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da Silva BEB, de Lemos LMD, Moura AR, Ferrari YAC, Lima MS, Santos MDO, Lima CA. Gynaecological cancer incidence and mortality trends in a Brazilian State with medium human development index: A 22-year analysis. Cancer Epidemiol 2024; 88:102493. [PMID: 38056244 DOI: 10.1016/j.canep.2023.102493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 11/03/2023] [Accepted: 11/10/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVE This study aimed to analyse trends in incidence and mortality rates of gynaecological cancer (GC) in Sergipe, a medium Human Development Index (HDI) state in northeastern Brazil during 1996-2017. METHODS Data were obtained from the Population-based Cancer Registry of Aracaju and Brazilian Mortality Information System database. We included vulvar (VUC), vaginal (VAC), cervical (CC), uterine (UC; C54-C55), ovarian (OC), placental (PC), and unspecified female genital organ cancers. Crude rates, and age-standardised incidence and mortality rates (ASIR and ASMR, respectively) were calculated using a denominator of 100,000 women. We assessed changes in trends using the annual percentage change (APC) and the average APC (AAPC), using the Joinpoint Regression Program. RESULTS From 1996-2017, GC ASIR exhibited a declining trend (AAPC: -3.1), while ASMR increased (AAPC: 2.1). CC had the highest ASIR and ASMR over the years, ranging from 11.6 to 34.3 cases and 4.2-9.0 deaths per 100,000, respectively. Annual decreases in ASIR were observed for CC (AAPC: -5.2) and VAC (AAPC: -5.5). OC saw an increase in mortality rates (AAPC: 1.9; 1996-2017), and CC experienced an increase during 1996-2003 (APC: 6.9). VUC displayed a substantial rise in ASMR from 2001 to 2009 (APC: 27.1), followed by a decrease (APC: -11.3). An increase in mortality trends for UC was observed during 1996-2004 (APC: 10.0), while its ASIR remained relatively unchanged over the years. CONCLUSION While overall GC incidence trends declined, mortality rates either increased or failed to decrease significantly. Therefore, additional efforts are required to enhance prevention, diagnosis, and treatment strategies, aimed at reducing and managing the burden of GC in the future.
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Affiliation(s)
| | | | - Alex Rodrigues Moura
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil; University Hospital, Ebserh, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Marcela Sampaio Lima
- University Hospital, Ebserh, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Carlos Anselmo Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil; University Hospital, Ebserh, Federal University of Sergipe, Aracaju, Sergipe, Brazil; Aracaju Cancer Registry, Aracaju, Sergipe, Brazil
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Santos MDO, Lima FCDSD, Martins LFL, Oliveira JFP, Almeida LMD, Cancela MDC. Estimativa de Incidência de Câncer no Brasil, 2023-2025. Rev Bras Cancerol 2023. [DOI: 10.32635/2176-9745.rbc.2023v69n1.3700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
Introdução: O câncer é um problema de saúde pública mundial. Na última década, houve um aumento de 20% na incidência e espera-se que, para 2030, ocorram mais de 25 milhões de casos novos. Estimativas do número de casos novos de câncer são uma ferramenta poderosa para fundamentar políticas públicas e alocação racional de recursos para o combate ao câncer. A vigilância do câncer é um elemento crucial para planejamento, monitoramento e avaliação das ações de controle do câncer. Objetivo: Estimar e descrever a incidência de câncer no país, Regiões geográficas, Unidades da Federação, Distrito Federal e capitais, por sexo, para o triênio 2023-2025. Método: As informações foram extraídas do Sistema de Informação sobre Mortalidade e dos Registros de Câncer de Base Populacional. Foram estimados os casos novos e suas respectivas taxas de incidência pelos modelos de predição tempo-linear ou pela razão de incidência e mortalidade. Resultados: São esperados 704 mil casos novos de câncer para o triênio 2023-2025. Excetuando o câncer de pele não melanoma, ocorrerão 483 mil casos novos. O câncer de mama feminina e o de próstata foram os mais incidentes com 73 mil e 71 mil casos novos, respectivamente. Em seguida, o câncer de cólon e reto (45 mil), pulmão (32 mil), estômago (21 mil) e o câncer do colo do útero (17 mil). Conclusão: No Brasil, por suas dimensões continentais e heterogeneidade, em termos de território e população, o perfil da incidência reflete a diversidade das Regiões geográficas, coexistindo padrões semelhantes ao de países desenvolvidos e em desenvolvimento.
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de Camargo Cancela M, de Oliveira Santos M, Migowski A, Piñeros M. Breast cancer among young women in Brazil: Differences between hospital and population-based series. Cancer Epidemiol 2022; 79:102193. [PMID: 35696767 DOI: 10.1016/j.canep.2022.102193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Marianna de Camargo Cancela
- Cancer Surveillance and Data Analysis Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil.
| | - Marceli de Oliveira Santos
- Cancer Surveillance and Data Analysis Division, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Arn Migowski
- Early Detection and Cancer Care Network Division, National Cancer Institute INCA, Rio de Janeiro, Brazil
| | - Marion Piñeros
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
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Lima CA, da Silva BEB, Hora EC, Lima MS, Brito EDAC, Santos MDO, da Silva AM, Nunes MAP, Brito HLDF, Lima MMM. Trends in prostate cancer incidence and mortality to monitor control policies in a northeastern Brazilian state. PLoS One 2021; 16:e0249009. [PMID: 33765051 PMCID: PMC7993820 DOI: 10.1371/journal.pone.0249009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 03/09/2021] [Indexed: 11/19/2022] Open
Abstract
Prostate cancer differently affects different regions of the world, displaying higher rates in more developed areas. After the implementation of prostate-specific antigen (PSA) testing, several studies described rising rates globally, but it is possible that indolent lesions are being detected given the lack of changes in mortality data. The Brazilian government recommends against PSA screening in the male population regardless of age, but the Urology Society issued a report recommending that screening should start at 50 years old for certain men and for those aged ≥75 years with a life expectancy exceeding 10 years. In this study, we examined the incidence and mortality rates of invasive prostate cancer over time in the Sergipe state of Brazil. The databases of the Aracaju Cancer Registry and Mortality Information System were used to calculate age-standardized rates for all prostate tumors (International Classification of Diseases 10th edition: C61 and D07.5) in the following age ranges: 20–44, 45–54, and ≥65 years. We identified 3595 cases of cancer, 30 glandular intraepithelial high-grade lesions, and 3269 deaths. Using the Joinpoint Regression Program, we found that the incidence of prostate cancer dramatically increased over time until the mid-2000s for all age groups, after which the rates declined. Prostate cancer mortality rates increased until 2005, followed by a non-significant annual percent change of 22.0 in 2001–2005 and a stable rate thereafter. We noticed that the increases and decreases of the incidence rates of prostate cancer were associated with the screening recommendations. Meanwhile, the increased mortality rates did not appear to be associated with decreased PSA testing; instead, they were linked to the effects of age and improvements in identification of the cause of death. Thus, we do not believe a PSA screening program would benefit the population of this study.
