SUMMARY OBJECTIVE: The radical change in the treatment of breast cancer has promoted the necessity for more comprehensive training of the professionals involved, ensuring the preservation of oncological safety while also allowing for cosmetic interventions to benefit breast cancer survivors. The aim of this study was to present the methods employed in the training of breast surgeons, highlighting the importance of oncoplasty and breast reconstruction. METHODS: A literature review was conducted in two databases, identifying articles related to medical education in the context of oncoplastic surgery and breast reconstruction. We also assessed the Brazilian experience in oncoplastic centers. RESULTS: The basis for educational discussions was derived from 16 articles. We observed approaches that included hands-on courses utilizing simulator models, porcine models, cadaver labs, and fellowship programs. Positive outcomes were observed in Brazil, a fact based on seven oncoplasty training centers for senior mastologists and five training centers for junior mastologists. From 2009 to 2023, an estimated 452 seniors and 42 juniors received training, representing approximately 30% of mastologists in Brazil who have acquired training and experience in oncoplasty. CONCLUSION: Despite the limited number of publications on training methods, oncoplastic centers have made significant progress in Brazil, establishing a successful model that can be replicated in other countries. OBJECTIVE involved survivors surgeons reconstruction METHODS databases RESULTS 1 handson hands models labs programs 200 2023 45 4 30 CONCLUSION countries 20 202 3 2

ABSTRACT Tuberculous mastitis (TM) is a rare cause of breast disease. The test sensitivity for TM is low and sometimes characterized by idiopathic granulomatous mastitis. Both have different treatments; however, many patients are treated with presumptive TM (P-TM). We present fifteen women with confirmed TM or P-TM. We found 4% (5/124) of TM and 8% (10/124) of P-TM, grouped according to their diagnosis, with no differences between them, except for follow-up and treatment time. P-TM is an entity that must be considered based on clinical and radiological suspicion and is associated with presumptive pathological data. (TM disease treatments however PTM. PTM P . (P-TM) TM. 4 5/124 5124 5 124 (5/124 8 10/124 10124 10 (10/124 PTM, TM, diagnosis them followup follow up time data (P-TM 5/12 512 12 (5/12 10/12 1012 1 (10/12 5/1 51 (5/1 10/1 101 (10/1 5/ (5/ 10/ (10/ (5 (10 ( (1

RESUMO Objetivo: O objetivo deste estudo foi analisar o prognóstico de mulheres com câncer de mama de acordo com os subtipos moleculares, variáveis sociodemográficas, características clínicas e de tratamento. Métodos: Este foi um estudo de coorte retrospectivo de base hospitalar. Foram analisadas 1.654 mulheres maiores de 18 anos diagnosticadas com câncer de mama invasivo entre 2000 a 2018. Os dados foram extraídos da Fundação Oncocentro de São Paulo, Brasil. As variáveis analisadas foram idade, histologia, subtipo moleculares, estadiamento clínico, tipo de tratamento e tempo entre o diagnóstico e tratamento. A análise de regressão de Cox foi aplicada para estimar o risco de morte. Resultados: As mulheres que apresentaram os subtipos moleculares HER-2-positivo (não luminal) e triplo negativo tiveram risco de morte quase duas vezes maior respectivamente, com razão de risco ajustada — HRaj=2,30 (intervalo de confiança de 95% — 95%IC 1,34–3,94) e HRaj=2,51 (95%IC 1,61–3,92). O atraso no tratamento associado ao avanço do estadiamento clínico ao diagnóstico aumentou em quatro vezes o risco de morte (HRaj=4,20 (IC95% 2,36–7,49). Conclusão: Os fenótipos HER-2-positivo (não luminal) e triplo negativo, além da interação entre estágio clínico avançado e maior tempo entre o diagnóstico e o tratamento, associaram-se a pior prognóstico. Assim, ações para reduzir as barreiras no diagnóstico e tratamento podem proporcionar melhores resultados, mesmo em fenótipos agressivos. Objetivo sociodemográficas Métodos hospitalar 1654 1 654 1.65 200 2018 Paulo Brasil idade histologia Resultados HER2positivo HERpositivo HER 2 positivo não luminal respectivamente HRaj230 HRaj 30 HRaj=2,3 intervalo 95 95IC IC 1,34–3,94 134394 34 3 94 HRaj251 51 HRaj=2,5 1,61–3,92. 161392 1,61–3,92 . 61 92 1,61–3,92) HRaj=4,20 HRaj420 4 20 (HRaj=4,2 IC95% IC95 (IC95 2,36–7,49. 236749 2,36–7,49 36 7 49 2,36–7,49) Conclusão associaramse associaram se Assim resultados agressivos 165 65 1.6 201 HRaj23 HRaj=2, 9 1,34–3,9 13439 HRaj25 5 16139 1,61–3,9 6 HRaj=4,2 HRaj42 (HRaj=4, IC9 (IC9 23674 2,36–7,4 16 1. HRaj2 HRaj=2 1,34–3, 1343 1613 1,61–3, HRaj=4, HRaj4 (HRaj=4 (IC 2367 2,36–7, HRaj= 1,34–3 134 161 1,61–3 HRaj=4 (HRaj= 236 2,36–7 1,34– 13 1,61– (HRaj 23 2,36– 1,34 1,61 2,36 1,3 1,6 2,3 1, 2,

