Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery.

OBJECTIVE: To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery. DESIGN: Clinical trial. SETTING: Health care center. PARTICIPANTS: Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. INTERVENTIONS: Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. MAIN OUTCOME MEASURES: Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods. RESULTS: There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024). CONCLUSIONS: MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.

Association of CYP1A1 A4889G and T6235C polymorphisms with the risk of sporadic breast cancer in Brazilian women.

OBJECTIVES: We examined the influence of CYP1A1 A4889G and T6235C polymorphisms on the risk of sporadic breast cancer. METHODS: DNA from 742 sporadic breast cancer patients and 742 controls was analyzed using the polymerase chain reaction, followed by the restriction fragment length polymorphism technique. RESULTS: More patients had the CYP1A1 4889AG+GG genotype compared to controls (29.0% versus 23.2%, p=0.004). The G allele carriers had a 1.50-fold increased risk (95% CI: 1.14-1.97) of sporadic breast cancer compared to the other study participants. The frequency of the 4889AG+GG genotype among the Caucasian patients was higher than in the non-Caucasian patients (30.4% versus 20.2%, p=0.03) and controls (30.4% versus 23.2%, p=0.002). Caucasians and G allele carriers had a 1.61-fold increased risk (95% CI: 1.20-2.15) of sporadic breast cancer compared to other subjects. The CYP1A1 4889AG+GG genotype was more common among patients with a younger median age at first full-term pregnancy than among controls (33.8% versus 23.2%, p=0.001) and subjects whose first full-term pregnancies occurred at an older age (33.8% versus 26.1%, p=0.03). Women with the CYP1A1 4889AG+GG genotype and earlier first full-term pregnancies had a 1.87-fold (95% CI: 1.32-2.67) increased risk of sporadic breast cancer compared to the other study participants. Excess CYP1A1 4889AG+GG (39.8% versus27.1%, p=0.01) and 6235TC+CC (48.4% versus 35.9%, p=0.02) genotypes were also observed in patients with grade I and II tumors compared to patients with grade III tumors and controls (39.8% versus 23.2%, p=0.04; 48.4% versus 38.6%, p=0.04). The G and C allele carriers had a 2.44-fold (95% CI: 1.48-4.02) and 1.67-fold (95% CI: 1.03-2.69) increased risk, respectively, of developing grade I and II tumors compared to other subjects. CONCLUSIONS: The CYP1A1 A4889G and T6235C polymorphisms may alter the risk of sporadic breast cancer in Brazilian women.

Association of CYP1A1 A4889G and T6235C polymorphisms with the risk of sporadic breast cancer in Brazilian women

OBJECTIVES:We examined the influence of CYP1A1 A4889G and T6235C polymorphisms on the risk of sporadic breast cancer.METHODS:DNA from 742 sporadic breast cancer patients and 742 controls was analyzed using the polymerase chain reaction, followed by the restriction fragment length polymorphism technique.RESULTS:More patients had the CYP1A1 4889AG+GG genotype compared to controls (29.0% versus 23.2%, p=0.004). The G allele carriers had a 1.50-fold increased risk (95% CI: 1.14-1.97) of sporadic breast cancer compared to the other study participants. The frequency of the 4889AG+GG genotype among the Caucasian patients was higher than in the non-Caucasian patients (30.4% versus 20.2%, p=0.03) and controls (30.4% versus 23.2%, p=0.002). Caucasians and G allele carriers had a 1.61-fold increased risk (95% CI: 1.20-2.15) of sporadic breast cancer compared to other subjects. The CYP1A1 4889AG+GG genotype was more common among patients with a younger median age at first full-term pregnancy than among controls (33.8% versus 23.2%, p=0.001) and subjects whose first full-term pregnancies occurred at an older age (33.8% versus 26.1%, p=0.03). Women with the CYP1A1 4889AG+GG genotype and earlier first full-term pregnancies had a 1.87-fold (95% CI: 1.32-2.67) increased risk of sporadic breast cancer compared to the other study participants. Excess CYP1A1 4889AG+GG (39.8% versus27.1%, p=0.01) and 6235TC+CC (48.4% versus 35.9%, p=0.02) genotypes were also observed in patients with grade I and II tumors compared to patients with grade III tumors and controls (39.8% versus 23.2%, p=0.04; 48.4% versus 38.6%, p=0.04). The G and C allele carriers had a 2.44-fold (95% CI: 1.48-4.02) and 1.67-fold (95% CI: 1.03-2.69) increased risk, respectively, of developing grade I and II tumors compared to other subjects.CONCLUSIONS:The CYP1A1 A4889G and T6235C polymorphisms may alter the risk of sporadic breast cancer in Brazilian women.

