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Steinberg J, Hughes S, Hui H, Allsop MJ, Egger S, David M, Caruana M, Coxeter P, Carle C, Onyeka T, Rewais I, Monroy Iglesias MJ, Vives N, Wei F, Abila DB, Carreras G, Santero M, O’Dowd EL, Lui G, Tolani MA, Mullooly M, Lee SF, Landy R, Hanley SJB, Binefa G, McShane CM, Gizaw M, Selvamuthu P, Boukheris H, Nakaganda A, Ergin I, Moraes FY, Timilshina N, Kumar A, Vale DB, Molina-Barceló A, Force LM, Campbell DJ, Wang Y, Wan F, Baker AL, Singh R, Salam RA, Yuill S, Shah R, Lansdorp-Vogelaar I, Yusuf A, Aggarwal A, Murillo R, Torode JS, Kliewer EV, Bray F, Chan KKW, Peacock S, Hanna TP, Ginsburg O, Hemelrijck MV, Sullivan R, Roitberg F, Ilbawi AM, Soerjomataram I, Canfell K. Risk of COVID-19 death for people with a pre-existing cancer diagnosis prior to COVID-19-vaccination: A systematic review and meta-analysis. Int J Cancer 2024; 154:1394-1412. [PMID: 38083979 PMCID: PMC10922788 DOI: 10.1002/ijc.34798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 10/04/2023] [Accepted: 10/20/2023] [Indexed: 02/12/2024]
Abstract
While previous reviews found a positive association between pre-existing cancer diagnosis and COVID-19-related death, most early studies did not distinguish long-term cancer survivors from those recently diagnosed/treated, nor adjust for important confounders including age. We aimed to consolidate higher-quality evidence on risk of COVID-19-related death for people with recent/active cancer (compared to people without) in the pre-COVID-19-vaccination period. We searched the WHO COVID-19 Global Research Database (20 December 2021), and Medline and Embase (10 May 2023). We included studies adjusting for age and sex, and providing details of cancer status. Risk-of-bias assessment was based on the Newcastle-Ottawa Scale. Pooled adjusted odds or risk ratios (aORs, aRRs) or hazard ratios (aHRs) and 95% confidence intervals (95% CIs) were calculated using generic inverse-variance random-effects models. Random-effects meta-regressions were used to assess associations between effect estimates and time since cancer diagnosis/treatment. Of 23 773 unique title/abstract records, 39 studies were eligible for inclusion (2 low, 17 moderate, 20 high risk of bias). Risk of COVID-19-related death was higher for people with active or recently diagnosed/treated cancer (general population: aOR = 1.48, 95% CI: 1.36-1.61, I2 = 0; people with COVID-19: aOR = 1.58, 95% CI: 1.41-1.77, I2 = 0.58; inpatients with COVID-19: aOR = 1.66, 95% CI: 1.34-2.06, I2 = 0.98). Risks were more elevated for lung (general population: aOR = 3.4, 95% CI: 2.4-4.7) and hematological cancers (general population: aOR = 2.13, 95% CI: 1.68-2.68, I2 = 0.43), and for metastatic cancers. Meta-regression suggested risk of COVID-19-related death decreased with time since diagnosis/treatment, for example, for any/solid cancers, fitted aOR = 1.55 (95% CI: 1.37-1.75) at 1 year and aOR = 0.98 (95% CI: 0.80-1.20) at 5 years post-cancer diagnosis/treatment. In conclusion, before COVID-19-vaccination, risk of COVID-19-related death was higher for people with recent cancer, with risk depending on cancer type and time since diagnosis/treatment.
