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      Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies Translated title: Fatores de risco do câncer de mama e o conhecimento sobre a doença: revisão integrativa de estudos Latino Americanos

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          Abstract

          Abstract The aim of this integrative review was to compare Latin American literature about risk and knowledge on breast cancer. Of 47 studies selected, 20 were about knowledge or awareness and 27 about risk of breast cancer. English was the dominant language in studies about risk, whereas studies about knowledge were mainly written in Spanish or Portuguese. Studies about knowledge were all cross- sectional, whereas case- control studies dominated authors’ interest about risk of breast cancer. Studies about knowledge were mainly focused on early detection of the disease and the most common study objective was breast self- examination (N = 14). In contrast, few studies about risk of breast cancer focused on early detection (N = 5). Obesity and overweight (N = 14), family history (N = 13), decreased parity (N = 12), and short breastfeeding duration (N = 10) were among the most frequent identified risk factors. Socio- economic factors such as income and educational level had variable effects on breast cancer risk and affected also knowledge of women about risk factors and early detection. Present results indicated that studies about risk of breast cancer were more often based on a better sound analytical background, compared to studies about knowledge, which were mostly descriptive.

          Translated abstract

          Resumo Esta revisão teve por objetivo comparar a literatura Latino-Americana sobre o conhecimento da neoplasia mamária e seus fatores de risco. Foram selecionados 47 estudos, dos quais 27 eram sobre o risco de desenvolver câncer de mama e 20 sobre o conhecimento ou a consciência sobre a doença. Os estudos sobre fatores de risco eram principalmente do tipo caso-controle e sua maioria estava no idioma Inglês. Já as pesquisas sobre conhecimento eram, sobretudo, do tipo transversal e foram publicadas nos idiomas Português e Espanhol. As pesquisas sobre conhecimento destacaram o diagnóstico precoce da neoplasia mamária, e o autoexame da mama foi o método de detecção mais abordado (N = 14). Por outro lado, os estudos sobre fatores de risco avaliaram, principalmente, sobrepeso (N = 14), historia familiar (N = 13), baixa paridade (N = 12) e curto período de amamentação (N = 10). Fatores socioeconômicos, como a renda e o nível educacional tiveram efeitos variáveis e afetaram também o conhecimento das mulheres sobre fatores de risco e detecção precoce. Os resultados da pesquisa indicaram que os estudos sobre fatores de risco do câncer de mama apresentaram melhor delineamento metodológico e fundamentação teórica, comparado com os estudos sobre conhecimento que foram na maioria dos casos descritivos.

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          Reproductive risk factors and breast cancer subtypes: a review of the literature.

          Aside from age, sex, and family history, risk of developing breast cancer is largely linked to reproductive factors, which characterize exposure to sex hormones. Given that, molecular testing at the tumor level is currently possible, clinical characterization of tumor subtypes is routinely conducted to guide treatment decisions. However, despite the vast amount of published data from observational studies on reproductive factor associations and breast cancer risk, relatively fewer reports have been published on associations specific to breast tumor subtypes. We conducted a review of the literature and summarized the results of associations between reproductive factors and risk or odds of three distinct tumor subtypes: estrogen receptor/progesterone receptor positive (hormone receptor positive, HR+ tumors), tumors overexpressing the human epidermal receptor 2 protein (HER2+), and triple negative breast cancer (TNBC), which lacks the three markers. Results show that the most consistent evidence for associations with reproductive risk factors exists for HR+ breast cancers, with nulliparity, current use of menopausal hormone therapy, and prolonged interval between menarche and age at first birth being the strongest risk factors; increased age at first birth and decreased age at menarche were fairly consistently associated with HR+ cancers; and though less consistent, older age at menopause was also positively associated, while lactation was inversely associated with HR+ tumors. Fewer consistent associations have been reported for TNBC. The single protective factor most consistently associated with TNBC was longer duration of breastfeeding. Increased parity, younger age at first birth, older age at menarche, and oral contraceptive use were less consistently shown to be associated with TNBC. No remarkable associations for HER2+ breast cancers were evident, although this was based on relatively scarce data. Findings suggest heterogeneity in reproductive risk factors for the distinct subtypes of breast tumors, which may have implications for recommended prevention strategies.
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            Disparities in cervical and breast cancer mortality in Brazil

            OBJECTIVE To analyze cervical and breast cancer mortality in Brazil according to socioeconomic and welfare indicators. METHODS Data on breast and cervical cancer mortality covering a 30-year period (1980-2010) were analyzed. The data were obtained from the National Mortality Database, population data from the Brazilian Institute of Geography and Statistics database, and socioeconomic and welfare information from the Institute of Applied Economic Research. Moving averages were calculated, disaggregated by capital city and municipality. The annual percent change in mortality rates was estimated by segmented linear regression using the joinpoint method. Pearson’s correlation coefficients were conducted between average mortality rate at the end of the three-year period and selected indicators in the state capital and each Brazilian state. RESULTS There was a decline in cervical cancer mortality rates throughout the period studied, except in municipalities outside of the capitals in the North and Northeast. There was a decrease in breast cancer mortality in the capitals from the end of the 1990s onwards. Favorable socioeconomic indicators were inversely correlated with cervical cancer mortality. A strong direct correlation was found with favorable indicators and an inverse correlation with fertility rate and breast cancer mortality in inner cities. CONCLUSIONS There is an ongoing dynamic process of increased risk of cervical and breast cancer and attenuation of mortality because of increased, albeit unequal, access to and provision of screening, diagnosis and treatment. 
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              Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal.

              To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                csc
                Ciência & Saúde Coletiva
                Ciênc. saúde coletiva
                ABRASCO - Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )
                1413-8123
                1678-4561
                January 2017
                : 22
                : 1
                : 135-149
                Affiliations
                [1] Campina Grande Paraíba orgnameUniversidade Estadual da Paraíba Brazil alinea.fje@ 123456gmail.com
                Article
                S1413-81232017000100135
                10.1590/1413-81232017221.09272015
                b7e8e872-b6ce-44f4-915f-55a344cdb0d3

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : 27 May 2015
                : 24 October 2015
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 69, Pages: 15
                Product

                SciELO Brazil


                Câncer de mama,Diagnóstico precoce,Fatores de risco,Conscientização,Breast cancer,Early detection of cancer,Risk factors,Knowledge

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