ABSTRACT Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics. Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil’s Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk. Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio — HRadj=2.30 (95% confidence interval — 95%CI 1.34–3.94) and HRadj=2.51 (95%CI 1.61–3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36–7.49). Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes. Objective characteristics Methods hospitalbased hospital based 1654 1 654 1,65 200 2018 Brazils Brazil s Paulo histology staging type diagnosistotreatment Results HER2positive HERpositive HER 2 positive nonluminal (nonluminal triplenegative triple negative HRadj230 HRadj 30 HRadj=2.3 95% 95 (95 95CI CI 1.34–3.94 134394 34 3 94 HRadj251 51 HRadj=2.5 1.61–3.92, 161392 1.61–3.92 , 61 92 1.61–3.92) respectively HRadj=4.20 HRadj420 4 20 (HRadj=4.2 2.36–7.49. 236749 2.36–7.49 . 36 7 49 2.36–7.49) Conclusion summary Therefore outcome 165 65 1,6 201 HRadj23 HRadj=2. 9 (9 1.34–3.9 13439 HRadj25 5 16139 1.61–3.9 6 HRadj=4.2 HRadj42 (HRadj=4. 23674 2.36–7.4 16 1, HRadj2 HRadj=2 ( 1.34–3. 1343 1613 1.61–3. HRadj=4. HRadj4 (HRadj=4 2367 2.36–7. HRadj= 1.34–3 134 161 1.61–3 HRadj=4 (HRadj= 236 2.36–7 1.34– 13 1.61– (HRadj 23 2.36– 1.34 1.61 2.36 1.3 1.6 2.3 1. 2.

SUMMARY OBJECTIVE: The aim of this study was to evaluate the impact of study methodology and evaluation type on the selection of studies during the presentation of scientific events. METHODS: A prospective, observational, transversal approach was applied to a cohort of studies that were submitted for presentation at the 2021 Brazilian Breast Cancer Symposium. Three forms of criteria (CR) were presented. CR1 was based on six criteria (method, ethics, design, originality, promotion, and social contribution); CR2 graded the studies from 0 to 10 for each study, and CR3 was based on five criteria (presentation, method, originality, scientific knowledge, and social contribution). To evaluate the item correlation, Cronbach’s alpha and factorial analysis were performed. For the evaluation of differences between the tests, we used the Kruskal-Wallis and post-hoc Dunn tests. To determine the differences in the study classifications, we used the Friedman test and Namenyi’s all-pairs comparisons. RESULTS: A total of 122 studies were evaluated. There was also a good correlation with the items concerning criterion 1 (α=0.730) and 3 (α=0.937). Evaluating CR1 methodology, study design and social contribution (p=0.741) represents the main factor and CR3 methodology, and the scientific contribution (p=0.994) represents the main factor. The Kruskal-Wallis test showed differences in the results (p<0.001) for all the criteria that were used [CR1-CR2 (p<0.001), CR1-CR3 (p<0.001), and CR2-CR3 (p=0.004)]. The Friedman test showed differences in the ranking of the studies (p<0.001) for all studies (p<0.01). CONCLUSION: Methodologies that use multiple criteria show good correlation and should be taken into account when ranking the best studies. OBJECTIVE events METHODS prospective observational 202 Symposium CR (CR presented method (method ethics originality promotion contribution) presentation, (presentation knowledge contribution. . Cronbachs Cronbach s performed tests KruskalWallis Kruskal Wallis posthoc post hoc classifications Namenyis Namenyi allpairs pairs comparisons RESULTS 12 evaluated α=0.730 α0730 α 730 (α=0.730 α=0.937. α0937 α=0.937 937 (α=0.937) p=0.741 p0741 p 741 (p=0.741 p=0.994 p0994 994 (p=0.994 p<0.001 p0001 001 (p<0.001 CR1CR2 CRCR [CR1-CR p<0.001, , CR1CR3 CR1-CR CR2CR3 CR2-CR p=0.004. p0004 p=0.004 004 (p=0.004)] p<0.01. p001 p<0.01 01 (p<0.01) CONCLUSION 20 α=0.73 α073 73 (α=0.73 α093 α=0.93 93 (α=0.937 p=0.74 p074 74 (p=0.74 p=0.99 p099 99 (p=0.99 p<0.00 p000 00 (p<0.00 CR1CR CR2CR p=0.00 (p=0.004) p00 p<0.0 (p<0.01 2 α=0.7 α07 7 (α=0.7 α09 α=0.9 9 (α=0.93 p=0.7 p07 (p=0.7 p=0.9 p09 (p=0.9 (p<0.0 p=0.0 (p=0.004 p0 p<0. α=0. α0 (α=0. (α=0.9 p=0. (p=0. (p<0. (p=0.00 p<0 α=0 (α=0 p=0 (p=0 (p<0 (p=0.0 p< α= (α= p= (p= (p< (α (p

