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S S, Mathew A, K M JK, P RN, Sankar A, T R V, George PS. Assessment of spatial variation in lung cancer incidence and air pollutants: spatial regression modeling approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2024:1-15. [PMID: 38851885 DOI: 10.1080/09603123.2024.2362844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Accepted: 05/27/2024] [Indexed: 06/10/2024]
Abstract
A notable finding is that Kerala's capital Thiruvananthapuram has shown an increasing trend in lung cancer (LC) incidence. Long-term exposure to air pollution is a significant environmental risk factor for LC. This study investigated the spatial association between LC and exposure to air pollutants in Thiruvananthapuram, using Spatial Lag Model (SLM), Spatial Error Model (SEM), and Geographically Weighted Regression (GWR). The results showed that overall LC incidence rate was 111 per 105 males (age >60 years), whereas spatial distribution map revealed that 48% of the area had an incidence rate greater than 150. The results revealed a significant association between PM2.5 and LC. SLM was identified as the best model that predicted 62% variation in LC. GWR model improved model performance and made better local predictions in the southeastern parts of the study area. This study explores the effectiveness of spatial regression techniques for dealing spatial effects and pinpointing high-risk areas.
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Affiliation(s)
- Sruthi S
- Division of Cancer Epidemiology & Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Aleyamma Mathew
- Division of Cancer Epidemiology & Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Jagathnath Krishna K M
- Division of Cancer Epidemiology & Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Remya Nath P
- Division of Cancer Epidemiology & Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Arun Sankar
- Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
| | - Vinod T R
- Geoinformatics Division, Centre for Environment and Development, Thiruvananthapuram, Kerala, India
| | - Preethi Sara George
- Division of Cancer Epidemiology & Biostatistics, Regional Cancer Centre, Thiruvananthapuram, Kerala, India
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Su J, Liang Y, He X. Global, regional, and national burden and trends analysis of gallbladder and biliary tract cancer from 1990 to 2019 and predictions to 2030: a systematic analysis for the Global Burden of Disease Study 2019. Front Med (Lausanne) 2024; 11:1384314. [PMID: 38638933 PMCID: PMC11024434 DOI: 10.3389/fmed.2024.1384314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024] Open
Abstract
Objectives Our aim was to explore the disease burden caused by gallbladder and biliary tract cancer globally, regionally, and nationally, by age and sex. Methods The absolute number of cases and age-standardized rates (ASR) of incidence, prevalence, mortality, and disability-adjusted life years (DALYs) due to gallbladder and biliary tract cancer were extracted from the Global Burden of Disease (GBD) Study 2019. We estimated the trends in disease burden by calculating the percentage change in the absolute number of cases and the estimated annual percentage change (EAPC) in ASR, by social development index (SDI), region, nation, sex, and age. Results From 1990 to 2019, the number of incident cases, prevalent cases, deaths, and DALYs worldwide significantly increased by 1.85-fold, 1.92-fold, 1.82-fold, and 1.68-fold, respectively. However, the age-standardized rates of incidence, prevalence, mortality, and DALYs tend to decrease globally over time. Nevertheless, heterogeneous disease burden patterns exist between geographic regions due to different geographical risk factors, distinct epidemiologically predominant gallbladder and biliary tract cancer subtypes, and potential genetic predispositions or ethnicity. Additionally, socioeconomic status mediates the regional variation in disease burden, with increasing SDI or HDI scores associated with downward trends in the age-standardized rates of incidence, prevalence, mortality, and DALYs. Older individuals and females are at higher risk of gallbladder and biliary tract cancer, but the increasing burden of early-onset gallbladder and biliary tract cancer is a cause for concern, especially for those living in lower SDI areas and males. High BMI is the primary risk factors underlying gallbladder and biliary tract cancer, accounted for 15.2% of deaths and 15.7% DALYs globally in 2019. Conclusion Our study comprehensively elucidated the distribution and dynamic trends of gallbladder and biliary tract cancer burden over the past three decades, from multiple dimensions. These findings emphasize the importance of promoting a healthy lifestyle as a population-level cancer prevention strategy and tailoring cancer control actions based on localized risk factors and the epidemic profiles of gallbladder and biliary tract cancer by anatomical subtype.
