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Affonso MVDG, Souza IG, de Rocha ES, Goloni-Bertollo EM, Gomes FDC, do Nascimento LS, de Melo-Neto JS. Association between Sociodemographic Factors, Coverage and Offer of Health Services with Mortality Due to Oral and Oropharyngeal Cancer in Brazil: A 20-Year Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13208. [PMID: 36293789 PMCID: PMC9603184 DOI: 10.3390/ijerph192013208] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/19/2022] [Accepted: 07/23/2022] [Indexed: 06/16/2023]
Abstract
To investigate the association between sociodemographic factors and variables related to oral health services in oral and oropharyngeal cancer mortality in Brazil, between 2000 and 2019. This study had an ecological design. Standardized mortality rates were compared between age group, sex, and regions. Age-Period-Cohort analysis was applied. Oral health services variables were analyzed in correlation tests. Survival analysis included Kaplan-Meier estimators, log-rank tests, and Cox regression. The mortality rate increased with age and was higher in men. Southeast and south regions had the highest rates for men, and the northeast and southeast had it for women. Age-Period-Cohort analysis showed a slight increase in female deaths and an increasing trend in the annual percent change in mortality for men over age 55. In survival analysis, males, Black individuals and southern residents were more strongly associated with death. The correlation between oral health teams' coverage was high and negative, while the number of dental specialty centers and soft tissue biopsies had a high and positive correlation. Mortality and survival patterns were dependent on sex, age, geographic region and race/ethnicity. It was observed that preventive and diagnostic procedures were not being performed, which may be related to the increase in mortality.
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Affiliation(s)
| | - Igor Gonçalves Souza
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | - Emerson Souza de Rocha
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
| | | | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), Sao Jose do Rio Preto 15090-000, Brazil
| | | | - João Simão de Melo-Neto
- Institute of Health Sciences, Federal University of Pará (UFPA), Belem 66075-110, Brazil
- School of Physiotherapy and Occupational Therapy, Federal University of Pará (UFPA), Street Augusto Corrêa, 01, Belem 66075-110, Brazil
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Mamani LC, Miyazawa M, Nogueira DA, Sperandio FF, Pereira AAC, Hanemann JAC. Development and Evolution of a Diagnostic and Oral Pathology Service in a Southeast Brazilian State. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n2.2468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Introduction: Oral squamous cell carcinoma (OSCC) is one of the most frequent cancers whose main causes are preventable because oral cavity is easily accessible for examination. OSCC involves many steps from the diagnosis until treatment which can result in late diagnosis and worst prognosis. Objective: Development and evolution of a Stomatology and Oral Pathology Service at the Federal University of Alfenas addressing early diagnosis and management of oral lesions. Method: Retrospective study developed with the files from 1998 to 2019. Data from all the cases diagnosed as oral malignancies were collected and the demographical, clinical, and microscope diagnosis were included. Results: 270 (84.64%) OSCC were found among 8,952 histopathological diagnoses. The patients age ranged from 24 to 94 years (mean 59.7±13.1 years), and more frequent in the sixth (32.3%) and seventh (26%) decades of life. Men were 2.5 times more affected than women. Most of patients were Caucasian (74.8%), and users of tobacco and alcohol. Over the years, there was an increase in the number of cases diagnosed and expansion of the area covered by the Service. Conclusion: The Dental Clinic (Stomatology) and Oral Pathology Laboratory has been playing an important role for the establishment and improvement of the healthcare system to the local population, mainly in rural areas.
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A Survey of Brazilian Patients with Oral Lichen Planus Showing No Evidence of Malignancy. Dermatol Res Pract 2022; 2022:5937540. [PMID: 35340913 PMCID: PMC8942684 DOI: 10.1155/2022/5937540] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 12/26/2021] [Accepted: 02/26/2022] [Indexed: 11/17/2022] Open
Abstract
Objectives There is conflicting evidence as to whether oral lichen planus (OLP) can undergo malignant transformation into oral squamous cell carcinoma (OSCC). This study aimed to address this issue by analyzing a sample of Brazilian patients with either OLP or OSCC. Patients and Methods. This study was conducted in São Paulo, the world's fourth-largest city by population. Two groups of patients were analyzed. The OLP group consisted of 370 patients, while the OSCC group consisted of 154 patients. The OLP patients were followed up for up to 21 years to monitor clinical benefits from the management or changes in the lesion morphology; conversely, patients with OSCC were examined only twice for diagnostic purposes and referred to a specialized center. Data concerning systemic diseases, use of medications, type of oral lesions, and health-risk behaviors were recorded for patients in both groups. Results None of the patients with OLP developed OSCC at the lesion site. Only one female patient with erosive OLP developed OSCC in the normal, lesion-free oral mucosa. None of the OSCC patients had concomitant OLP lesions; however, a higher percentage of OSCC cases (17.5%) showed white plaques (most likely oral leukoplakia) as a precursor lesion. Conclusion The findings strongly suggest that malignant transformation of OLP is virtually nonexistent in the Brazilian population.
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Kar D, Banerjee S. Epithelial expression of epithelia-cadherin in different grades of oral squamous cell carcinoma. J Oral Maxillofac Pathol 2021; 25:253-257. [PMID: 34703118 PMCID: PMC8491325 DOI: 10.4103/0973-029x.325123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/18/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The incidence of oral squamous cell carcinoma (OSCC) has been increasing day by day in the Southeast Asian countries. There is variation in the incidence rates in various parts of the world, with the highest recorded in Southeast Asian countries such as Sri Lanka, India, Bangladesh, and Pakistan. The survival rate for OSCC has remained generally unchanged in the past three decades, underlining the need for more biomarkers to be developed to aid prognostication and effective treatment planning and management. The prognostic potential of epithelia-cadherin (E-cadherin) expression in OSCCs has been variable in previous studies has been correlated with improved prognosis in other cancers. The aim of the present study was to investigate and analyze the expression of E-cadherin in different histopathological grades OSCC, to understand its potential as prognostic biomarker of most common oral cancer. Materials and Methods: E-cadherin expression was examined by immunohistochemistry in 35 cases of OSCC of the buccal mucosa and 5 of normal buccal mucosa. Results: In our study, E-cadherin expression appeared in widely differentiated squamous cell carcinoma (130.75 ± 30.64) moderately differentiated squamous cell carcinoma (123.66 ± 13.17), and poorly differentiated squamous cell carcinoma (88.52 ± 30.11). Conclusions: E-cadherin expression is reduced with higher grades of OSCC. However, the present results suggest that E-cadherin expression may be useful as prognostic markers for OSCC.
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Affiliation(s)
- Debkamal Kar
- Dental Surgeon & Oral & Maxillofacial Pathologist, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
| | - Sohini Banerjee
- Department of Periodontics, Dr. R. Ahmed Dental College and Hospital, Kolkata, West Bengal, India
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Panta P, Dhopathi SR, Reddy P. What is the impact of charcoal on human health and oral carcinogenesis? Oral Oncol 2021; 124:105514. [PMID: 34479821 DOI: 10.1016/j.oraloncology.2021.105514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022]
Affiliation(s)
- Prashanth Panta
- Department of Oral Medicine and Radiology, MNR Dental College and Hospital, Narsapur Road, Sangareddy 502294, Telangana, India.
| | - Sravya Reddy Dhopathi
- Department of Periodontics, MNR Dental College and Hospital, Narsapur Road, Sangareddy 502294, Telangana, India
| | - Prashanthi Reddy
- Department of Oral Medicine and Radiology, Government College of Dentistry, Sardar Patel Marg, Indore 452001, Madhya Pradesh, India
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Roi A, Roi CI, Andreescu NI, Riviş M, Badea ID, Meszaros N, Rusu LC, Iurciuc S. Oral cancer histopathological subtypes in association with risk factors: a 5-year retrospective study. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:1213-1220. [PMID: 34171069 PMCID: PMC8343614 DOI: 10.47162/rjme.61.4.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background: Oral cancer is a worldwide public health problem, being the sixth most common neoplasm. The high mortality rate of this type of cancer is due to a delayed diagnosis, a fast evolution and metastasis, no primary symptomatology, the multitude of risk factors and the lack of awareness among the population concerning oral malignancy. Aim: The aim of this 5-year retrospective study was to evaluate the incidence of oral cancer patients in the Clinic of Maxillo-Facial Surgery, Emergency County Hospital, Timişoara, Romania and quantify the histopathological (HP) subtypes, localization, age, gender, tumor staging and differentiation, positive loco-regional lymph nodes and risk factors. Patients, Materials and Methods: A number of 129 patients diagnosed with oral cancer were included in the study and their medical records were analyzed. A statistical analysis was performed that included the variables gender, age, tumor staging, differentiation grade, HP subtype, lymph nodes, localization, and risk factors. Results: Our results outlined a high prevalence of oral cancer among males (65.9%), squamous cell carcinoma (SCC) being the most common HP subtype. Tumor staging revealed the fact that the majority of were T3 and T4 tumors with dissemination in the loco-regional lymph nodes. In 52% of the cases, tobacco was identified as a risk factor, and the association of tobacco and alcohol was present in 28.3% of the cases. Conclusions: The early diagnosis is crucial for the improvement of oral cancer survival rate. The oral cavity is permanently exposed to carcinogenic substances that associated with other risk factors have an influence upon the incidence of oral malignancies.
