Breast Cancer Treatment with Chemotherapy: Hospital São Daniel Comboni (HSDC)

Abstract

Breast cancer is the second most common malignant neoplasm in women worldwide and the one that causes more deaths in Brazilian women, there has been a continuous increase in the number of new cases in recent years, making the early diagnosis of the disease essential for a prognosis favorable and increased survival of the diagnosed patient. It is a disease whose accompaniment is essential by a multiprofessional team, since the consequences are both physical and psychological. Breast cancer is a disease in which changes occur at the cellular level, where they alter the process of regulation of the cell cycle and as a consequence cause chromosomal changes. One of the most common signs found by women is the presence of nodules. The diagnosis comprises several actions, such as mammographic screening, breast self-examination and clinical examination performed by trained professionals. Treatment of the disease occurs through local treatment involving surgical and systemic procedures involving chemotherapy. It is up to us health professionals to properly guide patients seeking guidelines for breast cancer prevention.

Keywords: Breast Cancer; Disease; Chemotherapy.

Introduction

Cancer has a very characteristic natural history, where a healthy cell undergoes modifications until it becomes a malignant cell and takes the form of a tumor. It is a disease that can be hereditary, but most cases are associated with other risk factors. (LOPES; CHAMMAS; IYEYASU, 2013).

According to the Oncoguia Institute (2015), 596,070 new cases are expected in Brazil in 2016. Among the most common types is breast cancer. Being a significant public health issue, breast cancer is the most common neoplasm. Commonly detected and the leading cause of cancer death in women worldwide. In 2012, there were approximately 1.67 million new cases worldwide, representing 25% of all types of neoplasms diagnosed in women (NATIONAL CANCER INSTITUTE, 2015).

Because it is related to biological and endocrine factors, reproductive life, and lifestyle habits, breast cancer is considered multifactorial. The most common risk factors for developing this disease are: aging, family history, and aspects related to reproductive life. In addition, aspects related to alcohol consumption, excess weight, and lack of physical activity are also potential contributors to the development of this disease. (NATIONAL CANCER INSTITUTE, 2015).

According to research, early diagnosis and improved treatment have significantly improved patient survival rates. (LOPES; CHAMMAS; IYEYASU, 2013).

Healthy eating habits, physical activity, and maintaining an ideal weight are designated as primary prevention methods against the disease, potentially preventing approximately 30% of cases. For breast cancer screening, mammography is the most recommended imaging exam according to the Brazilian Ministry of Health (2006).

General Cancer Epidemiology

Epidemiology is described as the science that analyzes the causes, evolution, incidence, and spread of diseases in the population, and is employed in health control. Thus, epidemiology is linked to epidemics, their causes, diagnosis and prevention, treatments, services, and healthcare costs. Data acquired in research can aid new studies and also point to probable risk factors involved, as well as contribute to the determination of prevention programs. Information obtained through long-term non- inferential observational studies can be useful for conducting new studies with inferential properties. (LOPES; IYEYASU; CASTRO, 2008).

Since cancer is a disease characterized by disordered cell development and behavior, its ultimate consideration is demonstrated at the cellular and subcellular levels. The study of disease patterns in the population is relevant to understanding the origins of cancer. (KUMAR et al., 2010).

World Situation

Cancer is the disease cited as the cause of approximately 12% of deaths worldwide. Each year, around 7 million people die from this illness. A 2005 forecast by the International Union Against Cancer (UICC) showed that in 2002 the number of new cases was 11 million, and could reach around 15 million by 2020. (NATIONAL CANCER INSTITUTE, 2006).

The World Health Organization (WHO) (2017) estimates that approximately 27 million new cancer cases are expected worldwide by 2030, with 17 million deaths and 75 million people living with the disease. Data indicates that the highest incidence of cases will be in low- and middle-income countries. In 2012, approximately 14 million people worldwide were diagnosed with cancer. Data also show that in 2008 there was an increase in the incidence of cases, with approximately 12.7 million cases registered.

