Fellowship from São Paulo to Toronto: sharing of skills in breast cancer clinical practice

13 June 2019

Dr Maysa Silveira, Resident of Clinical Oncology

A. C. Camargo Cancer Center, São Paulo, Brazil

I work as a clinical oncologist resident in A.C. Camargo Cancer Center in São Paulo, Brazil, a large cancer center with many patients from both public and private health care plans. We do research to improve our services to help patients from all regions of Brazil. A.C. Camargo Cancer Center is an educational center too, so I can exchange knowledge with other health care professionals, oncology residents, and physicians.

In women, breast cancer is the most commonly diagnosed cancer and the leading cause of cancer death1, and in Brazil, it accounts for approximately 30% of all new cancer diagnoses and is responsible for 16.2% of all cancer deaths2. Brazil is expected to have about 59,700 new cases of breast cancer in 2019, with an estimated risk of 56.33 cases for every 100 thousand women3. The triple-negative (ER−/PR−/HER2−) breast cancer subtype is aggressive in nature and represents 15 to 20% of all invasive breast cancers. Early detection plays a key role in effective treatment4.

A huge challenge ahead

Nowadays, public health care is a big concern worldwide, especially in low- and middle-income countries, where the problems outnumber the resources by far. We, Brazilian doctors, are called to cope with a true riddle: how can we offer good care for our patients, in a reasonable time and with societal value for money? It is a huge challenge!

Why do research?

Studying and practicing clinical oncology raises several questions, and I feel compelled to take part in trying to solve them instead of merely waiting for answers. This goal inspired me to research new therapies, as well as therapies that are already available, but which can be optimized, refining patient selection for cancer therapy, public health care, and value-based medicine.

From Canada to Brazil

'The aim of my one-month fellowship visit to UICC member organisation Princess Margaret Cancer Centre, Toronto was to investigate the benefit of using adjuvant chemotherapy with the drug Capecitabine in triple negative breast cancer patients, who are at particular risk of disease recurrence, and to try to introduce this treatment as a standard in Brazilian public health care.'

Dr Maysa Silveira with colleague Dr Ricardo L. Coelho

It was an amazing opportunity to improve my knowledge of breast cancer and women’s health. I appreciated the great learning experience that I had with Drs Eitan Amir and Ramy Saleh. I returned home with many insights into the Canadian public health care system and its approach to value-based medicine and the interactions between patients, physicians, and health care.

Our research demonstrated the benefit of using the chemotherapeutic drug Capecitabine as an adjuvant to treat patients with high-risk (residual cancer burden, RCB-2, and RCB-3) triple-negative breast cancer to support their disease-free survival.

In Brazil, women in public health care don’t have access to adjuvant Capecitabine for high-risk breast cancer, but now we are accumulating data to support a claim in order to change this practice.

The results of this research will be important to rethink the formulation of health financing strategies and to try to add this treatment as a standard in the Brazilian public health system for triple negative breast cancer patients with a high burden of residual disease after standard neoadjuvant chemotherapy.


Dr Maysa Silveira with host supervisor from TorontoDr Eitan Amir (right)home supervisor in Brazil Dr Marcelo Corassa (left)

Future plans

I intend to apply and disseminate this knowledge among Brazilian health care professionals through meetings and educational events and also to continue studying and researching. I strongly believe that evidence-based medicine is the best way to improve standards of health for our community and to make a difference in health care at different levels, in politics, science, and education.

I would like to thank my mentors Dr Eitan Amir and Dr Ramy Salleh, the Breast Clinic Team and pharmaceutical professionals who welcomed me and gave me their support. I also would like to thank my Brazilian mentor Dr Marcelo Corassa for having supported my idea and the fellows that participated during the research, Dr Ricardo L. Coelho and Dr Marcos Teixeira. And, of course, thanks for the funding provided by the UICC Technical Fellowship for this outstanding opportunity.



1. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA and Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.  CA Cancer J Clin. 2018 Nov;68(6):394-424. doi.org/10.3322/caac.21492

2. Estatísticas de câncer. MS. INCA. Instituto Nacional de Câncer. Published on 21/05/2019. Website: https://www.inca.gov.br/numeros-de-cancer

3. Estimativa 2018: incidência de câncer no Brasil / Instituto Nacional de Câncer José Alencar Gomes da Silva. Coordenação de Prevenção e Vigilância. – Rio de Janeiro: INCA, 2017. Website: http://www1.inca.gov.br/estimativa/2018/sintese-de-resultados-comentarios.asp

4. Brown M, Tsodikov A, Bauer KR, Parise CA, Caggiano V. The role of human epidermal growth factor receptor 2 in the survival of women with estrogen and progesterone receptor-negative, invasive breast cancer: the California Cancer Registry, 1999-2004. Cancer. 2008 Feb 15;112(4):737-47. doi: 10.1002/cncr.23243.

About the author

Dr Maysa Silveria MD attended medical school at Universidade Comunitária da Região de Chapecó in Brazil before completing a residency in internal medicine at Hospital Heliópolis in São Paulo. She is currently carrying out a residency in medical oncology at UICC member organisation AC Carmargo Cancer Center, São Paulo where she also performs research in clinical oncology. Her research interests include immunotherapy and biology of breast cancer, melanoma, and lung cancer.

Last update: 
Friday 21 June 2019