Introducción. Situación mundial del Cáncer de Mama / Introduction. World situation of Breast Cancer

El cáncer de mama es el tumor de la mujer más diagnosticado en la gran mayoría de los países. Los factores no hereditarios son los principales impulsores de las diferencias internacionales e in­ter­étnicas observadas en la incidencia de este cáncer. Las tasas de incidencia del cáncer de ma­ma han aumentado en la mayoría de los países en transición en las últimas décadas, en tanto que en la mayoría de los países más avanzados, las tasas de mortalidad por cáncer de mama han ido en descenso como resultado de la detección temprana de la enfermedad, los avances en el trata­ miento y mayor accesibilidad a los servicios de salud. Los principales factores de riesgo para el cáncer de mama no son fácilmente modificables porque se derivan de exposiciones hormonales endógenas prolongadas. La prevención a través de la promoción de la lactancia materna, parti­cularmente su mayor duración, pudiera ser beneficioso. La incidencia de cáncer de mama en Pa­namá se comporta de manera similar a los países con índice de desarrollo Humano en transición; ha ido en aumento en las últimas décadas como resultado del aumento en la prevalencia de los factores de riesgo conocidos y la mejoría en la recolección de datos.

Breast cancer is the most diagnosed woman's tumor in the vast majority of countries. The non­here­ ditary factors are the main drivers of the international and inter­ethnic differences observed in the incidence of this cancer. Breast cancer incidence rates have increased in most countries in transi­tion in recent decades, while in most of the more advanced countries, breast cancer death rates ha­ve been declining asa result of breast cancer. early detection of the disease, advances in treatment and greater accessibility to health services . The main risk factors for breast cancer are not easily modifiable because they are derived from prolonged endogenous hormonal exposures. Prevention through the promotion of breastfeeding, particularly its longer duration, could be beneficial. The inci­ dence of breast cancer in Panama behaves similarly to countries with a Human Development Index in transition; It has been increasing in recent decades as a result of the inc rease in the prevalence of k nown risk factors and the improvement in data collection.

Disparidade racial na sobrevivência em 10 anos para o câncer de mama: uma análise de mediação usando abordagem de respostas potenciais / Racial disparity in 10-year breast cancer survival: a mediation analysis using potential responses approach / Disparidad racial en la supervivencia en 10 años para el cáncer de mama: un análisis de mediación usando un enfoque de respuestas potenciales

Os objetivos foram investigar a associação entre raça/cor e a sobrevivência em 10 anos de mulheres com câncer de mama e o papel do estadiamento como mediador. Coorte hospitalar com 481 mulheres com câncer invasivo de mama, diagnosticadas entre 2003 e 2005. Foram feitas comparações entre mulheres brancas e negras quanto às características sociodemográficas e ao estadiamento, usando o teste qui-quadrado, e à sobrevivência em 10 anos, usando os métodos de Kaplan-Meier e regressão de Cox. Foram estimados para a variável raça/cor efeitos diretos e indiretos, mediados pelo estadiamento, com ajuste para a condição social da área de residência e idade, utilizando o modelo de respostas potenciais (contrafactual) e regressão múltipla de Cox. As mulheres negras residiam em setores censitários de menor renda, eram usuárias do setor público em maior proporção e foram diagnosticadas com estadiamentos mais avançados. A sobrevivência específica em 10 anos foi de 64,3% (IC95%: 60,0; 68,9), com diferença significativa entre brancas (69,5%; IC95%: 64,8; 74,6) e negras (44%; IC95%: 35,2; 55,1). Nos modelos múltiplos, ajustados para renda e idade, as negras tiveram pior prognóstico (HR = 2,09; IC95%: 1,76; 2,51), e a proporção mediada pelo estadiamento foi de 40% (IC95%: 37; 42). Há disparidade racial na sobrevivência do câncer de mama em 10 anos, mediada principalmente pelo estadiamento mais avançado da doença nas mulheres negras. Isso aponta para a necessidade de ampliar a cobertura e a qualidade do programa de rastreamento dessa doença e facilitar o acesso ao diagnóstico e tratamento precoces, com vistas à redução da iniquidade racial.

