in this scenary.
Results: It was found 109 patients records. 66% (72/109) had received adjuvant chemotherapy. 35% (38/109) had AC (X6), 29% (32/109) had CMF (X6) and 2% (2/109) had AC-T (X4). The total cost for chemotherapy scheme were; AC (X6) US$ 346,9; CMF (X6), US$300,6; ACT (X4), US$395,9. The total cost of chemotherapy was US$ 23.596,83 to 72 patients. If we consider 14% (15/109) of adjuvant chemotherapy associate to a Oncotype DX use (Tailor X RS>25), It would reduce adjuvant chemotherapy administration to 15 patients. The chemotherapy cost would be US$ 4588,27. In our scenary, It could save US$ 19.008,56. Nevertheless, the Oncotype Dx cost to Brasil is US$ 3.200,00 for each test. To 109 patients the total cost would be (109 X US$ 3.200,00) US$ 348.800,00. Therefore, the total cost for Oncotype DX program plus adjuvant chemotherapy for our patients would be US$ 348.800,00 + US$ 4.588,27= US$ 353.388,27. While in the real situation we had spent US$ 23.596,83. The total estimate cost would be 15 times more.
Conclusion: At the moment, because of the assay high cost and the low cost of the adjuvant chemotherapy to HR+, HER2 negative T1N0 and T2N0, It would be difficult to consider Oncotype DX cost-effective to Brazilian public heath system. Even considering many advantages to spare chemotherapy to this population.
Citation Format: Cabello C, de Andrade RN, Cabello TF, Teixeira S, da Costa LS, Ramalho S. Oncotype DX cost effectivity to a Brazilian public hospital [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-15-04.
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Affiliation(s)
- C Cabello
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - RN de Andrade
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - TF Cabello
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - S Teixeira
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - LS da Costa
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
| | - S Ramalho
- State University of Campinas (UNICAMP), Campinas, Sao Paulo, Brazil
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Teixeira SRC, Camargo HSA, Ramalho S, Natal R, Machado H, Camargo MMA, Azevedo J, Arruda M, Negrão EMS, Almeida NR, Teixeira AL, Cabello V, Cabello C. Abstract P4-02-09: Breast cancer and magnetic resonance imaging (MRI): Background parenchymal enhancement (BPE) predicting response to neoadjuvant chemotherapy (NAC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-02-09] [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: To assess the association of MRI BPE and pathological response in women diagnosed with stage II/III breast cancer submitted to NAC. Methods: This observational and cross-sectional retrospective study was performed in consecutive women who underwent NAC and had MRI exams before and after chemotherapy. The MRI was done before and after 2 weeks of completing NAC. BPE was classified according to ACR-BIRADS 5th edition. The type of BPE before NAC, its changes and the relationship to total pathologic complete response (TpCR) were evaluated. Data were paired with patient age, size on MRI before and after NAC, features of clinical response according to the RECIST criteria, tumor grade and immunohistochemical (IHC) subtypes. MRI assessment included amount of fibroglandular tissue, symmetry of BPE and measurement of tumor at the longest diameter. All images were blinded reviewed by a radiologist. We used for the changes of the BPE the Bowker symmetry test or the McNemar test and to analyze the factors related to the clinical and pathologic responses, logistic regression analysis. The level of significance adopted was 5% (p<0.05). Results: We studied 71 women between 2009 and 2016. The medium age was 37 