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Introduction: Despite the lack of randomised evidence, there is a current trend towards omitting axillary surgery in cases of positive sentinel lymph node (SLN) following neoadjuvant chemotherapy (NACT). This study evaluated practice patterns of Brazilian breast surgeons when managing positive SLN following NACT. Methods: This was a nationwide electronic survey of breast surgeons affiliated with the Brazilian Society of Mastology. Management approaches for positive SLN after NACT (axillary dissection (AD), regional nodal irradiation (RNI) or no additional treatment) were evaluated as a function of residual disease volume in the SLN (macro-metastasis, micro-metastasis or isolated tumour cells (ITC)). Results: Survey response rate was 49%, with 799/1,627 questionnaires returned. Most respondents were <50 years old (61%), lived in south-eastern Brazil (50%), in a major city (67%), worked in an academic institute (80%) and were board-certified (80%). AD recommendation rate decreased according to residual nodal disease volume: 91% of respondents recommended AD for cases of macro-metastasis, 64% for micro-metastasis and 38% for ITC (p < 0.00001). Furthermore, 35% would recommend no additional surgery for micro-metastasis, while 27% would recommend no treatment at all for ITC (p < 0.00001). Not working in an academic institute was associated with RNI for micro-metastasis (p = 0.02), but not for macro-metastasis or ITC. Being board-certified did not affect axillary management. Conclusion: Most respondents would recommend AD and/or RNI in residual nodal disease following NACT irrespective of disease volume. Nevertheless, a trend towards surgical de-escalation was found with low-volume disease (micro-metastasis and ITC). Ongoing randomised trials will clarify the impact of this trend.
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PURPOSE: To evaluate the impact of the ACOSOG Z0011 trial on axillary breast cancer surgery management in Brazil following publication of that study (2010) and again in 2020. PATIENTS AND METHODS: A survey of members of the Brazilian Society of Mastology. RESULTS: Of 1627 breast surgeons, 799 (49.1%) completed and returned the questionnaire. For patients with the Z11 inclusion criteria, following detection of a positive sentinel lymph node (SLN), axillary dissection (AD) was recommended by 99.2% of respondents before publication of the study, 47.5% in 2010 and 18.5% in 2020 (p < 0.001). In breast-conserving surgery, if there were micro-metastases, 2.6% would perform AD, 30.3% axillary radiotherapy, and 67.1% no additional axillary treatment, while with macro-metastases, these proportions were 21.3%, 52.2%, and 26.5%, respectively. In cases of mastectomy and of nodal extracapsular extension, 43.4% and 36% of surgeons, respectively, recommended AD. For clinically negative axilla and suspicious findings at ultrasonography, 69% of the surgeons would apply the Z11 approach. Most applied the Z11 criteria in cases of younger patients (83.6%) and triple-negative and/or HER2 positive tumors (74%). AD was significantly more likely to be recommended by surgeons who did not work in academic institutes, who worked in locations other than capital cities, who were not board-certified, and who were ≥ 50 years old. CONCLUSIONS: This survey revealed substantial changes in axillary surgery management in cN0/pathologically positive SLN, particularly following publication of the updated Z11 results and other similar studies. A better education environment and long-term follow-up were factors associated with the incorporation of Z11-related changes in practice.
Assuntos
Neoplasias da Mama , Cirurgiões , Atitude , Axila , Brasil , Neoplasias da Mama/cirurgia , Ensaios Clínicos como Assunto , Feminino , Humanos , Excisão de Linfonodo , Linfonodos/cirurgia , Metástase Linfática , Mastectomia , Mastectomia Segmentar , Pessoa de Meia-Idade , Biópsia de Linfonodo SentinelaRESUMO
Mulheres em todas as categorias de risco estão buscando informações sobre seus riscos individuais de desenvolverem câncer de mama. Logo, faz-se necessário, para seus cuidados clínicos iniciais, avaliar os fatores de risco em suas famílias, fornecer informação individualizada do risco e oferecer recomendações de acompanhamento. Estimativas do número de mulheres com história familiar de câncer de mama variam de aproximadamente 5 a 10 porcento, dependendo da população pesquisada. Muitas dessas mulheres não apresentarão história familiar que sugira a presença do gene altamente penetrante de suscetibilidade ao câncer de mama. Entretanto, um pequeno subgrupo virá de famílias com alta incidência de câncer de mama e outros cânceres freqüentemente associados a mutações hereditárias. Este trabalho apresenta os cuidados clínicos que podem ser de grande valia para se definirem as famílias como de risco moderado ou alto, a avaliação e o aconselhamento para essas mulheres
Women in all risk categories are seeking information regarding their individual breast cancer risk, and there is a need for their primary care clinicians to be able to assess familial risk factors for breast cancer, provide individualized risk information, and offer surveillance recommendations. Estimates of the number of women with a family history of breast cancer range from approximately 5 percent to 10 percent, depending on the population surveyed. Many of these women will not have a family history that suggests the presence of a highly penetrant breast cancer susceptibility gene. However, a small subset of such women will come from families with a striking incidence of breast and other cancers often associated with inherited mutations. We present the care clinicians that may be helpful in defining families as moderate or high risk and the assessment and counseiling for these women
Assuntos
Feminino , Aconselhamento Genético , Predisposição Genética para Doença , Testes Genéticos , Mutação/genética , Neoplasias da Mama/diagnóstico , Neoplasias da Mama/genética , Fatores de RiscoRESUMO
Os autores analisam 570 papeletas de pacientes que procuraram o ambulatório para planejamento familiar da Igreja do Carmo de Belo Horizonte, que está vinculado ao Hospital Mater Dei e ao Centro de Pesquisas Clóvis Salgado (CEP ECS), no período de setembro de 1985 a junho de 1993. Säo avaliados aspectos epidemiológicos como a idade, raça, paridade, abortos, menarca, periodicidade dos ciclos menstruais, queixas menstruais, métodos anticoncepcionais mais utilizados e intercorrências ginecológicas. A média etária foi de 25,48 (ñ 5,86) anos; a paridade média foi de 1,51 (ñ 1,78); a média de abortos foi de 0,26 sendo que 29,9 por cento foram abortos provocados, correspondendo a 5,08 por cento do número total de pacientes; a idade média da primeira gestaçäo foi de 20,35 (ñ 3,87) anos e da menarca, de 13,21 (ñ 1,76) anos; os parâmetros clínicos menstruais se mantiveram dentro da normalidade; 22,4 por cento apresentaram algum grau de irregularidade menstrual; o método anticoncepcional mais prescrito foi o anticoncepcional hormonal oral (66,8 por cento). Foram observados baixos índices de salpingotripsia (3,3 por cento) que se devem ao fato de o ambulatório näo fornecer este método sendo as pacientes encaminhadas para serviços secundários. Acreditamos que o planejamento familiar ainda näo é praticado na sua plenitude no Brasil.