Sentinel lymph node biopsy (SLNB) is the gold standard for the axillary evaluation of clinically node-negative early breast cancer. The ACOSOG Z0011 study demonstrated the safety of omitting axillary dissection for limited SLNB disease, with other trials confirming SLNB alone or with axillary radiotherapy (AR) as non-inferior. We followed PRISMA guidelines and registered at PROSPERO. Using Medline, Embase, and Cochrane, we reviewed randomized controlled trials (2010-2024). Outcomes, including 5-, 8-, and 10-year OS, DFS, recurrence rates, and lymphedema, were analyzed with R software and assessed for bias (Cochrane RoB) and evidence quality (GRADE). The focus was ALND vs. SLNB, alone or with AR, in cT1-T3 BC with 1-2 metastatic SLNs. Thirteen articles from seven randomized controlled trials (RCTs) were included, covering 7338 women with a follow-up period of 2.8-10 years. SLNB was associated with a 65 % lower risk of lymphedema than ALND, with no significant differences in the 5-, 8-, or 10-year OS, DFS, or recurrence rates. A meta-analysis comparing micrometastasis and macrometastasis showed no impact on outcomes, indicating that ALND may be unnecessary in either case. Recurrence rates also did not differ between SLNB and ALND, reinforcing SLNB's significantly lower lymphedema risk of SLNB. This systematic review and meta-analysis support SLNB as a safe and effective alternative to ALND in early-stage BC with 1-2 positive SLNs, providing comparable survival and recurrence outcomes, with fewer complications.

Trastuzumab has significantly improved the treatment of HER2-positive breast cancer, particularly in the neoadjuvant setting, where its combination with chemotherapy increases the pathologic complete response (pCR) rate. This retrospective cohort study assesses the implications of disparities in access to trastuzumab within the Brazilian public healthcare system, focusing on pCR, overall survival (OS) and disease-free survival (DFS) in non-metastatic, HER2-positive breast cancer patients undergoing neoadjuvant chemotherapy (NAC). The study was conducted in the Hospital Pérola Byington (PEROLA), a public institution, and in the Hospital do Servidor Público Estadual (HSPE), a private institution. pCR was defined as the absence of residual invasive or in situ tumors in the breast and axillary nodes. OS and DFS were calculated by Kaplan-Meier survival analysis for a 5-year period. From 2011 to 2020, 381 patients at PEROLA and 78 at HSPE underwent NAC. Trastuzumab availability was higher at HSPE (83.4 % vs. 60.0 %, p < 0.0001). Use of trastuzumab correlated with significantly higher pCR rates at both the PEROLA (54.3 % vs. 26.4 %, p < 0.0001) and the HSPE (52.7 % vs. 26.4 %, p < 0.0001). HER2-positive patients with pCR at HSPE also had better OS (80 % vs. 61 %, p < 0.0001) and DFS (89 % vs. 67 %, p < 0.0001) compared to those at PEROLA. There were significant differences in the provision of trastuzumab between the public and private healthcare systems, adversely affecting clinical outcomes and patient survival. The current data highlight the pressing need to address equity in cancer treatment to improve prognosis for every patient.

Breast cancer (BC) is one of the most prevalent cancers globally, with 2.3 million new cases annually in 2023. In Brazil, it is estimated that there are 74,000 new cases per year, representing 20.3 % of cancers in women in the country. Limited access to adequate treatment forces patients to seek care elsewhere, straining the healthcare system and delaying treatment initiation. This study aimed to determine the migration rate of BC patients in Brazil and specifically to analyze migration rate by stage and treatment modality, as well as its costs and possible reasons for delays. A cross-sectional observational ecological study was conducted using retrospective data on the prevalence of breast cancer in Brazil, including the number of diagnoses and treatments in each state. The study evaluated patient migration rate for treatment, with information obtained from the DATASUS - SISCAN/Cancer Information System database. The selected analysis period was from 2017 to 2022, during which all necessary variables were available. Among the 275,140 cases analyzed, 98.18 % were women. The national migration rate was 2.12 %, ranging from 0.35 % in the Northeast to 9.31 % in the Midwest. Stage IV had the highest migration rate (1.74 %), and migration rate for radiotherapy was significant in some states, reaching 100 % in specific cases. The migration rate of BC patients for treatment in Brazil shows significant regional variations, with higher rates in the Midwest and lower rates in the South. Some states exhibited a 100 % migration rate for access to radiotherapy. Stage IV patients are the most prone to migrate, and the search for radiotherapy can lead patients to move to other states. These results highlight the need for specific health policies to ensure access to treatment across the country.

Breast cancer (BC) is the most prevalent cancer among Brazilian women, yet related data remain limited. The HER2-low classification has gained significance with the advent of targeted therapies. This study aimed to assess survival outcomes of HER2-low BC compared to other subtypes in a real-world Brazilian cohort. We analyzed data from 8,485 breast cancer patients treated at Pérola Byington Hospital between 2010 and 2019. Overall survival (OS) was the primary endpoint, stratified by cancer subtype. The t-test and chi-square test evaluated variable associations, while multivariate analysis calculated odds ratios and 95% confidence intervals. Cox regression assessed survival, and Kaplan–Meier curves illustrated OS differences. The patients with HER2-low breast cancers showed significantly better overall survival than those with the triple-negative subtype (p < 0.01). However, they had significantly poorer overall survival than those with the Luminal A-like subtype (p < 0.01). The patients with triple-negative HER2-low disease had a higher risk of mortality than those with HER2-0 (p < 0.01). Finally, patients who achieved pathological complete response experienced significantly better overall survival than those who did not (p < 0.01). Our findings highlight triple negative HER2-low BC as a distinct subtype identifiable via standard immunohistochemistry, beyond just biomarker status. The study underscores the prognostic diversity among BC subtypes and emphasizes the importance of personalized treatment strategies.