Cancer mortality in Brazil: Temporal Trends and Predictions for the Year 2030

Evaluation of Direct Medical Costs and Associated Factors Within the Last 30 days of Life of Hospitalized Cancer Patients

Background: An estimated 9.6 million people died from cancer globally in 2018, which is a reflection of the quality of patients' end-of-life care and its costs. Aim: To estimate direct medical costs of the last 30 days of oncology patients admitted to an inpatient clinic and to evaluate factors associated with medical costs at the end of life. Design: Cost-of-illness study with data from a retrospective cohort. Setting/Participants: We included patients aged 18 and older who were diagnosed with incurable cancer and who were admitted to a tertiary hospital in Brazil between January 1, 2018 and December 31, 2019. Results: Our sample included 109 patients with an average age of 69 (61‒76). The median overall survival was 4.3 (.9‒12.9) months. The median cost per patient per day related to hospitalization was BRL 119 (73‒181)/United States dollars [USD] 21 (13‒33). The cost of medication was BRL 66 (40‒105)/USD 12 (7‒19), representing 55.46% of costs while that of materials and supplies was BRL 30 (18‒49)/USD 5 (3‒9). In the multivariate analysis, when the limitation of interventions was recorded in the medical record, the median cost is reduced by BRL 50 (USD 9) per patient per day. Conclusions: The median cost per patient per day was BRL 119 (73‒181). The recording of limitations of therapeutic interventions in the medical record was a predictor variable that influenced the final medical cost of patients, suggesting that medical practice and decision-making in end-of-life care impact costs.

Predictors of Testicular Cancer Mortality in Brazil: A 20-Year Ecological Study

Testicular cancer is common in young men, and early detection and multimodality treatment can lead to successful outcomes. This study aims to identify sociodemographic and risk factors associated with higher testicular cancer mortality and poorer survival rates, while examining the impact of diagnostic and treatment procedures on reducing mortality. The retrospective ecological study analyzed mortality data from testicular cancer in Brazil from 2001 to 2020. Sociodemographic variables such as marital status, age, birth period, year of death (cohort), race, and geographic region were assessed. Risk factors included cryptorchidism and pesticide exposure. Data were subjected to statistical analysis, which revealed an increasing trend in mortality after 2011 among persons born after 1976 in the 15-40 age group. Individuals in the South Region, whites, and singles had higher age-standardized mortality rates (ASMRs), while singles had lower survival rates. The Northeast region had a higher survival rate. Fungicides and insecticides increase ASMR in Brazil. Herbicides increase ASMR in the Northeast and Midwest regions and insecticides increase ASMR in the Northeast, Southeast, and Midwest regions. High rates of implementation of diagnostic procedures in the Midwest were not sufficient to reduce ASMR. No treatment procedure was associated with mortality at the national or regional level.

The Nutrition Literacy Assessment Instrument for Brazilians, NLit-Br: An Exploratory Cross-Cultural Validity Study

This study aimed to test the validity of the cross-cultural adapted Nutrition Literacy Assessment Instrument for Brazilians (NLit-Br). An observational cross-sectional study was performed in chronic disease clinics from the Brazilian Public Health System in two phases: (1) linguistic and cultural adaptation and (2) validity testing. Six registered dietitians and thirty adult patients diagnosed with at least one chronic disease participated in the study using the nutrition literacy assessment instrument (NLit-Br) and the short assessment of health literacy for Portuguese-speaking adults (SAHLPA-18). Sample descriptive variables: age, sex, race, income, education, and occupation. To adapt the instrument to the Brazilian Portuguese and Brazilian culture, we tested cognitive interviewing and the Scale Content Validity Index (S-CVI) with a group of dietitians and patients. To test the tool’s validity, health literacy (SAHLPA-18) was used as a construct that presents similarities and differences with nutrition literacy (NLit-Br). The correlation of NLit-Br and the SAHLPA-18 was tested (Spearman’s Rho). Internal consistency was measured by Kuder−Richardson Formula 20 (KR-20). The NLit-Br content validity (S-CVI = 0.85) and internal consistency (KR-20 = 0.868) were confirmed. Additionally, NLit-Br presented a significant and robust correlation with SAHLPA-18 (r = 0.665, p < 0.001). Therefore, the NLit-Br was considered a linguistic, cultural, and valid instrument to measure Brazilian’s nutrition literacy.

Temporal trends and spatial clusters of gastric cancer mortality in Brazil

Objective

To identify nationwide temporal trends and spatial patterns of gastric cancer-related mortality in Brazil.

Methods

An ecological study was performed using death certificates registered from 2000 to 2019 in which gastric cancer was recorded as any cause of death (an underlying or associated cause). Trends over time were assessed using joinpoint regression models. Spatial and spatiotemporal clusters were identified by Kulldorff's space-time scan statistics to identify high-risk areas.

Results

In 276 897/22 663 091 (1.22%) death certificates gastric cancer was recorded as any cause of death. Age-adjusted gastric cancer-related mortality increased significantly over time (annual percentage change [APC]: 0.7, 95% confidence interval [CI]: 0.5 to 0.8). The increase in mortality was more pronounced in the less-developed North and Northeast Regions (North Region, APC: 3.1, 95% CI: 2.7 to 3.5; Northeast Region, APC: 3.1, 95% CI: 2.5 to 3.7). Eight spatiotemporally associated high-risk clusters of gastric cancer-related mortality were identified in the North, South, Northeast and Central-West Regions, as well as a major cluster covering a wide geographical range in the South and Southeast Regions of Brazil during the first years of the study period (2000 to 2009).

Conclusions

More recently, during 2010 to 2019, clusters of gastric cancer have been identified in the Northeast Region. The nationwide increase in mortality in this analysis of 20 years of data highlights the persistently high burden of gastric cancer in Brazil, especially in socioeconomically disadvantaged regions. The identification of these areas where the population is at high risk for gastric cancer-related mortality emphasizes the need to develop effective and intersectoral control measures.