Situation in Brazil

According to the National Cancer Institute (2015), information demonstrating the effect of cancer on communities in Brazil is provided by Population-Based Cancer Registries (PBCR), which are extremely important for the development and verification of cancer prevention and control measures. This information, together with Hospital Cancer Registries (HCR) and the Mortality Information System (SIM) of DataSUS, establishes an organized basis for disease surveillance and for the progress of research on the subject.

The change in the epidemiological profile in Brazil in recent decades is justified by changes in mortality and morbidity rates along with demographic and socioeconomic changes. The involvement of cancer in this change in the population's disease pattern in Brazil can be explained by several factors. (NATIONAL CANCER INSTITUTE, 2011).

The first factor, according to the National Cancer Institute (2011), is the increased exposure to carcinogenic agents, which can be defined as the effect of changing lifestyle habits and increasingly excessive industrialization. The second factor cited is the increased incidence of deaths from the disease. Finally, factors related to increased life expectancy and population aging are mentioned as being associated with:

I)  The birth rate has decreased;

II)  Economic conditions, which lead to improvements in basic sanitation in cities;

III)    Due to advances in medicine and technology, along with the use of antibiotics and vaccines currently available;

Approximately 600,000 new cases are expected in Brazil in the 2016/2017 biennium. With the exception of non-melanoma skin cancer, responsible for about 180,000 new cases, there will be around 420,000 new cancer cases. Of these new cases, it is estimated that 49% will be diagnosed in women and 51% in men. The most recurrent types in women will be non-melanoma skin cancer, lung cancer, cervical cancer, breast cancer, and colorectal cancer; while in men they will be prostate cancer, stomach cancer, colorectal cancer, non-melanoma skin cancer, and lung cancer. (NATIONAL CANCER INSTITUTE, 2015).

Breast Cancer

The breasts are complex structures made up of three main types of different tissues: glandular tissue, where the structures responsible for milk production during lactation are located; surrounding this is adipose tissue, fat whose proportion relative to glands is greater during the normal period than when the woman is breastfeeding, while during lactation the number of mammary glands increases relative to fat to meet the needs of the child. The third type of tissue found in a woman's breast consists of connective tissue, composed of collagen and elastin. The fundamental unit of glandular tissue is known as the alveolus, whose main function is milk production. It is surrounded by myoepithelial tissues, small muscles that, when stimulated, release the liquid out of the body. In the center of the breast is the nipple, composed of modified, darker skin, with small openings corresponding to the terminations of the milk- transporting ducts. Thus, the breast is generally divided into sections known as lobes, which are composed of lobules, small units made up of the glandular groups already mentioned. (ÓRFÃO; GOUVEIA, 2009; SCHNEIDER et al., 2007).

Therefore, it is important to emphasize that the breast has several functions, the first of which is its role in lactation. However, femininity is highlighted when this part of the body is full, as it is considered one of the most important sexual characteristics of a woman, acting as a sexual attractant in mating situations, which is a second function. (MAIESKI; SARQUIS, 2007).

The anatomical location of the breasts is overlying the upper portion of the pectoralis major muscle, which covers the ribs, extending vertically from the level of the second rib to the sixth or seventh. Horizontally, it can be found from the edge of the sternum to the imaginary line marking the end of the armpit, approximately. (ÓRFÃO; GOUVEIA, 2009).

