Advertisement

Neoadjuvant therapy for breast cancer treatment: an expert panel recommendation from the Brazilian Society of Breast Surgeons 2018

  • Fernanda Barbosa C Rocha
  • Ana Beatriz Falcone
  • Antonio Carlos Buzaid
  • Juliana Martins Pimenta
  • Gustavo Schvartsman
  • Antonio Luiz Frasson
Review
  • 15 Downloads

Abstract

Purpose

Breast cancer neoadjuvant chemotherapy (NAC) consists of the administration of cytotoxic and targeted drugs prior to breast surgery, with the objective of reducing the tumor burden to allow breast conservation. NAC also aims to improve long-term treatment outcomes such as disease-free and overall survival. To optimize clinical practice with the best available evidence for breast cancer patients in the setting of neoadjuvant treatment, the Brazilian Society of Breast Surgeons (Sociedade Brasileira de Mastologia—SBM) held a consensus conference to develop this guideline.

Methods

Twenty-two questions addressing relevant breast cancer neoadjuvant treatment were previously formulated. The voting panel comprised 25 specialists from the SBM. A consensus was established if there was 75% agreement. If there was less concordance, after discussion, the consensus was determined by a 51% concordance.

Results

The recommendations were based on the best level of scientific evidence and the opinion from breast cancer experts, when no such research data were available.

Conclusion

This manuscript provides updated guidance according to the views of the SBM’s experts for the clinical practice of breast cancer surgeons. This manuscript depicts the summarized recommendations for NAC treatment.

Keywords

Breast cancer Neoadjuvant chemotherapy Recommendations Surgery Radiotherapy Treatment 

Notes

Acknowledgements

The authors wish to thank the support of Brazilian Society of Breast Surgeons and the panelists who voted and discussed the questions described in this manuscript: Antonio Fernando Melo Filho, Carlos Alberto Ruiz, Cícero de Andrade Urban, Darley de Lima Ferreira Filho, Diego Chaves Rezende Morais, Eduardo Camargo Millen, Fábio Bagnoli, Fabio Postiglione Mansani, Fabrício Palermo Brenelli, Felipe Pereira Zerwes, Francisco Pimentel Cavalcante, Glauber Moreira Leitão, José Francisco Rinaldi, José Luiz Pedrini, José Ricardo Conte de Souza, Linei Urban, Luciana Naíra de Brito Lima Limongi, Marcos Nolasco H. Neves, Maria do Carmo de Abreu e Lima, Mirela Ávila Gurgel, Mônica Vieira M. Travassos Jourdan, Paula Cristina Saab, Rafael Henrique Szymanski Machado, Régis Resende Paulinelli, and Ricardo Antonio Boff. The authors also wish to thank Felipe Ades, MD, PhD for providing medical writing on behalf of Springer Healthcare. This manuscript was prepared according to the International Society for Medical Publication Professionals’ Good Publication Practice for Communicating Company-Sponsored Medical Research: the GPP3 Guidelines. Funding to support the preparation of this manuscript was provided by Produtos Roche Químicos e Farmacêuticos S.A. The authors take full responsibility for the content and conclusions stated in this manuscript. Roche did not influence the content of this publication.

Compliance with ethical standards

Conflict of interest

Fernanda Barbosa Coelho Rocha, Ana Beatriz Falcone and Gustavo Schvartsman declared that they have no conflict of interest. Antonio Carlos Buzaid is a consultant and/or plays an advisory role at Roche, BMS, MSD, Pfizer, AstraZeneca, Esai, Novartis and Blau. Juliana Martins Pimenta is a consultant and/or plays an advisory role at Roche and Novartis. Antonio Luiz Frasson is a consultant and/or plays an advisory role at Roche.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10549_2018_4912_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 27.554 KB)