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Affiliation(s)
- Julia Steinberg
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Suzanne Hughes
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Harriet Hui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Matthew J Allsop
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
| | - Sam Egger
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Michael David
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Medicine and Dentistry, Griffith University, Gold Coast, Australia
| | - Michael Caruana
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Peter Coxeter
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Chelsea Carle
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Tonia Onyeka
- Department of Anaesthesia/Pain & Palliative Care Unit, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
- IVAN Research Institute, Enugu, Enugu Stata, Nigeria
| | - Isabel Rewais
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Maria J Monroy Iglesias
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Nuria Vives
- Cancer Screening Unit, Institut Català d’Oncologia (ICO), Early Detection of Cancer Group, Epidemiology, Public Health, Cancer Prevention and Palliative Care Program, Institut d’Investigació Biomèdica de Bellvitge (IDIBELL), L’Hospitalet de Llobregat, Spain
- Ciber Salud Pública (CIBERESP), Instituto Salud Carlos III, Madrid, Spain
| | - Feixue Wei
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | | | - Giulia Carreras
- Oncologic Network, Prevention and Research Institute (ISPRO), Florence, Italy
| | - Marilina Santero
- Iberoamerican Cochrane Centre, IIB Sant Pau-Servei d’Epidemiologia Clínica i Salut Pública, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Emma L O’Dowd
- Department of Respiratory Medicine, Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom
| | - Gigi Lui
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | | | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Shing Fung Lee
- Department of Radiation Oncology, National University Cancer Institute, National University Hospital, Singapore
- Department of Clinical Oncology, Tuen Mun Hospital, New Territories West Cluster, Hospital Authority, Hong Kong, China
| | - Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville MD, United States
| | - Sharon JB Hanley
- Department of Academic Primary Care, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland
- Center for Environmental and Health Sciences, Hokkaido University, Sapporo, Japan
| | - Gemma Binefa
- Cancer Screening Unit,Cancer Prevention and Control Program, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
- Early Detection of Cancer Research Group, EPIBELL Programme, Bellvitge Biomedical Research Institute, Hospitalet de Llobregat, Barcelona, Spain
| | - Charlene M McShane
- Centre for Public Health, Queen’s University Belfast, Institute of Clinical Sciences Block B, Royal Victoria Hospital, Belfast, Northern Ireland
| | - Muluken Gizaw
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Ethiopia
- Institute for Medical Epidemiology, Biometrics and Informatics, Martin Luther University of Halle-Wittenberg, Germany
- NCD Working Group, School of Public Health, Addis Ababa University, Ethiopia
| | - Poongulali Selvamuthu
- Chennai Antiviral Research and Treatment Center and Clinical Research Site (CART CRS), Infectious Diseases Medical Center, Voluntary Health Services, Chennai, India
| | - Houda Boukheris
- University Abderrahmane Mira of Bejaia, School of Medicine, Algeria
- Departement of Epidemiology and Preventive Medicine, University Hospital of Bejaia, Algeria
| | - Annet Nakaganda
- Department of Cancer Epidemiology and Clinical Trials, Uganda Cancer Institute, Uganda
| | - Isil Ergin
- Department of Public Health, Faculty of Medicine, Ege University, Turkey
| | - Fabio Ynoe Moraes
- Department of Oncology, Queen’s University, Kingston, Ontario, Canada
| | - Nahari Timilshina
- Institute of Health Policy, Management and Evaluation, University of Toronto, Canada
| | - Ashutosh Kumar
- Department of Anatomy, All India Institute of Medical Sciences-Patna, Patna, India
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas (UNICAMP), Brazil
| | - Ana Molina-Barceló
- Cancer and Public Health Research Unit, Biomedical Research Foundation FISABIO, Valencia, Spain
| | - Lisa M Force
- Department of Health Metrics Sciences and Department of Pediatrics, Division of Hematology/Oncology, University of Washington, United States
| | - Denise Joan Campbell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Yuqing Wang
- School of Public Health, University of Sydney, Sydney, Australia
| | - Fang Wan
- School of Public Health, University of Sydney, Sydney, Australia
| | - Anna-Lisa Baker
- School of Public Health, University of Sydney, Sydney, Australia
| | - Ramnik Singh
- School of Public Health, University of Sydney, Sydney, Australia
| | - Rehana Abdus Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
| | - Susan Yuill
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
- School of Public Health, University of Sydney, Sydney, Australia
| | - Richa Shah
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Iris Lansdorp-Vogelaar
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, the Netherlands
| | - Aasim Yusuf
- Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore & Peshawar, Pakistan
| | - Ajay Aggarwal
- Department of Health Services Research and Policy, School of Hygiene and Tropical Medicine, King’s College London, London, United Kingdom
- Department of Oncology, Guy’s & St Thomas NHS Trust, London, United Kingdom
| | - Raul Murillo
- Centro Javeriano De Oncologia - Hospital Universitario San Ignacio, Bogotá, Colombia
- Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Julie S Torode
- Institute of Cancer Policy, King’s College London, London, United Kingdom
- Research Oncology, Bermondsey Wing, Guy’s Hospital, SE1 9RT, London, United Kingdom
| | - Erich V Kliewer
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Freddie Bray
- Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France
| | - Kelvin KW Chan
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
| | - Stuart Peacock