A serious breast pathology is cancer, which occurs in women when the cells that make up the organ are in constant and disordered multiplication, justified by the genetic characteristics located in the nucleus of each abnormal cell. It can affect any type of tissue described previously. In most recorded cases, it affects the cells of the mammary ducts, and for this reason, it is called Ductal Carcinoma, which can develop in two ways: in situ, when it is restricted to the first layer of cells of the ducts, or invasive, in situations where cancerous cells infiltrate the tissues adjacent to the ducts. Alternatively, breast cancer can initially affect the lobules of the breast, which are functional structures, forming Lobular Carcinoma, a less common type of tumor. Finally, there is a more aggressive form of cancer, inflammatory carcinoma, which affects the breast in general, presenting characteristics of inflammatory processes, such as heat and redness, throughout the organ. This is one of the rarest and most difficult to find. (MARTINS et al., 2009; NUNES, 2008; PORTUGAL, 2005). Para Paulinelli et al. (2002, p.170):

Breast cancer is a hormone-dependent malignant tumor of breast tissue. Calories and many nutrients can influence the synthesis, metabolism, and activity of hormonal agents, therefore they may be indirectly related to the cause of breast cancer. Evidence from diet, nutritional status, and endocrine secretions is important for understanding the etiology of breast cancer. It represents a serious public health problem worldwide due to its high incidence, morbidity, mortality, and high treatment costs. Ductal carcinoma in situ is one of the diseases that requires the most attention, as the frequency of its occurrence in healthy women increases each year. It is characterized by an exaggerated cell proliferation, mainly in the units that cover the terminal lactiferous ducts of the female breast. It is localized and presents in an early stage. It is a special type because it is located near ducts that can transport abnormal cells to other regions of the organ, thus facilitating the infiltration of healthy tissues by these cancerous cells. Therefore, when treatment is not performed correctly, recurrence and spread are possible. Its external characteristics can be expressed by lesions of varying shapes and sizes, occurring before or after a woman's menopause. It can be palpated when confined to the internal tissue as a nodule. On contrast radiography, small calcium particles deposited inside the organ's cells are visualized. Early diagnosis should be sought, as when treated appropriately there is a high chance of cure and disappearance of the tumor in question. The therapies generally prescribed for these patients are mastectomy, a surgical procedure to remove the breast, or quadrantectomy, removal of a quadrant of the breast. To prevent cancer growth, radiotherapy can be used, which consists of employing beams of ionizing radiation to destroy cancerous cells. The use of tamoxifen, an endocrine medication that aims to antagonize the effect of the hormone estrogen (hormone therapy), apparently involved in the process of ductal carcinoma, is also widely used to prevent recurrence of this type of tumor in women already affected by the disease. (NUNES, 2008; PORTUGAL, 2005; SALLES et al., 2006; SALLES et al., 2005).

In the case of invasive ductal carcinoma, firm, poorly circumscribed tumors form, with infiltrative edges and a sandy consistency. Most often it is well-defined and multinodular. It is the most common and frequent cancer in women. Its growth begins in the cells present in the walls of the lactiferous duct, which move, crossing the duct walls and invading the healthy neighboring tissues of the breast. At this stage, it is very common for cancerous cells to spread through the lymphatic and blood vessels responsible for local irrigation, accidentally falling into these sites, which serve as transport to other organs of the body. Treatment for this type of tumor is generally the same as or similar to that for ductal carcinoma in situ. Surgical intervention can be limited to the site of the nodule (conservative approach) or involve removal of the entire breast (radical approach). (NUNES, 2008; PORTUGAL, 2005).

Lobular carcinoma can also be divided into two types: in situ and invasive. The in situ tumor pattern originates within the lactiferous glands themselves and represents a more complex cancer model due to its inability to be detected through palpation or even simple mammography. Its diagnosis is usually made when a mammogram is ordered to investigate specific nodules, different from the type of anomaly in question, so it is an incidental finding. It is most commonly observed in women before menopause. Approximately 30% of women affected by this tumor develop invasive lobular carcinoma due to the spread of mutant cells, with manifestation usually occurring after age 40, similar to ductal carcinoma. There is also a high risk of dissemination to other tissues. It is important to emphasize that when the diagnosis is made while the infection is still in situ, the chances of a cure with appropriate treatments are significantly higher compared to when the infection has already spread within the breast itself. (NUNES, 2008; PORTUGAL, 2005).