SUMMARY OBJECTIVE: This study aimed to evaluate the association between self-reported race/color and ancestry in Brazilian patients with breast cancer. METHODS: This was an observational, transversal, epidemiological study, evaluating race and ancestry in 1,127 patients with breast cancer. For genetic ancestry, a 46-AIM-INDEL panel was used. The ancestral profile was evaluated with the Structure v.2.3.3 software. Descriptive statistics were performed. To assess differences between race and ancestry, an analysis of variance with Bonferoni adjustment was used. RESULTS: The race distribution was 77.7% white, 17.6% brown, 4.1% black, 0.4% yellow, and 0.3% cafuse. The African ancestry proportion was significantly (p<0.001) more evident in black [0.63±0.21 (0.17–0.96)], followed by brown [0.25±0.16 (0.02–0.70)], and less frequent in white skin color. The European ancestry proportion was significantly (p<0.001) higher in white [0.72±0.17 (0.02–0.97)], followed by brown [0.57±0.19 (0.12–0.92)], yellow [0.27±0.31 (0.12–0.620], and black [0.24±0.19 (0.02–0.72)]. The Asiatic ancestry proportion is significantly (p<0.001) higher in yellow [0.48±0.51 (0.04–0.93)]. The Amerindian ancestry proportion frequency was the least frequent in all groups, and cafuse patients did not express differences between all race groups. The brown race group presented differences in African and European ancestry. CONCLUSION: Although we found many similarities between white European ancestry, black African ancestry, and yellow Asian ancestry, there is great miscegenation between patients. Although they can be labeled as having one race, they do present many ancestral genes that would allow their inclusion in another race group. OBJECTIVE selfreported self reported racecolor color cancer METHODS observational transversal 1127 1 127 1,12 46AIMINDEL AIMINDEL 46 AIM INDEL used v233 v 2 3 v.2.3. software performed RESULTS 777 77 7 77.7 176 17 6 17.6 41 4 4.1 04 0 0.4 03 0.3 p<0.001 p0001 p 001 (p<0.001 0.63±0.21 063021 63 21 [0.63±0.2 0.17–0.96, 017096 0.17–0.96 , 96 (0.17–0.96)] 0.25±0.16 025016 25 16 [0.25±0.1 0.02–0.70, 002070 0.02–0.70 02 70 (0.02–0.70)] 0.72±0.17 072017 72 [0.72±0.1 0.02–0.97, 002097 0.02–0.97 97 (0.02–0.97)] 0.57±0.19 057019 57 19 [0.57±0.1 0.12–0.92, 012092 0.12–0.92 12 92 (0.12–0.92)] 0.27±0.31 027031 27 31 [0.27±0.3 0.12–0.620, 0120620 0.12–0.620 620 (0.12–0.620] 0.24±0.19 024019 24 [0.24±0.1 0.02–0.72. 002072 0.02–0.72 . (0.02–0.72)] 0.48±0.51 048051 48 51 [0.48±0.5 0.04–0.93. 004093 0.04–0.93 93 (0.04–0.93)] groups CONCLUSION 112 1,1 v23 v.2.3 77. 17. 4. 0. p<0.00 p000 00 (p<0.00 0.63±0.2 06302 [0.63±0. 01709 0.17–0.9 9 (0.17–0.96) 0.25±0.1 02501 [0.25±0. 00207 0.02–0.7 (0.02–0.70) 0.72±0.1 07201 [0.72±0. 00209 0.02–0.9 (0.02–0.97) 0.57±0.1 05701 5 [0.57±0. 01209 0.12–0.9 (0.12–0.92) 0.27±0.3 02703 [0.27±0. 012062 0.12–0.62 62 (0.12–0.620 0.24±0.1 02401 [0.24±0. (0.02–0.72) 0.48±0.5 04805 [0.48±0. 00409 0.04–0.9 (0.04–0.93) 11 1, v2 v.2. p<0.0 p00 (p<0.0 0.63±0. 0630 [0.63±0 0170 0.17–0. (0.17–0.96 0.25±0. 0250 [0.25±0 0020 0.02–0. (0.02–0.70 0.72±0. 0720 [0.72±0 (0.02–0.97 0.57±0. 0570 [0.57±0 0120 0.12–0. (0.12–0.92 0.27±0. 0270 [0.27±0 01206 0.12–0.6 (0.12–0.62 0.24±0. 0240 [0.24±0 (0.02–0.72 0.48±0. 0480 [0.48±0 0040 0.04–0. (0.04–0.93 v.2 p<0. p0 (p<0. 0.63±0 063 [0.63± 017 0.17–0 (0.17–0.9 0.25±0 025 [0.25± 002 0.02–0 (0.02–0.7 0.72±0 072 [0.72± (0.02–0.9 0.57±0 057 [0.57± 012 0.12–0 (0.12–0.9 0.27±0 027 [0.27± (0.12–0.6 0.24±0 024 [0.24± 0.48±0 048 [0.48± 004 0.04–0 (0.04–0.9 v. p<0 (p<0 0.63± 06 [0.63 01 0.17– (0.17–0. 0.25± [0.25 0.02– (0.02–0. 0.72± 07 [0.72 0.57± 05 [0.57 0.12– (0.12–0. 0.27± [0.27 0.24± [0.24 0.48± [0.48 0.04– (0.04–0. p< (p< 0.63 [0.6 0.17 (0.17–0 0.25 [0.2 0.02 (0.02–0 0.72 [0.7 0.57 [0.5 0.12 (0.12–0 0.27 0.24 0.48 [0.4 0.04 (0.04–0 (p 0.6 [0. 0.1 (0.17– 0.2 0.0 (0.02– 0.7 0.5 (0.12– (0.04– [0 (0.17 (0.02 (0.12 (0.04 [ (0.1 (0.0 (0. (0 (