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Affiliation(s)
- Alexandra Roi
- Department of Anesthesiology and Oral Surgery, Multidisciplinary Center for Research, Evaluation, Diagnosis and Therapies in Oral Medicine, Faculty of Dental Medicine, Victor Babeş University of Medicine and Pharmacy, Timişoara, Romania; ,
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Xavier GM, Guimarães ALS, de Carvalho Fraga CA, Guimarães TA, de Souza MG, Jones KM, Farias LC. Pathways Related to the Anti-Cancer Effects of Metabolites Derived from Cerrado Biome Native Plants: An Update and Bioinformatics Analysis on Oral Squamous Cell Carcinoma. Protein Pept Lett 2020; 28:735-749. [PMID: 33302827 DOI: 10.2174/0929866527999201209221012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/14/2020] [Accepted: 10/20/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Oral cancer is a significant health problem worldwide. Oral squamous cell carcinoma (OSCC) is a malignant neoplasm of epithelial cells that mostly affects different anatomical sites in the head and neck and derives from the squamous epithelium or displays similar morphological characteristics. Generally, OSCC is often the end stage of several changes in the stratified squamous epithelium, which begin as epithelial dysplasia and progress by breaking the basement membrane and invading adjacent tissues. Several plant-based drugs with potent anti-cancer effects are considered inexpensive treatments with limited side effects for cancer and other diseases. OBJECTIVE The aim of this review is to explore whether some Brazilian plant extracts or constituents exhibit anti-tumorigenic activity or have a cytotoxic effect on human oral carcinoma cells. METHODS Briefly, OSCC and several metabolites derived from Brazilian plants (i.e., flavonoids, vinblastine, irinotecan, etoposide and paclitaxel) were used as keywords to search the literature on PubMed, GenBank and GeneCards. RESULTS The results showed that these five chemical compounds found in Cerrado Biome plants exhibit anti-neoplastic effects. Evaluating the compounds revealed that they play a main role in the regulation of cell proliferation. CONCLUSION Preserving and utilising the biodiversity of our planet, especially in unique ecosystems, such as the Cerrado Biome, may prove essential to preserving and promoting human health in modern contexts.
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Khani Jeihooni A, Afzali Harsini P. The Effect of an Educational Intervention Based on PRECEDE Model on Oral Cancer Prevention Behaviors in Hookah Users. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1250-1260. [PMID: 31359373 DOI: 10.1007/s13187-019-01591-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Educational intervention about oral cancer prevention is essential for all people, especially in hookah users. The aim of this study is investigating the effect of an educational intervention based on PRECEDE model on oral cancer prevention in hookah users living in Fasa, Fars Province, Iran, in 2017-2018. In this quasi-experimental study, 360 hookah users were selected and divided into experimental and control groups (180 subjects for each group). Educational intervention was performed for experimental group in 12 sessions. A questionnaire consisting of items evaluating demographic information and PRECEDE model constructs (knowledge, attitude, self-efficacy, enabling factors, and reinforcing factors) was used to measure oral cancer prevention behaviors and nicotine dependency of subjects before and 6 months after intervention. Obtained data were analyzed by SPSS-22 software through paired t test, independent t test, and chi-square test at significance level of P < 0.05. Six months after intervention, experimental group showed significant increase in knowledge, attitude, self-efficacy, enabling factors, reinforcing factors, oral cancer prevention behaviors, and reduction of nicotine dependency compared with control group. This study showed the efficiency of educational intervention based on PRECEDE model in adoption of oral cancer prevention behaviors and reduction of nicotine dependency of hookah users 6 months after intervention.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran.
| | - Pooyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Mosaddad SA, Beigi K, Doroodizadeh T, Haghnegahdar M, Golfeshan F, Ranjbar R, Tebyanian H. Therapeutic applications of herbal/synthetic/bio-drug in oral cancer: An update. Eur J Pharmacol 2020; 890:173657. [PMID: 33096111 DOI: 10.1016/j.ejphar.2020.173657] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 10/01/2020] [Accepted: 10/20/2020] [Indexed: 12/18/2022]
Abstract
Oral cancer, as one of the most prevalent and invasive cancers that invade local tissue, can cause metastasis, and have high mortality. In 2018, around 355,000 worldwide oral cancers occurred and resulted in 177,000 deaths. Estimates for the year 2020 include about 53,260 new cases added to previous year's cases, and the estimated death toll from this cancer in 2020 is about 10,750 deaths more than previous years. Despite recent advances in cancer diagnosis and treatment, unfortunately, 50% of people with cancer cannot be cured. Of course, it should be remembered that the type of treatment used greatly influences patient recovery. There are not many choices when it comes to treating oral cancer. Research efforts focusing on the discovery and evolution of innovative therapeutic approaches for oral cancer are essential. Such traditional methods of treating this type of cancer like surgery and chemotherapy, have evolved dramatically during the past thirty to forty years, but they continue to cause panic among patients due to their side effects. Therefore, it is necessary to study and use drugs that are less risky for the patient as well as to provide solutions to reduce chemotherapy-induced adverse events that prevent many therapeutic risks. As mentioned above, this study examines low-risk therapies such as herbal remedies, biological drugs, and synthetic drugs in the hope that they will be useful to physicians, researchers, and scientists around the world.
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Affiliation(s)
- Seyed Ali Mosaddad
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Kimia Beigi
- Student Research Committee, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tayebeh Doroodizadeh
- Department of Pediatric Dentistry, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Haghnegahdar
- Department of Pharmacology & Toxicology, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Farzaneh Golfeshan
- Orthodontic Research Center, School of Dentistry, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Reza Ranjbar
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Tebyanian
- Research Center for Prevention of Oral and Dental Diseases, Baqiyatallah University of Medical Sciences, Tehran, Iran.
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Cunha ARD, Prass TS, Hugo FN. Mortality from oral and oropharyngeal cancer in Brazil, between 2000 and 2013: trends by sociodemographic strata. CIENCIA & SAUDE COLETIVA 2020; 25:3075-3086. [PMID: 32785543 DOI: 10.1590/1413-81232020258.31282018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/22/2018] [Indexed: 12/31/2022] Open
Abstract
Generalized observations of temporal trends in mortality could mask consistent specific patterns. This study aims to analyze the trend of oral and oropharyngeal cancer mortality rates in Brazil, from 2000 to 2013, considering the differences by gender, anatomical site, age group and ethnicity. Data on oral and oropharyngeal cancer mortality were retrieved from the Mortality Information System. The trend of historical series mortality rates by stratum was estimated through a generalized linear regression by the Prais-Winsten method. In total, 61,190 deaths from oral and oropharyngeal cancer were recorded in the 2000-2013 period (mean of coefficients: 3.50 deaths/100 thousand inhabitants/year). The trend of mortality rates was stable for males and increasing for females (1.31%/year). A growing pattern was identified for men aged 20-29 years (2.92%/year) and brown men (20.36%/year). The increasing pattern was also identified for white women (2.70%/year) and brown women (8.24%/year). We can conclude that surveillance of this condition should consider the sociodemographic differences of the population for equitable planning of care strategies because they reflected in different trends of oral and oropharyngeal cancer mortality rates in Brazil.
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Affiliation(s)
- Amanda Ramos da Cunha
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
| | | | - Fernando Neves Hugo
- Faculdade de Odontologia, Universidade Federal do Rio Grande do Sul (UFRGS). R. Ramiro Barcelos 2492, Santa Cecília. 90035-003 Porto Alegre RS Brasil.
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Silva CMG, Araújo DBD, Martins GB, Campos EDJ, Araújo RPCD. Tobacco and Alcohol Use and Clinical Staging of Head and Neck Tumors. PESQUISA BRASILEIRA EM ODONTOPEDIATRIA E CLÍNICA INTEGRADA 2020. [DOI: 10.1590/pboci.2020.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Cunha ARD, Prass TS, Hugo FN. Mortality from oral and oropharyngeal cancer in Brazil: impact of the National Oral Health Policy. CAD SAUDE PUBLICA 2019; 35:e00014319. [PMID: 31800779 DOI: 10.1590/0102-311x00014319] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 06/03/2019] [Indexed: 11/22/2022] Open
Abstract
The objective was to investigate if there is an association between the mortality rates due to oral and oropharyngeal cancer in Brazil and the expansion of access to public primary and specialized dental care services that resulted from the implementation of the National Oral Health Policy, between 2000 and 2013. The mortality data were obtained from the records of the Mortality Information System and the exposure variables were obtained from databases of the Brazilian Ministry of Health and the Brazilian Institute of Geography and Statistics. The main exposures investigated were "coverage of primary dental care" and "number of specialized dental care centers". Additional covariates included "Gini index of household income", "average number of years of study", "proportion of unemployed people" and "proportion of smokers". For the statistical analysis, a random coefficient model was used. There was a statistically significant association between the mortality rates by oral and oropharyngeal cancer with coverage by primary dental care and the number of specialized dental care centers with males. This study found that the expansion of the coverage of primary dental care and the number of specialized dental care centers are associated with the reduction of mortality rates due to oral and oropharyngeal cancer in Brazil. There is plausibility for the association found, which needs to be confirmed by implementation studies.
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Jeihooni AK, Dindarloo SF, Harsini PA. Effectiveness of Health Belief Model on Oral Cancer Prevention in Smoker Men. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2019; 34:920-927. [PMID: 29992432 DOI: 10.1007/s13187-018-1396-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The purpose of the present study is investigating the effect of educational intervention based on health belief model (HBM) on oral cancer prevention in smoker men. This is a quasi-experimental study carried out on 200 smoker men with the age of 40 or older (100 subjects for the experimental group and 100 subjects for control group) resident in Fasa City, Fars Province, Iran, in 2017-2018. The educational intervention for the experimental group included seven educational sessions for 50 or 55 min-based HBM. A questionnaire consisted of items about demographic information, knowledge, HBM constructs (perceived susceptibility, severity, benefits, barriers, self-efficacy, and cues to action) was used to measure the oral cancer prevention before and 6 months after the intervention. The mean age of the men was 51.35±8.41 years in the experimental group and 52.28±8.09 years in the control group. Based on the obtained results, significant enhancement is observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors in experimental group; however, no significant changes are observed in average scores of knowledge, perceived susceptibility, severity, benefits, self-efficacy, cues to action, and oral cancer prevention behaviors of control group. Also, results indicated that, the educational program based on HBM model have positive effect on oral cancer prevention with the improvement of subject's knowledge, perceived susceptibility, severity, benefits, and self-efficacy.
