RESUMO
PURPOSE: In Brazil, access to breast cancer screening outside of urban centers is limited. This study aims to describe the coverage and performance of a breast cancer screening program implemented with Mobile Screening Units (MSU) in northern São Paulo state. METHODS: This is a retrospective cohort study of a population-based mammography program targeting women ages 40-69 in 108 municipalities from 12/2010 to 07/2015. Screening coverage rates were estimated using the Brazil 2010 census data. We calculated performance measures for the number of exams, recalls, and detected cases of cancer. Screen-detected cases were compared to clinically detected cases using hospital cancer registry data and a propensity-score matching method. The down-staging of screen-detected cases relative to clinically detected cases was assessed using logistic regression to calculate risk ratios (RRs) with 95% confidence intervals. RESULTS: 122,634 women were screened through the MSU program, representing a cumulative coverage rate of 54.8% in the target population. For initial and subsequent rounds, recall rates were 12.25 and 6.10% and cancer detection rates were 3.63 (95% CI 3.23-4.10) and 1.94 (95% CI 1.59-2.41), respectively. 92.51% of referrals were successful. Screen-detected cases had more favorable prognoses than clinically detected cases, including smaller tumor size and a decreased risk of late-stage detection (RR 0.14 95% CI 0.074-0.25). CONCLUSIONS: MSUs are a feasible method for the delivery of mammography services in this setting. Patients who had breast cancer detected on an MSU had favorable prognostic factors when compared with clinically detected cases arising from the same target population.
Assuntos
Neoplasias da Mama/diagnóstico , Mamografia/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Brasil , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos RetrospectivosRESUMO
OBJECTIVE: There are currently multiple tests available for cervical cancer screening and the existing screening policies vary from country to country. No single approach will satisfy the specific needs and variations in risk aversion of all populations, and screening algorithms should be tailored to specific groups. We performed long term risk stratification based on screening test results and compared the accuracy of different tests and their combinations. METHODS: A longitudinal cohort study of the natural history of HPV infection and cervical neoplasia enrolled 2462 women from a low-income population in Brazil. The interviews and cervical screening with cytology and HPV DNA testing were repeated according to a pre-established protocol and the subjects were referred for colposcopy and biopsy whenever high grade lesions were suspected. We compared the specificity, sensitivity and predictive values of each screening modality. Long term risk stratification was performed through time-to-event analyses using Kaplan-Meier analysis and Cox regression. RESULTS: The best optimization of sensitivity and specificity was achieved when using dual testing with cytology and HPV DNA testing, whereby the screening test is considered positive if either component yields an abnormal result. However, when allowing 12months for the detection of lesions, cytology alone performed nearly as well. Risk stratification revealed that HPV DNA testing was not beneficial for HSIL cases, whereas it was for ASCUS and, in some combinations, for negative and LSIL cytology. CONCLUSION: Our results suggest that some high risk populations may benefit equally from cytology or HPV DNA testing, and may require shorter intervals between repeat testing.
Assuntos
Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Algoritmos , Brasil/epidemiologia , Estudos de Coortes , DNA Viral/análise , DNA Viral/genética , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Adulto JovemRESUMO
Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.