ABSTRACT Objective: This study aimed to analyze the prognosis of women with breast cancer by molecular subtypes, sociodemographic variables, and clinical and treatment characteristics. Methods: This hospital-based retrospective cohort study analyzed 1,654 women over 18 years of age diagnosed with invasive breast cancer from 2000 to 2018. Data were extracted from Brazil’s Oncocenter Foundation of São Paulo. The variables analyzed were age, histology, molecular subtypes, clinical staging, treatment type, and diagnosis-to-treatment time. Cox regression analysis was applied to estimate death risk. Results: Women with HER-2-positive (nonluminal) and triple-negative molecular subtypes were more than twice more likely to be at risk of death, with adjusted hazard ratio — HRadj=2.30 (95% confidence interval — 95%CI 1.34–3.94) and HRadj=2.51 (95%CI 1.61–3.92), respectively. A delayed treatment associated with an advanced clinical stage at diagnosis increased fourfold the risk of death (HRadj=4.20 (95%CI 2.36–7.49). Conclusion: In summary, besides that interaction between advanced clinical stage and longer time between diagnosis and treatment, HER-2-positive (nonluminal) and triple-negative phenotypes were associated with a worse prognosis. Therefore, actions to reduce barriers in diagnosis and treatment can provide better outcome, even in aggressive phenotypes.

RESUMO Objetivo: O objetivo deste estudo foi analisar o prognóstico de mulheres com câncer de mama de acordo com os subtipos moleculares, variáveis sociodemográficas, características clínicas e de tratamento. Métodos: Este foi um estudo de coorte retrospectivo de base hospitalar. Foram analisadas 1.654 mulheres maiores de 18 anos diagnosticadas com câncer de mama invasivo entre 2000 a 2018. Os dados foram extraídos da Fundação Oncocentro de São Paulo, Brasil. As variáveis analisadas foram idade, histologia, subtipo moleculares, estadiamento clínico, tipo de tratamento e tempo entre o diagnóstico e tratamento. A análise de regressão de Cox foi aplicada para estimar o risco de morte. Resultados: As mulheres que apresentaram os subtipos moleculares HER-2-positivo (não luminal) e triplo negativo tiveram risco de morte quase duas vezes maior respectivamente, com razão de risco ajustada — HRaj=2,30 (intervalo de confiança de 95% — 95%IC 1,34–3,94) e HRaj=2,51 (95%IC 1,61–3,92). O atraso no tratamento associado ao avanço do estadiamento clínico ao diagnóstico aumentou em quatro vezes o risco de morte (HRaj=4,20 (IC95% 2,36–7,49). Conclusão: Os fenótipos HER-2-positivo (não luminal) e triplo negativo, além da interação entre estágio clínico avançado e maior tempo entre o diagnóstico e o tratamento, associaram-se a pior prognóstico. Assim, ações para reduzir as barreiras no diagnóstico e tratamento podem proporcionar melhores resultados, mesmo em fenótipos agressivos.

