Carolina Maciel Reis Gonzaga

Disparities in female breast cancer mortality rates in Brazil between 1980 and 2009

OBJECTIVE: To describe the temporal trends in female breast cancer mortality rates in Brazil in its macro-regions and states between 1980 and 2009. METHODS: This was an ecological time-series study using data on breast cancer deaths registered in the Mortality Data System (SIM/WHO) and census data on the resident population collected by the Brazilian Institute of Geography and Statistics (IBGE/WHO). Joinpoint regression analyses were used to identify the significant changes in trends and to estimate the annual percentage change (APC) in mortality rates. RESULTS: Female breast cancer mortality rates in Brazil tended to stabilize from 1994 onward (APC = 0.4%). Considering the Brazilian macro-regions, the annual mortality rates decreased in the Southeast, stabilized in the South and increased in the Northeast, North, and Midwest. Only the states of Sao Paulo (APC = -1.9%), Rio Grande do Sul (APC = -0.8%) and Rio de Janeiro (APC = -0.6%) presented a significant decline in mortality rates. The greatest increases were found in Maranhao (APC = 12%), Paraiba (APC = 11.9%), and Piaui (APC = 10.9%). CONCLUSION: Although there has been a trend toward stabilization in female breast cancer mortality rates in Brazil, when the mortality rate of each macro-region and state is analyzed individually, considerable inequalities are found, with rate decline or stabilization in states with higher socioeconomic levels and a substantial increase in those with lower socioeconomic levels.

Cervical cancer mortality trends in Brazil: 1980-2009

The objective was to describe time trends in cervical cancer mortality rates in Brazil as a whole and in the countrys major geographic regions and States from 1980 to 2009. This was an ecological time series study using data recorded in the Mortality Information System (SIM) and census data collected by the Brazilian Institute of Geography and Statistics (IBGE). Analysis of mortality trends was performed using Poisson regression. Cervical cancer mortality rates in Brazil tended to stabilize. In the geographic regions, a downward trend was observed in the South (-4.1%), Southeast (-3.3%), and Central-West (-1%) and an upward trend in the Northeast (3.5%) and North (2.7%). The largest decreases were observed in the States of São Paulo (-5.1%), Rio Grande do Sul, Espírito Santo, and Paraná (-4.0%). The largest increases in mortality trends occurred in Paraíba (12.4%), Maranhão (9.8%), and Tocantins (8.9%). Cervical cancer mortality rates stabilized in the country as a whole, but there was a downward trend in three geographic regions and 10 States, while two geographic regions and another 10 States showed increasing rates.

Disparities in female breast cancer mortality rates between urban centers and rural areas of Brazil: Ecological time-series study☆

OBJECTIVES To evaluate trends in breast cancer mortality in urban centers and rural areas of Brazil. METHODS Ecological time-series study using data on breast cancer deaths and census. Mortality trends were analyzed using change-point regression: 1980-2010. RESULTS A declining trend was found in five urban centers: São Paulo (APC = -1.7%), Porto Alegre (APC = -1.6%), Belo Horizonte (APC = -1.2%), Rio de Janeiro and Recife (APC = -0.9%). An increasing was found in: Porto Velho (APC = 9.0%), Teresina (APC = 4.6%), João Pessoa (APC = 1.6%), Belém (APC = 0.8%) and Fortaleza (APC = 0.5%). In the majority of rural areas, mortality continues to rise, with the exception of some areas in the southern. CONCLUSION Disparities in breast cancer mortality were found across the country, with increasing trends occurring predominantly in the north and northeastern regions. One of the reasons for this disparity may be that access to treatment is more difficult for patients living in rural areas and in the north of Brazil.

