Suzana Sales de Aguiar

Determinantes do diagnóstico em estadio avançado do câncer do colo do útero no Brasil

PURPOSE To assess the determinants of late stage in women with cervical cancer in Brazil. METHODS A cross-sectional study of secondary basis. Women with invasive cervical cancer enrolled in the Cancer Hospital Registry between January 2000 and December 2009 were included. Late clinical stage (≥IIB) was the outcome considered. The following variables were studied: age at diagnosis, race or ethnicity, years of education, marital status, alcohol consumption, smoking status, place of residence, year of diagnosis, initial treatment received, and status after the first treatment. Odds ratio (OR) with 95% confidence intervals (95%CI) and a logistic regression model were used. P values<0.05 were considered statistically significant. RESULTS 37,638 cases were included, with a mean age of 52.4±14.1 years. Late clinical stages were observed in 70.6% of cases and were associated with the presence of squamous cell carcinoma (OR=1.8; 95%CI 1.7-2.0), age ≥50 years (OR=1.5; 95%CI 1.4-1.6), living with a partner (OR=1.3; 95%CI 1.2-1.4), black skin color (OR=1.2; 95%CI 1.1-1.4), and low educational level (OR=1.2; 95%CI 1.1-1.3). CONCLUSION In Brazil, the diagnosis of cervical cancer is a delayed event. Although the main factor associated with late stage of cervical cancer identified in this study is a biological factors (histological type) and, consequently, not eligible for intervention, it was confirmed that socioeconomic disparities in the country are associated with late stage disease.

The magnitude of the association between smoking and the risk of developing cancer in Brazil: a multicenter study

Objectives To estimate the magnitude of association and identify the aetiological fraction (AF) attributable to smoking in the development of different types of cancers in Brazil. Setting We conducted a case–control study, including 231 102 patients registered in the Cancer Hospital Registries (CHR) in the period from 1998 to 2011. Participants A total of 204 131 cancer cases relating to 30 topographies were compared with 26 971 cases of non-melanoma skin cancer. Primary and secondary outcome measures Smoking exposure was considered at the time of hospital registration. We calculated OR, unadjusted and adjusted for gender, age and alcohol consumption, with 95% CIs. Results After adjustment, the risk of developing cancer associated with smoking was very high (piriform sinus, bronchi and lung, larynx, hypopharynx, oropharynx and oral cavity), high (oesophagus and bladder), moderate (anus and anal canal stomach, nasal cavity, middle ear and paranasal sinuses, pancreas, nasopharynx, other parts of the biliary tract and kidney and low (liver, gall)). There was no association between smoking and cancers of the central nervous system and myeloid leukaemia. For thyroid cancer there was a decreased risk of developing the disease. The AF was higher than 50% for hypopharynx, larynx, bronchi and lung, oropharynx, oral cavity and oesophagus cancers. Conclusions This study confirms a high risk of developing cancer of the hypopharynx, bronchi and lung, larynx, oropharynx and oral cavity, oesophagus and bladder cancer among smokers and establishes the AF attributable to smoking in the development of different types of cancer in Brazil.

Determinants of advanced stage presentation of breast cancer in 87,969 Brazilian women.

BACKGROUND Breast cancer is commonly diagnosed at an advanced stage in Brazil. AIM Analyze the determinants of advanced staging in Brazilian women with breast cancer. METHODS Crosssectional study, including women diagnosed with breast cancer in Brazil, between 2000 and 2009. RESULTS A total of 59,317 women were included, 53.5% being classified as advanced stage (≥IIB). Younger age (18 to 49 years old) (OR=1.61 95% CI 1.51 to 1.72) or between 40 and 49 years old (OR=1.08 95% CI 1.03 to 1.14), having low educational level (OR=1.53 95% CI 1.48 to 1.58), living in less developed geographical regions (OR=1.27 95% CI 1.21 to 1.33), having invasive ductal carcinoma (OR=2.70 95% CI 2.56 to 2.84) and invasive lobular carcinoma (OR=2.63 95% CI 2.42 to 2.86) were associated with advanced breast cancer. CONCLUSION We conclude that future interventions should focus on these high risk groups.

Comparison of adenocarcinoma (ACA) and squamous cell carcinoma (SCC) of the uterine cervix in a sub-optimally screened cohort: A population-based epidemiologic study of 51,842 women in Brazil

BACKGROUND Most cancers of the uterine cervix are SCC, but the relative and absolute incidence of ACA has risen in recent years, and ACA now accounts for approximately 20% of invasive cervical cancers in the screened populations worldwide. OBJECTIVE To compare the epidemiological, clinical characteristics, and treatment outcomes of ACA with those of SCC of the cervix in a sub-optimally screened population. METHODS Data from cervical cancer patients with SCC and ACA treated from 2000 through 2009 were obtained from the Brazilian Hospital Cancer Register databases. The summary odds ratios and chi-square tests were estimated. RESULTS A total of 51,842 patients including 45,540 (87.8%) cases of SCC and 6302 (12.2%) of ACA were analyzed. Compared with the ACA patients, the SCC patients were younger and more frequently black and had a higher degree of illiteracy and alcohol and tobacco consumers. The tumor stage at the time of diagnosis was also significantly different between the two groups. However, initial therapeutic response and death rate after the first course of treatment were similar in both groups. CONCLUSIONS Differences between ACA and SCC were observed for all demographic and clinical variables analyzed but not for responses to treatment and death at the end of the first course of treatment. Irrespective of the histological subtype, the quality of screening and treatment must be improved in developing countries, since initial therapeutic response of ACA and SCC is similar.

