Jerônimo, Aline Ferreira de Araújo; Freitas, Ângela Gabrielly Quirino; Weller, Mathias

doi:10.1590/1413-81232017221.09272015

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Sumário

Review • Ciênc. saúde colet. 22 (1) • Jan 2017 • https://doi.org/10.1590/1413-81232017221.09272015 copiar

Fatores de risco do câncer de mama e o conhecimento sobre a doença: revisão integrativa de estudos Latino Americanos

Autoria SCIMAGO INSTITUTIONS RANKINGS

Resumo

Esta revisão teve por objetivo comparar a literatura Latino-Americana sobre o conhecimento da neoplasia mamária e seus fatores de risco. Foram selecionados 47 estudos, dos quais 27 eram sobre o risco de desenvolver câncer de mama e 20 sobre o conhecimento ou a consciência sobre a doença. Os estudos sobre fatores de risco eram principalmente do tipo caso-controle e sua maioria estava no idioma Inglês. Já as pesquisas sobre conhecimento eram, sobretudo, do tipo transversal e foram publicadas nos idiomas Português e Espanhol. As pesquisas sobre conhecimento destacaram o diagnóstico precoce da neoplasia mamária, e o autoexame da mama foi o método de detecção mais abordado (N = 14). Por outro lado, os estudos sobre fatores de risco avaliaram, principalmente, sobrepeso (N = 14), historia familiar (N = 13), baixa paridade (N = 12) e curto período de amamentação (N = 10). Fatores socioeconômicos, como a renda e o nível educacional tiveram efeitos variáveis e afetaram também o conhecimento das mulheres sobre fatores de risco e detecção precoce. Os resultados da pesquisa indicaram que os estudos sobre fatores de risco do câncer de mama apresentaram melhor delineamento metodológico e fundamentação teórica, comparado com os estudos sobre conhecimento que foram na maioria dos casos descritivos.

Palavras-chave
Câncer de mama; Diagnóstico precoce; Fatores de risco; Conscientização

	PubMed	SciELO	Duplicates^ Found in more than one database or found two times by different search terms.	All selected
Search terms: “Breast cancer” and “risk”
Without filter	55401	417	–
With filter^* * Full text articles published within the last five years.	7596	–	–
Selected	19	14	6	27
Search terms: “Breast cancer” and “knowledge”
Without filter	9317	137	–
With filter^* * Full text articles published within the last five years.	1566	–	–
Selected	6	17	6	17
Search terms: “Breast cancer” and “awareness”
Without filter	2064	38
With filter^* * Full text articles published within the last five years.	399	–
Selected	2	3	2	3
Total number of articles selected				47

