Cancer Incidence Among Adolescents and Young Adults (15 to 29 Years) in Brazil

Pattern of cancers in adolescent and young adults.: A 15-year retrospective study at King Fahad Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia

OBJECTIVES

To evaluate the incidence and pattern of cancer in adolescents and young adults (AYAs) age group in Al-Madinah Al-Munawwarah region of Saudi Arabia.

METHODS

This retrospective histopathology-based study was conducted at a tertiary care center in Al-Madinah Al-Munawwarah, Saudi Arabia and comprised cases of cancers for 15 years between January 2006 and December 2020.

RESULTS

During the last 15-year period, 8,769 cases of cancers were diagnosed out of which 475 (5.4%) cases were registered in AYAs. Of these cases, 232 (48.8%) were males while 243 (51.2%) were females, with a male-to-female ratio of 0.9:1. The 3 most common cancer groups in the entire cohort were carcinomas (n=165; 34.7%), lymphomas (n=135; 28.4%), and leukemias (n=91; 19.2%). The most common sites in carcinomas were thyroid (n=60; 12.6%), breast (n=35; 7.4%), and gastrointestinal (n=18; 3.8%). The leading cancers in males were the lymphomas (n=74; 15.6%), leukemias (n=57; 12%), bone (n=21; 4.4%), and central nervous system (n=20; 4.2%), while in females, the most common cancers were the lymphomas (n=61; 12.8%), thyroid (n=40; 8.4%), breast (n=34; 7.2%), and leukemias (n=34; 7.2%).

CONCLUSION

Our findings are in concordance with studies in national and international literature and we believe that our study provides a baseline tool for future population-targeted studies.

Cancer incidence and mortality trends in young adults in Metropolitan Lima young adults, 1990-2012

Aims

The purpose of this research was to calculate and compare standardised incidence and mortality ratios in young adults, based on the data published by the population-based cancer registry of Metropolitan Lima.

Method

A secondary analysis was carried out on the data published by the population-based cancer registry of Metropolitan Lima in its last five volumes. Calculating the standardised incidence ratio, in accordance with the World Health Organization’s standard population, was done using the direct method, and the annual percentage change was calculated using the Joinpoint Regression Program.

Results

From 1990 to 2012, 12,380 new cases of cancer in young adults between the ages of 20 and 49 were reported in Metropolitan Lima. The neoplasms with the highest standardised incidence ratio in the young adult male group were testicular cancer, brain and nervous system cancer, stomach cancer, non-Hodgkin’s lymphoma and bowel cancer. The neoplasms with the highest standardised mortality ratio for this group were stomach cancer, brain and nervous system cancer, non-Hodgkin’s lymphoma, tracheal cancer, bronchial and lung cancer and liver cancer. The neoplasms with the highest standardised incidence ratio in the young adult female group were breast cancer, cervical cancer, thyroid cancer, ovarian cancer and brain and nervous system cancer. The neoplasms with the highest standardised mortality ratio for this group were breast cancer, cervical cancer, stomach cancer, brain and nervous system cancer and non-Hodgkin’s lymphoma.

Conclusions

Young adults represent a highly unique group, characterised by little diagnostic suspicion, distribution and aggressiveness of the neoplasms that occur in them. Assessing and reporting incidence and mortality ratios in this age group can contribute to decision making.

Delays in the health care system for children, adolescents, and young adults with bone tumors in Brazil

OBJECTIVE

To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0-29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries.

METHODS

Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days.

RESULTS

There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay.

CONCLUSION

Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals.

Incidence and mortality of bone cancer among children, adolescents and young adults of Brazil

OBJECTIVES

Bone cancers occur frequently in children, adolescents, and young adults aging 15 to 29 years. Osteosarcoma and Ewing sarcoma are the most frequent subtypes in this population. The aim of this study was to describe incidence and mortality trends of bone cancers among Brazilian children, adolescents and young adults.

METHODS

Incidence information was obtained from 23 population-based cancer registries. Mortality data were extracted from the Atlas of Cancer Mortality from 1979 to 2013. Specific and adjusted rates per million were analyzed according to gender, morphology and age at diagnosis. Median rates were used as a measure of central tendency. Joinpoint regression was applied to analyze trends.

RESULTS

Median incidence rates were 5.74 and 11.25 cases per million in children and young adults respectively. Osteosarcoma in the 15-19 years aged group had the highest incidence rates. Stable incidence rates were observed among five registries in 0-14 year's age group. Four registries had a decreased incidence trend among adolescents and young adults. Median mortality rates were 1.22 and 5.07 deaths per million in children and young adults respectively. Increased mortality was observed on the North and Northeast regions. Decreased mortality trends were seen in the South (children) and Southeast (adolescents and young adults).

CONCLUSION

Osteosarcoma and Ewing Sarcoma are the most incident bone cancers in all Brazilian regions. Bone cancers showed incidence and mortality patterns variation within the geographic regions and across age groups, although not significant. Despite limitations, it is crucial to monitor cancer epidemiology trends across geographic Brazilian regions.