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Affiliation(s)
- Jiao Su
- Department of Biochemistry, Changzhi Medical College, Changzhi, China
| | - Yuanhao Liang
- Clinical Experimental Center, Jiangmen Key Laboratory of Clinical Biobanks and Translational Research, Jiangmen Central Hospital, Jiangmen, China
| | - Xiaofeng He
- Institute of Evidence-Based Medicine, Heping Hospital Affiliated to Changzhi Medical College, Changzhi, China
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Wassie LA, Mekonnen CK, Tiruneh YM, Melkam M, Belachew EA, Zegeye AF. Advanced-stage presentation of cancer at the time of diagnosis and its associated factors among adult cancer patients at Northwest Amhara comprehensive specialized hospitals, Northwest Ethiopia 2022. BMC Cancer 2024; 24:68. [PMID: 38216966 PMCID: PMC10785453 DOI: 10.1186/s12885-024-11835-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Accepted: 01/03/2024] [Indexed: 01/14/2024] Open
Abstract
INTRODUCTION Screening of cancer is the maximum effort and critical element for providing health related care in order to decrease cancer related dealt because of the disease burden is in its advanced stages. Unfortunately, advanced-stage presentation and late diagnosis of cancers endure a problem in low-income countries including Ethiopia. However, there is scarcity of published articles about the problem in Ethiopia. OBJECTIVE This study aimed to assess the prevalence of advanced-stage -stage presentation of cancer at the time of diagnosis and associated factors among adult cancer patients at Northwest Amhara comprehensive Specialized Hospitals, oncology treatment units, Northwest Ethiopia, 2022. METHODS An institution based cross-sectional study was conducted in Northwest Amhara public referral hospitals on 422 study participants. A systematic random sampling technique was performed. The data were collected through face to face interview and document review via structured, pretested questionnaires. Epi. Data version 4.6 and Stata version 14.0 software's were used for data entry and analysis respectively. Logistic regression were carried out to recognize factors associated with advanced-stage -stage presentation of cancer at the time of diagnosis. Adjusted odds ratio with a 95% confidence interval were used to measure the strength of association. Variables having p-value less than 0.2 in bivariable analysis were entered in to multivariable analysis; variables with a p-value < 0.05 were declared significantly associated with advanced-stage -stage presentation of cancer at the time of diagnosis. RESULTS The overall prevalence of advanced-stage presentation of cancer at the time of diagnosis was found to be 67.57%. Age ≥ 60 years old patients (AOR = 6.10, 95%: (1.16-32.1)), patients had have a feeling of burden (AOR = 1.82, 95%, CI: (1.04-3.20)), and cancer patients with comorbidity illness (AOR = 2.40, 95%, CI: (1.40-4.12)) were significantly associated with advanced-stage presentation of cancer at the time of diagnosis. CONCLUSION The prevalence of advanced-stage presentation of cancer at the time of diagnosis was found to be high. Its better, health care providers in oncology treatment facilities need to give special attention to older patients, having feeling of burden and cancer patient with comorbidity to reduce the risk of developing late stage presentation of cancer.
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Affiliation(s)
- Likinaw Abebaw Wassie
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia.
| | - Chilot Kassa Mekonnen
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Yenework Mulu Tiruneh
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Mamaru Melkam
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Eyayaw Ashete Belachew
- Department of clinical pharmacology of pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Alebachew Ferede Zegeye
- Department of Medical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Sokale IO, Oluyomi AO, Montealegre JR, Thrift AP. Racial/Ethnic Disparities in Cervical Cancer Stage at Diagnosis: Mediating Effects of Neighborhood-level Socioeconomic Deprivation. Cancer Epidemiol Biomarkers Prev 2023; 32:818-824. [PMID: 37067295 PMCID: PMC10233349 DOI: 10.1158/1055-9965.epi-23-0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 03/10/2023] [Accepted: 03/30/2023] [Indexed: 04/18/2023] Open
Abstract
BACKGROUND Mortality from cervical cancer has declined steadily in the United States over the past several decades due to widespread screening for precancerous and early-stage cervical cancer (ECC), which are significantly easier to treat compared with late-stage cervical cancer (LCC). Unequal screening access continues to cause significant racial/ethnic disparities in cervical cancer diagnosis stage. This study examined the underlying role of neighborhood-level socioeconomic disadvantage as a potential mediator of the association between race/ethnicity and cervical cancer diagnosis stage. METHODS We analyzed Texas Cancer Registry data for cervical cancer cases diagnosed among women ages 18 or older from 2010 to 2018. We performed causal mediation analyses of the association between race/ethnicity and cervical cancer stage at diagnosis mediated by neighborhood-level socioeconomic disadvantage. RESULTS Of the 9,192 women with cervical cancer, 4,720 (51.3%) had LCC at diagnosis. Compared with non-Hispanic white (NHW) women (106.13, standard deviation (SD) = 13.32), non-Hispanic Black (NHB; 111.46, SD = 9.55) and Hispanic (112.32, SD = 9.42) women had higher area deprivation index (ADI) and had greater odds of LCC diagnosis [total effects: adjusted odds ratios (AOR) = 1.29 (95% CI, 1.11-1.46) and AOR 1.14 (95% CI, 1.03-1.25), respectively]. Approximately 34.7% and 71.6% of the disparity in LCC diagnosis were attributable to higher neighborhood socioeconomic disadvantage among NHB and Hispanic women, respectively. CONCLUSIONS LCC disparity varied by race/ethnicity and was partly attributable to neighborhood disadvantage. The disparity among Hispanic women due to neighborhood deprivation was twice as high among NHB women. IMPACT Findings may be used to develop targeted race- and place-specific interventions to improve cancer care equity.
