Breast cancer survival in Brazil: How much health care access impact on cancer outcomes?

BACKGROUND: Breast cancer has a high incidence and increasing mortality in Southern Brazil. The present study evaluated clinical and sociodemographic characteristics, and their association with overall survival in a private cancer center. METHODS: 1113 breast cancer patients were included in this study. The association between survival and clinicopathological and sociodemographic characteristics was analyzed using Cox regression and Kaplan-Meyer curves. RESULTS: Median age at diagnosis was 52 years (SD 13.5). Most patients were diagnosed in stages 0 and I (62.7%), while only 1.3% had stage IV disease. Five- and 10-year overall survival were 93.5% and 83.8%, respectively. According to multivariate analysis, age at diagnosis (HR 1.05; CI95 1.03-1.06), staging (stage III: HR 4.04; CI95 1.34-12.19; stage IV: HR 9.61; CI95 2.17-42.50), high KI67 (HR 5.46; CI95 1.27-23.32) and distant recurrence (HR 7.28; CI95 4.79-11.06) were significantly associated with survival. Smoking status, years of education, BMI, and tumor biological status were not significantly associated with mortality. CONCLUSIONS: This cohort of Brazilian patients, who received timely and appropriate treatment, achieved outcomes that are comparable to those from high income countries. Breast cancer mortality seems dependent on the quality of health care available to patients.

Intususcepción como causa de obstrucción intestinal en el adulto: un desafío para los cirujanos / Intussusception as cause of intestinal obstruction in the adult: a challenge for surgeons

La intususcepción en adultos es una condición inusual, que corresponde al 5 % de todos los casos de obstrucción intestinal y carece de síntomas específicos. El diagnóstico preoperatorio sigue siendo un desafío para el cirujano y el tratamiento óptimo de esta condición es controvertido. Se presentan dos casos clínicos de intususcepción con diferente etiología. El primero sufrió una intususcepción colocólica por un adenocarcinoma y, el segundo, una intususcepción ileocólica por un tumor del estroma gastrointestinal (GIST). Los casos fueron diagnosticados preoperatoriamente mediante tomografía axial de abdomen. En ambos casos, se practicó una resección quirúrgica oncológica. El estudio de histopatología confirmó el diagnóstico definitivo. Se describen el diagnóstico y el tratamiento de la intususcepción como causa de obstrucción intestinal en los adultos, y se presenta una revisión de la literatura científica

Intestinal intussusception in adults is a rare finding, with non specific symptoms and is responsible for 5% of intestinal obstructions. Pre-operative diagnosis remains a challenge for surgeons and the optimal treatment is still in debate. We present two cases of intestinal intussusception caused by different etiologies; the first is a colon-colonic intussusception caused by an adenocarcinoma, and the second is an ileo-colonic intussusception caused by a gastrointestinal stromal tumor (GIST). Both cases were diagnostic pre-operatively by abdominal CT. Oncologic surgical resection was performed in both cases. Histopathology report confirmed neoplastic tissues. We describe the diagnosis and treatment of intestinal intussusception as a cause of intestinal obstruction in the adult population