René Aloisio da Costa Vieira

Although ovarian cancer is the most lethal among gynecological cancers, access to massive BRCA testing is still limited. Its cost‐effectiveness is still a topic of discussion in several countries. In Brazil, olaparib was recently incorporated into the public health system, access to BRCA testing is still limited. In this article, we aim to review the cost‐effectiveness of offering BRCA testing to the at‐risk population. A working group composed of 14 specialists in surgical oncology and cancer genetics was established to discuss the cost‐effectiveness of population‐based BRCA testing for ovarian cancer. The project was divided into five main areas, each with subtopics assigned among the 14 participants. They were: the existing clinical testing guidelines, the current healthcare infrastructure in the Brazilian public health system, cost‐effectiveness analysis, challenges in implementing prophylactic surgeries, and family counseling and risk communication. A comprehensive literature review was conducted, followed by a series of meetings among the article's contributors to reach consensus on unresolved issues. These discussions aimed to build recommendations based on the best available scientific evidence. Using as a basis the current structure already existing within the Brazilian public health service (SUS [Sistema Único de Saude]), and based on the testing of the at‐risk population chosen by our experts, we estimated savings. The net savings for a population of 100 000 women would range from BRL 7030.30 (US$1255.41) to BRL 1853.92 (US$331.05). And these costs could have an even greater impact when public service PARP inhibitors are incorporated. The working group of the Brazilian Society of Surgical Oncology understands that large‐scale BRCA testing is cost‐effective, especially when risk‐reducing surgery is implemented. Other measures are important, such as training teams of non‐specialists to recognize the population at risk, in addition to creating an entire line of care for patients with ovarian cancer in the SUS.

Background: The rising incidence of breast cancer and the growing number of survivors underscore the need for further research into quality of life. The BREAST-Q is one of the most comprehensive tools for assessing quality of life (QL) in patients undergoing breast surgery. Although translated into multiple languages, it has only been fully validated in English. Material and methods: This longitudinal study was conducted to validate and evaluate the psychometric properties of the BREAST-Q in Brazilian Portuguese. Breast cancer-related modules were assessed in 195 patients, mastectomy modules in 66 patients, breast-conserving therapy (BCT) modules in 79 patients, and reconstruction modules in 50 patients. Patient characteristics were analyzed using the mastectomy, BCT, and breast reconstruction modules, along with surgical data on complications and cosmetic outcomes. The psychometric properties of the questionnaires were evaluated for reliability using Cronbach’s α . Test–retest reproducibility was analyzed using the intraclass correlation coefficient (ICC). Construct validity was evaluated using Spearman’s correlation coefficient. Responsiveness to change was assessed using the Wilcoxon test. Comparisons among independent groups, performed using the Kruskal–Wallis test. Convergent and discriminant validity analysis was achieved by comparing the results with those of the BCTOS and EORTC QLQ questionnaires. Results: A total of 195 patients were recruited from the outpatient breast surgical oncology clinic. The sample was divided into five groups: mastectomy without reconstruction, mastectomy with reconstruction (short form), mastectomy with reconstruction (long form), BCT, and BCT with radiotherapy (RT). Internal reliability, measured by Cronbach’s α , was greater than 0.7 in most modules across all groups. Reproducibility, assessed by ICC, ranged from 0.23 to 0.97, with the lowest values observed in the expectation modules, particularly expectations regarding appearance in the long-form questionnaire. The BREAST-Q exhibited good convergent and discriminant validity, with ρ ≥ 0.4 (positive correlations) or ρ ≤ −0.4 (negative correlations). Responsiveness showed that the mastectomy without reconstruction group had worse quality of life. Comparisons among independent groups demonstrated, in the postoperative phase, highest QL in the BCT with radiotherapy group. Conclusion: The findings indicate that all breast cancer-related modules of the BREAST-Q effectively measured QL in Brazilian patients.

Locally advanced breast carcinoma (LABC) is a frequent condition in Brazil and in developing countries. Neoadjuvant systemic therapy (NST) has allowed for surgical de‐escalation of the breast and/or axilla, leading to increasing the rates of breast‐conserving‐surgery, skin/nipple preservative mastectomies and axillary preservation. There are no established quality indicators for LABC or NST. This article aimed to review the topic, highlighting Brazilian studies, identifying thirty potential quality indicators for surgical treatment.