Reference	Country and Language^* * Studies were mainly written in English (χ2- Test; p = 0.0094).	Sample Size^ The average sample number was 363.0 cases (t- Test; p = 0.0552). and Type	Methodological approach		Objective (RF/ED)
Reference			Type of Study	Analysis	Objective (RF/ED)
Amadou et al., 2013²¹21. Amadou A, Fabre A, Torres-Mejía G, Ortega-Olvera C, Angeles-Llerenas A, McKenzie F, Biessy C, Hainaut P, Romieu I. Hormonal Therapy and Risk of Breast Cancer in Mexican Women. PLos ONE 2013; 8(11):e79695.	Mexico English	1000 BC cases 1074 controls	Case-control	Multivariate	RF
Amadou et al., 2014³⁰30. Amadou A, Torres Mejía G, Fagherazzi G, Ortega C, Angeles-Llerenas A, Chajes V, Biessy C, Sighoko D, Hainaut P, Romieu I. Anthropometry, Silhouette Trajectory, and Risk of Breast Cancer in Mexican Women. Am J Prev Med 2014; 46(3Supl. 1):S52-S64.	Mexico English	1000 BC cases 1074 controls	Case-control	Multivariate	RF
Balderas-Penña et al., 2013³¹31. Balderas-Peña LMA, Sat-Muñoz D, Cervantes JMC, Ramírez-Orozco RE, Ángeles-Bueno WG, Flores-Márquez MR, Macías-López GG, Ruiz-Quezada SL, Salcedo-Rocha AL, Alba-García JEG, Solano-Murillo P. Porcentaje de adiposidad y su relación con el índice de inmunorreactividad de los receptores hormonales en mujeres mexicanas con cáncer de mama. Nutr Hosp 2013; 28(4):1321-1329.	Mexico Spanish	43 healthy women	Cross-sectional	Univariate	RF
Bering et al., 2015³²32. Bering T, Mauricio SF, Silva JB, Correia MITD. Nutritional and metabolic status of breast cancer women. Nutr Hosp 2015; 31(2):751-758.	Brazil English	78 BC cases	Cross-sectional	Univariate	RF
Matos et al., 2010²²22. Matos JC, Pelloso SM, Carvalho MDB. Prevalence of Risk Factors for Breast Neoplasm in the City of Maringá, Paraná State, Brazil. Rev Latino-Am Enfermagem 2010; 18(3):352-359.	Brazil Portuguese	439 healthy women	Cross sectional	Multivariate	RF
Matos et al., 2011³³33. Matos JC, Pelloso SM, Carvalho MDB. Fatores associados à realização da prevenção secundária do câncer de mama no Município de Maringá, Paraná, Brasil. Cad Saude Publica 2011; 27(5):888-898.	Brazil Portuguese	439 healthy women	Cross-sectional	Multivariate	ED
Fejerman et al., 2010³⁴34. Fejerman L, Romieu I, John EM, Lazcano-Ponce E, Huntsman S, Beckman KB, Pérez-Stable EJ, Burchard EG, Ziv E, Torres-Mejía G. European Ancestry Is Positively Associated with Breast Cancer Risk in Mexican Women. Cancer Epidemiol Biomarkers Prev 2010; 19(4):1074-1082.	Mexico English	846 BC cases 1035 controls	Case- control	Multivariate	RF
Garmendia et al., 2013³⁵35. Garmendia ML, Ruiz P, Uauy R. Obesidad y cáncer en Chile: estimación de las fracciones atribuibles poblacionales. Rev Med Chile 2013; 141(8):987-994.	Chile Spanish	Database	Ecological	Univariate	RF
Girianelli et al., 2014³⁶36. Girianelli VR, Gamarra CJ, Silva GA. Disparities in cervical and breast cancer mortality in Brazil. Rev Saude Publica 2014; 48(3):459-467.	Brazil English	Database	Ecological	Univariate	RF
Inumaru et al., 2012³⁷37. Inumaru LE, Quintanilha MIGD, Silveira EA, Naves MMV. Risk and Protective Factors for Breast Cancer in Midwest of Brazil. J Environ Public Health 2012; (2012):1-9.	Brazil English	93 BC cases 186 controls	Case-control	Multivariate	RF
Iwasaki et al., 2011³⁸38. Iwasaki M, Kasuga Y, Yokoyama S, Onuma H, Nishimura H, Kusama R, Hamada GS, Nishimoto IN, Maciel MS, Motola Júnior J, Laginha FM, Anzai R, Tsugane S. Comparison of postmenopausal endogenous sex hormones among Japanese, Japanese Brazilians, and non-Japanese Brazilians. BMC Medicine 2011; 9(16):1-11.	Brazil-Japan English	363 healthy women	Cross-sectional	Multivariate	RF
López-Carrillo et al., 2010³⁹39. López-Carrillo L, Hernández-Ramírez RU, Calafat AM, Torres-Sánchez L, Galván-Portillo M, Needham LL, Ruiz-Ramos R, Cebrián ME. Exposure to Phthalates and Breast Cancer Risk in Northern Mexico. Environ Health Perspect 2010; 118(4):539-544.	Mexico English	233 BC cases 221 controls	Case-control	Multivariate	RF
López-Carrillo et al., 2014²⁸28. López-Carrillo L, Torres-Sánchez L, Blanco-Muñoz J, Hernández-Ramírez RU, Knaul FM. Utilización correcta de las técnicas de detección de cáncer de mama en mujeres mexicanas. Salud Pública de México 2014; 56(5):538-546.	Mexico Spanish	1030 healthy women	Cross-Sectional	Multivariate	ED