- Department of Cancer Control Research, BC Cancer Research Institute, Vancouver, British Columbia, Canada
- Canadian Centre for Applied Research in Cancer Control, Vancouver, British Columbia, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Timothy P Hanna
- Division of Cancer Care and Epidemiology, Cancer Research Institute at Queen’s University, Kingston, Ontario, Canada
- Department of Oncology and Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Ophira Ginsburg
- Center for Global Health, National Cancer Institute, Maryland, United States
| | - Mieke Van Hemelrijck
- Translational Oncology and Urology Research (TOUR), Centre for Cancer, Society, and Public Health, School of Cancer and Pharmaceutical Sciences, King’s College London, London, United Kingdom
| | - Richard Sullivan
- Institute of Cancer Policy, King’s College London, London, United Kingdom
| | - Felipe Roitberg
- Department of Non-Communicable Diseases, World Health Organisation, Geneva, Switzerland
- Hospital Sírio Libanês, São Paulo, Brazil
- Rede Ebserh, Rede Brasileira de Serviços Hospitalares, Brasília, Brazil
| | | | | | - Karen Canfell
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia
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Fernandes JO, Machado BF, Cardoso-Filho C, Nativio J, Cabello C, Vale DB. Breast cancer survival after mammography dissemination in Brazil: a population-based analysis of 2,715 cases. BMC Womens Health 2023; 23:644. [PMID: 38049765 PMCID: PMC10696793 DOI: 10.1186/s12905-023-02803-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 11/24/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND This study aims to assess breast cancer survival rates after one decade of mammography in a large urban area of Brazil. METHODS It is a population-based retrospective cohort of women with breast cancer in Campinas, São Paulo, from 2010 to 2014. Age, vital status and stage were accessed through the cancer and mortality registry, and patients records. Statistics used Kaplan-Meier, log-rank and Cox's regression. RESULTS Out of the 2,715 cases, 665 deaths (24.5%) were confirmed until early 2020. The mean age at diagnosis was 58.6 years. Women 50-69 years were 48.0%, and stage I the most frequent (25.0%). The overall mean survival was 8.4 years (8.2-8.5). The 5-year survival (5yOS) for overall, 40-49, 50-59, 60-69, 70-79 years was respectively 80.5%, 87.7%, 83.7%, 83.8% and 75.5%. The 5yOS for stages 0, I, II, III and IV was 95.2%, 92.6%, 89.4%, 71.1% and 47.1%. There was no significant difference in survival in stage I or II (p = 0.058). Compared to women 50-59 years, death's risk was 2.3 times higher for women 70-79 years and 26% lower for women 40-49 years. Concerning stage I, the risk of death was 1.5, 4.1 and 8.6 times higher, and 34% lower, respectively, for stage II, III, IV and 0. CONCLUSIONS In Brazil, breast cancers are currently diagnosed in the early stages, although advanced cases persist. Survival rates may reflect improvements in screening, early detection and treatment. The results can reflect the current status of other regions or countries with similar health care conditions.
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Affiliation(s)
- Juliana O Fernandes
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Beatriz F Machado
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Cassio Cardoso-Filho
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Juliana Nativio
- Surveillance Section, Municipal Health Department, Campinas City Hall, Paço Municipal, Avenida Anchieta, nº 200, 13.015-904, Campinas, SP, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Women's Hospital, Unicamp. Rua Alexander Fleming, 101, 13083-881, Cidade Universitária, Campinas, SP, Brazil.
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Yoneda JY, Teixeira JC, Derchain S, Bragança JF, Zeferino LC, Vale DB. Screen-and-treat approach in managing cervical cancer precursor lesions: An observational study with 524 women. Eur J Obstet Gynecol Reprod Biol 2023; 280:78-82. [PMID: 36434824 DOI: 10.1016/j.ejogrb.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/02/2022] [Accepted: 11/18/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To detect factors related to overtreatment with the "Screen-and-treat" approach (S&T) in women with suspicious cervical precancerous lesions. STUDY DESIGN A retrospective observational study of 524 women with high-grade squamous intraepithelial lesions (HSIL) or more severe (HSIL+) in cytology, treated by the Large Loop Excision of the Transformation Zone (LLETZ): 161 without a previous biopsy (S&T group) and 363 with a previous biopsy (biopsy group) from January 2017 to July 2020. The main outcome was a diagnosis of LLETZ: negative (negative or low-grade squamous intraepithlelial lesion LSIL) or HSIL+. A negative diagnosis was interpreted as "overtreatment." Results were analyzed as a function of the S&T approach (whether previous biopsy or not). Variables were obtained from medical records, and were compared with Chi-square or Fisher's exact test (p, p-value), to estimate the chances of a logistic regression analysis (Odds Ratio, OR, or admitting a Confidence Interval (CI) of 95 %). RESULTS No differences were observed in groups regarding menopausal status, smoking, hormonal contraceptive use, colposcopy findings, LLETZ diagnosis, and recurrence. Comparing biopsy vs S&T groups, the frequency of women over 40 years was 28.4 % vs 39.7 % (p = 0.011), and transformation zone type 3 was 12.2 vs 26.8 % (p < 0.001), respectively. In women managed by S&T, when compared to a LLETZ diagnosis, an HSIL+ result was more frequent in women presenting with TZ 1 (93.1 % TZ1 vs 78.5 % TZ2 vs 73.8 % TZ3, p = 0.008) and in women with abnormal colposcopy (92.9 % abnormal vs 38.1 % negative, p < 0.001). Multiple regression analysis found that women with negative colposcopic findings presented a higher risk for negative LLETZ diagnosis (LSIL/Negative final histology) (18.6; 6.18-56.02). CONCLUSIONS No difference was observed in the LLETZ diagnosis in women who did or did not use the S&T approach: it was adequate for women referred by cytological HSIL along with high-grade colposcopic findings.
