Antonio Pedro Mirra

Tabagismo e câncer no Brasil: evidências e perspectivas

Neste artigo analisa-se a tendencia temporal da prevalencia do tabagismo no Brasil, bem como as assimetrias da prevalencia de acordo com as regioes do pais, a idade, o genero e o nivel socioeconomico da populacao. Desde o estabelecimento da relacao entre tabagismo e câncer de pulmao ha 60 anos, o numero de tumores malignos com evidencias de associacao causal com o tabagismo ascendeu a vinte. O declinio da prevalencia do tabagismo na populacao brasileira tem sido constante desde o final da decada de 80. Ate 2003, foi mais intenso entre os homens. A partir daquele ano, a queda tornou-se mais pronunciada entre as mulheres. As mais altas prevalencias de tabagismo encontram-se no Sudeste e Sul, as duas regioes com maiores incidencias de neoplasias estritamente relacionadas ao tabaco (cavidade oral, esofago e pulmao). A exposicao ambiental a fumaca do tabaco tambem foi examinada considerando-se os efeitos para os adultos nao fumantes, que apresentam maior risco de tumores de pulmao, laringe e faringe, e entre criancas de pais fumantes, suscetiveis ao risco de hepatoblastoma e leucemia linfocitica aguda. Apesar do incontestavel sucesso da politica de controle do tabagismo no pais, as acoes de prevencao devem considerar que as parcelas da populacao com piores condicoes socioeconomicas e com baixo nivel educacional sao as que apresentam taxas mais altas de prevalencia de tabagismo. Dentro destes segmentos populacionais os adolescentes representam uma prioridade.

Cancer incidence rates among Japanese immigrants in the city of São Paulo, Brazil, 1969–78

Cancer incidence rates among first-generation Japanese immigrants in the city of São Paulo, Brazil, were estimated from the data of the São Paulo Cancer Registry during the years 1969 to 1978. From all registered cases, 2,179 cancer cases of Japan-born residents (1,288 males, 891 females) were selected and age-specific and summary age-adjusted incidence rates (AAIR) were calculated for the selected sites of cancer. The AAIR for all sites except non-melanoma skin cancer was 195.2 per 100,000 population (95 percent confidence interval: 176.4–214.1) in males and 147.3 (134.6–160.0) in females. Stomach cancer had the highest incidence rate of all cancers in both sexes (males, 69.3; females, 32.0). This was followed by cancer of the lung (22.5), esophagus (10.2), colon (8.3), and prostate (7.1) in males; and by breast (24.0), cervix (18.0), colon (8.4), and lung (7.2) in females. When these rates were compared with those among Japanese in Japan, cancer of the stomach and rectum revealed significantly lower rates, while non-melanoma skin cancer, and prostate and breast cancer showed higher rates. No significant increase of colorectal cancer was recognized among Japanese immigrants in São Paulo, contrary to the remarkably high rates of colorectal cancer being observed among Japanese immigrants in the U5.

Influence of Air Pollution on the Incidence of Respiratory Tract Neoplasm

Abstract To evaluate the possible influence of air pollutants on the incidence of respiratory tract neoplasm we studied 12 São Paulo City districts where air pollution is observed. We collected data on pollutants from 1981–1990 and correlated it with the incidence of larynx and lung neoplasms in 1997. Ozone was the pollutant that best correlated with the incidence of neoplasm. The correlation coefficients were 0.7234 (p = 0.277) and 0.9929 (p = 0.007) for lung and larynx cancer, respectively. There may be a relationship between air pollution and the incidence of respiratory tract neoplasm. This study, however, does not allow us to conclude that there is a causal relationship.

Fatores de risco para o câncer de esôfago: estudo caso-controle em área metropolitana da região Sudeste do Brasil

The association between esophageal cancer and smoking and drinking habits, instruction and nutritional factors was examined by means of the utilization of data of a case-control study which was undertaken in the city of S. Paulo (Brazil). Eighty five cases were compared with two hundred and ninety two hospital controls, with different diseases, including other kinds of cancer. The crude estimations of the odds ratios were calculated for all the variables. Logistic regression was used in the next steps of the analysis. The drinking habit [odds ratio = 3.68, 95% confidence interval (1.74 - 7.78)], the smoking habit [odds ratio 4.86; 95% confidence interval (1.95 - 12.13)] and the frequent eating of hot pepper [odds ratio = 2.48; 95% confidence interval (1.46 - 4.23)] are important risk factors for the disease. The estimate of odds ratio for smoking ordinary cigarette was 3.43 (1.31-8.97) and for smoking of corn straw hand-rolled cigarrette was of 4.18 (1.38-12.66).

Cancer incidence in eighteen cities of the State of São Paulo, Brazil

OBJECTIVE As in Brazil cancer registries are mostly based on large cities, there are no estimates per state or per region and information on the disease incidence in the vast in-land areas is very scarce. An incidence survey was conducted in 18 major cities of the state of São Paulo, excluding the capital, aiming to collect information about cancer incidence in the state of São Paulo. METHODS Of the 18 cities in state of São Paulo included in the survey, all had available resources for cancer management. Data from the year of 1991 were collected by the personnel of the Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Statistics), who were especially trained by the study coordinators at the Fundação Oncocentro de São Paulo (Cancer Center of São Paulo). The collected data were processed and analyzed at the Oncocentro. Data collection, processing, and analyses were performed according to the recommendations of the International Agency for Research on Cancer. RESULTS Although some discrepancies were observed in cancer incidence rates between the cities, results obtained for all 18 cities combined were remarkably close to those recently found for the city of São Paulo in the year 1993. One remarkable finding was the relatively high cancer incidence rates in both sexes in the city of Santos. CONCLUSIONS The very similar all-sites cancer incidence rates found in the year 1991, when compared to those for the city of São Paulo in the year 1993, are suggestive that all regions have common cancer-related factors. Nevertheless, other explanations, such as the inclusion in the study of prevalent cases, as well as of non-residents, may have occurred in both studies, biasing the results. There is a need of further studies to confirm the high cancer incidence in Santos.