Inflammatory carcinoma, the third most frequent type of breast tumor in women, is defined by the high permeation of undifferentiated cells in the dermal lymphatic vessels of the breast, thus promoting the manifestation of a clinical picture similar to an inflammatory process, such as initially local erythema. As it progresses, it begins to affect a larger part of the breast tissue, up to 40% of the organ, causing edema, hardening, redness, local heat, and pain, a finding that is not common in carcinomas. This type of tumor is generally recurrent, meaning that even after treatment, a new tumor develops. The response to treatment is slow or even nonexistent, making it more complex than the other types mentioned. In the early stages of the disease, carcinoma is often mistaken for a simple infectious process, leading to incorrect treatment and further delaying referral for specific tests. This often results in a disease with a very poor prognosis, as it develops rapidly and the chances of metastasis are significant. (ALVARENGA et al., 2003; NUNES, 2008; PORTUGAL, 2005).

Other types of breast carcinomas are uncommon in women: 12% of patients present with tubular, mucinous, and medullary carcinoma. These are rare types, difficult to develop, appearing only when there are quite evident predisposing factors. They develop slowly, and diagnosis is mainly based on microscopic analysis. The tubular type offers a good prognosis, as it does not favor the formation of metastases throughout the body. Approximately 4% of breast cancer patients have this tumor. Treatment is established individually for each patient, whose body's response varies. Medullary breast cancer generally occurs in younger, high-risk patients, i.e., those with other associated diseases. It has the characteristic morphology of a benign lesion, which can delay diagnosis. Mucinous breast cancer is the rarest of all, with a very slow progression and difficult diagnosis. (ALVARENGA et al., 2003; EISENBERG; KOIFMAN, 2001; NUNES, 2008; PORTUGAL, 2005).

Epidemiology of Breast Cancer Worldwide

Breast cancer is the leading cause of cancer death in women worldwide, with an estimated 522,000 deaths in 2012. In developed countries, it is the second leading cause of death (NATIONAL CANCER INSTITUTE, 2015).

Epidemiology of Breast Cancer in Brazil

According to research conducted by the National Cancer Institute (2018), approximately 67,960 new cases of breast cancer are estimated for the year 2019 in Brazil, representing 56.20 cases per 100,000 women. It is the most common type of tumor in women in the South and Southeast regions, with 74.30/100,000 and 68.08/100,000 cases respectively, followed by the Central-West region (55.87/100,000) and Northeast region (38.74/100,000). It is the second most frequent type of tumor in the North region with 22.26/100,000 cases.

Clinical Diagnosis

Currently, breast cancer is curable thanks to early diagnosis, advances in surgical techniques, and complementary treatments. Early diagnosis is essential so that affected women can benefit from therapeutic advances and have a satisfactory prognosis after treatment, thus increasing their survival rate.(MARQUES; SILVA; AMARAL, 2011). Women play an important role in diagnosis by performing breast self- exams, getting mammograms, and seeing a doctor for regular checkups. (BLAND; COPELAND, 1994).

Breast disease has localized symptoms and is often easily detected physically, since the breast is easily accessible for examination and palpation. (BLAND; COPELAND, 1994).

According to the Brazilian Institute for Cancer Control (2016), although pain is a symptom present in cases affecting the mammary glands, it is not always linked to cancer, but rather to hormonal activity in the mammary parenchyma, or rarely as a consequence of extra-mammary causes such as: orthopedic, neurological, endocrine or inflammatory variations. Alarming manifestations include: nodules, changes in the size or shape of the breasts, and the appearance of skin retractions. It is important to emphasize that although these symptoms are considered warning signs, they are not necessarily indicators of cancer and may indicate benign pathologies.

In Brazil, recommendations differ: official guidelines recommend mammographic screening for women not belonging to high-risk population groups only from age 50; however, the Brazilian Society of Mastology (SBM) and the Brazilian Federation of Gynecology and Obstetrics Societies (FEBRASCO), supported by the Brazilian Medical Association (AMB) and the Federal Council of Medicine (CFM), follow international trends and maintain that annual mammographic screening should begin at age 40, every two years for women between 50 and 69, and after age 70 for those with favorable clinical conditions and life expectancy that allow for the examination, as the incidence increases with age. (MARQUES; SILVA; AMARAL, 2011).