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Affiliation(s)
- Juliana Y Yoneda
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Joana F Bragança
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Luiz C Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Rua Vital Brazil, 80 - Cidade Universitária, CEP 13083-888 Campinas, Brazil.
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Bonas MK, Discacciati MG, Videira HM, Cavalcante LA, Teixeira JC, Vale DB. Safety of Conservative Management of High-Grade Squamous Intraepithelial Lesion in Women Under 30 Years Old. Women's Health Reports 2022; 3:601-607. [PMID: 35814605 PMCID: PMC9258792 DOI: 10.1089/whr.2022.0024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/16/2022] [Indexed: 11/12/2022]
Abstract
Objectives: To evaluate the outcomes of conservative management in young women with high-grade squamous intraepithelial lesion (HSIL). Methods: A retrospective cohort study included women younger than 30 years referred with HSIL (cytology or biopsy) managed conservatively from 2012 to 2019, in Campinas/Brazil. Regression was the outcome when no evidence of HSIL was observed in at least two consecutive follow-ups. Kaplan–Meyer method was used to determine regression probabilities. Other tests were chi-square or Fisher, Mann–Whitney and COX regression. Results: During the study period, 89 patients were included. No progression to microinvasive or invasive cancer was observed. Sixty-one (69%) patients were younger than 25 years, and 28 (31%) were aged 25–30 years. Spontaneous regression was seen in 64 (72%) and persistence in 25 (28%) of the overall sample. The average time to regression was 15.4 months (standard deviation [SD] = 7.7), and the follow-up time was 31.6 months (SD 19.0). Age, parity, first sexual intercourse, smoking, hormonal contraception, and colposcopy impression were not different among women with regression or persistence. Regression probabilities were, respectively, 28.9%, 60.2%, and 78.1% after 12, 18, and 24 months. Most of the events happened between 12 and 18 months of follow-up. Conclusions: Conservative management in women younger than 30 years was safe: spontaneous regression was observed in 72% of all women younger than 30 with HSIL managed conservatively. No clinical variable was relevant, influencing regression. In 2 years the regression probability was 78%.
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Affiliation(s)
- Mariana K. Bonas
- Obstetrics and Gynecology Department, University of Campinas, Campinas, Brazil
| | | | - Hisa M. Videira
- Obstetrics and Gynecology Department, University of Campinas, Campinas, Brazil
| | - Lucas A. Cavalcante
- Obstetrics and Gynecology Department, University of Campinas, Campinas, Brazil
| | - Julio C. Teixeira
- Obstetrics and Gynecology Department, University of Campinas, Campinas, Brazil
| | - Diama B. Vale
- Obstetrics and Gynecology Department, University of Campinas, Campinas, Brazil
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Scheler CA, Discacciati MG, Vale DB, Lajos GJ, Surita F, Teixeira JC. Mortality in pregnancy and the postpartum period in women with severe acute respiratory distress syndrome related to COVID-19 in Brazil, 2020. Int J Gynaecol Obstet 2021; 155:475-482. [PMID: 34185314 PMCID: PMC9087770 DOI: 10.1002/ijgo.13804] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 06/17/2021] [Accepted: 06/20/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To estimate fatality rates due to severe acute respiratory distress syndrome (ARDS) related to COVID-19 in Brazilian women, comparing pregnant and postpartum women with nonpregnant women. METHODS A cross-sectional study of 12 566 pregnant and postpartum women (obstetric group) and 90 025 nonpregnant women (nonobstetric group) aged 15-49 years reported with severe ARDS in 2020. The Brazilian ARDS Surveillance System was used to compare the outcome (death or cure) between the groups, considering age, race, or comorbidities. RESULTS The mortality rate related to ARDS/COVID-19 in the obstetric group was 7.8% (377/4853) compared with 13.9% (5946/42 915) in the nonobstetric group. Comorbidity was associated with increased fatality cases for both groups, but higher in the nonobstetric group (22.8% vs 13.3%). In the obstetric group, deaths related to COVID-19 were concentrated in the third trimester or postpartum period. If comorbidity was present, deaths by COVID-19 were 4.4 times higher than ARDS due to other etiologies, and twice higher in women who self-reported as black (13.7%) than white women (6.7%). Considering ADRS etiology, deaths by COVID-19 were 3.4-6.7 times higher than any other etiology. CONCLUSION ARDS related to COVID-19 in obstetric patients was an important factor for worse clinical outcomes, with 3-6 times higher death rates than other ARDS etiologies. Pregnant and postpartum women with severe ARDS related to COVID-19 had a lower fatality rate than nonpregnant women, even with associated comorbidity.