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Affiliation(s)
- Carlos Anselmo Lima
- Aracaju Cancer Registry, Aracaju, Sergipe, Brazil
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Programa de Pós-graduação Profissional em Gestão e Inovação Tecnológica em Saúde, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- * E-mail:
| | | | - Evânia Curvelo Hora
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Erika de Abreu Costa Brito
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Angela Maria da Silva
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Programa de Pós-graduação Profissional em Gestão e Inovação Tecnológica em Saúde, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Marco Antonio Prado Nunes
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Programa de Pós-graduação Profissional em Gestão e Inovação Tecnológica em Saúde, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Hugo Leite de Farias Brito
- Health Sciences Graduate Program, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Marcia Maria Macedo Lima
- Programa de Pós-graduação Profissional em Gestão e Inovação Tecnológica em Saúde, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Moura AR, Marques AD, Dantas MS, de Abreu Costa Brito É, do Rosário Souza M, Lima MS, Siqueira HFF, da Silva AM, Lisboa ACR, Nunes MAP, de Oliveira Santos M, Lima CA. Trends in the incidence and mortality of colorectal cancer in a brazilian city. BMC Res Notes 2020; 13:560. [PMID: 33298152 PMCID: PMC7727142 DOI: 10.1186/s13104-020-05411-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/28/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES This study was conducted to analyze the trends in colorectal cancer (CRC) incidence and mortality in the city of Aracaju, Sergipe State, Brazil, between 1996 and 2015 with Joinpoint Regression Program 4.7.0.0 and to identify the geographical distribution of CRC in the municipality. RESULTS A total of 1322 cases of CRC and 467 CRC-related deaths during the study period were included. In total, 40% of the incident cases and 43% of the deaths occurred in men, while 60% of the incident cases and 57% of the deaths occurred in women. Males who were 20 to 44 years old had the most significant trend in growth. Among women, those in the group aged 45 to 64 years had the highest observed annual percent change (APC). In both sexes, mortality was stable. Regarding the geographic distribution, there were constant hotspots in the northeast region of the municipality. This study showed a significant increase in incidence, mainly in young men between 20 and 44 years of age, but stable mortality in Aracaju.
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Affiliation(s)
- Alex Rodrigues Moura
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Adriane Dórea Marques
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Mylena Santos Dantas
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | | | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | | | - Angela Maria da Silva
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Ana Carolina Ribeiro Lisboa
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | - Marco Antonio Prado Nunes
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
| | | | - Carlos Anselmo Lima
- Aracaju Cancer Registry, Aracaju, Sergipe Brazil
- Health Sciences Graduate Program, Aracaju, Sergipe Brazil
- University Hospital, EBSERH/Federal University of Sergipe, Aracaju, Sergipe Brazil
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Lima MS, Brito ÉDAC, Siqueira HFF, Santos MDO, da Silva AM, Nunes MAP, Brito HLDF, Lima MMM, Cipolotti R, Lima CA. Trends in cervical cancer and its precursor forms to evaluate screening policies in a mid-sized Northeastern Brazilian city. PLoS One 2020; 15:e0233354. [PMID: 32428033 PMCID: PMC7236979 DOI: 10.1371/journal.pone.0233354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 05/04/2020] [Indexed: 12/04/2022] Open
Abstract
Cervical cancer is a health issue that disproportionately affects developing countries, where the Papanicolaou test (Pap smear) remains an important screening tool. Brazilian government recommendations have focused screening on the female population aged from 25 to 64 years old. In this study, we examined the incidence and mortality rates of invasive cervical cancer lesions and the incidence rates of in situ precancerous cervical lesions, aiming to calculate their respective statistics over time in a mid-sized Brazilian city, Aracaju. The 1996-2015 database from the Aracaju Cancer Registry and Mortality Information System was used to calculate age standardized rates for all invasive cervical tumors (International code of diseases, ICD-10: C53) and preinvasive cervical lesions (ICD-10: D06) in the following patient age ranges; ≤ 24, 25-34, 35-44, 45-54, 55-64 and ≥ 65 years old. We identified 1,030 cancer cases, 1,871 in situ lesions and 334 deaths. Using the Joinpoint Regression Program, we calculated the annual percentage incidence changes and our analyses show that cervical cancer incidence decreased up to 2008, increased up to 2012 and decreased again thereafter, a significant trend in all age groups from 25 years. The incidence of precursor lesions increased from 1996 to 2005 and has since decreased, a result significant in all age groups until 64 years. Cervical cancer mortality has decreased by 3.8% annually and trend analysis indicates that Pap smears have been effective in decreasing cancer incidence and mortality. However, recent trends shown here show a decreasing incidence of in situ lesions and may indicate either a real decrease or incomplete catchment. Thus, we suggest health policies should be re-considered and include sufficient screening and HPV vaccination strategies to avoid cervical cancer resurgence in the population.
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Affiliation(s)
- Marcela Sampaio Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Érika de Abreu Costa Brito
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Hianga Fayssa Fernandes Siqueira
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Angela Maria da Silva
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Marco Antonio Prado Nunes
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Hugo Leite de Farias Brito
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Rosana Cipolotti
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Carlos Anselmo Lima
- Graduate Program in Health Sciences, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- University Hospital, EBSERH, Federal University of Sergipe, Aracaju, Sergipe, Brazil
- Aracaju Cancer Registry, Aracaju, Sergipe, Brazil
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Brito ÉDAC, Lima MS, Siqueira HFF, Marques AD, Moura AR, Hora EC, Lima CA, Santos MDO, de Souza MC, da Silva AM, Brito HLDF, Cipolotti R. Assessing trends of breast cancer and carcinoma in situ to monitor screening policies in developing settings. Sci Rep 2019; 9:14144. [PMID: 31578436 PMCID: PMC6775160 DOI: 10.1038/s41598-019-50504-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Accepted: 09/13/2019] [Indexed: 12/29/2022] Open
Abstract
There have been arguments about the role of breast cancer screening at the population level, and some points of controversy have arisen, such the establishment of organized screening policies and the age at which to begin screening. The real benefit of screening has been questioned because the results of this practice may increase the diagnosis of indolent lesions without decreasing mortality due to breast cancer. The authors have proposed a study of incidence and mortality trends for breast cancer in a developing setting in Brazil to monitor the effectiveness of the official recommendations that prioritize the age group from 50 to 69 years. The database of the Cancer Registry and the Mortality Information System was used to calculate age-standardized and age-specific rates, which were then used to calculate incidence and mortality trends using the Joinpoint Regression Program. The results showed stability in trends across all ages and age-specific groups in both incidence and mortality. In conclusion, we found that incidence and mortality rates are compatible with those in regions with similar human development indexes, and trends have demonstrated stabilization. Thus, we do not endorse changes in the official recommendations to conduct screening for ages other than 50 to 69 years, nor should policy makers implement organized screening strategies.
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Affiliation(s)
- Érika de Abreu Costa Brito
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Marcela Sampaio Lima
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Adriane Dórea Marques
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Alex Rodrigues Moura
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | | | - Carlos Anselmo Lima
- Aracaju Cancer Registry, Aracaju, Sergipe, Brazil.
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil.
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil.