years old. BPE was symmetrical in 68 women (95.8%). Moderate and marked BPE was present in 28 (39.4%) of the affected breasts and in 25 (34.2%) of the contralateral breasts. After NAC all BPE were symmetrical and just 3% of them were moderate or marked. Regarding the IHC subtype, 40 women (56.3%) were triple negative or HER2 positive, and these women had a higher frequency of TpCR (55% for each, compared to 12.9% in patients with luminal subtypes). We found to be independently associated with pCR: the reduction of BPE (in the affected or contralateral breast) and the molecular subtypes triple negative and HER2 positive
Table 1. Multivariate Analysis related to TpCR (n=71).VariableCategoryP-ValueO.R.*CI 95% O.R.*Tumor Size on MR pre-MAC (cm) 0.1710,8590.691-1.068Luminal subtypeLuminal B (ref.)---1.00--- Luminal A0.3120.450.10-2.11 HER2pos/ Luminal B HER20.0055.781.71-19.58 Triple negative0.0493.271.01-10.64Age (years) 0.3870.9820.942-1.023Nottingham grade1 (ref.)---1.00--- 20.0817.830.78-79.16 30.0967.100.71-71.31BPE pre-NAC (S or A)Asymmetric (ref.)---1.00--- Symmetric0.3273.030.33-27.76BPE pre-NAC affected breastMinimal (ref.)---1.00--- Mild0.8120.860.24-3.09 Moderate0.3711.890.47-7.64 Marked0.5911.570.30-8.17BPE pre-NAC contralateral breastMinimal (ref.)---1.00--- Mild0.7130.790.22-2.81 Moderate0.2502.330.55-9.77 Marked0.4701.880.34-10.43BPE ChangeSame/increased (ref.)---1.00--- Reduction0.0263.011.14-7.96* OR (Odds Ratio) = Risk ratio to pCR; (n=26 pCR, n=7 DpCR, n=31 PR e n=7 ED, where Total pCR is pathological complete response (without invasive and DCIS in the breast and axilla) DpCR is pathological response with just DCIS, PR is partial response and ED is stable disease – we haven't progression disease). CI 95% OR = Confidence interval of 95% to risk ratio. Ref.: reference level. Proportional risk models.
Conclusion: BPE reduction was significantly associated with TpCR. Nevertheless, patterns of BPE pre-NAC have no association with pathological response.
Citation Format: Teixeira SRC, Camargo HSAd, Ramalho S, Natal R, Machado HdC, Camargo MMAd, Azevedo J, Arruda MdS, Negrão EMS, Almeida NR, Teixeira AL, Cabello V, Cabello C. Breast cancer and magnetic resonance imaging (MRI): Background parenchymal enhancement (BPE) predicting response to neoadjuvant chemotherapy (NAC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-02-09.
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Affiliation(s)
- SRC Teixeira
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - HSAd Camargo
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - S Ramalho
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - R Natal
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - HdC Machado
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - MMAd Camargo
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - J Azevedo
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - MdS Arruda
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - EMS Negrão
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - NR Almeida
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - AL Teixeira
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - V Cabello
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
| | - C Cabello
- UNICAMP - State University of Campinas, Campinas, Sao Paulo, Brazil; CDE Diagnóstico por Imagem, Campinas, Sao Paulo, Brazil
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NematiShafaee M, Natal RA, Ramalho S, Dória MT, Conz L, Cabello V, Pavanello M, Mano MS, Linck RDM, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Bondy ML, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, Cabello C. Abstract P4-10-15: Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-10-15] [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