RESUMO Objetivo: avaliar simetria após a cirurgia conservadora da mama (CCM) para câncer. Métodos: estudo prospectivo de pacientes submetidos à CCM, as quais foram fotografadas segundo os mesmos critérios de avaliação. Os pontos de referência utilizados foram a diferença de altura do mamilo (AM), a distância mamilo-manúbrio (MM), a distância mamilo-esterno (ME) e o ângulo entre o sulco intramamário e o mamilo (ângulo mamilo; AnM). Foi usado o programa ImageJ. Avaliamos três modelos de simetria mamária: excelente/outros (modelo 1), excelente-bom/outros (modelo 2) e outros/ruim (modelo 3). Aplicamos a curva ROC para selecionar os critérios aceitáveis para a avaliação da simetria. Realizamos análise com o modelo de árvore de decisão. Resultados: foram avaliadas 274 mulheres. Os resultados do BCCT.core foram excelentes em 5,8% (16), bons em 24,1% (66), regulares em 46,4% (127) e ruins em 23,7% (65). A diferença de AM (dAM) foi associada a boa área mamária (0,837-0,846); diferenças aceitáveis foram inferiores a 3,1 cm, enquanto os valores inaceitáveis foram superiores a 6,4 cm. As diferenças MM (dMM) foram associadas à área regular das mamas (0,709-0,789); diferença de valor inferior a 4,5 cm foi aceitável, enquanto valores superiores a 6,3 cm foram inaceitáveis. O modelo combinado de árvore de decisão demonstrou resultado bom-excelente para pacientes com diferencial (d) dAM = 1 (0 a 5,30 cm) e dMM ≠ 3 (< 6,28 cm), e resultado ruim/ruim com dMM = 3 (> 6,35 cm). Conclusões: os resultados aqui apresentados são ferramentas simples que podem auxiliar o cirurgião na avaliação da simetria mamária.

ABSTRACT Objective: to evaluate symmetry after breast-conserving surgery (BCS) for cancer. Methods: a prospective study of patients undergoing BCS. These patients were photographed using the same criteria of evaluation. The references points used were the nipple height difference (NH), the nipple-manubrium distances (NM), nipple-sternum distances (NS) and the angle between the intramammary fold and the nipple (nipple angle; NA). ImageJ software was used. Three breast symmetry models were evaluated: excellent/others (model 1), excellent-good/others (model 2) and others/poor (model 3). The ROC curve was used to select acceptable criteria for the evaluation of symmetry. Decision tree model analysis was performed. Results: a total of 274 women were evaluated. The BCCT.core result was excellent in 5.8% (16), good in 24.1% (66), fair in 46.4% (127) and poor in 23.7% (65). The difference in NH was associated with good breast area (0.837-0.846); acceptable differences were below 3.1 cm, while unacceptable values were greater than 6.4 cm. Differences in the NM were associated with average breast area (0.709-0.789); a difference in value of less than 4.5 cm was acceptable, while values greater than 6.3 cm were unacceptable. In the decision tree combined model, a good-excellent outcome for patients with differential (d) dNH = 1 (0 to 5.30 cm) and dNM ≠ 3 (<6.28 cm); and for a poor/poor result, values dNM = 3 (> 6.35). Conclusions: the results presented here are simple tools that can assist the surgeon for breast symmetry evaluation.

RESUMO Objetivo: avaliar diferenças clínicas e patológicas entre os adenocarcinomas colônicos localmente avançados com aderências entre órgãos ou estruturas adjacentes (LACA) e adenocarcinomas colônicos com outras apresentações clínicas. Métodos: estudo retrospectivo a partir de amostra de conveniência de pacientes com adenocarcinoma colônico, estádio patológico pT3, distribuídos de acordo com características clínicas e patológicas em três grupos: tumores localmente avançados (LACA), tumores pT3 sem aderências ou metástases à distância (SF), e tumores com doença metastática (M1). Foram avaliadas as características clínicas e patológicas, e a expressão de sete marcadores imuno-histoquímicos relacionados à proliferação/apoptose, invasão celular/migração e metástase. Resultados: foram avaliados 101 pacientes: 30 LACA, 44 SF e 27 M1. Tumores localmente avançados apresentaram dimensões maiores e estiveram associados a aumento das taxas de infiltração linfocitária, menores níveis de expressão de bax e de CD 44v6 quando comparados aos grupos SF e M1. Diferenças significantes foram observadas em relação aos LACA e M1 em relação à localização colônica, histologia, estado linfonodal e expressão bax e CD44v6. Diferenças foram observadas em relação aos três grupos frente ao tamanho do tumor e infiltrado linfocítico. A sobrevida foi similar entre os grupos LACA e SF (p=0,66) e foi inferior no grupo M1 (p<0,001). Conclusão: os dados sugerem que os adenocarcinomas colônicos localmente avançados com aderências entre órgãos ou estruturas adjacentes representam uma entidade distinta.