Medical Students' Perception of Risk Factors for Cancer

To evaluate the perception of risk factors for cancer among medical students and how it varies among students in different years of their medical education. Cross-sectional study was conducted in 2019. The American Institute for Cancer Research Cancer Risk Awareness Survey questionnaire was administered to medical students at the Centro Universitário Saúde ABC. Students were divided into those in their 1st to 3rd year and those in their 4th to 6th year of medical education. Qualitative variables were described by frequency and percentage, and quantitative variables were described by mean and standard deviation or median and interquartile range. The scores of the groups on the questionnaire were compared using Student's t test. The 95% confidence interval was calculated, and p values < 0.05 were considered significant. We included 196 students, with approximately 30 to 35 students in each year of medical education. The median age was 22 (18 to 31), with 74% being female. Among risk factors for cancer, smoking (100%), cancer-causing genes (99.48%), and excessive sunlight exposure (99.48%) were the most cited by students. We observed a significant difference in the number of correct answers, favoring students in their 4th to the 6th year over those in their 1st to the 3rd year (mean = 16.46 vs. mean = 13.73, p < 0.001). Perception about risk factors for cancer is greater in the later years of medical education.

Mortality trend of cancer and main types according to macroregion in the state of Mato Grosso, Brazil, 2000 to 2015

OBJECTIVE

To describe the mortality trend from all cancers and the five main ones in the state of Mato Grosso, Brazil, from 2000 to 2015.

METHODS

This is a descriptive, ecological, time series study, with data referring to deaths of residents of Mato Grosso due to cancer (ICD-10 codes C00 to C97), from the Mortality Information System (SIM). Time trend analyses of the standardized mortality rate from all cancers and five specific cancers (lung, prostate, breast, colorectal and cervical) for the state and according to macroregion (South, West, North, East and Center-North) were performed using linear regression (p<0.05).

RESULTS

From 2000 to 2015, 28,525 deaths from all cancers in residents of the state of Mato Grosso were recorded. An increasing trend was observed for all cancers, in addition to lung, breast and colorectal cancers. The South and North macroregions showed an increasing trend for all cancers, breast and colorectal, and Center-North for breast and colorectal. East showed an increasing trend for all cancers, prostate and colorectal, and decreasing for cervical.

CONCLUSION

In the state of Mato Grosso, there was an increasing trend in mortality for all cancers and from specific ones, with emphasis on breast and colorectal cancer in most macroregions.

Incidence and Mortality by the Main Types of Cancer in the City of Cuiabá, Mato Grosso, Between the Years of 2008 and 2016

OBJECTIVE

To analyze the temporal trend of the incidence and mortality rate for prostate, breast, colorectal, lung, cervical, stomach and laryngeal cancer among residents in the city of Cuiabá between 2008 and 2016.

METHODS

Time series study with data from the Mortality Information System and the Population-Based Cancer Registry. Stratified by sex, the proportional distribution of new cases and deaths by age group and the cancer incidence and mortality rates standardized by the world population were calculated. Linear regression was used and the annual percentage change (APC) was estimated.

RESULTS

In males, most new cases and deaths, for the main types of cancer, occurred among those aged 50 years or older, and the incidence rate of prostate cancer showed a tendency to decrease in the period (APC=-4.33%). For females, the proportion of new cases and deaths, due to breast and cervical cancer, were more frequent among women aged 50 years or younger, and lung, stomach and colorectal cancer among women aged 50 years or older. The incidence rate of breast cancer showed an increasing trend (APC=3.60%). For both sexes, the mortality rate remained stable.

CONCLUSION

The incidence rate trend varied between sexes, an increase was observed for breast cancer among women and a reduction for prostate cancer among men. The mortality rate for the main types of cancer was stable.

Cancer mortality in the State of Mato Grosso from 2000 to 2015: temporal trend and regional differences

OBJECTIVE

To analyze the trend of standardized cancer mortality rate in the state of Mato Grosso according to health regions, from 2000 to 2015.

METHODS

Ecological time series study with data on deaths by cancer from the Mortality Information System. The rates were standardized using direct method and calculated by year and health regions. The annual percentage changes (APC) and respective confidence interval (95%CI) were obtained through simple linear regression. Thematic maps were built to show the spatial distribution of rates.

RESULTS

There were 28,525 deaths by cancer registered in Mato Grosso, with the main types being lung, prostate, stomach, breast and liver cancer. The highest mortality rates were found in regions Médio Norte, Baixada Cuiabana and Sul Mato-Grossense. From 2000 to 2015, an upward trend was seen in the mortality rate by cancer in Mato Grosso (APC=0.81%; 95%CI 0.38-1.26), and in four health regions, Garças Araguaia (APC=2.27%; 95%CI 1.46-3.08), Sul Mato-Grossense (APC=1.12%; 95%CI 0.28-1.97), Teles Pires (APC=1.93%; 95%CI 0,11-3,74) and Vale dos Arinos (APC=2.61%; 95%CI 1.10-4.70), while the other regions remained stable.

CONCLUSION

In the state of Mato Grosso and in the four health regions, cancer mortality rate showed a growing trend. The results point to the need to consider regional differences when thinking about actions for cancer prevention, control and assistance.

Stomach cancer incidence and mortality in Greater Cuiabá, Mato Grosso, Brazil, 2000-2016

OBJECTIVE

To analyze the incidence and mortality trend of stomach cancer in the Greater Cuiabá, in the state of Mato Grosso, Brazil, from 2000 to 2016.

METHODS

The incidence information was obtained from the Population-Based Cancer Registry, and the mortality information from the Mortality Information System. Crude and standardized rates were calculated using the direct method, with the world population as reference. The trends were estimated using the Joinpoint regression method, according to sex and age group, and evaluated through the Annual Percent Change (APC) and the Average Annual Percent Change (AAPC). The Joinpoint Regression Program software, version 4.9.0.0, was used.

RESULTS

There was a decreasing incidence trend of stomach cancer in males (AAPC=-5.2; 95% confidence interval - 95%CI -7.7--2.6), in men aged 60 to 69 years (AAPC=-3.7; 95%CI -5.6--1.8) and in 70-79 years (AAPC=-3.7; 95%CI -5.6--1.8), as well as in women aged 50 to 59 years (AAPC=-5.2; 95%CI -7.8--2.6) and 80 years or older (AAPC=-5.2; 95%IC -7.8--2.6). The mortality initially increased in women aged 60-69 years (AAPC=28.4; 95%CI 9.7-50.4), decreased for 80 years or older (AAPC=-26.4; 95%CI -38.0--12.6) and stable for the other age groups and males.