Mortalidade por câncer de mama feminino no Brasil de acordo com a cor

PURPOSE To describe the mortality of female breast cancer in Brazil according to color, in the years 2000 and 2010. METHODS A descriptive study in which demographic data were obtained from the Brazilian Institute of Geography and Statistics (IBGE). The breast cancer death information in Brazil was collected from the Ministry of Health through the Mortality Information System (SIM). The crude mortality rates for female breast cancer were calculated according to color and age group, up to 49 years and ≥50 years. The results obtained were distributed into five geographical regions of the country (North, Northeast, Midwest, South and Southeast). RESULTS In Brazil, in women aged 50 or more, the highest crude mortality rates of breast cancer in 2000 were 62.6/100,000, 46.0/100,000 and 29.7/100,000 among yellow, white and black women, respectively. In women under 50 years in 2000, the crude mortality ranged from 2.0/100,000 among indigenous women to 6.8/100,000 among white women. After ten years, in women over 50 years, the crude mortality rate among yellow, white and black women was 21.5, 53.2 and 40.4 per 100,000, respectively. In the countrys regions, the highest mortality rates of breast cancer were observed in white and black women from the South and Southeast. In the Northeast, mortality rates in black and brown women doubled in 2010. CONCLUSION Breast cancer mortality rates show ethnic and geographical variations. However, it is not possible to exclude the possibility that large variations have occurred as a result of improvement in the quality of information on mortality in the country.OBJETIVO: Descrever a mortalidade por câncer de mama feminino no Brasil segundo a cor, nos anos de 2000 e 2010.METODOS: Estudo descritivo, no qual os dados populacionais foram obtidos do Instituto Brasileiro de Geografia e Estatistica (IBGE). As informacoes de obitos por câncer de mama foram coletadas do Ministerio da Saude, atraves do Sistema de Informacoes sobre Mortalidade (SIM). Foram calculadas as taxas de mortalidade bruta por câncer de mama feminino de acordo com a cor e o grupo etario, ate 49 anos ou ≥ 50 anos. Os resultados foram tambem avaliados pelas cinco macrorregioes do pais (Norte, Nordeste, Centro-Oeste, Sul e Sudeste).RESULTADOS: No Brasil, em mulheres com 50 anos ou mais, as maiores taxas brutas de mortalidade por câncer de mama em 2000 foram de 62,6/100.000, 46,0/100.000 e 29,7/100.000, entre amarelas, brancas e pretas, respectivamente. Nas mulheres com menos de 50 anos, em 2000, a mortalidade bruta variou de 2,0/100.000 entre as indigenas a 6,8/100.000 entre as mulheres brancas. Apos dez anos, em mulheres com idade superior a 50 anos, a taxa bruta de mortalidade entre amarelas, brancas e pretas foi de 21,5, 53,2 e 40,4 por 100.000, respectivamente. Nas macrorregioes do pais, as maiores taxas de mortalidade por câncer de mama foram observadas nas mulheres brancas e pretas das regioes Sul e Sudeste. No Nordeste, as taxas de mortalidade em mulheres pretas e pardas dobraram em 2010.CONCLUSAO: As taxas de mortalidade por câncer de mama apresentam variacoes etnicas e geograficas. Entretanto, nao se pode excluir a possibilidade de que grandes variacoes tenham ocorrido em decorrencia de melhoria na qualidade da informacao sobre a mortalidade no pais.

Abstract P1-11-08: The impact of social inequalities on breast cancer mortality in Brazil