Assuntos
Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/virologia , Doenças do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , DNA Viral/análise , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/crescimento & desenvolvimento , Infecções por Papillomavirus/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologiaRESUMO
OBJECTIVES: We investigated the effects of alcohol consumption on the risk of cancers of the upper aerodigestive tract (UADT) in a hospital-based case-control study in Brazil. METHODS: A total of 784 cases of cancers of the mouth, pharynx, and larynx and 1578 non-cancer controls matched on age, gender, hospital area, and admission period provided information on alcohol drinking, smoking, and other characteristics via interview. Using logistic regression, we evaluated the relative risks (RR) of UADT cancer for different beverage types based on cumulative ethanol content exposure and frequency of consumption. RESULTS: Relative to nondrinkers of any alcohol, risks of UADT cancers varied across sites both with increased exposure to ethanol and by alcohol type. RRs at equivalent levels of ethanol consumption were highest for cancers of the mouth for hard liquor (6.9 for > 100 kg lifetime consumption, 95% confidence interval (CI) = 2.8-17.1) and cachaça (4.5 for 101-500 kg, 95% CI = 2.2-9.0). Although RRs increased with frequency of drinks per week, when evaluated against higher proportional alcohol intake, reductions in risk were observed for beer and wine. CONCLUSION: Although methods of measurement can influence the interpretation of the carcinogenic nature of alcohols, increased RRs persisted with continued exposure for all types.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/efeitos adversos , Neoplasias Laríngeas/etiologia , Neoplasias Bucais/etiologia , Neoplasias Faríngeas/etiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Neoplasias Laríngeas/epidemiologia , Masculino , Neoplasias Bucais/epidemiologia , Razão de Chances , Neoplasias Faríngeas/epidemiologia , Risco , Fatores de Risco , Fumar/efeitos adversosRESUMO
Infection with high-risk human papillomavirus (HPV) is the major risk factor for the development of malignant lesions in the uterine cervix. Environmental, behavioral, and ill-defined genetic factors also have been implicated in the pathogenesis of this disease. Associations between human leukocyte antigens (HLAs) and cervical cancer, precursor lesions, and HPV infections have been reported in several populations. To verify whether HLA-DRB1, -DQA1, and -DQB1 diversity is related to cervical cancer in the Brazilian population, 161 cases and 257 controls were HLA typed. Variants of DQA1 and DQB1 promoter regions were also typed in 92 cases and 228 controls. Polymorphism in HLA genes and promoters was distinguished by PCR-based methods, and the magnitude of associations was determined by logistic regression analysis. DRB1*15 [confounder-adjusted odds ratio (OR), 2.24; 95% confidence interval (CI), 1.29-3.90], DRB1*1503 (OR, 2.52; 95% CI, 1.16-5.48), and haplotype DRB1*15-DQB1*0602 (OR, 2.04; 95% CI, 1.15-3.61) were positively associated with cervical cancer. When we considered only DR15 haplotypes that did not carry the DQB1*0602 allele, the risk attributed to DRB1*15 more than doubled. A negative association was found between DQB1*05 and cervical cancer (OR, 0.57; 95% CI, 0.35-0.92), and similar trends were observed for DQA1*0101/04, DRB1*0101, and DRB1*1302. HPV positivity among controls was associated with DRB1*1503 (OR, 4.60; 95% CI, 1.33-15.9), DRB1*0405 (OR, 6.21; 95% CI, 1.66-23.2), and DQB1*0602 (OR, 2.48; 95% CI, 1.06-5.80). We suggest that HLA class II polymorphisms are involved in genetic susceptibility to cervical cancer and HPV infection in a Brazilian population from an area with a high incidence of this neoplasia.
Assuntos
Genes MHC da Classe II/genética , Infecções por Papillomavirus/complicações , Polimorfismo Genético , Infecções Tumorais por Vírus/complicações , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Pessoa de Meia-Idade , Papillomaviridae , Reação em Cadeia da Polimerase , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologiaRESUMO
The authors investigated the joint effects of tobacco and alcohol consumption on the risk of squamous cell carcinomas of the upper aero-digestive tract (UADT) using data from a hospital-based case-control study conducted in southern Brazil, 1986-1989. A total of 784 cases of cancers of the mouth, pharynx, and larynx and 1,578 non-cancer controls matched on age, sex, hospital catchment area, and period of admission were interviewed about their smoking and drinking habits and other characteristics. Using logistic regression, evidence was found for interaction between the cumulative exposures for smoking and alcohol on UADT cancer risk. The joint effects for pharyngeal cancers exceeded the levels expected under a multiplicative model for moderate smokers (p = 0.007). There was little statistical evidence, however, for interaction on cancers of the mouth (p = 0.28) or larynx (p = 0.95). Among never smokers, heavy drinkers had 9.2 times (95% confidence interval 1.7, 48.5) greater risk of cancers of mouth, pharynx, and supraglottis than never drinkers, with a dose-response trend (p = 0.013) with cumulative consumption. The authors conclude that the interaction occurring in the pharynx between smoking and alcohol on UADT cancers is not uniform, with varying effects depending on the level of smoking exposure. Alcohol may act as both a promoter for tobacco and as an independent risk factor.