[Knowledge, attitude and practice of breast self-examination in health centers]. / Conhecimento, atitude e prática do auto-exame das mamas em centros de saúde.

OBJECTIVE: Breast cancer is one of the most important problems of public health and education regarding breast self-examination is one of the important steps for identifying breast tumors at an early stage. The present study was carried out to assess knowledge, attitude, and practice of breast self-examination among patients attending health centers. METHODS: In a KAP (Knowledge, Attitude and Practice) survey 663 women of 13 randomly selected municipal health centers were interviewed. The number of interviews in each health center was proportional to the mean number of women seen per month. In the data analysis, women's answers for knowledge, attitude and practice regarding breast self-examination were classified according to their adequacy as previously defined. Adequacy was compared among categories of control variables with Chi2 test. RESULTS: The results showed that knowledge and practice of breast self-examination were adequate in 7.4% and 16.7%, respectively. However, attitude was adequate in 95.9% of the women interviewed. The study also showed that 58.1% of the women interviewed referred that forgetfulness was the main barrier for not performing self-examination. CONCLUSIONS: Women attending the health centers sampled in this study had inadequate knowledge and practice about breast self-examination but they had an adequate and favorable attitude about it.

Conhecimento, atitude e prática do auto-exame das mamas em centros de saúde / Knowledge, attitude and practice of breast self-examination in health centers

OBJETIVO: O câncer da mama é um dos principais problemas de saúde pública e a educaçäo para o auto-exame mamário é uma das etapas fundamentais na identificaçäo de tumores da mama em fase inicial. Realizou-se estudo com o objetivo de avaliar o conhecimento, a atitude e a prática do auto-exame das mamas entre usuárias de centros de saúde. MÉTODOS: Em estudo tipo inquérito CAP (conhecimento, atitude e prática) foram entrevistadas 663 mulheres de 13 centros de saúde municipais selecionados de forma aleatória. O número de entrevistas em cada centro de saúde foi proporcional ao número médio mensal de mulheres atendidas. As respostas das usuárias foram descritas quanto ao conhecimento, atitude e prática, e suas respectivas adequações para o auto-exame das mamas, como previamente definido. A adequaçäo foi comparada entre as categorias das variáveis de controle pelo teste X² RESULTADOS: Os resultados mostraram que o conhecimento e a prática do auto-exame das mamas foram adequados em 7,4 por cento e 16,7 por cento das entrevistadas respectivamente, embora a atitude frente a este procedimento tenha sido adequada em 95,9 por cento das entrevistas. O estudo também mostrou que o esquecimento desta prática foi a principal barreira para a sua näo realizaçäo, sendo referido por 58,1 por cento das mulheres. CONCLUSÕES: As mulheres que utilizaram os centros de saúde tiveram conhecimento e prática inadequados para auto-exame das mamas, apesar de apresentarem atitude adequada e favorável à realizaçäo desse procedimento.

O Papel do auto-exame mamário e da mamografia no diagnóstico precoce do câncer da mama / The role of breast self-examination and mammography in the early diagnosis of breast cancer

O câncer da mama é considerado um problema de saúde pública em quase todos os países. O efeito devastador causado por esta neoplasia tem motivado a criaçäo de programas de educaçäo em saúde a fim de se conseguir seu diagnóstico precoce, quando as chances de cura säo maiores. Este diagnóstico está fundamentado em três procedimentos: o auto-exame das mamas, o exame clínico e a mamografia. A maioria dos programas recomenda, principalmente onde o diagnóstico tardio é a realidade, a prática do auto-exame como uma das maneiras de identificaçäo precoce dos tumores; no entanto, a literatura científica também aponta a subutilizaçäo deste procedimento em mulheres pertencentes a classes sociais mais elevadas. Já o exame de mamografia, apesar de permanecer controverso seu real impacto na reduçäo da mortalidade por esta neoplasia, é a principal arma no diagnóstico do câncer de mama assintomático. Infelizmente, por se tratar de método diagnóstico mais sofisticado, tem deixado de fora significativa parcela da populaçäo feminina que näo tem acesso ao procedimento. Os autores revisaram trabalhos que mostram a importância do auto-exame das mamas e da mamografia, bem como a execuçäo dos mesmos pelas mulheres.