References

  1. 1.
    Seltzer MH, McDermott JH (1999) Breast screening in women aged 40–49 years. Lancet 354:946–947.  https://doi.org/10.1016/S0140-6736(05)75689-0 CrossRefPubMedGoogle Scholar
  2. 2.
    Nyström L, Andersson I, Bjurstam N et al (2002) Long-term effects of mammography screening: updated overview of the Swedish randomised trials. Lancet 359:909–919.  https://doi.org/10.1016/S0140-6736(02)08020-0 CrossRefPubMedGoogle Scholar
  3. 3.
    van Dijck JA, Holland R, Verbeek AL et al (1994) Efficacy of mammographic screening of the elderly: a case-referent study in the Nijmegen program in The Netherlands. J Natl Cancer Inst 86:934–938CrossRefPubMedGoogle Scholar
  4. 4.
    EBCTCG (Early Breast Cancer Trialists’ Collaborative Group) (2014) Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. The Lancet 383:2127–2135.  https://doi.org/10.1016/S0140-6736(14)60488-8 CrossRefGoogle Scholar
  5. 5.
    Regan MM, Francis PA, Pagani O et al (2016) Absolute benefit of adjuvant endocrine therapies for premenopausal women with hormone receptor-positive, human epidermal growth factor receptor 2-negative early breast cancer: TEXT and SOFT trials. J Clin Oncol Off J Am Soc Clin Oncol 34:2221–2231.  https://doi.org/10.1200/JCO.2015.64.3171 CrossRefGoogle Scholar
  6. 6.
    Francis PA, Regan MM, Fleming GF et al (2015) Adjuvant ovarian suppression in premenopausal breast cancer. N Engl J Med 372:436–446.  https://doi.org/10.1056/NEJMoa1412379 CrossRefPubMedGoogle Scholar
  7. 7.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2015) Aromatase inhibitors versus tamoxifen in early breast cancer: patient-level meta-analysis of the randomised trials. Lancet Lond Engl 386:1341–1352.  https://doi.org/10.1016/S0140-6736(15)61074-1 CrossRefGoogle Scholar
  8. 8.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2005) Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet Lond Engl 365:1687–1717.  https://doi.org/10.1016/S0140-6736(05)66544-0 CrossRefGoogle Scholar
  9. 9.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2012) Comparisons between different polychemotherapy regimens for early breast cancer: meta-analyses of long-term outcome among 100,000 women in 123 randomised trials. Lancet 379:432–444.  https://doi.org/10.1016/S0140-6736(11)61625-5 CrossRefGoogle Scholar
  10. 10.
    Early Breast Cancer Trialists’ Collaborative Group (EBCTCG) (2018) Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 19:27–39.  https://doi.org/10.1016/S1470-2045(17)30777-5 CrossRefGoogle Scholar
  11. 11.
    Cossetti RJD, Tyldesley SK, Speers CH et al (2015) Comparison of breast cancer recurrence and outcome patterns between patients treated From 1986 to 1992 and From 2004 to 2008. J Clin Oncol 33:65–73.  https://doi.org/10.1200/JCO.2014.57.2461 CrossRefPubMedGoogle Scholar
  12. 12.
    Perou CM, Sørlie T, Eisen MB et al (2000) Molecular portraits of human breast tumours. Nature 406:747–752.  https://doi.org/10.1038/35021093 CrossRefPubMedGoogle Scholar
  13. 13.
    Sorlie T, Tibshirani R, Parker J et al (2003) Repeated observation of breast tumor subtypes in independent gene expression data sets. Proc Natl Acad Sci U S A 100:8418–8423.  https://doi.org/10.1073/pnas.0932692100 CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Prat A, Ellis MJ, Perou CM (2012) Practical implications of gene-expression-based assays for breast oncologists. Nat Rev Clin Oncol 9:48–57.  https://doi.org/10.1038/nrclinonc.2011.178 CrossRefGoogle Scholar
  15. 15.