The study's objectives were to investigate the association between race/color and 10-year survival in women with breast cancer and the role of staging as mediator. This was a hospital cohort with 481 women with invasive breast cancer diagnosed from 2003 to 2005. Comparisons were made between white and black women as to sociodemographic characteristics and staging, using the chi-square test, and 10-year survival, using Kaplan-Meier and Cox regression methods. For the race/color variable, direct and indirect effects were estimated, mediated by staging, with adjustment for the socioeconomic status of the woman's area of residence and age, using the potential responses (counterfactual) model and Cox multiple regression. Black women living in low-income census tracts were more likely to use the public health care system and to be diagnosed at more advanced stages. Breast cancer-specific 10-year survival was 64.3% (95%CI: 60.0; 68.9), with a significant difference between whites (69.5%; 95%CI: 64.8; 74.6) and blacks (44; 95%CI: 35.2%; 55.1). In the multivariate models adjusted for income and age, black women had worse prognosis (HR = 2.09; 95%CI: 1.76; 2.51), and the proportion mediated by staging was 40% (95%CI: 37; 42). There is racial disparity in 10-year breast cancer survival in Brazilian women, mediated mainly by more advanced staging at diagnosis in black women. This highlights the need to expand both the coverage and the quality of breast cancer screening and to facilitate access to early diagnosis and treatment in order to reduce racial inequality.

Los objetivos fueron investigar la asociación entre raza/color y la supervivencia en 10 años de mujeres con cáncer de mama y el papel de la fase de desarrollo como mediador. Se trata de una cohorte hospitalaria de 481 mujeres, con cáncer invasivo de mama, diagnosticadas entre 2003 y 2005. Se realizaron comparaciones entre mujeres blancas y negras, en cuanto a las características sociodemográficas y a la fase del cáncer, usando el test chi-quadrado, y la supervivencia en 10 años, usando los métodos de Kaplan-Meier y regresión de Cox. Se estimaron para la variable raza/color efectos directos e indirectos, mediados por las diferentes fases, con ajuste en la condición social del área de residencia y edad, utilizando el modelo de respuestas potenciales (contrafactual) y regresión múltiple de Cox. Las mujeres negras residían en sectores censitarios de menor renta, eran usuarias del sector público en mayor proporción y fueron diagnosticadas en fases más avanzadas. La supervivencia específica en 10 años fue de un 64,3% (IC95%: 60,0; 68,9), con una diferencia significativa entre blancas (69,5%; IC95%: 64,8%-74,6%) y negras (44%; IC95%: 35,2; 55,1). En los modelos múltiples, ajustados para renta y edad, las negras tuvieron un peor pronóstico (HR = 2,09; IC95%: 1,76-2,51), y la proporción mediada por el estadio fue de un 40% (IC95%: 37; 42). Existe disparidad racial en la supervivencia del cáncer de mama en 10 años, mediada principalmente por el estadio más avanzado de la enfermedad en las mujeres negras. Esto apunta la necesidad de ampliar la cobertura y calidad del programa de rastreo de esa enfermedad y facilitar el acceso al diagnóstico y tratamiento precoces, con vistas a la reducción de la inequidad racial.

Clinical and pathological evaluation of fibrolamellar hepatocellular carcinoma: a single center study of 21 cases

OBJECTIVES: Fibrolamellar hepatocellular carcinoma is a rare primary malignant liver tumor that differs from conventional hepatocellular carcinoma in several aspects. The aim of this study was to describe the clinical, surgical and histopathological features of fibrolamellar hepatocellular carcinoma and to analyze the factors associated with survival. METHODS: We identified 21 patients with histopathologically diagnosed fibrolamellar hepatocellular carcinoma over a 22-year period. Clinical information was collected from medical records and biopsies, and surgical specimens were reviewed. RESULTS: The median age at diagnosis was 20 years. Most patients were female (67%) and did not have associated chronic liver disease. Most patients had a single nodule, and the median tumor size was 120 mm. Vascular invasion was present in 31% of patients, and extra-hepatic metastases were present in 53%. Fourteen patients underwent surgery as the first-line therapy, three received chemotherapy, and four received palliative care. Eighteen patients had “pure fibrolamellar hepatocellular carcinoma,” whereas three had a distinct area of conventional hepatocellular carcinoma and were classified as having “mixed fibrolamellar hepatocellular carcinoma.” The median overall survival was 36 months. The presence of “mixed fibrolamellar hepatocellular carcinoma” and macrovascular invasion were predictors of poor survival. Vascular invasion was associated with an increased risk of recurrence in patients who underwent surgery. CONCLUSION: Fibrolamellar hepatocellular carcinoma was more common in young female patients without chronic liver disease. Surgery was the first therapeutic option to achieve disease control, even in advanced cases. Vascular invasion was a risk factor for tumor recurrence. The presence of macrovascular invasion and areas of conventional hepatocellular carcinoma were directly related to poor survival. .