ABSTRACT Objective: to evaluate the clinical and pathological differences between locally advanced colonic adenocarcinomas (LACA) with adhesions between adjacent organs or structures, and colonic adenocarcinomas with other clinical presentations. Methods: we conducted a retrospective study from a convenience sample of patients with colonic adenocarcinoma, pathological stage pT3, distributed according to clinical and pathological characteristics in three groups: locally advanced tumors (LACA), pT3 tumors without adhesions or distant metastases (SF) and tumors with metastatic disease (M1). We evaluated clinical and pathological characteristics and the expression of seven immunohistochemical markers related to proliferation/apoptosis, cell invasion/migration and metastasis. Results: we studied 101 patients: 30 LACA, 44 SF and 27 M1. Locally advanced tumors presented larger dimensions and were associated with increased lymphocyte infiltration rates, lower levels of bax expression, and CD 44v6 when compared with SF and M1 groups. We observed significant differences between LACA and M1 in relation to colonic location, histology, lymph node status and bax and CD44v6 expression. We found differences were observed between the three groups for tumor size and lymphocytic infiltrate. Survival was similar in the LACA and SF groups (p=0.66) and was lower in the M1 group (p<0.001). Conclusion: the data suggest that locally advanced colonic adenocarcinomas with adhesions between adjacent organs or structures represent a distinct entity.

RESUMO INTRODUÇÃO: O tratamento conservador da mama (TCM), desde que associado à radioterapia, é seguro. As indicações inicialmente utilizadas para o TCM se elevaram, sendo importante modalidade de tratamento. Novas modalidades, como a oncoplastia associada ao TCM, tornam-se cada vez mais presentes no cotidiano. Pacientes submetidas ao TCM apresentam alguns parâmetros associados a uma melhor qualidade de vida em relação às pacientes mastectomizadas sem reconstrução. Há limitados instrumentos de qualidade de vida a serem utilizados específicamente no TCM, sendo um deles o Breast Cancer Treatment Outcome Scale (BCTOS), questionário este não traduzido e adaptado para a língua portuguesa/Brasil. O BCTOS contém 22 perguntas e quatro domínios (funcional, estético, sensibilidade mamária e oedema). MÉTODOS: Realizamos a tradução e adaptação cultural utilizando a metodologia proposta por Beaton e pelo EORTC. Em resumo, consiste de tradução para o português, resumo da tradução, tradução reversa para o inglês, comitê de especialistas, pré-teste (dez pacientes), revisão do questionário e teste da versão final (seis pacientes). RESULTADOS: As 16 pacientes foram submetidas a quadrantectomia e radioterapia. Linfedema esteve presente em quatro, alteração da força em cinco e alteração da mobilidade em seis pacientes. Avaliando o questionário, a versão de conciliação modificou dois itens. O pré-teste mostrou dificuldades em três pacientes, mas o questionário não se alterou, fato que não se observou no teste final. CONCLUSÃO: A tradução do BCTOS para o português nos ajudará a avaliar a qualidade de vida em pacientes submetidas a tratamento conservador da mama, avaliando as sequelas relacionadas ao tratamento, podendo ser útil na avaliação da cirurgia oncoplástica.

SUMMARY BACKGROUND: Breast conservative treatment (BCT) is safe when it is performed in association with radiotherapy. The number of referral for BCT has increased, and it has become an important treatment modality. Patients who undergo BCT present some characteristics that are associated with better quality of life compared with patients who undergo mastectomy without reconstruction. Instruments that measure the quality of life specifically used in cases of BCT are limited. One of these instruments is the Breast Cancer Treatment Outcome Scale (BCTOS), which has not yet been translated into Brazilian Portuguese. It contains 22 questions and four domains (functional, aesthetic, breast sensitivity and oedema). METHODS: We performed the translation and cultural adaptation process using Beaton's and EORTC translations process. In summary, the translation process is based on Portuguese translation, translation summary, reverse translation into English, expert committee, pre-test (10 patients), questionnaire review and test of the final version (6 patients). RESULTS: All 16 patients were submitted to quadrantectomy and mammary radiotherapy. Lymphedema was present in 4, altered strength in 5, and altered shoulder mobility in 6 patients. Considering the questionnaire, the reconciled version determined change in 2 items. Pre-test evaluation showed difficulties in 3 patients, but the questionnaire did not change. Test evaluation showed no problems. CONCLUSION: The translation of BCTOS into Portuguese will help us to evaluate the quality of life in BCT patients evaluating treatment-related sequelae and may be useful for oncoplastic surgery evaluation.

OBJECTIVE: MicroRNAs (miRNAs) are small non-coding RNAs that regulate gene expression at the posttranscriptional level. Some miRNAs, including let-7a and miR-195, have been described as tumor suppressors. However, the roles of these microRNAs in breast cancer progression remain controversial. The aim of this study is to evaluate miR-195 and let-7a expression as potential biomarkers of invasive breast cancer. METHODS: In the present study, 200 individuals were separated into three groups: (i) 72 women constituting the control group who were selected according to rigorous and well-established criteria; (ii) 56 patients with benign breast tumors; and (iii) 72 patients with malignant breast cancers of different clinical stages. The miR-195 and let-7a expression levels in serum were evaluated by real-time PCR. The results were assessed alone and in combination, and the analysis included an estimation of sensitivity and specificity in ROC curves. RESULTS: Compared with the benign and control groups, both microRNAs were downregulated in the malignant breast cancer patient group. Compared with the malignant group, the combination of both biomarkers in the control and benign groups showed good sensitivity and specificity in the serum with AUCs of 0.75 and 0.72, respectively. The biomarker combination for the control group versus the malignant group exhibited a better sensitivity and specificity than for the benign group versus the malignant group. CONCLUSION: These findings support the evidence that the analysis of miR-195 and let-7a can be used as a non-invasive biomarker for breast cancer detection.