CONCLUSION

A decreasing incidence trend of stomach cancer was found among men and, when analyzed by age, among elderly males and adults and elderly females, as well as a stability in the mortality, with an initial variation in elderly women. The production of regional information supports the planning of local policies aimed at reducing the burden of disease and deaths, considering unequal risk conditions and access to health services.

Cancer Statistics over Time in Northwestern São Paulo State, Brazil: Incidence and Mortality

BACKGROUND

Population studies can serve as an essential source of information on cancer's etiology, and assessments of cancer trends over time can detect changes. This study aimed to provide statistics over time on cancer incidence and mortality in the Barretos Region, Brazil.

METHODS

Cancer incidence data were obtained from the population-based cancer registry of the Barretos Region, and mortality data were obtained from the Official Federal Database from 2002 to 2016. Age-standardized rates for incidence and mortality were calculated. Joinpoint Regression software was used to estimate the average annual percentage changes (AAPC).

RESULTS

Age-standardized rates of incidence increased significantly for colon cancer (AAPC: 2.2), rectum and rectosigmoid (AAPC: 2.4), liver (AAPC: 4.7), female breast (AAPC: 2.2), and thyroid cancer (AAPC: 3.8) but decreased for esophageal (AAPC: -3.2), stomach (AAPC: -4.2), lung (AAPC: -2.0), and ovarian cancer (AAPC: -5.6). The mortality increased for liver cancer (AAPC: 2.3) and decreased for pharyngeal cancer (AAPC: -5.8), stomach cancer (AAPC: -6.6), cervical uterine cancer (AAPC: -5.9), prostate cancer (AAPC: -2.4), and ovarian cancer (AAPC: -3.3).

CONCLUSIONS

We observed decreases in some cancers related to tobacco smoking and cervical and stomach cancers related to infectious agents, showing strong regional and national prevention programs' successes. But, we also observed rises in many cancer sites linked to lifestyle factors, such as breast or colorectal cancer, without a sign of declining mortality.

IMPACT

These results can impact and support cancer control program implementation and improvement at the community level and extrapolate to the state level and/or the whole country.

Tendência da mortalidade por câncer e principais tipos segundo macrorregiões do Estado de Mato Grosso, 2000 a 2015

RESUMO: Objetivo: Descrever a tendência da mortalidade por todas as causas de câncer e as cinco principais causas no Estado de Mato Grosso, Brasil, no período de 2000 a 2015. Métodos: Trata-se de um estudo descritivo, ecológico, do tipo série temporal, com dados referentes aos óbitos de residentes de Mato Grosso por neoplasias (códigos C00 a C97 da Classificação Internacional de Doenças — CID-10), provenientes do Sistema de Informações sobre Mortalidade. A tendência temporal da taxa de mortalidade padronizada de todas as causas de câncer e de cinco causas específicas (pulmão, próstata, mama feminina, colorretal e colo do útero) para o Estado e segundo macrorregiões (Sul, Oeste, Norte, Leste e Centro-Norte) foi analisada por meio de regressão linear (p<0,05). Resultados: De 2000 a 2015, ocorreram 28.525 óbitos por todas as causas de câncer em residentes do Estado de Mato Grosso. Tendência crescente foi observada para todas as causas de câncer, além dos cânceres de pulmão, mama e colorretal. As macrorregiões Sul e Norte apresentaram tendência crescente para todas as causas, mama e colorretal; Centro-Norte para mama e colorretal; Leste foi crescente para todas as causas, próstata e colorretal e decrescente para colo do útero. Conclusão: No Estado de Mato Grosso, verificou-se tendência crescente de mortalidade por todas as causas de câncer e por causas específicas, com destaque para mama e colorretal na maioria das macrorregiões.

Incidência e mortalidade por câncer de estômago na Grande Cuiabá, Mato Grosso, 2000–2016

RESUMO: Objetivo: Analisar a tendência da incidência e da mortalidade por câncer de estômago na Grande Cuiabá, Mato Grosso, entre 2000 e 2016. Métodos: Dados de casos novos e óbitos de residentes dos municípios Cuiabá e Várzea Grande foram obtidos no Registro de Câncer de Base Populacional e no Sistema de Informações sobre Mortalidade, respectivamente. Foram calculadas taxas brutas e padronizadas pelo método direto, utilizando-se a população mundial como referência. As tendências foram estimadas pelo método de regressão Joinpoint, segundo sexo e faixa etária, e avaliadas por meio da variação percentual anual (annual percent change — APC) e da variação percentual média anual (average annual percent change — AAPC). Utilizou-se o software Joinpoint Regression Program, versão 4.9.0.0. Resultados: Verificou-se tendência decrescente da incidência do câncer de estômago no sexo masculino (AAPC=-5,2; intervalo de confiança — IC95% −7,7–-2,6), em homens com 60–69 anos (AAPC=-3,7; IC95% −5,6–-1,8) e 70–79 anos (AAPC=-3,7; IC95% −5,6–-1,8), bem como em mulheres com 50–59 anos (AAPC=-5,2; IC95% −7,8–-2,6) e 80 anos ou mais (AAPC=-5,2; IC95% −7,8–-2,6). A mortalidade apresentou, inicialmente, aumento em mulheres com 60–69 anos (AAPC=28,4; IC95% 9,7–50,4), redução para 80 anos ou mais (AAPC=-26,4; IC95% −38,0–-12,6) e estabilidade nas demais faixas etárias e entre homens. Conclusão: Verificou-se redução da incidência de câncer de estômago em homens e, quando analisada por idade, entre homens idosos e mulheres adultas e idosas, bem como estabilidade na mortalidade, com variação inicial em idosas. A produção de informações regionais subsidia o planejamento de políticas locais que visem à redução da carga da doença e de óbitos, considerando condições desiguais de risco e acesso a serviços de saúde.