Assuntos
Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias Laríngeas/epidemiologia , Neoplasias Bucais/epidemiologia , Neoplasias Faríngeas/epidemiologia , Fumar/efeitos adversos , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de RiscoRESUMO
Acquisition and clearance of cervical human papillomavirus (HPV) infection were analyzed among 1425 low-income women attending a maternal and child health program in São Paulo, Brazil. Specimens collected every 4 months were tested by a polymerase chain reaction protocol (MY09/11). In all, 357 subjects were positive at least once. There were 1.3% new infections per month, with 38% cumulative positivity after 18 months. Of 177 positive subjects at enrollment, only 35% remained infected after 12 months. The monthly clearance rate was higher for nononcogenic types (12.2%; 95% confidence interval [CI], 9.6-15.4) than for oncogenic HPV infections (9.5%; 95% CI, 7.5-11.9). Median retention times were 8.1 months (95% CI, 7.8-8.3) for oncogenic types and 4.8 months (95% CI, 3.9-5.6) for nononcogenic HPV infections. The mean infection durations were 8.2 and 13.5 months for nononcogenic and oncogenic types, respectively. Although a woman's age did not affect mean duration for oncogenic types (13-14 months), nononcogenic-type infections lasted longer (10. 2 months) among younger (<35 years old) than in older women (5.6 months).
Assuntos
Colo do Útero/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Infecções Tumorais por Vírus/imunologia , Infecções Tumorais por Vírus/virologia , Doenças do Colo do Útero/imunologia , Doenças do Colo do Útero/virologia , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologiaRESUMO
Tobacco smoking has long been identified as the most important risk factor for upper aero-digestive tract cancers. To investigate the effect of different tobacco types and the benefit of smoking cessation, we analyzed data from a case-control study of 784 cases of mouth, pharynx, and larynx cancers and 1,578 non-cancer controls in three metropolitan hospital areas in Brazil. Subjects were interviewed as to their smoking and drinking habits, demographics, environmental exposures, occupational history, health characteristics, and diet. Controlling for total tobacco and alcohol consumption, risks for ex-smokers compared with current smokers decreased substantially with time since cessation of the habit. Compared with never smokers, ex-smokers of >20 years had a relative risk (RR) of 1.98 [95% confidence interval (CI) = 1.0-3.8] for all upper aerodigestive tract cancers. RRs for long-term (>20 years) ex-smokers tended to be lower for mouth (RR = 1.61) and pharynx (RR = 1.52) than for larynx (RR = 3.63) cancers. The benefit of quitting was strongest for commercial cigarettes (RR = 1.45, 95% CI = 0.7-3.0) for ex-smokers of >10 years, as compared with smoking of black tobacco (RR = 2.57, 95% CI = 1.4-4.6), cigars (RR = 2.59, 95% CI = 0.6-11.6), and pipe tobacco (RR = 3.40, 95% CI = 1.3-8.8).
Assuntos
Neoplasias de Cabeça e Pescoço/epidemiologia , Nicotiana , Plantas Tóxicas , Abandono do Hábito de Fumar , Brasil/epidemiologia , Humanos , Neoplasias Laríngeas/epidemiologia , Neoplasias Bucais/epidemiologia , Neoplasias Faríngeas/epidemiologia , Medição de Risco , Fatores SocioeconômicosRESUMO
The Brazilian Wilms' Tumour Study Group carried out a hospital-based multicentre case-control study of potential risk factors for the disease between April 1987 and January 1989. The parents of 109 cases of Wilms' tumour (WT) were interviewed when they were admitted to hospital for diagnosis and treatment. Also interviewed were the parents of two controls per case, matched for age, sex and interviewer, who were admitted to the same or nearby hospitals for treatment of non-neoplastic conditions. Odds ratios adjusted for family income and parental education were calculated by conditional logistic regression. Among cases diagnosed before 25 months of age there was a marked gradient of increasing risk of WT with increasing maternal age at the time of the child's birth. There was no increased risk for cases diagnosed after 25 months of age. The effects of paternal age were less marked. Possible explanations for these results are discussed.
Assuntos
Neoplasias Renais/epidemiologia , Idade Materna , Idade Paterna , Tumor de Wilms/epidemiologia , Adulto , Idade de Início , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Renais/etiologia , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco , Fatores Socioeconômicos , Tumor de Wilms/etiologiaRESUMO
The Brazilian Wilms' Tumour Study Group carried out a hospital-based multicentre case-control study of potential risk factors for the disease between April 1987 and January 1989. The parents of 109 cases of Wilms' tumour (WT) were interviewed when they were admitted to hospital for diagnosis and treatment. Also interviewed were the parents of two controls per case, matched for age, sex and interviewer, who were admitted to the same or nearby hospitals for treatment of non-neoplastic conditions. Odds ratios adjusted for family income and parental education were calculated by conditional logistic regression. Among cases diagnosed before 25 months of age there was a marked gradient of increasing risk of WT with increasing maternal age at the time of the child's birth. There was no increased risk for cases diagnosed after 25 months of age. The effects of paternal age were less marked. Possible explanations for these results are discussed.