- Researcher, CHAMADA MS/CNPq/FAPITEC/SE/SES - No 06/2018, Sergipe, Brazil.
| | | | | | - Angela Maria da Silva
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Hugo Leite de Farias Brito
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
| | - Rosana Cipolotti
- Health Sciences Graduate Program, Aracaju, Sergipe, Brazil
- University Hospital/EBSERH/Federal University of Sergipe, Aracaju, Sergipe, Brazil
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Gil TCP, Castier MB, Gondar AFP, Sales AF, Santos MDO, de Lima FCDS, Mourilhe-Rocha R. Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension. Arq Bras Cardiol 2019; 113:677-684. [PMID: 31482990 PMCID: PMC7020880 DOI: 10.5935/abc.20190176] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/03/2019] [Accepted: 01/30/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) is the most common heart disease of genetic origin in the world population, with a prevalence of at least 1/500. The association with systemic arterial hypertension (SAH) is not uncommon, as it affects approximately 25% of the world population. Most studies aim at the differential diagnosis between these diseases, but little is known about the magnitude of this association. OBJECTIVE To compare left ventricular global longitudinal strain (GLS) in HCM patients with and without associated SAH. METHODS Retrospective cross-sectional study that included 45 patients with HCM and preserved ejection fraction, with diagnosis confirmed by magnetic resonance imaging, including 14 hypertensive patients. Transthoracic echocardiography was performed, with emphasis on left ventricular myocardial strain analysis using GLS. In this study, p < 0.05 was considered statistically significant. RESULTS Left ventricular strain was significantly lower in hypertensive individuals compared to normotensive individuals (-10.29 ± 2.46 vs. -12.35% ± 3.55%, p = 0.0303), indicating greater impairment of ventricular function in that group. Mean age was also significantly higher in hypertensive patients (56.1 ± 13.9 vs. 40.2 ± 12.7 years, p = 0.0001). Diastolic dysfunction was better characterized in hypertensive patients (p = 0.0242). CONCLUSION Myocardial strain was significantly lower in the group of patients with HCM and SAH, suggesting greater impairment of ventricular function. This finding may be related to a worse prognosis with early evolution to heart failure. Prospective studies are required to confirm this hypothesis.
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Feliciano SVM, Santos MDO, Pombo-de-Oliveira MS, de Aquino JÂP, de Aquino TA, Arregi MMU, Antoniazzif BN, da Costa AM, Formigosa LAC, Laporte CA, Lima CA, Machado NC, de Oliveira JC, Pereira LD, de Souza A, Dos Santos CMA, de Souza PCF, Venezian DB. Incidence and mortality of myeloid malignancies in children, adolescents and Young adults in Brazil: A population-based study. Cancer Epidemiol 2019; 62:101583. [PMID: 31472325 DOI: 10.1016/j.canep.2019.101583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 08/02/2019] [Accepted: 08/05/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Myeloid malignancies (MM) are heterogeneous when it comes to incidence rates and pathogenesis. These variation rates are important to generate hypotheses on causal aetiology. This study aimed to describe incidence and mortality patterns of MM among children, adolescents and young adults (cAYA) in Brazil and to evaluate trends in incidence and mortality rate overtime. METHODS Data were extracted from a dataset of 15 Population-based Cancer Registries located in five Brazilian geographical regions and calculated by age-specific, crude, and age-standardized incidence (ASR) and mortality rates per million persons. Joinpoint regression analyses were performed for trends evaluations, regionally. Annual Percent Change (APC) and Average Annual Percent Change (AAPC) were also estimated. RESULTS The overall ASR for incidence and mortality of MM in Brazil was 14.57 and 8.83 per million, respectively. The AML (non-APL AML and APL) incidence rate is 8.18 per million, whereas other MM subtypes altogether have an incidence rate of 2.62 per million, and not otherwise specified (NOS) is 3.70 per million. The analysis of incidence trends (AAPC) showed a significant decline in Manaus (-5.6%) and São Paulo (-4.7%), and a significant increase was observed in Fortaleza (5.8%). Mortality trends steadily declined in all registries, with significant declines occurring in Goiânia (-1.5%), Belo Horizonte (-2.3%), São Paulo (-2.5%), Curitiba (-2.8%) and Porto Alegre (-4.1%). CONCLUSION Our findings showed differences in the incidence and mortality rates of MM in cAYA in Brazil, geographically. Infants-AML have the highest incidence within the cAYA population (17.42 per million). There was a substantial decrease in mortality rate observed, which was interpreted as an improvement in MM recognition and therapeutic approach.
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Affiliation(s)
- Suellen Valadares Moura Feliciano
- Programa de Hematologia-Oncologia Pediátrica - PHOP, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - Marceli de Oliveira Santos
- Divisão de Vigilância e Análise de Situação, Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil
| | - Maria S Pombo-de-Oliveira
- Programa de Hematologia-Oncologia Pediátrica - PHOP, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brazil.
| | | | | | - Miren Maite Uribe Arregi
- Secretaria de Saúde do Estado do Ceará, Registro de Câncer de Base Populacional de Fortaleza, Brazil
| | - Berenice Navarro Antoniazzif
- Secretaria Estadual de Saúde de Minas Gerais, Superintendência de Epidemiologia, Registro de Câncer de Base Populacional de Belo Horizonte, Brazil
| | - Allini Mafra da Costa
- Hospital de Câncer de Barretos, Fundação Pio XII, Registro de Câncer de Base Populacional de Barretos, Brazil
| | - Lucrecia Aline Cabral Formigosa
- Coordenação Estadual de Atenção Oncológica, Secretaria Estadual de Saúde do Pará, Registro de Câncer de Base Populacional de Belém, Brazil
| | - Cyntia Asturian Laporte
- Secretaria Municipal de Saúde de Curitiba, Registro de Câncer de Base Populacional de Curitiba, Brazil
| | - Carlos Anselmo Lima
- Secretaria Estadual de Saúde, Hospital Gov. João Alves Filho, Registro de Câncer de Base Populacional de Aracaju, Brazil
| | - Nayara Cabral Machado
- Fundação Centro de Controle de Oncologia, Registro de Câncer de Base Populacional de Manaus, Brazil
| | - José Carlo de Oliveira
- Associação de Combate ao Câncer de Goiás, Registro de Câncer de Base Populacional de Goiânia, Brazil
| | - Larissa Dell'Antonio Pereira
- Secretaria Estadual de Saúde do Espírito Santo, Registro de Câncer de Base Populacional de Espírito Santo, Brazil
| | - Adriana de Souza
- Faculdade de Saúde Pública da Universidade de São Paulo, Registro de Câncer de Base Populacional de São Paulo, Brazil
| | | | - Paulo Cesar Fernandes de Souza
- Secretaria de Estado de Saúde do Mato Grosso, Superintendência de Vigilância em Saúde, Registro de Câncer de Base Populacional de Cuiabá, Brazil
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Balmant NV, Reis RDS, Santos MDO, Maschietto M, de Camargo B. Incidence and mortality of bone cancer among children, adolescents and young adults of Brazil. Clinics (Sao Paulo) 2019; 74:e858. [PMID: 31090796 PMCID: PMC6536091 DOI: 10.6061/clinics/2019/e858] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 01/17/2019] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVES Bone cancers occur frequently in children, adolescents, and young adults aging 15 to 29 years. Osteosarcoma and Ewing sarcoma are the most frequent subtypes in this population. The aim of this study was to describe incidence and mortality trends of bone cancers among Brazilian children, adolescents and young adults. METHODS Incidence information was obtained from 23 population-based cancer registries. Mortality data were extracted from the Atlas of Cancer Mortality from 1979 to 2013. Specific and adjusted rates per million were analyzed according to gender, morphology and age at diagnosis. Median rates were used as a measure of central tendency. Joinpoint regression was applied to analyze trends. RESULTS Median incidence rates were 5.74 and 11.25 cases per million in children and young adults respectively. Osteosarcoma in the 15-19 years aged group had the highest incidence rates. Stable incidence rates were observed among five registries in 0-14 year's age group. Four registries had a decreased incidence trend among adolescents and young adults. Median mortality rates were 1.22 and 5.07 deaths per million in children and young adults respectively. Increased mortality was observed on the North and Northeast regions. Decreased mortality trends were seen in the South (children) and Southeast (adolescents and young adults). CONCLUSION Osteosarcoma and Ewing Sarcoma are the most incident bone cancers in all Brazilian regions. Bone cancers showed incidence and mortality patterns variation within the geographic regions and across age groups, although not significant. Despite limitations, it is crucial to monitor cancer epidemiology trends across geographic Brazilian regions.
