Vania Reis Girianelli

Tendência da mortalidade por câncer nas capitais e interior do Brasil entre 1980 e 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.

Custo-efetividade no diagnóstico precoce do câncer de colo uterino no Brasil

Trata-se de estudo de custo-efetividade comparando o teste de Papanicolaou com as novas tecnologias de rastreamento do câncer cervico-uterino. Foi utilizado um modelo analitico de decisao para simular os impactos economicos e em saude das tecnologias de rastreamento, tendo como unidade de desfecho os casos detectados de câncer de colo uterino ou lesoes precursoras de alta malignidade. As estrategias de rastreamento examinadas foram: teste de Papanicolaou; citologia em meio liquido; captura hibrida para Papilomavirus (CH-HPV); CH-HPV com autocoleta; associacao do teste de Papanicolaou com CH-HPV; e associacao de citologia em meio liquido com CH-HPV. O universo temporal restringiu-se a um ano. A perspectiva adotada no estudo foi a do sistema de saude, contabilizando-se apenas os custos medicos diretos de rastreamento dos casos detectados e utilizando os valores propostos pela tabela da Classificacao Brasileira Hierarquizada de Procedimentos Medicos. Estimaram-se tambem os precos que as tecnologias nao presentes na tabela de reembolso do SUS precisariam ter para que as relacoes de custo-efetividade fossem, no minimo, equivalentes ao teste de Papanicolaou. Concluiu-se que, embora o teste de Papanicolaou possa ser mais custo-efetivo, as novas estrategias de rastreamento do câncer cervico-uterino podem vir a mostrar melhor razao de custo-efetividade na dependencia dos precos praticados no setor de saude.

Cancer mortality trends in Brazilian state capitals and other municipalities between 1980 and 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.

Factors associated with the risk of progression to precursor lesions or cervical cancer in women with negative cytologic findings

To evaluate factors associated with progression to cervical cancer or moderate to severe precursor lesions (cervical intraepithelial neoplasia grade 2 [CIN 2] or higher) in women with negative cervical screening results.

Tendencia de la mortalidad por cáncer en las capitales e interior de Brasil entre 1980 y 2006

OBJECTIVE To analyze the corrected trend of overall cancer mortality and leading sites in the state capitals and other municipalities of Brazil between 1980 and 2006. METHODS Data on deaths (n = 2,585,012) caused by cancer between 1980 and 2006 were obtained from Sistema de Informações sobre Mortalidade (Mortality Information System), and demographic data were provided by Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The rates of overall cancer mortality and major types were corrected by proportionally redistributing 50% of ill-defined causes of death and standardizing them by age according to the standard world population. Trend curves for Brazil and its major regions were calculated for state capitals and other municipalities according to sex, and were evaluated by means of simple linear regression. RESULTS Among men, ascending mortality rates were observed for lung, prostate and colorectal cancer; declining rates for stomach cancer; and stable rates for esophagus cancer. Among women, mortality from breast, lung and colorectal cancer increased, and the rates for cervical and stomach cancer declined. Mortality evolution varied across the regions of Brazil, with distinct patterns between state capitals and other municipalities. CONCLUSIONS The correction of mortality rates based on redistribution of ill-defined causes of death increased the magnitude of the overall cancer mortality in Brazil by approximately 10% in 1980 and 5% in 2006. In the inland municipalities no decrease or stability was identified, differently from what was observed in the state capitals. Limited scope of prevention actions and lower access to services of cancer diagnosis and treatment for the population living away from large urban centers may partly explain these differences.OBJETIVO: Analizar la tendencia corregida de la mortalidad general por cancer y principales tipos en las capitales y demas municipios de Brasil entre 1980 a 2006. METODOS: Los datos sobre obitos (n= 2.585.012) originados por cancer entre 1980 y 2006 fueron obtenidos en el Sistema de Informaciones sobre Mortalidad, y los demograficos, en el Instituto Brasileno de Geografia y Estadistica. Las tasas de mortalidad general por cancer y principales tipos fueron corregidas redistribuyendo proporcionalmente 50% de las muertes mal definidas y estandarizandolas por edad segun poblacion patron mundial. Las curvas de tendencia para Brasil y grandes regiones fueron calculadas para capitales y demas municipios segun sexo y evaluadas por medio de regresion linear simple. RESULTADOS: Entre los hombres, las tasas de mortalidad para los canceres de pulmon, prostata y colorrectal fueron ascendentes; declinantes para el de estomago y estables para el de esofago. Entre las mujeres, hubo aumento de la mortalidad por cancer de mama, pulmon y colorrectal; y disminucion de las tasas para los canceres de cuello uterino y de estomago. La evolucion de la mortalidad vario entre las regiones del Pais, con patrones distintos entre las capitales y demas municipios. CONCLUSIONES: La correccion de las tasas de mortalidad con redistribucion de los obitos mal definidos aumento la magnitud de la mortalidad general por cancer en Brasil en cerca de 10% en 1980 y 5% en 2006. En los municipios del interior no se observo tendencia de disminucion o estabilidad como en las capitales. Menor alcance de las acciones de prevencion y la dificultad de acceso a servicios diagnostico y tratamiento para cancer para la poblacion residente fuera de los grandes centros urbanos pueden explicar, en parte, estas diferencias.