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Introduction: Breast cancer (BC) is the most common cancer among women globally. Vitamin D has been considered a protective factor; however, its relationship with any aspect of the disease remains controversial. Methods: A cross-sectional, single-center clinical study was conducted between 2015 and 2018, including 141 women diagnosed with BC and 239 women in the control group, with mean ages of 43.1 and 41.7 years, respectively (p = 0.103). Serum levels of vitamin D and lipid profile were measured. Clinical and nutritional data were obtained through interviews and medical records. Results: The vitamin D dosage presented an average value of 25.5 ng/mL and 31.0 ng/mL in the case and control groups, respectively (p < 0.001). The vitamin D cut-off point for discriminating the presence of BC was 27.45 ng/mL. Additionally, low-density lipoprotein cholesterol levels were higher in the case group (121.4 mg/dL) compared to the control group (110.7 mg/dL) (p = 0.002), whereas high-density lipoprotein cholesterol levels were lower in the case group (47.6 mg/dL) compared to the control group (53.3 mg/dL) (p = 0.001). Alcohol consumption was significantly higher in the case group than in the control group (2.7 vs. 5.3 doses/day; p < 0.001). Conclusion: The results indicate a significant association between lower vitamin D levels and BC, persisting after multivariate analysis (p < 0.001). These findings could inform prevention strategies, highlighting the importance of maintaining adequate vitamin D levels and potentially identifying a risk group.

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The development of antiprogestins was initially a gynecological purpose. However, since mifepristone was developed, its application for breast cancer treatment was immediately proposed. Later, new compounds with lower antiglucocorticoid and antiandrogenic effects were developed to be applied to different pathologies, including breast cancer. We describe herein the studies performed in the breast cancer field with special focus on those reported in recent years, ranging from preclinical biological models to those carried out in patients. We highlight the potential use of antiprogestins in breast cancer prevention in women with BRCA1 mutations, and their use for breast cancer treatment, emphasizing the need to elucidate which patients will respond. In this sense, the PR isoform ratio has emerged as a possible tool to predict antiprogestin responsiveness. The effects of combined treatments of antiprogestins together with other drugs currently used in the clinic, such as tamoxifen, CDK4/CDK6 inhibitors or pembrolizumab in preclinical models is discussed since it is in this scenario that antiprogestins will be probably introduced. Finally, we explain how transcriptomic or proteomic studies, that were carried out in different luminal breast cancer models and in breast cancer samples that responded or were predicted to respond to the antiprogestin therapy, show a decrease in proliferative pathways. Deregulated pathways intrinsic of each model are discussed, as well as how these analyses may contribute to a better understanding of the mechanisms involved.

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Breast cancer (BC) has surpassed lung cancer as the most diagnosed cancer and, in terms of mortality, is the fifth leading cause with 684,996 new deaths (6.7% of all cancer-related deaths) and the highest mortality amongst all cancers (15.5%) in women. Selective estrogen-receptor modulators (SERMs) have been used for the last thirty years for estrogen receptor-positive (ER+) BC prevention and treatment. Tamoxifen (TAM), the most widely used SERM, is orally administered and its long-term oral administration has been associated to toxicity and adverse side effects. Endoxifen (EDX) is one of the known active metabolites of TAM, with an affinity to ERα 100 times higher than TAM. Furthermore, EDX has shown antiproliferative activity against the ER+ BC cell line MCF-7. Alternative administration routes that avoid the metabolic processing of TAM seem an appealing alternative to its oral administration. With this aim, we have prepared a polymeric gel-like solution of Pluronic® F127 as vehicle for topical administration of EDX. In order to shed light on the potential clinical use of this formulation, we have compared it with the standard pharmaceutical form, i.e. orally administered TAM. The biodistribution, antitumor efficacy and toxic effects of topical EDX and oral TAM were evaluated in ER+ tumor xenograft athymic nu/nu mouse models. The results showed a statistically significant antitumor effect and reduced toxicity of topical EDX as compared to oral TAM or empty F127 gel. This novel administration route of SERMs could also have a strong impact in the prevention of BC at early development stages and could help to ameliorate the mortality and morbidity related to this disease.

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Worldwide, the coronavirus has intensified the management problems of health services, significantly harming patients. Some of the most affected processes have been cancer patients' prevention, diagnosis, and treatment. Breast cancer is the most affected, with more than 20 million cases and at least 10 million deaths by 2020. Various studies have been carried out to support the management of this disease globally. This paper presents a decision support strategy for health teams based on machine learning (ML) tools and explainability algorithms (XAI). The main methodological contributions are: first, the evaluation of different ML algorithms that allow classifying patients with and without cancer from the available dataset; and second, an ML methodology mixed with an XAI algorithm, which makes it possible to predict the disease and interpret the variables and how they affect the health of patients. The results show that first, the XGBoost Algorithm has a better predictive capacity, with an accuracy of 0.813 for the train data and 0.81 for the test data; and second, with the SHAP algorithm, it is possible to know the relevant variables and their level of significance in the prediction, and to quantify the impact on the clinical condition of the patients, which will allow health teams to offer early and personalized alerts for each patient.