Tabagismo entre alunos e funcionários da Faculdade de Saúde Pública da Universidade de São Paulo

Dois inqueritos sobre a prevalencia do tabagismo entre os alunos e funcionarios da Faculdade de Saude Publica da Universidade de Sao Paulo, presentes a aula inaugural, cujo tema foi tabagismo, foram realizados em 1980 e 1995. No primeiro inquerito, em 1980, estavam presentes 177 funcionarios e alunos de cursos de especializacao e pos graduacao (homens = 38,4% e mulheres = 61,6%) e 128, no segundo, em 1995 (homens = 29,7% e mulheres = 70,3%). Observou-se que houve um decrescimo na prevalencia de fumantes regulares de 56,9% para 26,3% no sexo masculino e de 45,9% para 22,2% no feminino, sendo essas diferencas mais acentuadas entre os mais jovens (20 a 39 anos de idade). Os profissionais com formacao biologica foram os mais motivados para nao adquirirem o vicio de fumar, seguindo-se o grupo com formacao basica em ciencias exatas e sociais e os educadores; os profissionais relacionados as letras, advogados, foram os que nao mostraram motivacao, pois houve aumento da prevalencia de fumantes regulares. A idade no inicio de fumar foi semelhante a da populacao geral (10-14 anos de idade), bem como as razoes para esse inicio e a manutencao do vicio. A grande maioria dos entrevistados afirmou ter conhecimento dos maleficios do tabaco. A midia falada (TV/ Radio) foi selecionada como meio mais adequado para a divulgacao dos efeitos nocivos do fumo. Programas de combate ao tabagismo mais efetivos devem ser implementados na escolas de saude publica, a fim de que ocorra a reducao de fumantes entre os alunos dos seus cursos regulares e seus funcionarios.

Proportional cancer incidence according to selected sites: comparison between residents in the City of S. Paulo, Brazil: Japanese and Brazilian/Portuguese descent

The percentual distributions of selected sites of cancer cases according to origin, sex and age are compared. Data were obtained from the Registry of Cancer of S. Paulo (School of Public Health of the University of S. Paulo, Brazil). The reference period for inhabitants of Japanese descent was 1969/78 and for those of Brazilian descent, the period was 1969/75. Standardized Proportionate Incidence Ratios (SPIR) with approximate 95% Confidence Intervals (CI) were evaluated using age specific Incidence Ratios of S. Paulo, 1973, as standards. The results agree with findings of previous works on mortality, but show different patterns according to origin. The well known fact that some sub-groups of a population may be different from the overall group is once again brought to the fore. Attention should be drawn to the differences detected for stomach, skin and prostate, in males, and for stomach, skin, cervix and uterus in females.

Smoking control at the School of Public Health, Universidade de São Paulo

INTRODUCTION schools of Public Health, by their nature, have increased responsibility in the development of health promotion programs, focusing on tobacco control. The participation of groups of health professionals in educational actions helps to convey information about smoking to the population. OBJECTIVE to evaluate the prevalence of smoking and the effectiveness of control programs among the teaching and non-teaching staff of the School of Public Health of the Universidade de São Paulo (FSP-USP). They were monitored by surveys conducted from 1980 to 2013. METHODS application of a questionnaire, containing the variables: identity, gender, smoking habit (are you a smoker, former smoker or non-smoker), which was answered in a private interview. Data analysis was done using absolute and relative frequencies. RESULTS the prevalence of smokers had a reduction from 50.3%, in 1980, to 13.4%, in 2013; among males, prevalence fell from 56.9% to 12.8%, and among females from 45.9% to 13.7%. As for the teaching staff, there was a fall from 10.2% (2006) to 5.9% (2013); the decrease among non-teaching employees was from 21.6% to 16.3%. CONCLUSION knowledge by health professionals of the harms caused by tobacco smoking contributed to their participation in anti-smoking programs, and led to a decline in the number of smokers at FSP-USP. The creation of 100% tobacco-free environments and programs to treat smokers who want to cease their addiction should be encouraged.

The importance of legislative measures on tobacco control in Brazil

INTRODUCTION In the tobacco control program, educational, socioeconomic, ecological and legislative actions should be planned. Legislative actions should include the federal, state and municipal spheres, have a primarily preventive purpose and federal reach. OBJECTIVE Survey of bills presented in both legislative houses at federal level, House of Representatives and Senate (which together form the National Congress) and the resulting laws. METHOD In the period from 1965 to 2015, 254 bills were filed with the House of Representatives and, from 1971 to 2015, 68 others were presented to the Senate. RESULTS In the House of Representatives, of the 254 bills, 68.9% were archived/rejected/returned, 14.9% did not have a result, 12.2% are currently being processed/analyzed by commissions, 2.0% refer to the inclusion of amendments/law annexes, 1.2% were transformed into legal norm/proposition of origin and 0.8% were transformed into laws. In the Senate, of the 68 bills, 19.1% were filed, 33.8% did not have a result, 4.4% were currently being processed, and 42.7% referred to changes in the law. Anti--tobacco actions were more prevalent in the periods 1979-1984 by the AMB, 1985-2007 by MS/INCA, and in 2008-2015 by the ACT. CONCLUSION Tobacco control legislation has progressed constantly, with the provocation of legislators from both Houses triggered by the MS/INCA and civil entities committed to smoking control, such as a number of non-governmental organizations (especially the AMB and the ACT).