EGFR Mutation Testing: Changing Patterns of Molecular Testing in Brazil.

BACKGROUND: In Brazil, cancer is the second most common cause of death. Most patients in resource-limited countries are diagnosed in advanced stages. Current guidelines advocate for EGFR mutation testing in all patients with metastatic adenocarcinoma. Tyrosine kinase inhibitors are recommended in patients with advanced or metastatic disease harboring sensitizing mutations. In Brazil, there are limited data regarding the frequency of EGFR testing and the changes in patterns of testing overtime. MATERIALS AND METHODS: This was an observational, retrospective study. We obtained deidentified data from a commercial database, which included 11,684 patients with non-small cell lung cancer treated between 2011 and 2016 in both public and private settings. We analyzed the frequency of EGFR mutation testing over time. We also directly studied 3,664 tumor samples, which were analyzed between 2011 and 2013. These samples were tested for EGFR mutations through an access program to tyrosine kinase inhibitors in Brazil. RESULTS: Overall, 38% of patients were tested for EGFR mutations; 76% of them were seen in the private sector, and 24% were seen in the public center. The frequency of testing for EGFR mutations increased significantly over time: 13% (287/2,228 patients) in 2011, 34% (738/2,142) in 2012, 39% (822/2,092) in 2013, 44% (866/1,972) in 2014, 53% (1,165/2,184) in 2015, and 42% (1,359/3,226) in 2016. EGFR mutations were detected in 25.5% of analyzed samples (857/3,364). Deletions in Exon 19 were the most frequent mutations, detected in 54% of patients (463/857). CONCLUSION: Our findings suggest that the frequency of EGFR mutation in this cohort was lower than that found in Asia but higher than in North American and Western European populations. The most commonly found mutations were in Exon 19 and Exon 21. Our study shows that fewer than half of patients are being tested and that the disparity is greater in the public sector. IMPLICATIONS FOR PRACTICE: These data not only indicate the shortage of testing but also show that the rates of positivity in those tested seem to be higher than in other cohorts for which data have been published. This study further supports the idea that awareness and access to testing should be improved in order to improve survival rates in lung cancer in Brazil.

Associations Between Cardiorespiratory Fitness and Overweight With Academic Performance in 12-Year-Old Brazilian Children.

Obesity has been associated with poor academic achievement, while cardiorespiratory fitness (CRF) has been linked to academic success. PURPOSE: To investigate whether CRF is associated with academic performance in Brazilian students, independently of body mass index (BMI), fatness and socioeconomic status (SES). METHODS: 392 5th and 6th grade students (193 girls) (12.11 ± 0.75 years old) were evaluated in 2012. Skinfold thickness measures were performed, and students were classified according to BMI-percentile. CRF was estimated by a 20-meter shuttle run test, and academic achievement by standardized math and Portuguese tests. Multiple linear regression analyses were conducted to explore the association between academic performance and CRF, adjusted for SES, skinfold thickness or BMI-percentile. RESULTS: Among girls CRF was associated with higher academic achievement in math (ß = 0.146;p = .003) and Portuguese (ß = 0.129;p = .004) in crude and adjusted analyses. No significant association was found among boys. BMI was not associated with overall academic performance. There was a weak negative association between skinfold thickness and performance in mathematics in boys (ß =- 0.030;p = .04), but not in girls. CONCLUSION: The results highlight the importance of maintaining high fitness levels in girls throughout adolescence a period commonly associated with reductions in physical activity levels and CRF.

Is the association between unhealthy weight and academic performance influenced by children's physical activity level? / A associação entre peso não saudável e desempenho escolar é influenciada pelo nível de atividade física em crianças?

The purpose of this study was to verify the association between unhealthy weight and academic performance and the influence of physical activity level (PAL) in elementary school children. This study was conducted with 450 elementary school students (50% girls) enrolled in 1st to 4th grades. PAL was assessed by self-reported questionnaire of typical physical activity and daily food intake (DAFA). Academic achievement (Portuguese and Mathematics) was estimated based on the academic performance system of public schools from Recife/Brazil. Binary logistic regression was used to verify the association between unhealthy weight (underweight and overweight) and normal weight with academic performance. The results showed that 26.6% of the students presented overweight, 11.1% presented underweight, 49.1% and 50.9% were classified as high and low PAL, respectively. In addition, 56.9% had sufficient academic performance in Portuguese and 51.1% had sufficient academic performance in Mathematics. Students with overweight presented higher odds for insufficient performance in Portuguese when compared to normal weight counterparts, even when adjusted for reported PAL, gender and age (OR = 1.69; 95%CI: 1.08-2.64). The results corroborate with evidences that unhealthy weight is associated with poor academic performance in children.

O objetivo deste estudo foi verificar a associação entre peso não saudável e desempenho escolar e a influência do Nível de Atividade Física (NAF) em crianças do ensino fundamental. Este estudo foi realizado com 450 alunos do ensino fundamental (50% meninas) matriculados na 1ª a 4ª série. NAF foi avaliado indiretamente através de um questionário de auto relatado Dia Típico de Atividade Física e Alimentação (DAFA). Desempenho escolar (Português e Matemática) foi estimado com base no sistema de desempenho escolar das escolas públicas do Recife / Brasil. Regressão logística binária foi utilizada para verificar a associação entre o peso não saudável (baixo peso e sobrepeso) e peso normal, com o desempenho escolar. Os resultados mostraram que 26,6% dos estudantes apresentavam sobrepeso, 11,1% apresentavam baixo peso, 49,1% e 50,9% foram classificados como alto e baixo NAF, respectivamente. Em adição, 56,9% apresentavam desempenho suficiente em Português e 51,1% apresentavam desempenho suficiente em Matemática. Estudantes com sobrepeso apresentaram maior odds para desempenho insuficiente em português quando comparados aos seus pares com peso normal, mesmo quando ajustada por reportada NAF, gênero e idade (OR = 1.69; 95%IC: 1.08-2.64). Os resultados corroboram com evidências de que o peso não saudável é associado com pobre desempenho escolar em crianças.