Incidence of Brain Metastases in Nonmetastatic and Metastatic Breast Cancer: Is There a Role for Screening?

BACKGROUND: Current National Comprehensive Cancer Network and American Society of Clinical Oncology guidelines recommend against screening breast cancer patients for asymptomatic brain metastases. Because brain metastases are a major cause of morbidity and mortality from breast cancer, we undertook a literature review to ascertain whether there might be a role for brain metastases screening in high-risk patient subgroups. MATERIALS AND METHODS: A literature search was conducted on the OvidSP platform in the MedLine database, using MeSH terms and subject headings related to breast cancer, brain metastases, and incidence. The search was conducted without language or publication restrictions, and included articles indexed from January 1, 2006 to June 10, 2018. Experimental and observational studies that reported the incidence of brain metastases in patients with nonmetastatic or metastatic breast cancer were included. RESULTS: One hundred seventy studies were identified, with 33 included in the final analysis. Among nonmetastatic breast cancer patients, incidence of brain metastases as site of first recurrence per year of median follow-up ranged from 0.1% to 3.2%. Although incidence of brain metastases was much higher among the metastatic breast cancer population overall, it was particularly high among metastatic HER2-overexpressing (HER2+) and triple-negative populations, ranging between 22% and 36% for the former, and 15%-37% for the latter in the absence of screening. CONCLUSION: In patients with nonmetastatic breast cancer, screening for asymptomatic brain metastases cannot currently be justified. However, due to the high incidence of brain metastases among patients with metastatic HER2+ and triple-negative breast cancer, studies to determine the value of screening for brain metastases should be undertaken in these subgroups.

Prevalencia de factores de riesgo del cáncer de mama en población rural femenina / Breast cancer risk factors prevalence in female rural population

RESUMEN Fundamento: el cáncer de mama, en Cuba, es la segunda causa de muerte por cáncer en mujeres. Objetivo: establecer la prevalencia de factores de riesgo del cáncer de mama en población rural femenina. Métodos: se realizó un estudio transversal y descriptivo en un universo de 107 pacientes femeninas mayores de 20 años, residentes en la comunidad rural de Santo Domingo, durante el primer semestre de 2018. Resultados: la prevalencia del cáncer de mama en mujeres de procedencia rural fue baja. La edad mayor de 50 años y el color blanco de la piel, el tabaquismo y la obesidad, y la enfermedad proliferativa de la mama con acompañamiento de atipia celular fueron los factores de riesgo no modificables, modificables e histológicos respectivamente más prevalentes. Conclusiones: los factores de riesgo de cáncer de mama en población femenina de procedencia rural tienen una prevalencia alta.

ABSTRACT Background: the breast cancer, in Cuba, is the second cause of cancer death in women. Objective: to establish the prevalence of the breast cancer risk factors in female rural population. Methods: a descriptive and traverse study was carried out in a universe of 107 feminine patients older than 20 years, residents in Santo Domingo rural community, during the first semester of the 2018. Results: the breast cancer prevalence in women of rural origin was low. The age older than 50 years and the white skin color, the smoking and the obesity and the breast proliferative decease for atypical cellular accompanying they were the most prevalent non-modifiable, modifiable and histologic risk factors, respectively. Conclusions: the breast cancer risks factors in female population of rural origin have a high prevalence.

Natural history of ductal carcinoma in situ / História natural do carcinoma ductal in situ

Ductal carcinoma in situ (DCIS) has been detected more frequently in the last decades using the mammographic screening. The objective of the present study was to review the epidemiological aspects of DCIS. A bibliographic narrative review was carried out focusing on the following aspects: the epidemiology of DCIS to discuss subtypes; natural history; screening; and survival. It was possible to verify that the DCIS is currently considered a precursor lesion of breast cancer, presenting a considerable and uneven increased incidence between developed and developing countries, probably due to the inclusion of mammographic screening programs. There are controversies regarding the benefit or not of its detection, diagnosis, treatment and survival of patients with DCIS. It is concluded that the considerable increase in the incidence of DCIS raises an important discussion about the real need for its diagnosis as well as its real biological significance