Pancreatic cancer incidence and mortality trends: a population-based study

Objectives To analyze trends in pancreatic cancer incidence and mortality in Latin American countries. Methods An ecological study with incidence data from the International Agency for Research on Cancer and mortality data from the World Health Organization. The trend of incidence by Joinpoint regression, the variation of the annual average and the 95% confidence interval were analyzed. Results There were increasing trends in incidence in Brazil, in males, aged 40-59 years, and reduction in Costa Rica. In females, there was stability in all age groups. The mortality rates increased in the elderly in Brazil (AAPC: 1.09%; 95% CI: 0.76; 1.42), Peru (AAPC: 1.76%; 95% CI: 0.36; 3.17) and El Salvador (AAPC: 2.88%; 95% CI: 0.38; 5.43), while in Mexico, there was a reduction. In females, this rate increased in Brazil (AAPC: 1.38%; 95% CI: 1.07; 1.69), Peru (AAPC: 2.25%; 95% CI: 0.68; 3.85), Chile (AAPC: 3.62%; 95% CI:1.96; 5.31), Nicaragua (AAPC: 2.51%; 95% CI: 0.36; 4.71) and Paraguay (AAPC: 1.17%; 95% CI: 0.37; 1.98) and a downward trend was observed in Colombia and Ecuador. Conclusions Pancreatic cancer had a higher incidence in the elderly population of both sexes and an increase of the mortality trend in females was noted.

Mortalidade por câncer no estado de Mato Grosso, Brasil, no período de 2000 a 2015: tendência temporal e diferenças regionais

RESUMO: Objetivo: Analisar a tendência da taxa padronizada de mortalidade por câncer no estado de Mato Grosso, Brasil, conforme regiões de saúde, no período de 2000 a 2015. Métodos: Estudo ecológico de séries temporais com dados de óbitos por neoplasias do Sistema de Informação sobre Mortalidade. As taxas foram padronizadas pelo método direto e calculadas por ano e por regiões de saúde. A variação anual percentual (annual percent change — APC) e seu respectivo intervalo de 95% de confiança (IC95%) foram obtidos por meio da regressão linear simples. Construíram-se mapas temáticos para descrever a distribuição espacial das taxas. Resultados: Foram registrados 28.525 óbitos por câncer em Mato Grosso, e os cinco principais tipos de câncer foram de pulmão, próstata, estômago, mama e fígado. As maiores taxas de mortalidade foram encontradas nas regiões Médio Norte, Baixada Cuiabana e Sul-Mato-Grossense. No período de 2000 a 2015 foi observada tendência crescente na taxa de mortalidade por câncer em Mato Grosso (APC=0,81%; IC95% 0,38–1,26), e em quatro regiões de saúde, Garças Araguaia (APC=2,27%; IC95% 1,46–3,08), Sul-Mato-Grossense (APC=1,12%; IC95% 0,28–1,97), Teles Pires (APC=1,93%; IC95% 0,11–3,74) e Vale dos Arinos (APC=2,61%; IC95% 1,10–4,70). As demais regiões apresentaram estabilidade. Conclusão: No estado de Mato Grosso e em quatro regiões de saúde foi verificada tendência crescente de mortalidade por câncer. Os resultados indicam a necessidade de se considerar as diferenças regionais para as ações de prevenção e assistência ao câncer e de controle.

Incidência e mortalidade pelos principais tipos de câncer no município de Cuiabá, Mato Grosso, entre os anos de 2008 e 2016

RESUMO: Objetivo: Analisar a tendência temporal das taxas de incidência e mortalidade por câncer de próstata, de mama, colorretal, de pulmão, do colo de útero, de estômago e de laringe entre residentes no município de Cuiabá, Mato Grosso, entre 2008 e 2016. Métodos: Estudo de séries temporais com informações do Sistema de Informação sobre Mortalidade e do Registro de Câncer de Base Populacional. Foram calculadas, por sexo, a distribuição proporcional dos casos novos e óbitos por faixa etária e as taxas de incidência e mortalidade por câncer padronizadas pela população mundial. Foi empregada a regressão linear, e estimou-se a variação percentual anual (VPA). Resultados: No sexo masculino, a maioria dos casos novos e óbitos, para os principais tipos de câncer, ocorreu entre aqueles com 50 anos ou mais, e a taxa de incidência de câncer de próstata apresentou tendência de redução no período (VPA=-4,33%). Para o sexo feminino, a proporção de casos novos e óbitos, por câncer de mama e colo de útero, foi mais frequente entre mulheres com 50 anos ou menos, e câncer de pulmão, estômago e colorretal mais comuns entre as mulheres com 60 anos ou mais. A tendência da taxa de incidência de câncer de mama foi crescente (VPA=3,60%). Para ambos os sexos, a taxa de mortalidade apresentou estabilidade. Conclusão: A tendência da taxa de incidência variou entre os sexos, foi observado aumento para câncer de mama entre mulheres e viu-se redução para câncer de próstata entre homens. A taxa de mortalidade para os principais tipos de câncer apresentou estabilidade.

Design, synthesis, docking, ADMET studies, and anticancer evaluation of new 3-methylquinoxaline derivatives as VEGFR-2 inhibitors and apoptosis inducers

Vascular endothelial growth factor receptor-2 (VEGFR-2) plays a critical role in cancer angiogenesis. Inhibition of VEGFR-2 activity proved effective suppression of tumour propagation. Accordingly, two series of new 3-methylquinoxaline derivatives have been designed and synthesised as VEGFR-2 inhibitors. The synthesised derivatives were evaluated in vitro for their cytotoxic activities against MCF-7and HepG2 cell lines. In addition, the VEGFR-2 inhibitory activities of the target compounds were estimated to indicate the potential mechanism of their cytotoxicity. To a great extent, the results of VEGFR-2 inhibition were highly correlated with that of cytotoxicity. Compound 27a was the most potent VEGFR-2 inhibitor with IC50 of 3.2 nM very close to positive control sorafenib (IC50 = 3.12 nM). Such compound exhibited a strong cytotoxic effect against MCF-7 and HepG2, respectively with IC50 of 7.7 and 4.5 µM in comparison to sorafenib (IC50 = 3.51 and 2.17 µM). In addition, compounds 28, 30f, 30i, and 31b exhibited excellent VEGFR-2 inhibition activities (IC50 range from 4.2 to 6.1 nM) with promising cytotoxic activity. Cell cycle progression and apoptosis induction were investigated for the most active member 27a. Also, the effect of 27a on the level of caspase-3, caspase-9, and BAX/Bcl-2 ratio was determined. Molecular docking studies were implemented to interpret the binding mode of the target compounds with the VEGFR-2 pocket. Furthermore, toxicity and ADMET calculations were performed for the synthesised compounds to study their pharmacokinetic profiles.

