THE ROLE OF EARLY DETECTION IN IMPROVING TREATMENT OUTCOMES FOR BREAST CANCER PATIENTS IN LMICS IMPACT OF TWO INDEPENDENT STRATEGIES TO PROMOTE DOWNSTAGING IN BRAZIL

MAIRA CALEFFI, MD, PH.D CHIEF OF BREAST CENTER AT HOSPITAL MOINHOS DE VENTO

PORTO ALEGRE, BRAZIL

VOLUNTEER PRESIDENT OF FEMAMA

UICC BOARD MEMBER

STRATEGY 1

Núcleo Mama Porto Alegre (NMPA) u  A Private Public Partnership with the support of a IMAMA NGO;

u  9,218 women above 15 years-old from a specific area in Porto Alegre;

u  Accrual from March 2004 to March 2006;

u  Asymptomatic 40-69 years-old women entered the annual clinical examination and mammographic screening cohort;

u  Women out of this age range did their routine exams in the primary health care facilities. In case of any breast complaint, they were referred immediately to NMPA.

7 DAYS

ZERO

14 DAYS

21 DAYS

35 DAYS

NMPA

MMG

BIOPSY

SURGERY

CHEMO

PHCF

PATIENT’S JOURNEY

CHARACTERISTICS OF THE COHORT PARTICIPANTS REGARDING MODE OF BREAST CANCER DETECTION

Characteris*cs  Mode  of  detec*on  

Screen-­‐detected  (n=50)  N  (%)   Not  screen  detected  (n=40)  N  (%)   p-­‐value**  

Age  of  menarche*   12.8  (1.7)   13,2  (2.1)   0.27  

Body  mass  index  (kg/m2)*   30.4  (6.3)   28.7  (6.4)   0.23  

Number  of  pregnancies*   3.7  (2.7)   4.0  (3.1)   0.63  

Age  (years)*   58.4  (9.4)   55.0  (14.7)   0.20  

Age  (years)‡   59  (  12.5)   55  (24.8)      

Age  range  (years)              

   <40     0     8  (20.0)      

     40-­‐49   11(22.0)   6  (15.0)      

     50-­‐69   34  (68.0)   17  (42.5)      

   ≥  70   5  (10.0)   9  (22.5)   <0.05  

Years  of  study              

     Iliterate   5  (10.0)   3  (7.5)      

     1  to  8  years     33  (66.0)   29  (72.5)      

     9  years  or  more   11(22.0)   8  (20.0)      

     Not  informed   1  (2,0)   0,0   0.91  

Smoking              

       Ex-­‐smoking   4  (8.7)   0        

       Non  smoking   31  (67.4)   20(58.8)      

       Current  smoking     11  (23.9)   14  (41.2)   0.09  

PARTICIPATION RATE OF WOMEN IN MAMMOGRAPHIC SCREENING IN 18 MONTHS, ACCORDING TO AGE - NMPOA

PATHOLOGIC FEATURES OF SCREEN-DETECTED AND NOT SCREEN DETECT BREAST CARCINOMAS. 2004-2013

Characteris*cs  Mode  of  detec*on  

Screen-­‐detected  (N=50)  N  (%)    Not  screen  detected  (N=40)  N  (%)   p  Tumor  size  (mm)*   16.7  (10.0)   18.5  (15.4)   0.54  Tumor  size  (mm)‡   15.0  (10.0)   15.5  (17.5)      Tumor  size  categories                        <  20  mm   28  (65.1)   23  (  63.9)            >20-­‐50  mm   14  (32.6)   6  (30.6)            >50  mm   1  (2.3)   2(5.6)   0.75  Tumor  type                    IDC   38  (80.0)   32  (77.5)            ILC   2  (2.0)   1  (5.0)            Mixed   3  (4.0)   0  (2.5)            Other   2  (2.0)   1  (5.0)            DCIS   4  (12.0)   6  (10,0)   0.54  Stage**                    I   21  (47.7)   13  (38.2)            II   19  (43.2)   14  (41.2)            III   4  (9.1)   6  (17.6)            IV   1  (2.9)   0   0.53  Grade**                  Grade  1   10  (29.4)   2  (8.0)          Grade  2   19  (55.9)   13  (52.0)          Grade  3   5  (14.7)   10  (40.0)   0.03  

Official data (2011): u  10% STAGE I AND 53% STAGE III AND IV

u  51.3% of cancer patients had their 1st treatment between 60 and 120 days.

Cohort Nucleo Mama Porto Alegre Data (2014):

u  According to our research, 43% of the patients were STAGE I and 15% of patients were STAGE III and IV.

u  The tumor size was not statistically different among the two studied groups (screened and not screened)

u  The average time to 1st treatment in our cohort was 21 days.

FINDINGS

u  Based on the NMPA prospected study, we can infer that:

(1) an efficient health care system with well trained and committed u  Based on the NMPA prospected study, we can infer that: (1) an efficient health care system with well trained and committed health professionals and (2) intensive community and primary care physicians awareness may be as good as annual screening mammography to promote breast cancer

in LMICs. changes in public policies in order to achieve cancer control.

National coalition of 58 patients groups in 17 States in Brazil. Founded in 2008.

– CIVIL SOCIETY’S ROLE TOWARDS BREAST CANCER SURVIVAL IMPROVEMENT DUE TO EARLY DETECTION FEMAMA’S ACHIEVEMENTS SINCE 2008 ACHIEVEMENTS SINCE 2008

75% of mammography

coverage

Law of Mammography after 40 years-old #11.664/2008 -

March 23, 2012. National Program for Quality in Mammography INCA

30 days maximum time between

1st consultation and treatment initiation

certification for providers of SUS services and

supplementary

100%

May 23, 2013. Law #12.732 - Period of 60 days to start cancer treatment after diagnosis (pathological report)

March 23, 2011. Cervical and Breast Cancer Control National Plan

PATIENT’S PATH

30 days LAW PROJECT

# PL 5722/13 for exams when cancer is suspected indicated by the physician # PL 5722/13

approval of the Law of 30 days during the Pink October 2013; u  Participation in 2 Public Audiences with request to approve the Law of 30

days in House of Representatives; u  Request for Congressman to vote urgently the Law of 30 days;

u  Institutional events held manifestation of agreement with the Law of 30 days:

2) Forum to Fight Cancer Woman 1) National Congress All Together Against Cancer 2) Forum to Fight Cancer Woman

ADVOCACY CAMPAIGN #OTEMPOCORRECONTRA #TIMERUNSAGAINST

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Folders Banners

ADVOCACY CASE: LOBBY DAY

THANK YOU! Maira Caleffi, MD, Ph.D Chief of Breast Center at Hospital Moinhos de Vento

Volunteer President of FEMAMA

UICC Board Member