Diagnostic Assessment

According to Lopes et al. (2013), the diagnosis of breast cancer is based on self-examination, medical examination, imaging methods, and biopsy. Self-examination should not be discarded and should be encouraged in all women, especially postmenopausal women, despite its low efficiency in cancer screening, as some studies have shown.

Breast self-examination is part of the breast cancer screening strategy and should be performed monthly, preferably one week after the start of menstruation from the age of 20, and for women who do not menstruate, they should be encouraged to choose an arbitrary day of the month to perform the self-examination (CANCER INSTITUTE, 2010; BARROS et al, 2001).

Women should be aware that breasts are not always exactly the same size and that a breast lump is not always an indicator of a malignant neoplasm. The importance of self-examination lies in performing it monthly, because once a woman has a reference point for normal palpation, any changes will be noticed immediately. This occurs in 90% of cases, where the woman herself discovers these breast changes. (NAKAMATU, 2008; SANTOS, 2008).

The technique for performing breast self-examination mirrors that of the clinical examination performed by doctors, and patients should learn to examine their breasts in various positions. Palpation is performed with the fingers of the left hand palpating the right breast and vice versa (LISBOA, 2009; INSTITUTO DO CÂNCER, 2010).

Breast self-examination consists of a monthly inspection, through palpation, preferably at the same time each month, and should be performed standing in front of a mirror, during a shower, and while lying down. The purpose of self-examination is to detect changes or lumps in the breasts. (LOPES; CHAMMAS; IYEYASU, 2013; MARQUES; SILVA; AMARAL, 2011).

Although current therapies prolong the lives of women with breast cancer, the initial stage of the disease is crucial for patient survival. Clinical breast examination, essential for diagnosis, should be performed as a physical and gynecological examination, thus forming an important basis for ordering complementary tests. Static and dynamic inspection, palpation of the armpits and breast should be performed with the patient lying down. (MARQUES; SILVA; AMARAL, 2011).

Mammography is an X-ray of the breast that allows for the early detection of cancer. It is capable of showing lesions in their initial stages, even very small ones (millimeters), that is, the so-called pre-clinical lesions, which have a better therapeutic response and cure rate (INSTITUTO DO CÂNCER, 2010; GODINHO, KOCH, 2004).

Given that it is still an expensive method in our country, the World Health Organization (WHO) now recommends annual mammograms in cases of suspected clinical examination and in women with risk factors aged 40 or older, even if they do not present any abnormalities on clinical examination. Mammography is performed using an appropriate X-ray machine called a mammograph, and access to it is guaranteed by federal law 11.664/2008 (MS), as part of secondary prevention in breast cancer screening and control (LISBOA, 2009; BRASIL, 2008). The  examination  is performed by compressing the breasts, where two views (craniocaudal and mediolateral oblique) are taken of each breast. The discomfort caused by mammography is slight and tolerable. Radiological signs of malignancy are divided into direct and indirect. Direct signs are nodules, microcalcifications, and focal or diffuse asymmetric densities. Indirect signs include parenchymal distortions, isolated ductal dilation, skin thickening, skin retraction and/or nipple-areola complex, and axillary lymphadenopathy. A very dense nodule with a spiculated outline has a high probability of representing cancer (GODINHO, KOCH, 2004; SENISKI, 2008).

The mammography report should present the following items: indication for the examination; breast composition; examination findings; comparison with previous examinations, if any; and final evaluation, which is the evaluation of all the previous items (MARQUES; SILVA; AMARAL, 2011), through the BIRADS classification that will be discussed later.

Ultrasound is an examination performed with a device that emits ultrasound waves and, through the recording of the echo, gives us information about the texture and content of breast nodules. In most cases, it will be a complementary method to mammography. Ultrasound has great application in differentiating between cystic and solid tumors and is also able to identify lesions inside a cyst, indicating the removal of the cyst through surgery. This examination has better results when performed on dense breasts, with exuberant glandular tissue, such as the breasts of young women < 35 years old (NAKAMATU, 2008; SANTOS, 2008).

Treatment Options for Breast Cancer

Breast cancer treatment is divided into two types: local treatment and systemic treatment.

Local treatment consists of surgical treatment, either mastectomy or breast-conserving surgery, in conjunction with adjuvant radiotherapy when indicated, focusing on reducing the risk of locoregional recurrence (LOPES; CHAMMAS; IYEYASU, 2013).

Systemic treatment, which includes chemotherapy with cytotoxic agents, hormone therapy, and targeted therapy, focuses on preventing distant disease recurrence by eliminating possible hidden micrometastases. Systemic treatment complements local treatment and is largely responsible for the decrease in mortality and the increase in the chances of curing this disease. Therefore, the choice of the best method and therapeutic sequence to follow depends on the stage of the disease the patient was diagnosed with and the prognostic and predictive factors of the tumor's therapeutic response (LOPES; CHAMMAS; IYEYASU, 2013).

Chemotherapy

Chemotherapy is described as a drug treatment for cancer, which can be administered intravenously or orally. To reach cancer cells throughout the body, chemotherapy is administered intravenously, thus entering the bloodstream and spreading systemically throughout the patient's body (INSTITUTO ONCOGUIA, 2014).

Chemotherapy is also useful as part of a multimodal approach in clinical oncology for the treatment of locally advanced cancers, such as breast cancer, allowing for more limited surgery and even the cure of cases that would have been incurable in the past (BRUNTON; CHABNER; KNOLLMANN, 2012).

Currently, chemotherapy is being used in three relevant clinical circumstances:

1) in primary induction treatment for advanced disease or for cancers for which there is no other effective treatment; 2) in neoadjuvant treatment for patients with localized disease, where local therapy methods, such as radiotherapy or surgery, have not proven compatible; 3) in adjuvant treatment for local forms of therapy, including surgery and radiotherapy, or even both (KATZUNG; MASTERS; TREVOR, 2014).

Primary Induction Chemotherapy

This modality relates to chemotherapy applied as primary therapy for individuals with advanced-stage cancer who have no alternative treatment. This type of therapy has become the preferred approach in the treatment of patients whose disease is in an advanced metastatic phase and, in most cases, aims to manage tumor-related symptoms, improve quality of life, and extend the time of tumor progression. Based on studies conducted on a wide variety of tumors, chemotherapy in patients with advanced disease has been shown to provide a survival benefit when combined with supportive care, producing a tangible justification for choosing prior pharmacological treatment (KATZUNG; MASTERS; TREVOR, 2014).

Neoadjuvant Chemotherapy

This modality concerns the use of chemotherapy in individuals who have localized cancer, for which there are alternative local therapies, such as surgery, but which are not fully effective. Currently, it is frequently used in the treatment of breast cancer, as well as in cases of esophageal, laryngeal, bladder, and other cancers (KATZUNG; MASTERS; TREVOR, 2014).

This type of chemotherapy aims to reduce tumor volume, transforming unresectable tumors into resectable ones, or enabling conservative surgery in tumors that initially required radical mastectomy (MARQUES; SILVA; AMARAL, 2011).

Chemotherapy regimens based on regimens containing anthracyclines (adriamycin or epirubicin) associated with taxanes (AT) or cyclophosphamide and fluorouracil (FAC, FEC, [adriamycin, cyclophosphamide – AC]), administered in 3 to 4 cycles, depending on the response, have been shown to be a predictive factor for disease-free survival and overall survival (MARQUES; SILVA; AMARAL, 2011).

