Among the clinical parameters studied, only tumor size was correlated with metastatic involvement in axillary lymph nodes. The size of the metastases and the number of positive SLN also directly increased the possibility of systemic recurrence. The different rates of recurrence indicate that the biological significance of these types of metastases is different and that patients with SLN metastases may also have different risks of metastatic involvement of other axillary lymph nodes.

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Introduction: During primary breast cancer (BC) treatment, both systemic and local therapies are used to eliminate tumoral cells and reduce the risk of recurrence or disease progression. However, despite the efficacy and success of these treatments, most patients have their quality of life affected by some treatment-related side effects. Among them, fatigue and reductions in cardiorespiratory fitness are commonly observed in response to treatment toxicities during and even following primary treatment. To date, exercise has been considered an effective intervention to counteract these side effects. In the past few years, guidelines from the American Cancer Society, American College of Sports Medicine, and Exercise and Sport Science Australia were published highlighting the importance of being physically active before or after a cancer diagnosis. Recently, the Brazilian Clinical Oncology Society also started a new guideline in exercise and oncology. However, even with numerous studies demonstrating that exercise is effective, the relationship between its prescription variables and effects on these outcomes is unclear. Consequently, it is of great interest to understand the effects of different exercise modalities (e.g., resistance training, aerobic exercise or combined resistance, and aerobic exercise) and their effects on fatigue and cardiorespiratory fitness. Objective: The aim of this study was to describe the effects and moderators of exercise on fatigue and cardiorespiratory fitness in women with BC. Methods: This is a narrative literature review concerning the exercise effects and moderators of exercise response on fatigue and cardiorespiratory fitness in women with BC. The search was undertaken in PubMed using the following terms: “cancer” AND “exercise” AND (“fatigue” OR “cardiorespiratory fitness”) in November 2021. Given the specificity of the topic and outcomes of interest, we selected seven systematic reviews with meta-analysis to describe the exercise effects and moderators of exercise response on fatigue and cardiorespiratory fitness in BC patients. Results: In summary, the design of supervised exercise programs could benefit women with BC. In addition, exercise could result in greater effects in patients presenting higher levels of fatigue when compared to those who do not present. Some examples of supervised exercise programs are in studies from the Supervised Trial of Aerobic Versus Resistance Training (START), Combined Aerobic and Resistance Exercise (CARE), and Optimal Training Women with BC trials (OptiTrain). These studies prescribed resistance training, aerobic exercise, and combined resistance and aerobic exercise, 2–3 exercise sessions per week, 1–3 sets of 8–12 repetitions at 60–70% of one-repetition maximum (1RM) per resistance exercise, and 20–30 min of continuous or high-intensity interval aerobic exercise at 13–15 of the rated perceived exertion (RPE) scale. Regarding the exercise program prescription, supervised, high-intensity, or nonlinear schedule aerobic exercises are also associated with greater effects on cardiorespiratory fitness. The fact that supervised exercise results in greater benefits in cardiorespiratory fitness compared to unsupervised programs (supervised exercise, ES=0.34, 95%CI 0.28–0.40; unsupervised exercise, ES=0.19, 95%CI 0.07–0.32) is an important information. Conclusion: Sufficient evidence indicates that exercise promotes significant effects on fatigue and cardiorespiratory fitness in women with BC. In addition, specific subgroups of patients based on age and baseline levels appear to respond more favorably than others. Regarding contraindications, the exercise prescription should occur accordingly to and with the clearance of the oncologist and the medical team, respecting patients’ individualities, the feasible period for exercise, symptoms, and treatment course.

PvuII foi de 16,8% e 39,4% nas mulheres com câncer de mama e 10,8% e 18,3% nas sem câncer. A frequência de mutações em ESR1 XbaI, CYP3A4*1B e CYP1A1 MspI foi de 15,1, 44,2 e 3,6% nas mulheres sem câncer de mama e de 25, 22,2% e 0 nas com câncer de mama. O genótipo L/L do gene COMT foi significantemente mais frequente no grupo controle (28,9 vs. 8,6%), sugerindo que este polimorfismo poderia ser um fator protetor ao câncer de mama na população estudada.

Introduction: Breast cancer (BC) has already been extensively studied in the field of exercise oncology, with a 300% growth rate for publications in the past 12 years, after the American Society for Sports Medicine published the first roundtable for exercise in cancer survivors. However, even with numerous studies demonstrating effectiveness, there is a lack of information for health-care professionals, including breast surgeons and clinical oncologists, and also for patients and caregivers. Despite this, specialized programs and exercise professionals trained to support this population are rare, and it is not different in Brazil. Maple Tree Cancer Alliance (MTCA) is a nonprofit organization working with cancer patients since 2011 in the United States. In 2019, an international process was started, and the first unit outside the United States started operating in 2020 in Brazil. The exercise protocol developed by the MTCA includes resistance training and aerobic modalities, prescribed in a phase system, according to the kind of treatment the person is doing for cancer, and also according to cardiovascular fitness and previous experiences. Patients were followed for a period of 12–48 weeks, and assessments were done before starting, every 12 weeks. Objective: The aim of this study was to describe the first-year experience for MTCA in Brazil, until December 2021. Methods: Every patient starting the MTCA program performs an initial assessment, to get information about the disease, treatment, cardiovascular fitness, and corporal measures. The assessments are repeated in a 12-week interval. Parameters like weight, body mass index (BMI), body weight (with bioimpedance), muscle strength, flexibility, cardiovascular fitness, and postural evaluation are scored and compared with previous analysis during the patient’s participation. Results: During the first year of operating in Brazil, the MTCA performed 107 physical assessments. Of these, 86 were BC patients, either during (chemotherapy, radiotherapy, or hormone therapy) or post-treatment (80.37%). In all, 20 patients did not continue the exercise program (23.25%), and there were 2 deaths (2.32% — all patients in this group started the program as metastatic BC). The mean age was 50.69 years old (26– 79 years old). We observed in the BC patients, as reported in the literature, higher rates of overweight and obesity: mean BMI was 28.57 kg/m2 (ranging from 19.1 to 47 kg/m2 ). Overweight and obese patients correspond to 75.6% according to the first assessment measure. Comparing initial assessment and the first reassessment, 40 patients have completed the first phase of MTCA training, 45% lost weight, 47.5% gained, and 7.5% were stable. The mean weight gain was 3.49 kg and the mean weight loss was 1.9 kg. Treatment phase was not considered in this observation. We also observed some resistance for health-care professionals in authorizing the participation in exercise for metastatic patients. It is important to score that the same benefits are seen in this group of patients, especially with regard to treatment side effects, and we already have a recently published guideline for exercise in bone metastasis scenery. Conclusion: Many challenges were faced in the first-year experience for MTCA in Brazil. Despite legal bureaucracy, engaging patients, clinicians, and breast surgeons in exercise oncology is certainly difficult, especially for metastatic patients. We could observe a high rate of BC patients and survivors in overweight and obesity, and with resistance to nutritional education and to change their life habits. It is important that health-care professionals encourage their patients to participate in exercise protocols, but also in nutritional education. Patient reports are unanimous for a better quality of life and less side effects after engaging in the exercise program. As an ongoing work, we hope to decrease the dropout rate and improve weight loss and also deliver the standard exercise program from MTCA to other cities in Brazil.