Resumo Objetivo: Identificar fatores relacionados ao sistema de saúde que determinam atraso no diagnóstico do câncer de mama no Brasil. Método: Utilizou-se metodologia de revisão sistemática nas bases de dados PubMed e LILACS, pesquisando os termos "Breast cancer", "system of health" e "Brazil or Brasil". Não se avaliou a qualidade da publicação, mas seu conteúdo, sendo ele categorizado em função da metodologia PRISMA baseada no PICTOS. Na data limite de 16/12/2015, foi possível identificar 94 publicações na PubMed e 43 publicações na LILACS. Avaliando o título e resumo, e excluindo-se 21 publicações repetidas, foi possível identificar 51 publicações para avaliação completa, na qual foram excluídos 21 artigos, restando 30 publicações. Resultados: Observou-se que a base de mamógrafos é limitada, o tempo até o diagnóstico é elevado, e o estadio ao diagnóstico é avançado. A cobertura populacional é baixa, havendo problemas na qualidade da mamografia. As pacientes de menor renda, menor escolaridade e etnia não branca são as mais vulneráveis. Observam-se exemplos de mutirões e experiências iniciais de rastreamento. Necessita-se de aprimoramento do fluxo de diagnóstico e tratamento. A desigualdade na mortalidade é reflexo da estrutura para rastreamento e tratamento, observando-se melhores resultados em serviços públicos bem estruturados. Conclusão: Há diversas barreiras relacionadas ao sistema de saúde que refletem no estádio avançado ao diagnóstico e limitam os resultados na sobrevida. O estabelecimento de um fluxo de diagnóstico e tratamento rápidos e efetivos, dentro de um contexto hierarquizado, são importantes etapas a serem aprimoradas dentro do contexto da saúde pública.

Summary Objective: Identify factors related to the health system that lead to a late diagnosis of breast cancer in Brazil. Method: We performed a systematic review in the PubMed and LILACS databases using as keywords "Breast cancer," "system of health" and "Brazil or Brasil." We evaluated the content of the articles using the PRISMA methodology based on PICTOS. The final date was 12/16/2015. We were able to identify 94 publications in PubMed and 43 publications in LILACS. After assessing the title and summary, and excluding 21 repeated publications, we selected 51 publications for full evaluation. At this stage, we excluded 21 articles, with 30 publications remaining for study. Results: The population coverage is low, and there are problems related to the quality of mammography. Patients with lower income, nonwhite and less educated are more vulnerable. We observed punctual and initial experiences in breast cancer screening. Diagnosis and treatment flows must be improved. The inequality in mortality reflects the differences related to screening structure and treatment. Better results are observed in well-structured services. Conclusion: There are several barriers in the health system leading to advanced stage at diagnosis and limiting the survival outcomes. The establishment of a rapid and effective order for diagnosis and treatment, based on hierarchical flow, are important steps to be improved in the public health context.

Developing countries have limited healthcare resources and use different strategies to diagnose breast cancer. Most of the population depends on the public healthcare system, which affects the diagnosis of the tumor. Thus, the indicators observed in developed countries cannot be directly compared with those observed in developing countries because the healthcare infrastructures in developing countries are deficient. The aim of this study was to evaluate breast cancer screening strategies and indicators in developing countries. A systematic review and the Population, Intervention, Comparison, Outcomes, Timing, and Setting methodology were performed to identify possible indicators of presentation at diagnosis and the methodologies used in developing countries. We searched PubMed for the terms “Breast Cancer” or “Breast Cancer Screening” and “Developing Country” or “Developing Countries”. In all, 1,149 articles were identified. Of these articles, 45 full articles were selected, which allowed us to identify indicators related to epidemiology, diagnostic intervention (diagnostic strategy, diagnostic infrastructure, percentage of women undergoing mammography), quality of intervention (presentation of symptoms at diagnosis, time to diagnosis, early stage disease), comparisons (trend curves, subpopulations at risk) and survival among different countries. The identification of these indicators will improve the reporting of methodologies used in developing countries and will allow us to evaluate improvements in public health related to breast cancer.