Rare cancers in childhood and adolescence in Brazil: First report of data from 19 population-based cancer registries

BACKGROUND

Rare childhood cancer is challenging to define. The Italian Pediatric Rare Tumor (TREP) Study considers rare tumors to include solid malignancies characterized by an annual incidence rate of <2 cases per 1 million and not enrolled in clinical trials. The objective of the current study was to analyze the population incidence rate of rare tumors among children and adolescents (those aged birth-19 years) in Brazil.

METHODS

Incidence data were obtained from 19 population-based cancer registries covering the 5 geographic regions in Brazil. Newly diagnosed cases were selected according to the TREP definition, using the International Classification of Diseases for Oncology. To calculate the crude incidence rate, the numbers of incident children and adolescents with a specific rare cancer were divided by the corresponding person-years lived for the population aged <20 years during the same period.

RESULTS

Two tumors had an incidence rate that was >2 cases per 1 million (thyroid and skin cancers) in adolescents only. Several tumors demonstrated variations in incidence across the Brazilian regions. Adrenocortical carcinoma had a high incidence rate (4 cases per 1 million) in the south region among children aged <10 years. Thyroid and skin carcinoma had higher incidence rates in the midwest, southeast, and south regions.

CONCLUSIONS

Due to the extraordinary rarity of these events, networking is important for improving basic research, clinical studies, and trials. Centralization of diagnosis is the only way to improve the diagnosis and treatment of children affected by these rare diseases. The registration and surveillance of rare pediatric cancers are crucial from a public health point of view, and therefore the quality of registration has to be improved.

Who cares for adolescents and young adults with cancer in Brazil?

OBJECTIVE

Approximately 6% of all cancers arise in adolescents and young adults. Currently, the ward type best placed to treat this patient group remains controversial. The aim of this study was to evaluate exactly where adolescents and young adults with cancer are treated in Brazil.

METHODS

Data were extracted from 271 Brazilian hospital-based cancer registries (2007-2011), including all five national regions (North, Northeast, Midwest, South, and Southeast). Variables included gender, age, ethnicity, National Code of Health Establishment, hospital unit state, and region. Tumors were classified according to the World Health Organization classification for adolescents and young adults with cancer. Odds ratios with 95% confidence intervals were computed by unconditional logistic regression.

RESULTS

Most patients were managed on medical oncology wards, followed by pediatric oncology and then by non-specialist wards. Of patients aged 15-19 years, 49% were managed on pediatric wards; most of the older patients (96%; aged 20-24) were managed on adult wards. Patients were more likely to be seen in medical oncology wards as their age increased (OR=2.03 [1.98-2.09]), or if they were based in the South (OR=1.50 [1.29-1.73]). Conversely, bone tumors were less likely to be treated (decreased OR) on medical oncology wards, regardless of age, gender, and region.

CONCLUSION

An elevated risk of treatment on medical oncology wards was observed for older patients and those treated in the South. Bone tumors were generally treated in pediatric oncology wards, while skin cancers were treated in medical oncology wards, regardless of age, gender, and region.

Cancer Incidence in Adolescents and Young Adults in 24 Selected Populations of Latin America

OBJECTIVE

Describe incidence rates for the most common cancers in Latin American adolescents and young adults (AYA).

METHODS

Incidence data were extracted from the Cancer Incidence in Five Continents series, available online (IARC). Age-standardized incidence rates and trend analysis were calculated. Trends were calculated by joinpoint regression analysis to obtain average annual percentage change values.

RESULTS

There were 22,990 invasive incident cancer cases in AYA between 1998 and 2007, obtained from 24 population-based cancer registries. The most common cancer in males was gonadal germ cell tumor, with incidence rates ranging from 1.7 to 7.0/100,000; in females the most common cancer was thyroid cancer, with rates ranging from 0.9 to 10.0/100,000. Incidence trends were limited to four regional populations and increased for all malignancies, in males from 1.8% to 3.4% and in females from 0.9% to 1.8%.

CONCLUSIONS

Cancer incidence rates in Latin American AYA are low. There are few PBCRs with long-term data, and therefore, the results herein presented are a partial view of cancer in Latin American AYA populations.

Oral Mucositis in Pediatric Patients in Treatment for Acute Lymphoblastic Leukemia

Oral mucositis in oncologic patients is the most undesirable event of the chemotherapeutic treatment. This study aimed to identify damage to the oral cavity resulting from chemotherapy in pediatric patients with acute lymphoblastic leukemia (ALL). This is a prospective study with a sample of 42 children and adolescents evaluated for 10 consecutive weeks after diagnosis. The modified Oral Assessment Guide (OAG) was used, and data were analyzed by Spearman’s rank correlation coefficient (α = 5%). Changes to the normal lips and saliva were positively related to an increase in the OAG score during all 10 weeks of evaluation. Alterations to the labial mucosa were correlated with an increase in the OAG score from the 2nd to 10th week, which was also found for changes in the tongue and in the swallowing function in Weeks 1, 6, 8, 9, and 10 and for gum changes from the 5th to 7th week. No significant vocal changes were correlated with the total OAG score at any point during the monitoring period. Changes in lips, cheek and/or palatal mucosa, labial mucosa, and gum areas and in swallowing function were positively correlated with an increase in the severity of oral mucositis in patients with ALL after beginning chemotherapeutic treatment.