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Affiliation(s)
- Itunu O. Sokale
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Abiodun O. Oluyomi
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
| | - Jane R. Montealegre
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Aaron P. Thrift
- Department of Medicine, Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, Texas
- Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, Texas
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Dantas TS, de Sousa ASA, Sales TOP, deOliveira Filho OV, de Barros Silva PG, Alves APNN, Mota MRL, Sousa FB. Outcomes of Oral and Oropharyngeal Squamous Cell Carcinoma Related to Healthcare Coverage: A Retrospective Cohort Study in Brazil. Cancer Invest 2022; 40:680-692. [PMID: 35731734 DOI: 10.1080/07357907.2022.2092634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
We investigated the differences in prognosis according to the type of healthcare coverage of patients with oral and oropharyngeal squamous cell carcinoma (OOSCC). This study included 875 medical records. Patients covered by the publicly funded Unified Health System (SUS) had a low educational level, with advanced T stage and delayed treatment initiation. Multivariate analyses revealed an association between T stage (p = .035) and poor prognosis in oral squamous cell carcinoma, and age (p = .029) in oropharyngeal squamous cell carcinoma. Surgical treatment (p = .036) and marital status (p = .015) were considered predictors of better prognosis in OOSCC. Exclusive SUS-dependency can be considered an indirect prognostic factor for OOSCC.
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Affiliation(s)
- Thinali Sousa Dantas
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
| | | | | | - Osias Vieira deOliveira Filho
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Paulo Goberlânio de Barros Silva
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
| | | | - Mário Rogério Lima Mota
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil
| | - Fabrício Bitu Sousa
- Division of Oral Pathology, Faculty of Pharmacy, Dentistry and Nursing, Federal University of Ceará, Fortaleza, Brazil.,Department of Dentistry, Unichristus, Fortaleza, Brazil
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de Lima KYN, Cancela MDC, de Souza DLB. Spatial assessment of advanced-stage diagnosis and lung cancer mortality in Brazil. PLoS One 2022; 17:e0265321. [PMID: 35303029 PMCID: PMC8932618 DOI: 10.1371/journal.pone.0265321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 02/28/2022] [Indexed: 01/21/2023] Open
Abstract
The high incidence and mortality rates make lung cancer a global public health issue. Socioeconomic conditions and the provision of health services may be associated with this reality. This study investigates the spatial distribution of advanced-stage diagnosis and mortality due to lung cancer and its association with the healthcare services supply and demographic and socioeconomic indicators in Brazil. This is an ecological study with 161 Intermediate Regions of Urban Articulation. Mortality data were extracted from the Mortality Information System, and the cases of lung cancer were obtained from the Integrator of Hospital-Based Cancer Registries from 2011 to 2015. Analyses employed Moran’s I, local indicators of spatial association, and the multivariable model. The proportion of advanced-stage diagnosis was 85.28% (95% CI 83.31–87.10) and was positively associated with the aging rate (Moran’s I 0.11; p = 0.02), per capita income (Moran’s I 0.05; p = 0.01) and negatively associated with Gini Index (Moran’s I -0.16; p = 0.01). The mean age-adjusted mortality rates was 12.82 deaths/100,000 inhabitants (SD 5.12). The age-adjusted mortality rates for lung cancer presented a positive and statistically significant spatial association with all demographic, socioeconomic and healthcare services supply indicators, except for the "density of family health teams" (Moran’s I -0.02 p = 0.28). The multivariable model for the mortality rates was constituted by the variables “Density of facilities licensed in oncology”, “Per capita income”, and “Health plan coverage”. The per capita income presented positive association and health plan coverage negative association with age-adjusted mortality rates. Both associations were statistically significant. The variable density of facilities licensed in oncology showed no significant association with age-adjusted mortality rates. There is a high proportion of advanced-stage diagnosis across the Brazilian territory and inequalities in lung cancer mortality, which are correlated with the most developed areas of the country.