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Affiliation(s)
- Carlos A Scheler
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Michelle G Discacciati
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Diama B Vale
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Giuliane J Lajos
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Fernanda Surita
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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Vale DB, Teixeira JC, Bragança JF, Derchain S, Sarian LO, Zeferino LC. Elimination of cervical cancer in low- and middle-income countries: Inequality of access and fragile healthcare systems. Int J Gynaecol Obstet 2020; 152:7-11. [PMID: 33128771 DOI: 10.1002/ijgo.13458] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 09/15/2020] [Accepted: 10/29/2020] [Indexed: 12/24/2022]
Abstract
In 2018, WHO called for global action to eliminate cervical cancer. The complexity of the processes involved in terms of prevention is often underestimated. Low- and middle-income countries do not have a robust healthcare framework to ensure high-quality programs. The present article discusses how fragile healthcare systems are barriers to eliminating cervical cancer, and also reports the experience of a Brazilian prevention program. The article considers how cervical cancer can be interpreted as an indicator of inequality: how women's attitudes and access to care determine an early or late diagnosis, and how strategies combining vaccine and DNA-HPV tests are crucial. New vaccine schemes, the critical analysis of local data, strengthening communication, managing sentinel events, and integrating vaccination and screening data for the health information system are some of the key activities to sustainable improvement in both access and quality of care.
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Affiliation(s)
- Diama B Vale
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Julio C Teixeira
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Joana F Bragança
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Luis O Sarian
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
| | - Luiz C Zeferino
- Department of Obstetrics and Gynecology, University of Campinas, Campinas, Brazil
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Sánchez OR, Vale DB, Rodrigues L, Surita FG. Violence against women during the COVID-19 pandemic: An integrative review. Int J Gynaecol Obstet 2020; 151:180-187. [PMID: 32880941 PMCID: PMC9087782 DOI: 10.1002/ijgo.13365] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 08/05/2020] [Accepted: 08/27/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, incipient data have revealed an increase in violence against women (VAW). OBJECTIVE To analyze the existing scientific literature on strategies and recommendations to respond to VAW during the implementation of social distancing measures in response to the COVID-19 pandemic. SEARCH STRATEGY An integrative review was conducted based on articles published between December 2019 and June 2020. Suitable articles were identified from the PubMed, SciELO, and LILACS databases, using relevant terms. SELECTION CRITERIA Eligible studies included opinion and primary research articles describing the dynamics of VAW during quarantine and in the context of the restrictive measures taken during the COVID-19 pandemic and proposing recommendations to respond to this issue. DATA COLLECTION AND ANALYSIS Data were extracted from eligible publications and qualitative synthesis was used. MAIN RESULTS The 38 articles included in the study showed that some factors increasing women's vulnerabilities to violence were exacerbated during the social distancing and lockdown period. Health professionals are essential for screening and responding to VAW during the pandemic. CONCLUSIONS Strategies must include integrated actions aiming to prevent and respond to violence during and after the COVID-19 pandemic. These must be designed based on lessons learned from previous public health emergencies.
