Artigos Originais Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):712-718
DOI 10.1590/S0100-72032005001200002
PURPOSE: to verify the fetal heart rate (FHR) patterns of large for gestational age (LGA) fetuses in pregnancies at term complicated by pregestational diabetes. METHODS: fetal surveillance was performed weekly in 64 fetuses of mothers with pregestational diabetes. Inclusion criteria were: diagnosis of pregestational diabetes mellitus, single pregnancy, alive fetus, absence of fetal anomalies, and computerized cardiotocography performed at the 37th week of gestation. Exclusion criteria included: postnatal diagnosis of fetal anomalies and delivery not performed at the local hospital. The FHR patterns were studied with computerized cardiotocography and the parameters were analyzed according to a fetal weight as LGA (birth weight above percentile 90). The cardiotocography parameters included: basal FHR, episodes of high variation, episodes of low variation, and short-term variation. RESULTS: forty-two patients fulfilled the proposed criteria. Ten (23.8%) newborns were LGA. Normal criteria were met in all performed examinations. FHR accelerations (above 15 bpm) were present in 7 (70%) LGA cases and in 29 (90.6%) non-LGA (p=0.135). Accelerations were more frequent in the non-LGA group (1.5±1.3 accelerations/10 min) when compared to LGA group (0.8±0.9 accelerations/10min, p=0.04, Mann-Whitney test). The high variation episodes were detected in all cases. The mean FHR variation in these episodes was different in the LGA group (16.2±2.5 bpm) when compared to the non-LGA group (19.7±4.2 bpm, p=0.02, Mann-Whitney test). CONCLUSION: the FHR patterns of non-LGA (higher frequency of accelerations and higher FHR variation in the high variation episodes) reflect parameters commonly analyzed by traditional cardiotocography of a healthy fetus. This fact appears to confirm the patterns of better oxygen supply to the fetuses less compromised by diabetes in pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):712-718
DOI 10.1590/S0100-72032005001200002
PURPOSE: to verify the fetal heart rate (FHR) patterns of large for gestational age (LGA) fetuses in pregnancies at term complicated by pregestational diabetes. METHODS: fetal surveillance was performed weekly in 64 fetuses of mothers with pregestational diabetes. Inclusion criteria were: diagnosis of pregestational diabetes mellitus, single pregnancy, alive fetus, absence of fetal anomalies, and computerized cardiotocography performed at the 37th week of gestation. Exclusion criteria included: postnatal diagnosis of fetal anomalies and delivery not performed at the local hospital. The FHR patterns were studied with computerized cardiotocography and the parameters were analyzed according to a fetal weight as LGA (birth weight above percentile 90). The cardiotocography parameters included: basal FHR, episodes of high variation, episodes of low variation, and short-term variation. RESULTS: forty-two patients fulfilled the proposed criteria. Ten (23.8%) newborns were LGA. Normal criteria were met in all performed examinations. FHR accelerations (above 15 bpm) were present in 7 (70%) LGA cases and in 29 (90.6%) non-LGA (p=0.135). Accelerations were more frequent in the non-LGA group (1.5±1.3 accelerations/10 min) when compared to LGA group (0.8±0.9 accelerations/10min, p=0.04, Mann-Whitney test). The high variation episodes were detected in all cases. The mean FHR variation in these episodes was different in the LGA group (16.2±2.5 bpm) when compared to the non-LGA group (19.7±4.2 bpm, p=0.02, Mann-Whitney test). CONCLUSION: the FHR patterns of non-LGA (higher frequency of accelerations and higher FHR variation in the high variation episodes) reflect parameters commonly analyzed by traditional cardiotocography of a healthy fetus. This fact appears to confirm the patterns of better oxygen supply to the fetuses less compromised by diabetes in pregnancy.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):719-725
DOI 10.1590/S0100-72032005001200003
PURPOSE: to evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLV I/II infection in pregnant women screened by the Pregnant Protection Program of the State of Mato Grosso do Sul Brazil. METHODS: it is a descriptive and transversal study of 32,512 pregnant women submitted to a prenatal screening from November 2002 to October 2003. HTLV I/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western blot and PCR performed on the child's blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by the chi2 test considering p<0.05 to reject the null hypothesis. RESULTS: a prevalence of 0.1% (37) 0.1% HTLV I/II among 32,512 pregnant women was found. The mean age of the infected women was 25.4 ± 6.4 years, and 78.4% of them were from other areas than the capital. There was no association between