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O Câncer de mama é uma doença que afeta as células mamarias, e é uma das principais causas da mortalidade em muitas mulheres, principalmente se detectado tardiamente. Objetivo: Demonstrar a importância do enfermeiro na prevenção do câncer de mama, sensibilização e conscientização das mulheres. Metodologia: Trata-se de uma revisão integrativa da literatura. Resultados e discussão: Foram selecionados 15 artigos para a amostra desta revisão, o período de publicação analisada foi de 2013 a 2023, sendo o buscador principal as bases de dados Literatura Latino-Americana em Ciências em Saúde (LILACS) e Scientific Eletronic Library Online (SCIELO). Os resultados encontrados na pesquisa mostram a importância da prática profissional do enfermeiro relacionado a orientação, educação e diagnóstico precoce da neoplasia. Conclusão: Foi possível concluir que o enfermeiro é profissional qualificado e comprometido com atributos para orientar, prevenir e promover ações de educação em saúde, visando melhorar a qualidade de vida.

Breast Cancer is a disease that affects breast cells, and is one of the main causes of mortality in many women, especially if detected late. Objective: To demonstrate the importance of nurses in the prevention of breast cancer, awareness and awareness of women. Methodology: This is an integrative literature review. Results and discussion: 15 articles were selected for the sample of this review, the publication period analyzed was from 2013 to 2023, the main search engine being the Latin American Literature in Health Sciences (LILACS) and Scientific Electronic Library Online databases ( SCIELO). The results found in the research show the importance of professional nursing practice related to guidance, education and early diagnosis of cancer. Conclusion: It was possible to conclude that the nurse is a qualified and committed professional with attributes to guide, prevent and promote health education actions, aiming to improve the quality of life.

El Cáncer de Mama es una enfermedad que afecta a las células mamarias, y es una de las principales causas de mortalidad en muchas mujeres, especialmente si se detecta tarde. Objetivo: Demostrar la importancia de las enfermeras en la prevención del cáncer de mama, concienciación y sensibilización de las mujeres. Metodología: Se trata de una revisión bibliográfica integradora. Resultados y discusión: 15 artículos fueron seleccionados para la muestra de esta revisión, el período de publicación analizado fue de 2013 a 2023, siendo el principal motor de búsqueda las bases de datos Literatura Latinoamericana en Ciencias de la Salud (LILACS) y Scientific Electronic Library Online ( SCIELO). Los resultados encontrados en la investigación muestran la importancia de la práctica profesional de enfermería relacionada con la orientación, educación y diagnóstico precoz del cáncer. Conclusiones: Fue posible concluir que la enfermera es una profesional cualificada y comprometida con atributos para orientar, prevenir y promover acciones de educación para la salud, con el objetivo de mejorar la calidad de vida.

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This study aimed to evaluate the awareness and practice of breast self-examination (BSE) and the awareness of screening and risk factors for breast cancer among patients from a mastology clinic and to associate such findings with sociodemographic factors of that population. A total of 202 randomly selected patients from the outpatient clinic of the Mastology Unit of São Paulo School of Medicine were interviewed. A structured questionnaire was used and included questions regarding sociodemographic variables, questions to assess the knowledge and practice of BSE, and knowledge of mammographic screening and risk factors for breast cancer. The vast majority of patients were aware of the existence of BSE (93.1%). BSE was performed by most patients (64.9%), although only 20.3% performed it adequately. Only 21.8% of respondents showed awareness of the best screening method for breast cancer. Furthermore, 17.3% of patients showed adequate awareness of risk factors for breast cancer. The analysis of sociodemographic variables showed that older, postmenopausal, and less-educated women showed better practice of BSE. Overall, the patients had no adequate awareness of BSE, mammographic screening, and risk factors for breast cancer, and the majority failed to practice BSE adequately, particularly the group of patients with the higher level of education. These data show that educational measures regarding the practice of BSE and, especially, mammograms should be emphasized, regardless of education level or family income of the patient.

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INTRODUCTION: In Uruguay, breast cancer has the highest incidence and mortality of all cancer in women. Knowledge of the distribution of risk factors related to disease development supports the implementation of prevention strategies in routine clinical practice. This study aimed to determine the epidemiological profile for breast cancer and the frequency of mammographic surveillance in the surveyed population. MATERIALS AND METHODS: A survey was conducted among Uruguayan women diagnosed with breast cancer who were assisted in the mastology unit of the oncology service of the Hospital de Clínicas in Montevideo, Uruguay, from September 1, 2018, to March 1, 2020. RESULTS: This study included 398 respondents, with a median (SD) age at diagnosis of 61 (34-86) years. A total of 310 respondents (78.0%) had 1 or more risk factors. Most women aged over 50 years (264 out of a total of 338 [78.1%]) underwent mammographic surveillance at least biennially. CONCLUSIONS: Consistent with international reports, most respondents had a risk factor. Among the group of respondents aged over 50 years, most underwent mammographic and clinical surveillance at least biennially. Although it is only possible to formulate conclusions about the surveyed women because of the study design, the obtained data further our understanding of the epidemiological profile of the Uruguayan population, which can contribute to prevention practices.

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Este estudo objetivou analisar as trajetórias empreendidas por mulheres acima de 60 anos, usuárias do SUS, na busca por detecção precoce do câncer de mama (CM), por meio da mamografia. A pesquisa, de natureza qualitativa, utilizou a técnica do grupo focal (GF). Abarcou as trajetórias de três diferentes mulheres e os envolvimentos que entrelaçaram as dimensões de análise foram: a representação da doença e a experiência de busca por cuidados, a organização dos serviços de saúde, e as redes de apoio e sustentação das mulheres. Desenhar as trajetórias possibilitou demonstrar os caminhos trilhados pelas mulheres na busca por cuidados preventivos e analisar as dificuldades dos serviços em assegurar-lhes a mamografia, ressaltando que os empecilhos para a efetivação da detecção precoce do CM são reais.