Pereira et al., 2012⁴⁰40. Pereira A, Garmendia ML, Alvarado ME, Albala C. Hypertension and the Risk of Breast Cancer in Chilean Women: a Case-control Study. Asian Pacific J Cancer Prev 2012; 13(11):5829-5834.	Chile English	170 BC cases 170 controls	Case-control	Multivariate.	RF
Ronco et al., 2011⁴¹41. Ronco AL, De Stefani E, Correa P, Deneo-Pellegrini H, Boffetta P, Acosta G, Mendilaharsu M. Dietary Benzo[a]pyrene, Alcohol Drinking, and Risk of Breast Cancer: a Case-control Study in Uruguay. Asian Pacific J Cancer Prev 2011; 12(6):1463-1467.	Uruguay English	460 BC cases 638 controls	Case-control	Multivariate	RF
Ronco et al., 2012⁴²42. Ronco AL, De Stefani E, Deneo-Pellegrini H, Quarneti A. Diabetes, Overweight and Risk of Postmenopausal Breast Cancer: A Case-Control Study in Uruguay. Asian Pacific J Cancer Prev 2012; 13(1):139-146.	Uruguay English	367 BC cases 545 controls	Case-control	Multivariate	RF
Ronco et al., 2012⁴³43. Ronco AL, De Stefani E, Deneo-Pellegrini H. Risk Factors for Premenopausal Breast Cancer: A Case-control Study in Uruguay. Asian Pacific J Cancer Prev 2012; 13(6):2879-2886.	Uruguay English	253 BC cases 497 controls	Case-control	Multivariate	RF
De Stefani et al., 2011⁴⁴44. De Stefani E, Moore M, Aune D, Deneo-Pellegrini H, Ronco AL, Boffetta P, Correa P, Acosta G, Mendilaharsu M, Luaces M, Silva C, Landó G. Maté Consumption and Risk of Cancer: a Multi-site Case- Control Study in Uruguay. Asian Pacific J Cancer Prev 2011; 12(4):1089-1093.	Uruguay English	8875 BC cases 4326 controls	Case- Control	Multivariate	RF
De Stefani et al., 2012⁴⁵45. De Stefani E, Boffetta P, Ronco AL, Deneo-Pellegrini H, Correa P, Acosta G, Mendilaharsu G, Luaces ME, Silva C. Processed meat consumption and risk of cancer: a multisite case-control study in Uruguay. Br J Cancer 2012; 107(9):1584-1588.	Uruguay English	3528 cases of different cancers 2532 controls	Case–control	Multivariate	RF
Cordero et al., 2012⁴⁶46. Cordero MGA, Sánchez MN, López CAP, Ramírez MLP, Rillo AG, López AMS. Factores de riesgo como pronóstico de padecer cáncer de mama en un estado de México. Nutr Hosp 2012; 27(5):1631-1636.	Mexico Spanish	115 BC cases 115 controls	Case-control	Multivariate	RF
Cabello et al., 2013⁴⁷47. Cabello G, Valenzuela-Estrada M, Siques P, Brito J, Parra E, Valdivia U, Lavin C, Manríquez A, Ortega A. Relation of Breast Cancer and Malathion Aerial Spraying in Arica, Chile. Int J Morphol 2013; 31(2):640-645.	Chile English	158 BC cases	Cross-sectional	Univariate	RF
Calderón- Garciduenñas et al., 2012⁴⁸48. Calderón-Garcidueñas AL, Sanabria-Mondragón M, Hernández-Beltrán L, López-Amador N, Cerda-Flores RM. Mammographic Breast Density Patterns in Asymptomatic Mexican Women. Radiology Research and Practice 2012; 2012:127485.	Mexico English	300 healthy women	Cross-sectional	Multivariate	ED
Rodríguez et al., 2013²³23. Rodríguez CC, Biset AED, Mayeta YB. Factores de riesgo de cáncer de mama en mujeres pertenecientes a um consultorio médico del Centro Urbano “José Martí”. MEDISAN 2013; 17(9):4089-4095.	Cuba Spanish	70 BC cases	Cross sectional	Descriptive	RF
Ferri et al., 2010⁴⁹49. Ferri NN, Felice a Ferri A, Francisco a Ferri A, Brunicardi AH, Franco AT, Franco AM. Cáncer de mama e índice de masa corporal en mujeres posmenopáusicas. Rev Venez Oncol 2010; 22(2):94-102	Venezuela Spanish	100 BC cases 103 controls	Case-control	Univariate	RF
Font-Gonzalez et al., 2013⁵⁰50. Font-Gonzalez A, Piñeros M, Vries E. Self-reported early detection activities for breast cancer in Colombia in 2010: impact of socioeconomic and demographic characteristics. Salud Publica Mex 2013; 55:368-378.	Colombia English	Database 27.116 healthy women	Cross-sectional	Multivariate	ED
Hernández et al., 2010⁵¹51. Hernández D, Borges R, Márquez G, Betancourt L. Factores de riesgo conocidos para cáncer de mama. Rev Venez Oncol 2010; 22(1):16-31.	Venezuela Spanish	507 BC cases 505 controls	Case-control	Multivariate	RF
Ospina-Diíaz et al., 2011²⁹29. Ospina Díaz JM, Manrique Abril FG, Vega NA, Morales Pacheco AL, Ariza RNE. La no realización del autoexamen de mama en Tunja, Colombia. Enfermaría Global 2011; 10(3):30-40.	Colombia Spanish	218 BC cases 225 controls	Case-control	Univariate.	ED