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Affiliation(s)
- Ali Khani Jeihooni
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran.
| | - Samira Fatehi Dindarloo
- Department of Public Health, School of Health, Fasa University of Medical Sciences, Fasa Ibn Sina square, Fasa, 7461686688, Iran
| | - Pouyan Afzali Harsini
- Department of Public Health, School of Health, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Colares N, Souza Rodrigues DF, Freitas MO, Dantas TS, Cunha MDPSS, Sousa FB, Barros Silva PGD. Smoking History Decreases Survival in Patients with Squamous Cell Carcinoma of the Mouth: A Retrospective Study with 15 Years of Follow-up. Asian Pac J Cancer Prev 2019; 20:1781-1787. [PMID: 31244300 PMCID: PMC7021610 DOI: 10.31557/apjcp.2019.20.6.1781] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Indexed: 12/18/2022] Open
Abstract
Background: The purpose of this study was to evaluate the influence of smoking history on the clinical-pathological, sociodemographic and prognostic characteristics of patients with oral squamous cell carcinoma (SCC). Materials and Methods: A retrospective cohort study was carried out with the records of 136 smokers with SCC and 68 nonsmokers with oral SCC who were diagnosed and treated at Haroldo Juaçaba Hospital (2000-2014). Data on patient sex, age, race, education level, tumor location, tumor size, lymph node involvement, distant metastasis, treatment type, marital status, method of health care access (public or private health systems) and overall survival (15 years) were analyzed by the X² test, Mantel-Cox tests and multinomial and Cox logistic regression models (SPSS 20.0, p <0.05). Results: Smoking history was directly associated with male sex (p <0.001), low levels of education (p = 0.001), tumors of the mouth and palate (p = 0.001), stage T3/4 tumors (p = 0.014), lymph node metastasis (N+) (p = 0.024), palliative treatment (p = 0.024) and receiving health care through the public health system (p = 0.006), with education level being the only independently associated factor (p = 0.039). Lower survival was observed in patients who were smokers (p = 0,002), with low levels of education (p = 0.001), who had stage T3/4 tumors (p = 0.004), with N+ (p = 0.021), and had received palliative treatment (p = 0.002). Age (>65 years old, p = 0.015) and T staging (T3/4, p = 0.033) decreased the survival of SCC patients regardless of the other factors. Conclusions: Smoking history had an independent association with low education level and a history of alcoholism, and survival was negatively associated with older age and larger tumor size, which were more prevalent in smokers.
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Affiliation(s)
- Naiara Colares
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil.
| | | | | | - Thinali Sousa Dantas
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil.
| | | | - Fabrício Bitu Sousa
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil. ,Haroldo Juaçaba Hospital, Ceará Cancer Institute, Rua Papi Júnior, 1222, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
| | - Paulo Goberlânio de Barros Silva
- Department of Dentistry, Unichristus, Rua João Adolfo Gurgel 133, Fortaleza, Ceará, Brazil. ,Haroldo Juaçaba Hospital, Ceará Cancer Institute, Rua Papi Júnior, 1222, Rodolfo Teófilo, Fortaleza, Ceará, Brazil
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Amorim CA, De Souza LP, Moreira JP, Luiz RR, De V Carneiro AJ, De Souza HSP. Geographic distribution and time trends of esophageal cancer in Brazil from 2005 to 2015. Mol Clin Oncol 2019; 10:631-638. [PMID: 31086670 DOI: 10.3892/mco.2019.1842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 04/05/2019] [Indexed: 12/18/2022] Open
Abstract
The purpose of the present study was to investigate the geographical distribution and time trends of the incidence and lethality of esophageal cancer (EC) in Brazil. The present study conducted an ecological study of EC using records from January 2005 to December 2015 in the Health Informatics Department of the Brazilian Ministry of Health (DATASUS) registry. In addition to demographical data on the population, EC incidence and lethality rates were estimated from hospitalizations and in-hospital mortalities and were adjusted by total available hospital beds. The adjusted EC rates per 100,000 increased from 9.1 in 2005 to 12.1 in 2015. The prevalence among males increased from 69 to 78%, while the female rates remained stable over the same period. Although EC was the most common in South and Southeast Brazil, the rates increased proportionately more in the other regions of the country, especially among males. Geographical analysis revealed higher rates of EC in more urbanized areas, with a coast-to-inland gradient. While rates increased in people older than 50 years, they decreased among people below this age. However, the lethality rates remained stable and high during the study period, overlapping with hospital admission rates. The recent increasing trend in the EC incidence, with shifts from the south towards the north and from more urbanized towards rural areas, suggests that environmental factors are crucial in EC pathogenesis. The concentration of EC in South Brazil may reflect the presence of major environmental factors in association with a possible genetic predisposition. The unchanging high mortality associated with EC in the rapidly aging population suggests that EC will continue to impose a significant social and economic burden in the future.
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Affiliation(s)
- César Augusto Amorim
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Lucila Perrota De Souza
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Jessica P Moreira
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Ronir R Luiz
- Institute of Public Health Studies, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Antonio José De V Carneiro
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil
| | - Heitor S P De Souza
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-913, Brazil.,D'Or Institute for Research and Education (IDOR), Rio de Janeiro 22281-100, Brazil
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Kfouri SA, Eluf Neto J, Koifman S, Curado MP, Menezes A, Daudt AW, Wünsch Filho V. Fração de câncer de cabeça e pescoço atribuível ao tabaco e ao álcool em cidades de três regiões brasileiras. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 21:e180005. [DOI: 10.1590/1980-549720180005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 01/31/2018] [Indexed: 01/25/2023] Open
Abstract
RESUMO: Objetivo: Estimar a fração de câncer de cabeça e pescoço (CCP) atribuível ao tabaco e ao álcool em cidades das regiões Centro-Oeste, Sudeste E Sul do Brasil. Métodos: Estudo caso-controle com 1.594 casos de CCP e 1.292 controles hospitalares. A associação de CCP com tabaco e álcool foi estimada pela odds ratio e intervalos de confiança de 95% via regressão logística não condicional, ajustada por idade, sexo, escolaridade, consumo de frutas e legumes, consumo de bebidas alcoólicas (para examinar o efeito do tabaco) e tabagismo (para examinar o efeito do álcool). As proporções de CCP atribuíveis ao tabaco e ao álcool foram estimadas pelo cálculo da fração atribuível (FA). Foram realizadas estimativas separadas para Goiânia (Centro-Oeste), Rio de Janeiro e São Paulo (Sudeste) e Pelotas e Porto Alegre (Sul). Resultados: A fração de CCP atribuível ao tabagismo foi discretamente mais elevada em Goiânia (FA = 90%) em comparação às cidades do Sudeste (FA = 87%) e do Sul (FA = 86%). A fração de CCP atribuível ao consumo de bebidas alcoólicas apresentou resultados similares e mais altos nas cidades do Sudeste (FA = 78%) e Sul (FA = 77%) em comparação a Goiânia (FA = 62%). Conclusão: As frações de CCP atribuíveis ao tabagismo foram mais expressivas do que para o consumo de álcool. Embora com discretas distinções entre si, as FA para tabaco e álcool observadas nas cidades das três regiões brasileiras foram semelhantes às obtidas em estudos em outras regiões da América Latina, porém, mais altas que em outras partes do mundo.
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Perea LME, Peres MA, Boing AF, Antunes JLF. Trend of oral and pharyngeal cancer mortality in Brazil in the period of 2002 to 2013. Rev Saude Publica 2018; 52:10. [PMID: 29412371 PMCID: PMC5802649 DOI: 10.11606/s1518-8787.2018052000251] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 01/30/2017] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE To analyze the trend of oral and pharyngeal cancer mortality rates in the period of 2002 to 2013 in Brazil according to sex, anatomical site, and macroregion of the country. METHODS The mortality data were obtained from the Mortality Information System and the population data were obtained from the Brazilian Institute of Geography and Statistics. The trend of the rates standardized by sex and age was calculated using the Prais-Winsten estimation, and we obtained the annual percentage change and the respective 95% confidence intervals, analyzed according to sex, macroregion, and anatomical site. RESULTS The average coefficient of oral cancer mortality was 1.87 per 100,000 inhabitants and it remained stable during the study period. The coefficient of pharyngeal cancer mortality was 2.04 per 100,000 inhabitants and it presented an annual percentage change of -2.6%. Approximately eight in every 10 deaths occurred among men. There was an increase in the rates of oral cancer in the Northeast region (annual percentage change of 6.9%) and a decrease in the Southeast region (annual percentage change of -2.9%). Pharyngeal cancer mortality decreased in the Southeast and South regions with annual percentage change of -4.8% and -5.1% respectively. Cancer mortality for tonsil, other major salivary glands, hypopharynx, and other and unspecified parts of mouth and pharynx showed a decreasing trend while the other sites presented stability. CONCLUSIONS Pharyngeal cancer mortality decreased in the period of 2002 to 2013. Oral cancer increased only in the Northeast region. Mortality for tonsil cancer, other major salivary glands, hypopharynx, and other and ill-defined sites in the lip, oral cavity, and pharynx decreased.
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Affiliation(s)
- Lillia Magali Estrada Perea
- Universidade Federal de Santa Catarina. Programa de Pós-Graduação em Saúde Coletiva. Florianópolis, SC, Brasil
| | - Marco Aurélio Peres
- University of Adelaide. Adelaide Dental School. Australian Research Center for Population Oral Health. Adelaide, Australia
| | - Antonio Fernando Boing
- Universidade Federal de Santa Catarina. Departamento de Saúde Pública. Florianópolis, SC, Brasil
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Moi GP, Silva AMC, Galvão ND, de Castro Meneghim M, Pereira AC. Spatial analysis of the death associated factors due oral cancer in Brazil: an ecological study. BMC Oral Health 2018; 18:14. [PMID: 29361933 PMCID: PMC5781345 DOI: 10.1186/s12903-018-0473-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 01/09/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Oral cancer (OC) is among the ten most common cancers and the seventh most frequent cause of death worldwide. It has been reported that these incidence rates are higher in developed country and these mortality rates are higher in less developed areas. So, the objective of the present study was to analyze the spatial joint distribution and to explore possible associations of the epidemiological aspects with mortality rates due to OC in the Brazil. METHODS An exploratory ecological study investigated the global spatial autocorrelation of epidemiological aspects with mortality rates due to OC from the Brazilian Federative Units (FUs) (n = 27) in the period 2005-2014, using the "global" and "local" Moran statistic method and a multiple spatial regression, having as variables of exposure the habits and lifestyle, sociodemographic indicators, the consumption of pesticides, the presence of comorbidities, the use of health services and food consumption; and, as a variable response, mortality rates due to OC. The software used was Stata 11.0, SPSS 18.0 and GeoDa 0.95-i. RESULTS The spatial distribution of OC mortality rates to age-standard was not random and showed high spatial autocorrelation and predominance of significant spatial groupings in the Central-South region of Brazil. In the multiple regression, statistically negative associations were observed between the Human Development Index (HDI) and OC age-standardized in the studied period (p < 0.05) and positive associations among the proportion of the population with dental appointment within last year, percentage of consumption of oils and fats, percentage of consumption of ready-to-eat foods and industrial mixtures and percentage of overweight adults with this type of cancer (p < 0.05). CONCLUSION This is the first study that analyzed the factors associated to the spatial clusters of mortality due to oral cancer in the Brazilian FUs. A fairly unequal distribution of OC mortality rates was found, being that these rates presented inverse association with HDI and direct association with dental appointment, consumption of oils and fats, ready-to-eat foods and industrial mixtures consumption and overweight these rates. It suggests the need to redirect Brazilian public policies aimed at combating them so that they cease to be temporary and become permanent.