Early detection of breast cancer by mammography: an analysis of women's trajectories. The aim of this study is to analyze the trajectories taken by women over 60, who are SUS users, for early detection of breast cancer (BC) through mammography. This is a qualitative study that used the focus group (FG) technique. It covers the trajectories of three different women and the main factors involved were the representation of the disease and the experience of seeking care, the organization of health services, and the support networks for women. Tracing their trajectories made it possible to demonstrate the paths taken by women in their search for preventive care, as well as to analyze the difficulties of the services in ensuring them access to mammography. In addition, it highlights that the obstacles to carrying out early detection of BC are real.

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RESUMO O câncer de mama pode ser considerado, atualmente, um problema de saúde pública devido a sua crescente incidência e índices de letalidade. Diante disso, o movimento Outubro Rosa visa chamar a atenção da população a respeito dessas neoplasia em mulheres de todo o mundo, de modo que suas ações têm por objetivo comum realizar o diagnóstico precoce no intuito de diminuir a mortalidade em decorrência dessa neoplasia. Dessa forma, o presente artigo objetiva relatar a experiência de acadêmicos do curso de Medicina da Universidade Estadual de Santa Cruz, no Módulo de Práticas de Integração Ensino, Serviço e Comunidade III (Piesc III), numa ação conjunta com a Equipe de Saúde da Família (ESF) de Iguape, em Ilhéus (BA), no contexto do movimento Outubro Rosa, objetivando também compartilhar considerações sobre a formação médica levantadas pelo grupo acerca da vivência descrita. No período, realizou-se abordagem inicial na sala de espera, anamnese dirigida e foi feito o exame físico das mamas das pacientes que compareceram à Unidade de Saúde da Família. A experiência não consistiu apenas em identificar pacientes com suspeita de câncer de mama e quantificar os dados, mas numa oportunidade de exercício da Educação e Comunicação em Saúde e de desenvolvimento da relação médico-paciente. Ainda permitiu aos acadêmicos reconhecer e entender melhor as dificuldades das usuárias em relação à prevenção e promoção da saúde das mamas, sendo que se observou que diversas mulheres não estavam familiarizadas com os temas abordados. O estudante de Medicina precisa compreender que o conhecimento teórico-prático se reconstrói em cada paciente com contexto histórico específico e com diferentes visões e interpretações dos conceitos de saúde e doença. Além disso, o profissional médico deve exercitar, desde a graduação, habilidades que extrapolam o ortodoxo trabalho médico, assumindo também uma postura de multiplicador de cidadania, um agente propagador de direitos e deveres.

ABSTRACT The breast cancer can now be considered a public health problem due to its increasing incidence and lethality rates. In view of this, the October Rosa mobilization aims at drawing the population’s attention regarding this neoplasm in women from all over the world, so that their common objective is to perform the early diagnosis in order to reduce mortality due to this neoplasm. Thus, the following article describes the experiences of undergraduate medical students at the Universidade Estadual de Santa Cruz (Uesc) regarding the practice module on Integrated Teaching with Community Health and Service, as part of a joint initiative with a Family Health Team in the outskirts of Ilhéus, Bahia, Brazil, within the context of the “Pink October” movement, also aiming to share thoughts on the medical degree raised by the group on the experience described. As part of the Pink October initiative, the students were given the opportunity to take a clinical approach in the waiting room, collecting information and performing physical examinations on patients who appear at the Family Health Unit. This experience was not only intended to identify patients with suspected cancer and measure the data collected, but was also designed to provide the students the opportunity to put their health education and communication skills into practice, developing the doctor-patient relationship. It also allows academics to better recognize and understand users’ difficulties in preventing and promoting breast health. In this context, it was observed that several women were not familiar with the recommended techniques for the breast self-exam (???). Medical students must understand that practical and theoretical knowledge is reconstructed with every single patient according to their specific historical context and varying viewpoints and interpretations of the concepts of health and disease. In addition, the medical professional must exercise, from the undergraduate, skills that extrapolate the orthodox medical work, also assuming a position of multiplier of citizenship, a propagating agent of rights and duties.

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Objetivos: Investigar a percepção e o conhecimento de 820 mulheres usuárias do Hospital Universitário da Universidade Federal de Juiz de Fora acerca do autoexame das mamas, a forma pela qual têm adquirido conhecimento sobre esse exame, bem como a sua associação com variáveis socioeconômicas. Métodos: Estudo transversal realizado com 820 mulheres usuárias do Hospital Universitário da Universidade Federal de Juiz de Fora, mediante entrevista estruturada. A associação entre as variáveis foi feita pelo teste do ?2 . Resultados: Na amostra, 92,4% das pacientes tinham conhecimento sobre o autoexame das mamas. Os principais meios de informação foram televisão, consulta médica e campanhas educativas com, respectivamente, 50,5%; 43,8 e 17,2%. Das entrevistadas, 68,8% consideram-se aptas a fazer o autoexame das mamas, e 61,3% o fazem. Destas, 62,4% o realizam mensalmente. Quanto ao momento ideal para realização do autoexame das mamas, 38,5% acreditam que seja logo após a menstruação; 20,5%, a qualquer momento; 17,7%, antes da menstruação; 7,4%, durante a menstruação e 15,9% não sabem. Uma taxa de 55,7% acredita não saber diferenciar o tecido mamário normal do nódulo durante o exame. Observou-se maior realização e conhecimento sobre o autoexame das mamas entre aquelas com renda superior a dois salários-mínimos (p=0,01). Conclusões: Mesmo sendo uma prática controversa, a maioria das mulheres adquire informações sobre o autoexame das mamas por meio de fontes leigas. Em decorrência disso, mais da metade das mulheres não sabe o momento ideal para a sua realização e não se sente apta para realizá-lo, justificando uma necessidade de informações técnicas adequadas e baseadas em evidências.