The impacts of long-term exposure to PM2.5 on cancer hospitalizations in Brazil

BACKGROUND

Long-term exposure to PM_2.5 has been linked to cancer incidence and mortality. However, it was unknown whether there was an association with cancer hospitalizations.

METHODS

Data on cancer hospitalizations and annual PM_2.5 concentrations were collected from 1,814 Brazilian cities during 2002-2015. A difference-in-difference approach with quasi-Poisson regression was applied to examine State-specific associations. The State-specific associations were pooled at a national level using random-effect meta-analyses. PM_2.5 attributable burden were estimated for cancer hospitalization admissions, inpatient days and costs.

RESULTS

We included 5,102,358 cancer hospitalizations (53.8% female). The mean annual concentration of PM_2.5 was 7.0 μg/m³ (standard deviation: 4.0 μg/m³). With each 1 μg/m³ increase in two-year-average (current year and previous one year) concentrations of PM_2.5, the relative risks (RR) of hospitalization were 1.04 (95% confidence interval [CI]: 1.02 to 1.07) for all-site cancers from 2002 to 2015 without sex and age differences. We estimated that 33.82% (95%CI: 14.97% to 47.84%) of total cancer hospitalizations could be attributed to PM_2.5 exposure in Brazil during the study time. For every 100,000 population, 1,190 (95%CI: 527 to 1,836) cancer hospitalizations, 8,191 (95%CI: 3,627 to 11,587) inpatient days and US$788,775 (95%CI: $349,272 to $1,115,825) cost were attributable to PM_2.5 exposure.

CONCLUSIONS

Long-term exposure to ambient PM_2.5 was positively associated with hospitalization for many cancer types in Brazil. Inpatient days and cost would be saved if the annual PM_2.5 exposure was reduced.

Spatial and temporal distribution of cancer mortality in a Brazilian Legal Amazon State between 2000 and 2015

OBJECTIVE

To analyze the spatial distribution of the four-year cancer mortality rates in the state of Mato Grosso, Brazil, from 2000 to 2015.

METHODOLOGY

Ecological design study, in which mortality from neoplasia was analyzed, from 2000 to 2015, for the municipalities of Mato Grosso State. Mortality rates due to cancer were calculated by the ratio of the sum of deaths by cancer in each quadrennium, divided by the average of the population in the two central years of the period, multiplied by 10,000 inhabitants. Annual percentage change was calculated by the ratio of the linear regression coefficient to the cancer mortality rates in Mato Grosso State at the beginning of the analyzed period (2000 to 2003). Thematic maps were constructed for each quadrennium using intervals of equal classes.

RESULTS

Cancer caused 31,097 deaths in the state of Mato Grosso in the period, 13,058 in women and 18,039 in men, with a male to female ratio of 1.38. The top five causes of cancer death in the period were lung (12.2%), prostate (8.7%), stomach (7.7%), breast (6.0%), and liver (4.7%). There was an increase in the number of municipalities with rates greater than 23.67 deaths per 100,000 inhabitants in the period.

CONCLUSION

There was an increase in cancer mortality and an increase in the proportion of municipalities with higher mortality rates. Higher density of cancer mortality occurred in the municipalities located in the West, Center-South, Southeast, and Center-North regions of the state.

Incidence and mortality by larynx cancer in Central and South America

OBJECTIVE

To describe how the incidence and mortality trends for laryngeal cancer in South and Central American countries.

METHODS

Time series study, with incidence data from the International Agency for Research on Cancer, from 1990 to 2012 and mortality data from 17 countries of the World Health Organization, from 1995 to 2013. The trend was analyzed by Joinpoint regression.

RESULTS

The highest incidence rate for laryngeal cancer was in Brazil, with 5.9 new cases per 100,000 men, and the highest mortality rate in Uruguay with 4.2 deaths per 100,000 men. The incidence ratio between genders ranged from 4: 1 (Colombia) to 12: 1 (Ecuador). The mortality ratio between the sexes ranged from 4: 1 (Peru) to 14: 1 (Uruguay).

CONCLUSION

Most countries had low incidence rates and reduced mortality in Latin America.

Features of third generation photosensitizers used in anticancer photodynamic therapy: Review

Cancer remains a main public health issue and the second cause of mortality worldwide. Photodynamic therapy is a clinically approved therapeutic option. Effective photodynamic therapy induces cancer damage and death through a multifactorial manner including reactive oxygen species-mediated damage and killing, vasculature damage, and immune defense activation. Anticancer efficiency depends on the improvement of photosensitizers drugs used in photodynamic therapy, their selectivity, enhanced photoproduction of reactive species, absorption at near-infrared spectrum, and drug-delivery strategies. Both experimental and clinical studies using first- and second-generation photosensitizers had pointed out the need for developing improved photosensitizers for photodynamic applications and achieving better therapeutic outcomes. Bioconjugation and encapsulation with targeting moieties appear as a main strategies for the development of photosensitizers from their precursors. Factors influencing cellular biodistribution and uptake are briefly discussed, as well as their roles as cancer diagnostic and therapeutic (theranostics) agents. The two-photon photodynamic approach using third-generation photosensitizers is present as an attempt in treating deeper tumors. Although significant advances had been made over the last decade, the development of next-generation photosensitizers is still mainly in the developmental stage.

Obesity as a Possible Risk Factor for Progression from Monoclonal Gammopathy of Undetermined Significance Progression into Multiple Myeloma: Could Myeloma Be Prevented with Metformin Treatment?

Obesity is increasingly associated with the transformation of monoclonal gammopathy of undetermined significance (MGUS) into multiple myeloma (MM). Obesity, MGUS, and MM share common etiopathogenesis mechanisms including altered insulin axis and the action of inflammatory cytokines. Consistent with this interconnection, metformin could predominantly exert inhibition of these pathophysiological factors and thus be an attractive therapeutic option for MGUS. Despite the possible clinical significance, only a limited number of epidemiological studies have focused on obesity as a risk factor for MGUS and MM. This review describes multiple biological pathways modulated by metformin at the cellular level and their possible impacts on the biology of MGUS and its progression into MM.