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Affiliation(s)
- Gisele Pedroso Moi
- Piracicaba Dental School, Campinas State University - FOP.UNICAMP, Piracicaba, Brazil. .,University Center of Várzea Grande - UNIVAG, Várzea Grande, Brazil. .,Rua Nossa Senhora da Guia, 504. Apto. 901.2, Jardim Santa Martha, Cuiabá, MT, 78043-605, Brazil.
| | - Ageo Mário Cândido Silva
- Institute of Public Health, Federal University of Mato Grosso - ISC.UFMT, Cuiabá, Brazil.,University Center of Várzea Grande - UNIVAG, Várzea Grande, Brazil
| | - Noemi Dreyer Galvão
- Institute of Public Health, Federal University of Mato Grosso - ISC.UFMT, Cuiabá, Brazil
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Joury E, Naja F, Nour A, Itani L, Rafii B, Nakhleh K, Manadili A. Dietary patterns and the risk of oral, pharyngeal and laryngeal cancer in Syria: a case control study. BMC Nutr 2016. [DOI: 10.1186/s40795-016-0048-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Perdomo S, Martin Roa G, Brennan P, Forman D, Sierra MS. Head and neck cancer burden and preventive measures in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S43-S52. [PMID: 27678322 DOI: 10.1016/j.canep.2016.03.012] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 01/01/2023]
Abstract
RATIONALE AND OBJECTIVE Central and South America comprise one of the areas characterized by high incidence rates for head and neck cancer. We describe the geographical and temporal trends in incidence and mortality of head and neck cancers in the Central and South American region in order to identify opportunities for intervention on the major identified risk factors: tobacco control, alcohol use and viral infections. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. Age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years were estimated. RESULTS Brazil had the highest incidence rates for oral and pharyngeal cancer in the region for both sexes, followed by Cuba, Uruguay and Argentina. Cuba had the highest incidence and mortality rates of laryngeal cancer in the region for males and females. Overall, males had rates about four times higher than those in females. Most countries in the region have implemented WHO recommendations for both tobacco and alcohol public policy control. CONCLUSION Head and neck squamous-cell cancer (HNSCC) incidence and mortality rates in the Central and South America region vary considerably across countries, with Brazil, Cuba, French Guyana, Uruguay and Argentina experiencing the highest rates in the region. Males carry most of the HNSCC burden. Improvement and implementation of comprehensive tobacco and alcohol control policies as well as the monitoring of these factors are fundamental to prevention of head and neck cancers in the region.
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Affiliation(s)
- Sandra Perdomo
- International Agency for Research on Cancer, Section of Genetics, France.
| | | | - Paul Brennan
- International Agency for Research on Cancer, Section of Genetics, France
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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Dantas TS, de Barros Silva PG, Sousa EF, da Cunha MDP, de Aguiar ASW, Costa FWG, Mota MRL, Alves APNN, Sousa FB. Influence of Educational Level, Stage, and Histological Type on Survival of Oral Cancer in a Brazilian Population: A Retrospective Study of 10 Years Observation. Medicine (Baltimore) 2016; 95:e2314. [PMID: 26817864 PMCID: PMC4998238 DOI: 10.1097/md.0000000000002314] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Revised: 08/23/2015] [Accepted: 11/24/2015] [Indexed: 11/26/2022] Open
Abstract
The mortality rate associated with oral cancer is estimated at approximately 12,300 deaths per year, and the survival rate is only 40% to 50% for diagnosed patients and is closely related to the duration of time between disease perception and its diagnosis and treatment. Socioeconomic risk factors are determinants of the incidence and mortality related to oral cancer. We conducted a retrospective, cross-sectional study of 573 records of patients with oral cancer at Haroldo Juaçaba Hospital - Cancer Institute of Ceará from 2000 to 2009 to evaluate the influence of socioeconomic factors on survival and epidemiological behavior of this neoplasia in a Brazilian population. In this study, patients with oral cancer were males greater than 60 years of age, presented squamous cell carcinoma in the floor of mouth and were characterized by low education levels. A total of 573 lesions were found in oral cavities. Cox proportional hazards regression model showed that the histological type, tumor stage, and low degree of education significantly influenced survival. A lower patient survival rate was correlated with a more advanced stage of disease and a worse prognosis. Squamous cell carcinoma is associated with a higher mortality when compared with other histological types of malign neoplasia.
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Affiliation(s)
- Thinali Sousa Dantas
- From the Laboratory of Oral Pathology, Federal University of Ceará (TSD, PGDBS); Ceará School of Oncology, Haroldo Juaçaba Hospital (EFS, MDPDC, FBS); Division of Diplomacy Health (ASWDA); Division of Oral Radiology and Imaginology (FWGS); Laboratory of Oral Pathology (MRLM, APNNA); and Laboratory of Oral Pathology, Federal University of Ceará, Fortaleza, Ceará, Brazil (FBS)
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Bragante K, Wienandts P, Mozzini C, Pinto R, da Motta N, Jotz G. Jaw mobility changes in patients with upper aerodigestive tract cancer undergoing radiation therapy. Med Oral Patol Oral Cir Bucal 2015; 20:e693-8. [PMID: 26449427 PMCID: PMC4670249 DOI: 10.4317/medoral.20477] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 04/09/2015] [Indexed: 11/06/2022] Open
Abstract
Background Radiation therapy is a therapeutic modality widely used for treatment of upper aerodigestive tract (UADT) neoplasms. However, its action is not restricted to tumor cells, and it may cause a variety of adverse reactions, including reduced jaw mobility. Material and Methods A prospective cohort study was conducted to assess changes in jaw mobility in patients with UADT cancer undergoing radiation therapy. Results Fifty-six patients completed the study. The results showed a significant reduction in mouth opening (p<0.001), right lateral excursion (p=0.038) and left lateral excursion (p=0.035) of the jaw, a significant increase in the presence (p<0.001) and severity of oral mucositis (p<0.001), and a significant decrease in performance status (p<0.001) after radiation therapy. Thirty-six patients (64.3%) exhibited reduction in mouth opening after treatment. The variables significantly associated with mouth opening reduction on bivariate analysis were: modification of diet (p=0.037), radiation field (p=0.024), presence of mucositis (p=0.003), and reduction in performance status (p=0.007). After adjustment by the multivariate model, the only variables that remained significantly associated with reduction in mouth opening were presence of mucositis (p=0.018) and reduction in performance status (p=0.47). Conclusions These findings indicate that patients with upper aerodigestive tract cancer experience reduced jaw mobility after radiation therapy, which is strongly correlated with mucositis and reduced functional ability. Key words:Head and neck neoplasms, vertical dimension, radiation therapy, mucositis, temporomandibular joint, joint range of motion, trismus.
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Peritumoral infiltrate in the prognosis of epidermoid carcinoma of the oral cavity. Braz J Otorhinolaryngol 2015; 81:416-21. [PMID: 26141206 PMCID: PMC9442739 DOI: 10.1016/j.bjorl.2014.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/21/2014] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Patients with squamous cell carcinoma of the oral cavity present deficits in their cellular immunity that contribute to neoplastic growth. Thus, the inflammatory activity, such as the immunological response to the tumor, can be used as a prognostic factor. OBJECTIVES To evaluate the correlation between peritumoral inflammation and clinical characteristics of the patients, survival, and the disease-free interval. METHODS The study sample consisted of a retrospective hospital-based cohort of patients undergoing surgery for resection of oral cavity tumor. The inflammatory infiltrate on the slides was evaluated semi-quantitatively, and were divided into minor and major inflammatory processes. RESULTS This study included 57 tumor samples, with infiltration of lymphocytes, plasma cells, and histiocytes. The log-rank test showed no significance for the survival curves and recurrence of the "minor inflammatory" and "major inflammatory" processes, with p=0.14 and p=0.24, respectively. A direct association between age and inflammation (p=0.04) was observed, as well as an indirect association between the degree of tumor differentiation and inflammation (p=0.01). CONCLUSION Although associated with histological differentiation, the peritumoral inflammatory process cannot be considered a prognostic factor in squamous cell carcinoma of the oral cavity, as it is not related to survival and disease-free interval.
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Gleber-Netto FO, Braakhuis BJM, Triantafyllou A, Takes RP, Kelner N, Rodrigo JP, Strojan P, Vander Poorten V, Rapidis AD, Rinaldo A, Brakenhoff RH, Ferlito A, Kowalski LP. Molecular events in relapsed oral squamous cell carcinoma: Recurrence vs. secondary primary tumor. Oral Oncol 2015; 51:738-44. [PMID: 25987307 DOI: 10.1016/j.oraloncology.2015.04.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 04/26/2015] [Accepted: 04/27/2015] [Indexed: 01/01/2023]
Abstract
Relapses have a great impact on both the morbidity and mortality rates of oral squamous cell carcinoma (OSCC) patients. Current classification criteria are imprecise and need improvements. Recent advances in understanding of OSCC relapses on a molecular level provide new possibilities to better classify true recurrences and second primary tumors. This review discusses the limitations of the current OSCC relapse classification method and presents possible alternatives to improve this classification based on molecular techniques. Moreover, these molecular techniques add to the further understanding of these lesions and may provide tools for clinical management.
