[Show abstract][Hide abstract] ABSTRACT: Breast cancer is the most frequent neoplasm in women, and some studies have shown social inequalities in incidence and survival, which are poorly investigated in Brazil. To assess iniquity in prognosis, a hospital-based cohort study was carried out. Follow-up was made by active search in medical records and in the Mortality Information System, phone calls, and consultation on Individual Tax-Collection Record status. Survival functions were estimated by the Kaplan-Meier method, and the Cox proportional hazards model was employed for prognostic assessment. Disease-specific survival was estimated at 76.3% (95%CI: 71.9-81.0) in 5 years. Women seen at public facilities had worse prognosis (HR = 1.79; 95%CI: 1.09-2.94), which was particularly due to the disease being diagnosed at a more advanced stage. These findings point to inequalities of access to screening actions, as women of lower social conditions with later diagnostic and therefore with worse prognostic.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 09/2015; 31(8):1673-1684. DOI:10.1590/0102-311X00145214 · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: To describe the main characteristics of women with breast cancer, according to the immunohistochemical profile.
The population comprised a hospital cohort, consisting of women diagnosed with breast cancer between 2003 and 2005 (n = 601) and treated at a referral center for cancer care in Juiz de Fora, MG, Brazil. Only 397 women who had complete immunohistochemistry analysis were selected. To define the groups according to the immunohistochemical profile, the assessment of estrogen and progesterone receptors, Ki-67 cell proliferation index, and overexpression of human epidermal growth factor receptor 2 (HER2) was chosen. According to the different phenotypes, five subtypes were defined: luminal A, luminal B HER2 negative, luminal B HER2 positive, triple negative, and HER2 overexpression.
Most patients were white (80.7%) and post-menopausal (64.9%), with a mean age of 57.4 years (± 13.5). At diagnosis, 57.5% had tumor size > 2.0 cm, and 41.7% had lymph node involvement. The most common subtypes were luminal B - HER2 negative (41.8%) and triple negative (24.2%). In the luminal A subtype, 72.1% of patients were post-menopausal, while the highest percentage of premenopausal women were observed in the luminal B - HER2 positive and triple negative subtypes (45.2% and 44.2%, respectively). A higher frequency of tumors > 2.0 cm and lymph node involvement was observed in triple negative and HER2 positive subtypes.
This study allowed the distribution assessment of the main clinical and pathological characteristics and those related to health services in a cohort of Brazilian women with breast cancer, according to the immunohistochemical tumor subtypes.
Revista da Associação Médica Brasileira 04/2012; 58(2):178-87. DOI:10.1590/S0104-42302012000200013 · 0.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The purpose of this study was to analyze five-year survival and the main prognostic factors among women with invasive breast cancer diagnosed from 1998 to 2000 that had undergone surgical treatment in the city of Juiz de Fora, Minas Gerais State, Brazil. Study variables were: age, skin color, place of residence, tumor-related variables, and treatment-related variables. Survival functions were calculated by the Kaplan-Meier method, and multivariate analysis was performed using the Cox proportional hazard model. Disease-specific survival was 81.8%. Tumor size and lymph node involvement were the main independent prognostic factors in the study population, with increased risk of death for women with tumor size greater than 2.0 cm (HR = 1.97; 95%CI: 1.26-3.07) and positive axillary lymph nodes (HR = 4.04; 95%CI: 2.55-6.39). The results emphasize the need for earlier diagnosis and treatment. Access to screening at different levels of care, mainly for women at high risk, should be a key priority for the Unified National Health System in Brazil.
Cadernos de saúde pública / Ministério da Saúde, Fundação Oswaldo Cruz, Escola Nacional de Saúde Pública 11/2009; 25(11):2455-66. · 0.98 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Analyze the 5-year breast cancer specific-survival rate of women diagnosed with invasive non-metastatic disease, who as part of their primary treatment underwent surgery followed by adjuvant chemotherapy.
Four hundred twenty eight patients diagnosed between 1998 and 2000 were recruited from all oncology services of the municipality of Juiz de Fora, MG, Brasil. Survival time was counted from the date of the histopathological diagnosis and the date of death due to breast cancer was considered the adverse event. Women alive until December 2005, the final date of the follow-up, were censored. For those who interrupt treatment, censor date was the last follow-up in the medical records. Kaplan-Meier survival curves were estimated, with the differences assessed by the log-rank test.
Mean age was 51.2 years, and most (72.6%) were Caucasian. Clinical Stages II (47.4%) and III (38.6%) predominated. Breast cancer specific five-year survival rate was 82.0%. A worst survival was observed among women with disease diagnostic before menopause (p=0.02), with tumor size greater than 2.0 cm (p=0.05), with lymph node involvement (p=0,000), in a more advanced disease stage (p=0.000), on a full adjuvant chemotherapy regimen (p=0.03), and who used hormone therapy (p=0.05).
This research allowed identification of the profile and disease survival of breast cancer patients who used adjuvant chemotherapy. These results stimulated the adoption of intensive strategies by the local health authorities for disease control and prevention in this population, emphasizing the increasing need of breast cancer screening, mainly for women considered as of high risk and the availability of timely treatment for all cases diagnosed.
Revista da Associação Médica Brasileira 08/2008; 54(4):339-46. DOI:10.1590/S0104-42302008000400020 · 0.93 Impact Factor