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Sala A, Luppi CG, Wagner GA, Pinheiro Junior RVB, Carneiro Junior N. Performance of primary health care in São Paulo state, Brazil, during the period 2010-2019. CIENCIA & SAUDE COLETIVA 2024; 29:e04112023. [PMID: 38896671 DOI: 10.1590/1413-81232024296.04112023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Accepted: 08/08/2023] [Indexed: 06/21/2024] Open
Abstract
This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.
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Affiliation(s)
- Arnaldo Sala
- Secretaria de Estado da Saúde de São Paulo. Av. Doutor Arnaldo 351, 5º andar. 01246-901 São Paulo SP Brasil.
| | - Carla Gianna Luppi
- Departamento de Medicina Preventiva, Universidade Federal de São Paulo. São Paulo SP Brasil
| | | | | | - Nivaldo Carneiro Junior
- Departamento de Saúde Coletiva, Faculdade de Ciências Médicas da Santa Casa de São Paulo. São Paulo SP Brasil
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2
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Silva GRPD, Guimarães RA, Vieira FVM, Silva GO, Oliveira FDS, Aredes NDA. [Trend in breast cancer mortality rate among women aged 20 years or older in Brazil, 2005-2019]. CIENCIA & SAUDE COLETIVA 2024; 29:e01712023. [PMID: 38451636 DOI: 10.1590/1413-81232024293.01712023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 05/02/2023] [Indexed: 03/08/2024] Open
Abstract
The aim is to analyze the trend in breast cancer mortality rates and its correlation with the socioeconomic development status in Brazil. It involved an ecological time series study carried out in the 26 units of the federation, Federal District and regions of Brazil. Data sources included the Mortality Information System (number of deaths), the Brazilian Institute of Geography and Statistics (resident population) and the study of the Global Burden of Disease (Socio-demographic Index - SDI). Data from 2005 to 2019 were used. The trend was analyzed using Prais-Winsten regression models. The relationship between the mortality rate and the SDI was analyzed using Spearman's correlation coefficient. During the study period, 207,683 deaths from breast cancer occurred. The average standardized mortality rate was 19.95 deaths per 100,000 women in Brazil. All the regions of Brazil showed an increasing trend in mortality. Of the total federative units, 22 showed an increasing trend. There was a positive relationship between the mortality rate and the SDI. The standardized mortality rate for breast cancer showed an increasing trend in Brazil, in all regions and in most states. There was a direct association between mortality and SDI, indicating a greater magnitude in more developed regions.
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Affiliation(s)
- Gabriela Rodarte Pedroso da Silva
- Faculdade de Enfermagem, Universidade Federal de Goiás. R. 235, Qd. 41, Lt.23, Setor Leste Universitário. 74340-025 Goiânia GO Brasil.
| | - Rafael Alves Guimarães
- Faculdade de Enfermagem, Universidade Federal de Goiás. R. 235, Qd. 41, Lt.23, Setor Leste Universitário. 74340-025 Goiânia GO Brasil.
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Goiás. Goiânia GO Brasil
- Programa de Pós-Graduação em Medicina Tropical e Saúde Pública, Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás. Goiânia GO Brasil
| | - Flaviana Vely Mendonça Vieira
- Faculdade de Enfermagem, Universidade Federal de Goiás. R. 235, Qd. 41, Lt.23, Setor Leste Universitário. 74340-025 Goiânia GO Brasil.
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Goiás. Goiânia GO Brasil
| | - George Oliveira Silva
- Faculdade de Enfermagem, Universidade Federal de Goiás. R. 235, Qd. 41, Lt.23, Setor Leste Universitário. 74340-025 Goiânia GO Brasil.
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Goiás. Goiânia GO Brasil
| | - Faétila Dos Santos Oliveira
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Goiás. Goiânia GO Brasil
| | - Natália Del' Angelo Aredes
- Faculdade de Enfermagem, Universidade Federal de Goiás. R. 235, Qd. 41, Lt.23, Setor Leste Universitário. 74340-025 Goiânia GO Brasil.
- Programa de Pós-Graduação em Enfermagem, Faculdade de Enfermagem, Universidade Federal de Goiás. Goiânia GO Brasil
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da Luz Costa T, Dantas DB, de Campos Gomes F, Soares CO, Castelhano JR, Fonseca LC, Neves LMT, Figueiredo ERL, de Melo Neto JS. Impacts of Sociodemographic Factors, Screening, and Organization of Health Services on Breast Cancer Mortality in Brazil: An Ecological Study of 20 Years. Int J Breast Cancer 2023; 2023:6665725. [PMID: 37936925 PMCID: PMC10627721 DOI: 10.1155/2023/6665725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/20/2023] [Accepted: 10/04/2023] [Indexed: 11/09/2023] Open
Abstract
Background Breast cancer mortality is increasing in Brazil. This study examines the impact of sociodemographic factors, screening procedures, and primary healthcare (PHC) on breast cancer mortality. Methods An ecological study analyzed secondary data of women diagnosed with breast cancer who died between 2000 and 2019. Sociodemographic factors, screening procedures, and PHC were examined in relation to breast cancer mortality. Statistical analyses included normality tests, Kruskal-Wallis and one-way ANOVA tests with post hoc comparisons, Pearson and Spearman correlation tests, age-period-cohort analysis, Kaplan-Meier analysis, and Cox regression analysis. Significance was set at p < 0.05. Results Mortality rates were higher in the southeast (15.77) and south (15.97) regions compared to the north (5.07) (p < 0.0001). Survival rates were longer in the southeast (70.3 ± 0.05) and south (70.6 ± 0.09) than in the north (63.98 ± 0.053) (p ≤ 0.001). Mortality increased with age after 32 years (p ≤ 0.001). Brown and indigenous women had lower mortality and survival rates. Increased coverage of PHC, ultrasound, and biopsy did not reduce mortality. However, improved cytopathologic analysis led to a decrease in mortality. Conclusions Sociodemographic factors, screening procedures, and PHC are specific predictors of breast cancer mortality in Brazil.
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Affiliation(s)
- Thalita da Luz Costa
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Diego Bessa Dantas
- Institute of Health Sciences, Federal University of Pará (UFPA), Belém, PA, Brazil
| | - Fabiana de Campos Gomes
- Faculty of Medicine of São José do Rio Preto (FAMERP), São José do Rio Preto, São Paulo, Brazil
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Silva GAE, Damacena GN, Ribeiro CM, Alcantara LLDM, de Souza PRB, Szwarcwald CL. Papanicolaou test in Brazil: analysis of the National Health Survey of 2013 and 2019. Rev Saude Publica 2023; 57:55. [PMID: 37878841 PMCID: PMC10519687 DOI: 10.11606/s1518-8787.2023057004798] [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: 04/20/2022] [Accepted: 09/26/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVES To compare the coverage of cervical cancer screening in Brazil in 2013 and 2019, investigating the factors associated with having the test performed and the reasons given for not doing it. Additionally, a comparison is made concerning the time taken to receive the test result in SUS (Sistema Único de Saúde) and in the private health services. METHODS Using data from the National Health Survey (Pesquisa Nacional de Saúde - PNS), prevalence rates and corresponding confidence intervals were calculated to determine the frequency of recent cervical cancer screenings among women aged between 25 and 64 years old in Brazil, for both 2013 and 2019. Poisson regression models were employed to compare the prevalence of the outcome according to sociodemographic characteristics. The reasons for not having the test and the time between performing and receiving the result were also analyzed. RESULTS The findings revealed an increase in the coverage of preventive cervical cancer exams in Brazil from 78.7% in 2013 to 81.3% in 2019. Additionally, there was a decline in the proportion of women who had never undergone the exam, from 9.7% to 6.1%. Prevalence of test uptake was higher among white women, those with higher levels of education and income, and those residing in the South and Southeast regions of the country. The most commonly cited reasons for not taking the test were the impression it was unnecessary (45% in both 2013 and 2019) and never having been asked to undergo the test (20.6% in 2013 and 14.8% in 2019). CONCLUSIONS Despite the high coverage of screening achieved in the country, there is great inequality in access to the test, and a non-negligible number of women are at greater risk of dying from a preventable disease. Efforts must be made to structure an organized screening program that identifies and captures the most vulnerable women.
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Affiliation(s)
- Gulnar Azevedo e Silva
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrazilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brazil
| | - Giseli Nogueira Damacena
- Fundação Oswaldo CruzInstituto de Comunicação e Informação Científica e Tecnológica em SaúdeRio de JaneiroRJBrazil Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brazil
| | - Caroline Madalena Ribeiro
- Ministério da SaúdeProgramas de RastreamentoRio de JaneiroRJBrazilMinistério da Saúde. Programas de Rastreamento. Rio de Janeiro, RJ, Brazil
| | - Luciana Leite de Mattos Alcantara
- Universidade Federal do Rio de JaneiroPrograma de Engenharia BiomédicaRio de JaneiroRJBrazil Universidade Federal do Rio de Janeiro. Programa de Engenharia Biomédica. Rio de Janeiro, RJ, Brazil
| | - Paulo Roberto Borges de Souza
- Fundação Oswaldo CruzInstituto de Comunicação e Informação Científica e Tecnológica em SaúdeRio de JaneiroRJBrazil Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brazil
| | - Célia Landmann Szwarcwald
- Fundação Oswaldo CruzInstituto de Comunicação e Informação Científica e Tecnológica em SaúdeRio de JaneiroRJBrazil Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, RJ, Brazil
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De Camargo Cancela M, Monteiro Dos Santos JE, Lopes de Souza LB, Martins LFL, Bezerra de Souza DL, Barchuk A, Hanly P, Sharp L, Soerjomataram I, Pearce A. The economic impact of cancer mortality among working-age individuals in Brazil from 2001 to 2030. Cancer Epidemiol 2023; 86:102438. [PMID: 37579673 PMCID: PMC10577440 DOI: 10.1016/j.canep.2023.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/02/2023] [Accepted: 08/05/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030. METHODS We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016). RESULTS Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers. CONCLUSIONS Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer.
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Affiliation(s)
- Marianna De Camargo Cancela
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil.
| | - Jonas Eduardo Monteiro Dos Santos
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Leonardo Borges Lopes de Souza
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | - Luís Felipe Leite Martins
- Division of Surveillance and Data Analysis, Coordination of Prevention and Surveillance, Brazilian National Cancer Institute, Ministry of Health, Rio de Janeiro, Brazil
| | | | - Anton Barchuk
- Faculty of Social Sciences, Health Sciences, Tampere University, Finland
| | - Paul Hanly
- School of Business, National College of Ireland, Dublin, Ireland
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University Centre for Cancer, University of Newcastle, Newcastle Upon Tyne, United Kingdom
| | | | - Alison Pearce
- Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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dos Santos L, Roszkowski I, Pujals C, de Oliveira RR, Fernando Castilho FC, Borghesan DHP, Romani I, Bitencourt MR, Alarcão ACJ, Marques VD, Pereira Silva MDA, Carvalho MDDB, Raíssa Bocchi RB, Pelloso SM. Comparative Analysis of Mortality due to Breast Cancer and Mammography Uptake in the Federative Units of Brazil-2015 to 2021. Asian Pac J Cancer Prev 2023; 24:4339-4348. [PMID: 38402419 PMCID: PMC10909118 DOI: 10.31557/apjcp.2023.24.12.4339] [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: 06/12/2023] [Accepted: 11/28/2023] [Indexed: 02/26/2024] Open
Abstract
Objective: Compare the breast cancer mortality rate and the rate of mammograms with socioeconomic factors, in Brazilian´s Federative Units, during the period of 2015 to 2021. Methods: This is an ecological study, of a descriptive nature, which covers the 27 Brazilian federative units, using secondary data extracted from the DATASUS System. The information analyzed was mammography data, breast cancer mortality, demographic and economic data of the resident population and women over 20 years of age. Results: There is a direct relationship between mortality rate and mammograms rates in the Federative Units. The data obtained for Brazil presents a total of 133,048 deaths from breast cancer and 17,324,526 mammography exams in the period from 2015 to 2021. In other words, Brazil presents a standardized mortality rate value, 19.25 deaths per 100,000 women. Regarding the mammography rate, the value of the exam-specific mammography rate was 2,506.55 per 100,000 women. In relation to socioeconomic data by mortality rate group, higher mortality rates from breast cancer present higher rates in the variables: income rate by State (2,594.86), people with income (63.5), average percentage of women with more over 50 years old (29.5%), women with average years of education (6.64), white population (55.1%) and mammography exam rate (2873.20). When analysing the highest rates of mammography exam rates, higher rates are observed income rate by State (2,161.47), people with income (62.5%), average percentage of women over 50 years old (28.6%), women with an average number of years of education (5.8). Conclusion: Brazil has a high mortality rate due to breast cancer, when compared to other countries. The reasons are diverse, such as the modern, industrialized and populous lifestyle. The Federative Units with the highest mortality rate also have high rates of mammograms, that is, in the Federative Units with "better" sociodemographic conditions, the South and Southeast.
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Affiliation(s)
- Lander dos Santos
- Post-Graduation Program in Health Sciencies at State University of Maringa, PR, Brazil.
| | - Igor Roszkowski
- Post-Graduation Program in Health Sciencies at State University of Maringa, PR, Brazil.
| | - Constanza Pujals
- Post-Graduation Program in Health Sciencies at State University of Maringa, PR, Brazil.
| | | | | | | | - Isaac Romani
- Post-Graduation Program in Health Sciencies at State University of Maringa, PR, Brazil.
| | | | | | | | | | | | | | - Sandra Marisa Pelloso
- Post-Graduation Program in Health Sciencies at State University of Maringa, PR, Brazil.
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Luizaga CTDM, Jardim BC, Wünsch V, Eluf J, Silva GAE. Recent changes in trends of mortality from cervical cancer in Southeastern Brazil. Rev Saude Publica 2023; 57:25. [PMID: 37075421 PMCID: PMC10118416 DOI: 10.11606/s1518-8787.2023057004709] [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: 03/18/2022] [Accepted: 07/08/2022] [Indexed: 04/21/2023] Open
Abstract
OBJECTIVE To analyze the trends of cervical cancer mortality in Brazilian Southeastern states, and to compare them to Brazil and other regions between 1980 and 2020. METHODS Time series study based on data from the Sistema de Informações de Mortalidade (Brazilian Mortality Information System). Death data were corrected by proportional redistribution of deaths from ill-defined causes and cervical cancer of unspecified portion. Age-standardized and age-specific rates were calculated by screening target (25-39 years; 40-64 years) and non-target (65 years or older) age groups. Annual percentage changes (APC) were estimated by linear regression model with breakpoints. The coverage of Pap Smear exam in the Unified Health System (SUS) was evaluated between 2009 and 2020 according to age group and locality. RESULTS There were increases in corrected mortality rates both in 1980 and in 2020 in all regions, with most evident increments at the beginning of the series. There was a decrease in mortality nationwide between 1980-2020; however, the state of São Paulo showed a discrete upward trend in 2014-2020 (APC=1.237; 95%CI 0.046-2.443). Noteworthy is the trend increment in the 25-39 year-old group in all study localities, being sharper in the Southeast region in 2013-2020 (APC=5.072; 95%CI 3.971-6.185). Screening coverage rates were highest in São Paulo and lowest in Rio de Janeiro, with a consistent decline from 2012 onwards at all ages. CONCLUSIONS São Paulo is the first Brazilian state to show a reversal trend in mortality from cervical cancer. The changes in mortality patterns identified in this study point to the need for reorganization of the current screening program, which should be improved to ensure high coverage, quality, and adequate follow-up of all women with altered test results.
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Affiliation(s)
| | - Beatriz Cordeiro Jardim
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
- nstituto Nacional de CâncerRio de JaneiroRJBrasilInstituto Nacional de Câncer. Rio de Janeiro, RJ, Brasil
| | - Victor Wünsch
- Fundação Oncocentro de São PauloSão PauloSPBrasilFundação Oncocentro de São Paulo. São Paulo, SP, Brasil
- Universidade de São PauloFaculdade de Saúde PúblicaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Saúde Pública. São Paulo, SP, Brasil
| | - José Eluf
- Universidade de São PauloFaculdade de MedicinaSão PauloSPBrasilUniversidade de São Paulo. Faculdade de Medicina. São Paulo, SP, Brasil
| | - Gulnar Azevedo e Silva
- Universidade do Estado do Rio de JaneiroInstituto de Medicina Social Hesio CordeiroRio de JaneiroRJBrasilUniversidade do Estado do Rio de Janeiro. Instituto de Medicina Social Hesio Cordeiro. Rio de Janeiro, RJ, Brasil
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de Aguiar BS, Pellini ACG, Rebolledo EAS, Ribeiro AG, Diniz CSG, Bermudi PMM, Failla MA, Baquero OS, Chiaravalloti-Netto F. Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023; 26:e230008. [PMID: 36629620 PMCID: PMC9838235 DOI: 10.1590/1980-549720230008.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 10/06/2022] [Accepted: 10/06/2022] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. METHODS Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. RESULTS Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). CONCLUSION The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.
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Affiliation(s)
- Breno Souza de Aguiar
- Secretaria Municipal da Saúde de São Paulo, Coordenação de Epidemiologia e Informação – São Paulo (SP), Brasil
| | | | | | | | | | | | - Marcelo Antunes Failla
- Secretaria Municipal da Saúde de São Paulo, Coordenação de Epidemiologia e Informação – São Paulo (SP), Brasil
| | - Oswaldo Santos Baquero
- Universidade de São Paulo, Faculdade de Medicina Veterinária e Zootecnia – São Paulo (SP), Brasil
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Pecinato V, Jacobo A, da Silva SG. Mortality trends of breast and cervical cancer in Passo Fundo, Rio Grande do Sul: an analysis by age and schooling, 1999-2019. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2023; 31:e2022440. [PMID: 36629594 PMCID: PMC9887960 DOI: 10.1590/s2237-96222022000300021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 10/19/2022] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE to analyze the temporal trend of mortality due to malignant neoplasms of the breast and cervix from 1999 to 2019 in Passo Fundo, Rio Grande do Sul, Brazil. METHODS this was a time-series study based on data from the Mortality Information System; standardized rates were calculated according to age and schooling, and the temporal trend was assessed using Prais-Winsten regression. RESULTS the overall mortality coefficients for cervical cancer (β = -0.03; 95%CI -0.08;0.02) and for breast cancer (β = -0.006; 95%CI -0.02;0.01) were stable over the time series; in both types of neoplasms, a rising trend was identified in women with up to 7 years of schooling; on the other hand, a stationary trend was found in the majority of the age strata analyzed. CONCLUSION older women and those with low levels of schooling had the worst prognosis.
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Affiliation(s)
- Vanessa Pecinato
- Universidade Federal da Fronteira Sul, Curso de Medicina, Passo
Fundo, RS, Brazil
| | - Andréia Jacobo
- Universidade Federal da Fronteira Sul, Curso de Medicina, Passo
Fundo, RS, Brazil
| | - Shana Ginar da Silva
- Universidade Federal da Fronteira Sul, Programa de Pós-Graduação em
Ciências Biomédicas, Passo Fundo, RS, Brazil
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10
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Aguiar BSD, Pellini ACG, Rebolledo EAS, Ribeiro AG, Diniz CSG, Bermudi PMM, Failla MA, Baquero OS, Chiaravalloti-Netto F. Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2023. [DOI: 10.1590/1980-549720230008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
ABSTRACT Objective: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. Methods: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. Results: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR – relative risk: 0.97; 95%CI – credible interval: 0.93–1.00); women being the head of the household (RR 0.97; 95%CI 0.94–0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00–1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87–0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18–1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01–1.18). Conclusion: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.
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Trends in Hospitalization and Mortality from Cervical Cancer in Brazil Are Linked to Socioeconomic and Care Indicators. WOMEN 2022. [DOI: 10.3390/women2030026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We aimed, through an ecological survey of cervical cancer outcomes in Brazil, to analyze the influence of socioeconomic and care indicators of social vulnerability. The study sample (2010–2015) is composed of women diagnosed with cervical cancer, in different regions of the country. Data were collected from the Department of Health, in addition to searching the social vulnerability database of the Institute of Applied Economic Research. The incidence of age-standardized hospital admission declined over the years of the study in almost all regions but only one region showed a significant decline in indices of social vulnerability. In two other regions, one important indicator (human capital) significantly decreased. There was a positive correlation between vulnerability indices and age-standardized hospital admissions in most of the country. Decreasing vulnerability by easy access to cancer screening and early treatment improves cervical cancer outcomes.
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Duarte MB, Argenton JL, Carvalheira JB. Impact of COVID-19 in Cervical and Breast Cancer Screening and Systemic Treatment in São Paulo, Brazil: An Interrupted Time Series Analysis. JCO Glob Oncol 2022; 8:e2100371. [PMID: 35696624 PMCID: PMC9225667 DOI: 10.1200/go.21.00371] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE COVID-19 caused a disruption in cancer management around the world, resulting in an estimated excess burden secondary to screening disruption and excess lag time for treatment initiation. METHODS We gathered information from primary reimbursement data sets of the public health system of São Paulo, Brazil, from April 2020 to November 2021, and compared these data with those of the pre–COVID-19 period. We used an interrupted time series model to estimate the effect of the COVID-19 pandemic on the rate of key procedures of breast and cervical cancer health care chain. RESULTS We estimated that 1,149,727, 2,693, and 713,616 pap smears, conizations, and mammograms, respectively, were missed or delayed during the COVID-19 pandemic, compared with those in the years immediately before the COVID-19 stay-at-home restrictions. Specifically, we observed an acute decrease of procedures after the COVID-19 stay-at-home restrictions, with a trend to recovery in the long term. Regarding the systemic treatment analysis, we observed a 25% reduction in the rate of initiation of adjuvant systemic treatment for early breast cancer (stage I/II). However, we did not find a clear effect on the other settings of systemic treatment for breast cancer. We estimated an excess of 156 patients starting palliative care for cervical cancer after the COVID-19 stay-at-home restrictions. CONCLUSION The COVID-19 pandemic significantly reduced the performance rate of pap smears, conizations, and mammograms. The initiation of adjuvant treatment for early-stage breast cancer was most susceptible to COVID-19's health system disruption. Furthermore, the downward trend of treatment of advanced cervical cancer was interrupted. Therefore, public health policies are urgently needed to decrease the incidence of advanced cervical and breast cancers caused by delayed diagnosis and treatment initiation. The COVID-19 control policies resulted in reduction of cancer patients' delivery of care. This study evaluated the pandemic's influence in key procedures of breast and cervical cancer chain of care in São Paulo, Brazil. We observed a substantial reduction in the number of mammograms, pap smears, and conizations performed since the onset of the COVID-19 pandemic. In addition, stage I and II breast cancer adjuvant treatment presented a reduced realization rate, whereas palliative treatment delivered for advanced cervical cancer increased. Our results support the need for public health policies focused on mitigating the long-term effects of COVID-19 in cancer-related mortality.
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Affiliation(s)
- Mateus B.O. Duarte
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
- Uberlândia Cancer Hospital, Federal University of Uberlândia, UFU, Uberlândia, Minas Gerais, Brazil
| | - Juliana L.P. Argenton
- Fundação de Desenvolvimento da Universidade Estadual de Campinas (FUNCAMP), Campinas, São Paulo, Brazil
| | - José B.C. Carvalheira
- Division of Oncology, Department of Anesthesiology, Oncology and Radiology, School of Medical Sciences, Universidade Estadual de Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Meira KC, Magnago C, Mendonça AB, Duarte SFS, de Freitas PHO, dos Santos J, de Souza DLB, Simões TC. Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5591. [PMID: 35564986 PMCID: PMC9105639 DOI: 10.3390/ijerph19095591] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/06/2022] [Accepted: 04/13/2022] [Indexed: 02/01/2023]
Abstract
Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women's age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000-2004) and Tocantins (1995-2004; 2010-2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.
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Affiliation(s)
- Karina Cardoso Meira
- Health School, Federal University of Rio Grande do Norte, Natal 59078-970, Brazil
| | - Carinne Magnago
- School of Public Health, University of São Paulo, São Paulo 01246-904, Brazil;
| | - Angelo Braga Mendonça
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil; (A.B.M.); (J.d.S.)
| | - Stephane Fernanda Soares Duarte
- Department of Demography and Actuarial Sciences, Federal University of Rio Grande Norte, Natal 59078-970, Brazil; (S.F.S.D.); (P.H.O.d.F.)
| | - Pedro Henrique Oliveira de Freitas
- Department of Demography and Actuarial Sciences, Federal University of Rio Grande Norte, Natal 59078-970, Brazil; (S.F.S.D.); (P.H.O.d.F.)
| | - Juliano dos Santos
- Brazilian National Cancer Institute, Rio de Janeiro 20230-130, Brazil; (A.B.M.); (J.d.S.)
| | | | - Taynãna César Simões
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte 30190-002, Brazil;
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Mafra da Costa A, Hernandes ICP, Weiderpass E, Soerjomataram I, Fregnani JHTG. Cancer Statistics over Time in Northwestern São Paulo State, Brazil: Incidence and Mortality. Cancer Epidemiol Biomarkers Prev 2022; 31:707-714. [PMID: 35131883 DOI: 10.1158/1055-9965.epi-21-0842] [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: 07/21/2021] [Revised: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 12/24/2022] Open
Abstract
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.
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Affiliation(s)
- Allini Mafra da Costa
- Population-Based Cancer Registry of Barretos Region, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | | | | | | | - José Humberto Tavares Guerreiro Fregnani
- Population-Based Cancer Registry of Barretos Region, Barretos Cancer Hospital, Pio XII Foundation, Barretos, São Paulo, Brazil
- A.C. Camargo Cancer Center, São Paulo, Brazil
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Buss LF, Cury L, Ribeiro CM, Silva GAE, Eluf Neto J. Access to colposcopy in the State of São Paulo, Brazil: probabilistic linkage study of administrative data. CAD SAUDE PUBLICA 2022; 38:e00304820. [DOI: 10.1590/0102-311x00304820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 04/01/2021] [Indexed: 12/24/2022] Open
Abstract
Cervical cancer screening is a multistage process, therefore access to both the primary test and subsequent diagnostic procedures is essential. Considering women undergoing screening on the public health system in the State of São Paulo, Brazil, we aimed to estimate the proportion of women accessing colposcopy within six months of an abnormal smear result. We retrieved records from two administrative databases, the Information System on Uterine Cervical Cancer (SISCOLO) that contains smear results and the Outpatient Information System of the Brazilian Unified National Health System (SIA/SUS) that records colposcopies. A reference cohort consisted of women, aged 25 years or older, with an abnormal smear result between May 1, 2014, and June 30, 2014. We excluded prevalent cases. We linked the reference cohort and records in the SIA/SUS extending to December 31, 2014. After excluding prevalent cases, 1,761 women with abnormal cytology results were left. A total of 700 (39.8%) women were linked to a colposcopy record within the follow-up period; this dropped to 671 (38.1%) women when follow-up was censored at six months. We could notice a slightly higher attendance in women living in the metropolitan region of São Paulo compared with residents of the rest of the state. We found no association between colposcopy attendance and age or cytology class. These results emphasize that access to colposcopy in the public health system in São Paulo is limited. This compromises the quality of screening, and the issue needs to be prioritized in service planning.
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Affiliation(s)
| | - Lise Cury
- Fundação Oncocentro de São Paulo, Brasil
| | - Caroline Madalena Ribeiro
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil; Universidade do Estado do Rio de Janeiro, Brazil
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Leão MJDR, Cardoso VIDS, Lima AJPD, Santos SC, de Araújo EMCF, Paixão KDC, Santos LG, Fraga CADC, de Souza CDF, de Sales Marques C. Temporal trend analysis of hospitalizations and in-hospital deaths due to female breast cancer in the state of Alagoas from 2009 to 2019: a cross-sectional study. SAO PAULO MED J 2022; 140:268-277. [PMID: 35293937 PMCID: PMC9610248 DOI: 10.1590/1516-3180.2021.0385.r1.23072021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/23/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Breast cancer is a common neoplasm in women worldwide. Its varying patterns of incidence and clinical prognosis in Brazil make it an important and complex public health problem that needs to be solved. OBJECTIVES To analyze the temporal dynamics of hospital admissions and deaths due to female breast cancer in the state of Alagoas, Brazil, from 2009 to 2019. DESIGN AND SETTING Cross-sectional study including secondary data from hospital admissions and deaths due to female breast cancer in Alagoas. METHODS A joinpoint regression model was constructed for temporal analysis of hospital admissions and deaths due to female breast cancer in Alagoas, over this period. The hospital information system of the Department of Informatics of the National Health System was used. RESULTS There were 5,801 hospitalizations and 633 hospital deaths due to neoplasm in Alagoas over the period. The age group from 50 to 59 years old stood out, corresponding to 28.1% of hospitalizations and 31.1% of registered deaths. An increasing trend in the rate of hospital admissions was observed (average annual percentage change, AAPC = 14.0; P-value < 0.001), from 14.9/100,000 inhabitants in 2009 to 53.6 in 2019. There was a growth trend in the in-hospital mortality rate (AAPC = 19.8; P-value < 0.001), from 6.3% in 2009 to 11.0% in 2019. CONCLUSION The results indicated an increasing trend of hospital admissions and mortality rates in the state of Alagoas, with a higher percentage of hospitalizations and deaths in the 50-59 age group.
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Affiliation(s)
- Myra Jurema da Rocha Leão
- MD. Physician and Master’s Student, Department of Oncological Surgery, Santa Casa de Misericórdia de Maceió, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | | | | | - Samilla Cristinny Santos
- Medical Student, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | | | - Karen da Costa Paixão
- Medical Student, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | - Lucas Gomes Santos
- Medical Student, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | - Carlos Alberto de Carvalho Fraga
- PhD. Biologist and Professor, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | - Carlos Dornels Freire de Souza
- PhD. Physical Therapist and Professor, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
| | - Carolinne de Sales Marques
- PhD. Biochemistry and Professor, Center for Medical Sciences and Nursing, Universidade Federal de Alagoas (UFAL), Arapiraca (AL), Brazil.
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Ferreira MDC, Sarti FM, Barros MBDA. Social inequalities in the incidence, mortality, and survival of neoplasms in women from a municipality in Southeastern Brazil. CAD SAUDE PUBLICA 2022; 38:e00107521. [DOI: 10.1590/0102-311x00107521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 08/28/2021] [Indexed: 12/24/2022] Open
Abstract
This study aims to analyze inequalities in the incidence, mortality, and survival of the main types of cancer in women according to the Social Vulnerability Index (SVI). The study was conducted in Campinas, São Paulo State, Brazil, from 2010 to 2014, and used data from the Population-based Cancer Registry and the Mortality Information System. Incidence and mortality rates standardized by age and 5-year survival estimates were calculated according to the social vulnerability strata (SVS), based on the São Paulo Social Vulnerability Index. Three SVS were delimited, with SVS1 being the lowest level of vulnerability and SVS3 being the highest. Rate ratios and the concentration index were calculated. The significance level was 5%. Women in SVS1 had a higher risk of breast cancer (0.46; 95%CI: 0.41; 0.51), colorectal cancer (0.56; 95%CI: 0.47; 0.68), and thyroid cancer (0.32; 95%CI: 0.26; 0.40), whereas women from SVS3 had a higher risk of cervical cancer (2.32; 95%CI: 1.63; 3.29). Women from SVS1 had higher mortality rates for breast (0.69; 95%CI: 0.53; 0.88) and colorectal cancer (0.69; 95%CI: 0.59; 0.80) and women from SVS3 had higher rates for cervical (2.35; 95%CI: 1.57; 3.52) and stomach cancer (1.43; 95%CI: 1.06; 1.91). Women of highest social vulnerability had lower survival rates for all types of cancer. The observed inequalities differed according to the location of the cancer and the analyzed indicator. Inequalities between incidence, mortality, and survival tend to revert and the latter is always unfavorable to the segment of highest vulnerability, indicating the existence of inequality in access to early diagnosis and timely treatment.
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Baquero OS, Rebolledo EAS, Ribeiro AG, Bermudi PMM, Pellini ACG, Failla MA, Aguiar BSD, Diniz CSG, Chiaravalloti Neto F. Pink October and mammograms: when health communication misses the target. CAD SAUDE PUBLICA 2021; 37:e00149620. [PMID: 34816950 DOI: 10.1590/0102-311x00149620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 03/04/2021] [Indexed: 12/24/2022] Open
Abstract
Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.
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Affiliation(s)
- Oswaldo Santos Baquero
- Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil.,Instituto de Estudos Avançados, Universidade de São Paulo, São Paulo, Brasil
| | | | | | | | - Alessandra Cristina Guedes Pellini
- Coordenação de Epidemiologia e Informação, Secretaria Municipal de Saúde de São Paulo, São Paulo, Brasil.,Universidade Nove de Julho, São Paulo, Brasil
| | | | - Breno Souza de Aguiar
- Faculdade de Saúde Pública, Universidade de São Paulo, São Paulo, Brasil.,Coordenação de Epidemiologia e Informação, Secretaria Municipal de Saúde de São Paulo, São Paulo, Brasil
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Ferreira MDC, Vale DB, Barros MBDA. Incidence and mortality from breast and cervical cancer in a Brazilian town. Rev Saude Publica 2021; 55:67. [PMID: 34730748 PMCID: PMC8522755 DOI: 10.11606/s1518-8787.2021055003085] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/03/2020] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES To analyze the magnitude of changes in the incidence and mortality from cervical cancer (CC) and breast cancer (BC) in Campinas, São Paulo State, between the five-year periods of 1991-1995 and 2010-2014. METHODS data on cancer were obtained from the Campinas Population-Based Cancer Registry and data on deaths from the Mortality Information System of the Computing Department of the Unified Health System. Age-standardized incidence and mortality rates were calculated by the direct method, with the respective 95% confidence intervals. The magnitude of the changes was measured by the rate ratio (rate ratio; 95%CI). RESULTS among the periods studied, there was a threefold increase in the detection rate of in situ CC (3.03; 95%CI: 2.64-3.47) and fivefold increase for in situ BC (5.23; 95%CI: 4.98-5.50). The proportion of cases of in situ BC in relation to the total number of cases of BC increased from 3.31% to 11.05%. The incidence rate of invasive CC decreased by 57% (0.43; 95%CI: 0.40-0.47), and the incidence rate of invasive BC increased by 40% (1.40; 95%CI: 1.33-1.47). The mortality rate of the CC decreased by 58% (0.42; 95%CI: 0.32-0.56), and that of BC by 15% (0.85; 95%CI: 0.82-0.89). CONCLUSION the incidence of in situ carcinomas of CC and BC increased in almost two decades. The rate of invasive carcinoma of CC decreased, and that of BC increased. Mortality from both cancers decreased. Observing these changes is useful for assessing the impact of the actions carried out in the period and for planning future actions.
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Affiliation(s)
- Maria do Carmo Ferreira
- Universidade Estadual de CampinasFaculdade de Ciências MédicasPrograma de Pós-Graduação em Saúde ColetivaCampinasSPBrasilUniversidade Estadual de Campinas. Faculdade de Ciências Médicas. Programa de Pós-Graduação em Saúde Coletiva. Campinas, SP, Brasil
| | - Diama Bhadra Vale
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de TocoginecologiaCampinasSPBrasilUniversidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Tocoginecologia. Campinas, SP, Brasil
| | - Marilisa Berti de Azevedo Barros
- Universidade Estadual de CampinasFaculdade de Ciências MédicasDepartamento de Saúde ColetivaCampinasSPBrasilUniversidade Estadual de Campinas. Faculdade de Ciências Médicas. Departamento de Saúde Coletiva. Campinas, SP, Brasil
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Inequalities in Mortality and Access to Hospital Care for Cervical Cancer-An Ecological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010966. [PMID: 34682711 PMCID: PMC8535933 DOI: 10.3390/ijerph182010966] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/03/2021] [Accepted: 10/13/2021] [Indexed: 11/25/2022]
Abstract
Cervical cancer is the second most common form of cancer in the world among women, and it is estimated to be the third most frequent cancer in Brazil, as well as the fourth leading cause of death from cancer. There is a difference in cervical cancer mortality rates among different administrative regions in Brazil along with an inadequate distribution of cancer centers in certain Brazilian regions. Herein, we analyze the trends in hospital admission and mortality rates for CC between 2000 and 2012. This population-based ecological study evaluated the temporal trend in cervical cancer between the years 2000 and 2012, stratifying by Brazilian administrative regions. The North and Northeast regions had no reduction in mortality in all age groups studied (25 to 64 years); when analyzing hospitalization rates, only the age group of 50 to 64 years from the North Region did not present a reduction. During the years studied, in the South Region, the age group ranging from 50 to 54 years had the greatest reduction in mortality rates (β = −0.59, p = 0.001, r2 = 0.63), and the group ranging from 45 to 49 years had the greatest reduction in hospital admission rates (β = −8.87, p = 0.025, r2 = 0.37). Between the years 2000 and 2012, the greatest reduction in the incidence of UCC was in the South Region (β = −1.43, p = 0.236, r2 = 0.12) followed by the Central-West (β = −1, p < 0.001, r2 = 0.84), the Southeast (β = −0.95, p < 0.001, r2 = 0.88), the Northeast (β = −0.67, p = 0.080, r2 = 0.25), and, finally, by the North (β = −0.42, p = 0.157, r2 = 0.17). There was a greater reduction in mortality rates and global hospitalization rates for CC in Brazil than in the United States during the same period with exceptions only in Brazil’s North and Northeast regions.
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Passos CM, Sales JB, Maia EG, Caldeira TCM, Rodrigues RD, Figueiredo N, Claro RM. Trends in access to female cancer screening in Brazil, 2007-16. J Public Health (Oxf) 2021; 43:632-638. [PMID: 32201896 DOI: 10.1093/pubmed/fdaa028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 01/08/2020] [Accepted: 02/04/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study aims to analyse changes in the prevalence of cervical cancer (CCa) and breast cancer (BCa) screening among women in the Brazilian capitals and Federal District in the last decade (2007-16). METHODS Data from the surveillance system of risk and protective factors for chronic diseases through telephone interviews (n = 267 949) were used. Adequate screening consisted of, at least, one Pap test triennially, for women aged between 25 and 64 years, and mammography exam biannually, for women aged between 50 and 69 years. The prevalence of adequate screening was investigated for each type of cancer isolated and combined (women aged between 50 and 64 years). The prevalence of adequate screening was estimated for the total population and according to socioeconomic variables. Linear regression models were used. RESULTS The prevalence of adequate screening test for CCa remained stable, around 82%, while the screening test for BCa increased from 71 to 78% between 2007 and 2016. Higher increases were observed among women with low schooling and from less developed regions. The percentage of adequate screening (considering both types), for women aged between 25 and 69 years, remained stable, close to 78%. CONCLUSIONS Screening for BCa increased significantly. Smaller coverage rates are verified among women with low schooling and from less developed regions.
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Affiliation(s)
- Camila M Passos
- Department of Medicine and Nursing, Federal University of Viçosa, Viçosa, MG, Brazil, 36570-900.,Nursing Postgraduate Program, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, 30130-100
| | - Jacqueline B Sales
- Nursing Postgraduate Program, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, 30130-100
| | - Emanuella G Maia
- Nursing Postgraduate Program, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, 30130-100.,Department of Health Sciences, State University of Santa Cruz, Ilhèus, BA, Brazil, 45662-900
| | - Thaís C M Caldeira
- Public Health Postgraduate Program. Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, 30130-100
| | - Roberta D Rodrigues
- Municipal UnderSecretariat for Food and Nutrition Security. Belo Horizonte City Hall. Belo Horizonte, MG, Brazil, 30130-100
| | - Natasha Figueiredo
- Master Human Nutrition and Public Health, Sorbonne Paris Nord University, Bobigny, France, 930000
| | - Rafael M Claro
- Department of Nutrition, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil, 30130-100
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Dantas de Araújo Santos Camargo J, dos Santos J, Simões TC, de Carvalho JBL, Silva GWDS, Dantas ESO, Rodrigues WTDS, Freire FHMDA, Meira KC. Mortality due to breast cancer in a region of high socioeconomic vulnerability in Brazil: Analysis of the effect of age-period and cohort. PLoS One 2021; 16:e0255935. [PMID: 34388198 PMCID: PMC8362978 DOI: 10.1371/journal.pone.0255935] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 07/27/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Breast cancer is an important public health problem worldwide, with important disparities in incidence, mortality, and survival rates between developed and developing countries due to inequalities regarding access to measures for the prevention and treatment of the disease. In Brazil, there are higher rates of incidence and a downward trend in mortality in regions of greater socioeconomic development. OBJECTIVE To evaluate the effect of age, period, and birth cohort on breast cancer mortality in women aged 20 years and older in the states of the Northeast Region of Brazil, an area of high socioeconomic vulnerability, from 1980 to 2019. METHODS The death records were extracted from the DATASUS Mortality Information System website (Department of National Health Informatics) from the Ministry of Health of Brazil. Estimable functions were used to estimate the age-period and cohort models (APC) using the Epi library from the R statistical software version 6.4.1. RESULTS The average breast cancer mortality rate for the period was 20.45 deaths per 100,000 women. The highest coefficients per 100,000 women were observed in the states of Pernambuco (21.09 deaths) and Ceará (20.85 deaths), and the lowest in Maranhão (13.58 deaths) and Piauí (15.43 deaths). In all of the locations, there was a progressive increase in mortality rates in individuals over 40 years of age, with higher rates in the last five-year period (2015-2019). There was an increase in the risk of death for the five-year period of the 2000s in relation to the reference period (1995-1999) in the Northeast region and in the states of Alagoas, Bahia, Maranhão, Paraíba, and Piauí. In addition, there was an increased risk of death for women born after the 1950s in all locations. CONCLUSION The highest mortality rates in all five-year periods analyzed were observed in states with greater socioeconomic development, with an increase in mortality rates in the 2000s, and a higher risk of death in the younger cohorts.
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Affiliation(s)
| | - Juliano dos Santos
- Cancer Hospital III, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taynãna César Simões
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
| | | | | | | | | | | | - Karina Cardoso Meira
- Graduate Program in Demography at the Federal University of Rio Grande do Norte, Natal, Brazil
- Health School, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Madalena Ribeiro C, Dos Santos Silva I, Eluf Neto J, Pereira Baltar Cury LC, Azevedo E Silva G. Follow-up of women screened for cervical cancer in São Paulo, Brazil: An analysis of the times to diagnostic investigation and treatment. Cancer Epidemiol 2021; 72:101940. [PMID: 33906100 DOI: 10.1016/j.canep.2021.101940] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Cervical cancer incidence and mortality rates are higher in Brazil than in western countries. Access to cytology-based screening has increased in the country in recent decades, but few studies have assessed the quality of the follow-up care of women with abnormal screening tests that require further investigation. METHODS A record-linkage cohort study was conducted in São Paulo state. Women aged 25+ years, who were screened in 2010, and whose test revealed a high-grade, or more severe, lesion were eligible. Follow-up information on diagnostic investigations, treatments and mortality was obtained through record-linkage of health databases. The Kaplan-Meier method was used to estimate median times between screening and diagnostic investigation, and diagnosis and treatment initiation. Cox survival models were used to identify correlates of the length of these time intervals. RESULTS 4300 women had a high-grade, or more severe, test result. Of these, 2788 (64.8 %) had a diagnostic investigation record, 1763 (41 %) a confirmed diagnosis of a precursor lesion or cancer, and 1247 (70.7 %) a treatment record. The median time to diagnosis was 190 days, with the probability of undergoing a diagnostic investigation within 30 days of the abnormal screening test being 7%. The median time to treatment was 81 days, with the probability of undergoing treatment within 60 days of a confirmed diagnosis being 44 %. Delays in diagnosis and treatment were associated with area-based healthcare indicators. CONCLUSION Times to diagnosis and treatment were long, well above recommendations. Strategies to improve follow-up care must be prioritized to ensure screening reduces cervical cancer incidence and mortality.
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Affiliation(s)
| | - Isabel Dos Santos Silva
- Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK.
| | - José Eluf Neto
- Department of Preventive Medicine, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil.
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Regional inequalities in cervical cancer survival in Minas Gerais State, Brazil. Cancer Epidemiol 2021; 71:101899. [PMID: 33548845 DOI: 10.1016/j.canep.2021.101899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/05/2020] [Accepted: 01/23/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Cervical cancer survival is marked by socioeconomic and demographic inequalities. We investigated differences in survival across health regions in Minas Gerais, Brazil, in cervical cancer patients who underwent treatment in the Brazilian Public Health System. METHODS From a database developed through probabilistic and deterministic linkage of data from information systems of the Brazilian Public Health System, we identified cervical cancer cases, diagnosed between 2002 and 2010, who underwent radiation and/or chemotherapy and lived in Minas Gerais, Brazil. Five-year overall and cause-specific survivals were estimated by the Kaplan-Meier method and compared using the log-rank test. We used extended Cox models to assess the relationship between the health region of residence and the overall and cause-specific death risk, adjusting for relevant variables. RESULTS We included 5613 patients with a median age of 55.0 years. Median follow-up time was 70.0 months. Five-year overall and cause-specific survivals were 56.3 % and 63.6 %, respectively. Across the 13 health regions, 5-year survival ranged from 46.6%-64.2% (p < 0.001) in the overall analysis and from 52.0% to 72.0% (p < 0.001) in the cause-specific analysis. Multivariate models revealed a significantly higher death risk for most health regions in comparison to the reference health region (Norte). Adjustment by age, tumor stage, comorbidity, treatment, travel time, and year of diagnosis had little effect on the association. CONCLUSION We found regional disparities in cervical cancer survival that persisted after relevant adjustments. Uneven regional provision of health services might be implicated in these disparities, affecting timely access to treatment for cervical cancer patients.
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Silva GAE, Jardim BC, Ferreira VDM, Junger WL, Girianelli VR. Cancer mortality in the Capitals and in the interior of Brazil: a four-decade analysis. Rev Saude Publica 2020; 54:126. [PMID: 33295593 PMCID: PMC7688260 DOI: 10.11606/s1518-8787.2020054002255] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/17/2020] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE: to describe the trend of mortality from general cancer and more frequent types among men and women living in the Capitals and other municipalities of the five macro-regions of Brazil between 1978 and 2017. METHODS: Time series study with mortality data corrected by redistribution of ill-defined causes. Proportional cancer mortality was calculated for Brazil and regions. The annual percentage change in rates for total cancer and specific types in each segment and in the selected unit of analysis was calculated by generalized linear regression with Gaussian binding. RESULTS: the proportion of cancer increased progressively for both sexes from 1978 to 2017. Important differences between the Capitals and the interior of the macro-regions were seen with disaggregated data. The greatest declines occurred for stomach cancer, except in the northern and interior regions of the Northeast, and for the cervix cancer, with a generalized fall, with the exception of the interior of the northern region. Lung cancer decreased among men in the Southeast and South regions and had a generalized increase among women. Breast and prostate cancers tended to decrease in the Southeast and South regions and among residents of the Capitals but showing an increase in the interior of the North and Northeast regions. Colorectal cancer had a general tendency to increase; with stability among men in the Capitals of the South region and among women of the Southeast and Midwest regions and, since 2007, a decrease among women in the South region. CONCLUSIONS: Cancer mortality showed great variation among residents of capitals and the interior of the country's major regions. Clear decrease in mortality was seen for the main types in the Southeast and South regions. The North and Northeast regions have patterns compatible with cancers associated with poverty, while the large increase of the cancers related to sedentary lifestyle stand out.
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Affiliation(s)
- Gulnar Azevedo E Silva
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Beatriz Cordeiro Jardim
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil.,Instituto Nacional de Câncer José Alencar Gomes da Silva. Rio de Janeiro, RJ, Brasil
| | - Vanessa de Melo Ferreira
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Washington Leite Junger
- Universidade do Estado do Rio de Janeiro. Instituto de Medicina Social. Departamento de Epidemiologia. Rio de Janeiro, RJ, Brasil
| | - Vania Reis Girianelli
- Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sérgio Arouca. Rio de Janeiro, RJ, Brasil
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Inequalities in the burden of female breast cancer in Brazil, 1990-2017. Popul Health Metr 2020; 18:8. [PMID: 32993727 PMCID: PMC7525962 DOI: 10.1186/s12963-020-00212-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 06/23/2020] [Indexed: 01/04/2023] Open
Abstract
Background Breast cancer is the most frequently diagnosed cancer in women and the leading cause of cancer death among females worldwide. In recent decades, breast cancer death rates have been stable or decreasing in more developed regions; however, this has not been observed in less developed regions. This study aims to evaluate inequalities in the burden of female breast cancer in Brazil including an analysis of interregional and interstate patterns in incidence, mortality and disability-adjusted life years (DALYs) rates from 1990 to 2017, and mortality-to-incidence ratio (MIR), and their association with the Socio-demographic Index (SDI). Methods Using estimates from the global burden of disease (GBD) study, we applied a spatial exploratory analysis technique to obtain measurements of global and local spatial correlation. Percentage changes of breast cancer incidence, mortality, and DALYs rates between 1990 and 2017 were calculated, and maps were developed to show the spatial distribution of the variables. Spatial panel models were adjusted to investigate the association between rates and SDI in Brazilian states. Results In Brazil, while breast cancer mortality rate have had modest reduction (−4.45%; 95% UI: −6.97; −1.76) between 1990 and 2017, the incidence rate increased substantially (+39.99%; 95% UI: 34.90; 45.39). Breast cancer incidence and mortality rates in 1990 and 2017 were higher in regions with higher SDI, i.e., the most developed ones. While SDI increased in all Brazilian states between 1990 and 2017, notably in less developed regions, MIR decreased, more notably in more developed regions. The SDI had a positive association with incidence rate and a negative association with MIR. Conclusion Such findings suggest an improvement in breast cancer survival in the period, which may be related to a broader access to diagnostic methods and treatment. This study also revealed the inequality in breast cancer outcomes among Brazilian states and may guide public policy priorities for disease control in the country.
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Giunta DH, Carvalho de Souza M, Kneipp Dias MB, Szklo M, de Almeida LM. Time trends and age-period-cohort analysis of cervical cancer mortality rate in Brazil. J Cancer Policy 2020; 25:100230. [PMID: 36895140 DOI: 10.1016/j.jcpo.2020.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 03/28/2020] [Accepted: 04/13/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Cervical cancer (CC) is a common preventable and curable disease that may lead to death. Our aim was to describe the patterns of time trends in CC mortality rates among women in Brazil from 1980 to 2017, and identify the influence of age, period and birth cohort (APC) stratified by region (North NR, Northeast NER, Southeast SER, South SR, Center-Western region CWR). METHODS We performed a time-series analysis using secondary data bases. Crude (MR) and WHO age-standardized CC mortality rates (aMR) were estimated per 100,000 women. We evaluated time trends using permutation joinpoint regression models (JP) and APC models to estimate the effect of APC on MR. RESULTS The JP analysis showed a temporal decrease in all regions, except the NR, which had an annual percentage increase of 0.44 (95%CI 0.2 - 0.7). MR in the NR was 2 to 4 times higher than in the other regions. We observed steady increases in MR with age in the NR and NER. A plateau after age 40 was observed in SER, SR, and CWR. The NR and NER MR ratio stabilized around the year 2000. Birth cohort effect showed decreasing MR ratio from 1900 to 1970 for all regions, except the NR, which showed increasing MR rate from older to more recent cohorts. CONCLUSION We showed relevant differences in cervical MR by region, which may reflect inequality in access to primary and secondary prevention as well as treatment, particularly in the NR.
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Affiliation(s)
- Diego Hernan Giunta
- Internal Medicine Research Unit / Research Department, Hospital Italiano de Buenos Aires, Tte. Gral. Juan Domingo Perón 4190, Ciudad Autónoma de Buenos Aires, CP C1199ABB, Argentina.
| | - Mirian Carvalho de Souza
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
| | - Maria Beatriz Kneipp Dias
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
| | - Moyses Szklo
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil; Division of Epidemiology, The Johns Hopkins University, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.
| | - Liz Maria de Almeida
- Population Research Division, National Cancer Institute, Ministry of Health Brazil, R. Marquês de Pombal, 125 - Centro, Rio de Janeiro, RJ 20230-240, Brazil.
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Ramos JLS, Figueiredo FWDS, Zuchelo LTS, Purcino FAC, Adami F, Goncalves R, Ruiz CA, Baracat EC, Soares Junior JM, Sorpreso ICE. Health Services, Socioeconomic Indicators, and Primary Care Coverage in Mortality by Lower Genital Tract and Breast Neoplasias in Brazilian Women during Reproductive and Non-Reproductive Periods. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5804. [PMID: 32796632 PMCID: PMC7460456 DOI: 10.3390/ijerph17165804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 06/11/2023]
Abstract
Women's health assistance at the low-complexity level is focused on the most common diseases and can be affected by primary health care coverage, particularly in areas far away from large urban centers. Thus, in this work, we aim to analyze the relationship between socioeconomic status, health care indicators, and primary care coverage in mortality from neoplasms of the lower genital tract and breast in Brazilian women during reproductive and non-reproductive periods. We conducted an ecological study at the Gynecology Discipline, Medicine School, University of São Paulo. Secondary data were collected from women according to reproductive periods and mortality data from the Mortality Information System based on International Classification of Disease-10th edition regarding breast and lower genital tract neoplasms in 2017. The health service and socioeconomic indicators were obtained from the Informatics Department of the Unified Health System and Brazilian Institute of Geography and Statistics. Our results showed that primary care coverage and health service indicators were not associated with mortality from breast cancer and the female lower genital tract, both in reproductive and non-reproductive periods. Sociodemographic indicators were found to be associated with mortality from breast cancer and the female lower genital tract, with income being associated with reproductive period (β = -0.4; 95% CI, -0.8 to -0.03) and educational level in the non-reproductive period (β = 9.7; 95% CI, 1.5 to 18.0).
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Affiliation(s)
- José Lucas Souza Ramos
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | | | - Lea Tami Suzuki Zuchelo
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | - Flávia Abranches Corsetti Purcino
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | - Fernando Adami
- Epidemiology and Data Analysis Laboratory, Faculdade de Medicina do ABC (FMABC), Santo André, SP 09060-870, Brazil; (F.W.d.S.F.); (F.A.)
| | - Rodrigo Goncalves
- Setor de Mastologia, Disciplina de Ginecologia, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 01246-000, Brazil;
| | - Carlos Alberto Ruiz
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | - Edmund Chada Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | - José Maria Soares Junior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
| | - Isabel Cristina Esposito Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP 05403-000, Brazil; (J.L.S.R.); (L.T.S.Z.); (F.A.C.P.); (C.A.R.); (E.C.B.); (J.M.S.J.)
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Universal cervical cancer control through a right to health lens: refocusing national policy and programmes on underserved women. BMC INTERNATIONAL HEALTH AND HUMAN RIGHTS 2020; 20:21. [PMID: 32736623 PMCID: PMC7393343 DOI: 10.1186/s12914-020-00237-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 07/13/2020] [Indexed: 12/30/2022]
Abstract
Background Cervical cancer claims 311,000 lives annually, and 90% of these deaths occur in low- and middle-income countries. Cervical cancer is a highly preventable and treatable disease, if detected through screening at an early stage. Governments have a responsibility to screen women for precancerous cervical lesions. Yet, national screening programmes overlook many poor women and those marginalised in society. Under-screened women (called hard-to-reach) experience a higher incidence of cervical cancer and elevated mortality rates compared to regularly-screened women. Such inequalities deprive hard-to-reach women of the full enjoyment of their right to sexual and reproductive health, as laid out in Article 12 of the International Covenant on Economic, Social and Cultural Rights and General Comment No. 22. Discussion This article argues first for tailored and innovative national cervical cancer screening programmes (NCSP) grounded in human rights law, to close the disparity between women who are afforded screening and those who are not. Second, acknowledging socioeconomic disparities requires governments to adopt and refine universal cancer control through NCSPs aligned with human rights duties, including to reach all eligible women. Commonly reported- and chronically under-addressed- screening disparities relate to the availability of sufficient health facilities and human resources (example from Kenya), the physical accessibility of health services for rural and remote populations (example from Brazil), and the accessibility of information sensitive to cultural, ethnic, and linguistic barriers (example from Ecuador). Third, governments can adopt new technologies to overcome individual and structural barriers to cervical cancer screening. National cervical cancer screening programmes should tailor screening methods to under-screened women, bearing in mind that eliminating systemic discrimination may require committing greater resources to traditionally neglected groups. Conclusion Governments have human rights obligations to refocus screening policies and programmes on women who are disproportionately affected by discrimination that impairs their full enjoyment of the right to sexual and reproductive health. National cervical cancer screening programmes that keep the right to health principles (above) central will be able to expand screening among low-income, isolated and other marginalised populations, but also women in general, who, for a variety of reasons, do not visit healthcare providers for regular screenings.
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de Souza BC, Dos Santos Figueiredo FW, de Alcantara Sousa LV, da Silva Maciel E, Adami F. Regional disparities in the flow of access to breast cancer hospitalizations in Brazil in 2004 and 2014. BMC Womens Health 2020; 20:137. [PMID: 32605615 PMCID: PMC7325567 DOI: 10.1186/s12905-020-00995-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Accepted: 06/18/2020] [Indexed: 12/25/2022] Open
Abstract
Background Access to the diagnosis and treatment of breast cancer in Brazil is marked by immense inequalities in the provision of specialized assistance, which leads patients to seek treatment outside the place of residence. To evaluate the variations between 2004 and 2014 in the distribution of flow between place of residence and care, and the average distance traveled for treatment of breast cancer in the administrative regions and federal states of Brazil. Method Analysis of secondary data from the years 2004 and 2014, extracted from the Department of Informatics of the Unified Health System through the Hospital Information System. Data from Hospitalization Release Authorizations were collected, and the maps were created with TabWin 3.6 software. Descriptive analysis was performed on Stata® (StataCorp, LC) 11.0. Results In the total flow, it was observed that there was a decrease in referrals between 2004 and 2014 in most regions. In 2004 the main direction of flow was in the Midwest and Southeast regions. In 2014, however, the intensity of these admissions was centralized in the Southeast region. In relation to the average distance traveled, the North, Northeast, and Midwest regions had the highest values of displacement. Of the 27 federative units, 17 presented an increase in average distance between these periods. Conclusion Despite the improvement in the hospitalization of residents, in most regions and federal units, Brazilians still travel great distances when they require treatment for breast cancer.
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Affiliation(s)
- Beatriz Castro de Souza
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil.
| | | | - Luiz Vinicius de Alcantara Sousa
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
| | - Erika da Silva Maciel
- Universidade Federal do Tocantins, Campus Miracema. Avenida Lourdes Solino s/n°, Setor Universitário, Miracema, Tocantins, Brazil
| | - Fernando Adami
- Laboratório de Epidemiologia e Análise de Dados, Faculdade de Medicina do ABC - FMABC, Av. Lauro Gomes, 2000. Santo André, São Paulo, 09060-870, Brazil
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Abstract
Background Cervical cancer represents an important preventable cause of morbidity and mortality in developing countries such as Brazil. Investigating temporal evolution of a disease burden in the different realities of the country is essential for improving public policies. Objective To describe the national and subnational burden of cervical cancer, based on the estimates of the 2017 Global Burden of Disease study. Methods Descriptive study of premature mortality (years of life lost [YLL]) and burden of disease (disability-adjusted life years [DALYs]) associated with cervical cancer among Brazilian women aged 25-64 years, between 2000 and 2017. Findings During the study period, age-standardized incidence decreased from 23.53 (22.79-24.26) to 18.39 (17.63-19.17) per 100,000 women, while mortality rates decreased from 11.3 (11.05-11.56) to 7.74 (7.49-8.02) per 100,000 women. These rates were about two to three times greater than equivalent rates in a developed country, such as England: 11.98 (11.45-12.55) to 10.37 (9.85-10.9), and 3.75 (3.68-3.84) to 2.82 (2.75-2.9) per 100,000 women, respectively. Poorer regions of Brazil had greater rates of the disease; for instance, Amapá State in the Northern Region had rates twice as high as the national rates during the same period. Cervical cancer was the leading cause of premature cancer-related mortality (YLL = 100.69, 91.48-110.61 per 100,000 women) among young women (25-29 years) in Brazil and eight federation units of all country regions except the Southeast in 2017. There was a decrease in the burden of cervical cancer in Brazil from 339.59 (330.82-348.83) DALYs per 100,000 women in 2000 to 238.99 (230.45-247.99) DALYs per 100,000 women in 2017. Conclusion Although there has been a reduction in the burden of cervical cancer in Brazil, the rates remain high, mainly among young women. The persistence of inequalities between regions of Brazil suggests the importance of socioeconomic determinants in the burden for this cancer.
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Tallon B, Monteiro D, Soares L, Rodrigues N, Morgado F. Tendências da mortalidade por câncer de colo no Brasil em 5 anos (2012-2016). SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO O câncer do colo uterino é uma importante causa de morte no Brasil. O objetivo deste estudo é avaliar a mortalidade por esse câncer na população brasileira, entre 2012 e 2016, conhecendo a mortalidade nos grupos etários e nas diferentes regiões. Foi realizado um estudo de corte transversal descritivo. Os dados foram obtidos pelo Sistema de Informações sobre Mortalidade. Entre 2012 e 2016, o total de óbitos por câncer do colo do útero foi de 27.716 casos. A taxa de mortalidade específica para o Brasil passou de 6,86 para 7,18. O crescimento do coeficiente de mortalidade foi de 4,6%. Nas mulheres abaixo de 25 anos, observaram-se 189 mortes, o que equivale a 0,68% do total. Entre 25 e 64 anos, houve 18.574 óbitos (67,02%), e 8.950 mortes no grupo acima de 64 anos (32,29%). O maior percentual de óbitos ocorreu na faixa etária de 50-54 anos. A região Norte apresentou os maiores índices de óbitos e taxas de mortalidade, e o Sul o maior índice de crescimento. A mortalidade por câncer do colo uterino no Brasil apresentou crescimento durante os anos observados, com mais óbitos entre 50-54 anos. A região Sul apresentou o maior crescimento nas taxas de mortalidade.
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Affiliation(s)
| | - Denise Monteiro
- Centro Universitário Serra dos Órgãos, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | - Leila Soares
- Universidade do Estado do Rio de Janeiro, Brasil
| | - Nádia Rodrigues
- Universidade do Estado do Rio de Janeiro, Brasil; Fundação Oswaldo Cruz, Brasil
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Tallon B, Monteiro D, Soares L, Rodrigues N, Morgado F. Trends in cervical cancer mortality in Brazil in 5 years (2012-2016). SAÚDE EM DEBATE 2020. [DOI: 10.1590/0103-1104202012506i] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O câncer do colo uterino é uma importante causa de morte no Brasil. O objetivo deste estudo é avaliar a mortalidade por esse câncer na população brasileira, entre 2012 e 2016, conhecendo a mortalidade nos grupos etários e nas diferentes regiões. Foi realizado um estudo de corte transversal descritivo. Os dados foram obtidos pelo Sistema de Informações sobre Mortalidade. Entre 2012 e 2016, o total de óbitos por câncer do colo do útero foi de 27.716 casos. A taxa de mortalidade específica para o Brasil passou de 6,86 para 7,18. O crescimento do coeficiente de mortalidade foi de 4,6%. Nas mulheres abaixo de 25 anos, observaram-se 189 mortes, o que equivale a 0,68% do total. Entre 25 e 64 anos, houve 18.574 óbitos (67,02%), e 8.950 mortes no grupo acima de 64 anos (32,29%). O maior percentual de óbitos ocorreu na faixa etária de 50-54 anos. A região Norte apresentou os maiores índices de óbitos e taxas de mortalidade, e o Sul o maior índice de crescimento. A mortalidade por câncer do colo uterino no Brasil apresentou crescimento durante os anos observados, com mais óbitos entre 50-54 anos. A região Sul apresentou o maior crescimento nas taxas de mortalidade.
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Affiliation(s)
| | - Denise Monteiro
- Centro Universitário Serra dos Órgãos, Brasil; Universidade do Estado do Rio de Janeiro, Brasil
| | - Leila Soares
- Universidade do Estado do Rio de Janeiro, Brasil
| | - Nádia Rodrigues
- Universidade do Estado do Rio de Janeiro, Brasil; Fundação Oswaldo Cruz, Brasil
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Meira KC, Silva GWDS, dos Santos J, Guimarães RM, de Souza DLB, Ribeiro GPC, Dantas ESO, de Carvalho JBL, Jomar RT, Simões TC. Analysis of the effects of the age-period-birth cohort on cervical cancer mortality in the Brazilian Northeast. PLoS One 2020; 15:e0226258. [PMID: 32074101 PMCID: PMC7029866 DOI: 10.1371/journal.pone.0226258] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Accepted: 11/23/2019] [Indexed: 12/11/2022] Open
Abstract
Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980-2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.
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Affiliation(s)
- Karina Cardoso Meira
- Health School, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Juliano dos Santos
- Cancer Hospital III, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Gilcilene Pretta Cani Ribeiro
- Biologist, specialist in management in Health Systems and Services, State Secretariat of Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | | | - Rafael Tavares Jomar
- Assistance Coordination, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Taynãna César Simões
- René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
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Fantin R, Santamaría‐Ulloa C, Barboza‐Solís C. Socioeconomic inequalities in cancer mortality: Is Costa Rica an exception to the rule? Int J Cancer 2020; 147:1286-1293. [DOI: 10.1002/ijc.32883] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 12/16/2019] [Accepted: 01/08/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Romain Fantin
- Centro Centroamericano de Población Universidad de Costa Rica San José Costa Rica
- Escuela de Salud Pública, Facultad de Medicina Universidad de Costa Rica San José Costa Rica
- Escuela de Medicina, Facultad de Medicina Universidad de Costa Rica San José Costa Rica
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Vargas AC, Dell Agnolo C, Melo WAD, Pelloso FC, Santos LD, Carvalho MDDB, Pelloso SM. Trends in Cervical Cancer Mortality in Brazilian Women who are Screened and Not Screened. Asian Pac J Cancer Prev 2020; 21:55-62. [PMID: 31983164 PMCID: PMC7294021 DOI: 10.31557/apjcp.2020.21.1.55] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 11/26/2022] Open
Abstract
Objective: This study aimed to analyze the trend in cervical cancer (ICD C53) mortality in Brazilian regions in women who are who are screened and not screened from 1996 to 2015. Methods: An epidemiological study, of time series of mortality from cervical cancer performed in 90,856 women under 24 years old (343 women), between 25 and 64 years old (32,703 women), and over 65 years old (10,909 women). The data from this research were collected from the DATASUS, from the SIM Health Surveillance Secretariat files, captured through TABNET selecting the resident population by gender and age group and ICD 10 C53 from 1996 to 2015. Results: Among women, 43.8% were white, and 76% had less than eight years of formal education. Polynomial regression showed an increasing trend in cervical cancer mortality in Brazil for women aged 15 - 24 years (p=0.01). Between 25 - 64 and 65 years or older it remained constant, but high (p=0.07; 0.99). The Northeast region pointed a growing trend in women aged 15 to 24 (p=0.01), 25 to 64 years (p=0.01) and 65 or older (p=0.001). The Northeast presented the highest average growth per year. In the Southeast, South and Midwest regions, decreasing trends were observed despite the high rates. The Joinpoint regression showed a 95% confidence interval, and that mortality from cervical cancer in the North region increased throughout the period analyzed. an increasing trend was observed from 1996 to 1998, whereas in the Midwest region, the trend remained stable throughout the period analyzed. The Federal District presented an upward trend from 1996 to 2015. In Brazil, an upward trend was observed throughout the whole period analyzed. Conclusions: Cervical cancer mortality in younger women is becoming more predominant, in addition to the high rate observed for women aged 65 or older.
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Affiliation(s)
- Adriana Cunha Vargas
- Department of Health Sciences, Maringá State University, Maringa, Paraná, Brazil
| | - Catia Dell Agnolo
- Department of Health Sciences, Maringá State University, Maringa, Paraná, Brazil
| | - Willian Augusto de Melo
- Department of Nursing, Paraná State University, UNESPAR Av. Gabriel Esperidião, S / N - Jd. Morumbi, Paranavaí, Brazil
| | | | - Lander Dos Santos
- Department of Medicine, Maringá State University, Maringa, Paraná, Brazil
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Sousa GJB, Garces TS, Pereira MLD, Moreira TMM, Silveira GMD. Temporal pattern of tuberculosis cure, mortality, and treatment abandonment in Brazilian capitals. Rev Lat Am Enfermagem 2019; 27:e3218. [PMID: 31826160 PMCID: PMC6896801 DOI: 10.1590/1518-8345.3019.3218] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 08/15/2019] [Indexed: 12/02/2022] Open
Abstract
Objective: to analyze the temporal pattern of tuberculosis cure, mortality, treatment abandonment in Brazilian capitals. Method: this is an ecological study whose data source was the Information System of Notifiable Diseases for Tuberculosis (Sistema de Informação de Agravos de Notificação para Tuberculose). For analysis of temporal evolution, regressions by join points were performed considering the annual percentage variation and the significance of the trend change with 95% confidence interval. Results: 542,656 cases of tuberculosis were found, with emphasis on a 3% decrease per year in the cure rate for Campo Grande (interval: −5.0 - −0.9) and a 3.5% increase for Rio de Janeiro (interval: 1.9 - 4.7). Regarding abandonment, it decreased 10.9% per year in Rio Branco (interval: −15.8 - −5.7) and increased 12.8% per year in Fortaleza (interval: 7.6 - 18.3). For mortality, a decreasing or stationary tendency was identified, with a greater decrease (7.8%) for Porto Velho (interval:−11.0 - −5.0) and a lower one (2.5%) in Porto Alegre (interval:−4.5 - −0.6). Conclusion: the rates of cure and abandonment are far from the ones recommended by the World Health Organization, showing that Brazilian capitals need interventions aimed at changing this pattern.
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Affiliation(s)
- George Jó Bezerra Sousa
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico, Fortaleza, CE, Brazil
| | - Thiago Santos Garces
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES), Brazil
| | | | | | - Germana Maria da Silveira
- Universidade Estadual do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil.,Bolsista da Fundação Cearense de Apoio ao Desenvolvimento Científico e Tecnológico, Fortaleza, CE, Brazil
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Nuche-Berenguer B, Sakellariou D. Socioeconomic determinants of cancer screening utilisation in Latin America: A systematic review. PLoS One 2019; 14:e0225667. [PMID: 31765426 PMCID: PMC6876872 DOI: 10.1371/journal.pone.0225667] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 11/08/2019] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Cancer incidence and mortality in Latin America are rising. While effective cancer screening services, accessible to the whole population and enabling early cancer detection are needed, existing research shows the existence of disparities in screening uptake in the region. OBJECTIVE We conducted a systematic review to investigate the socioeconomic determinants for the disparities in the use of breast, cervical and colorectal cancer screening services in Latin America. METHODS We searched for studies reporting on socioeconomic determinants impacting on access to breast, cervical and colorectal cancer screening, published from 2009 through 2018. The studies that qualified for inclusion contained original analyses on utilisation of breast, cervical and colorectal cancer screening across socioeconomic levels in Latin America. For each study, paired reviewers performed a quality analysis followed by detailed review and data extraction. RESULTS Twenty-four articles that met the eligibility criteria and were of sufficient quality were included in this review. Thirteen of the included articles were written in English, eight in Portuguese and three in Spanish, and they reported on the use of breast or cervical cancer screening. No studies were found on the socioeconomic determinants regarding the utilisation of colorectal cancer screening in Latin America. Low income, low education level, lack of health insurance and single marital status were all found to be determinants of underuse of breast and cervical cancer screening services. CONCLUSIONS Cancer screening programs in the region must prioritize reaching those populations that underuse cancer screening services to ensure equitable access to preventive services. It is important to develop national screening programmes that are accessible to all (including uninsured people) through, for example, the use of mobile units for mammography and self-screening methods.
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Affiliation(s)
| | - Dikaios Sakellariou
- School of Healthcare Sciences, Cardiff University, Cardiff, United Kingdom
- * E-mail:
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Silva AMC, Campos PHN, Mattos IE, Hajat S, Lacerda EM, Ferreira MJM. Environmental Exposure to Pesticides and Breast Cancer in a Region of Intensive Agribusiness Activity in Brazil: A Case-Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16203951. [PMID: 31627286 PMCID: PMC6843507 DOI: 10.3390/ijerph16203951] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 10/07/2019] [Accepted: 10/10/2019] [Indexed: 12/24/2022]
Abstract
Background: Breast cancer is a serious public health problem and is the second most prevalent cancer type in the world. The purpose of this article is to evaluate the association between pesticide use and breast cancer in a region of intense agribusiness activity in the state of Mato Grosso, Brazil. Methods: A case-control study was conducted on women living in the city of Rondonópolis, in the south of Mato Grosso state. There were 85 cases of women with confirmed breast cancer and 266 controls who were randomly selected from primary health care users. Bivariate and stratified analyses were performed. Multiple logistic regression was then performed, keeping in the final model the factors with a significance level lower than or equal to 0.05 or considered important according to apriori biological criteria. Results: In the final model, living near cropland with pesticides (OR: 2.37; CI: 95% 1.78–3.16) and women aged over 50 years who experienced early menarche (OR: 2.08; CI: 95% 1.06–4.12) had a higher risk of developing breast cancer compared to control subjects. Conclusion: This study highlights the importance of exposure to pesticides as an environmental risk factor for the development of breast cancer among women.
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Affiliation(s)
- Ageo M C Silva
- Post Graduated Program of Environment and Health, Cuiaba University, Cuiabá 78065900, Brazil.
| | - Paulo H N Campos
- Post Graduated Program of Environment and Health, Cuiaba University, Cuiabá 78065900, Brazil.
| | - Inês E Mattos
- National School of Public Health, Fundação Oswaldo Cruz, Rio de Janeiro 21041-210, Brazil.
| | - Shakoor Hajat
- London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Eliana M Lacerda
- London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK.
| | - Marcelo J M Ferreira
- Post Graduated Program of Public Health, Medicine School, Federal University of Ceará, Fortaleza 60430-140, Brazil.
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Incidence of cervical cytological abnormalities following a negative smear result in an opportunistic screening scenario: A cohort study. Eur J Obstet Gynecol Reprod Biol 2019; 242:103-108. [PMID: 31580961 DOI: 10.1016/j.ejogrb.2019.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 03/21/2019] [Accepted: 09/19/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To analyse the incidence of atypical cells and their risk factors in an opportunistic screening context. STUDY DESIGN This cohort study with passive follow-up is based on analysis of 86,609 women living in Maranhão State - Brazil, who had a negative cervical cytological test recorded in the Cervical Cancer Information System (SISCOLO) in 2007 and who had at least 1 follow-up test up to 31 December 2012. The cumulative incidence (CI) and incidence rate (IR) of low grade squamous intraepithelial lesion (LSIL) and high-grade squamous intraepithelial lesions and cancer (HSIL+) were calculated. A Cox regression model was used to identify independent factors associated with the risk of presenting atypical cells. RESULTS At 60 months follow-up the CI of LSIL reached 10.7 per 1000 and that of HSIL + was 3.9 per 1000. LSIL and HSIL + IRs were 334.7 and 120.3 per 100,000 person-years (PYs), respectively. LSIL and HSIL + occurred in 65.0% and 57.3% of women <3 years after the study entry, respectively. The risk of presenting HSIL + increased when a previous cervical cytological test had not been performed, with advancing age and when the Municipal Human Development Index (MHDI) decreased. CONCLUSION This study highlights a significant tendency towards increased IR and risk of presenting HSIL + as MHDI decreased.
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Ali MS, Ichihara MY, Lopes LC, Barbosa GC, Pita R, Carreiro RP, dos Santos DB, Ramos D, Bispo N, Raynal F, Canuto V, de Araujo Almeida B, Fiaccone RL, Barreto ME, Smeeth L, Barreto ML. Administrative Data Linkage in Brazil: Potentials for Health Technology Assessment. Front Pharmacol 2019; 10:984. [PMID: 31607900 PMCID: PMC6768004 DOI: 10.3389/fphar.2019.00984] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 07/31/2019] [Indexed: 12/17/2022] Open
Abstract
Health technology assessment (HTA) is the systematic evaluation of the properties and impacts of health technologies and interventions. In this article, we presented a discussion of HTA and its evolution in Brazil, as well as a description of secondary data sources available in Brazil with potential applications to generate evidence for HTA and policy decisions. Furthermore, we highlighted record linkage, ongoing record linkage initiatives in Brazil, and the main linkage tools developed and/or used in Brazilian data. Finally, we discussed the challenges and opportunities of using secondary data for research in the Brazilian context. In conclusion, we emphasized the availability of high quality data and an open, modern attitude toward the use of data for research and policy. This is supported by a rigorous but enabling legal framework that will allow the conduct of large-scale observational studies to evaluate clinical, economical, and social impacts of health technologies and social policies.
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Affiliation(s)
- M Sanni Ali
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), Center for Statistics in Medicine (CSM), University of Oxford, Oxford, United Kingdom
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Maria Yury Ichihara
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
- Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil
| | | | - George C.G. Barbosa
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Robespierre Pita
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Roberto Perez Carreiro
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | | | - Dandara Ramos
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Nivea Bispo
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Fabiana Raynal
- Department of Management and Incorporation of Health Technology, Ministry of Health (DGITS/MS), Brasília, Brazil
| | - Vania Canuto
- Department of Management and Incorporation of Health Technology, Ministry of Health (DGITS/MS), Brasília, Brazil
| | - Bethania de Araujo Almeida
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Rosemeire L. Fiaccone
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
- Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil
- Department of Statistics, Federal University of Bahia (UFBA), Salvador, Brazil
| | - Marcos E. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
- Department of Computing, Federal University of Bahia (UFBA), Salvador, Brazil
- Institute of Health Informatics, University College London, London, United Kingdom
| | - Liam Smeeth
- Faculty of Epidemiology and Population Health, Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
| | - Mauricio L. Barreto
- Centre for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Muniz, Fundação Osvaldo Cruz, Salvador, Brazil
- Institute of Public Health, Federal University of Bahia (UFBA), Salvador, Brazil
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Ribeiro CM, Dias MBK, Pla MAS, Correa FM, Russomano FB, Tomazelli JG. [Parameters for programming line of care procedures for cervical cancer in Brazil]. CAD SAUDE PUBLICA 2019; 35:e00183118. [PMID: 31291431 DOI: 10.1590/0102-311x00183118] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 02/06/2019] [Indexed: 11/22/2022] Open
Abstract
The study estimated parameters for planning and programming the supply of procedures for screening, diagnostic workup, and treatment of precursor lesions of uterine cervical cancer. These estimates were used as the basis for assessing the adequacy of Brazil's production of procedures performed by the Brazilian Unified National Health System (SUS) in 2017. Estimates were calculated using as the reference the recommended management in the national screening guidelines. Data on screening tests were obtained from the Information System on Uterine Cervical Cancer and the follow-up data from patient charts in a referral center for cervical pathology. Brazil's production of procedures was obtained from data in the Outpatient and Hospital Information Systems of the SUS. For every one hundred thousand women in the target age bracket for screening (25 to 64 years) there was an estimated annual need for 44,134 cytopathology tests, 1,886 colposcopies, 275 biopsies, 236 type 1 and 2 outpatient exicision procedures, 236 type 2 and 3 hospital exicision procedures, and 39 high-complexity referrals for surgery, chemotherapy, and/or radiotherapy. Applying the estimated parameters to the number of women screened in Brazil in 2017, a deficit was identified in all the procedures for adequate follow-up of the women with altered test results, varying from 7% in colposcopies to 74% in type 3 excisions. The results point to the need to expand and upgrade the supply of line of care procedures for cervical cancer. The estimated parameters can support policymakers in programming and implementing organized screening programs.
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Affiliation(s)
| | | | | | | | - Fábio Bastos Russomano
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Oliveira MMD, Nomellini PF, Curado MP. Cancer Mortality Among Adolescents and Young Adults (15–29 Years Old) According to the Population Size of Brazilian Municipalities. J Adolesc Young Adult Oncol 2019; 8:262-271. [DOI: 10.1089/jayao.2018.0096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Patrícia Ferreira Nomellini
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Health Secretariat of the State of Tocantins, Palmas, Brazil
- Health Secretariat of the City of Palmas, Palmas, Brazil
| | - Maria Paula Curado
- Epidemiology and Statistics Group, ACCamargo Cancer Center, São Paulo, Brazil
- Graduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
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Azevedo PRM, Rocha JB, Fernandes TAADM, Fernandes JV. Analysis of cervical cancer mortality rate trends in Natal-RN, Brazil, between 2000 and 2012. Rev Salud Publica (Bogota) 2019; 21:161-167. [DOI: 10.15446/rsap.v21n2.68893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 02/16/2019] [Indexed: 11/09/2022] Open
Abstract
Objective To describe cervical cancer mortality rates and their corresponding trends, and to analyze the spatial correlations of this type of cancer in Natal-RN, Brazil, between 2000 and 2012.Materials and Methods The simple linear regression model, the empirical Bayes method and the Global Moran's index were used for the statistical analysis.Results The mortality coefficient of cervical cancer in Natal, standardized by age range, was 5.5 per 100 000 women. All historical series for the coefficients studied were classifiedas stable. The Global Moran's index obtained was 0.048, with a p-value for the spatial test correlation between neighborhoods of 0.300. The average family income by neighborhood showed no significant correlation to cervical cancer mortality rates.Conclusion This study found a temporal stabilization and spatial independence trend of cervical cancer mortality rates in women from Natal, as well as the absence of correlationbetween these rates and the average family income of the of the participating women distributed by neighborhoods. In view of this, changes in the public policies should be made aimed at preventing the disease; adopting these measures could positively impact the screening program, improving the coverage of Pap smears and immunization campaigns against HPV, in order to reverse this trend and achieve a reduction of mortality rates.
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Corrêa CSL, Leite ICG, Andrade APS, Carvalho SM, Borges RM, Guerra MR. Qualidade de vida e fatores associados em mulheres sobreviventes ao câncer do colo do útero. HU REVISTA 2019. [DOI: 10.34019/1982-8047.2017.v43.2898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
O tratamento para o câncer do colo do útero pode levar à ocorrência de efeitos adversos tardios, como disfunções sexuais, intestinais ou urinárias; menopausa precoce e linfedema em membro inferior, os quais podem ter impacto negativo na qualidade de vida. O objetivo do estudo foi avaliar a qualidade de vida de sobreviventes ao câncer do colo do útero, seus fatores associados e comparar a qualidade de vida com um grupo controle de mulheres sem história de câncer. O grupo câncer foi composto por mulheres com término do tratamento há três meses (n= 37). O grupo controle, de base populacional, foi composto por mulheres sem história de câncer (n= 37). A qualidade de vida foi avaliada pelo WHOQOL-bref e a função sexual pelo Female Sexual Function Índex. Variáveis clínicas, terapêuticas e socioeconômicas foram avaliadas por questionário desenvolvido pelos autores. Em comparação ao controle, o grupo câncer apresentou maior percentual de mulheres que viviam sem companheiro, que consideravam o relacionamento com o companheiro como ruim/regular e que apresentavam disfunções urinárias, intestinais e sexuais. Além disso, o grupo câncer apresentou piores escores nos domínios “Físico” e “Relações Sociais” do WHOQOL-bref (p=0,03 e 0,01, respectivamente). Foram fatores independentemente associados ao domínio “Físico”: linfedema de membros inferiores e retenção urinária; e ao domínio “Relações Sociais”: apoio social de amigos e estenose/encurtamento vaginal. Os resultados sugerem impacto negativo da doença e de seu tratamento sobre a qualidade de vida das sobreviventes. Deve-se investigar a qualidade de vida e os fatores que a influenciam, visando um atendimento mais integral, direcionado às necessidades das pacientes, por meio de equipe multiprofissional.
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da Costa AM, Hashim D, Fregnani JHTG, Weiderpass E. Overall survival and time trends in breast and cervical cancer incidence and mortality in the Regional Health District (RHD) of Barretos, São Paulo, Brazil. BMC Cancer 2018; 18:1079. [PMID: 30404614 PMCID: PMC6223073 DOI: 10.1186/s12885-018-4956-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 10/15/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Breast and cervical cancers represent a significant cause of morbidity and mortality among women. The purpose of this study was to analyse the survival and time trends in two of the most common female cancers in the Regional Health District (RHD) of Barretos, São Paulo, Brazil. METHODS From 2000 through 2015, we calculated the breast and cervical cancer incidence and mortality rates per 100,000 women who were age-standardized to the world population. We obtained the time trends using the Joinpoint Regression software. We estimated the overall survival rates using the Kaplan-Meier methods. RESULTS The age-standardized rates (ASR) for incidence of breast cancer increased annually, with an average annual percentage change (AAPC) of 4.3 (95% Confidence Interval (CI): 2.4 to 6.3) for invasive breast cancer and 10.2 (95% CI: 6.1 to 14.5) for in situ breast cancer. The mortality rates for invasive breast cancer decreased with an AAPC of 0.2 (95% CI: -1.9 to 2.4). The ASR incidence of invasive cervical cancer showed an AAPC of - 1.9 (95% CI: -4.7 to 0.9). For in situ cases, the ASR showed an AAPC of 9.3 (95% CI: 3.3 to 15.7). The ASR mortality for cervical cancer showed an AAPC of - 5.3 (95% CI: -9.5 to - 0.8). The Kaplan-Meier analysis indicated 5-year overall survival rates of 74.3% for breast cancer and 70.7% for cervical cancer. CONCLUSIONS The incidence of in situ and invasive breast cancer is increasing, while the mortality rates remain stable. We observed an increase in the incidence of in situ cervical cancer and a decrease in invasive incidence rates during the study period, and we noted that the cervical cancer mortality significantly declined during the study period.
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Affiliation(s)
- Allini Mafra da Costa
- Hospital-Based Cancer Registry, Barretos Cancer Hospital, Rua Antenor Duarte Vilela, 1331, Dr. Paulo Prata, Barretos, São Paulo 14784-400 Brazil
- Population-Based Cancer Registry of Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
- Institute of Education and Research, Barretos Cancer Hospital, Barretos, São Paulo 14784-400 Brazil
| | - Dana Hashim
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
| | | | - Elisabete Weiderpass
- Department of Research, Cancer Registry of Norway, Institute of Population-Based Cancer Research, Oslo, Norway
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Community Medicine, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, Tromsø, Norway
- Genetic Epidemiology Group, Folkhälsan Research Center, Helsinki, Finland
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Nascimento SGD, Carvalho CPALD, Silva RSD, Oliveira CMD, Bonfim CVD. Decline of mortality from cervical cancer. Rev Bras Enferm 2018; 71:585-590. [PMID: 29562015 DOI: 10.1590/0034-7167-2016-0530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2016] [Accepted: 09/07/2017] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To describe occurrences of mortality due to cervical cancer in Recife (PE), in northeastern Brazil. METHOD This was a time-series ecological study using data from the Mortality Information System (SIM) regarding the total number of deaths due to cervical cancer (C53 ICD10) that occurred between 2000 and 2012. RESULTS It was observed that the risk of death due to this form of cancer was higher among women over 60 years of age, those of mixed skin color (53.24%), those who only worked at home (63.16%) and those who did not have a partner (44.32%). CONCLUSION Additional efforts towards maintaining early detection and health education programs and towards using therapeutic strategies of greater efficiency are needed, given that mortality due to this form of cancer is considered avoidable when diagnosed early.
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Affiliation(s)
| | | | - Ricarlly Soares da Silva
- State Secretariat of Health of Pernambuco, Department of Health Surveillance. Recife, Pernambuco, Brazil
| | | | - Cristine Vieira do Bonfim
- Universidade Federal de Pernambuco, Postgraduate Program in Public Health. Recife, Pernambuco, Brazil
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Panis C, Kawasaki ACB, Pascotto CR, Justina EYD, Vicentini GE, Lucio LC, Prates RTC. Critical review of cancer mortality using hospital records and potential years of life lost. ACTA ACUST UNITED AC 2018; 16:eAO4018. [PMID: 29694620 PMCID: PMC5968795 DOI: 10.1590/s1679-45082018ao4018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/04/2017] [Indexed: 12/21/2022]
Abstract
Objective To determine and discuss cancer mortality rates in southern Brazil between 1988 and 2012. Methods This was a critical review of literature based on analysis of data concerning incidence and mortality of prostate cancer, breast cancer, bronchial and lung cancer, and uterine and ovarian cancer. Data were collected from the online database of the Brazil Instituto Nacional de Câncer José Alencar Gomes da Silva. Results The southern Brazil is the leading region of cancer incidence and mortality. Data on the cancer profile of this population are scarce especially in the States of Santa Catarina and Paraná. We observed inconsistency between data from hospital registers and death recorded. Conclusion Both cancer incidence and the mortality are high in Brazil. In addition, Brazil has great numbers of registers and deaths for cancer compared to worldwide rates. Regional risk factors might explain the high cancer rates.
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Affiliation(s)
- Carolina Panis
- Universidade Estadual do Oeste do Paraná, Francisco Beltrão, PR, Brazil
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Fayer VA, Guerra MR, Cintra JRD, Bustamante-Teixeira MT. Ten-year survival and prognostic factors for breast cancer in the southeast region of Brazil. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2018; 19:766-778. [PMID: 28146166 DOI: 10.1590/1980-5497201600040007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 05/31/2016] [Indexed: 11/22/2022] Open
Abstract
Introduction: Breast cancer is an important public health issue in many parts of the world. Thus, it shows relevant incidence and is considered one of the main causes of death from cancer among women. Objective: To analyze ten-year survival and prognostic factors in women with invasive breast cancer. Methods: The cohort was composed of 195 women assisted in an oncology referral center in the municipality of Juiz de Fora, state of Minas Gerais, Brazil, who were diagnosed with the disease in 2000 and 2001. Sociodemographic, tumoral, health service, and treatment-related characteristics were analyzed. The Kaplan-Meier method was used to estimate the survival functions and the Cox model of proportional hazards for the evaluation of prognostic factors. Results: The ten-year survival after diagnosis was of 56.3%. The major independent prognostic factors associated with increased risk of death were tumor size > 2.0 cm (hazard ratio - HR = 1.9; confidence interval - 95%CI 1.0 - 3.2) and presence of compromised lymph nodes (HR = 3.7; 95%CI 2.1 - 5.9). Conclusion: These findings reinforce the need of adopting actions that ensure access of the target population to the recommended diagnostic and therapeutic modalities, thus contributing to achieve earlier diagnosis and better survival rates.
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Affiliation(s)
- Vívian Assis Fayer
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil
| | - Maximiliano Ribeiro Guerra
- Programa de Pós-Graduação em Saúde Coletiva, Universidade Federal de Juiz de Fora - Juiz de Fora (MG), Brasil
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Jerônimo AFDA, Freitas ÂGQ, Weller M. Risk factors of breast cancer and knowledge about the disease: an integrative revision of Latin American studies. CIENCIA & SAUDE COLETIVA 2018; 22:135-149. [PMID: 28076537 DOI: 10.1590/1413-81232017221.09272015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 10/24/2015] [Indexed: 11/22/2022] Open
Abstract
The aim of this integrative review was to compare Latin American literature about risk and knowledge on breast cancer. Of 47 studies selected, 20 were about knowledge or awareness and 27 about risk of breast cancer. English was the dominant language in studies about risk, whereas studies about knowledge were mainly written in Spanish or Portuguese. Studies about knowledge were all cross- sectional, whereas case- control studies dominated authors' interest about risk of breast cancer. Studies about knowledge were mainly focused on early detection of the disease and the most common study objective was breast self- examination (N = 14). In contrast, few studies about risk of breast cancer focused on early detection (N = 5). Obesity and overweight (N = 14), family history (N = 13), decreased parity (N = 12), and short breastfeeding duration (N = 10) were among the most frequent identified risk factors. Socio- economic factors such as income and educational level had variable effects on breast cancer risk and affected also knowledge of women about risk factors and early detection. Present results indicated that studies about risk of breast cancer were more often based on a better sound analytical background, compared to studies about knowledge, which were mostly descriptive.
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Affiliation(s)
- Aline Ferreira de Araújo Jerônimo
- Programa de Pós-Graduação em Saúde Pública, Universidade Estadual da Paraíba. R. Baraúnas 351, Universitário. 58429-500 Campina Grande PB Brasil.
| | - Ângela Gabrielly Quirino Freitas
- Programa de Pós-Graduação em Saúde Pública, Universidade Estadual da Paraíba. R. Baraúnas 351, Universitário. 58429-500 Campina Grande PB Brasil.
| | - Mathias Weller
- Programa de Pós-Graduação em Saúde Pública, Universidade Estadual da Paraíba. R. Baraúnas 351, Universitário. 58429-500 Campina Grande PB Brasil.
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