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Affiliation(s)
- Nathalie Vieira Balmant
- Instituto Nacional do Cancer, Rio de Janeiro, RJ, BR
- Centro de Pesquisa, Instituto Nacional de Cancer, Rio de Janeiro, RJ, BR
| | | | | | - Mariana Maschietto
- Laboratorio Nacional de Biociencias, Centro Nacional de Pesquisa em Energia e Materiais, Campinas, SP, BR
| | - Beatriz de Camargo
- Centro de Pesquisa, Instituto Nacional de Cancer, Rio de Janeiro, RJ, BR
- Corresponding author. E-mail:
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Balmant NV, de Souza Reis R, de Oliveira Santos M, de Camargo B, Gatta G. Rare cancers in childhood and adolescence in Brazil: First report of data from 19 population-based cancer registries. Cancer 2019; 125:2638-2646. [PMID: 31013367 DOI: 10.1002/cncr.32121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 02/25/2019] [Accepted: 03/03/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Rare childhood cancer is challenging to define. The Italian Pediatric Rare Tumor (TREP) Study considers rare tumors to include solid malignancies characterized by an annual incidence rate of <2 cases per 1 million and not enrolled in clinical trials. The objective of the current study was to analyze the population incidence rate of rare tumors among children and adolescents (those aged birth-19 years) in Brazil. METHODS Incidence data were obtained from 19 population-based cancer registries covering the 5 geographic regions in Brazil. Newly diagnosed cases were selected according to the TREP definition, using the International Classification of Diseases for Oncology. To calculate the crude incidence rate, the numbers of incident children and adolescents with a specific rare cancer were divided by the corresponding person-years lived for the population aged <20 years during the same period. RESULTS Two tumors had an incidence rate that was >2 cases per 1 million (thyroid and skin cancers) in adolescents only. Several tumors demonstrated variations in incidence across the Brazilian regions. Adrenocortical carcinoma had a high incidence rate (4 cases per 1 million) in the south region among children aged <10 years. Thyroid and skin carcinoma had higher incidence rates in the midwest, southeast, and south regions. CONCLUSIONS Due to the extraordinary rarity of these events, networking is important for improving basic research, clinical studies, and trials. Centralization of diagnosis is the only way to improve the diagnosis and treatment of children affected by these rare diseases. The registration and surveillance of rare pediatric cancers are crucial from a public health point of view, and therefore the quality of registration has to be improved.
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Affiliation(s)
- Nathalie V Balmant
- Postgraduate Program, Research Center, Hospital Cancer Foundation, Tumor registry, Rio de Janeiro, Brazil
| | | | | | - Beatriz de Camargo
- Postgraduate Program, Research Center, Hospital Cancer Foundation, Tumor registry, Rio de Janeiro, Brazil
| | - Gemma Gatta
- IRCCS Foundation, Evaluative Epidemiology Unit, Evaluative Epidemiology Unit, National Cancer Institute, Milan, Italy
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Feliciano SVM, Santos MDO, Pombo-de-Oliveira MS. Incidência e Mortalidade por Câncer entre Crianças e Adolescentes: uma Revisão Narrativa. Rev Brasileira De Cancerologia 2019. [DOI: 10.32635/2176-9745.rbc.2018v64n3.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Introdução: O câncer em crianças e adolescentes com idade entre 0-19 anos configura-se como um problema de saúde pública tanto nos países desenvolvidos como nos países em desenvolvimento. É considerado raro e distinto quando comparado com o câncer em adultos. Apresenta padrões de incidência e mortalidade que variam em todo mundo, sendo que aproximadamente 80% dos cânceres infantis ocorrem nos países com baixo índice de desenvolvimento humano, com acesso aos serviços de cuidado à saúde de baixa qualidade. Objetivo: Apresentar um panorama geral do câncer em crianças e adolescentes com idade entre 0-19 anos com ênfase na descrição dos resultados de estudos de base populacional para incidência e mortalidade nas diferentes regiões geográficas no Mundo e no Brasil. Resultados: As taxas de incidência gerais para o câncer em crianças e adolescentes com idade entre 0-19 variaram entre 50 e 200 casos por milhão por ano em diferentes países e continentes. No Brasil, a mediana das taxas a incidência foi de 154,3 por milhão. A mortalidade apresentou declínio em várias partes do mundo, sendo considerada a segunda causa de morte em países desenvolvidos. Conclusão: As informações dos registros de câncer são indispensáveis no enfrentamento do câncer na população pediátrica, principalmente nos países em desenvolvimento, onde o impacto do câncer é pouco conhecido, ao passo que seu efeito sobre a população está aumentando. Melhorias na adoção de estratégias de tratamento integrado devem ser consideradas para melhorar as taxas de mortalidade por câncer em crianças e adolescentes no Brasil e no Mundo.
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Santos MDO. Incidência, Mortalidade e Morbidade Hospitalar por Câncer em Crianças, Adolescentes e Adultos Jovens no Brasil: Informações dos Registros de Câncer e do Sistema de Mortalidade. Rev Brasileira De Cancerologia 2019. [DOI: 10.32635/2176-9745.rbc.2018v64n3.56] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Crítica de livro relacionado ao campo temático do controle do câncer,
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14
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Abstract
Essa estimativa de casos novos de câncer apresenta, de forma inédita, as taxas de incidência ajustadas por idade; medida que tem por objetivo eliminar o impacto da distribuição etária populacional e, assim, permitir comparações tanto regionais quanto internacionais.
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Reis RDS, Silva NDP, Santos MDO, Oliveira JFP, Thuler LCS, de Camargo B, Pombo-de-Oliveira MS. Mother and child characteristics at birth and early age leukemia: a case-cohort population-based study. J Pediatr (Rio J) 2017; 93:610-618. [PMID: 28738185 DOI: 10.1016/j.jped.2016.12.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 12/16/2016] [Accepted: 12/22/2016] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The population-based cancer registries (PBCR) and the Information System on Live Births in Brazil (Sistema de Informações sobre Nascidos Vivos [SINASC]) have information that enables the test for risk factors associated with leukemia at an early age. The aim of this study was to identify maternal and birth characteristics associated with early-age acute leukemia (EAL) in Brazil. METHODS A case-cohort study was performed using secondary dataset information of PBCR and SINASC. The risk association variables were grouped into (i) characteristics of the child at birth and (ii) characteristics of maternal exposure during pregnancy. The case-control ratio was 1:4. Linkage was performed using R software; odds ratio (OR) and 95% confidence interval (CI) were calculated by logistic regression models. RESULTS EAL was associated with maternal occupational exposure to chemicals (agricultural, chemical, and petrochemical industry; adjOR: 2.18, 95% CI: 1.16-4.10) and with birth defects (adjOR: 3.62, 95% CI: 1.19-11.00). CONCLUSIONS The results of this study, with the identification of EAL risk factors in population-based case-cohort study, strengthen the knowledge and improve databases, contributing to investigations on risk factors associated with childhood leukemia worldwide.
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Affiliation(s)
- Rejane de Souza Reis
- Instituto Nacional do Câncer (INCA), Coordenação de Prevenção e Vigilância, Divisão de Vigilância e Análise de Situação, Rio de Janeiro, RJ, Brazil
| | - Neimar de Paula Silva
- Instituto Nacional do Câncer (INCA), Centro de Pesquisa, Programa de Pesquisa Pediátrica em Hematologia e Oncologia, Rio de Janeiro, RJ, Brazil
| | - Marceli de Oliveira Santos
- Instituto Nacional do Câncer (INCA), Coordenação de Prevenção e Vigilância, Divisão de Vigilância e Análise de Situação, Rio de Janeiro, RJ, Brazil
| | - Julio Fernando Pinto Oliveira
- Instituto Nacional do Câncer (INCA), Coordenação de Prevenção e Vigilância, Divisão de Vigilância e Análise de Situação, Rio de Janeiro, RJ, Brazil
| | | | - Beatriz de Camargo
- Instituto Nacional do Câncer (INCA), Centro de Pesquisa, Programa de Pesquisa Pediátrica em Hematologia e Oncologia, Rio de Janeiro, RJ, Brazil
| | - Maria S Pombo-de-Oliveira
- Instituto Nacional do Câncer (INCA), Centro de Pesquisa, Programa de Pesquisa Pediátrica em Hematologia e Oncologia, Rio de Janeiro, RJ, Brazil.
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Lins MM, Santos MDO, de Albuquerque MDFPM, de Castro CCL, Mello MJG, de Camargo B. Incidence and survival of childhood leukemia in Recife, Brazil: A population-based analysis. Pediatr Blood Cancer 2017; 64. [PMID: 28000427 DOI: 10.1002/pbc.26391] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 11/05/2016] [Accepted: 11/10/2016] [Indexed: 11/10/2022]
Abstract
BACKGROUND Leukemia is the most common pediatric cancer with incidence rates of around 48 per million for children under 15 years of age. The median age-adjusted incidence rate (AAIR) in children aged 0-14 years in Brazil is 53.3 per million. While overall survival rates for children with leukemia have improved significantly, data for incidence, trends, and relative survival among children and adolescents with leukemia in Recife, Brazil, remain incomplete, which hampers our analyses and provision of the best healthcare. The objective of this report is to provide that data. METHODS Data from the Population-Based Cancer Registry of Recife were analyzed from 1998 to 2007. Our analyses included frequencies and AAIR, together with age-specific incidence rates for all leukemias, acute lymphoblastic leukemia, and acute myeloid leukemia. To evaluate incidence trends, joinpoint regression, including annual average percent change, were analyzed. Relative survival was calculated using the life-table method. RESULTS One hundred seventy-five cases were identified, 51% in females. The review reduced the not otherwise specified (NOS) leukemia category by 50% and diagnosis by death certificate only from 5.7% to 1.1%. The AAIR for leukemia was 41.1 per million, with a peak among children aged 1-4 (78.3 per million). Incidence trends during the period were stable. The five-year relative survival rate was 69.8%. CONCLUSIONS These data represent the incidence rate and survival of childhood leukemia in Recife, located in the northeast region of Brazil, using a high-quality database.
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Affiliation(s)
- Mecneide Mendes Lins
- Instituto de Medicina Integral Prof. Fernando Figueira (IMIP), Recife, PE, Brazil.,Instituto Nacional de Cancer, Rio de Janeiro, Brazil.,Pediatric Oncology Unit, Instituto de Medicina Integral Prof. Fernando Figueira-IMIP, Recife, PE, Brazil
| | - Marceli de Oliveira Santos
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância (Surveilance Division and Surveilance and Prevention Coordination Situation of Analysis) at Instituto Nacional do Câncer, Rio de Janeiro, Brazil
| | | | | | - Maria Julia Gonçalves Mello
- Pediatric Research Center, Instituto de Medicina Integral Prof. Fernando Figueira - IMIP, Recife, PE, Brazil
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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da Silva Viana L, Balmant NV, de Paula Silva N, de Oliveira Santos M, Thuler LCS, de Souza Reis R, de Camargo B. Incidence Trends of Cervical Cancer in Adolescents and Young Adults: Brazilian Population Based Data. J Adolesc Young Adult Oncol 2017; 7:54-60. [PMID: 28723263 DOI: 10.1089/jayao.2017.0048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE High incidence rates for cervical cancer in adolescents and young adults (AYAs: 15-29 years) make this the most common carcinoma in Brazil. Our aim was to analyze the incidence trends for cervical cancer (CC) and in situ neoplasia (IsN) among this age group. METHODS Incidence data were extracted from 21 Brazilian population-based cancer registries (PBCRs). Tumors with behavior code/3 (malignant) were classified as CC. Tumors with behavior code/2 were classified as IsN. Age-adjusted and age-specific incidence rates were calculated for individuals aged 15-19 years, 20-24 years, and 25-29 years. Incidence trends were evaluated by joinpoint regression analyses. RESULTS The median incidence rate of CC for AYA in Brazil was 3.63 per 100,000, with the highest rate observed in Recife (27.50 per 100,000). Significant increase in incidence for CC was identified in two PBCRs, with decreased rates for three PBCRs. The median incidence rate of IsN was 16.78 per 100,000 and was highest in Roraima (93.37 per 100,000). Increased incidence rates for IsN were identified in six PBCRs, with significant decreases in two PBCRs. CONCLUSION The incidence rate for CC among AYA in Brazil is high and warrants intervention in terms of both prevention and control.