maternal age and the patients' origin and infection. In all the eight evaluated newborns, which represented 21.6% of the sample, HTLV I/II serum antibodies were found. Only one newborn infant was breast-fed. CONCLUSIONS : HTLV I/II prevalence among pregnant women of the State of Mato Grosso do Sul Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same as that described for non-endemic areas and in some Brazilian reports. The vertical transmission rate of HTLV I/II was 100%, in spite of breast-feeding having been proscribed. Improving the follow-up of the pregnant women and their newborns in the State is mandatory, since only a few infants were investigated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(12):719-725
DOI 10.1590/S0100-72032005001200003
PURPOSE: to evaluate the prevalence, epidemiological profile (age and origin) and vertical transmission rate of HTLV I/II infection in pregnant women screened by the Pregnant Protection Program of the State of Mato Grosso do Sul Brazil. METHODS: it is a descriptive and transversal study of 32,512 pregnant women submitted to a prenatal screening from November 2002 to October 2003. HTLV I/II infection was diagnosed in all pregnant women by ELISA, confirmed by Western blot and PCR. Congenital HTLV infection was investigated by ELISA test, Western blot and PCR performed on the child's blood sample. The associations between data (age, origin and HTLV infection) were statistically analyzed by the chi2 test considering p<0.05 to reject the null hypothesis. RESULTS: a prevalence of 0.1% (37) 0.1% HTLV I/II among 32,512 pregnant women was found. The mean age of the infected women was 25.4 ± 6.4 years, and 78.4% of them were from other areas than the capital. There was no association between maternal age and the patients' origin and infection. In all the eight evaluated newborns, which represented 21.6% of the sample, HTLV I/II serum antibodies were found. Only one newborn infant was breast-fed. CONCLUSIONS : HTLV I/II prevalence among pregnant women of the State of Mato Grosso do Sul Brazil was lower than the rates reported by endemic HTLV countries. This rate was almost the same as that described for non-endemic areas and in some Brazilian reports. The vertical transmission rate of HTLV I/II was 100%, in spite of breast-feeding having been proscribed. Improving the follow-up of the pregnant women and their newborns in the State is mandatory, since only a few infants were investigated.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):683-690
DOI 10.1590/S0100-72032005001100009
PURPOSE: to evaluate human immunodeficiency virus (HIV) vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p<0.05). RESULTS: HIV infection was confirmed in 84 (45.4%) patients during gestation. Viral load was below 1,000 copies/mL in 60.4% patients. Highly active antiretroviral therapy was the predominant antiretroviral regimen (65.5%). C-section rate was high: 79.5%. Prematurity rate was 18.2%. There were 184 (97.8%) live births and four (2.2%) perinatal deaths among 188 neonates. Among live neonates 97.8% received zidovudine after birth. Global mother-to-child transmission rate was 3.8%. Virus vertical transmission rates for each period were: 60%, until 1996; 28% between 1996 and 1998; 0.68%, between 1999 and 2004. Significant risk factors were not found related to perinatal HIV-infection because there was a small number of infected neonates (n=6). CONCLUSION: there was a great reduction of HIV vertical transmission during the analyzed period. Current transmission rate is zero. This confirms that by adopting adequate measures perinatal virus transmission can be prevented.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):683-690
DOI 10.1590/S0100-72032005001100009
PURPOSE: to evaluate human immunodeficiency virus (HIV) vertical transmission and risk factors related to perinatal infection. METHODS: descriptive study of 170 HIV-infected pregnant women and their 188 neonates, admitted from June 1994 to September 2004 at the "Maternidade do Hospital das Clínicas da UFMG". Demographic characteristics, mother's serologic state, mode of delivery and perinatal results were analyzed. Children were followed for 18 months after birth. Data were stored and analyzed by Epi-Info, version 6.0. Confidence interval was established at 95% (p<0.05). RESULTS: HIV infection was confirmed in 84 (45.4%) patients during gestation. Viral load was below 1,000 copies/mL in 60.4% patients. Highly active antiretroviral therapy was the predominant antiretroviral regimen (65.5%). C-section rate was high: 79.5%. Prematurity rate was 18.2%. There were 184 (97.8%) live births and four (2.2%) perinatal deaths among 188 neonates. Among live neonates 97.8% received zidovudine after birth. Global mother-to-child transmission rate was 3.8%. Virus vertical transmission rates for each period were: 60%, until 1996; 28% between 1996 and 1998; 0.68%, between 1999 and 2004. Significant risk factors were not found related to perinatal HIV-infection because there was a small number of infected neonates (n=6). CONCLUSION: there was a great reduction of HIV vertical transmission during the analyzed period. Current transmission rate is zero. This confirms that by adopting adequate measures perinatal virus transmission can be prevented.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):677-682