Risk Factor	Reference
Early detection
No mammography	22, 28, 33, 50
No clinical breast examination	22, 28, 33, 50
No BSE	22, 28, 29, 33, 50
Reproductive
Early age at menarche	21, 22, 23, 32, 34, 38, 39, 41, 42, 43, 46, 48
Positive status of menopause	22, 23, 31, 32, 34, 38, 40, 41, 42, 43, 46, 48, 51
Nulliparity or decreased parity	21, 22, 30, 34, 38, 39, 40, 41, 42, 43, 46, 51
Short total breastfeeding time	21, 22, 23, 30, 34, 39, 42, 43, 46, 51
Old age at first gestation	21, 30, 38, 39, 42, 46
Lifestyle- related
Smoking	22, 23, 38, 40, 46, 48
High alcohol consumption	21, 22, 30, 34, 38, 40, 41, 42, 46, 48
No physical exercise and sedentarism	21, 23, 29, 30, 37, 38, 40, 42, 43, 46
Overweight and obesity	21, 22, 23, 31, 32, 34, 35, 38, 40, 42, 43, 46, 48, 49
Diet rich in fried foods and/or meat	21, 40, 41, 42, 43, 44, 45, 50
Diet poor in vegetables and fruits	43
Increased caloric intake	30, 34
Decreased BMI	30, 34
Increased BMI	32, 38, 46
Round body shape (Endomorphy)	30, 32, 41
Diabetes	42
Hypertension	31, 40, 42, 43
Hormone replacement therapy	21, 22, 30, 32, 34, 40, 48
Use of contraceptives	21, 30, 40, 42, 43
Harmful hormone concentrations	32, 38
Ethical, socioeconomic and environment factors
Increased educational level	34, 36, 40
Decreased educational level	22, 29, 37, 50
Increased HDI	36
Lower income	22, 29, 37, 50
Higher income	22, 30, 34
No Caucasian or Caucasian ancestry	34, 50
Rural living place	37, 41, 50
Chemical contaminants	39, 47
Age and history of breast cancer
Family history of breast cancer	21, 22, 23, 30, 34, 37, 40, 41, 42, 43, 47, 48, 51
Personal history of breast cancer	22, 34, 51
Older age	28, 30, 32, 33, 34, 37, 39, 40, 41, 42, 47, 50