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Affiliation(s)
- Kálya Yasmine Nunes de Lima
- Postgraduate Program in Collective Health, Federal University of Rio Grande do Norte–UFRN, Natal, Rio Grande do Norte, Brazil
| | - Marianna de Camargo Cancela
- Division of Population Research, Division of Population Research, National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Dyego Leandro Bezerra de Souza
- Department of Collective Health, Postgraduate Programme in Collective Health, Federal University of Rio Grande do Norte–UFRN, Natal, Rio Grande do Norte, Brazil
- Faculty of Health Science and Welfare, Research group on Methodology, Methods, Models and Outcomes of Health and Social Sciences(M3O), Centre for Health and Social Care Research (CESS), University of Vic-Central University of Catalonia (UVic-UCC), Vic, Spain
- * E-mail:
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Wijeratne DT, Gunasekera S, Booth CM, Promod H, Jalink M, Jayarajah U, Seneviratne S. Demographic, tumour, and treatment characteristics of female patients with breast cancer in Sri Lanka; results from a hospital-based cancer registry. BMC Cancer 2021; 21:1175. [PMID: 34732162 PMCID: PMC8567653 DOI: 10.1186/s12885-021-08929-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
Background Although breast cancer is the most common cancer among Sri Lankan women, there is little published data on patient characteristics and treatment in the local context. We aimed to describe disease characteristics and management in a large contemporary cohort of women with breast cancer at the National Cancer Institute of Sri Lanka (NCISL). Methods All women with invasive primary breast cancers diagnosed during 2016–2020 were identified from the NCISL breast cancer registry. The NCISL sees approximately 40% of all cancer patients in Sri Lanka. Cancer stage at diagnosis was defined according to the Tumour, Node, and Metastasis (TNM) staging system and the Estrogen (ER) and progesterone (PR) receptor status was determined based on the results of immunohistochemistry tests. Descriptive statistics were used to describe the study cohort and treatment patterns. Results Over 5100 patients were diagnosed with breast cancer during the study period at the NCISL. The mean age of the women was 56 (SD 12) years. Common co-morbidities were hypertension (n = 1566, 30%) and diabetes mellitus (n = 1196, 23%). Two thirds (66%) of the cancers were early stage (stage I & II) at diagnosis. ER/PR positivity rate was 72% and HER-2 positivity rate was 22%. Two thirds of the women had undergone mastectomy while 68% had undergone axillary clearance. The rate of chemotherapy delivery was 91% for women with node positive disease while 77% of eligible women (i.e., after wide local excision or with > 3 positive lymph nodes) had received adjuvant radiotherapy. Endocrine therapy was initiated in 88% of eligible women with hormone receptor positive disease while rate of trastuzumab use was 59% among women with HER2 positive breast cancer. Conclusions High percentage of advanced breast cancer at diagnosis and high prevalence of comorbidities are some of the major challenges faced in the management of breast cancer in Sri Lanka. Given that stage at diagnosis is the most important prognostic factor determining survival, greater efforts are needed to promote early diagnosis of breast cancer. Considerable lapses in the concordance between guideline recommendations and the delivery of cancer care warrants closer assessment and intervention.
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Affiliation(s)
| | | | - Christopher M Booth
- Department of Oncology, Queen's University, Kingston, Canada.,Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Hasitha Promod
- Health Information Unit, Ministry of Health, Colombo, Sri Lanka
| | - Matthew Jalink
- Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Umesh Jayarajah
- Department of Surgery, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka
| | - Sanjeewa Seneviratne
- Department of Surgery, Faculty of Medicine, University of Colombo, Kynsey Road, Colombo 08, Sri Lanka.