Breast cancer molecular subtypes in Oman: correlation with age, histology, and stage distribution - analysis of 542 cases

Breast cancer [BC] is one of the most common malignancies and a foremost health issue throughout world. BC accounted for 23.1% of cancer cases diagnosed in Oman in 2009. BC is a heterogeneous disease, and immuno-histochemical [IHC] markers are used to further classify it into distinct subtypes, which are biologically discrete and display different behaviors. IHC testing of the estrogen receptor [ER], progesterone receptor [PR] and human epidermal growth factor receptor-2 [Her-2]; can sub-classify BC into 4 principal molecular subtypes. These subtypes are luminal A [ER+ and/or PR+, HER2-], luminal B [ER+ and/or PR+, HER2+], basal like [BCL - ER-, PR-, HER2-], and Her2/neu [ER-, PR-, HER2+]. Previous studies have shown preliminary evidence and high probabilities of molecular differences across ethnic and geographic groups which may be responsible for disparities in presentation, biological behavior, treatment response and outcome. BC data from 2006-2010 at the National Oncology Center - The Royal Hospital, Oman were retrospectively retrieved from the electronic patient record system [Al-Shifa]. Data were analyzed with respect to ER, PR, and Her-2 status and tumours were classified on molecular basis. Molecular subtypes were correlated with age, histology and treatment outcome. The results were compared with published regional and international data. There were 542 cases of BC accessible for evaluation. Luminal A subtype was the most common and the BCL subtype was highest among Omani females. Age was a significant factor in basal-like [63.8% younger than 50 years vs. 36.2% older than 50 years] and Her2 +ve tumours [60.9% vs. 39.1%]. High grade tumors were mostly observed [41%] in basal tumors and were lowest in luminal A [19%]. A higher stage at presentation [Stage III and IV] was observed in Her2+ tumours [59%], and a higher [22.4%] mortality was detected in basal like/TN tumours. The molecular classification and sub-typing of BC have revealed ethnic and geographic variation. Luminal A subtype is the most common among Omani female breast cancers but it is less common than in Western females. BCL subtype is highest among Omani females compared with Western females. These differences may have diagnostic, therapeutic and prognostic implications. Large scale and multi-centre studies may confirm these findings and can be translated and incorporated to pertinent management strategies

Explorando potencialidades para a criação de rede de apoio social a mulheres lusófonas com câncer de mama e que vivem em Toronto, Canadá / Exploring potentialities for the creation of a social support network for Portuguese-Speaking women with breast cancer and who live in Toronto, Canada

Introdução: Indicadores gerais de saúde tendem a alterarem-se devido à participação de indivíduos em redes sociais. Objetivo: Conhecer as ideias dos membros de comunidades lusófonas em Toronto, Canadá, sobre a possibilidade da criação de uma rede de apoio social a mulheres com câncer de mama. Método: Estudo etnográfico crítico com 19 participantes que opinaram sobre a construção de uma rede de apoio social, pontos positivos e negativos, bem como pessoas a serem convidadas a ajudar. As discussões foram transcritas, analisadas e codificadas com o auxílio do programa de análise qualitativa Atlas ti 6.0. Resultados: Os componentes fundamentais para a construção da rede de apoio social foram a desmistificação do câncer de mama e de sua prevenção, ênfase na educação em saúde, divulgação da necessidade de voluntários e apoio social direto às mulheres com câncer. Os pontos positivos seriam a participaçãode mulheres mais idosas como líderes, uso do ambiente escolar e das instituições religiosas para a divulgação. Os empecilhos encontrados foram o câncer de mama ser uma doença vivida pelas mulheres, o desconhecimento relativo à cura e à falta de sensibilização. Em relação à participação de lideranças comunitárias, houve sugestão de diplomatas,padres e pastores, diretores de escolas e empresários da área da comunicação. Conclusão: A criação da rede de apoiosocial deve considerar a sensibilidade cultural e a diversidade interna das comunidades lusófonas. A recomendação é de que líderes sociais e profissionais angolanos sejam convidados para delinear a estrutura da rede de apoio conforme seus traços culturais específicos

Introduction:Health indicators tend to be altered due to the participation of people in social networks. Objective:to find out ideas of individuals belonging to Portuguese speaking communities in toronto,canada, about the possibility of creating a social support network for women experiencing breast cancer...