Reference	Country and Language	Sample Size and type	Methodological approach^* * Authors did not perform case- control studies (χ2- Test; p < 0.0001) and most studies were purely descriptive (χ2- Test; p < 0.0001).	Objective (RF/ED)^ Most studies focused exclusively on early detection (χ2- Test; p < 0.0001).
Banegas et al., 2012²⁴24. Banegas MP, Puschel K, Martínez-Gutiérrez J, Anderson JC, Thompson B. Perceived and Objective Breast Cancer Risk Assessment in Chilean Women Living in an Underserved Area. Cancer Epidemiol Biomarkers Prev 2012; 21(10):1716-1721.	Chile English	500 healthy women	Multivariate	RF
Silva, Riul, 2011⁶⁴64. Silva PA, Riul SS. Câncer de mama: fatores de risco e detecção precoce. Rev Bras Enferm 2011; 64(6):1016-1021.	Brazil Portuguese	18 BC cases	Descriptive	ED
Silva et al., 2013²⁵25. Silva TB, Mauad EC, Carvalho AL, Jacobs LA, Shulman LN. Difficulties in implementing an organized screening program for breast cancer in Brazil with emphasis on diagnostic methods. Rural and Remote Health 2013; 13:2321.	Brazil English	248 BC cases	Univariate	ED
Schneider et al., 2013²⁶26. Schneider IJC, Corseuil MW, Boing AF, D’Orsi E. Knowledge about mammography and associated factors: population surveys with female adults and elderly. Rev Bras Epidemiol 2013; 16(4):930-942.	Brazil English	1899 healthy women	Univariate	ED
Grego et al., 2011⁵²52. Grego MC, Ohara CVS, Pereira SR, Brêtas JRS. Workshop on breast self-examination: a strategy for selfknowledge of adolescents. Acta Paul Enferm 2011; 24(4):493-499.	Brazil English	474 adolescent women	Descriptive	RF and ED
Kim et al., 2010⁵³53. Kim DD, Araujo ALL, Tsai AIA, Kojima FH, Takashima JSI, Otsuka Júnior LF, Gamboa RAB, Kimura R, Sugawara RT, Tambellini EF, Silveira C, Oliveira RLS. Saber é prevenir: uma nova abordagem no combate ao câncer de mama. Cien Saude Colet 2010; 15(1):1377-1381.	Brazil Portuguese	72 healthy women	Descriptive	ED
Hechavarría et al., 2011⁵⁴54. Hechavarría GAP, Cortés JTA, Capdesuñer AS, Selva OTG, Hechavarría ARP. Actividades educativas en mujeres com factores de riesgo de cáncer de mama. MEDISAN 2011; 15(6):754-761.	Cuba Spanish	94 healthy women	Univariate	ED
Sáez et al., 2011⁵⁵55. Sáez IH, Sáez YG, Benítez LYH, Cardoso AAH, Martín MC, Oliva SA. Intervención educativa sobre detección precoz del cáncer de mamas. Revista Archivo Médico Camaguey 2011; 15(3):487-503.	Cuba Spanish	54 BC cases	Descriptive	RF and ED
Jacobo-Galindo et al., 2014⁶³63. Jacobo-Galindoa T, Villalobos-Arámbulab L, Gallegos-Torresc R, Xeque-Moralesd AS, Reyes-Rochae B, Palomé-Vegaf G. Patrones de comportamiento para la detección de CA mamario em trabajadoras de una institución hospitalaria. Enfermería Universitaria 2014; 11(3):101-109.	Mexico Spanish	105 healthy women	Descriptive	ED
Munñoz et al., 2012⁶⁵65. Muñoz LM, Sánchez LC, Menes ML, Almaguer CC, López MCM. Valoración del conocimiento del autoexamen de mama en mujeres en edad reproductiva del Policlínico Bernardo Posse. Revista Habanera de Ciencias Médicas 2012; 11(3):361-368.	Cuba Spanish	80 healthy women	Descriptive	ED
Guerrero et al., 2011⁵⁶56. Guerrero GEM, Rodríguez YH, Martínez AMF. Acciones instructivas en mujeres con riesgo de padecer cáncer de mama. Revista Cubana de Obstetricia y Ginecología 2011; 37(4):541-550.	Cuba Spanish	119 healthy women	Descriptive	RF and ED
Gomes et al., 2012⁶⁶66. Gomes LMX, Alves MC, Santos TB, Andrade-Barbosa TL, Leite MTS. Conhecimento e prática do autoexame das mamas por acadêmicas de enfermagem. Revista Cubana de Enfermería 2012; 28(4):465-473.	Brazil Portuguese	202 healthy women	Descriptive	ED
Brito et al., 2010⁵⁸58. Brito LMO, Chein MBC, Brito LGO, Amorim AMM, Marana HRC. Conhecimento, prática e atitude sobre o autoexame das mamas de mulheres de uma cidade do Nordeste do Brasil. Rev Bras Ginecol Obstet 2010; 32(5):241-246.	Brazil Portuguese	552 healthy women	Multivariate	ED
Montanñez et al., 2011⁵⁷57. Montañez SP, Alemán IR, Capdesuñer AS, Palácios MC. Modificación de conocimientos sobre cáncer de mama en trabajadoras com factores de riesgo de la enfermedad. MEDISAN 2011; 15(1):92-98.	Cuba Spanish	30 healthy women	Univariate	RF and ED
Freitas et al., 2011⁶⁷67. Freitas CRP, Terra KL, Mercês NNA. Conhecimentos dos acadêmicos sobre prevenção do câncer de mama. Rev Gaúcha Enferm 2011; 32(4):682-687.	Brazil Portuguese	50 healthy women	Descriptive	RF
Silva et al., 2013⁶⁰60. Silva NRA, Soares DA, Jesus SR. Conocimiento y práctica del autoexamen de mamas por usuarias de la Unidad de Salud de la Familia. Rev Enfermería Global 2013; 12(29):463-476.	Brazil Spanish	116 healthy women	Univariate	ED
González et al., 2012⁶⁸68. González JR, González AR, Torres AT, Taño RM. Conocimientos de los factores de riesgo sobre cáncer de mama en Puerto La Cruz, estado Anzoátegui, Venezuela. Revista Habanera de Ciencias Médicas 2012; 11(5):673-683.	Venezuela Spanish	1525 healthy women	Descriptive	RF and ED
Santos, Chubaci, 2011⁶⁹69. Santos GD, Chubaci RYS. O conhecimento sobre o câncer de mama e a mamografia das mulheres idosas frequentadoras de centros de convivência em São Paulo (SP, Brasil). Cien Saude Colet 2011; 16(5):2533-2540.	Brazil Portuguese	98 healthy women	Univariate	ED
Batiston et al., 2011²⁷27. Batiston AP, Tamaki EM, Souza LA, Santos MLM. Conhecimento e prática sobre os fatores de risco para o câncer de mama entre mulheres de 40 a 69 anos. Rev. Bras. Saúde Matern Infant 2011; 11(2):163-171.	Brazil Portuguese	393 healthy women	Univariate	RF and ED
Curiel et al., 2014⁵⁹59. Curiel AT, Farías MV, Gutiérrez BLN, Carlos AAR, González ES, López JLL. Representación social que los adolescentes de Jalisco, México, tienen de la detección precoz del cáncer de Mama. Aten Primaria 2014; 46(8):408-415.	Mexico Spanish	135 healthy women	Descriptive	ED