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Mathew A, George PS, Kunnambath R, Mathew BS, Kumar A, Syampramod R, Booth CM. Educational Status, Cancer Stage, and Survival in South India: A Population-Based Study. JCO Glob Oncol 2021; 6:1704-1711. [PMID: 33156718 PMCID: PMC7713566 DOI: 10.1200/go.20.00259] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
PURPOSE Lower socioeconomic status is associated with more advanced cancer at the time of cancer diagnosis. It is unknown whether this leads to inferior survival in low- and middle-income countries. Here, we explore the association between educational level and survival in South India. METHODS The Trivandrum Cancer Registry (3.3 million population) was used to identify all cases of breast and cervical cancer (women) and oral cavity (OC) and lung cancer (men) diagnosed during 2012-2014. Educational level was classified as illiterate/primary school, middle school, and secondary school and above. Survival was measured from date of diagnosis using the Kaplan-Meier method. Cox proportional hazards regression modeling was used to describe the associations among education, stage of cancer at diagnosis, and survival. RESULTS The study population included 3,640 patients with breast (n = 1,727), cervical (n = 425), OC (n = 702), and lung (n = 786) cancer. Educational level was 27%, 23%, and 32% for illiterate/primary, middle, and secondary school and above, respectively. The 5-year survival rate for breast cancer was 59%, 68%, and 73% (P = .001); for cervical cancer, 51%, 52%, and 60% (P = .146); and for OC cancer, 42%, 35%, and 48% (P = .012) for illiterate/primary, middle school, and secondary school and above, respectively. The survival gradient across social groups was substantially attenuated when stage was added to the multivariable model. There was no observed difference in survival across educational groups for lung cancer (2%, 4%, and 3%; P = .224). CONCLUSION Data from this population-based study in South India demonstrate that patients from a lower educational background have inferior survival and that this is at least partially explained by having more advanced disease at the time of diagnosis. Public health efforts are needed to facilitate timely diagnosis and reduce disparities in cancer outcomes.
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Affiliation(s)
- Aleyamma Mathew
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Preethi Sara George
- Department of Cancer Epidemiology, Queen's University, Kingston, Ontario, Canada
| | - Ramadas Kunnambath
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Beela Sarah Mathew
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Aswin Kumar
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Roshni Syampramod
- Department of Radiation Oncology, Queen's University, Kingston, Ontario, Canada
| | - Christopher M Booth
- Department, of Oncology, Queen's University, Kingston, Ontario, Canada.,Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Association of Life-Course Educational Attainment and Breast Cancer Grade in the MEND Study. Ann Glob Health 2021; 87:59. [PMID: 34277361 PMCID: PMC8269775 DOI: 10.5334/aogh.3142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Nigeria reports the highest age-standardized mortality rate for breast cancer (BC) among African countries and disproportionately high rates of high-grade cancer. Histological grade is a strong predictor of mortality, and evidence suggests that educational attainment influences cancer outcomes. Objective: We characterize the association between educational trends across the life-course and BC grade at diagnosis. Methods: Data on 224 BC patients enrolled in the Mechanisms for Established and Novel Risk Factors for Breast Cancer in Nigerian Women (MEND) study was analyzed. Participant and parental (mother and father) education was categorized as low (primary school or less) or high (secondary school or greater). Accordingly, the educational trend across the life-course was determined for each participant relative to each parent: stable high, increasing, decreasing, or stable low. BC grade was classified as high (grade 3) or low (grades 1–2). Findings: About 34% of participants, 71% of fathers, and 85% of mothers had low education. Approximately one-third of participants were diagnosed with high-grade BC. Participants with low-grade BC were more likely to have highly educated fathers (p = 0.04). After adjusting for age, comorbidities, marital status and mammogram screening, participants with highly educated fathers were 60% less likely to have high-grade BC (aOR 0.41; 95% CI 0.20 to 0.84) compared to those with less-educated fathers. Stable high life-course education relative to father was also associated with a significantly lower likelihood of having high-grade BC (aOR 0.36; 95% CI 0.15 to 0.87) compared to stable low life-course education. No significant associations were observed for the participant’s education, mother’s education, or life-course education relative to mother. Conclusions: Early-life socioeconomic status (SES) may influence BC grade. This deserves further study to inform policies that may be useful in reducing high-grade BC in Nigeria.