DOI 10.1590/S0100-72032005001100008
PURPOSE: to evaluate the influence of the delivery route on pelvic floor (PF) muscle strength. METHODS: a cross-sectional study was conducted to evaluate PF muscle strength by the pelvic floor strength evaluation (PFSE) test and perineometer in primiparous patients aged 20 to 30 years 4 to 6 months after delivery. The categorization was: zero lack of muscle contraction; one - weak contraction; two - moderate contraction not sustained for 6 s and three - normal contraction sustained for 6 s. A total of 94 patients were divided into there groups based on prior delivery route. They were: 32 patients with vaginal delivery with singleton cephalic presentation; 32 patients with cesarean delivery, and 30 nulliparous patients as a control group. The independent variable was delivery route and the dependent one was the muscle strength of the PF. Comparison between contraction levels was performed by Kruskal-Wallis and Dunn multiple comparison tests and the influence of delivery method was tested by chi2. Confidence interval of 95% was obtained for relative risk (RR) of Pf muscle strength changes and kappa statistics. RESULTS: the 1st and 3rd quartiles of delivery route regarding PF muscle strength were lower (p=0.01) for vaginal delivery (2.0;1-2) and intermediate for cesarean section (2.0;2-3) compared to the nulliparous (3.0;2-3) by the PFSE test and perineometer. RR of the altered examination was increased after vaginal delivery (RR=2.58; CI 95%: 1.32-5.04, p=0.002); (RR=2.31; CI 95%: 1.24-4.32, p=0.005), and after cesarean section (RR=1.56; CI 95%: 0.94-2.57, p= 0.12); (RR=1.38; CI 95%: 0.85-2.23, p=0.29) by AFA and perineometer, respectively. CONCLUSIONS: vaginal delivery decreased PF muscle strength when compared with cesarean delivery and control groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):677-682
DOI 10.1590/S0100-72032005001100008
PURPOSE: to evaluate the influence of the delivery route on pelvic floor (PF) muscle strength. METHODS: a cross-sectional study was conducted to evaluate PF muscle strength by the pelvic floor strength evaluation (PFSE) test and perineometer in primiparous patients aged 20 to 30 years 4 to 6 months after delivery. The categorization was: zero lack of muscle contraction; one - weak contraction; two - moderate contraction not sustained for 6 s and three - normal contraction sustained for 6 s. A total of 94 patients were divided into there groups based on prior delivery route. They were: 32 patients with vaginal delivery with singleton cephalic presentation; 32 patients with cesarean delivery, and 30 nulliparous patients as a control group. The independent variable was delivery route and the dependent one was the muscle strength of the PF. Comparison between contraction levels was performed by Kruskal-Wallis and Dunn multiple comparison tests and the influence of delivery method was tested by chi2. Confidence interval of 95% was obtained for relative risk (RR) of Pf muscle strength changes and kappa statistics. RESULTS: the 1st and 3rd quartiles of delivery route regarding PF muscle strength were lower (p=0.01) for vaginal delivery (2.0;1-2) and intermediate for cesarean section (2.0;2-3) compared to the nulliparous (3.0;2-3) by the PFSE test and perineometer. RR of the altered examination was increased after vaginal delivery (RR=2.58; CI 95%: 1.32-5.04, p=0.002); (RR=2.31; CI 95%: 1.24-4.32, p=0.005), and after cesarean section (RR=1.56; CI 95%: 0.94-2.57, p= 0.12); (RR=1.38; CI 95%: 0.85-2.23, p=0.29) by AFA and perineometer, respectively. CONCLUSIONS: vaginal delivery decreased PF muscle strength when compared with cesarean delivery and control groups.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):672-676
DOI 10.1590/S0100-72032005001100007