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Affiliation(s)
- Lucian da Silva Viana
- 1 Instituto Nacional de Câncer , Rio de Janeiro, Brazil .,2 Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro, Brazil
| | - Nathalie Vieira Balmant
- 1 Instituto Nacional de Câncer , Rio de Janeiro, Brazil .,2 Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro, Brazil
| | - Neimar de Paula Silva
- 1 Instituto Nacional de Câncer , Rio de Janeiro, Brazil .,2 Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro, Brazil
| | - Marceli de Oliveira Santos
- 3 Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional de Câncer , Rio de Janeiro, Brazil
| | | | | | - Beatriz de Camargo
- 2 Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro, Brazil
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Balmant NV, de Souza Reis R, de Oliveira Santos M, Pinto Oliveira J, de Camargo B. Trends in Cancer Mortality Among Adolescents and Young Adults in Brazil. J Adolesc Young Adult Oncol 2017; 6:341-347. [PMID: 28051344 DOI: 10.1089/jayao.2016.0042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Adolescents and young adults (AYA) with cancer comprise an intermediate age group between pediatric and adult oncology, and have a spectrum of different types of cancers. Survival among this group has not improved as much as in younger children with cancer. The aim of this study was evaluate the trends in cancer mortality of AYA aged 15-29 years in Brazil. METHODS Data were extracted from the Atlas of Cancer Mortality databases from 1979 to 2013. Age-specific mortality rates were calculated based on the deaths from each type of cancer and the period via a direct method using the proposed world population age groups. To identify significant changes in the trends, we performed joinpoint regression analysis. RESULTS The mortality rates per million were 54 deaths in those aged 15-19 years, 61 deaths in those aged 20-24 years, and 88 deaths in those aged 25-29 years. Leukemias, lymphomas, and central nervous system (CNS) tumors occurred at high rates in all age groups. Rates of cervical cancer were highest in those aged 25-29 years. There were significant increases in mortality trends in the North and Northeast regions for all tumor groups, especially CNS tumors. A small decrease in the mortality rate from lymphomas was observed in the South and Southeast regions. CONCLUSION Mortality in Brazilian AYA was slightly higher than in other studies conducted throughout the world. When separated by tumor type, Brazil presents a specific pattern, with high mortality from cervical cancer.
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Affiliation(s)
| | - Rejane de Souza Reis
- 2 Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro, Brazil
| | | | - Julio Pinto Oliveira
- 2 Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro, Brazil
| | - Beatriz de Camargo
- 3 Pediatric Hematology and Oncology Program, Research Center , Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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de Paula Silva N, de Souza Reis R, Garcia Cunha R, Pinto Oliveira JF, Santos MDO, Pombo-de-Oliveira MS, de Camargo B. Maternal and Birth Characteristics and Childhood Embryonal Solid Tumors: A Population-Based Report from Brazil. PLoS One 2016; 11:e0164398. [PMID: 27768709 PMCID: PMC5074509 DOI: 10.1371/journal.pone.0164398] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 09/23/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Several maternal and birth characteristics have been reported to be associated with an increased risk of many childhood cancers. Our goal was to evaluate the risk of childhood embryonal solid tumors in relation to pre- and perinatal characteristics. METHODS A case-cohort study was performed using two population-based datasets, which were linked through R software. Tumors were classified as central nervous system (CNS) or non-CNS-embryonal (retinoblastoma, neuroblastoma, renal tumors, germ cell tumors, hepatoblastoma and soft tissue sarcoma). Children aged <6 years were selected. Adjustments were made for potential confounders. Odds ratios (OR) with 95% confidence intervals (CI) were computed by unconditional logistic regression analysis using SPSS. RESULTS Males, high maternal education level, and birth anomalies were independent risk factors. Among children diagnosed older than 24 months of age, cesarean section (CS) was a significant risk factor. Five-minute Apgar ≤8 was an independent risk factor for renal tumors. A decreasing risk with increasing birth order was observed for all tumor types except for retinoblastoma. Among children with neuroblastoma, the risk decreased with increasing birth order (OR = 0.82 (95% CI 0.67-1.01)). Children delivered by CS had a marginally significantly increased OR for all tumors except retinoblastoma. High maternal education level showed a significant increase in the odds for all tumors together, CNS tumors, and neuroblastoma. CONCLUSION This evidence suggests that male gender, high maternal education level, and birth anomalies are risk factors for childhood tumors irrespective of the age at diagnosis. Cesarean section, birth order, and 5-minute Apgar score were risk factors for some tumor subtypes.
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Affiliation(s)
- Neimar de Paula Silva
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro-RJ, Brazil
| | - Rejane de Souza Reis
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rio de Janeiro-RJ, Brazil
| | - Rafael Garcia Cunha
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rio de Janeiro-RJ, Brazil
| | - Júlio Fernando Pinto Oliveira
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rio de Janeiro-RJ, Brazil
| | - Marceli de Oliveira Santos
- Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rio de Janeiro-RJ, Brazil
| | - Maria S. Pombo-de-Oliveira
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro-RJ, Brazil
| | - Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro-RJ, Brazil
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Abstract
Incidence rates of childhood leukemia vary between different regions of the world. The objective of this study was to test possible trends in incidence rate of early childhood leukemia (children <5 years old at the diagnosis) in Brazil. Data from 18 population-based cancer registries (PBCRs) were analyzed (period 1999-2010). The analysis consisted of frequencies, age-adjusted incidence rates, and joinpoint regression results, including annual average percent change (AAPC) in incidence rates and 95% confidence intervals (CIs). The median age-adjusted incidence rate (AAIR) of overall early childhood leukemia was 61 per million. The AAIR for acute lymphoid leukemia (ALL) was 44 per million and nonlymphoid acute leukemia (NLAL) was 14 per million. The median ALL/NLAL ratio was 3.0, suggesting higher incidence rate of NLAL in these settings. The joinpoint analysis demonstrated increased leukemia incidence rate in João Pessoa (AAPC = 20; 95% CI: 3.5, 39.4) and Salvador (AAPC = 8.68; 95% CI: 1.0, 16.9), respectively, whereas incidence rate in São Paulo PBCR decreased (AAPC = -4.02%; 95% CI: -6.1%, -1.9%). Correlation between ALL AAIR and selected variables of socioeconomic (SES) factors was not observed. Increased AAIR regionally overtime was observed. However, the interpretation for such phenomenon should be cautious because it might reflect the access to health care, diagnosis procedures, and improvement of PBCR´s quality. The observed trend supports the necessity of further ecological studies.
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Affiliation(s)
- Rejane de Souza Reis
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Marceli de Oliveira Santos
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | - Beatriz de Camargo
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
| | - Julio Fernando Pinto Oliveira
- a Divisão de Vigilância e Análise de Situação Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer , Rio de Janeiro , Brazil
| | | | - Maria S Pombo-de-Oliveira
- b Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer , Rio de Janeiro , Brazil
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Moore SP, Forman D, Piñeros M, Fernández SM, de Oliveira Santos M, Bray F. Cancer in indigenous people in Latin America and the Caribbean: a review. Cancer Med 2014; 3:70-80. [PMID: 24403278 PMCID: PMC3930391 DOI: 10.1002/cam4.134] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 07/20/2013] [Accepted: 08/17/2013] [Indexed: 12/29/2022] Open
Abstract
Cancer is a leading cause of death in Latin America but there have been few assessments of the cancer burden for the 10% of the population who are indigenous. Evidence from other world regions suggests cancer survival is poorer for indigenous people than for others due to a greater incidence of case-fatal cancers, later stage at diagnosis, and less cancer treatment. A status report on the cancer profile of indigenous people in Latin America and the Caribbean (LAC) is therefore clearly warranted. We undertook a systematic review of the peer-reviewed literature in academic databases, and considered evidence from cancer registries from 1980, to assess cancer epidemiology among indigenous people in LAC. We identified 35 peer-reviewed articles pertaining to cancer in indigenous people. Rates of cervical cancer in parts of Brazil, Ecuador, and Guyana, stomach cancer rates in regions of Chile and gallbladder rates in Chile and Bolivia, were higher for indigenous compared to others. Breast cancer rates were lower in Ecuador, Brazil, and Chile. Six cancer registries in Brazil provided incidence data but no other reports of incidence, mortality, or survival were identified. There was a paucity of data surrounding the cancer burden of indigenous people in LAC. In view of predicted increases in cancer rates in ensuing decades, and the disparities in burden already experienced by indigenous people in the region, it is imperative that cancer profiles are obtained and cancer control measures identified and prioritized.