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Agodirin O, Aremu I, Rahman G, Olatoke S, Olaogun J, Akande H, Romanoff A. Determinants of Delayed Presentation and Advanced-Stage Diagnosis of Breast Cancer in Africa: A Systematic Review and Meta-Analysis. Asian Pac J Cancer Prev 2021; 22:1007-1017. [PMID: 33906291 PMCID: PMC8325140 DOI: 10.31557/apjcp.2021.22.4.1007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Indexed: 12/26/2022] Open
Abstract
Background/Objective: Breast cancer (BC) mortality is exceptionally high in Africa due to late presentation and advanced-stage diagnosis. Previous studies examining barriers to early BC presentation are markedly inconsistent, showing conflicting findings within and between African regions, making resource allocation and designing interventional campaigns challenging. Our objective was to assess the strength or magnitude of the association between determinants/risk factors and delayed presentation/advanced-stage diagnosis of BC in Africa. Methods: Electronic searches in PubMed, AJOL, Google, ResearchGate, ScienceDirect, and PubMed Central found eligible articles between 2000 and 2020. The meta-analytical procedure in Meta-XL used the quality effect model. I-squared (I2) above 75% indicated high heterogeneity. The summary effect size was the odds ratio with 95% confidence intervals. Results: The effect of socio-economic and demographic determinants on delay varies across African regions. Low level of education (1.63, 95% CI 1.01-2.63), and not performing breast self examination (BSE) (13.59, 95% CI 3.33-55.4) were significantly associated with delayed presentation. Younger patients had more significant delays in West Africa (WA, 1.41, 95%CI 1.08-1.85), and the reverse occurred in North Africa (0.68, 95%CI 0.48-0.97). Lack of BC knowledge (1.59, 95% CI 1.29-1.97), not performing BSE, or no history of undergoing clinical breast examination (CBE) (2.45, 95% CI 1.60-3.40), were associated with advanced-stage disease at diagnosis. Older patients had significantly more advanced disease in WA, and the reverse occurred in South Africa. Aggressive molecular BC subtypes [Triple negative (OR 1.62, 95% CI 1.27-2.06) or HER2 positive (1.56, 95% CI 1.10-2.23)] were significant determinants of advanced-stage diagnosis. Conclusion: Promoting early presentation and reducing advanced-stage BC throughout Africa should focus on modifiable factors, including providing quality education, improving breast health awareness and BC knowledge, and developing strategies to increase BSE and CBE. Interventions targeting socio-demographic determinants should be context-specific.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Isiaka Aremu
- Department of Surgery, University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Ganiyu Rahman
- Department of Surgery, University of Cape Coast and Cape Coast Teaching Hospital, Cape Coast. Ghana
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara State. Nigeria
| | - Julius Olaogun
- Department of Surgery, Ekiti State University, and Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti state. Nigeria
| | - Halimat Akande
- Department of Radiology, University of Ilorin and University of Ilorin Teaching Hospital, Ilorin, Kwara state. Nigeria
| | - Anya Romanoff
- Department of Global Health and Health System Design, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Global Cancer Disparities Initiatives, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Paiva EMDC, Moraes CMD, Brito TRPD, Lima DB, Fava SMCL, Nascimento MCD. Perfil dos atendimentos oncológicos de uma macrorregião de saúde brasileira. AVANCES EN ENFERMERÍA 2020. [DOI: 10.15446/av.enferm.v38n2.83297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objetivo: conhecer a configuração epidemiológica dos atendimentos oncológicos em uma macrorregião de saúde brasileira, localizada no estado de Minas Gerais, entre 2008 e 2017.Materiais e métodos: estudo quantitativo, exploratório, transversal e descritivo, realizado com dados secundários de cinco municípios localizados no estado de Minas Gerais.Resultados: houve 54.206 atendimentos a indivíduos com câncer, com predominância do sexo masculino (53,38 %), faixa etária de 60 a 79 anos (49,95 %), cor branca (79,08 %), ensino fundamental incompleto (48,36 %) e estado conjugal casado (57,34 %). As neoplasias de pele representam a mais frequente localização primária (22,35 %). O estadiamento I do tumor foi o mais observado (20,98 %). As razões mais predominantes para não tratar, depois da opção “não se aplica”, foram doença avançada, falta de condições clínicas ou outras (6,97 %), ao passo que se verificou predomínio de doença estável (31,59 %) no final do primeiro tratamento recebido.Conclusão: os resultados apresentados oferecem subsídios para identificar as prioridades da atenção oncológica e traçam a configuração dos atendimentos a pacientes com câncer, o que direciona o planejamento de intervenções para proporcionar um atendimento de qualidade.
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