Novos métodos funcionais na avaliação de lesões mamárias / Novel functional methods in the evaluation of breast lesions

O câncer de mama é um dos mais prevalentes nas mulheres. A mamografia é um excelente método com impacto comprovado na redução da mortalidade pelo câncer de mama. Porém, não é um método perfeito, apresentando alguns pontos fracos, principalmente no rastreamento de mulheres com mamas densas, estadiamento e avaliação de tratamento. A ressonância magnética mamária mostrou a necessidade e importância da avaliação funcional mamária. Descrevemos dois métodos de avaliação funcional mamária e demonstramos nossa experiência com a mamografia digital com contraste e com a imagem molecular mamária realizada em gama-câmara específica. Estes dois métodos já estão disponíveis em nosso meio e apresentam resultados promissores na detecção de lesões mamográficas ocultas, confirmação de lesões suspeitas e redução de biópsias desnecessárias, podendo assim melhorar o estudo mamário, principalmente nos pontos falhos da mamografia.

Breast cancer is one of the most prevalent cancers in women. Mammography is an excellent method with proven impact on breast cancer mortality reduction. Nevertheless, mammography is not a perfect method, with some weaknesses, especially in screening women with dense breasts, preoperative staging and treatment evaluation. Breast magnetic resonance imaging has shown the necessity and relevance of functional evaluation of breast lesions. The authors describe two methods of functional evaluation of breasts and describe their own experience with contrast-enhanced digital mammography and with breast-specific gamma imaging. Both methods are already available in our country and have shown promising results in the detection of mammographically occult lesions, confirmation of suspicious lesions and in the reduction of unnecessary biopsies and may supplement the weaknesses of mammography, particularly in the investigation of dense breasts.

Clinico-pathologic manifestations of Iranian patients with breast cancer

Breast cancer is the most common malignancy in women and is the second cause of cancer death in female population. The objective was to find out different clinical manifestations and epidemiology of breast cancer among various ethnics groups to help improve health system in the country. In this retrospective cross sectional study, we evaluated clinical and pathologic features of one thousand Iranian women with breast cancer. The data including age, type of surgery, pathology report, tumor size, lymph node involvement, tumor stage and receptor status were extracted from medical records and were analyzed. The highest prevalence of breast cancer was in patients in 40-49 years age group [37.4%]. The most common performed surgery was modified radical mastectomy and the most common pathology report was intra-ductal carcinoma. Tumor size was 2-5 cm in most of patients. Sixty percent of patients had lymph node involvement. Finally, 49.1% of patients were diagnosed when they were in stage II and 36.7% were in stage III. In 72.9% of patients, estrogen receptor, progesterone receptor or both receptors were positive and of 116 patients who were checked for Her-2, 27 patients [23.2%] were 3+ positive. Our findings suggest that Iranian breast cancer patients are relatively younger than patients in western countries and mostly present at higher pathologic stages. We highly recommend screening test to be performed at lower ages [at least 40 years old]

Knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang: a cross-sectional survey

The objective of this study was to assess and compare the knowledge and perception of breast cancer among women of various ethnic groups in the state of Penang. A cross-sectional survey was conducted from February 5 to March 15, 2008. 384 participants were conveniently selected and interviewed face to face by a trained researcher [M.A.H.] using a validated questionnaire. Participants were required to answer 22 questions concerning knowledge of breast cancer and 5 questions on the perception of breast cancer management and treatment outcomes. The mean total score of knowledge was 59.1%, with Indian women having significantly less knowledge than the Chinese and Malay women [P< 0.001]. Only 117 [32.3%] and 120 [33.0%] women were aware of the recommended breast self-examination [BSE] and clinical breast examination [CBE] guidelines, respectively. Multiple regression analysis showed that ethnicity, age, level of education and employment status were major determinants of breast cancer knowledge. The current study has demonstrated that women in the state of Penang have serious knowledge deficits about breast cancer and poor awareness of BSE and CBE guidelines. This study has highlighted the need of an intensive breast cancer awareness campaign which should also stress the importance of early detection and reporting of breast cancer