    Cortazar P, Zhang L, Untch M et al (2014) Pathological complete response and long-term clinical benefit in breast cancer: the CTNeoBC pooled analysis. Lancet Lond Engl 384:164–172.  https://doi.org/10.1016/S0140-6736(13)62422-8 CrossRefGoogle Scholar
  16. 16.
    Cardoso F, Costa A, Senkus E et al (2017) 3rd ESO–ESMO international consensus guidelines for Advanced breast cancer (ABC 3). Breast 31:244–259.  https://doi.org/10.1016/j.breast.2016.10.001 CrossRefPubMedGoogle Scholar
  17. 17.
    Curigliano G, Burstein HJ, Winer P E, et al (2017) De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol Off J Eur Soc Med Oncol 28:1700–1712.  https://doi.org/10.1093/annonc/mdx308 Google Scholar
  18. 18.
    Forero A, Lyons J, Marcom PK et al (2018) NCCN Guidelines Panel Disclosures. Breast Cancer 209Google Scholar
  19. 19.
    Oxford Centre for Evidence (2009) Oxford Centre for Evidence-based Medicine—Levels of Evidence. In: CEBM. https://www.cebm.net/2009/06/oxford-centre-evidence-based-medicine-levels-evidence-march-2009/. Accessed 18 Apr 2018
  20. 20.
    Fisher B, Brown A, Mamounas E et al (1997) Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National surgical adjuvant breast and bowel project B-18. J Clin Oncol Off J Am Soc Clin Oncol 15:2483–2493.  https://doi.org/10.1200/JCO.1997.15.7.2483 CrossRefGoogle Scholar
  21. 21.
    Mamounas EP (1997) NSABP Protocol B-27. Preoperative doxorubicin plus cyclophosphamide followed by preoperative or postoperative docetaxel. Oncol Williston Park N 11:37–40Google Scholar
  22. 22.
    Gianni L, Pienkowski T, Im Y-H et al (2012) Efficacy and safety of neoadjuvant pertuzumab and trastuzumab in women with locally advanced, inflammatory, or early HER2-positive breast cancer (NeoSphere): a randomised multicentre, open-label, phase 2 trial. Lancet Oncol 13:25–32.  https://doi.org/10.1016/S1470-2045(11)70336-9 CrossRefPubMedGoogle Scholar
  23. 23.
    Schneeweiss A, Chia S, Hickish T et al (2013) Pertuzumab plus trastuzumab in combination with standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: a randomized phase II cardiac safety study (TRYPHAENA). Ann Oncol Off J Eur Soc Med Oncol ESMO 24:2278–2284.  https://doi.org/10.1093/annonc/mdt182 CrossRefGoogle Scholar
  24. 24.
    Gianni L, Eiermann W, Semiglazov V et al (2010) Neoadjuvant chemotherapy with trastuzumab followed by adjuvant trastuzumab versus neoadjuvant chemotherapy alone, in patients with HER2-positive locally advanced breast cancer (the NOAH trial): a randomised controlled superiority trial with a parallel HER2-negative cohort. Lancet 375:377–384.  https://doi.org/10.1016/S0140-6736(09)61964-4 CrossRefPubMedGoogle Scholar
  25. 25.
    Rastogi P, Anderson SJ, Bear HD et al (2008) Preoperative chemotherapy: updates of national surgical adjuvant breast and bowel project protocols B-18 and B-27. J Clin Oncol Off J Am Soc Clin Oncol 26:778–785.  https://doi.org/10.1200/JCO.2007.15.0235 CrossRefGoogle Scholar
  26. 26.
    Baselga J, Bradbury I, Eidtmann H et al (2012) Lapatinib with trastuzumab for HER2-positive early breast cancer (NeoALTTO): a randomised, open-label, multicentre, phase 3 trial. Lancet 379:633–640.  https://doi.org/10.1016/S0140-6736(11)61847-3 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Ades F, Zardavas D, Bozovic-Spasojevic I et al (2014) Luminal B breast cancer: molecular characterization, clinical management, and future perspectives. J Clin Oncol Off J Am Soc Clin Oncol 32:2794–2803.  https://doi.org/10.1200/JCO.2013.54.1870 CrossRefGoogle Scholar
  28. 28.
    Jacobs C, Clemons M, Addison C et al (2016) Issues affecting the loco-regional and systemic management of patients with invasive lobular carcinoma of the breast. Breast J 22:45–53.  https://doi.org/10.1111/tbj.12520 CrossRefPubMedGoogle Scholar