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Affiliation(s)
- Odette R. Sánchez
- Department of Obstetrics and GynecologyUniversity of CampinasCampinasBrazil
| | - Diama B. Vale
- Department of Obstetrics and GynecologyUniversity of CampinasCampinasBrazil
| | - Larissa Rodrigues
- Department of Obstetrics and GynecologyUniversity of CampinasCampinasBrazil
| | - Fernanda G. Surita
- Department of Obstetrics and GynecologyUniversity of CampinasCampinasBrazil
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Armaroli P, Riggi E, Basu P, Anttila A, Ponti A, Carvalho AL, Dillner J, Elfström MK, Giordano L, Lönnberg S, Ronco G, Senore C, Soerjomataram I, Tomatis M, Vale DB, Jarm K, Sankaranarayanan R, Segnan N. Performance indicators in breast cancer screening in the European Union: A comparison across countries of screen positivity and detection rates. Int J Cancer 2020; 147:1855-1863. [PMID: 32159224 DOI: 10.1002/ijc.32968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 02/05/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023]
Abstract
Comparable performance indicators for breast cancer screening in the European Union (EU) have not been previously reported. We estimated adjusted breast cancer screening positivity rate (PR) and detection rates (DR) to investigate variation across EU countries. For the age 50-69 years, the adjusted EU-pooled PR for initial screening was 8.9% (cross-programme variation range 3.2-19.5%) while DR of invasive cancers was 5.3/1,000 (range 3.8-7.4/1,000) and DR of ductal carcinoma in situ (DCIS) was 1.3/1,000 (range 0.7-2.7/1,000). For subsequent screening, the adjusted EU-pooled PR was 3.6% (range 1.4-8.4%), the DR was 4.0/1,000 (range 2.2-5.8/1,000) and 0.8/1,000 (range 0.5-1.3/1,000) for invasive and DCIS, respectively. Adjusted performance indicators showed remarkable heterogeneity, likely due to different background breast cancer risk and awareness between target populations, and also different screening protocols and organisation. Periodic reporting of the screening indicators permits comparison and evaluation of the screening activities between and within countries aiming to improve the quality and the outcomes of screening programmes. Cancer Screening Registries would be a milestone in this direction and EU Screening Reports provide a fundamental contribution to building them.
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Affiliation(s)
- Paola Armaroli
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Emilia Riggi
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Ahti Anttila
- Mass Screening Registry, Finish Cancer Registry, Helsinki, Finland
| | - Antonio Ponti
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Andre L Carvalho
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Miriam K Elfström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Livia Giordano
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Stefan Lönnberg
- Mass Screening Registry, Finish Cancer Registry, Helsinki, Finland
| | - Gugliemo Ronco
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
- International Agency for Research on Cancer, Lyon, France
| | - Carlo Senore
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | - Mariano Tomatis
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
| | - Diama B Vale
- Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil
| | - Katja Jarm
- Epidemiology and Cancer Registry, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Nereo Segnan
- 'AOU Città della Salute e della Scienza' University Hospital, CPO Piemonte, Turin, Italy
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9
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Vale DB, Gozzi B, Marcelino AC, Oliveira JF, Cardoso-Filho C, Cunha GT, Batista P, Zeferino LC. Breast cancer mortality rates trends by race in São Paulo, Brazil. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.1162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Breast cancer is the main cause of female death by neoplasia in Brazil. Although half of the Brazilian population is black/brown (BB), socio-economic disparities translate in a vulnerable situation to those women. Access to health care is an important barrier to improve the health of BB women. This study aims to investigate trends in breast cancer mortality rates regarding race and age.
Methods
This is a population-based study of trends evaluation on breast cancer mortality in São Paulo state, Brazil, from 2000 to 2017. The absolute number of deaths and population figures (including race) by age-groups and years were available online from government data. Data on race were not available by ten-year age-groups, so the figures were projected according to the female age structure by year. Total rates by year and race were age-adjusted to the 'World Population (2000)'. For trend analysis, linear regression was used, with 5% level of significance.
Results
In the period were observed 60,940 breast cancer deaths, 76.7% in white and 17.5% in BB women. The absolute number of deaths in white and BB women was respectively 2,095 and 333 in 2000, and 3,076 and 999 in 2017. The total age-adjusted mortality rates per 100,000 women of white and BB in 2000 were respectively 16.4, 17.2 and 7.5. In 2017 rates were 14.6, 16.6 and 16.1. There was a trend towards reducing the mortality rates of white women (P = 0.002) and in their age-groups from 40 to 79 years (P < 0.03). There was a trend towards increasing the mortality rates of BB women (P < 0.001) and in all their age-groups (P < 0.02).
Conclusions
Although breast cancer figures of death and mortality rates in BB women have more than doubled in 18 years, rates reached almost the same figures of white women in the period. Changes in behaviour risk factors may explain this result. However, it is very likely that access to health care to these women has been improved, reducing the disparities in the health system.
Key messages
Breast cancer mortality rates in black/brown women have reached almost the same figures as white women from 2000 to 2017 in São Paulo, Brazil. Access to health care in black women may have improved in São Paulo, Brazil.