Exploração de fatores de risco para câncer de mama em mulheres de etnia Kaingáng, Terra Indígena Faxinal, Paraná, Brasil, 2008 / Exploring breast cancer risk factors in Kaingáng women in the Faxinal Indigenous Territory, Paraná State, Brazil, 2008

O objetivo do presente estudo foi analisar a saúde das mulheres Kaingáng da Terra Indígena Faxinal, Paraná, Brasil, quanto aos fatores de risco para o câncer de mama. O estudo, de caráter descritivo-exploratório, foi realizado com 95,4 por cento da população feminina com vinte anos ou mais. O aleitamento materno por mais de 1 ano foi relatado por 92,3 por cento das mulheres; 41,4 por cento tinham mais de cinco filhos; a idade média da menarca foi 13,4 anos; 61,5 por cento nunca tinham ouvido falar do câncer de mama; o auto-exame da mama era realizado por apenas 2,9 por cento das mulheres; o médico não realizava o exame clínico da mama, segundo 81,7 por cento delas, e 99 por cento nunca fizeram mamografia. Não foi relatado caso de câncer de mama ou extramamário. Destacaram-se a presença dos fatores de proteção para a carcinogênese e a ausência de alguns fatores de risco, como o uso de terapia de reposição hormonal por mais de cinco anos e etilismo, na maioria das mulheres Kaingáng.

This study analyzes the health of Kaingáng women in the Faxinal indigenous territory in Paraná State, Brazil, with regard to risk factors for breast cancer. A descriptive and exploratory investigation was undertaken that included 95.4 percent of females 20 years or over. Data showed that 92.3 percent of Kaingáng women reported breastfeeding for more than one year; 41.4 percent had more than 5 children; mean age at menarche was 13.4 years; 61.5 percent had never heard of breast cancer; breast self-examination was only performed by 2.9 percent; 81.7 percent reported no clinical breast examination by a physician; 99 percent had never had a mammogram. No cases of breast or non-breast cancer were reported. The study highlights protective factors against carcinogenesis and the absence of key risk factors like hormone replacement therapy for more than five years and alcohol consumption in most Kaingáng women.

Barriers for breast cancer screening among Asian women: a mini literature review.

Breast cancer is the most commonly diagnosed cancer among Asian women. Breast cancer is detected in advanced stages and among younger age group women in Asia. The delay in presentation is attributed mainly to the social-cultural perception of the disease, poverty, and the strong influence of traditional medicine. Many of Asian women are not aware of the importance of regular screening. Cultural attitudes toward breast cancer screening tests, modesty, lack of encouragement by family members and physicians are the major inhibitors to women's participation in breast cancer screening. Health education using media and community health programs to create awareness of the advantages of earlier presentation and diagnosis of breast cancer in Asian women can motivate participation in breast cancer screening programs.

Survival rates of invasive breast cancer among ethnic Chinese women born in East Asia and the United States.

BACKGROUND: Few studies have compared the breast cancer survival rates of US born ethnic Chinese women and the survival rates of Chinese immigrants. The main purpose of this study is to explore the difference of breast cancer survival rates between the two populations and compare the survival rates to those of Caucasians born in the US. METHODS: Between 1973 and 2002, 365,215 women who had been diagnosed with primary invasive breast cancer (ICD-O-2 C500:C509) were recorded in the Surveillance, Epidemiology, and End Results (SEER) registries. Of the 316,881 breast cancer patients who were white, 180,835 (57%) were born in the United States, 20,983 (7%) were born elsewhere, and 115,063 (36%) had unknown birthplaces. Among the 3,634 breast cancer patients who were ethnically Chinese, 952 (26%) patients were born in the US, 1,356 (37%) were born in East Asia, 146 (4%) were born elsewhere, and 1,180 (33%) had unknown birthplaces. We compared the survival rates and estimated the risk ratios (RRs) by the Kaplan-Meier estimates and the Cox proportional hazards models. RESULTS: A lower 5-year overall survival rate of breast cancer was observed among Chinese women born in East Asia (0.74, 95% CI=0.72-0.77) than those born in the U.S. (0.79, 95% CI=0.76-0.81), with an adjusted hazards ratio of 1.22 (95% CI=1.06-1.40). The 5-year survival rates for SEER stage were higher among Chinese women born in the U.S. (localized: 0.90, 95% CI=0.87-0.93; regional: 0.71, 95% CI=66-0.77; distant: 0.16, 95% CI=0.06-0.25) than that among Chinese women born in East Asia (localized: 0.86, 95% CI=0.83-0.89; regional: 0.68, 95% CI=0.63-0.73; distant: 0.16, 95% CI=0.07-0.25). Higher 5-year survival rates among Chinese women born in the U.S. in comparison to Chinese women born in East Asia were also observed in different calendar years (1973-1980, 1981-1990, 1991-2002), in surgery and radiation therapy. CONCLUSIONS: Our analysis showed that among the Chinese breast cancer patients, women born in East Asia had lower 5-year survival rates than women born in the United States. SEER stage, grade, and tumor size appear to be important prognostic factors. The poor 5-year survival rates among Chinese women born in East Asia indicate potential problems of accessing medical facilities for early detection, diagnosis and treatment because of potential language and culture barriers, lower education level, as well as stress of the first generation of migrant Chinese women in the United States.