Background: Access to medical care vary across the world and is related to different health systems with an impact in recurrence.Objective: To evaluate disparities in breast cancer(BC) diagnosis and treatment between public and private services in southwest Brazil and at two public safety net hospitals in Houston, Texas.Methods: Women diagnosed with BC stages I-III between 2009 to 2011, and treated at the four hospitals in Brazil and two health centers in US were included. All statistical analyses were performed in R studio software, and p<0.05 was considered significant.Results: 1245 women were included: 967 from public health system (PHS) (20.3% from Houston, Texas) and 274 from private system(PS). Recurrence rate was higher in PHS (14.6% vs. 2.6%, p<0.001)
Table 1. Clinical and demographic characteristics of the patientsCharacteristicsPublic (%), n=967Private (%), n=274pDiscovery of BC By patient530 (54.8)92 (33.5) Routine exam87 (9)109 (39.8) Screening mammography270 (27.9)23 (8.4) Other80 (8.3)50 (18.3)<0.001Initial treatment Surgery687 (71)241 (88) Neo-adjuvant chemotherapy224 (23.2)27 (9.8) Neo-adjuvant hormone therapy23 (2.3)27 (9.8) Not available33 (3.4)3 (1.1)<0.001Clinical Stage I293 (30.3)113 (41.2) II342 (35.4)52 (19) III271 (28)15 (5.5) Unknown61 (6.3)94 (34.3)<0.001Subtype HR+/HER2 -561 (58)192 (70.1) HR-/HER2+108 (11.1)29 (10.6) HR-/HER2+76 (7.9)14 (5.1) Triple negative149 (15.4)28 (10.2) Unknown73 (7.6)11 (4)0.012Symptomatic at Diagnosis Yes591 (61.1)100 (36.5) No306 (31.6)97 (35.4) Unknown70 (7.2)77 (28.1)<0.001Recurencen=772n=146 No719 (74.4)193 (70.4) Yes142 (14.6)7 (2.6) Unknown106 (11)74 (27)<0.001
. Considering the interval in weeks: symptoms to diagnosis, diagnosis to first treatment (either surgery or neoadjuvant chemotherapy), diagnosis to first systemic treatment, diagnosis to surgical treatment and diagnosis to radiotherapy were longer in public patients (24.1 vs. 8.7; 11.1 vs. 3.5; 18.6 vs. 9.8; 16.9 vs. 5.6; 51.4 vs. 26.1; p<0.001).
Table 2. Delay disparities between public and private health system PublicPrivatepSymptoms to diagnosis Number of patients575146 Time (weeks)24.1 (0.4-104.9)8.7 (0.0-43.7)<0.001Diagnosis to first treatment Number of patients663180 Time (weeks)11.1 (2.0-31.5)3.5 (0.0-11.0)<0.001Diagnosis to first systemic treatment Number of patients526106 Time (weeks)18.6 (2.6-44.7)9.8 (1.9-29.3)<0.001Diagnosis to surgical treatment Number of patients657178 Time (weeks)16.9 (3.4-45.6)5.6 (0.0-32.9)<0.001Diagnosis to radiotherapy Number of patients465127 Time (weeks)51.4 (18.7-88.4)26.1 (5.6-66.4)<0.001
In multivariate analysis, PHS (HR 1.72; 95% CI 1.34-1.88; p adj=0.003), presence of symptoms (HR 2.29; 95% CI 1.39-3.78; p adj=0.001), clinical stage III (HR 1.62; 95% CI 1.35-1.93; p adj<0.001), and triple negativity and HER2neu positivity (1.18; 95% CI 1.03-1.35; p adj=0.021) were all associated with a higher recurrence rate.Conclusions: There were significant disparities between PHS and PS. Women in the PHS presented higher rates of recurrence, advanced clinical stages at diagnosis, symptoms and more aggressive subtypes by IHC. additionally, the interval between symptoms to diagnosis and diagnosis to treatments was longer in PHS.
Citation Format: NematiShafaee M, Natal RA, Ramalho S, Dória MT, Conz L, Cabello V, Pavanello M, Mano MS, Linck RDM, Batista LS, Pedro EP, Bines J, de Paula BH, Zucca-Matthes G, Bondy ML, Ellis MJ, Podany E, Debord L, Makawita S, Stewart K, Cabello C. Impact of delay in breast cancer diagnosis and treatment according to health insurance status in southwest Brazil and Houston, Texas [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-15.
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Affiliation(s)
- M NematiShafaee
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - RA Natal
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - S Ramalho
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - MT Dória
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - L Conz
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - V Cabello
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - M Pavanello
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - MS Mano
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - RDM Linck
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - LS Batista
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - EP Pedro
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - J Bines
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - BH de Paula
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - G Zucca-Matthes
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - ML Bondy
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - MJ Ellis
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - E Podany
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - L Debord
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - S Makawita
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - K Stewart
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
| | - C Cabello
- Baylor College of Medecine, Houston, TX; State University of Campinas, Campinas, Sao Paulo, Brazil; Sírio Libanês Hospital, São Paulo, Brazil; Brazilian National Cancer Institute, Rio de Janeiro, Brazil; Barretos Cancer Hospital, Barretos, Sao Paulo, Brazil
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Hyams DM, Schuur E, Angel Aristizabal J, Bargallo Rocha JE, Cabello C, Elizalde R, García-Estévez L, Gomez HL, Katz A, Nuñez De Pierro A. Selecting postoperative adjuvant systemic therapy for early stage breast cancer: A critical assessment of commercially available gene expression assays. J Surg Oncol 2017; 115:647-662. [PMID: 28211064 PMCID: PMC5484338 DOI: 10.1002/jso.24561] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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] [Received: 12/12/2016] [Revised: 12/15/2016] [Accepted: 12/15/2016] [Indexed: 12/13/2022]
Abstract
Risk stratification of patients with early stage breast cancer may support adjuvant chemotherapy decision-making. This review details the development and validation of six multi-gene classifiers, each of which claims to provide useful prognostic and possibly predictive information for early stage breast cancer patients. A careful assessment is presented of each test's analytical validity, clinical validity, and clinical utility, as well as the quality of evidence supporting its use.
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Affiliation(s)
- David M Hyams
- Desert Surgical Oncology, Eisenhower Medical Center, Rancho Mirage, California
| | | | | | | | | | | | | | - Henry L Gomez
- Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru
| | - Artur Katz
- Hospital Sírio-Libanes, Sao Paulo, Brazil
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15
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Cabello C, Alvarenga M, Alvarenga CA, Duarte GM, Pereira PN, Marshall PS. Case report and review of the literature: secretory breast cancer in a 13-year-old boy--10 years of follow up. Breast Cancer Res Treat 2011; 133:813-20. [PMID: 22083230 DOI: 10.1007/s10549-011-1869-4] [Citation(s) in RCA: 8] [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: 10/30/2011] [Accepted: 10/31/2011] [Indexed: 11/25/2022]
Abstract
Carcinoma of the breast is very rare in childhood, accounting for less than 1% of all childhood malignancies and is especially rare in boys. Delay in diagnosis and treatment in children with breast cancer may occur because surgeons are very reluctant to perform biopsies on the developing breast, since these can cause future deformity. We report a case of male secretory breast carcinoma in a 13-year-old boy. Radical mastectomy was performed followed by chemotherapy. The patient is free of disease after 10 years. Secretory breast carcinoma (SBC) is the commonest type of breast carcinoma in children. In this article, we discuss the diagnosis and treatment options for breast cancer among children as well as features of SBC, based on a literature review.
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Affiliation(s)
- Cesar Cabello
- University of Campinas, Av. Alexander Flemming, 101, Cidade Universitária, Campinas, SP 13083-881, Brazil.
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16
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Duarte GM, Cabello C, Torresan RZ, Alvarenga M, Telles GHQ, Bianchessi ST, Caserta N, Segala SR, de Lima MCL, Etchebehere ECSC, Camargo EE. Radioguided Intraoperative Margins Evaluation (RIME): Preliminary results of a new technique to aid breast cancer resection. Eur J Surg Oncol 2007; 33:1150-7. [PMID: 17498909 DOI: 10.1016/j.ejso.2007.03.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [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: 02/03/2007] [Accepted: 03/21/2007] [Indexed: 10/23/2022] Open
Abstract
AIMS Women undergoing breast-conserving surgery for cancer can present residual disease. We have developed a technique called Radioguided Intraoperative Margins Evaluation (RIME) that uses a radiopharmaceutical to distinguish normal and cancer tissues. The aim of this study was to assess whether RIME is a feasible technique, and if it could help in breast cancer resection with free margins, minimizing residual disease. METHODS Twenty-three breast cancer patients programmed for mastectomy were selected. Before surgery, the patients were submitted to scintimammography with 99mTc-sestamibi to estimate the optimal time to begin radioguided surgery. Twenty patients were submitted to magnetic resonance imaging (MRI), to evaluate skin, deep fascia and to detect other tumor foci. At the beginning of the surgery, the same dose of 99mTc-sestamibi was intravenously injected into patients. Tumor resection was performed under guidance of a gamma-probe, characterizing the RIME technique. Finally, modified radical mastectomy was performed. Tumor and residual breast were histopathologically examined. RESULTS The RIME technique was successfully performed in all patients. The principal tumor was removed by this technique and provided 82.6% of histologically free margins (mean margins, 4.8 mm). Additionally, 47.8% of patients were without residual disease. The mean size of residual carcinoma was 3.67 mm and generally located near the tumor bed (<1.5 cm). There was no significant association between presence of residual disease and tumor size or margin status. CONCLUSION RIME is a feasible technique that could help tumor resection with free margins; however, it seems to be limited for small carcinoma foci.