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Ferman S, Santos MDO, Ferreira JMDO, Reis RDS, Oliveira JFP, Pombo-de-Oliveira MS, Camargo BD. Childhood cancer mortality trends in Brazil, 1979-2008. Clinics (Sao Paulo) 2013; 68:219-24. [PMID: 23525319 PMCID: PMC3584264 DOI: 10.6061/clinics/2013(02)oa16] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Accepted: 10/26/2012] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Childhood cancer mortality has substantially declined worldwide as a result of significant advances in global cancer care. Because limited information is available in Brazil, we analyzed trends in childhood cancer mortality in five Brazilian regions over 29 years. METHODS Data from children 0-14 years old were extracted from the Health Mortality Information System for 1979 through 2008. Age-adjusted mortality rates, crude mortality rates, and age-specific mortality rates by geographic region of Brazil and for the entire country were analyzed for all cancers and leukemia. Mortality trends were evaluated for all childhood cancers and leukemia using joinpoint regression. RESULTS Mortality declined significantly for the entire period (1979-2008) for children with leukemia. Childhood cancer mortality rates declined in the South and Southeast, remained stable in the Middle West, and increased in the North and Northeast. Although the mortality rates did not unilaterally decrease in all regions, the age-adjusted mortality rates were relatively similar among the five Brazilian regions from 2006-2008. CONCLUSIONS Childhood cancer mortality declined 1.2 to 1.6% per year in the South and Southeast regions.
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Affiliation(s)
- Sima Ferman
- Pediatric Oncology Department, Instituto Nacional de Câncer, Rio de Janeiro, RJ, Brazil
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Ferreira JMDO, Klumb CE, Reis RDS, Santos MDO, Oliveira JFP, de Camargo B, Pombo-de-Oliveira MS. Lymphoma subtype incidence rates in children and adolescents: First report from Brazil. Cancer Epidemiol 2012; 36:e221-6. [DOI: 10.1016/j.canep.2012.03.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 03/01/2012] [Accepted: 03/04/2012] [Indexed: 10/28/2022]
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Brito ADS, Coeli CM, Barbosa FDS, Caetano R, Santos MDO, Vaisman M. Estimates of thyroid cancer incidence in Brazil: an approach using polynomial models. CAD SAUDE PUBLICA 2011; 27:1441-4. [DOI: 10.1590/s0102-311x2011000700019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2010] [Accepted: 04/05/2011] [Indexed: 11/22/2022] Open
Abstract
This study aimed to estimate thyroid cancer incidence in Brazil in 2006 using polynomial models that take age and birth cohort effects into account in the estimation process. Estimates were based on new cases of thyroid cancer in nine Brazilian cities (Manaus, Palmas, Natal, Recife, Cuiabá, Belo Horizonte, São Paulo, Porto Alegre, and Curitiba) and the Federal District from 1997 to 2001. We estimated 6,066 new cases, of which 1,065 in men and 5,001 in women. The incidence rates were, respectively, 1.16 and 5.27 per 100,000 inhabitants. Rates increased with age in both genders, especially after 30 years. The size and profile of rates according to age and gender indicate that the method yields plausible estimates.
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de Camargo B, de Oliveira Ferreira JM, de Souza Reis R, Ferman S, de Oliveira Santos M, Pombo-de-Oliveira MS. Socioeconomic status and the incidence of non-central nervous system childhood embryonic tumours in Brazil. BMC Cancer 2011; 11:160. [PMID: 21545722 PMCID: PMC3112157 DOI: 10.1186/1471-2407-11-160] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 05/05/2011] [Indexed: 12/13/2022] Open
Abstract
Background Childhood cancer differs from most common adult cancers, suggesting a distinct aetiology for some types of childhood cancer. Our objective in this study was to test the difference in incidence rates of 4 non-CNS embryonic tumours and their correlation with socioeconomic status (SES) in Brazil. Methods Data was obtained from 13 Brazilian population-based cancer registries (PBCRs) of neuroblastoma (NB), Wilms'tumour (WT), retinoblastoma (RB), and hepatoblastoma (HB). Incidence rates by tumour type, age, and gender were calculated per one million children. Correlations between social exclusion index (SEI) as an indicator of socioeconomic status (SES) and incidence rates was investigated using the Spearman's test. Results WT, RB, and HB presented with the highest age-adjusted incidence rates (AAIRs) in 1 to 4 year old of both genders, whereas NB presented the highest AAIR in ≤11 month-olds. However, differences in the incidence rates among PBCRs were observed. Higher incidence rates were found for WT and RB, whereas lower incidence rates were observed for NB. Higher SEI was correlated with higher incidences of NB (0.731; p = 0.0117), whereas no SEI correlation was observed between incidence rates for WT, RB, and HB. In two Brazilian cities, the incidence rates of NB and RB were directly correlated with SEI; NB had the highest incidence rates (14.2, 95% CI, 8.6-19.7), and RB the lowest (3.5, 95% CI, 0.7-6.3) in Curitiba (SEI, 0.730). In Natal (SEI, 0.595), we observed just the opposite; the highest incidence rate was for RB and the lowest was for NB (4.6, 95% CI, 0.1-9.1). Conclusion Regional variations of SES and the incidence of embryonal tumours were observed, particularly incidence rates for NB and RB. Further studies are necessary to investigate risk factors for embryonic tumours in Brazil.
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Affiliation(s)
- Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil.
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de Souza Reis R, de Camargo B, de Oliveira Santos M, de Oliveira JM, Azevedo Silva F, Pombo-de-Oliveira MS. Childhood leukemia incidence in Brazil according to different geographical regions. Pediatr Blood Cancer 2011; 56:58-64. [PMID: 21108440 DOI: 10.1002/pbc.22736] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Resource-rich countries tend to have a higher incidence of childhood acute lymphoblastic leukemia (ALL), whereas lower rates are seen in more deprived countries. This study describes the incidence of childhood acute leukemia in Brazil, an upper middle-income country, based on data from 16 population-based cancer registries (PBCRs). PROCEDURE Data were examined from 16 PBCRs in Brazilian cities located in five geographical regions during the period from 1997 to 2004. Incidence rates were analyzed according to gender, age, and type of leukemia. The Wilcoxon test was performed to evaluate for gender-age based difference between by leukemia type. RESULTS The median age-adjusted incidence rate (AAIR) of leukemia in children aged 0-14 years old was 53.3 per million. A different AAIR was found regarding ALL and myeloproliferative disorders (MPD) that ranged from 24.8 to 76.84 per 1,000,000 children. Manaus, although located in a poor area of Brazil, exhibited the highest AAIR (56.6 per million) of ALL. Goiania had the highest AAIR (24.5 per million) of MPD. The median age-specific incidence rate (ASIR) for the 16 Brazilian PBCRs demonstrated a marked peak in incidence of ALL at age 3 years old, in both genders. CONCLUSIONS This population-based study of childhood leukemia demonstrates that substantial regional differences exist regarding the incidence of acute leukemia in Brazil, which warrants further ecological study.