Knowledge	Reference
Early Detection
Mammography	25, 26, 27, 53, 63, 64, 69
Clinical breast examination	25, 27, 53, 63, 64, 69
BSE	25, 52, 53, 54, 55, 56, 58, 60, 63, 64, 65, 66, 68, 69
Reproductive risk factors
Nulliparity or decreased parity	55, 68
Early age at menarche	68
Old age at first gestation	55, 68
Positive status of menopause	55, 67, 68
Short total breastfeeding time	27, 55, 67, 68
Lifestyle-related risk factors
Smoking	27, 52, 56, 68
Alcohol consumption	27, 52, 68
Use of contraceptives	56, 67
No physical exercise and sedentarism	52, 67
Diet poor in vegetables and fruits	27, 52, 67
Overweight and obesity	55, 67, 68
Hormone replacement therapy	27, 67, 68
Insufficient auto-care	27
Stress	27
Risk perception	24
Age and history of breast cancer as risk factors
Family history of breast cancer	27, 55, 56, 68
Personal history of breast cancer	27, 55, 68
Older age	55, 68

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[1] Collaboration

All the three authors contributed to acquisition of data. AFA Jerônimo contributed to creation of tables. AFA Jerônimo and AGQ Freitas contributed to manuscript draft and critical review. Study design, manuscript draft and data analysis were mainly performed by M Weller.