Introduction: Locally advanced breast cancer (LABC) often requires extensive surgical resection, resulting in large chest wall defects that necessitate flap reconstruction. In this context, the latissimus dorsi myocutaneous flap (LDMF) is a widely used reconstructive option; however, its association with local disease control remains unclear. Methods: This retrospective study included patients who underwent mastectomy followed by LDMF reconstruction for chest wall defect closure between 2010 and 2020. Data were analyzed descriptively. Actuarial survival was estimated using the Kaplan-Meier method, and comparisons between groups were performed using the log-rank test. Results: A total of 15 patients were included, with low rates of major postoperative complications. Cases of wound dehiscence and flap necrosis were successfully managed with debridement and resuturing. Mean recurrence-free survival was 13.3 months, while the actuarial survival rates were 46.7%, 26.7%, 17.8%, 8.9% and 8.9% at 12, 24, 36, 48 and 60 months respectively. Patients who achieved complete resection (R0) demonstrated improved overall survival compared with those who underwent incomplete resections (R1/R2). Conclusion: The LDMF proved to be a safe and effective option for chest wall defect closure in patients with LABC, with improved overall survival associated with complete (R0) resection.

RESUMO Introdução: O carcinoma mamário localmente avançado (CMLA) muitas vezes requer amplas ressecções cirúrgicas, necessitando de retalhos para o fechamento do defeito torácico. Nesse contexto, o retalho miocutâneo do latíssimo do dorso (RM-LD) é uma opção amplamente utilizada; entretanto, é desconhecida a sua associação com o controle local da doença. Metodologia: Estudo retrospectivo que incluiu pacientes submetidas à mastectomia com RM-LD para fechamento do defeito torácico, no período de 2010 a 2020. Os dados foram apresentados de maneira descritiva. A sobrevida atuarial foi estimada pelo método de Kaplan-Meier, e a comparação entre os grupos foi realizada pelo teste de log-rank. Resultados: Foram incluídas 15 pacientes, com baixas taxas de complicações; os casos de deiscência e necrose foram resolvidos por debridamento e ressutura. A sobrevida média livre de recorrência foi de 13,3 meses, e a sobrevida atuarial global foi de 46,7%, 26,7%, 17,8%, 8,9% e 8,9% aos 12, 24, 36, 48 e 60 meses, respectivamente. Pacientes com ressecção completa (R0) apresentaram melhor sobrevida global em comparação com aquelas com ressecções incompletas (R1/R2). Conclusão: O RM-LD mostrou-se seguro no fechamento do defeito torácico em pacientes com CMLA, com melhor sobrevida global quando obtida ressecção completa (R0).

Osteoradionecrosis is uncommon and associated with breast cancer, with decreasing incidence. It can present as a local inflammatory process, skin ulceration, and bone changes, and may be associated with osteomyelitis. Clinical treatment is usually combined with surgical treatment. This study, with Certificate of Submission for Ethical Assessment (CAAE) 81761124.9.0000.5105, was approved by the Research Ethics Committee. A systematic literature review was conducted using the PICO (problem, intervention, comparison, and outcome) and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodologies, conducted in two databases (the United States National Library of Medicine (PubMed) and the Latin American and Caribbean Literature on Health Sciences (LILACS). The descriptors used were: breast neoplasms and (osteoradionecrosis or osteomyelitis). Furthermore, we evaluated all institutional cases treated in the last five years. Using the terms, 125 studies were identified, 22 of which were included in the study. In the differential diagnosis with osteomyelitis, the most recommended tests are thoracic magnetic resonance imaging and triphasic scintigraphy. In general, clinical treatment does not control the lesion, requiring debridement (with or without rib resection) combined with the use of flaps, with myocutaneous flaps being the most commonly used. Two patients were treated at the service, representing 0.07% of the cases treated, one of whom had previously undergone breast-conserving treatment. All underwent resection, with the latissimus dorsi muscle being used for local coverage; one patient also underwent chest wall resection. In the presence of ulceration/osteoradionecrosis, a thorough evaluation should be performed to rule out osteomyelitis. Clinical treatment is generally ineffective. Surgical debridement with resection of the affected area, antibiotic therapy, and the use of myocutaneous flaps are good options for early recovery and local control.