OBJECTIVE: To evaluate ipsilateral breast tumor recurrence after breast-conserving surgery for locally advanced breast cancer. METHODS: A retrospective observational cohort study was performed in patients with locally advanced breast cancer submitted to breast-conserving surgery after neoadjuvant chemotherapy based on an adriamycin-cyclophosphamide-paclitaxel regimen. We evaluated the clinical, pathologic, immunohistochemistry, and surgical factors that contribute to ipsilateral breast tumor recurrence and locoregional recurrence. A Kaplan-Meier analysis and Cox model were used to evaluate the main factors related to disease-free survival. RESULTS: Of the 449 patients who received neoadjuvant chemotherapy, 98 underwent breast-conserving surgery. The average diameter of the tumors was 5.3 cm, and 87.2% reached a size of up to 3 cm. Moreover, 86.7% were classified as clinical stage III, 74.5% had T3-T4 tumors, 80.5% had N1-N2 axilla, and 89.8% had invasive ductal carcinoma. A pathologic complete response was observed in 27.6% of the tumors, and 100.0% of samples had free margins. The 5-year actuarial overall survival rate was 81.2%, and the mean follow-up was 72.8 months. The rates of ipsilateral breast tumor recurrence and locoregional recurrence were 11.2% and 15.3%, respectively. Multifocal morphology response was the only factor related to ipsilateral breast tumor recurrence disease-free survival (p=0.04). A multivariate analysis showed that the pathologic response evaluation criteria in solid tumors (RECIST)-breast cutoff was the only factor related to locoregional recurrence disease-free survival (p=0.01). CONCLUSIONS: Breast-conserving surgery is a safe and effective therapy for selected locally advanced breast tumors.

OBJETIVO: Avaliar a taxa de resposta patológica completa atingida pelas pacientes com diagnóstico de câncer de mama localmente avançado submetidas à quimioterapia neoadjuvante baseada no esquema doxorrubicina/ciclofosfamida seguido de paclitaxel. MÉTODOS: Coorte retrospectiva de pacientes admitidas no Hospital de Câncer de Barretos com câncer de mama localmente avançado entre 2006 e 2008 submetidas ao protocolo de doxorrubicina/ciclofosfamida seguido de paclitaxel (4 ciclos de doxorrubicina 60mg/m² e ciclofosfamida 600mg/m² a cada 21 dias; 4 ciclos de paclitaxel 175mg/m² a cada 21 dias). As seguintes variáveis foram avaliadas: idade, menopausa, performance status, estadiamento clínico inicial, dados antropométricos, quimioterapia (dose - duração), perfil de toxicidade, estadiamento clínico pós-tratamento, cirurgia, resposta patológica completa, sobrevida livre de doença e características anatomopatológicas (tipo e grau histológico, perfil hormonal e comprometimento linfonodal). A análise estatística foi realizada considerando-se o nível de significância de 5%. RESULTADOS: Das 434 pacientes avaliadas, 136 foram excluídas por erro no estadiamento ou por terem recebido outro tipo de quimioterapia. A mediana de idade foi 50 anos, todas com performance status 0-1. A mediana do tamanho clínico inicial do tumor foi 65mm e a mediana do tamanho clínico final do tumor foi 22mm. Apresentaram resposta patológica completa 51 (17,1%) pacientes. Aquelas que apresentavam perfil hormonal negativo ou que eram triplo-negativas (Her-2 e perfil hormonal negativos) tiveram impacto favorável na resposta patológica completa. CONCLUSÃO: Quimioterapia neoadjuvante com doxorrubicina/ciclofosfamida seguidas de paclitaxel ofereceu taxa de resposta patológica completa na população estudada de acordo com a literatura. Pacientes triplo-negativas tiveram maior chance de atingir essa resposta.

OBJECTIVE: To evaluate the complete pathologic response attained by patients diagnosed with locally advanced breast cancer submitted to neoadjuvant chemotherapy based on the doxorubicin/cyclophosphamide regimen followed by paclitaxel. METHODS: A retrospective cohort of patients with locally advanced breast cancer, admitted to the Hospital de Câncer de Barretos between 2006 and 2008 submitted to the doxorubicin/cyclophosphamide protocol followed by paclitaxel (4 cycles of doxorubicin 60mg/m² and cyclophosphamide 600mg/m² every 21 days; 4 cycles of paclitaxel 175mg/m² every 21 days). The following variables were assessed: age, menopause, performance status, initial clinical staging, anthropometric data, chemotherapy (dose - duration), toxicity profile, post-treatment staging, surgery, pathologic complete response rate, disease-free survival, and pathological characteristics (type and histological degree, hormonal profile and lymph node involvement). Statistical analysis was performed using a 5% level of significance. RESULTS: Of the 434 patients evaluated, 136 were excluded due to error in staging or because they had received another type of chemotherapy. Median age was 50 years, all with performance status 0-1. Median initial clinical size of tumor was 65mm and the median final clinical size of the tumor was 22mm. Fifty-one (17.1%) patients experienced a pathologic complete response. Those with a negative hormonal profile or who were triple-negative (negative Her-2 and hormonal profile) experienced a favorable impact on the pathologic complete response. CONCLUSION: Neoadjuvant chemotherapy with doxorubicin/cyclophosphamide followed by paclitaxel provided a pathologic complete response in the population studied in accordance with that observed in the literature. Triple-negative patients had a greater chance of attaining this response.