Objectives: To investigate the understanding and knowledge of breast self-examination among 820 women assisted at the University Hospital of Universidade Federal de Juiz de Fora, in addition to the manner in which they have acquired knowledge of this examination, and its association with socioeconomic variables. Methods: This was a cross-sectional study. Structured interviews were conducted with 820 women assisted at the University Hospital of the Universidade Federal de Juiz de Fora.The association between the variables was performed using the ?2 test. Results: 92.4% of the sample was aware of the breast self-examination. The main sources of information were television, medical consultation and educational campaigns, accounting for 50.5, 43.8 and 17.2%, respectively. Among the interviewed women, 68.8% considered themselves capable of performing the breast self-examination and 61.3% reported the habit of performing it. Among these, 62.4% perform it monthly. With regard to the best period to perform the breast selfexamination, 38.5% consider that it should be done immediately after menstruation, 20.5% at any time, 17.7% before menstruation, 7.4% during menstruation, and 15.9% do not know. A total of 55.7% believed they were not able to differentiate a normal breast tissue from a nodule during the exam. We observed higher occurrence and understanding of breast self-examination among women whose income was above two minimum wages (p=0.01). Conclusions: Despite being a controversial practice, most women acquire information about the breast self-examination by means of non-medical sources. As a consequence, over half of the women are not aware of the proper time to perform the exam as well as they do not feel capable of performing it. This justifies the need for technical and evidence-based adequate information.

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SUMMARY Objective: to evaluate the relationship between levels of physical activity, fatigue and quality of life (QOL) in women diagnosed with breast cancer. Methods: 215 women between the ages of 40 and 65 years were recruited at a cancer clinic. Physical activity levels were assessed by using the International Physical Activity Questionnaire (IPAQ), fatigue levels by using the revised Piper scale, and QOL by means of EORTC QLQ-C30 and WHOQOL-Bref. Statistical analysis was performed using Minitab statistical software, version 16. Results: the mean age of subjects was 52.66 years (SD=8.6); patients were mostly white (58.14%) and overweight (55.81%). Most women were fatigued (72.09%) while physically active women showed lower symptoms of fatigue (p<0.001). Mean scores for QOL were significantly lower among fatigued women (p<0.001). More active women scored higher on all scales of QOL (EORTC), especially for functional capacity (p<0.001), compared with the sedentary patients. A significant association was found between level of physical activity and overall QOL (WHOQOL-Bref) for all domains (p<0.001). Climacteric symptoms ranged from mild to strong and did not show any statistically significant results; however, the most active women had the fewest symptoms. Conclusion: physical activity appears to positively influence fatigue and QOL in women diagnosed with breast cancer.

RESUMO Objetivo: avaliar a relação entre os níveis de atividade física, fadiga e qualidade de vida (QV) em mulheres diagnosticadas com câncer de mama. Métodos: foram selecionadas 215 mulheres com idades entre 40 e 65 anos selecionadas em um hospital de referência para tratamento de câncer de mama, no estado do Rio Grande do Norte, Brasil. Os níveis de atividade física foram avaliados por meio do Questionário Internacional de Atividade Física (IPAQ), a fadiga por meio da escala de Piper revisada, e a QV por meio do EORTC-QLQ-C30 e WHOQOL-Breaf. A análise estatística foi realizada utilizando o software estatístico Minitab, versão 16. Resultados: a idade média dos participantes foi de 52,66 anos (DP = 8,6), em sua maioria brancas (58,14%) e classificadas com sobrepeso (55,81%). Detectou-se alta prevalência de fadiga (72,09%), enquanto as mulheres fisicamente ativas apresentaram sintomas mais baixos de fadiga (p<0,001). Os escores médios de qualidade de vida foram significativamente menores para as mulheres sedentárias (p<0,001). Mulheres mais ativas apresentaram escores mais altos de QV (EORTC), principalmente na capacidade funcional (p<0,001), quando comparadas com as sedentárias. Foi encontrada uma associação significativa entre nível de atividade física e qualidade de vida global (WHOQOL-Bref) para todos os domínios (p<0,001). Sintomas climatéricos variaram de leve a forte intensidade e não apresentaram resultados estatisticamente significativos, porém as mulheres mais ativas apresentaram menor número de sintomas. Conclusão: Mulheres com níveis mais altos de atividade física apresentaram menos sintomas de fadiga e escores mais altos de qualidade de vida.

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Objective: Surveying the actions for preventing breast cancer, according to the levels set by Leavell & Clark, at the Family Health Strategy in Sirinhaém (PE). Method: This is a quantitative study, carried out with 261 women aged > 18 years old, and enrolled in the FHS. The collection took place in the Family Health Units in the town, from August 2012 to January 2013, through a structured questionnaire. Results: The age extremes were of 18 and 84 years old. Among the interviewed women, 12.6% had received guidance on the theme, 49.4% practice self-examination, and 13.8% indicated they have undergone clinical breast examination. Conclusion: it was observed precariousness regarding the health promotion and protection actions and the early diagnosis services for breast cancer.

Objetivo: Levantar as ações de prevenção ao câncer de mama, segundo os níveis estabelecidos por Leavell & Clarck, na Estratégia Saúde da Família de Sirinhaém (PE). Método: Trata-se de estudo quantitativo, desenvolvido com 261 mulheres com idades > 18 anos e cadastradas na ESF. A coleta ocorreu nas unidades de Saúde da Família do município, de agosto de 2012 a janeiro de 2013, por um questionário estruturado. Resultados: Os extremos etários foram 18 e 84 anos. Entre as entrevistadas, 12,6% haviam recebido orientação acerca do tema, 49,4% praticam o autoexame e 13,8% indicaram ter realizado o exame clínico das mamas. Conclusão: Observou-se precariedade em relação às ações de promoção e proteção à saúde e aos serviços de diagnóstico precoce do câncer de mama.

Objetivo: Evaluar las acciones de prevención al cáncer de mama, de acuerdo con los niveles establecidos por Leavell & Clark, en la Estrategia de Salud de la Familia de Sirinhaém (PE). Método: Esto es un estudio cuantitativo, desarrollado con 261 mujeres con edades > 18 años e inscritas en la ESF. La recogida ocurrió en unidades de Salud de la Familia del municipio, de agosto de 2012 a enero de 2013, por cuestionario estructurado. Resultados: Los extremos etarios fueron 18 y 84 años. Entre las encuestadas, 12,6% habían recibido orientación acerca del tema, 49,4% practican el auto-examen y 13,8% indicaron que habían realizado el examen clínico de las mamas. Conclusión: Se observó precariedad con relación a las acciones de promoción y protección a la salud y a los servicios de diagnóstico precoz del cáncer de mama.

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Este artículo analiza las acciones de prevención del cáncer de cuello de útero y de mama en servicios de salud públicos, privados y de la seguridad social y en organizaciones no gubernamentales de la Ciudad Autónoma de Buenos Aires. Su propósito es reflexionar acerca de los alcances y las limitaciones de los enfoques preventivos implementados en los tres subsectores del sistema de salud y la comunidad para evitar que las mujeres se enfermen y se mueran por causa de esas enfermedades, en un contexto fragmentado del sistema de salud con fuertes heterogeneidades en el acceso y agudas desigualdades sociales en el ejercicio de la prevención. La investigación parte de una definición amplia de prevención, que integra la educación, la concientización y la detección temprana de lesiones precancerosas y de cáncer, entre otros componentes médicos y no médicos. Los resultados obtenidos a partir de entrevistas semiestructuradas a referentes de hospitales públicos, obras sociales, empresas de medicina privada y organizaciones sociales que trabajan en el tema del cáncer muestran que, en contraposición a un abordaje integral, cada institución recorta su accionar en torno a un eje de la prevención, y predominan respuestas aisladas y desarticuladas que no alcanzan a generar en las mujeres una demanda por cuidados y asistencia de manera autónoma e informada.(AU)

The article analyzes actions for the prevention of cervical and breast cancer in public, private, and employment-based health services and in non-governmental organizations in the city of Buenos Aires. The article seeks to reflect on the reach and limitations of the approaches implemented in the three subsectors of the health care system and the community to prevent women from suffering or eventually dying as a consequence of these diseases, in the fragmented context of a health system with great heterogeneity in access and deep social inequalities in the use of preventive actions. The study utilizes a broad definition of prevention which integrates education, awareness-building and early detection of pre-carcinogenic and carcinogenic lesions, among other medical and non-medical components. The results were obtained using semi-structured interviews with subjects from public hospitals, employment-based health care services, private medical companies and non-governmental organizations with work in cancer prevention. These results show that contrary to a comprehensive approach, each institution limits its actions to only one aspect of prevention, implementing predominately isolated or disconnected actions inadequate to generate an autonomous and well-informed demand for treatment and health care among women.(AU)

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Este artículo analiza las acciones de prevención del cáncer de cuello de útero y de mama en servicios de salud públicos, privados y de la seguridad social y en organizaciones no gubernamentales de la Ciudad Autónoma de Buenos Aires. Su propósito es reflexionar acerca de los alcances y las limitaciones de los enfoques preventivos implementados en los tres subsectores del sistema de salud y la comunidad para evitar que las mujeres se enfermen y se mueran por causa de esas enfermedades, en un contexto fragmentado del sistema de salud con fuertes heterogeneidades en el acceso y agudas desigualdades sociales en el ejercicio de la prevención. La investigación parte de una definición amplia de prevención, que integra la educación, la concientización y la detección temprana de lesiones precancerosas y de cáncer, entre otros componentes médicos y no médicos. Los resultados obtenidos a partir de entrevistas semiestructuradas a referentes de hospitales públicos, obras sociales, empresas de medicina privada y organizaciones sociales que trabajan en el tema del cáncer muestran que, en contraposición a un abordaje integral, cada institución recorta su accionar en torno a un eje de la prevención, y predominan respuestas aisladas y desarticuladas que no alcanzan a generar en las mujeres una demanda por cuidados y asistencia de manera autónoma e informada.

The article analyzes actions for the prevention of cervical and breast cancer in public, private, and employment-based health services and in non-governmental organizations in the city of Buenos Aires. The article seeks to reflect on the reach and limitations of the approaches implemented in the three subsectors of the health care system and the community to prevent women from suffering or eventually dying as a consequence of these diseases, in the fragmented context of a health system with great heterogeneity in access and deep social inequalities in the use of preventive actions. The study utilizes a broad definition of prevention which integrates education, awareness-building and early detection of pre-carcinogenic and carcinogenic lesions, among other medical and non-medical components. The results were obtained using semi-structured interviews with subjects from public hospitals, employment-based health care services, private medical companies and non-governmental organizations with work in cancer prevention. These results show that contrary to a comprehensive approach, each institution limits its actions to only one aspect of prevention, implementing predominately isolated or disconnected actions inadequate to generate an autonomous and well-informed demand for treatment and health care among women.

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FUNDAMENTOS: Estudos demonstram que a realização da mamografia em programas de rastreamento diminui a mortalidade do câncer de mama. Entretanto, há indícios de grande desigualdade no acesso à realização deste exame no Brasil. OBJETIVOS: Analisar o percentual de mulheres que não realizaram mamografia segundo variáveis socioeconômicas e demográficas em mulheres de 40 a 69 anos de Teresina-PI. MÉTODOS: Estudo transversal realizado em 2010/2011, com amostragem multifásica em cinco etapas, realizando-se entrevista face a face com cada mulher sorteada. Processou-se os dados com programa SPSS 19.0, realizando-se análise uni e multivariada. RESULTADOS: Dentre as 433 mulheres que responderam o questionário, a taxa de realização de mamografia foi de 75,3%,sendo que, destas, 17,2% a haviam realizado há mais de dois anos. A não realização de mamografia esteve relacionada com raça parda/negra (p = 0,030), ausência de companheiro (p = 0,041), menor grau de instrução (p = 0,010), menor renda (p < 0,001), tabagismo (p = 0,006), não possuir plano ou seguro de saúde (p < 0,001). O Sistema Único de Saúde (SUS) foi responsável por realizar 56,3% das mamografias. CONCLUSÃO: 24,7% das mulheres teresinenses nunca haviam realizado mamografia e 37,9% não a haviam realizado nos últimos dois anos. A não realização deste exame foi associada à existência de desigualdades racial e socioeconômica.

INTRODUCTION: Randomized studies have shown that screening for breast cancer with mammography reduces the breast cancer mortality. However there are signs of a great inequality in access to mammography in Brazil. OBJECTIVES: To analyze the percentage of women who did not undergo mammography according to socioeconomic and demographic variables in women aged from 40 to 69 years in Teresina, Piauí State, Brazil. METHODS: This was a cross-sectional population-based study in women aged 40-69 years in Teresina-Piauí in 2010/2011. The sampling was randomly conducted in five stages. The data were processed by SPSS 19.0 and it was performed univariate and multivariate analysis. RESULTS: Among 433 women who answered the questionnaire, 75,3% had a mammography and 17,2% of these women had not a mammography over the last two years. The lack of breast cancer screening was associated with non-white skin color (p = 0,030), never being married (p = 0,041), low levels of education (p = 0,010), low family income (p < 0,001), smoking (p = 0,006), having no private health insurance (p < 0,001). The Unified National Health System (SUS) performed 56,3% of reported mammograms. CONCLUSION: About 24.7% of women in the sample never had a mammography. According to the findings, the lack of breast cancer screening is associated with social and racial inequalities.

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Introducción: conocer los factores de riesgo y realizar el autoexamen de mama es de vital importancia para prevenir el cáncer de mama, una de las principales causas de muertes prevenibles en el sexo femenino. Objetivo: modificar el conocimiento sobre los factores de riesgo que causan el cáncer de mamas. Métodos: se realizó un estudio de intervención en el Local # 4 del Policlínico Comunitario Docente, Arturo Puig Ruiz de Villa, municipio Minas, en Camagüey el período comprendido entre enero de 2009 a junio de 2010. El universo quedó constituido por 219 féminas y la muestra fue de 119 según muestreo intencional puro no probabilístico, se confeccionó un cuestionario según bibliografía revisada e interés de los autores, con variables como edad, antecedentes familiares de cáncer, ingestión de tabletas anticonceptivas y hábitos tóxicos, frecuencia con que se realiza el autoexamen de mama. Los resultados fueron procesados mediante un paquete estadístico SPSS. Se aplicó la estadística descriptiva e inferencial con tablas. Resultados: predominó el grupo de edades, 40 - 49, 68 (57,14 por ciento), antecedentes familiares 71 (59,66 por ciento), contraceptivos hormonales usaron 92 (77,31 por ciento) antes de la intervención y después 5 (4,20 por ciento), con hábito tóxico 103 (86,55 por ciento) lo practicaban, después 5 (4,20 por ciento) mantuvieron el hábito, la práctica del autoexamen de mamas 68 (57,14 por ciento) lo realizan una vez al año, después de la intervención el 84,03 por ciento mensual. Conclusiones: se elevó el nivel de conocimiento que demuestra con este la utilidad de los estudios de intervención para disminuir factores de riesgo en la población(AU)