Association of the XRCC1 gene polymorphisms with cancer risk in Turkish breast cancer patients

The X-ray repair cross-complementing group 1 (XRCC1) gene is believed to play an important role in base excision repair and displays genetic polymorphisms. Data on the role of XRCC1 polymorphisms in cancer susceptibility is inconsistent. In the present study, we investigated the effect of two XRCC1 polymorphisms, Arg194Trp and Arg399Gln, on breast cancer risk in a case- control study involving Turkish breast cancer patients and healthy women. Both alleles exhibited a similar distribution among cases and controls leading to lack of any significant association between the XRCC1 polymorphisms and breast cancer risk, either in homozygotes and heterozygotes or combined. The allele frequency of the codon 194 variant was very low in cases and healthy individuals (5.3 and 3.9%, respectively) compared to that of the variant 399Gln allele (39.7 and 37.4%). Our results do not support evidence for a role of the XRCC1 polymorphism in developing breast cancer.

The role of Hispanic race/ethnicity and poverty in breast cancer survival

The association of Hispanic race/ethnicity and poverty with general survival time and breast cancer survival time was examined for a total of 14,896 breast cancer patients (14,035 White and 861 Hispanic) included in the National Cancer Institute Surveillance Epidemiology and End Results (NCI SEER) program in New Mexico and San Francisco between 1975 and 1984. Variables examined included: age, marital status, stage at diagnosis, tumor histology, delay, treatment, period of diagnosis (1975-79 vs. 1980-84), and poverty. Univariate analysis of 14,896 patients indicated that a greater proportion of Hispanics (vs. Whites) with breast cancer were: younger than age 50, married, diagnosed at a later stage, diagnosed in New Mexico, lived in greater poverty, were diagnosed between 1980-84, and died from breast cancer. Univariate Cox Proportion Hazards analysis indicated that poverty was a significant predictor for reduced general survival time. Being diagnosed in the 1980-84 period was a predictor for improved general survival time. Poverty and Hispanic race/ethnicity were significant predictors of reduced breast cancer survival time. Multivariate Cox Proportional Hazards models indicated that Hispanic race/ethnicity was a significant risk factor for breast cancer survival time for women aged 50 and older. For White women: state, marital status, poverty, surgery, radiation/hormonal treatments, and histology were significant risk factors for breast cancer survival time. For Hispanic women: stage, surgery, hormonal treatment and period of diagnosis were significant risk factors for breast cancer survival time. For White breast cancer patients, period of diagnosis was not a significant risk factor for reduced breast cancer survival time; but for Hispanics, it was a significant risk factor. In the age and race/ethnicity-stratified models of breast cancer survival time, similar risk factors emerged for both Whites and Hispanics. For both younger and older Hispanics, being diagnosed in the early 1980's (vs. the late 1970's) was associated with reduced breast cancer survival time--vs. Whites, who experienced no significant change in breast cancer survival time in the same time period. Poverty was not a predictor for Hispanic survival time in any of the models; however, it was a predictor for younger Whites for breast cancer survival time. These results fueled discussion in three areas targeting breast cancer in underserved women: the development of racial/ethnic-specific cancer control guidelines, the development of a breast cancer integrated delivery system, and population management

study of knowledge, attitude, and practice among fertile females towards breast cancer in a rural area