Leukemia mortality in children from Latin America: trends and predictions to 2030

Background

Reports suggest that Latin American and Caribbean (LAC) countries have not reduced leukemia mortality compared to high-income countries. However, updated trends remain largely unknown in the region. Given that leukemia is the leading cause of cancer-related death in LAC children, we evaluated mortality trends in children (0-14y) from 15 LAC countries for the period 2000–2017 and predicted mortality to 2030.

Methods

We retrieved cancer mortality data using the World Health Organization Mortality Database. Mortality rates (standardized to the world standard SEGI population) were analyzed for 15 LAC countries. We evaluated the average mortality rates for the last 5 years (2013–2017). Joinpoint regression analysis was used to evaluate leukemia mortality trends and provide an estimated annual percent change (EAPC). Nordpred was utilized for the calculation of predictions until 2030.

Results

Between 2013 and 2017, the highest mortality rates were reported in Venezuela, Ecuador, Nicaragua, Mexico, and Peru. Upward mortality trends were reported in Nicaragua (EAPC by 2.9% in boys, and EAPC by 2.0% in girls), and Peru (EAPC by 1.4% in both sexes). Puerto Rico experienced large declines in mortality among both boys (EAPC by − 9.7%), and girls (EAPC by − 6.0%). Leukemia mortality will increase in Argentina, Ecuador, Guatemala, Panama, Peru, and Uruguay by 2030.

Conclusion

Leukemia mortality is predicted to increase in some LAC countries by 2030. Interventions to prevent this outcome should be tailor to reduce the socioeconomic inequalities and ensure universal healthcare coverage.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12887-020-02408-y.

Ecotoxicological assessment of chemotherapeutic agents using toxicity tests with embryos of Mellita quinquiesperforata

The consumption of anticancer agents has increased in the recent decades, and these substances may be present in sewage. Consequently, they may reach the environment when sanitation infrastructure is ineffective. This study evaluated the toxicity of three anticancer agents-Tamoxifen (TAM), Cisplatin (CisPt), and Cyclophosphamide (CP)-on the development of embryos of the sand-dollar Mellita quinquiesperforata. Adult individuals were collected in sandy beaches, and gametes were obtained. Freshly-fertilized eggs were exposed to increasing sets of concentrations of each compound, and the effective concentrations needed to cause a 50% effect in the organisms (EC50) were calculated. The three compounds were toxic, and their EC50 values were 16.78 ± 2.42 ng·L^-1 (TAM), 27.20 ± 38.26 ng·L^-1 (CisPt), and 101.82 ± 70.96 ng·L^-1 (CP). There is no information on the environmental levels of these compounds in Brazil, but as they were already detected in ng·L^-1 levels worldwide, it can be expected that these substances pose environmental risks to the marine biota.

Depression, anxiety and spirituality in oncology patients

OBJECTIVE To relate anxiety and depression levels to the spirituality levels of oncology patients in the ABC region. METHODS Cross-sectional study performed at the ABC University Center oncology outpatient clinics. For the evaluation of spirituality, the Religiosity, Spirituality, and Personal Beliefs instrument of the World Health Organization (SRPB-WHO) was applied. To evaluate the levels of depression and anxiety, the Hospital Anxiety and Depression Scale (HADS) was applied. Qualitative variables were described by frequency and percentage, and quantitative variables by mean and standard deviation or median and range. Relationships were established using either the T-test or Wilcoxon-Mann-Whitney test and correlations with Pearson or Spearman tests, depending on the normality assessed by the Shapiro-Wilk test. RESULTS We included 99 patients, 68% female, with a median age of 60 years (19 to 81). A total of 24% had high or borderline levels of anxiety and 21% of depression. There was a negative correlation between levels of depression and spirituality (rho = -0.44, p <0.001), and anxiety and spirituality (rho=-0.232, p=0.02). We found no significant difference between levels of anxiety, depression, or spirituality when stratified by schooling, income, ethnicity, or marital status. There was a positive correlation between levels of anxiety and depression (cor = 0.477, p <0.001). CONCLUSION Spirituality can be a complementary tool in the treatment of patients with cancer.

Perception of risk factors for cancer in the ABC population

OBJECTIVE To evaluate the knowledge about risk factors for cancer in patients treated at the ABC Medical School (FMABC). METHODS Cross-sectional observational study conducted in 2019. The American Cancer Institute's Cancer Risk Awareness Survey questionnaire was used with 29 cancer risk factors, 14 of which were proven to cause cancer and 15 without consensus or scientific evidence of causality with cancer but that are often reminded by most of the population. Qualitative variables were described by frequency and percentage, and quantitative variables by mean and standard deviation or median and range depending on normality, assessed by the Shapiro-Wilk test. The study was conducted in accordance with the Helsinki Declaration for Research and approved by the Research Ethics Committee. RESULTS 191 patients were included. Median age 54 (20 to 90), 64% female. 35.6% reported current or previous smoking. 3.1% consumed alcohol more than 5 drinks/week. 56% reported sedentary lifestyle. 44% had at least 1 case of cancer in relatives up to 2nd degree. The average of correct answers in the analyzed population was 12.83 ± 3.06. A weak positive correlation was observed between income and number of cases (rho = 0.177, p = 0.02). No relationship was observed between the number of correct answers and level of education, age, sex, marital status, race or patients with a positive family history for cancer. CONCLUSION The knowledge about risk factors for cancer in the ABC population is low, which may contribute to the adoption of risk behaviors for the disease.

Describing mortality trends for major cancer sites in 133 intermediate regions of Brazil and an ecological study of its causes

BACKGROUND

In Brazil, 211 thousand (16.14%) of all death certificates in 2016 identified cancer as the underlying cause of death, and it is expected that around 320 thousand will receive a cancer diagnosis in 2019. We aimed to describe trends of cancer mortality from 1996 to 2016, in 133 intermediate regions of Brazil, and to discuss macro-regional differences of trends by human development and healthcare provision.

METHODS

This ecological study assessed georeferenced official data on population and mortality, health spending, and healthcare provision from Brazilian governmental agencies. The regional office of the United Nations Development Program provided data on the Human Development Index in Brazil. Deaths by misclassified or unspecified causes (garbage codes) were redistributed proportionally to known causes. Age-standardized mortality rates used the world population as reference. Prais-Winsten autoregression allowed calculating trends for each region, sex and cancer type.

