Impact of ICU bed availability on ovarian cancer surgical hospitalization rates during the first wave of the coronavirus disease 2019 pandemic

SUMMARY OBJECTIVES: The coronavirus disease 2019 pandemic, which began in 2020, disrupted healthcare services. Reports of changes in surgical activities coincide with the outbreak period. We aimed to identify if changes could be determined in hospitalization rates of ovarian cancer patients from 2016 to 2020, comparing pre-pandemic and pandemic levels. METHODS: Aggregated data were obtained from the State of São Paulo Secretary of Health regarding ovarian cancer clinical and surgical hospitalization, both Coronavirus disease-specific ICU and infirmary bed occupation rates, average social distancing rates, coronavirus disease 2019 incidence, mortality, and lethality rates. We performed the joinpoint analysis to verify if there were changes regarding hospitalization rates during this period. We also calculated hospitalization rate ratios and tested if they were correlated with pandemic-related variables. RESULTS: Hospitalization rates in the state fell, coinciding with the pandemic. Surgical hospitalization rate ratios were inversely correlated with Coronavirus disease-specific ICU bed occupation rates during the third trimester of 2020, with a Pearson's correlation coefficient of −0.50 (95%CI −0.78 to −0.05, p=0.03). CONCLUSION: These results demonstrate the impact of the coronavirus disease 2019 pandemic on the treatment of conditions that compete for the same healthcare resources.

Impact of coronavirus disease 2019 pandemic on breast cancer screening and detection of high-risk mammographic findings

SUMMARY OBJECTIVE: The coronavirus disease 2019 pandemic has disrupted cancer screening worldwide. This study aims to analyze the changes in the rates of screening mammograms and BIRADS 4 or 5 mammograms during the coronavirus disease 2019 pandemic in the opportunistic scenario. METHODS: We integrated three different public databases from the state of São Paulo, Brazil, to obtain the rate of screening mammograms per 1,000, and the rate of BIRADS 4 or 5 mammograms per 100,000 women aged from 50 to 69 years in the years from January 2017 to December 2020. RESULTS: The mean monthly screening mammograms decreased from 14.8/1,000 in 2019 to 9.25/1,000 in 2020, with the lowest rates being recorded in May 2020 (3.1/1,000). The mean monthly high-risk mammograms decreased from 12.8/100,000 in 2019 to 9.1/100,000 in 2020, with the lowest rates being recorded in April 2020 (4.3/100,000). CONCLUSIONS: Coronavirus disease 2019 pandemic significantly decreased mammography screening in an opportunistic scenario, a warning sign for decreasing diagnosis of breast cancer in early stages, and increasing advanced stage diagnosis and mortality in the future.

Bases moleculares da história reprodutiva na prevenção do câncer de mama / Molecular basis of reproductive history on breast cancer prevention

A taxa atual de mortalidade por falha do tratamento do câncer de mama e o aumento de sua incidência suporta o investimento na preveção primária. O risco de desenvolver câncer de mama é dependente de condições endócrinas moduladas pela função ovariana, tais como a menarça precoce, menopausa tardia e a paridade. Gestação precoce é um fator sabidamente preventivo. Mulheres que levam uma gestação a termo antes de 24 anos de idade apresentam redução no risco de desenvolver câncer de mama e gestações adicionais aumentam a proteção. As tendências atuais de controle de natalidade e gestação tardia associadas à utilização de métodos hormonais de anticoncepção podem ser fatores responsáveis pelo aumento substancial na incidência do câncer de mama nas últimas décadas. Dados experimentais em modelos animais sugerem que o efeito preventivo da gestação é secundário à exposição à gonadotrofina coriônica humana (hCG). O hCG é capaz de modular a expressão genética de células mamárias, resultando em sua completa diferenciação. Essa ação parece ser mediada por mecanismos epigenéticos. A demonstração de que o hCG é capaz de modular a expressão de genes responsáveis pela diferenciação celular promovendo efeito quimio-preventivo é a base do modelo futuro da prevenção primária da doença.

The current mortality rate due to breast cancer treatment failure and the worldwide increase in its incidence support the effort in primary breast cancer prevention. The risk of developing breast cancer is dependent on endocrine conditions modulated by ovarian function, such as early menarche, late menopause and parity. Early pregnancy is a known protective factor. Women who gave birth before 24 years old exhibit a decrease in their lifetime risk of developing breast cancer, as additional pregnancies increase the protection. Current tendency regarding birth control and late pregnancy associated with the use of hormonal contraceptive methods could be responsible or the increasing incidence of breast cancer. Experimental data in animal models suggest that this preventive role is due to the exposure to human chorionic gonadotropin (hCG). Human chorionic gonadotropin is able to modulate the expression of genes in breast cells resulting in the complete differentiation. The data gathered suggest that its modulation activity is due to a mechanism called epigenetic changes. The demonstration that hCG can modulate the expression of genes through epigenetic changes leading to breast cell differentiation and promoting a chemo-preventive effect is the base that support the future model for primary preventive care of this neoplam.