Incidence Trends of Cervical Cancer in Adolescents and Young Adults: Brazilian Population Based Data

PURPOSE

High incidence rates for cervical cancer in adolescents and young adults (AYAs: 15-29 years) make this the most common carcinoma in Brazil. Our aim was to analyze the incidence trends for cervical cancer (CC) and in situ neoplasia (IsN) among this age group.

METHODS

Incidence data were extracted from 21 Brazilian population-based cancer registries (PBCRs). Tumors with behavior code/3 (malignant) were classified as CC. Tumors with behavior code/2 were classified as IsN. Age-adjusted and age-specific incidence rates were calculated for individuals aged 15-19 years, 20-24 years, and 25-29 years. Incidence trends were evaluated by joinpoint regression analyses.

RESULTS

The median incidence rate of CC for AYA in Brazil was 3.63 per 100,000, with the highest rate observed in Recife (27.50 per 100,000). Significant increase in incidence for CC was identified in two PBCRs, with decreased rates for three PBCRs. The median incidence rate of IsN was 16.78 per 100,000 and was highest in Roraima (93.37 per 100,000). Increased incidence rates for IsN were identified in six PBCRs, with significant decreases in two PBCRs.

CONCLUSION

The incidence rate for CC among AYA in Brazil is high and warrants intervention in terms of both prevention and control.

Epidemiological Profile and Treatment Outcomes in Young Adults (19-29 Years of Age) Treated for Cancer in a Tertiary Hospital in São Paulo, Brazil

BACKGROUND

Worldwide, the incidence of cancer in young adults (20-39 years) is increasing, and represents an important cause of mortality in this age group. A retrospective study was undertaken to provide information that may lead to improved treatment outcomes.

METHODS

Epidemiological, clinicopathological, treatment, and survival information were retrieved from the electronic database registry of a tertiary referral hospital in São Paulo, Brazil for patients 19-29 years of age diagnosed with cancer between January 2007 and December 2012.

RESULTS

There were 960 patients with a median age at diagnosis of 26 years; female patients comprised 59.2%. A previous diagnosis of malignancy was present in 2.3%; 0.4% had malignant tumors that were radiation-associated; regular alcohol use was present in 10.4%; 9% of patients reported tobacco use; a family history of cancer was present in 41.7%. Malignant tumors included carcinomas (45.7%), germ cell and trophoblastic neoplasms (12.3%), and lymphomas (12.1%). Median follow-up was 47.7 months (range: 0.62-100.9 months) during which time 111 patients (13.5%) died. Carcinomas (n = 43, 38.7%), soft tissue sarcomas (n = 18, 16.2%), and leukemias (n = 10, 9.0%) were the most common causes of death.

CONCLUSIONS

This study has shown that carcinomas represent the most common malignancy in adolescents and young adults referred to a tertiary cancer center in Brazil and are the most common cause of mortality. Because clinical outcome may be affected by multiple factors in this patient population, further global studies are needed to characterize this population and improve clinical care.

Trends in Cancer Mortality Among Adolescents and Young Adults in Brazil

PURPOSE

Adolescents and young adults (AYA) with cancer comprise an intermediate age group between pediatric and adult oncology, and have a spectrum of different types of cancers. Survival among this group has not improved as much as in younger children with cancer. The aim of this study was evaluate the trends in cancer mortality of AYA aged 15-29 years in Brazil.

METHODS

Data were extracted from the Atlas of Cancer Mortality databases from 1979 to 2013. Age-specific mortality rates were calculated based on the deaths from each type of cancer and the period via a direct method using the proposed world population age groups. To identify significant changes in the trends, we performed joinpoint regression analysis.

RESULTS

The mortality rates per million were 54 deaths in those aged 15-19 years, 61 deaths in those aged 20-24 years, and 88 deaths in those aged 25-29 years. Leukemias, lymphomas, and central nervous system (CNS) tumors occurred at high rates in all age groups. Rates of cervical cancer were highest in those aged 25-29 years. There were significant increases in mortality trends in the North and Northeast regions for all tumor groups, especially CNS tumors. A small decrease in the mortality rate from lymphomas was observed in the South and Southeast regions.

CONCLUSION

Mortality in Brazilian AYA was slightly higher than in other studies conducted throughout the world. When separated by tumor type, Brazil presents a specific pattern, with high mortality from cervical cancer.