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Affiliation(s)
- Frederico O Gleber-Netto
- Laboratory of Medical Genomics, International Research Center, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Boudewijn J M Braakhuis
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Asterios Triantafyllou
- Oral and Maxillofacial Pathology, School of Dentistry, University of Liverpool and Cellular Pathology, University Hospital Aintree, Liverpool, UK
| | - Robert P Takes
- Department of Otolaryngology-Head and Neck Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natalie Kelner
- Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center, São Paulo, Brazil
| | - Juan P Rodrigo
- Department of Otolaryngology, Hospital Universitario Central de Asturias, University of Oviedo, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Vincent Vander Poorten
- Otorhinolaryngology-Head and Neck Surgery, Department of Oncology, Section Head and Neck Oncology, University Hospitals KU Leuven, Leuven, Belgium
| | - Alexander D Rapidis
- Department of Head and Neck Surgery, Greek Anticancer Institute, Saint Savvas Hospital, Athens, Greece
| | | | - Ruud H Brakenhoff
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group
| | - Luiz P Kowalski
- Department of Head and Neck Surgery and Otorhinolaryngology, A. C. Camargo Cancer Center and National Institute of Science and Technology on Oncogenomics (INCITO), São Paulo, Brazil
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Rocha RDS, Meireles JRC, de Moraes Marcílio Cerqueira E. Chromosomal damage and apoptosis analysis in exfoliated oral epithelial cells from mouthwash and alcohol users. Genet Mol Biol 2014; 37:702-7. [PMID: 25505845 PMCID: PMC4261970 DOI: 10.1590/s1415-47572014005000022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 06/18/2014] [Indexed: 11/22/2022] Open
Abstract
Chromosomal damage and apoptosis were analyzed in users of mouthwash and/or alcoholic beverages, using the micronucleus test on exfoliated oral mucosa cells. Samples from four groups of 20 individuals each were analyzed: three exposed groups (EG1, EG2 and EG3) and a control group (CG). EG1 comprised mouthwash users; EG2 comprised drinkers, and EG3 users of both mouthwashes and alcoholic beverages. Cell material was collected by gently scraping the insides of the cheeks. Then the cells were fixed in a methanol/acetic acid (3:1) solution and stained and counterstained, respectively, with Schiff reactive and fast green. Endpoints were computed on 2,000 cells in a blind test. Statistical analysis showed that chromosomal damage and apoptosis were significantly higher in individuals of groups EG1 and EG3 than in controls (p < 0.005 and p < 0.001, respectively). No significant difference in chromosomal damage and apoptosis was observed between the exposed groups. In EG2, only the occurrence of apoptosis was significantly higher than in the controls. These results suggest that mouthwashes alone or in association with alcoholic drinks induce genotoxic effects, manifested as chromosomal damage and apoptosis. They also suggest that alcoholic drinks are effective for stimulating the process of apoptosis. However, these data need to be confirmed in larger samples.
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Affiliation(s)
- Rodrigo Dos Santos Rocha
- Laboratório de Genética Toxicológica , Departmento de Ciências Biológicas , Universidade Estadual de Feira de Santana , Feira de Santana, BA , Brazil
| | - José Roberto Cardoso Meireles
- Laboratório de Genética Toxicológica , Departmento de Ciências Biológicas , Universidade Estadual de Feira de Santana , Feira de Santana, BA , Brazil
| | - Eneida de Moraes Marcílio Cerqueira
- Laboratório de Genética Toxicológica , Departmento de Ciências Biológicas , Universidade Estadual de Feira de Santana , Feira de Santana, BA , Brazil
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Bandeira CM, Almeida AÁD, Gonçalves AJ. Genetic polymorphisms in the Cytochrome P450 family and squamous cell carcinoma of the oral cavity, pharynx and larynx. Rev Col Bras Cir 2014; 41:366-72. [DOI: 10.1590/0100-69912014005012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2013] [Accepted: 06/05/2014] [Indexed: 11/22/2022] Open
Abstract
Objective:To analyze the genetic polymorphisms of the cytochrome P450 family and their relationship with squamous cell carcinoma of the oral cavity, pharynx and larynx.Methods: We present a narrative literature review, conducted in Pubmed, Lilacs and Cochrane Databases of articles published in the last five years correlating genetic polymorphisms of the cytochrome P450 family and cancer risk in different populations worldwide.Results: We initially found 65 articles and, after selection criteria, 20 case-control studies with various populations worldwide were eligible. The most studied polymorphisms were those of CYP2E1 and CYP1A1 subfamilies. There is little about the other subfamilies. The association found between polymorphisms and cancer risk amounted to a countless number of variables, amongst them: population, selection methods, racial factors and different modes of exposure to carcinogens, genotyping methods, and nomenclature of the polymorphisms.Conclusion: so far, there is no proven link between genetic polymorphisms of cytochrome P450 family and squamous cell carcinoma of the oral cavity, pharynx and larynx relationship.
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Matos LLD, Manfro G, Santos RVD, Stabenow E, Mello ESD, Alves VAF, Pinto FR, Kulcsar MAV, Brandão LG, Cernea CR. Tumor thickness as a predictive factor of lymph node metastasis and disease recurrence in T1N0 and T2N0 squamous cell carcinoma of the oral tongue. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 118:209-17. [DOI: 10.1016/j.oooo.2014.03.023] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Revised: 03/24/2014] [Accepted: 03/31/2014] [Indexed: 10/25/2022]
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Rasool M, Khan SR, Malik A, Khan KM, Zahid S, Manan A, Qazi MH, Naseer MI. Comparative Studies of Salivary and Blood Sialic Acid, Lipid Peroxidation and Antioxidative Status in Oral Squamous Cell Carcinoma (OSCC). Pak J Med Sci 2014; 30:466-71. [PMID: 24948960 PMCID: PMC4048487 DOI: 10.12669/pjms.303.4985] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Revised: 02/01/2014] [Accepted: 03/06/2014] [Indexed: 11/15/2022] Open
Abstract
Objective: Oral squamous cell carcinoma (OSCC) is considered to be a serious life threatening issue for almost two decades. The objective of this study was to evaluate the over production of lipid peroxidation (LPO) byproducts and disturbances in antioxidant defense system in the pathogenesis of oral cancer. Methods: Lipid peroxidation and antioxidant status in OSCC patients were estimated and compared the sensitivity and specificity of circulating biomarkers (MDA, Sialic acid, Catalase, SOD, GSH and Neuraminidase) with β-2 microglobulin (β-2MG) at different thresholds in blood and saliva using receiver operating characteristics (ROC) curve design. Results: Our results showed that the levels of MDA and Sialic acid were significantly increased in plasma of OSCC patients as compared to healthy subjects whereas antioxidant level was significantly decreased. Conclusion: ROC analysis indicated that MDA in saliva is a better diagnostic tool as compared to MDA in blood and β-2MG in blood is better diagnostic marker as compared to β-2MG level in saliva.
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Affiliation(s)
- Mahmood Rasool
- Mahmood Rasool, Center of Excellence in Genomic Medicine Research (CEGMR),King Abdulaziz University, Jeddah, Saudi Arabia
| | - Saima Rubab Khan
- Saima Rubab Khan, Institute of molecular biology and biotechnology,The University of Lahore, Lahore, Pakistan
| | - Arif Malik
- Arif Malik, Institute of molecular biology and biotechnology,The University of Lahore, Lahore, Pakistan
| | - Khalid Mahmood Khan
- Khalid Mahmood Khan, Fatima Jinaah Medical College, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Sara Zahid
- Sara Zahid, Institute of molecular biology and biotechnology,The University of Lahore, Lahore, Pakistan
| | - Abdul Manan
- Abdul Manan, Institute of molecular biology and biotechnology,The University of Lahore, Lahore, Pakistan
| | - Mahmood Husain Qazi
- Mahmood Husain Qazi, Centre for Research in Molecular Medicine, The University of Lahore, Lahore, Pakistan
| | - Muhammad Imran Naseer
- Muhammad Imran Naseer, Center of Excellence in Genomic Medicine Research (CEGMR),King Abdulaziz University, Jeddah, Saudi Arabia
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Almeida AÁD, Bandeira CM, Gonçalves AJ, Araújo AJ. Nicotine dependence and smoking habits in patients with head and neck cancer. J Bras Pneumol 2014; 40:286-93. [PMID: 25029652 PMCID: PMC4109201 DOI: 10.1590/s1806-37132014000300012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 05/08/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To assess smoking habits and nicotine dependence (ND) in patients with head and neck cancer Methods: This study involved 71 smokers or former smokers with squamous cell carcinoma in the oral cavity, pharynx, or larynx who were treated at a university hospital in the city of São Paulo between January and May of 2010. We used the Fagerström Test for Nicotine Dependence to evaluate smoking habits and ND in the sample. Data regarding cancer treatment were collected from medical records. Depending on the variables studied, we used the chi-square test, Fisher's exact test, Student's t-test, or Spearman's correlation test. RESULTS Of the 71 patients, 47 (66.2%) presented with high or very high ND, 40 (56.3%) smoked more than 20 cigarettes/day, and 32 (45.1%) smoked their first cigarette within 5 min of awakening. Advanced disease stage correlated significantly with the number of cigarettes smoked per day (p = 0.011) and with smoking history (p = 0.047). We found that ND did not correlate significantly with gender, disease stage, smoking cessation, or number of smoking cessation attempts, nor did the number of cigarettes smoked per day correlate with smoking cessation or gender. Treatment for smoking cessation was not routinely offered. CONCLUSIONS In most of the patients studied, the level of ND was high or very high. The prevalence of heavy smoking for long periods was high in our sample. A diagnosis of cancer is a motivating factor for smoking cessation. However, intensive smoking cessation treatment is not routinely offered to smoking patients diagnosed with cancer.
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Affiliation(s)
| | - Celso Muller Bandeira
- School of Medical Sciences, Santa Casa de Misericórdia de São Paulo, São Paulo, Brazil
| | - Antonio José Gonçalves
- Department of Surgery, Santa Casa de Misericórdia de São Paulo, School of Medical Sciences, São Paulo, Brazil
| | - Alberto José Araújo
- Thoracic Diseases Institute, Center for the Study and Treatment of Smoking, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Santos FBG, Vasconcelos-Raposo JJB, Figueiredo MDCT. Correlation between symptoms and course duration of upper aerodigestive tract cancer at early and advanced stages. Braz J Otorhinolaryngol 2014; 79:673-80. [PMID: 24474477 PMCID: PMC9442429 DOI: 10.5935/1808-8694.20130125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 07/31/2013] [Indexed: 11/20/2022] Open
Abstract
There still are many clinical and biological aspects of the natural history of cancer of the upper aerodigestive tract to be unveiled; which in Brazil is a direct consequence of the failure of systematic prevention and early diagnosis campaigns. Objective To analyze the signs and symptoms presented by patients with the disease at initial and advanced stages. Other variables such as disease duration, general and nutritional status were considered. Method A historical cohort study with a cross-section involving 895 subjects with cancer of the upper aerodigestive tract. Results Clinical findings were not statistically correlated with disease progression, nor with the disease in early stages, but it showed rapid disease development. Conclusion The results suggest a disease of insidious onset in the early stages and fast course afterwards. The long disease duration - greater than three months, was associated with worsening in general and nutritional states of patients.
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Andrade MC, Ferreira SBP, Gonçalves LC, De-Paula AMB, de Faria ES, Teixeira-Carvalho A, Martins-Filho OA. Cell surface markers for T and B lymphocytes activation and adhesion as putative prognostic biomarkers for head and neck squamous cell carcinoma. Hum Immunol 2013; 74:1563-74. [PMID: 23994583 DOI: 10.1016/j.humimm.2013.08.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 07/23/2013] [Accepted: 08/10/2013] [Indexed: 01/29/2023]
Abstract
The study population comprised HNSCC patients, risk-positive controls (tabagism and alcoholism habits), and risk-negative controls (without risk factors). Significant increases in the activation status of CD4(+)and CD8(+) T-cells, and higher migration potentials of lymphocytes were observed in HNSCC patients compared with control groups. Although decreased frequency of CD19(+)-B lymphocytes was observed in HSNCC patients, a higher percentage of HLA-DR(+)CD19(+)-B lymphocytes was detected in these individuals as compared with other evaluated groups. Metastasis and tumor grading were the major pathological parameters associated with significant alterations in the expression of activation molecules on circulating CD4(+) and CD8(+) T-cells. A reduced frequency of CD38-expressing CD8(+) T-cells was the most relevant biomarker associated with HNSCC aggressiveness. Performance analysis suggested a cut-off point for the CD8(+)CD38(+)/CD8(+) T-cell ratio of 7.0 for segregating patients according to tumor grading. In contrast, a higher proportion of CD8(+)CD54(+)/CD8(+) T-cells could represent a relevant biomarker associated with metastasis in HNSCC patients, and performance analysis suggested a cut-off point for the CD8(+)CD54(+)/CD8(+) T-cell ratio of 30 for segregating patients according to absence or presence of metastasis. The results obtained can increment immunological aspects of HNSCC and provide tools for the determination of cut-off scores of clinically relevant immunophenotypic prognostic biomarkers.
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Significance of cyclin D1 polymorphisms in patients with head and neck cancer. Int J Biol Markers 2013; 28:49-55. [PMID: 23125009 DOI: 10.5301/jbm.2012.9768] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2012] [Indexed: 12/12/2022]
Abstract
Cyclin D1 plays a key role in cell cycle control, particularly in the transition from G1 to S phase, regulated by cyclin-dependent kinases. The objective of the present study was to screen the cyclin D1 gene (CCND1) for polymorphisms in patients with head and neck cancer (HNC). Genomic DNA was isolated from blood samples of 380 HNC patients and 350 controls. In a hospital-based case-control study using the PCR-SSCP technique we found 3 novel germline mutations: g3578C>A, g3475G>C and g3383delA. The commonly reported guanine to adenine polymorphisms in exon 4 g7656G>A (rs9344) and g10861C>A (rs7177) in 3'UTR of CCND1 were also observed. The calculated frequencies of the g7656G>A (rs9344) polymorphism in GG, GA and AA genotypes were 27.3%, 38.6%, and 33.9% in HNC cases, and 44.2%, 29.4%, and 26.2% in normal healthy controls, respectively. Adjusted by age (in years), sex and smoking status, multivariate logistic regression analysis showed that the AA and GA genotypes were associated with a significantly increased risk (OR 1.34, 95% CI 1.03-1.64, p=0.028) for HNC. The CCND1 AA genotype variant was associated with an increased risk in individuals who were <40 years old (OR 1.45, 95% CI 1.02-2.08, p=0.04). In conclusion, it is suggested that the CCND1 G/A polymorphism is associated with the early onset of HNC and may contribute to HNC susceptibility in a Pakistani population.
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Analysis of ECOG performance status in head and neck squamous cell carcinoma patients: association with sociodemographical and clinical factors, and overall survival. Support Care Cancer 2013; 20:2679-85. [PMID: 22314971 DOI: 10.1007/s00520-012-1386-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2011] [Accepted: 01/08/2012] [Indexed: 01/22/2023]
Abstract
PURPOSE In the present study, we analyzed sociodemographical and clinical factors, and the Eastern Cooperative Oncology Group performance status (ECOG-PS) scale in head and neck squamous cell carcinoma (HNSCC) patients. We evaluated the impact of a range of variables on overall survival. METHODS We investigated a sample of HNSCC patients (n = 671), using sociodemographical and clinical information, and survival data collected from a review of epidemiological, clinical, and treatment reports. Statistical associations were analyzed by bivariate and multivariate statistical tests. Statistical significance was set at p < 0.05. RESULTS Of patients 85.4% recorded good ECOG-PS scores. Poor ECOG-PS scores were associated with the covariates indicative of dysphagia [odd ratios (OR) = 2.660, CI 95% = 1.661–4.260, p = 0.000] and large-size malignant disease (T3–T4; OR = 5.337, CI 95% = 2.251–12.652, p = 0.000). Overall survival analysis revealed that ECOG-PS scores (OR = 1.879, CI 95% = 1.162–3.038, p = 0.010), tumor size (OR = 1.665, CI 95% = 1.035–2.680, p = 0.036), and the presence of cervical metastasis (OR = 3.145, CI 95% = 2.008–4.926, p = 0.000) were independent predictors. CONCLUSION Evaluation of physical consumption in head and neck cancer patients at diagnosis may indicate a more aggressive type of malignant disease. Thus, the ECOG-PS scale may help to identify HNSCC patients in need of rapid referral, who may benefit from specific therapeutic and rehabilitative interventions.
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de Oliveira Semenzati G, de Souza Salgado B, Rocha NS, Michelin Matheus SM, de Carvalho LR, Garcia Martins RH. Histological and immunohistochemical study of the expression of p53 and ki-67 proteins in the mucosa of the tongue, pharynx and larynx of rats exposed to cigarette smoke. Inhal Toxicol 2013; 24:723-31. [PMID: 22954396 DOI: 10.3109/08958378.2012.715317] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Head and neck cancers are linked to smoking. The most affected sites are the oral cavity, pharynx and larynx. Experimental studies show epithelial lesions caused by cigarette smoke. OBJECTIVES To investigate in rats the effects of acute cigarette smoke exposure on the mucosa of the tongue, pharynx and larynx. MATERIAL AND METHOD Wistar rats were allocated into two groups of 20 animals: CG (control) receiving food and water ad libitum and TG (Tobacco) exposed to the smoke of 40 cigarettes/day for 60 days. Biopsy of their tongues, pharynxes and larynxes were subjected to histopathological, histomorphometric and immunohistochemical studies of protein p53 and ki-67. RESULT The histological analysis of tongue from the Tobacco group revealed epithelial hyperplasia (90%), basal cell hyperplasia (95%) and mild to moderate dysplasia (85%). In pharynx showed basal cell hyperplasia (85%), dysplasia (25%) and vascular congestion (95%). In larynx showed basal cell hyperplasia (70%), epithelial hyperplasia (55%), congestion (100%) and inflammatory infiltrate (25%). Morphometric analysis revealed that keratin layer thickness was greater in the tobacco group. P53 immunoexpression was negative in both groups. Ki-67 immunoexpression was positive in basal cell nuclei but in parabasal cell nuclei it was positive only in the Tobacco group. CONCLUSIONS The exposure of animals to cigarette smoke for 60 days resulted in benign lesions. The duration of exposure was not enough to cause the development cancer, as confirmed by the negative expression of p53 protein in all slides examined. Analysis of ki-67 expression showed intense epithelial proliferation in response to damage.
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Affiliation(s)
- Graziela de Oliveira Semenzati
- Department of Ophthalmology, Otorhinolaryngology, Head and Neck Surgery, Student of Botucatu Medical School, São Paulo State University- UNESP, Botucatu, Brazil
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Ferreira MAF, Gomes MN, Michels FAS, Dantas AA, Latorre MDRDDO. Desigualdade social no adoecimento e morte por câncer de boca e orofaríngeo no município de São Paulo, Brasil: 1997 a 2008. CAD SAUDE PUBLICA 2012; 28:1663-73. [DOI: 10.1590/s0102-311x2012000900006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 06/18/2012] [Indexed: 11/21/2022] Open
Abstract
A ocupação do espaço geográfico é determinada historicamente pelo modelo socioeconômico e pelo dinamismo de suas relações sociais, políticas e ideológicas. O objetivo deste trabalho é avaliar a distribuição espacial e o efeito de indicadores socioeconômicos no adoecimento e morte por câncer de boca e orofaríngeo no Município de São Paulo, Brasil, no período de 1997 a 2008. Os dados foram coletados no Registro de Câncer de Base Populacional e no Programa de Aprimoramento das Informações de Mortalidade - PRO-AIM e georreferenciados pelos softwares Terraview e GeoDa. O referencial teórico para avaliação dos resultados foi baseado na teoria de Milton Santos. As taxas de incidência apresentaram um índice de autocorrelação Global de Moran de 0,226 e as taxas de mortalidade de 0,337. A Incidência de câncer de boca e orofaríngeo não apresenta um padrão espacial bem definido no Município de São Paulo, mas é bastante desigual no que se refere à Mortalidade, concentrando as suas menores taxas na área central, mais rica e economicamente menos desigual.
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Silveira A, Gonçalves J, Sequeira T, Ribeiro C, Lopes C, Monteiro E, Pimentel FL. [Head and neck cancer: health related quality of life assessment considering clinical and epidemiological perspectives]. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2012; 15:38-48. [PMID: 22450491 DOI: 10.1590/s1415-790x2012000100004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 04/11/2011] [Indexed: 11/22/2022] Open
Abstract
The importance of oncology diseases as a cause of morbidity and mortality is increasing worldwide, and their social impact is being recognized due to economic and social costs involved in prevention, treatment and rehabilitation. Head and neck cancer is one of the six most prevalent neoplasms worldwide, with an estimated 900,000 new cases diagnosed annually. Regardless of tumor site, deterioration of basic functions affecting head and neck areas are perceived and affect patients' lives. Appropriate cancer registration may provide a better analysis of health-related quality of life outcomes. In this study, 380 head and neck cancer patients were evaluated. The study showed that women have lower overall Quality of Life results. It also emphasizes the importance of early diagnosis, which often relates to stages with better prognosis and better Quality of Life outcomes. The study concluded that tumor location has an impact on Quality of Life self-perception. Values of Health Related Quality of Life should be analyzed along with socio-demographic and clinical variables in order to better understand the epidemiology, pathogenesis, and prevention of Head and Neck Cancer.
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Affiliation(s)
- Augusta Silveira
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal.
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Servato JPS, Prieto-Oliveira P, de Faria PR, Loyola AM, Cardoso SV. Odontogenic tumours: 240 cases diagnosed over 31 years at a Brazilian university and a review of international literature. Int J Oral Maxillofac Surg 2012; 42:288-93. [PMID: 22704484 DOI: 10.1016/j.ijom.2012.05.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 03/09/2012] [Accepted: 05/08/2012] [Indexed: 11/28/2022]
Abstract
This study describes the epidemiology and clinical presentation of odontogenic tumours (OT) seen at a regional Brazilian oral and maxillofacial pathology service; to assess the quantitative impact of the most recent World Health Organization (WHO) classification of these lesions; and to compare this series with others available in international databases. The study was carried out by retrospectively analysing 240 cases diagnosed from 1978 to 2009, followed by a comprehensive review of the literature. The patients' mean age was 29 years, with a male to female ratio of 1:1.1. Benign lesions comprised 97.9% of the cases (mostly keratocystic odontogenic tumours (KCOT), odontomas and ameloblastomas) with the remaining tumours depicting a prevalence of less than 5%. Adenomatoid OT were less frequent than in most previous studies, while malignant OT were strikingly numerous. Most OT in children and in the anterior maxilla were odontomas, while maxillary ameloblastomas were rare. Lack of swelling was more frequent in KCOT than in ameloblastomas. The present study confirms the relative impact of KCOT in the epidemiology of OT and identifies more similarities between the present series with reports from the United States and Europe than with African and Asian populations.
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Affiliation(s)
- J P S Servato
- Oral Pathology Area, School of Dentistry, Federal University of Uberlândia, Brazil
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Helen-Ng LC, Razak IA, Ghani WMN, Marhazlinda J, Norain AT, Raja Jallaludin RL, Rahman ZAA, Abdullah N, Zain RB. Dietary pattern and oral cancer risk--a factor analysis study. Community Dent Oral Epidemiol 2012; 40:560-6. [PMID: 22679921 DOI: 10.1111/j.1600-0528.2012.00704.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 04/24/2012] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The role of diet in cancer risk has mainly been investigated based on intake of individual food items. However, food consumption is made up of a combination of various food items. This study aims to determine the association of dietary patterns with oral cancer risk. METHODS A total of 306 matched cases and controls were recruited in this study. Data on dietary intake were obtained using food frequency questionnaire (FFQ). Factor analysis (FA) was performed to identify dietary patterns based on the intake of nine major food groups, resulting in four factors/components being retained. The odds ratio (OR) was computed for each component using conditional logistic regression. RESULTS The first pattern labelled as 'modern' was loaded with processed foods and snacks, whereas the second pattern termed as 'prudent' was characterized by intake of fruits and vegetables. The third pattern labelled as 'traditional' consisted of beverages and starches, while the fourth pattern termed as 'combination' was loaded with intakes of dairy, fermented/salted and meat/by-products. A significant reduced risk was found for 'prudent' (OR 0.53, 95% CI = 0.28-0.98), whereas an increased risk was found for both 'combination' (OR 2.43, 95% CI = 1.33-4.45) and 'traditional' (OR 2.32, 95% CI = 1.23-4.25) patterns. However, after adjusting for risk habits of tobacco smoking, alcohol consumption and betel quid chewing, only 'combination' (aOR 2.99, 95% CI = 1.55-5.75) and 'traditional' (aOR 2.08, 95% CI = 1.09-3.97) patterns remained significant. CONCLUSION Consumption in the highest tertile of 'traditional' and 'combination' patterns may induce twice and thrice the risk of oral cancer, respectively.
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Affiliation(s)
- Lee Ching Helen-Ng
- Oral Cancer Research & Coordinating Centre, University of Malaya, Kuala Lumpur, Malaysia
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Gaio EJ, Haas AN, Carrard VC, Oppermann RV, Albandar J, Susin C. Oral health status in elders from South Brazil: a population-based study. Gerodontology 2012; 29:214-23. [DOI: 10.1111/j.1741-2358.2011.00617.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Chromosomal damage and apoptosis in exfoliated buccal cells from individuals with oral cancer. Int J Dent 2012; 2012:457054. [PMID: 22315605 PMCID: PMC3272342 DOI: 10.1155/2012/457054] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 10/06/2011] [Accepted: 10/11/2011] [Indexed: 11/18/2022] Open
Abstract
This study aimed to investigate cytological abnormalities indicative of chromosome damage (micronuclei) and apoptosis (karyorrhexis, pyknosis, and condensed chromatin) in exfoliated cells from the buccal mucosa of patients with oral cancer and control subjects. The sample included twenty individuals with oral cancer and forty individuals with normal buccal mucosa. Material was collected from the cheek epithelium in areas with lesions and areas without abnormalities. A minimum of one thousand cells was analyzed. Micronuclei were found significantly more frequently in cells collected from lesions than in cells from normal areas, independent of the presence/absence of cancer (P < 0.0001). They were also significantly more frequent in smokers and in mouthwash users (P < 0.0001). Apoptosis occurred significantly less frequently in individuals with oral cancer (P < 0.0001). These results show that oral cancer is associated with higher frequency of chromosomal damage and suggest that apoptosis is compromised in the buccal cells of individuals with this kind of neoplasia.
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de Souza Figueiredo PT, Leite AF, Barra FR, Dos Anjos RF, Freitas AC, Nascimento LA, Melo NS, Guerra ENS. Contrast-enhanced CT and MRI for detecting neck metastasis of oral cancer: comparison between analyses performed by oral and medical radiologists. Dentomaxillofac Radiol 2012; 41:396-404. [PMID: 22241874 DOI: 10.1259/dmfr/57281042] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of the study was to verify the concordance of contrast-enhanced CT (CECT) and MRI evaluation among four radiologists in detecting metastatic cervical lymph nodes of oral cancer patients. METHODS Ten patients underwent clinical and imaging examinations (CECT and MRI). Four radiologists, two oral and maxillofacial radiologists (OMRs) and two medical radiologists (MRs), independently analysed the images twice. Cohen's kappa index and Wilcoxon signed-rank test were used to verify the concordance between all analyses. RESULTS Regarding the interobserver agreement, the OMRs presented excellent kappa values for determining the regional lymph nodes (N-stage) in both CECT and MRI. The MRs presented moderate agreement for CECT evaluation at the first reading, but no concordance was found for the other analyses. When each imaging modality was analysed separately, kappa values were higher between all examiners. Greater variability was demonstrated between N-stage evaluation using different examinations. All radiologists were able to identify a greater number of metastatic lymph nodes in CECT than in MRI, except one MR, but no significant difference was found for all readers. The differences between the number of metastatic lymph nodes among all radiologists were not statistically significant. Moderate intraobserver agreement was observed for CECT and MRI evaluation, except for one MR. CONCLUSIONS The differences found between the N-stage performed by OMRs and MRs support the necessity of a multidisciplinary approach in the imaging evaluation of metastatic nodes. Further studies are necessary to confirm which imaging modality should be employed when evaluating neck areas.
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Ruback MJC, Galbiatti AL, Arantes LMRB, Marucci GH, Russo A, Ruiz-Cintra MT, Raposo LS, Maniglia JV, Pavarino ÉC, Goloni-Bertollo EM. Clinical and epidemiological characteristics of patients in the head and neck surgery department of a university hospital. SAO PAULO MED J 2012; 130:307-13. [PMID: 23174870 PMCID: PMC10836462 DOI: 10.1590/s1516-31802012000500007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 08/08/2011] [Accepted: 03/07/2012] [Indexed: 11/22/2022] Open
Abstract
CONTEXT AND OBJECTIVES Head and neck cancer is the fifth most common type of cancer worldwide. The objective of this study was to evaluate the clinical and epidemiological parameters in a head and neck surgery service. DESIGN AND SETTING Cross-sectional study using patients' records, developed in otolaryngology and head and neck department of a university hospital in the northwest of the state of São Paulo. METHODS A total of 995 patients in the head and neck surgery service between January 2000 and May 2010 were evaluated. The variables analyzed included: age, gender, skin color, tobacco and alcohol consumption, primary site, staging and histological tumor type, treatment and number of deaths. RESULTS The disease was more frequent among men (79.70%), smokers (75.15%) and alcohol abusers (58.25%). The most representative sites were oral cavity (29.65%) and larynx (24.12%) for the primary site; squamous cell carcinoma (84.92%) was the most frequent histological type, and surgery (29.04%) and radiotherapy (14.19%) were the most common treatments. CONCLUSION The cancer that affects patients assisted by the head and neck surgery service occurs mainly men, smokers and alcohol abusers, and the oral cavity and larynx are the sites with the highest incidence. The high rate of patients with stages III and IV indicates late diagnosis by the treatment centers, which reflects the need for prevention education campaigns for early diagnosis of the disease.
