Observational Study

. 2019 Nov:5:1-10.

doi: 10.1200/JGO.19.00263.

Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115)

Maria Alice Franzoi^{1

2

3}, Daniela D Rosa^{3

4

5}, Facundo Zaffaroni³, Gustavo Werutsky^{3

4}, Sérgio Simon^{3

4}, José Bines^{3

4

6}, Carlos Barrios^{3

4}, Eduardo Cronemberger⁷, Geraldo Silva Queiroz⁸, Vladmir Cordeiro de Lima⁹, Ruffo Freitas Júnior¹⁰, José Couto¹¹, Karla Emerenciano¹², Heloísa Resende¹³, Susanne Crocamo¹⁴, Tomás Reinert¹⁵, Brigitte Van Eyli¹⁶, Yeni Nerón¹⁷, Vanessa Dybal¹⁸, Nicolas Lazaretti¹⁹, Rita de Cassia Costamillan²⁰, Diocésio Alves Pinto de Andrade²¹, Clarissa Mathias²², Giovana Zerwes Vacaro²³, Giuliano Borges²⁴, Alessandra Morelle⁵, Carlos Alberto Sampaio Filho¹⁸, Max Mano²⁵, Pedro E R Liedke^{1

3

4}

Affiliations

¹ Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
² Jules Bordet Institut, Brussels, Belgium.
³ Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
⁴ Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil.
⁵ Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁶ Instituto Nacional do Cancer, Rio de Janeiro, Brazil.
⁷ Centro Regional Intregado de Oncologia, Fortaleza, Brazil.
⁸ Hospital Araújo Jorge, Goiás, Brazil.
⁹ A.C. Camargo Cancer Center, São Paulo, Brazil.
¹⁰ Universidade Federal de Goiás, Goiânia, Brazil.
¹¹ Hospital do Câncer de Londrina, Londrina, Brazil.
¹² Liga Norte Riograndense, Natal, Brazil.
¹³ Hospital Jardim Amalia, Volta Redonta, Brazil.
¹⁴ Oncoclínica Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁵ Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caxias do Sul, Brazil.
¹⁶ Instituto do Câncer Dr Arnaldo, São Paulo, Brazil.
¹⁷ Centro de Pesquisas em Oncologia, Florianópolis, Brazil.
¹⁸ Clínica Assistência Multidisciplinar em Oncologia, Salvador, Brazil.
¹⁹ Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil.
²⁰ Universidade de Caxias do Sul, Caxias do Sul, Brazil.
²¹ Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil.
²² Núcleo Oncológico da Bahia, Lauro de Freitas, Brazil.
²³ Hospital São Vicente de Paulo, Passo Fundo, Brazil.
²⁴ Clínica de Neoplasia Litoral, Itajaí, Brazil.
²⁵ Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.

PMID: 31730380
PMCID: PMC6882517
DOI: 10.1200/JGO.19.00263

Observational Study

Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115)

Maria Alice Franzoi et al. J Glob Oncol. 2019 Nov.

. 2019 Nov:5:1-10.

doi: 10.1200/JGO.19.00263.

Authors

Affiliations

¹ Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
² Jules Bordet Institut, Brussels, Belgium.
³ Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
⁴ Grupo Brasileiro de Estudos em Câncer de Mama, Porto Alegre, Brazil.
⁵ Hospital Moinhos de Vento, Porto Alegre, Brazil.
⁶ Instituto Nacional do Cancer, Rio de Janeiro, Brazil.
⁷ Centro Regional Intregado de Oncologia, Fortaleza, Brazil.
⁸ Hospital Araújo Jorge, Goiás, Brazil.
⁹ A.C. Camargo Cancer Center, São Paulo, Brazil.
¹⁰ Universidade Federal de Goiás, Goiânia, Brazil.
¹¹ Hospital do Câncer de Londrina, Londrina, Brazil.
¹² Liga Norte Riograndense, Natal, Brazil.
¹³ Hospital Jardim Amalia, Volta Redonta, Brazil.
¹⁴ Oncoclínica Rio de Janeiro, Rio de Janeiro, Brazil.
¹⁵ Centro de Pesquisa e Educação da Serra Gaúcha- DeVita, Caxias do Sul, Brazil.
¹⁶ Instituto do Câncer Dr Arnaldo, São Paulo, Brazil.
¹⁷ Centro de Pesquisas em Oncologia, Florianópolis, Brazil.
¹⁸ Clínica Assistência Multidisciplinar em Oncologia, Salvador, Brazil.
¹⁹ Centro Integrado de Terapia Onco-Hematológica, Passo Fundo, Brazil.
²⁰ Universidade de Caxias do Sul, Caxias do Sul, Brazil.
²¹ Instituto Oncológico de Ribeirão Preto, Ribeirão Preto, Brazil.
²² Núcleo Oncológico da Bahia, Lauro de Freitas, Brazil.
²³ Hospital São Vicente de Paulo, Passo Fundo, Brazil.
²⁴ Clínica de Neoplasia Litoral, Itajaí, Brazil.
²⁵ Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil.