Alcohol consumption and the risk of cancer in Brazil: A study involving 203,506 cancer patients

This study aims to analyze the association between alcohol consumption and the risk of developing the most common types of cancer in the Brazilian population. It is a case-control study in which the most common types of cancer were considered as cases and non-melanoma skin cancers as controls. Data were routinely obtained by hospital-based cancer registrars. Individuals between 18 and 100 years old, diagnosed between January 1, 2000 and December 31, 2009, with information regarding alcohol consumption, were included. The odds ratio (OR) for each type of cancer was calculated, adjusting for confounding variables. The etiologic fraction (EF) was calculated in cases with statistically significant results. The study included 203,506 individuals (110,550 women and 92,956 men), with an average age of 59 years. A statistically significant association was found between alcohol consumption and increased risk of cancers of the respiratory and digestive systems, prostate, and female breast. The association between alcohol consumption and cancers of the urinary tract, male genital organs, and other neoplasias was not statistically significant. Consumption of alcoholic beverages increased the risk of developing cancer of the nasal cavity, pyriform sinus, oral cavity, oropharynx, nasopharynx, larynx, hypopharynx, lung, esophagus, stomach, liver, pancreas, breast, prostate, colon and rectum, and anus and anal canal.

Quality of Life and Volume Reduction in Women with Secondary Lymphoedema Related to Breast Cancer

Purpose. To assess the quality of life (QOL) as a predictor of volume reduction in women undergoing complex physical therapy (CPT) for lymphoedema following breast cancer. Methods. Clinical trial in 57 women undergoing CPT. Results. At baseline, in measuring quality of life for the EORTC QLQ-C30 questionnaire subscale of functionality, the worst scores for emotional function (55 points) and better social function (89 points) were observed. The symptom scales showed the worst pain averaged (66 points). The overall quality of life showed a low score (40 points). In the BR 23 module, low scores were observed in the field of future perspective (47 points). After treatment of lymphoedema, absolute reduction of excess volume between the upper limbs of 282 mL was observed, representing a reduction of 15%. No association was observed between the domains of quality of life and response to treatment of lymphoedema. Conclusion. This study included 57 women with advanced and chronic lymphoedema in early treatment with CPT and low scores for quality of life. The lymphoedema therapeutic response was not influenced by the QOL at the beginning of treatment.

Análise dos determinantes que influenciam o tempo para o início do tratamento de mulheres com câncer de mama no Brasil

This study aimed to analyze the time elapsed between breast cancer diagnosis and initiation of treatment in woman treated from 2000 to 2011 in the Brazilian public health system and to identify factors associated with delayed onset of treatment. This retrospective cohort study included 137,593 women diagnosed in 239 hospitals in Brazil from 2000 to 2011. In 63.1% of cases the time between diagnosis and treatment was 60 days. Delayed treatment was associated with nonwhite skin color (OR = 1.18; 95%CI: 1.13-1.23), single marital status (OR = 1.05; 95%CI: 1.01-1.09), less than eight years of schooling (OR = 1.13; 95%CI: 1.08-1.18), early-stage disease (OR = 1.27; 95%CI: 1.22-1.32), treatment from 2006 to 2011 (OR = 1.54; 95%CI: 1.47-1.60), and patients in the public health system (OR = 1.19; 95%CI: 1.13-1.25). Stratified analysis showed variability of factors between regions of Brazil. The identification of factors associated with delayed initiation of breast cancer treatment can support the development of interventions targeted to specific population groups.Este estudo teve como objetivo analisar o intervalo de tempo entre o diagnostico e o inicio do tratamento do câncer de mama em mulheres e seus determinantes. Foi realizado um estudo de coorte retrospectiva com 137.593 mulheres diagnosticadas em 239 unidades hospitalares do Brasil entre 2000 a 2011. Em 63,1% dos casos, o intervalo entre o diagnostico e o tratamento foi de ate 60 dias. No pais, as mulheres mais suscetiveis ao atraso foram nao brancas (OR = 1,18; IC95%: 1,13-1,23), sem companheiro (OR = 1,05; IC95%: 1,01-1,09), com menos de oito anos de estudo (OR = 1,13; IC95%: 1,08-1,18), com doenca em estadiamento inicial (OR = 1,27; IC95%: 1,22-1,32), tratadas de 2006 a 2011 (OR = 1,54; IC95%: 1,47-1,60) e provenientes do sistema publico de saude (OR = 1,19; IC95%: 1,13-1,25). Na analise estratificada foi observada a variabilidade dos fatores entre as regioes do Brasil. A identificacao de fatores associados a demora no inicio do tratamento podera possibilitar a elaboracao de propostas de intervencoes destinadas a grupos populacionais especificos.