Introduction: breast carcinoma is the commonest cancer among women and the leading cause of death in the age-group 40-44. The knowledge of risk factors and the breast self- examination are essential for its prevention. Objective: to modify the knowledges on the risk factors leading to breast cancer. Methods: an interventional study was conducted in the Arturo Puig Ruiz de Villa Teaching Community Policlinic, Minas municipality, Camagüey province from January, 2009 to June, 2010. Universe included 210 women and sample included 119 according a non-probabilistic pure intentional sampling; a questionnaire was designed using the following variables: age, cancer family history, use of contraceptive tablets and toxic habits, as well as the frequency of breast self-examination. Results were processed by a SPSS statistic package. The descriptive and inferential statistics was applied using tables. Results: there was predominance of age-groups 40-69, 68 (57.14 percent), 71 family histories (59.66 percent), 92 used hormonal contraceptives (77.31 percent) before intervention and 5 after it (4.20 percent), 103 were smokers (86.55 percent), afterwards only 5 (4.20 percent) remains the habit, 68 patients practiced the breast self-examination (57.14 percent) carried out yearly, after intervention the 84.03 percent make it monthly. Conclusions: the knowledge increase demonstrating the usefulness of interventional studies to decrease the risk factors in population(AU)

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Estudo com o objetivo de identificar o conhecimento dos acadêmicos, quanto aos fatores de prevenção para o câncer de mama. De natureza quantitativa, exploratória e descritiva, desenvolvido numa instituição de ensino superior do Estado de Santa Catarina, com 50 acadêmicos matriculados nos cursos de enfermagem, fisioterapia e psicologia no 1º semestre de 2008. A coleta de dados ocorreu de fevereiro a abril de 2008. Utilizou-se um questionário semi-estruturado e análise estatística descritiva. Os resultados apontaram que os acadêmicos dos cursos de enfermagem e fisioterapia demonstraram maior conhecimento sobre o tema. Os fatores de prevenção mencionados foram: consumo de legumes, verduras, frutas, exercícios físicos e amamentação. Conclui-se que o nível de conhecimento dos estudantes sobre os fatores de prevenção do câncer de mama, numa perspectiva interdisciplinar, é importante para repensar a inserção da educação em saúde como conteúdo curricular imprescindível na promoção de uma universidade saudável.

This study aimed to identify what undergraduate students know of factors for breast cancer prevention. This was a quantitative, exploratory and descriptive study, developed in a University in the state of Santa Catarina, Brazil, with 50 students enrolled in nursing, physiotherapy and psychology programs in the first semester of 2008. The data were collected from February to April, 2008. A semi-structured questionnaire and descriptive statistics were used. Results showed that students of nursing and physiotherapy demonstrated greater knowledge about the issue than the psychology students. Mentioned prevention factors: consumption of vegetables, greens and fruits, physical exercises and breastfeeding. Conclusions indicate that the level of students' knowledge about factors that can prevent breast cancer, in an interdisciplinary perspective, is important to rethink the inclusion of health education as an essential curriculum content to promote a healthy university.

Objetivo del estudio fue identificar el conocimiento de los estudiantes, acerca de los factores para la prevención del cáncer de mama. Un cuantitativo exploratorio y descriptivo, desarrollado en una institución de educación superior de Santa Catarina, Brasil, con 50 estudiantes matriculados en la enfermería, fisioterapia y psicología en el primer semestre de 2008. Los datos fueron recolectados de febrero a abril de 2008. Se utilizó un cuestionario semi-estructurado y estadística descriptiva. Los resultados mostraron que los estudiantes de enfermería y terapia física han demostrado mayor conocimiento sobre el tema que los estudiantes de psicología. Menciona factores: el consumo de verduras, frutas, el ejercicio físico y la lactancia. Se concluye que el nivel de conocimiento acerca de los factores que pueden prevenir el cáncer de mama, una perspectiva interdisciplinaria, es importante para reconsiderar la inclusión de la educación para la salud como los contenidos curriculares esenciales en la promoción de una universidad saludable.

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Introducción: conocer los factores de riesgo y realizar el autoexamen de mama es de vital importancia para prevenir el cáncer de mama, una de las principales causas de muertes prevenibles en el sexo femenino. Objetivo: modificar el conocimiento sobre los factores de riesgo que causan el cáncer de mamas. Métodos: se realizó un estudio de intervención en el Local # 4 del Policlínico Comunitario Docente, Arturo Puig Ruiz de Villa, municipio Minas, en Camagüey el período comprendido entre enero de 2009 a junio de 2010. El universo quedó constituido por 219 féminas y la muestra fue de 119 según muestreo intencional puro no probabilístico, se confeccionó un cuestionario según bibliografía revisada e interés de los autores, con variables como edad, antecedentes familiares de cáncer, ingestión de tabletas anticonceptivas y hábitos tóxicos, frecuencia con que se realiza el autoexamen de mama. Los resultados fueron procesados mediante un paquete estadístico SPSS. Se aplicó la estadística descriptiva e inferencial con tablas. Resultados: predominó el grupo de edades, 40 - 49, 68 (57,14 por ciento), antecedentes familiares 71 (59,66 por ciento), contraceptivos hormonales usaron 92 (77,31 por ciento) antes de la intervención y después 5 (4,20 por ciento), con hábito tóxico 103 (86,55 por ciento) lo practicaban, después 5 (4,20 por ciento) mantuvieron el hábito, la práctica del autoexamen de mamas 68 (57,14 por ciento) lo realizan una vez al año, después de la intervención el 84,03 por ciento mensual. Conclusiones: se elevó el nivel de conocimiento que demuestra con este la utilidad de los estudios de intervención para disminuir factores de riesgo en la población

