BREAST CANCER SCREENING BASED ON PHYSICAL EXAMINATION OF THE BREAST PERFORMED BY COMMUNITY HEALTH WORKERS: ITABERAÍ PROJECT
Priscila Dias Watanabe1; Ruffo de Freitas Júnior1; Danielle Cristina Netto Rodrigues1; Rosangela da Silveira Corrêa1; Paola Ferreira de Freitas1; Marcus Nascimento Borges1; Maria do Carmo Egito de Sá2; Leonardo Ribeiro Soares1
1CORA – Advanced Breast Diagnosis Center, Federal University of Goiás. Brazilian Network of Breast Cacer Research, Brazil.
2Municipal Health Department of Itaberaí – Goiás, Brazil.
Objective: The objective of this study is to evaluate the effectiveness of screening actions based on Physical Breast Examination (PBE) performed by Community Health Workers (CHW) for the reduction of advanced tumors (Stages III-IV) and reduction of mortality rate. Methodology: This is a randomized, phase III, open-label clinical trial. Women aged 40 or older, without a diagnosis of breast cancer, and assisted in their homes by CHW, are eligible. For the randomization, the headquarters where the NHS are located were randomized (by drawing) into Control Groups (CG) and Intervention Group (IG). The intervention consisted of performing the PBE by female CHW, who receive continuous theoretical-practical training. For data collection, a system called “Rosa App” was developed. The variables used to build the App were: sociodemographic data, lifestyle habits, anamnesis, information about previous exams, and about the physical breast examination. For the follow-up of altered cases identified by the CHW, a web system was developed. The sample size calculation was defined to detect the reduction of severe cases and mortality (by 10% and 20%, respectively). For this, 80% of sample power was adopted, with a 5% Type I error, after adjusting for intracluster correlation and sample effect (0.032 and 1,892, respectively). The trial was approved by the Research Ethics Committee (CAAE 56916522.8.0000.5078) and ReBEC (RBR-39vm2nd). Results: For the first Participating Center (municipality of Itaberaí – Goiás), a population of 1,894 women was estimated in each group (total of 3,788). The study was activated in December 2022, and until February 29, 2024, 3,101 women were randomized, with 1,607 in the CG and 1,494 in the IG. Of these, 366 showed alterations identified in the PBE performed by the CHW, and eight received a diagnosis of breast cancer. Conclusion: The trial could help establish new public policy strategies for breast cancer screening. Support: Avon Institute and Libbs Pharmaceuticals.
Keywords: Clinical Protocols, Breast Cancer, Community Health Workers.
HIGH RISK OF METABOLIC DYSFUNCTION IN NON-OBESE BREAST CANCER SURVIVORS
Daniel Buttros¹, Pedro Paulo Perroni da Silva Filho², Luciana de Araújo Brito Buttros³, Heloisa Maria de Luca Vespoli², Eliana Aguiar Petri Nahás²
¹ Faculdade de Medicina de Botucatu – UNESP|Rio Claro|SP|BRASIL
² Faculdade de Medicina de Botucatu – UNESP|Botucatu|SP|BRASIL
³ Faculdade de Medicina de Botucatu – UNESP|Sorocaba|SP|BRASIL
Objective: To evaluate the metabolic profile of non-obese women with breast cancer compared to non-obese women without cancer. Methodology: A cross-sectional comparative clinical study was carried out with the inclusion of 260 women (according to sample calculation). The main group consisted of 130 women with a body mass index (BMI) < 30kg/m2, with a histological diagnosis of breast cancer, stages I to III, aged between 45-75 years, in amenorrhea ≥ 12 months and without cardiovascular disease (CVD) established. The control group consisted of 130 women with the same inclusion criteria, without breast cancer. The groups were matched by age, BMI and time since menopause and compared in a 1:1 ratio. Clinical, anthropometric and biochemical data were collected. Women who had three or more diagnostic criteria were considered to have metabolic syndrome (MS): WC > 88 cm; triglycerides (TG) > 150 mg/dL; HDL cholesterol < 50 mg/dL; blood pressure > 130/85 mmHg; glucose >100 mg/dL. For statistical analysis, the Student’s t-test, the Gamma Distribution (asymmetric variables), the Chi-square test and logistic regression (odds ratio-OR) were used. Results: In assessing the factors that affect the metabolic profile, a higher occurrence of MS and blood pressure impairment was observed among women treated for breast cancer when compared to controls (30.8% vs. 20.0%, and 25.4% vs 14.6%, respectively) (p<0.05). A higher proportion of women treated for breast cancer also had higher than desirable levels of total cholesterol and blood glucose in the comparative analysis (56.2% vs 43.1% and 29.2% vs 15.4%, respectively) (p<0 .05). In the risk analysis of metabolic dysfunction, adjusted for age and time since menopause, women with breast cancer had a significantly higher risk for MS (OR=2.76, 95% CI 1.48-5.15), increased blood glucose OR=2.69, 95% CI 1.46-4.96) and blood pressure (OR=3.03, 95% CI 1.51-6.10). In the analysis of the subgroup with BMI <25k/m2, the main group had a higher occurrence of metabolic syndrome when compared to the group without breast cancer (n=53) (17.2% vs 1.9%, respectively, p=0.007) . Women with a BMI<25kg/m2 had significantly higher values for WC (82.6±8.5 vs 79.9±6.4 cm, p=0.048), SBP and DBP (129.2±17.1 and 77. 7 ±8.8 mmHg vs 118.2±15.1 and 73.6±8.8 mmHg, p=0.0002 and p=0.01, respectively) and blood glucose (99.7±32.5 vs 86 .6±7.6 mg/dL, p=0.0002) when compared to women with the same BMI. Conclusion: Non-obese women treated for breast cancer were at high risk for metabolic dysfunction, expressed by the higher prevalence of MS, hypertension and diabetes when compared to women without breast cancer. The risk remains in the subgroup with ideal BMI.
Keywords: breast cancer, metabolic syndrome, diabetes, hypertension, obesity.