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Affiliation(s)
- Rejane de Souza Reis
- Coordenação de Prevenção e Vigilância, Instituto Nacional do Câncer, Rua dos Inválidos, Rio de Janeiro, Brazil
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de Camargo B, de Oliveira Santos M, Rebelo MS, de Souza Reis R, Ferman S, Noronha CP, Pombo-de-Oliveira MS. Cancer incidence among children and adolescents in Brazil: first report of 14 population-based cancer registries. Int J Cancer 2010; 126:715-20. [PMID: 19642142 DOI: 10.1002/ijc.24799] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The Brazilian Population-Based Cancer Registry (PBCR) was started in 1967; today there are 20 PBCRs in Brazil. We report the first descriptive analysis of the incidence of childhood cancer based on data from 14 PBCRs, corresponding to 15% of the child and adolescent population in Brazil. Data were obtained from registry databases, including information on population coverage and data quality indicators. The International Classification of Childhood Cancer was used. Age-adjusted rates were calculated by world population. Incidence by cancer registry, age, sex, and cancer type were calculated per 1,000,000 children. Age-adjusted rates per 1,000,000 children/adolescents ranged from 92 to 220 among the 14 PBCRs. The principal groups of cancers were leukemia, lymphoma and central nervous tumors. The median incidence rate of childhood cancer in the 14 PBCRs was 154.3 per million; children 1-4 years of age had the highest incidence rates. The Brazilian PBCRs provide important information about pediatric cancer incidence in an emerging country. The observed incidence rates of childhood leukemia were similar to previous reported rates, and the age-specific incidence rates of retinoblastoma (0-4 years of age) were higher than those for developed countries. These data can be used as baseline incidence rates of childhood and adolescent cancer in Brazil in future epidemiological studies.
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Affiliation(s)
- Beatriz de Camargo
- Pediatric Hematology and Oncology Program, Research Center, Instituto Nacional de Câncer, Rio de Janeiro, Brazil
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Azevedo-Silva F, Reis RDS, de Oliveira Santos M, Luiz RR, Pombo-de-Oliveira MS. Evaluation of childhood acute leukemia incidence and underreporting in Brazil by capture–recapture methodology. Cancer Epidemiol 2009; 33:403-5. [DOI: 10.1016/j.canep.2009.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2009] [Revised: 09/08/2009] [Accepted: 09/16/2009] [Indexed: 10/20/2022]
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Reis RDS, Santos MDO, Bloch KV. Colorectal cancer in Porto Alegre and Fortaleza, Brazil: incidence trends and distribution pattern from 1990 to 1999. CAD SAUDE PUBLICA 2009; 25:1046-53. [DOI: 10.1590/s0102-311x2009000500011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2008] [Accepted: 05/07/2008] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to describe the incidence distribution of colorectal cancer in Fortaleza, Ceará State, and Porto Alegre, Rio Grande do Sul State, Brazil, and the time trend in the disease from 1990 to 1999. Mean annual age-adjusted incidence rates and estimated annual percent change were calculated by gender, using population-based cancer registries. EAPC showed an increase in the rates in Porto Alegre and Fortaleza for men, +4.2% (p = 0.14) and +9.3% (p < 0.001), and women, +4.6% (p = 0.11) and +5.3% (p = 0.15), respectively. The mean adjusted incidence rates were three times higher in Porto Alegre than in Fortaleza both for men (25.1 vs. 8.6/100 thousand) and women (19.9 vs. 7.1/100 thousand). This rise in incidence rates may be due to early cancer detection strategies, lifestyle changes, and alterations in the population age structure. A population profile similar to that of developed countries may explain the higher incidence rates in Porto Alegre. However, Fortaleza showed the largest increases during the period studied.
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Silva GAE, Noronha CP, Santos MDO, Oliveira JFP. Diferenças de gênero na tendência de mortalidade por câncer de pulmão nas macrorregiões brasileiras. Rev bras epidemiol 2008. [DOI: 10.1590/s1415-790x2008000300008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O câncer de pulmão é a primeira causa de óbito por câncer entre homens e a segunda entre mulheres no Brasil. Em países desenvolvidos, a mortalidade por este tipo de câncer vem declinando entre homens, mas não entre as mulheres. Este estudo analisou as tendências de mortalidade por câncer de pulmão no Brasil para homens e mulheres durante o período de 1979 a 2003 em todo o país e nas cinco macrorregiões. Foram calculadas taxas de mortalidade padronizadas por idade e específicas para os grupos etários de 40-59 e 60 anos e mais. As variações percentuais anuais estimadas (Estimated Annual Percent Change - EAPC) foram avaliadas para os períodos: 1979-1987, 1988-1995, 1996-2003. A mortalidade por câncer de pulmão em todo o período (1979-2003) aumentou em 29% entre homens e em 86% entre mulheres. Desagregando-se os dados, observou-se uma tendência inversa evidente na região Sudeste entre 1996 e 2003 para o grupo etário mais jovem com diminuição para homens (EAPC = - 2,1) e aumento para mulheres (EAPC = 3,2). Merece destaque a grande variação positiva nas tendências para mulheres na região Norte e Nordeste a partir de 1988 nos dois grupos etários estudados. Os resultados reforçam a necessidade de dar continuidade às ações de controle do tabagismo para os homens e de aperfeiçoar as estratégias voltadas para as mulheres.
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Abstract
No Brasil, ainda são poucos os trabalhos que abordam temas relacionados à epidemiologia dos tumores pediátricos. As informações sobre incidência do câncer provêm dos Registros de Câncer de Base Populacional (RCBP). Atualmente, há no Brasil 22 RCBP implantados. Destes, 17 contêm informações consolidadas disponíveis para análise. Essas informações foram obtidas a partir de um aplicativo informatizado, desenvolvido pelo Instituto Nacional de Câncer (INCA), para entrada e consolidação dos dados colhidos pelos RCBP, o SisBasepop. Apresentase, neste trabalho, uma análise descritiva das informações disponíveis sobre a incidência dos principais tumores pediátricos no país. Observa-se, em geral, uma predominância dos casos de leucemias, que variam de 15% a 45% de todos os tumores pediátricos, seguidos dos linfomas (5% a 25%) e tumores do sistema nervoso central (5% a 22%). Conclui-se ressaltando que é viável obter dados de incidência de câncer pediátrico, em larga escala, a partir dos RCBP.
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