Introduction: Female breast cancer mortality has decreased considerably in developed nations. In contrast, an increase has been observed in developing countries. Objective: To describe the impact of social inequalities in female breast cancer mortality in Brazil, between the years of 1990 and 2011. Methods: Breast cancer mortality data and estimates for the resident population were obtained from the Brazilian National Health Service (SUS) database for the 1990-2011 period. Age-standardized mortality rates were calculated (20-39, 40-49, 50-69 and ≥70 years) by direct standardization using the 1960 standard world population. Trends were modeled using linear regression, with mortality rates as the dependent variable and the year of death as the independent variable. The Social Exclusion Index (SEI) and the Human Development Index (HDI) were used to classify the 27 Brazilian states. Pearson’s correlation was used to describe the association between the SEI and the HDI and the variations in mortality rates in each state. Results: Age-standardized mortality rates in Brazil were found to be stable (annual percent change [APC] = 0.32; 95%CI: -0.1 – 0.7). Statistically significant decreases in mortality rates were found in the states of Rio Grande do Sul, Rio de Janeiro and Sao Paulo. Increases in mortality rates were most notable in the states of Maranhao (APC = 11.2; 95%CI: 5.8 – 16.9), Piaui (APC = 9.8; 95%CI: 7.6 – 12.1) and Paraiba (APC = 9.3; 95%CI: 6.0 – 12.8). There was a statistically significant correlation between SEI and a change in female breast cancer mortality rates in the Brazilian states between 1990 and 2011 and between HDI and mortality between 2001 and 2011. This reduction was most notable in the Brazilian states with better socioeconomic conditions. Conclusions: It was observed a direct impact of social inequalities in female breast cancer mortality rates in Brazil. Reductions in these rates were found in the more developed states, possibly reflecting a better local healthcare. Citation Format: Ruffo Freitas-Junior, Carolina M Gonzaga, Maria-Paula Curado, Ana-Luiza L Sousa, Marta R Souza. The impact of social inequalities on breast cancer mortality in Brazil [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-08.

Impact of Breast Cancer Treatment on Female Sexual Function: A Systematic Review

INTRODUCTION: Breast cancer (BC) is the most common cancer in women worldwide and, nowadays, advances in BC screening and treatments have led to increasing rates of survival. This factor leads to a special concern about this women’s quality of life and among them, the sexuality. Sexual changes can become the most problematic aspect of a woman’s life. The impact of such changes can last for many years after successful treatment, and can be associated with serious physical and emotional side-effects. The aim of this study was to identify the most common type of female sexual dysfunction (FSD) after the treatment for BC. METHODS: It was performed a systematic review of studies published in the literature until July 2012 in the following database: MEDLINE, Pubmed, SciELO e Lilacs. It was used as used the descriptor: “breast cancer” associated with the following: “sexual dysfunction”, “sexual function” and “sexuality”. It were included studies which evaluated quantitatively the sexual dysfunction presence after BC treatment. It was considered sexual dysfunctions: disorders of desire, lubrication, arousal, orgasm and the presence of pain during the sexual intercourse. The exclusion criteria were narrative review, editorials, case studies and qualitative researches, because there is no objective data, making its compilation impossible. One researcher performed the studies search and two researchers, independently, evaluated the articles to be analyzed by means of structured guide with the following items: 1) sample characterizes, 2) type of treatment for BC and 3) method used to evaluate female sexual function. RESULTS: By reading the title, were chosen for inclusion in 97 articles, of which 85 were excluded after reading the abstract and another 2 were excluded after reading the entire article. It was included 10 studies which evaluated a total of 8. 465 women. The most frequent treatment for BC were: chemotherapy (100%), surgeries for BC (100%) and radiotherapy (83%). The most frequent sexual dysfunction were: decrease of desire/sexual interest (66%), difficulty in lubrication (50%), lack of arousal (33%) and pain during the sexual intercourse (11%). Other associated symptoms were described as fatigue, insomnia, physical problems, lack of satisfaction, shortness of intercourse, feeling less attractive, partner lack of understanding about their feelings and concern about partner desire/interest. DISCUSSION: in a recent study it was questioned the assessment of sexual function during a routine visits. The evidence showed that this theme approach increases the FSD diagnostic capability and improves access to treatment. Due to the high prevalence of these disorders in women who underwent treatment of BC and the various non-hormonal treatment options, it is important to underscore the tackling of this issue by Breast Cancer Specialist and/or Oncologist during consultation and forward for treatment when necessary. CONCLUSION: The FSD were identified as hypoactive sexual desire, lubrication difficult and lack of arousal. The studies demonstrated that the various treatment of BC negatively impact female sexual function.