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Affiliation(s)
- D B Vale
- Medicine School, Unicamp, Campinas, Brazil
| | - B Gozzi
- Medicine School, Unicamp, Campinas, Brazil
| | | | | | | | - G T Cunha
- Medicine School, Unicamp, Campinas, Brazil
| | - P Batista
- Medicine School, UFS, Aracajú, Brazil
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10
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Ponti A, Basu P, Ritchie D, Anttila A, Carvalho AL, Senore C, Mallafré-Larrosa M, Piccinelli C, Ronco G, Soerjomataram I, Primic-Žakelj M, Dillner J, Elfström MK, Lönnberg S, Vale DB, Tomatis M, Armaroli P, Giordano L, Sankaranarayanan R, Segnan N. Key issues that need to be considered while revising the current annex of the European Council Recommendation (2003) on cancer screening. Int J Cancer 2020; 147:9-13. [PMID: 31970768 DOI: 10.1002/ijc.32885] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 11/26/2019] [Accepted: 01/09/2020] [Indexed: 01/09/2023]
Abstract
The 2003 European Council recommendation urging the Member States to introduce or scale up breast, cervical and colorectal cancer screening through an organized population-based approach has had a remarkable impact. We argue that the recommendation needs to be updated for at least two sets of reasons. First, some of the current clinical guidelines include new tests or protocols that were not available at the time of the Council document. Some have already been adopted by organized screening programs, such as newly defined age ranges for mammography screening, Human Papillomavirus (HPV)-based cervical cancer screening, fecal immunochemical test (FIT) and sigmoidoscopy for colorectal cancer screening. Second, the outcomes of randomized trials evaluating screening for lung and prostate cancer have been published recently and the balance between harms and benefits needs to be pragmatically assessed. In the European Union, research collaboration and networking to exchange and develop best practices should be regularly supported by the European Commission. Integration between primary and secondary preventive strategies through comprehensive approaches is necessary not only to maximize the reduction in cancer burden but also to control the rising trend of other noncommunicable diseases sharing the same risk factors.
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Affiliation(s)
- Antonio Ponti
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - David Ritchie
- Association of European Cancer Leagues, Brussels, Belgium
| | - Ahti Anttila
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Andre L Carvalho
- Screening Group, International Agency for Research on Cancer, Lyon, France
| | - Carlo Senore
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | | | | | - Guglielmo Ronco
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
- Infections and Cancer Epidemiology Group, International Agency for Research on Cancer, Lyon, France
| | - Isabelle Soerjomataram
- Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France
| | | | - Joakim Dillner
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Pathology/Cytology, Karolinska University Laboratory, Karolinska University Hospital, Stockholm, Sweden
| | | | - Stefan Lönnberg
- Mass Screening Registry/Finnish Cancer Registry, Helsinki, Finland
| | - Diama B Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | - Mariano Tomatis
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Paola Armaroli
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | - Livia Giordano
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
| | | | - Nereo Segnan
- CPO, University Hospital 'Città Della Salute e Della Scienza', Turin, Italy
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11
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Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Response to the author: invitation to cancer screening: putting the car before the horse? Eur J Cancer Prev 2019; 28:458-459. [PMID: 31385844 DOI: 10.1097/cej.0000000000000474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Diama B Vale
- Departamento de Tocoginecologia, Divisão de Oncologia, Universidade Estadual de Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Cancer Registry of Norway, Oslo, Norway, Finnish Cancer Registry, Helsinki, Finland
| | | | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
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12
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Vale DB, Anttila A, Ponti A, Senore C, Sankaranaryanan R, Ronco G, Segnan N, Tomatis M, Žakelj MP, Elfström KM, Lönnberg S, Dillner J, Basu P. Invitation strategies and coverage in the population-based cancer screening programmes in the European Union. Eur J Cancer Prev 2019; 28:131-140. [PMID: 29570103 DOI: 10.1097/cej.0000000000000426] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
The aim of this study was to describe the compliance of the population-based cancer screening programmes in the European Union Member States to the invitation strategies enumerated in the European Guidelines and the impact of such strategies on the invitational coverage. Experts in screening programme monitoring from the respective countries provided data. Coverage by invitation was calculated as the proportion of individuals in the target age range receiving a screening invitation over the total number of annualized eligible population. The invitation strategies of 30 breasts, 25 cervical and 27 colorectal national or regional population-based screening programmes are described. Individual mail invitations are sent by 28 breasts, 20 cervical and 25 colorectal screening programmes. Faecal occult blood test kits are sent by post in 17 of the colorectal cancer screening programmes. The majority of programmes claimed to have a population registry, although some use health insurance data as the database for sending invitations. At least 95% invitation coverage was reached by 16 breast, six cervical and five colorectal screening programmes. Majority of the programmes comply with the invitation strategies enumerated in the European guidelines, although there is still scope for improvements. Coverage by invitation is below the desirable level in many population-based cancer screening programmes in European Union.