Determinants of the time between breast cancer diagnosis and initiation of treatment in Brazilian women

This study aimed to analyze the time elapsed between breast cancer diagnosis and initiation of treatment in woman treated from 2000 to 2011 in the Brazilian public health system and to identify factors associated with delayed onset of treatment. This retrospective cohort study included 137,593 women diagnosed in 239 hospitals in Brazil from 2000 to 2011. In 63.1% of cases the time between diagnosis and treatment was 60 days. Delayed treatment was associated with nonwhite skin color (OR = 1.18; 95%CI: 1.13-1.23), single marital status (OR = 1.05; 95%CI: 1.01-1.09), less than eight years of schooling (OR = 1.13; 95%CI: 1.08-1.18), early-stage disease (OR = 1.27; 95%CI: 1.22-1.32), treatment from 2006 to 2011 (OR = 1.54; 95%CI: 1.47-1.60), and patients in the public health system (OR = 1.19; 95%CI: 1.13-1.25). Stratified analysis showed variability of factors between regions of Brazil. The identification of factors associated with delayed initiation of breast cancer treatment can support the development of interventions targeted to specific population groups.Este estudo teve como objetivo analisar o intervalo de tempo entre o diagnostico e o inicio do tratamento do câncer de mama em mulheres e seus determinantes. Foi realizado um estudo de coorte retrospectiva com 137.593 mulheres diagnosticadas em 239 unidades hospitalares do Brasil entre 2000 a 2011. Em 63,1% dos casos, o intervalo entre o diagnostico e o tratamento foi de ate 60 dias. No pais, as mulheres mais suscetiveis ao atraso foram nao brancas (OR = 1,18; IC95%: 1,13-1,23), sem companheiro (OR = 1,05; IC95%: 1,01-1,09), com menos de oito anos de estudo (OR = 1,13; IC95%: 1,08-1,18), com doenca em estadiamento inicial (OR = 1,27; IC95%: 1,22-1,32), tratadas de 2006 a 2011 (OR = 1,54; IC95%: 1,47-1,60) e provenientes do sistema publico de saude (OR = 1,19; IC95%: 1,13-1,25). Na analise estratificada foi observada a variabilidade dos fatores entre as regioes do Brasil. A identificacao de fatores associados a demora no inicio do tratamento podera possibilitar a elaboracao de propostas de intervencoes destinadas a grupos populacionais especificos.

Effectiveness of four inflammatory markers in predicting prognosis in 2374 women with breast cancer

OBJECTIVE To analyze the association between four biomarkers and overall survival in patients with breast cancer (BC). METHODOLOGY This cohort study had a sample of 2374 women over the age of 18, diagnosed and treated in a single reference center for BC in Brazil, during the year 2008-2009. The following pretreatment indices were analyzed: neutrophil-lymphocyte ratio (NLR), a derived neutrophil-lymphocyte ratio (dNLR), absolute neutrophil count (ANC) and platelet-lymphocyte ratio (PLR). A descriptive analysis was performed using median (range) and absolute and relative frequency as categorical variables. Exploratory survival evaluation was performed using the Kaplan-Meier method and the log-rank test for comparison between survival curves, with a statistical significance level of 5%. The variables with p<0.20 were selected for inclusion in a multivariate Cox regression model, considering as statistically significant p<0.05. RESULTS After adjusting for clinical variables, the biomarkers associated with worse overall survival were NLR >5 (HR=1.66 95%CI 1.08-2.55; p=0.021) and PLR >300 (HR=1.82 95%CI 1.10-2.99; p=0.019). When stratified by molecular subtype, the independent markers related to death were PLR >300 for triple negative (HR 3.27 95%CI 1.38-7.76; p=0.007); NLR >5 (HR 2.47 95%CI 1.16-5.28; p=0.019), ANC >7500 (HR 1.84 95%CI 1.17-2.90; p=0.008) and dNLR >3 (HR 2.45 95%CI 1.29-4.66; p=0.006) for luminal. CONCLUSION NLR and PLR are independent markers of prognosis in BC. Further studies are needed in patients with overexpression of HER 2.

Response to “Men and women show similar survival rates after breast cancer”, Yin Pan, Ze-Zhou Song

analysis stratified by age. For this, we classified patients into subgroups of age (<50 or ≥70 years), assuming the age of 50 years as a proxy for menopause in women (Phipps et al., 2010). In the population less than 50 years of age, there were no statistically significant differences in oestrogen, progesterone, or HER2 receptors between sexes. However, among those aged 50 years or older, a higher proportion of positive oestrogen and progesterone receptors was observed among men, and a higher proportion of HER2 was observed among women (Table 1), as previously found by other authors (Fentiman et al. 2006; Sanguinetti et al. 2016). In the age-stratified survival analysis, there were no differences in disease-free survival (Fig. 1a, b) and overall survival (Fig. 2a, b) between sexes (Table 2). In conclusion, these new results reinforce that there are no differences in disease-free survival and overall survival To the editors: