Education, tobacco smoking, alcohol consumption, and IL-2 and IL-6 gene polymorphisms in the survival of head and neck cancer

The association of education, tobacco smoking, alcohol consumption, and interleukin-2 (IL-2 +114 and -384) and -6 (IL-6 -174) DNA polymorphisms with head and neck squamous cell carcinoma (HNSCC) was investigated in a cohort study of 445 subjects. IL-2 and IL-6 genotypes were determined by real-time PCR. Cox regression was used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of disease-specific survival according to anatomical sites of the head and neck. Mean age was 56 years and most patients were males (87.6%). Subjects with 5 or more years of schooling had better survival in larynx cancer. Smoking had no effect on HNSCC survival, but alcohol consumption had a statistically significant effect on larynx cancer. IL-2 gene +114 G/T (HR = 0.52; 95%CI = 0.15-1.81) and T/T (HR = 0.22; 95%CI = 0.02-3.19) genotypes were associated with better survival in hypopharynx cancer. IL-2 +114 G/T was a predictor of poor survival in oral cavity/oropharynx cancer and larynx cancer (HR = 1.32; 95%CI = 0.61-2.85). IL-2 -384 G/T was associated with better survival in oral cavity/oropharynx cancer (HR = 0.80; 95%CI = 0.45-1.42) and hypopharynx cancer (HR = 0.68; 95%CI = 0.21-2.20), but an inverse relationship was observed for larynx cancer. IL-6 -174 G/C was associated with better survival in hypopharynx cancer (HR = 0.68; 95%CI = 0.26-1.78) and larynx cancer (HR = 0.93; 95%CI = 0.42-2.07), and C/C reduced mortality in larynx cancer. In general, our results are similar to previous reports on the value of education, smoking, alcohol consumption, and IL-2 and IL-6 genetic polymorphisms for the prognosis of HNSCC, but the risks due to these variables are small and estimates imprecise.

Alcohol and tobacco, and the risk of cancers of the upper aerodigestive tract in Latin America: a case-control study

BACKGROUND

Cancers of the upper aerodigestive tract (UADT; including oral cavity, pharynx, larynx and oesophagus) have high incidence rates all over the world, and they are especially frequent in some parts of Latin America. However, the data on the role of the major risk factors in these areas are still limited.

METHODS

We have evaluated the role of alcohol and tobacco consumption, based on 2,252 upper aerodigestive squamous-cell carcinoma cases and 1,707 controls from seven centres in Brazil, Argentina, and Cuba.

RESULTS

We show that alcohol drinkers have a risk of UADT cancers that is up to five times higher than that of never-drinkers. A very strong effect of aperitifs and spirits as compared to other alcohol types was observed, with the ORs reaching 12.76 (CI 5.37-30.32) for oesophagus. Tobacco smokers were up to six times more likely to develop aerodigestive cancers than never-smokers, with the ORs reaching 11.14 (7.72-16.08) among current smokers for hypopharynx and larynx cancer. There was a trend for a decrease in risk after quitting alcohol drinking or tobacco smoking for all sites. The interactive effect of alcohol and tobacco was more than multiplicative. In this study, 65% of all UADT cases were attributable to a combined effect of alcohol and tobacco use.

CONCLUSIONS

In this largest study on UADT cancer in Latin America, we have shown for the first time that a prevailing majority of UADT cancer cases is due to a combined effect of alcohol and tobacco use and could be prevented by quitting the use of either of these two agents.

A first step incorporating smoking education into a Brazilian medical school curriculum: results of a survey to assess the cigarette smoking knowledge, attitudes, behaviour, and clinical practices of medical students

Smoking-related illnesses are the leading causes of morbidity and mortality in Brazil. Despite a smoking prevalence of approximately 40%, there is limited national effort to reduce tobacco use in Brazil by means of public education and training of health care professionals to promote smoking education. In particular, the need for information about tobacco warrants increased emphasis in undergraduate medical education. An educational program on nicotine addiction during medical school could facilitate the incorporation of smoking cessation interventions into routine medical practice. As a preliminary step toward implementing a tobacco education and intervention program, this study was designed to assess knowledge and attitudes about smoking among Brazilian medical students. Five hundred thirteen (N = 513) medical students from the Federal University of Rio Grande do Sul, the southernmost state of Brazil, completed a self-reported questionnaire during the 1995-1996 academic school year. Most students recognize the adverse health effects of smoking and the importance of their professional role in promoting smoking cessation. In contradiction, however, few medical students currently provide their patients who smoke with even minimal intervention. This discrepancy supports the idea that training in nicotine addiction and smoking cessation techniques will help medical students to develop the skills and confidence needed to successfully intervene with their current and future patients.

[Opiates in pain management: correct or underestimated use? Data from a university hospital]

OBJECTIVE

Opiates use, mainly in the treatment of acute intense pain (post-surgical patients) and chronic pain in oncologic patients has been usually underestimated in general clinical practice. This paper has the objective to assess the pattern of opiates use (Meperidin and Morphine), that is being used in Hospital de Clínicas de Porto Alegre, Rio Grande do Sul (Brazil).

MATERIAL AND METHOD

Medical teams prescriptions were analyzed using the following parameters: pattern of use, dose, interval and the use of concomitant analgesics. 1,107 prescriptions were analyzed, related to 445 inpatients, in the period from May to July of 1993.

RESULTS AND DISCUSSION

Only 6.5% of all prescriptions were considered correct. The pattern if necessary was responsible for 74% of all prescriptions.

CONCLUSIONS

Pain, either acute or chronic, is not being adequately managed in our hospital.

[Mortality from uterine cervix cancer in Rio Grande do Sul]

The mortality from cervical cancer was studied by checking the death rates in Rio Grande do Sul (RS) and in its 24 microregions. Each tendency (linear regression), in the period from 1970 to 1989, was also investigated. We have also studied the relative rates of this kind of cancer, the comparison with the rate in other places and the risk factors. The data were obtained at the Office of Health in Rio Grande do Sul as well as in the Statistics and Geography Brazilian Institute and World Health Organization. The average mortality rates/100,000 women in RS (1970-1989) was 3.8, with ascending tendency. Important differences in the death rates in the 24 microregions in RS were observed and they ranged from 2.5 to 6.7. The cervical cancer was the fourth cause of death in women from RS (mortality by cancer), in 1989. Papillomaviruses and smoking were important factors in the development of cervical cancer.

[Cutaneous malignant melanoma in Rio Grande do Sul, Brazil: study of 101 cases]

Between 1985 and 1989, at the Hospital de Clínicas de Porto Alegre (HCPA), 101 cases of cutaneous malignant melanoma (CMM) were reviewed in order to evaluate the status of the disease at diagnosis. The cases were obtained from the records of the pathology service of the HCPA. Nodular Melanoma (ND) was the most frequent type (36.6%). In males, the predominant site was in the head, neck and trunk while in females it was in the lower limbs Clark level V was found in 35.6% of the cases. In 23.8%, the tumor was larger than 4mm in depth according to Breslow classification. These results clearly demonstrate that the diagnosis of CMM is established in later stages of the disease.