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Affiliation(s)
- Diama B Vale
- Department of Obstetrics and Gynecology, State University of Campinas (Unicamp), Campinas, Brazil
| | | | - Antonio Ponti
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Carlo Senore
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | | | - Guglielmo Ronco
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Nereo Segnan
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Mariano Tomatis
- CPO Piemonte and University Hospital 'Cittàdella Salute e dellaScienza', Turin, Italy
| | - Maja P Žakelj
- Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | | | - Stefan Lönnberg
- Finnish Cancer Registry, Helsinki, Finland
- Cancer Registry of Norway, Oslo, Norway
| | | | - Partha Basu
- Screening Group, International Agency for Research on Cancer, Lyon, France
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13
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Xavier-Júnior JCC, Vale DB, Zeferino LC, Dufloth RM. Association between concurrent genital bleeding and cervical cancer: a cross-sectional study. Acta Obstet Gynecol Scand 2015; 94:949-53. [PMID: 26033639 DOI: 10.1111/aogs.12682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Accepted: 05/11/2015] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Genital bleeding may be a common symptom among women with cervical cancer. MATERIAL AND METHODS Cross-sectional study evaluating whether the prevalence of cervical smear results is different in women with and without clinical information about concurrent genital bleeding. RESULTS The sample consisted of 2 324 836 smears; of these, 0.4% had clinical information on genital bleeding. When stratified by age group, women with genital bleeding had a higher chance of a cytological result of a high-grade squamous intraepithelial lesion [30-49 years odds ratio (OR) 2.38; 95% confidence interval (CI) 1.60-3.53 and ≥50 years OR 6.30; 95%CI 3.72-10.67), of squamous cell carcinoma (SCC) (30-49 years OR 24.70; 95%CI 11.96-51.03 and ≥50 years OR 48.91; 95%CI 31.28-76.47) and of atypical glandular cells (30-49 years OR 5.72; 95%CI 3.30-9.93 and ≥50 years OR 11.56; 95%CI 5.96-22.45); there was also a higher chance of adenocarcinoma for women ≥50 years (OR 53.13; 95%CI 28.08-100.51). The sensitivity of genital bleeding for women aged 18-29 years was 0.4% for high-grade squamous intraepithelial lesion (HSIL); for women 30-49 years old the rate was 0.9% for HSIL, 8.6% for SCC and 2.1% for atypical glandular cells of undetermined significance (AGUS), while for women aged from 50 years or more the rates were 2.0% for HSIL, 13.7% for SCC, 3.6% for AGUS and 14.7% for adenocarcinoma. CONCLUSION Women ≥30 years old with genital bleeding should be referred for colposcopy to rule out the possibility of cervical cancer.
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Affiliation(s)
| | - Diama B Vale
- Department of Gynecology and Obstetrics, Campinas State University (UNICAMP), Campinas, Brazil
| | - Luiz C Zeferino
- Department of Gynecology and Obstetrics, Campinas State University (UNICAMP), Campinas, Brazil
| | - Rozany M Dufloth
- Pathology Department, Paulista State University (UNESP), Botucatu, Brazil
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Xavier-Júnior JC, Vale DB, Vieira LF, Lima MT, Zeferino LC, Dufloth RM. Results of screening for cervical cancer among pregnant and non-pregnant women in Brazil. Int J Gynaecol Obstet 2015; 130:36-9. [DOI: 10.1016/j.ijgo.2015.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Revised: 12/27/2014] [Accepted: 03/23/2015] [Indexed: 01/12/2023]
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Vale DB, Westin MC, Zeferino LC. High-grade squamous intraepithelial lesion in women aged <30 years has a prevalence pattern resembling low-grade squamous intraepithelial lesion. Cancer Cytopathol 2013; 121:576-81. [DOI: 10.1002/cncy.21312] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 03/22/2013] [Accepted: 04/22/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Diama B. Vale
- School of Medicine; Rondonia Federal University; Rondonia Brazil
- School of Medicine; Campinas State University; Campinas Brazil
| | - Maria C. Westin
- School of Medicine; Campinas State University; Campinas Brazil
- Dr. Jose Aristodemos Pinotti Women's Hospital; Campinas State University; Campinas Brazil
| | - Luiz C. Zeferino
- School of Medicine; Campinas State University; Campinas Brazil
- Dr. Jose Aristodemos Pinotti Women's Hospital; Campinas State University; Campinas Brazil
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