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Affiliation(s)
- Maurício José Cabral Ruback
- MD, MSc. Master’s Student. Unidade de Pesquisa em Genética e Biologia Molecular (UPGEM), Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Ana Lívia Galbiatti
- MD, MSc. Master’s Student. Unidade de Pesquisa em Genética e Biologia Molecular (UPGEM), Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Lidia Maria Rebolho Batista Arantes
- MD, MSc. Master’s Student. Unidade de Pesquisa em Genética e Biologia Molecular (UPGEM), Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Gustavo Henrique Marucci
- MD, MSc. Master’s Student. Unidade de Pesquisa em Genética e Biologia Molecular (UPGEM), Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Anelise Russo
- MD, MSc. Master’s Student. Unidade de Pesquisa em Genética e Biologia Molecular (UPGEM), Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Mariangela Torreglosa Ruiz-Cintra
- PhD. Adjunct Professor, Department of Biological Sciences, Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.
| | - Luiz Sérgio Raposo
- MD, MSc. Professor, Department of Otolaryngology and Head and Neck Surgery, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - José Victor Maniglia
- MD, PhD. Adjunct Professor, Department of Otolaryngology and Head and Neck Surgery, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil.
| | - Érika Cristina Pavarino
- PhD. Adjunt Professor, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil
| | - Eny Maria Goloni-Bertollo
- PhD. Adjunt Professor, Department of Molecular Biology, Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, São Paulo, Brazil
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Montoro JRDMC, Mamede RCM, Neder Serafini L, Saggioro FP, Figueiredo DLA, Silva WAD, Jungbluth AA, Spagnoli GC, Zago MA. Expression of cancer-testis antigens MAGE-A4 and MAGE-C1 in oral squamous cell carcinoma. Head Neck 2011; 34:1123-8. [PMID: 22083937 DOI: 10.1002/hed.21880] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2011] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Tumor markers are genes or their products expressed exclusively or preferentially in tumor cells and cancer-testis antigens (CTAs) form a group of genes with a typical expression pattern expressed in a variety of malignant neoplasms. CTAs are considered potential targets for cancer vaccines. It is possible that the CTA MAGE-A4 (melanoma antigen) and MAGE-C1 are expressed in carcinoma of the oral cavity and are related with survival. METHODS This study involved immunohistochemical analysis of 23 patients with oral squamous cell carcinoma (SCC) and was carried out using antibodies for MAGE-A4 and MAGE-C1. Fisher's exact test and log-rank test were used to evaluate the results. RESULTS The expression of the MAGE-A4 and MAGE-C1 were 56.5% and 47.8% without statistical difference in studied variables and survival. CONCLUSION The expression of at least 1 CTA was present in 78.3% of the patients, however, without correlation with clinicopathologic variables and survival.
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Affiliation(s)
- José Raphael de Moura Campos Montoro
- Department of Ophthalmology, Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Squamous cell carcinoma of the tongue and floor of the mouth: analysis of survival rate and independent prognostic factors in the Amazon region. J Craniofac Surg 2011; 22:925-30. [PMID: 21558919 DOI: 10.1097/scs.0b013e31820fe1cb] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Oral squamous cell carcinoma (OSCC) accounts for more than 95% of all malignant neoplasms in the oral cavity. Although several studies have shown the epidemiology of this cancer in Brazil, there do not seem to be any studies that describe the prognostic factors related to OSCC in the Amazon region. Therefore, the aim of this study was to determine the survival rate and prognostic significance of different factors in patients from this region affected by OSCC. Data from 85 patients with histologically confirmed squamous cell carcinoma of the tongue and floor of the mouth identified from the Ofir Loyola Hospital archives were collected and analyzed using univariate (log-rank test) and multivariate (Cox proportional hazard model) tests. The overall 5-year survival rate was found to be 27%. Univariate analysis showed that the 5-year survival rate was significantly higher for younger (≤ 45 y) female patients, patients with T1-2 tumors and clinically clear neck nodes (N0), patients with early stage cancers (AJCC stage I-II), and patients treated with surgical procedures. However, multivariate analysis showed that the 5-year survival rate was significantly higher only in the younger patients and those who underwent surgical treatment. The age of the patient at the moment of diagnosis and treatment with surgical procedures were the only independent prognostic factors that affected the 5-year survival rate of the patients in this region.
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Marchioni DML, Gattás GJF, Curioni OA, Carvalho MBD. [Interaction between dietary intake and GSTM1 and GSTT1 polymorphisms in head and neck cancer risk: a case-control study in São Paulo, Brazil]. CAD SAUDE PUBLICA 2011; 27:379-87. [PMID: 21359474 DOI: 10.1590/s0102-311x2011000200019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Accepted: 12/06/2010] [Indexed: 11/22/2022] Open
Abstract
A hospital-based case-control study was conducted to investigate the potential interaction between dietary factors and polymorphisms in phase II metabolic enzymes GSTM1 and GSTT1, associated with head and neck cancer risk. The study included 103 histologically confirmed incident cases and 101 controls. Food intake was estimated with a validated food frequency questionnaire. The gene polymorphisms were evaluated by PCR. Increased risk was observed in the highest tertile of beef consumption in the presence of the GSTM1 (OR = 10.79; 95%CI: 2.17-53.64) and GSTT1 null alleles (OR = 3.41; 95%CI: 0.43-27.21). Assessment of dietary intake considering the ratio between animal product and vegetable consumption showed OR = 2.35 (95%CI: 0.27-19.85) in the intermediate tertile and OR = 3.36 (95%CI: 0.41-27.03) in the highest tertile. The results suggest a possible interaction between meat intake and GSTM1/GSTT1 polymorphisms in modulating the risk of head and neck cancer, influenced by vegetable consumption.
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Affiliation(s)
- Dirce Maria Lobo Marchioni
- Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo 715, São Paulo, SP, Brazil.
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Barros SSLV, Henriques ÁCG, Pereira KMA, de Medeiros AMC, Galvão HC, Freitas RDA. Immunohistochemical expression of matrix metalloproteinases in squamous cell carcinoma of the tongue and lower lip. Arch Oral Biol 2011; 56:752-60. [PMID: 21255765 DOI: 10.1016/j.archoralbio.2010.11.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2010] [Revised: 09/30/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To evaluate the immunohistochemical expression of MMP-1, -2, -7, -9 and -26 in oral squamous cell carcinomas (SCCs) according to tumour site and histological grade of malignancy. STUDY DESIGN Fifteen cases of SCC of the lower lip and 15 cases of tongue SCC were selected and divided into low grade malignancy (n = 17) and high grade malignancy (n = 13). RESULTS Higher immunohistochemical expression of MMPs by neoplastic cells was observed in tongue SCCs, with a statistically significant difference for MMP-9 (P < 0.05). High-grade SCCs showed a higher expression of MMPs, except for MMP-2, with a statistically significant difference for MMP-7 (P < 0.05) and MMP-26 (P < 0.05). In addition, a direct association was observed between morphological scores of malignancy and MMP immunoreactivity, with the association being significant for MMP-7 and MMP-26. CONCLUSION The present results demonstrate the important role of MMPs in the development of SCCs of the lower lip and tongue.
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Carrard VC, Haas AN, Rados PV, Filho MS, Oppermann RV, Albandar JM, Susin C. Prevalence and risk indicators of oral mucosal lesions in an urban population from South Brazil. Oral Dis 2010; 17:171-9. [DOI: 10.1111/j.1601-0825.2010.01712.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Determinants of oral cancer at the national level: just a question of smoking and alcohol drinking prevalence? Odontology 2010; 98:144-52. [DOI: 10.1007/s10266-010-0133-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Accepted: 05/11/2010] [Indexed: 10/19/2022]
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Vaccarezza GF, Antunes JLF, Michaluart-Júnior P. Recurrent sores by ill-fitting dentures and intra-oral squamous cell carcinoma in smokers. J Public Health Dent 2010; 70:52-7. [PMID: 19694933 DOI: 10.1111/j.1752-7325.2009.00143.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To examine whether denture use and recurrent sores caused by ill-fitting dentures are associated with intra-oral squamous cell carcinoma (IO-SCC) in individuals exposed to tobacco. METHODS We conducted a hospital-based case-control study. The study population 124 patients wi th IO-SCC and the same number of controls (individually paired according to gender and age) recruited from outpatient units of the same hospital. Conditional logistic regression analysis assessed the effect of denture use and recurrent oral sores by ill-fitting dentures, adjusted by covariates on the lifetime exposure to alcohol and tobacco, socioeconomic standings, and dietary patterns. RESULTS The use of dentures showed no association with IO-SCC [adjusted odds ratio (OR) 1.40, 95 percent confidence interval 0.51-3.87, P = 0.513] in an assessment controlled by socioeconomic position, lifetime exposure to alcohol and tobacco, and dietary patterns. However, the report of recurrent sores caused by ill-fitting dentures showed significant association with the disease (adjusted OR 4.58, 95 percent confidence interval 1.52-13.76, P = 0.007). CONCLUSIONS The association between recurrent oral sores caused by ill-fitting dentures and squamous cell carcinoma of the mouth in smokers is in agreement with the hypothesis that the chronic physical irritation of oral mucosa contributes to the topical carcinogenic effect of tobacco, which must be taken into careful consideration in the planning of dental services for adults and the elderly.
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Abstract
Scanty information, limited to selected areas of the country, is available on cancer mortality in Brazil. Age-standardized (world population) mortality rates between 1980 and 2004, derived from the WHO database, were computed for all cancers and 24 major cancer sites in Brazil. Joinpoint regression analyses were used to identify the significant changes in trends and estimate annual percent change (APC) in rates. Total cancer mortality rates increased over the last decade in men (APC = 0.5) to reach 101.2/100 000, and in women (APC = 0.3) to reach 71.3/100 000. In men, upward trends were observed for cancers of the oral cavity and pharynx with a rate of 5.9/100 000 in 2000-2004, intestines (whose rate, however was low, i.e. 7.6), prostate (12.2), and leukemias (3.4). Male lung cancer increased until 1993 (APC = 1.39) and decreased thereafter (APC = -0.29), with a relatively low rate of 16.2/100 000 in 2000-2004. In women, there were steady upward trends for cancers of the lung (APC = 2.3), reaching 6.2/100 000 in 2000-2004, and leukemias (2.5). Breast cancer mortality leveled off at around 10/100 000 in the last decade, whereas declines were observed for cancers of the uterus, whose rate (8.3) however, remained comparatively high. Declines were observed for stomach cancer in both sexes, with rates of 11.1 in men and 4.6 in women. In conclusion, the key issues of cancer mortality in Brazil are the high rates of head and neck cancers in men and (cervix) uterine cancer in women, that is, in principle cancers that are largely avoidable through prevention, screening, and early diagnosis.
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