  29. 29.
    Jung S-Y, Jeong J, Shin S-H et al (2010) The invasive lobular carcinoma as a prototype luminal A breast cancer: a retrospective cohort study. BMC Cancer 10:664.  https://doi.org/10.1186/1471-2407-10-664 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Truin W, Vugts G, Roumen RMH et al (2016) Differences in response and surgical management with neoadjuvant chemotherapy in invasive lobular versus ductal breast cancer. Ann Surg Oncol 23:51–57.  https://doi.org/10.1245/s10434-015-4603-3 CrossRefPubMedGoogle Scholar
  31. 31.
    Lips EH, Mukhtar RA, Yau C et al (2012) Lobular histology and response to neoadjuvant chemotherapy in invasive breast cancer. Breast Cancer Res Treat 136:35–43.  https://doi.org/10.1007/s10549-012-2233-z CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Yang L, Sun H, Zhao Y et al (2017) Clinicopathological characteristics and survival outcomes in pleomorphic lobular breast carcinoma of the breast: a SEER population-based study. Cancer Med 6:2867–2875.  https://doi.org/10.1002/cam4.1244 CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Jung SP, Lee SK, Kim S et al (2012) Invasive pleomorphic lobular carcinoma of the breast: clinicopathologic characteristics and prognosis compared with invasive ductal carcinoma. J Breast Cancer 15:313–319.  https://doi.org/10.4048/jbc.2012.15.3.313 CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Boughey JC, Suman VJ, Mittendorf EA et al (2013) Sentinel lymph node surgery after neoadjuvant chemotherapy in patients with node-positive breast cancer: the ACOSOG Z1071 (Alliance) clinical trial. JAMA 310:1455–1461.  https://doi.org/10.1001/jama.2013.278932 CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    El Hage Chehade H, Headon H, El Tokhy O et al (2016) Is sentinel lymph node biopsy a viable alternative to complete axillary dissection following neoadjuvant chemotherapy in women with node-positive breast cancer at diagnosis? An updated meta-analysis involving 3,398 patients. Am J Surg 212:969–981.  https://doi.org/10.1016/j.amjsurg.2016.07.018 CrossRefPubMedGoogle Scholar
  36. 36.
    Kuehn T, Bauerfeind I, Fehm T et al (2013) Sentinel-lymph-node biopsy in patients with breast cancer before and after neoadjuvant chemotherapy (SENTINA): a prospective, multicentre cohort study. Lancet Oncol 14:609–618.  https://doi.org/10.1016/S1470-2045(13)70166-9 CrossRefPubMedGoogle Scholar
  37. 37.
    Hylton NM, Gatsonis CA, Rosen MA et al (2016) Neoadjuvant chemotherapy for breast cancer: functional tumor volume by MR imaging predicts recurrence-free survival-results from the ACRIN 6657/CALGB 150007 I-SPY 1 TRIAL. Radiology 279:44–55.  https://doi.org/10.1148/radiol.2015150013 CrossRefPubMedGoogle Scholar
  38. 38.
    Londero V, Bazzocchi M, Del Frate C et al (2004) Locally advanced breast cancer: comparison of mammography, sonography and MR imaging in evaluation of residual disease in women receiving neoadjuvant chemotherapy. Eur Radiol 14:1371–1379.  https://doi.org/10.1007/s00330-004-2246-z CrossRefPubMedGoogle Scholar
  39. 39.
    Marinovich ML, Houssami N, Macaskill P et al (2013) Meta-analysis of magnetic resonance imaging in detecting residual breast cancer after neoadjuvant therapy. JNCI J Natl Cancer Inst 105:321–333.  https://doi.org/10.1093/jnci/djs528 CrossRefPubMedGoogle Scholar
  40. 40.
    Pilewskie M, Morrow M (2014) Applications for breast magnetic resonance imaging. Surg Oncol Clin N Am 23:431–449.  https://doi.org/10.1016/j.soc.2014.03.001 CrossRefPubMedGoogle Scholar