RESULTS

Trends were predominantly on the increase in the North and Northeast, whereas they were mainly decreasing or stationary in the South, Southeast, and Center-West. Also, the variation of trends within intermediate regions was more pronounced in the North and Northeast. Intermediate regions with higher human development, government health spending, and hospital beds had more favorable trends for all cancers and many specific cancer types.

CONCLUSIONS

Patterns of cancer trends in the country reflect differences in human development and the provision of health resources across the regions. Increasing trends of cancer mortality in low-income Brazilian regions can overburden their already fragile health infrastructure. Improving the healthcare provision and reducing socioeconomic disparities can prevent increasing trends of mortality by all cancers and specific cancer types in Brazilian more impoverished regions.

[Corrected cancer mortality rates for the elderly in the states of the Brazilian northeast]

Estimates of the true magnitude of mortality in the Brazilian northeast has been fraught with major obstacles due to underreporting and problems with the quality of information on the basic causes of death. The scope of this study was to evaluate the impact of the redistribution of deaths corrected by Active Search Research and Garbage codes on the mortality rates of the major types of cancer among the elderly in the northeastern states. The Ledermann method was used to reallocate the deaths. The number of deaths before and after the correction revealed a significant variation, especially the figures for breast cancer where the variation was 53.5%. With corrected data, the elderly aged 80 years or older had a prostate cancer death rate which was 18 times higher than those aged 60 to 64 years. Higher levels of prostate cancer deaths among men, and breast cancer among women, were observed in all of the northeastern states. Tracheal, bronchial, lung and stomach cancer resulted in different levels of distribution according to gender, with higher rates among men than among women. Correction of death data resulted in significant increases in the number of recorded deaths. The methodology adopted in this work was the simple application of feasible factual data by the information system managers.

Trends in regional cancer mortality in Taiwan 1992-2014

BACKGROUND

Although the cancer mortality rate in Taiwan has been declining in recent years, no study has yet reported any regional differences in cancer mortality rates in Taiwan. We hypothesized that regional cancer mortality rates in Taiwan, an ethnically homogeneous society, exhibited no significant variations.

METHODS

We investigated the trends in Taiwan regional cancer mortality between 1992 and 2014. We analyzed regional age-standardized cancer mortality rates for lung, liver, colon, stomach, oral, breast, and prostate cancers using the Taiwan Longitudinal Health Insurance Database and Demographic Database. Furthermore, we applied Joinpoint regression analysis to evaluate the trends across different regions.

RESULTS

There are clear regional variations in mortality rates for liver, stomach, and oral cancers, but not for lung, colon, breast, and prostate cancers. The regional death rates of oral cancer, especially for eastern Taiwan, not only elevate the fastest (APC = 14.78% per year, P < 0.001) but also show the largest disparities between men and women. Regional death rates for stomach cancer, which declined most rapidly, are converging in both general and gender groups. Liver cancer is the only one with regional variations whose trends do not all go in the same direction. We also demonstrated that northern Taiwan has significant regional advantages with respect to cancer mortality.

CONCLUSIONS

Some but not all cancers in Taiwan show regional disparities. Liver, stomach, and oral cancers in Taiwan exhibit clear regional variations in mortality rates. In particular, the regional variations in oral cancer mortality rates are consistent with those in alcohol consumption.

How to Optimize Health Messages About Cancer on Facebook: Mixed-Methods Study

BACKGROUND

Incidence rate of cancer is increasing worldwide, with longer life expectancy being one of the main causes. Yet, between 30% and 50% of cancer cases are preventable, and early detection contributes to a better prognosis. This makes health communication strategies essential. Facebook, the world's most used social networking site in 2017 and 2018, can be a useful tool for disseminating powerful messages on health promotion, prevention, and early detection.

OBJECTIVE

We aimed to (1) offer ways of optimizing health messages about cancer on Facebook, focusing on topics, such as risk factors, prevention, treatment, early diagnosis, and cure, and (2) investigate which aspects of these messages generate greater engagement.

METHODS

To verify what generates greater engagement in topics related to cancer on Facebook, we analyzed 16 Brazilian pages with the main theme of cancer. We performed a manual analysis of texts, content, and engagement rates. Finally, we developed a software program to operationalize the analysis of Facebook posts. The tool we devised aims to automate the analysis of any Facebook page with cancer as the main theme.

RESULTS

We analyzed 712 posts over a 1-month period. We divided the posts into the following 8 categories: "Testimonies or real-life stories," "Solidarity," "Anniversaries," "Science and health," "Events," "Institutional," "Risk factors," and "Beauty." The pages were also organized into groups according to the type of profile to which they belonged (ie, hospitals or foundations, informative, nongovernmental organizations, and personal pages).The results showed that the categories generating greater engagement in Brazil were not those with the highest percentage of cancer-related content. For instance, in the "Informative" group the "Testimonies or real-life stories" category generated an engagement of 79.5%. However, only 9.5% (25/261) of the content within the relevant time period dealt with such topics. Another example concerns the category "Science and health." Despite being the one with the highest number of posts (129/261, 49.4%), it scored 5th in terms of engagement. This investigation served as the basis for the development of a tool designed to automate the analysis of Facebook pages. The list of categories and keywords generated by this analysis was employed to feed the system, which was then able to categorize posts appearing on a Facebook page. We tested the system on 163 posts and only 34 were classified incorrectly, which amounts to a 20.8% error rate (79.2% accuracy).

CONCLUSIONS

The analysis we conducted by categorizing posts and calculating engagement rates shows that the potential of Facebook pages is often underutilized. This occurs because the categories that generate the greatest engagement are often not those most frequently used. The software developed in this research may help administrators of cancer-related pages analyze their posts more easily and increase public interest as a result.

Magnitude and variation of the burden of cancer mortality in Brazil and Federation Units, 1990 and 2015

Objective:

To analyze the mortality rates from malignant neoplasia in Brazil and Federal Units (FU) in the years 1990 and 2015, according to sex and main types of cancer.

Methods:

Using estimates of global disease burden for Brazil made by the GBD 2015 study, age-adjusted cancer mortality rates and respective 95% uncertainty intervals were calculated for Brazil and FU in 1990 and 2015, as well as their percentage variation in the period. The main causes of cancer mortality by sex were analyzed, considering the five highest rates in the country and for each state.