PURPOSE: to evaluate the influence of vaginal environment of pregnant women on group B streptococcus (GBS) survival after 8, 24 e 48 h in Amies and Stuart transport media. METHODS: Three vaginal samples were collected from 30 pregnant women attending the Prenatal Care Outpatient Clinic of the Centro de Atenção Integral à Saúde da Mulher (CAISM), Universidade Estadual de Campinas (UNICAMP). The first sample was placed directly onto Todd-Hewitt selective medium; the second was used to perform a gram-stained microscopy, and the third swab was placed in 2 mL physiological saline to which 200 µL of a suspension with 1-2 x 10(8) colony-forming units of GBS was added. After homogenization, six swabs were collected from this suspension (3 from Amie medium and 3 from Stuart medium). These six swabs were kept at room temperature for 8, 24 and 48 h and then incubated on blood agar. Bacterial growth at 37ºC was observed after a 24-h incubation period and it was semiquantitatively graded (0-3+) according to the number of colonies. Statistical analysis was performed by the exact Fisher test and the level of significance was set at 0.05. RESULTS: the recovery of GBS after 48-h storage in Amie and Stuart media was 97 e 87%, respectively. In one of the four cases where no GBS recovery was possible after 48 h of storage, vaginal pH was higher than 4.5, and in two of those cases cytolytic vaginosis was found. CONCLUSIONS: both transport media showed to be appropriate for GBS recovery up to 48 h after sampling. Characteristics of the vaginal enviroment did not influence GBS recovery as observed in this study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):672-676
DOI 10.1590/S0100-72032005001100007
PURPOSE: to evaluate the influence of vaginal environment of pregnant women on group B streptococcus (GBS) survival after 8, 24 e 48 h in Amies and Stuart transport media. METHODS: Three vaginal samples were collected from 30 pregnant women attending the Prenatal Care Outpatient Clinic of the Centro de Atenção Integral à Saúde da Mulher (CAISM), Universidade Estadual de Campinas (UNICAMP). The first sample was placed directly onto Todd-Hewitt selective medium; the second was used to perform a gram-stained microscopy, and the third swab was placed in 2 mL physiological saline to which 200 µL of a suspension with 1-2 x 10(8) colony-forming units of GBS was added. After homogenization, six swabs were collected from this suspension (3 from Amie medium and 3 from Stuart medium). These six swabs were kept at room temperature for 8, 24 and 48 h and then incubated on blood agar. Bacterial growth at 37ºC was observed after a 24-h incubation period and it was semiquantitatively graded (0-3+) according to the number of colonies. Statistical analysis was performed by the exact Fisher test and the level of significance was set at 0.05. RESULTS: the recovery of GBS after 48-h storage in Amie and Stuart media was 97 e 87%, respectively. In one of the four cases where no GBS recovery was possible after 48 h of storage, vaginal pH was higher than 4.5, and in two of those cases cytolytic vaginosis was found. CONCLUSIONS: both transport media showed to be appropriate for GBS recovery up to 48 h after sampling. Characteristics of the vaginal enviroment did not influence GBS recovery as observed in this study.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):665-671
DOI 10.1590/S0100-72032005001100006
PURPOSE: to define the characteristics of unviable embryos that may be donated for stem-cell research. METHODS: a retrospective evaluation of in vitro fertilzation cycles between January 1995 and January 2005 was structured. Cycles were chosen in which the embryos transferred to the uterine cavity had the same morphological characteristics. Subsequently, the rates of pregnancy, implantation, and involution of the gestational sacs of the fresh embryos as well as of those cryopreserved were analyzed and distributed into groups according to their morphology. Embryos that were symmetric and with 0% of fragmentation were designated type A; asymmetric with up to 25% of fragmentation were designated type B; between 25 and 50% of volume occupied were designated type C, and those with 50% or more of fragmentation were designated type D. RESULTS: one hundred and seventy-two type D embryos transferred in 87 cycles presented low rates of implantation (11%) with 50% of those implanted persisting in development. Embryos with the same morphology, after cryopreservation and thawing, did not show the capacity to evolve. In 36 cycles, 113 thawed type D embryos were transferred, resulting in only one implantation, presenting a minute 3% pregnancy rate. The implanted gestational sac did not evolve, showing a 100% rate of involution. CONCLUSION: embryos with low morphological scores cannot be considered unviable because they are capable, even though with a very low frequency, of supporting gestation. However, these same embryos, after cryopreservation, thawing and transfer showed an insignificant rate of pregnancy, that did not result in viable pregnancy. Therefore, when in excess to requirements, type D embryos should not be cryopreserved; instead, rather than discarded, they should be donated for embryo stem-cell research.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):665-671
DOI 10.1590/S0100-72032005001100006
PURPOSE: to define the characteristics of unviable embryos that may be donated for stem-cell research. METHODS: a retrospective evaluation of in vitro fertilzation cycles between January 1995 and January 2005 was structured. Cycles were chosen in which the embryos transferred to the uterine cavity had the same morphological characteristics. Subsequently, the rates of pregnancy, implantation, and involution of the gestational sacs of the fresh embryos as well as of those cryopreserved were analyzed and distributed into groups according to their morphology. Embryos that were symmetric and with 0% of fragmentation were designated type A; asymmetric with up to 25% of fragmentation were designated type B; between 25 and 50% of volume occupied were designated type C, and those with 50% or more of fragmentation were designated type D. RESULTS: one hundred and seventy-two type D embryos transferred in 87 cycles presented low rates of implantation (11%) with 50% of those implanted persisting in development. Embryos with the same morphology, after cryopreservation and thawing, did not show the capacity to evolve. In 36 cycles, 113 thawed type D embryos were transferred, resulting in only one implantation, presenting a minute 3% pregnancy rate. The implanted gestational sac did not evolve, showing a 100% rate of involution. CONCLUSION: embryos with low morphological scores cannot be considered unviable because they are capable, even though with a very low frequency, of supporting gestation. However, these same embryos, after cryopreservation, thawing and transfer showed an insignificant rate of pregnancy, that did not result in viable pregnancy. Therefore, when in excess to requirements, type D embryos should not be cryopreserved; instead, rather than discarded, they should be donated for embryo stem-cell research.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):661-664
DOI 10.1590/S0100-72032005001100005
PURPOSE: to compare the outcome of treatment in patients undergoing assisted reproductive technology (ART) cycles who donated eggs during their own ART treatment with the outcome of patients undergoing ART without egg donation. METHODS: we studied retrospectively the pregnancy and implantation rates of 50 patients who donated eggs during the course of their ART treatment (donor group), and the pregnancy and implantation rates of 50 patients who underwent ART cycles and kept all their eggs (non-donor group). between the years 2001-2003. The inclusion criteria used were as follows: age <35 years old, normal menstrual cycles, FSH<10 mIU/mL, first attempt of ART treatment and more than six mature oocytes retrieved. The results were analyzed statistically using the chi2 test. RESULTS: both groups were comparable in terms of age, indication, and duration of infertility. The mean age was 30.6 years for the donor group and 31.1 years for the non-donor group. All the patients of the donor group produced more than 6 eggs. From the donor group we collected 590 oocytes; 215 eggs were donated to recipients (36.5%) and 152 embryos were transferred. A total of 15 pregnancies were achieved (pregnancy rate per transfer: 30%); the implantation rate was 11.2% and there were 2 miscarriages (miscarriage rate: 13.3%). From the non-donor group, 545 oocytes were collected and 153 embryos were transferred. A total 17 pregnancies were achieved (pregnancy rate per transfer: 34%); the implantation rate was 14.3% and there were 3 miscarriages (miscarriage rate: 17.6%). The pregnancy and implantation rates were similar in both groups, and there were no significant statistical differences regarding the miscarriage rate (p>0.05). CONCLUSION: this study suggests that in patients who produce more than 6 oocytes, egg donation in the treatment cycle does not influence adversely the outcome of ART cycles and does not increase the miscarriage rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):661-664
DOI 10.1590/S0100-72032005001100005
PURPOSE: to compare the outcome of treatment in patients undergoing assisted reproductive technology (ART) cycles who donated eggs during their own ART treatment with the outcome of patients undergoing ART without egg donation. METHODS: we studied retrospectively the pregnancy and implantation rates of 50 patients who donated eggs during the course of their ART treatment (donor group), and the pregnancy and implantation rates of 50 patients who underwent ART cycles and kept all their eggs (non-donor group). between the years 2001-2003. The inclusion criteria used were as follows: age <35 years old, normal menstrual cycles, FSH<10 mIU/mL, first attempt of ART treatment and more than six mature oocytes retrieved. The results were analyzed statistically using the chi2 test. RESULTS: both groups were comparable in terms of age, indication, and duration of infertility. The mean age was 30.6 years for the donor group and 31.1 years for the non-donor group. All the patients of the donor group produced more than 6 eggs. From the donor group we collected 590 oocytes; 215 eggs were donated to recipients (36.5%) and 152 embryos were transferred. A total of 15 pregnancies were achieved (pregnancy rate per transfer: 30%); the implantation rate was 11.2% and there were 2 miscarriages (miscarriage rate: 13.3%). From the non-donor group, 545 oocytes were collected and 153 embryos were transferred. A total 17 pregnancies were achieved (pregnancy rate per transfer: 34%); the implantation rate was 14.3% and there were 3 miscarriages (miscarriage rate: 17.6%). The pregnancy and implantation rates were similar in both groups, and there were no significant statistical differences regarding the miscarriage rate (p>0.05). CONCLUSION: this study suggests that in patients who produce more than 6 oocytes, egg donation in the treatment cycle does not influence adversely the outcome of ART cycles and does not increase the miscarriage rate.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):656-660
DOI 10.1590/S0100-72032005001100004
PURPOSE: to analyze time trends in the clinical staging at the moment of diagnosis in patients with breast and cervix cancer based on data produced by the Brazilian Public Health System (SUS). METHODS: in the first part of this study we identified the published documents describing clinical staging of patients at the moment of diagnosis. Considering their scarcity and poor representativity we conducted the second part of this study through an active search for information. A form was sent via regular mail to all cancer centers in the country (n=173) requesting information about the tumor site and stage at diagnosis by year, in the period of 1995-2002. The statistical analysis was performed using the "R" statistical package. The results are reported as percentage and boxplots. RESULTS: in the first part of the study (1990-1994) we described data from 18 hospitals concerning 7,458 patients with breast cancer and 7,216 patients with cervix cancer. The median of the percentage of cancers diagnosed at an advanced stage (stages III or IV) was 52.6 and 56.8%, respectively. In the second part of the study (1995-2002) data were collected from 89 cancer hospitals and 7 chemotherapy or radiotherapy clinics. There was a total of 43,442 cases of breast cancer and 29,263 of cervix cancer. The response rate based on the potential contact list was 55%. The median percentage of patients in advanced stage was 45.3% for breast cancer and 42.5% for cervix cancer. CONCLUSIONS: few studies have examined the time trends in staging of cancer at diagnosis in Brazilian hospitals. Data obtained from Hospital Cancer Registries showed that in the last decade there was a reduction in the percentage of cervix and breast cancer at the advanced stage. This reduction can be due to an improvement in early detection of these cancers.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2005;27(11):656-660
DOI 10.1590/S0100-72032005001100004
PURPOSE: to analyze time trends in the clinical staging at the moment of diagnosis in patients with breast and cervix cancer based on data produced by the Brazilian Public Health System (SUS). METHODS: in the first part of this study we identified the published documents describing clinical staging of patients at the moment of diagnosis. Considering their scarcity and poor representativity we conducted the second part of this study through an active search for information. A form was sent via regular mail to all cancer centers in the country (n=173) requesting information about the tumor site and stage at diagnosis by year, in the period of 1995-2002. The statistical analysis was performed using the "R" statistical package. The results are reported as percentage and boxplots. RESULTS: in the first part of the study (1990-1994) we described data from 18 hospitals concerning 7,458 patients with breast cancer and 7,216 patients with cervix cancer. The median of the percentage of cancers diagnosed at an advanced stage (stages III or IV) was 52.6 and 56.8%, respectively. In the second part of the study (1995-2002) data were collected from 89 cancer hospitals and 7 chemotherapy or radiotherapy clinics. There was a total of 43,442 cases of breast cancer and 29,263 of cervix cancer. The response rate based on the potential contact list was 55%. The median percentage of patients in advanced stage was 45.3% for breast cancer and 42.5% for cervix cancer. CONCLUSIONS: few studies have examined the time trends in staging of cancer at diagnosis in Brazilian hospitals. Data obtained from Hospital Cancer Registries showed that in the last decade there was a reduction in the percentage of cervix and breast cancer at the advanced stage. This reduction can be due to an improvement in early detection of these cancers.