PMID: 31730380
PMCID: PMC6882517
DOI: 10.1200/JGO.19.00263

Abstract

Purpose: Breast cancer (BC) in young women is uncommon and tends to present with more aggressive characteristics. To better understand and characterize this scenario in Brazil through real-world data, we performed a subanalysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973).

Methods: The AMAZONA III study (GBECAM 0115) is a prospective registry that included 2,950 women newly diagnosed with invasive BC in Brazil from January 2016 until March 2018 at 22 sites. Valid data were obtained from 2,888 patients regarding age at diagnosis and complete baseline information. To compare epidemiologic and clinicopathological features at the time of diagnosis, patients with BC were divided into two groups according to age: ≤ 40 years and > 40 years. Quantitative variables were described as means, and categorical variables were described as frequencies and percentages and compared using the Pearson's χ² test.

Results: Of 2,888 women diagnosed with BC, 486 (17%) were ≤ 40 years old. Young women had higher educational level, most were employed and a significant number were married (P < .001 for all associations). Younger patients were more symptomatic at BC diagnosis (P < .001), and they also presented more frequently with stage III, T3/T4, grade 3 tumors, HER-2-positive, luminal B, and triple-negative subtypes.

Conclusion: Brazilian women younger than age 40 years have unfavorable clinicopathological features of BC at diagnosis, with more aggressive subtypes and advanced stage when compared with older women. These differences are not explained by socioeconomic or ethnic imbalances. The causes of a higher prevalence of BC among young women in Brazil deserve additional investigation.

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Conflict of interest statement

Daniela D. Rosa

Honoraria: Roche, Novartis, Pfizer, AstraZeneca, Eisai, Eli Lilly

Consulting or Advisory Role: Eli Lilly, Novartis, Roche

Sérgio Simon

Consulting or Advisory Role: Roche, AstraZeneca, MSD Oncology, Pfizer

Speakers' Bureau: AstraZeneca, Novartis, Roche

Travel, Accommodations, Expenses: Roche, AstraZeneca

Carlos Barrios

Stock and Other Ownership Interests: Biomarker, MedSIR, Tummi

Honoraria: Novartis, Roche, Pfizer, GlaxoSmithKline, Sanofi, Boehringer Ingelheim, Eisai

Consulting or Advisory Role: Boehringer Ingelheim, Roche, Novartis, GlaxoSmithKline, Eisai, Pfizer, AstraZeneca, Libbs, MSD Oncology, United Medical

Research Funding: Pfizer, Novartis, Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Roche, Eli Lilly, Sanofi, GlaxoSmithKline, Taiho Pharmaceutical, Mylan, Merrimack, Merck, AbbVie, Astellas Pharma, Biomarin, Bristol-Myers Squibb, Daiichi Sankyo, Abraxis BioScience, AB Science, Asana Biosciences, Medivation, Daiichi Sankyo, Exelixis, ImClone Systems, LEO Pharma, Millennium, Janssen, Atlantis Clinica, INC Research, Halozyme, Covance, Celgene, inVentiv Health

Travel, Accommodations, Expenses: Roche, Novartis, Pfizer, BMS Brazil, AstraZeneca, MSD Oncology

Eduardo Cronemberger

Honoraria: Roche, Merck Sharp & Dohme

Consulting or Advisory Role: Roche, Merck Sharp & Dohme

Research Funding: AstraZeneca/MedImmune (Inst), Roche (Inst),MSD Oncology (Inst), Janssen-Cilag (Inst), Merck Serono (Inst)

Travel, Accommodations, Expenses: AstraZeneca, Pfizer

Vladmir Cordeiro de Lima

Honoraria: Roche, BMS Brazil, MSD Oncology, AstraZeneca, Boehringer Ingelheim, Pfizer, Merck Serono

Consulting or Advisory Role: Roche, BMS Brazil, AstraZeneca, Pfizer, MSD Oncology

Speakers' Bureau: Roche, BMS Brazil, Boehringer Ingelheim, MSD Oncology, Merck Serono

Travel, Accommodations, Expenses: Roche, MSD Oncology, AstraZeneca, Boehringer Ingelheim, BMS Brazil