The aim of this work is to study knowledge, attitude, and practice towards breast cancer among fertile females in an Egyptian rural area. The study was conducted on 400 fertile females selected randomly from El-Manawate Village, Giza Governorate during the period from December 1992 to the end of December [1993. It was found that married women had a better knowledge about breast sorer than did single females. The percentage of women who considered that early puberty and late menopause as risk factors for breast cancer was less than 5%, while the percentage of those had knowledge about the curly signs of breast cancer was about 30%. All married females of our sample preferred to consult a doctor if there was any breast ailment while only one quarter of single females made this choice. It was recommended that a well designed programme for health education of fertile females must he carried out mainly through mass media TV. as well as training physicians and nursing stuff on performing health education of the target fertile females

Cancer de mama em homem: relato de caso / Male breast cancer: a case report

Os autores relatam um caso de cancer (Ca) de mama em homem. Devido a raridade da situacao e a dificuldade em se avaliar um numero significativo de pacientes, algumas incertezas ainda existem em relacao ao tratamento. Ao ser comparado com o Ca de mama em mulheres, observam-se, entretanto, muitas similaridades, que serao discutidas durante a apresentacao deste relato

Câncer de mama na mulher idosa

A possível relação entre a agressividade do câncer e a idade é polêmica. O objetivo desta pesquisa é verificar, dentro de um grupo de mulheres com câncer de mama na pós-menopausa, se as idosas têm um prognóstico diferente das demais. Realizamos um estudo de coorte histórico com 291 casos de câncer de mama na pós-menopausa, registrados no Hospital do Câncer entre 1983 e 1987. Arbitramos como idosa a paciente com 70 anos ou mais (grupo em estudo - 84 casos), e comparamos este grupo com um controle, constituído por pacientes com idade inferior (207 casos). Analisamos as diferenças entre os dois grupos em relação ao tipo e duração da sintomatologia, tempo de menopausa, presença de doenças intercorrentes, localização do tumor, estadiamento clínico, terapêutica, tipo histológico do tumor, estadiamento pós-cirúrgico da axila e tempo de sobrevida (livre de doença e total). Estudamos a influência de cada variável na sobrevida e procedemos à análise multivariada pela regressão logística. Por fim, realizamos a curva de sobrevida em relação aos dois grupos e ao estadiamento pós-cirúrgico da axila. Verificamos que, em idêntico estadiamento clínico, houve uma ndência para cirurgias mais limitadas no grupo em estudo. A análise multivariada demonstrou significância estatística em relação à idade, à localização do tumor primário e ao estadiamento pós-cirúgico da axila, com pior prognóstico no grupo em estudo. A curva de sobrevida, entretanto, não demonstrou diferença significativa entre os dois grupos e, do ponto de vista estatístico, o prognóstico relacionou-se principalmente ao comprometimento histológico dos linfonodos axilares.

The possible relationship between cancer aggressiveness and age still controversial. The objective of this study is to verify, in a group of post menopausal women with breast cancer, if the elderly have a different prognosis than others. We have performed an historical cohort study with 291 cases of post menopausal breast cancer registered at Hospital do Cancer between 1983 and 1987. We have defined as elderly the women aged 70 years or more (study group - 84 cases) and we compared this group with an younger control group (207 cases). We have analised the differences between the two groups In relation to the kind and duration of the symptomatology, numbers of years SInce menopause, concurrent sistemic diseases, tumor localization, clinical staging, treatment, histologic type of the tumor, pathological staging of lymph nodes and disease free survival time and overall survival time. We have studied the influence of each variable on the survival time and performed a multivariate analysis by logistic regression. Finally, we have done the life table survival anlysis on the two groups and also taking in consideration the pathological staging of lymph nodes. We have verified that, even if there was no differences in the clinical stating, the surgical treatment in the study group was less extensive.The multivariate analysis has demonstrated that age, localization the tumor and pathological staging of lymph nodes were significant, and that the prognosis was worst in the study group. However, the life table survival did not show a significant difference between the two groups. The prognosis was influenced by the pathological staging of lymph nodes.

Correlaçäo entre receptores estrogênicos e características epidemiológicas no câncer de mama / Correlation between estrogen receptors and epidemiologic characteristics in breast cancer

Foram estudadas 51 pacientes com câncer de mama. Correlacionou-se a presença ou näo de receptores estrogênicos, com características epidemiológicas (idade, cor, estado civil, paridade, menarca, menopausa e aleitamento). Os autores näo encontraram correlaçäo entre as variáveis analisadas