Results:

The cancer mortality rate for male and female population remained stable between the two years in the country. The same behavior pattern was observed in almost all the FU, and the majority of states in the northeast region and half of the north region showed a non-significant increase in mortality rates. Regarding the types of cancer, there was a drop in mortality rates for stomach cancers in both sexes (women: -38.9%, men: -37.3%), cervical cancer in women (-33.9%), and lung and esophagus cancer in men (-12.0% and -14.1%, respectively); in contrast, there was an increase in lung cancers in women (+20.7%) and colon and rectum cancers in men (+29.5%).

Conclusion:

Differences in the behavior of major cancers, with a decrease mainly in the more developed regions and an increase in the less developed regions of the country, seem to reflect the socioeconomic inequalities as well as difficulties in access to health services by the Brazilian population.

[Breast cancer mortality in Brazilian municipalities and associated factorsMortalidad por cáncer de mama en municipios brasileños y factores asociados]

Objetivo.

Analisar o comportamento da mortalidade por câncer de mama nos municípios brasileiros e avaliar a influência de fatores socioeconômicos e demográficos sobre as taxas e mortalidade.

Métodos.

Foram calculadas taxas de mortalidade, padronizadas por faixa etária e corrigidas por causas mal definidas, centradas em 1990, 2000 e 2010. Posteriormente, foram estimados modelos de regressão, com dados em painel, que permitiram verificar o grau de associação entre os fatores de interesse e a taxa de mortalidade pela doença.

Resultados.

Verificou-se uma tendência de crescimento da mortalidade no país. Contudo, os modelos indicaram que a mortalidade poderia ter diminuído (tendência negativa), principalmente no Sudeste e Sul, caso alguns fatores associados à doença (por exemplo, nível de renda, educação, longevidade, taxa de fecundidade, gastos em saúde, infraestrutura, entre outros) tivessem permanecido constantes durante o período considerado. Observou-se que a mortalidade por câncer de mama apresentou associação positiva/significativa com a longevidade e negativa/significativa com o nível de gastos públicos em saúde. A mortalidade foi maior nas regiões Sul e Sudeste, nos municípios com mais de 500 000 habitantes e naqueles onde a população é inferior a 5 000.

Conclusões.

O crescimento da renda per capita, a elevação da expectativa de vida e a diminuição da taxa de fecundidade podem estar associados a elevadas taxas de mortalidade por câncer de mama e a uma tendência de crescimento na mortalidade por esse câncer nos municípios brasileiros.

Burden of colorectal cancer in Central and South America

RATIONALE AND OBJECTIVE

The colorectal cancer (CRC) burden is increasing in Central and South American due to an ongoing transition towards higher levels of human development. We describe the burden of CRC in the region and review the current status of disease control.

METHODS

We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries, as well as cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change for 1997-2008.

RESULTS

The CRC rate in males was 1-2 times higher than that in females. In 2003-2007, the highest ASRs were seen in Uruguayan, Brazilian and Argentinean males (25.2-34.2) and Uruguayan and Brazilian females (21.5-24.7), while El Salvador had the lowest ASR in both sexes (males: 1.5, females: 1.3). ASMRs were<10 for both sexes, except in Uruguay, Cuba and Argentina (10.0-17.7 and 11.3-12.0). CRC incidence is increasing in Chilean males. Most countries have national screening guidelines. Uruguay and Argentina have implemented national screening programs.

CONCLUSION

Geographic variation in CRC and sex gaps may be explained by differences in the prevalence of obesity, physical inactivity, diet, smoking and alcohol consumption, early detection, and cancer registration practices. Establishing optimal CRC screening programs is challenging due to lack of healthcare access and coverage, funding, regional differences and inadequate infrastructure, and may not be feasible. Given the current status of CRC in the region, data generated by population-based cancer registries is crucial for cancer control planning.

Trends and predictions for gastric cancer mortality in Brazil

AIM: To analyze the effect of age-period and birth cohort on gastric cancer mortality, in Brazil and across its five geographic regions, by sex, in the population over 20 years of age, as well as make projections for the period 2010-2029.

METHODS: An ecological study is presented herein, which distributed gastric cancer-related deaths in Brazil and its geographic regions. The effects of age-period and birth cohort were calculated by the Poisson regression model and projections were made with the age-period-cohort model in the statistical program R.

RESULTS: Progressive reduction of mortality rates was observed in the 1980’s, and then higher and lower mortality rates were verified in the 2000’s, for both sexes, in Brazil and for the South, Southeast and Midwest regions. A progressive decrease in mortality rates was observed for the Northeast (both sexes) and North (men only) regions within the period 1995-1999, followed by rising rates.

CONCLUSION: Regional differences were demonstrated in the mortality rates for gastric cancer in Brazil, and the least developed regions of the country will present increases in projected mortality rates.

Genetic aberrations in multiple myeloma characterized by cIg-FISH: a Brazilian context

Genetic abnormalities are critical prognostic factors for patients diagnosed with multiple myeloma (MM). This retrospective, multicenter study aimed to contribute with the genetic and clinical characterization of MM patients in a country with continental dimensions such as Brazil. Genetic abnormalities were assessed by cIg-fluorescent in situ hybridization (cIg-FISH) in a series of 152 MM patients (median age 55 years, 58.5% men). Overall, genetic abnormalities were detected in 52.7% (80/152) of patients. A 14q32 rearrangement was detected in 33.5% (n=51), including t(11;14), t(4;14) and t(14;16) in 18.4, 14.1, and 1% of cases, respectively. del(13q) was identified in 42.7% (n=65) of patients, of whom 49.2% (32/65) presented a concomitant 14q32 rearrangement. del(17p) had a frequency of 5.2% (n=8). del(13q) was associated with high plasma cell burden (≥50%, P=0.02), and del(17p) with advanced ISS stages (P=0.05) and extramedullary disease (P=0.03). t(4;14) was associated with advanced Durie-Salmon stages (P=0.008), renal insufficiency (P=0.01) and was more common in patients over 60 years old. This study reports similar frequencies of genetic abnormalities to most series worldwide, whereas the t(14;16) and del(17p), two high risk factors for newly diagnosed patients, exhibited lower frequencies. Our results expand the knowledge on the molecular features of MM in Brazil, a country where innovative therapies that could overcome a poor prognosis for some genetic abnormalities are not always available.