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Affiliation(s)
- G M Duarte
- Division of Oncology and Senology, Department of Obstetrics and Gynecology, School of Medicine, Universidade Estadual de Campinas, Campinas, Brazil.
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17
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Cabello C, Manjarrez ME, Olvera R, Villalba J, Valle L, Paramo I. Frequency of viruses associated with acute respiratory infections in children younger than five years of age at a locality of Mexico City. Mem Inst Oswaldo Cruz 2006; 101:21-4. [PMID: 16612508 DOI: 10.1590/s0074-02762006000100005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A locality in the district of Tlalpan, Mexico City, was selected in order to identify the viral agents in children younger than 5 years of age with acute respiratory infection (ARI). A total of 300 children were randomly selected and were included in this study for a period of 13 months. During this period nasopharyngeal exudates were collected for the isolation of viral agents. Monoclonal fluorescent antibodies were used for viral identification after cell culture. Viral infection was detected in 65% of the specimens. The respiratory syncytial virus (RSV) was the most common virus agent detected. Children required an average of two consultations during the study period. Two high incidence peaks were observed, one during the summer and the other during winter; the most frequent viruses during these seasons were influenza A and RSV, respectively. The largest number of viruses was isolated in the group of children between 1 and 2 years of age and in the group between 4 and 5 years of age. This study demonstrated the presence of ARI and of different viruses in a period of 13 months, as well as the most frequent viruses in children younger than 5 years of age from a community of Mexico City.
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Affiliation(s)
- C Cabello
- Departamento de Investigación en Virología, Instituto Nacional de Enfermedades Respiratorias, Calzada de Tlalpan 4502, Mexico, DF
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Tahan HA, Cabello C. Cultural values in health care: questions and answers. Semin Nurse Manag 1999; 7:154-5. [PMID: 11013578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/17/2023]
Affiliation(s)
- H A Tahan
- Mount Sinai Hospital, New York, NY, USA
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Babero BB, Cabello C, Kinoed JE. [Helminth fauna of Chile. V. Additional parasites records from the coypu Myocastor coypus (Molina, 1782) (author's transl)]. Bol Chil Parasitol 1979; 34:26-31. [PMID: 540081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Babero BB, Cattan PE, Cabello C. A new species of whipworm from the rodent Akodon longipilis in Chile. Trans Am Microsc Soc 1976; 95:232-5. [PMID: 1274050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Babero BB, Cattan PE, Cabello C. Trichuris bradleyi sp. n., a whipworm from Octodon degus in Chile. J Parasitol 1975; 61:1061-3. [PMID: 1195067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Schenone H, Galdames M, Cabello C. [Treatment of human intestinal helminthiasis with a combined dosage of mebendazole and thiabendazole (author's transl)]. Bol Chil Parasitol 1975; 30:89-90. [PMID: 1212288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Schenone H, Verdaguer J, Knierim F, Cabello C, Rojas B, Lechuga M, González R, Leclercq N. [Preliminary investigation of toxoplasmosis in mentally deficient boys of Santiago, Chile (author's transl)]. Bol Chil Parasitol 1974; 29:109-11. [PMID: 4455267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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