Ruffo Freitas Júnior

Honoraria: Roche, Libbs, Pfizer

Consulting or Advisory Role: Roche

Research Funding: Roche (Inst), MSD Oncology (Inst)

Travel, Accommodations, Expenses: Roche, Libbs

Heloísa Resende

Travel, Accommodations, Expenses: Pfizer

Tomás Reinert

Honoraria: Novartis, AstraZeneca, Pfizer, Eli Lilly, Pierre Fabre, AstraZeneca

Yeni Nerón

Other Relationship: AstraZeneca (Inst), Roche (Inst), Clovis Oncology (Inst), Merck Serono (Inst)

Vanessa Dybal

Speakers' Bureau: Novartis, Roche

Travel, Accommodations, Expenses: Pfizer, Roche

Nicolas Lazaretti

Research Funding: Acerta Pharma (Inst), BeiGene (Inst), Bristol-Myers Squibb (Inst), AstraZeneca (Inst), Roche (Inst), Merck (Inst), Medivation (Inst), Regeneron (Inst)

Travel, Accommodations, Expenses: MSD Oncology, Roche

Diocésio Alves Pinto de Andrade

Speakers' Bureau: Novartis

Clarissa Mathias

Consulting or Advisory Role: Roche

Alessandra Morelle

Consulting or Advisory Role: Roche, Amgen, MSD Oncology, Eli Lilly, Novartis

Speakers’ Bureau: Roche, Eli Lilly, Novartis, MSD Oncology

Carlos Alberto Sampaio Filho

Employment: Clinica AMO

Leadership: Clinica AMO Salvador Brazil

Stock and Other Ownership Interests: Clinica AMO

Consulting or Advisory Role: Pneuma Respiratory

Max Mano

Stock and Other Ownership Interests: Biotoscana, Fleury Group, Hypera

Honoraria: Roche, Novartis, Oncologia Brasil, Eli Lilly/ImClone

Consulting or Advisory Role: Novartis, Roche, Pfizer, AstraZeneca, Eli Lilly/ImClone

Travel, Accommodations, Expenses: Roche

Uncompensated Relationships: Roche

Pedro E. R. Liedke

Consulting or Advisory Role: Zodiac Pharma

Research Funding: Merck Sharp & Dohme, Merck Serono, Roche, AstraZeneca, Halozyme, Acerta Pharma, Novartis, Bristol-Myers Squibb, Regeneron, Medivation, Myovant Sciences, Janssen, PharmaMar, Eurofarma, Pfizer, PPD, PRA Health Sciences, Covance, Quintiles, ICON Clinical Research, Parexel, Intrials

Travel, Accommodations, Expenses: Pfizer, Roche, Oncoclinicas

No other potential conflicts of interest were reported.

Figures

**FIG 1**
Bar graphs of (A) clinical stage, (B) tumor grade, and (C) tumor size at diagnosis by age groups of Brazilian women included in the AMAZONA III study. (*) P < .001.

**FIG 2**
Breast cancer subtype by age groups of Brazilian women included in the AMAZONA III study. (*) P < .001.

See this image and copyright information in PMC

References

1. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. - PubMed
1. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2018. CA Cancer J Clin. 2018;68:7–30. - PubMed
1. World Bank: DataBank. World development indicators. https://databank.worldbank.org/reports.aspx?source=2&series=SP.POP.TOTL&....
1. Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância: Estimativa 2018: Incidência de Câncer no Brasil. https://www.inca.gov.br/publicacoes/livros/estimativa-2018-incidencia-de....
1. Instituto Nacional de Câncer, Ministério da Saúde: Atlas On-line de Mortalidade. https://mortalidade.inca.gov.br/MortalidadeWeb/

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Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115)

Affiliations

Advanced Stage at Diagnosis and Worse Clinicopathologic Features in Young Women with Breast Cancer in Brazil: A Subanalysis of the AMAZONA III Study (GBECAM 0115)

Authors

Affiliations

Abstract

Conflict of interest statement

Daniela D. Rosa

Sérgio Simon

Carlos Barrios

Eduardo Cronemberger

Vladmir Cordeiro de Lima

Ruffo Freitas Júnior

Heloísa Resende

Tomás Reinert

Yeni Nerón

Vanessa Dybal

Nicolas Lazaretti

Diocésio Alves Pinto de Andrade

Clarissa Mathias

Alessandra Morelle

Carlos Alberto Sampaio Filho

Max Mano

Pedro E. R. Liedke

Figures

References

Publication types

MeSH terms

Associated data

LinkOut - more resources

Full Text Sources

Medical

Research Materials