Mudanças no diagnóstico e tratamento das doenças da mama em 20 anos (1998 a 2008) no Hospital das Clínicas da UFMG

Abstract

Background: Breast diseases are very common in Brazil and worldwide. Among them, breast cancer can be emphasized, since its a frequent cause of morbimortality, as well as benign breast diseases, which are important as differential diagnosis of cancer and, in some cases, are risk factors for this disease. In the past 20 years, significant changes have occurred in diagnostic and therapeutic modalities of these diseases. The Hospital das Clínicas of the Federal University of Minas Gerais (HC-UFMG) is a public reference service for patients with benign and malignant breast neoplasms. In 1989, the Laboratory of Breast Pathology (LBP) of the School of Medicine was inaugurated, aiming at teaching, research and extension. Aims: The aims of this study are to evaluate how the diagnosis and treatment of breast diseases have changed, with emphasis on breast cancer, between 1989 and 2008, in the HC-UFMG. Methods: All breast pathology exams available in the LBP corresponding to the study period were reviewed. Frequencies of type of material received were compared in different time periods using the chi-square test, and patients ages using the Kruskal-Wallis test. As for breast cancer surgical treatment, a logistic regression model was fitted, having type of surgery as the response variable (total mastectomy versus breast-conserving surgery). Results: During the study period, 12,662 breast specimens were received in the LBP. Comparing the period between 1989 and 1993 and 2004 and 2008, the proportion of mammaplasties and excisional biopsies have decreased; the first, from 35.8% (716 specimens) to 20.7% (852 specimens), and the second from 31.1% (622 specimens) to 18.2% (750 specimens). Second opinion exams have increased from 1.6% (32 cases) to 11.7% (481 cases). As for histology, there has been a descrease in the proportion of normal breasts (34.9%, 698 cases, to 13.5%, 537 cases) and an increase in the proportion of breast carcinomas (23.5%, 469 cases, to 42.5%, 1694 cases). Considering the surgical technique for breast cancer treatment, 1974 cases were analysed; in 1989, 82.2% of cases (37) were submitted to total mastectomy, whereas in 2008, the proportion shifted to 46.9% (75 cases). In logistic regression, factors associated with mastectomy were surgery between 1989 and 1999, patients older age, laterality (right), larger tumour size and higher number of positive lymph nodes. Conclusions: Changes have occurred in the management of breast diseases in the HC-UFMG, both in diagnosis and in therapeutics. Those changes have reflected themselves in the proportion of types of specimens received over time, as well as in characteristics of patients submitted to exam or treatment in this service. Breast-conserving surgery for cancer treatment has become consolidated as possible treatment for patients in early disease stages.