  41. 41.
    Weber JJ, Jochelson MS, Eaton A et al (2017) MRI and prediction of pathologic complete response in the breast and axilla after neoadjuvant chemotherapy for breast cancer. J Am Coll Surg 225:740–746.  https://doi.org/10.1016/j.jamcollsurg.2017.08.027 CrossRefPubMedGoogle Scholar
  42. 42.
    Marinovich ML, Macaskill P, Irwig L et al (2013) Meta-analysis of agreement between MRI and pathologic breast tumour size after neoadjuvant chemotherapy. Br J Cancer 109:1528–1536.  https://doi.org/10.1038/bjc.2013.473 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Bernier J (2015) Post-mastectomy radiotherapy after neodjuvant chemotherapy in breast cancer patients: a review. Crit Rev Oncol Hematol 93:180–189.  https://doi.org/10.1016/j.critrevonc.2014.10.011 CrossRefPubMedGoogle Scholar
  44. 44.
    Boughey JC, Ballman KV, Le-Petross HT et al (2016) Identification and Resection of clipped node decreases the false-negative rate of sentinel lymph node surgery in patients presenting with node-positive breast cancer (T0-T4, N1-N2) who receive neoadjuvant chemotherapy: results from ACOSOG Z1071 (alliance). Ann Surg 263:802–807.  https://doi.org/10.1097/SLA.0000000000001375 CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Caudle AS, Yang WT, Krishnamurthy S et al (2016) Improved axillary evaluation following neoadjuvant therapy for patients with node-positive breast cancer using selective evaluation of clipped nodes: implementation of targeted axillary dissection. J Clin Oncol 34:1072–1078.  https://doi.org/10.1200/JCO.2015.64.0094 CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Schulz-Wendtland R, Dankerl P, Bani MR et al (2017) Evaluation of a marker clip system in sonographically guided core needle biopsy for breast cancer localization before and after neoadjuvant chemotherapy. Geburtshilfe Frauenheilkd 77:169–175.  https://doi.org/10.1055/s-0042-124191 CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Youn I, Choi SH, Kook SH et al (2015) Ultrasonography-guided surgical clip placement for tumor localization in patients undergoing neoadjuvant chemotherapy for breast cancer. J Breast Cancer 18:44.  https://doi.org/10.4048/jbc.2015.18.1.44 CrossRefPubMedPubMedCentralGoogle Scholar
  48. 48.
    Fusco R, Petrillo A, Catalano O et al (2014) Procedures for location of non-palpable breast lesions: a systematic review for the radiologist. Breast Cancer 21:522–531.  https://doi.org/10.1007/s12282-012-0427-1 CrossRefPubMedGoogle Scholar
  49. 49.
    Raphael J, Paramsothy T, Li N et al (2017) A single-institution experience of salvage therapy for patients with early and locally advanced breast cancer who progress during neoadjuvant chemotherapy. Breast Cancer Res Treat 163:11–19.  https://doi.org/10.1007/s10549-017-4167-y CrossRefPubMedGoogle Scholar
  50. 50.
    Caudle AS, Gonzalez-Angulo AM, Hunt KK et al (2011) Impact of progression during neoadjuvant chemotherapy on surgical management of breast cancer. Ann Surg Oncol 18:932–938.  https://doi.org/10.1245/s10434-010-1390-8 CrossRefPubMedPubMedCentralGoogle Scholar
  51. 51.
    Boughey JC, Peintinger F, Meric-Bernstam F et al (2006) Impact of preoperative versus postoperative chemotherapy on the extent and number of surgical procedures in patients treated in randomized clinical trials for breast cancer. Ann Surg 244:464–470.  https://doi.org/10.1097/01.sla.0000234897.38950.5c PubMedPubMedCentralGoogle Scholar
  52. 52.