carcinoma ductal in situ (CDIS) tem sido detectado com maior frequência nas últimas décadas a partir do rastreamento mamográfico. O objetivo do presente estudo foi revisar os aspectos epidemiológicos do CDIS. Foi realizada uma revisão bibliográfica narrativa enfocando os aspectos do CDIS: epidemiologia, para discussão a respeito dos subtipos; história natural; rastreamento; e sobrevida. Foi possível verificar que o CDIS é atualmente considerado como uma lesão precursora do câncer de mama e apresenta aumento considerável e desigual em sua incidência entre países desenvolvidos e em desenvolvimento, devido, provavelmente, à inclusão dos programas de rastreamento mamográfico. Há controversas quanto ao benefício ou não da detecção, do diagnóstico, do tratamento e da sobrevida de pacientes que apresentam o CDIS. Conclui-se que o aumento considerável da incidência do CDIS levanta importante discussão sobre a necessidade real de seu diagnóstico, bem como do seu real significado biológico

Effectiveness of breast cancer screening policies in countries with medium-low incidence rates

ABSTRACT Chile has lower breast cancer incidence rates compared to those in developed countries. Our public health system aims to perform 10 biennial screening mammograms in the age group of 50 to 69 years by 2020. Using a dynamic programming model, we have found the optimal ages to perform 10 screening mammograms that lead to the lowest lifetime death rate and we have evaluated a set of fixed inter-screening interval policies. The optimal ages for the 10 mammograms are 43, 47, 51, 54, 57, 61, 65, 68, 72, and 76 years, and the most effective fixed inter-screening is every four years after the 40 years. Both policies respectively reduce lifetime death rate in 6.4% and 5.7% and the cost of saving one life in 17% and 9.3% compared to the 2020 Chilean policy. Our findings show that two-year inter-screening interval policies are less effective in countries with lower breast cancer incidence; thus we recommend screening policies with a wider age range and larger inter-screening intervals for Chile.

Estudo retrospectivo de pacientes diagnosticados com câncer de mamainternados em hospital universitário / Retrospective study of patients diagnosed with breast cancer hospitalized in university hospital

O câncer de mama é a segunda neoplasia com maior incidência na população feminina, sendo o primeiro, o câncer de pele não melanoma. A concentração de quase 70% da população em grandes centros favorece a exposição aos fatores de risco ambientais, aos quais é atribuída relação direta ou indireta com 80% dos casos de câncer. Algumas substâncias químicas, o tabagismo, a poluição ambiental e a disparidade socioeconômica podem gerar influência na distribuição e na incidência do câncer nas diferentes regiões brasileiras. O estudo teve como objetivo realizar uma análise retrospectiva de pacientes, diagnosticadas com câncer de mama internadas em Hospital Universitário Sul Fluminense, Vassouras (RJ), entre o período de janeiro de 2010 a abril de 2014. A idade variou entre 20 a 90 anos, com idade média de 57,4 anos, em que houve predomínio da faixa etária de 50 a 59 anos. Em relação à cor da pele, notou-se maior incidência em mulheres brancas (51%). De acordo com a classificação histológica, o carcinoma predominante foi o do tipo ductal invasivo grau 2 de Nottingham. Com base nos nossos resultados, concluímos que o tipo de câncer com maior incidência ocorreu em grande parte em mulheres brancas e que o tratamento preconizado para a maioria dos casos foi a remoção cirúrgica, sendo associada à outra estratégia terapêutica, principalmente a quimioterapia.

Breast cancer is the second cancer with the highest incidence on the female population, and the firstis the non-melanoma skin cancer. The concentration of nearly 70% of the population in big citiesfavors exposure to environmental risk factors, which is attributed a direct or indirect relation to 80%of cancer cases. Some chemicals, smoking, environmental pollution and socioeconomic disparity cangenerate influence on the distribution and incidence of cancer in different Brazilian regions. Thestudy aimed at carring out a retrospective analysis of patients diagnosed with breast cancer admittedto a University Hospital Sul Fluminense, Vassouras (RJ), Brazil, in the period from January 2010 toApril 2014. The age ranged from 20 to 90 years, the mean age was 57.4 years, in which there was apredominance of the age group 50-59 years. With regard to skin color, it was seen a higher incidencein white women (51%). According to histological classification, the predominant cell carcinoma wasinvasive ductal type 2 grade of Nottingham. Based on our results, we conclude that the type of cancerwith the highest incidence occurred largely in white women and the treatment recommended formost cases was the surgical removal that was associated with another therapeutic strategy, especiallychemotherapy.