Introduction: breast carcinoma is the commonest cancer among women and the leading cause of death in the age-group 40-44. The knowledge of risk factors and the breast self- examination are essential for its prevention. Objective: to modify the knowledges on the risk factors leading to breast cancer. Methods: an interventional study was conducted in the Arturo Puig Ruiz de Villa Teaching Community Policlinic, Minas municipality, Camagüey province from January, 2009 to June, 2010. Universe included 210 women and sample included 119 according a non-probabilistic pure intentional sampling; a questionnaire was designed using the following variables: age, cancer family history, use of contraceptive tablets and toxic habits, as well as the frequency of breast self-examination. Results were processed by a SPSS statistic package. The descriptive and inferential statistics was applied using tables. Results: there was predominance of age-groups 40-69, 68 (57.14 percent), 71 family histories (59.66 percent), 92 used hormonal contraceptives (77.31 percent) before intervention and 5 after it (4.20 percent), 103 were smokers (86.55 percent), afterwards only 5 (4.20 percent) remains the habit, 68 patients practiced the breast self-examination (57.14 percent) carried out yearly, after intervention the 84.03 percent make it monthly. Conclusions: the knowledge increase demonstrating the usefulness of interventional studies to decrease the risk factors in population

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Introdução: A mamografia é um método preventivo que reduz a mortalidade por câncer de mama e que deve ser oferecido a todas as mulheres com idade superior a 40 anos. Avaliamos neste estudo a aderência de mulheres que frequentam o ambulatório de especialidades da FM-ABC quanto ao uso da mamografia e os motivos que justificam as eventuais falhas a esta aderência. Métodos: Foi desenvolvido um questionário abordando dados demográficos, socioeconômicos e de conhecimentos sobre o exame preventivo de mamografia a sua assiduidade, como também o por que da não realização do mesmo. Este questionário foi aplicado em mulheres com mais de 50 anos, que não apresentaram doença mamária previa, e que frequentam o ambulatório da Faculdade de Medicina do ABC, nas diversas especialidades. Resultados: Do total das 109 mulheres entrevistadas, somente 11 (10,1%) nunca tinham realizado o exame da mamografia. A não realização do exame preventivo de mamografia se associou significativamente com idade mais avançada (p = 0,01) e também pela ausência de recomendação médica. Curiosamente, 9 das 11 pacientes que nunca tinham feito mamografia já tinham ouvido falar do exame. Em relação às mulheres que já fizeram mamografia, a idade média da primeira mamografia foi 45,61 anos, sendo a média de tempo desde a última mamografia de 21,9 meses. Conclusão: Para que todas as mulheres a partir dos 40 anos tenham o compromisso com a prevenção do câncer de mama, médicos devem estimular o procedimento, insistindo inclusive com as mulheres mais idosas, enfatizando sempre a necessidade da periodicidade do exame.

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No Brasil, dados do Ministério da Saúde apontam o câncer de mama como principal causa de morte em mulheres, apesar dos avanços no diagnóstico e tratamento desta enfermidade. Sucessivas campanhas de esclarecimento à população enfatizaram os meios disponíveis para prevenção: autoexame, exame clínico por profissional da saúde e a mamografia. Apesar da sua importância, estas estratégias isoladamente não reduziram a incidência deste agravo à saúde, já que não atuam nos fatores predisponentes para sua iniciação. O objetivo desse estudo foi desenvolver uma atividade de promoção à saúde através do reforço de conhecimentos existentes e agregação de novas informações sobre o câncer de mama no contexto de Unidade Básica de Saúde. Trata-se de um estudo transversal de intervenção pedagógica em salas de espera de Unidade Básica de Saúde. A intervenção pedagógica foi realizada através de questionário interativo, palestra informativa e discussão livre sobre o tópico, associados à avaliação quantitativa e qualitativa desta intervenção. A abordagem proposta foi positiva, uma vez que houve melhora quantitativa e qualitativa da compreensão do público sobre os temas abordados, boa interatividade entre os palestrantes e o público, e criação de agentes multiplicadores de conhecimento.

Data from the Brazilian Ministry of Health shows that the breast cancer is one of the leading causes of women's death, despite the enhancements in treatment and diagnosis of this disease. Successive explanatory advertising campaigns emphasized the methods available for prevention: auto examination, clinical examination by a health care professional and mammography. Regardless of their relevance, only these strategies did not reduced incidence of breast cancer, since they do not impact on the oncogenesis factors. The objective of this article is to develop a health promotion activity through the reinforcement of the previous knowledge and aggregation of new information about breast cancer of a basic health unit. The methodology used was a transversal study of pedagogical intervention in the waiting rooms of a basic health unit. The pedagogical intervention was composed by an interactive questionnaire, lecture and discussion about the topic associated with a qualitative and quantitative evaluation of the activity. The proposed activity had positive results since the participants had qualitative and quantitative improvement in their knowledge and also a good interactivity with the researchers.

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