    Bossuyt V, Provenzano E, Symmans WF et al (2015) Recommendations for standardized pathological characterization of residual disease for neoadjuvant clinical trials of breast cancer by the BIG-NABCG collaboration. Ann Oncol 26:1280–1291.  https://doi.org/10.1093/annonc/mdv161 CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Volders JH, Haloua MH, Krekel NMA et al (2016) Neoadjuvant chemotherapy in breast-conserving surgery—consequences on margin status and excision volumes. Eur J Surg Oncol EJSO 42:986–993.  https://doi.org/10.1016/j.ejso.2016.02.252 CrossRefPubMedGoogle Scholar
  54. 54.
    Houssami N, Macaskill P, Marinovich ML, Morrow M (2014) The association of surgical margins and local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy: a meta-analysis. Ann Surg Oncol 21:717–730.  https://doi.org/10.1245/s10434-014-3480-5 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Buchholz TA, Mittendorf EA, Hunt KK (2015) Surgical considerations after neoadjuvant chemotherapy: breast conservation therapy. JNCI Monogr 2015:11–14.  https://doi.org/10.1093/jncimonographs/lgv020 CrossRefGoogle Scholar
  56. 56.
    Murthy V, Chamberlain RS (2013) Defining a place for nipple sparing mastectomy in modern breast care: an evidence based review. Breast J 19:571–581.  https://doi.org/10.1111/j.1524-4741.2011.01220.x CrossRefPubMedGoogle Scholar
  57. 57.
    Mota BS, Riera R, Ricci MD et al (2016) Nipple- and areola-sparing mastectomy for the treatment of breast cancer. Cochrane Database Syst Rev 11:CD008932.  https://doi.org/10.1002/14651858.CD008932.pub3 PubMedPubMedCentralGoogle Scholar
  58. 58.
    Santoro S, Loreti A, Cavaliere F et al (2015) Neoadjuvant chemotherapy is not a contraindication for nipple sparing mastectomy. Breast Edinb Scotl 24:661–666.  https://doi.org/10.1016/j.breast.2015.08.001 CrossRefGoogle Scholar
  59. 59.
    Wengler CA, Valente SA, Al-Hilli Z et al (2017) Determinants of short and long term outcomes in patients undergoing immediate breast reconstruction following neoadjuvant chemotherapy. J Surg Oncol 116:797–802.  https://doi.org/10.1002/jso.24741 CrossRefPubMedGoogle Scholar
  60. 60.
    Song J, Zhang X, Liu Q et al (2014) Impact of neoadjuvant chemotherapy on immediate breast reconstruction: a meta-analysis. PloS ONE 9:e98225.  https://doi.org/10.1371/journal.pone.0098225 CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Masuda N, Lee S-J, Ohtani S et al (2017) Adjuvant capecitabine for breast cancer after preoperative chemotherapy. N Engl J Med 376:2147–2159.  https://doi.org/10.1056/NEJMoa1612645 CrossRefPubMedGoogle Scholar
  62. 62.
    Huang EH, Tucker SL, Strom EA et al (2004) Postmastectomy radiation improves local-regional control and survival for selected patients with locally advanced breast cancer treated with neoadjuvant chemotherapy and mastectomy. J Clin Oncol Off J Am Soc Clin Oncol 22:4691–4699.  https://doi.org/10.1200/JCO.2004.11.129 CrossRefGoogle Scholar
  63. 63.
    Autier P, Boniol M, La Vecchia C et al (2010) Disparities in breast cancer mortality trends between 30 European countries: retrospective trend analysis of WHO mortality database. BMJ 341:c3620CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Hospital Israelita Albert EinsteinSão PauloBrazil
  2. 2.Instituto do Câncer do Estado de São Paulo (Icesp) – Faculdade de Medicina da Universidade de São Paulo (FMUSP)São PauloBrazil
  3. 3.Hospital Municipal Dr Cámino CaricchioSão PauloBrazil
  4. 4.Beneficência PortuguesaSão PauloBrazil
  5. 5.Escola de Medicina da Pontifícia Universidade Católica do Rio Grande do Sul (PUC-RS)Porto AlegreBrazil
  6. 6.Sociedade Brasileira de Mastologia (Gestão 2017-2019)Rio de JaneiroBrazil

Personalised recommendations