Adjuvant Chemotherapy

This modality consists of a systemic treatment, acting as an adjuvant to local treatment modalities, such as surgery or radiotherapy, constituting one of the most important roles of chemotherapy (KATZUNG; MASTERS; TREVOR, 2014).

In addition to surgery, the use of chemotherapeutic agents increases the chance of curing the disease. In cases where the disease has spread, this type of treatment is palliative and no longer curative; that is, the priority is to control the signs and symptoms, prolonging the patient's life (MARQUES; SILVA; AMARAL, 2011).

In breast cancer, this type of chemotherapy is responsible for significant clinical improvement and tumor regression by eliminating micrometastases after local therapy, reducing the incidence of both local and systemic recurrence, and improving overall patient survival. It should be initiated as soon as possible, preferably within 4 weeks after surgery (MARQUES; SILVA; AMARAL, 2011).

Chemotherapy Treatment for Breast Cancer

Among the breast cancer treatment methods analyzed, this work will focus on chemotherapy. This choice is justified by one main reason: the widespread use of chemotherapy in breast cancer treatment, either alone or in conjunction with other available treatment methods, as demonstrated in the previous section. According to Marques et al. (2011), the beneficial effects of chemotherapy in breast cancer are widely described in the literature, especially in premenopausal women, with an increase of up to 12% in survival and a decrease of 10 to 27% in recurrence.

The anti-ablative effect of chemotherapy is derived from transformations in the synthesis or structure of nucleic acids, or from the inhibition of proteins and enzymes necessary for cell division, resulting in the continuous elimination of a fraction of dividing cells. As a consequence of breast carcinoma activity, the proliferating portion of the tumor, that is, the cells sensitive to the action of chemotherapy, varies from 40 to 60%, thus being moderately sensitive tumors to anti-ablative drugs (MARQUES; SILVA; AMARAL, 2011).

The chance of obtaining good results with chemotherapy is approximately 50%, considering that the smaller the population of tumor cells, the greater the effectiveness of the treatment (MARQUES; SILVA; AMARAL, 2011).

Chemotherapy Treatment Performed at São Daniel Comboni Hospital (HSDC)

HSDC maintains an outpatient clinic offering chemotherapy and radiotherapy, including specialized consultations, 15 beds for oncology hospitalization, and a clinical laboratory. Also operating adjacent to the hospital is a support house for patients and their companions, maintained by the Masonic lodges of the State of Rondônia.

The following table shows the number of patients diagnosed with breast cancer who underwent examinations and chemotherapy treatment at São Daniel Comboni Hospital in Cacoal, Rondônia, in 2018.

  Source: São Daniel Comboni Hospital, 2018.

Final Considerations

Breast cancer is a disease that has been gradually increasing over the years, primarily affecting women. Typically, in its early stages, breast cancer is asymptomatic, which hinders early diagnosis. One of the most common signs women often find during self-examination is the presence of hardened nodules that are easily distinguishable from the rest of the breast. Breast cancer usually manifests in various ways, such as: the presence of nodules, differences in breast size, nipple inversion, increased pores in the breast area, among many others.

Among the various types of treatment analyzed, emphasis was placed on chemotherapy. Chemotherapy, as a form of treatment, whether adjuvant, neoadjuvant, curative or palliative, is widely used in the treatment of breast cancer. The main therapeutic regimens used in chemotherapy were studied, analyzing their side effects, drug interactions, and indications, which vary and depend on the stage of the disease.

It is clear that the effects of the phenomena affecting women in today's world are even more pronounced when they undergo chemotherapy treatment for breast cancer. This suggests the need for public policies that support these women, enabling them to access comprehensive healthcare, understanding that guaranteeing social and financial support are fundamental factors for the greater goal of promoting health.

Breast cancer cannot yet be completely prevented, but essential methods can be adopted for a good quality of life, which includes reducing exposure to certain risk factors. It is also essential that women know their bodies, perform self-exams, and opt for lifestyle changes such as physical exercise and healthy eating habits, in addition to the indispensable factor of having regular checkups.

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