RESUMO

BACKGROUND: Tobacco use is one of the main risk factors for Lung Cancer (LC) development. However, about 10-20% of those diagnosed with the disease are never-smokers. For Non-Small Cell Lung Cancer (NSCLC) there are clear differences in both the clinical presentation and the tumor genomic profiles between smokers and never-smokers. For example, the Lung Adenocarcinoma (LUAD) histological subtype in never-smokers is predominately found in young women of European, North American, and Asian descent. While the clinical presentation and tumor genomic profiles of smokers have been widely examined, never-smokers are usually underrepresented, especially those of a Latin American (LA) background. In this work, we characterize, for the first time, the difference in the genomic profiles between smokers and never-smokers LC patients from Chile. METHODS: We conduct a comparison by smoking status in the frequencies of genomic alterations (GAs) including somatic mutations and structural variants (fusions) in a total of 10 clinically relevant genes, including the eight most common actionable genes for LC (EGFR, KRAS, ALK, MET, BRAF, RET, ERBB2, and ROS1) and two established driver genes for malignancies other than LC (PIK3CA and MAP2K1). Study participants were grouped as either smokers (current and former, n = 473) or never-smokers (n = 200) according to self-report tobacco use at enrollment. RESULTS: Our findings indicate a higher overall GA frequency for never-smokers compared to smokers (58 vs. 45.7, p-value < 0.01) with the genes EGFR, KRAS, and PIK3CA displaying the highest prevalence while ERBB2, RET, and ROS1 the lowest. Never-smokers present higher frequencies in seven out of the 10 genes; however, smokers harbor a more complex genomic profile. The clearest differences between groups are seen for EGFR (15.6 vs. 21.5, p-value: < 0.01), PIK3CA (6.8 vs 9.5) and ALK (3.2 vs 7.5) in favor of never-smokers, and KRAS (16.3 vs. 11.5) and MAP2K1 (6.6 vs. 3.5) in favor of smokers. Alterations in these genes are comprised almost exclusively by somatic mutations in EGFR and mainly by fusions in ALK, and only by mutations in PIK3CA, KRAS and MAP2K1. CONCLUSIONS: We found clear differences in the genomic landscape by smoking status in LUAD patients from Chile, with potential implications for clinical management in these limited-resource settings.

Assuntos

Neoplasias Pulmonares , não Fumantes , Fumantes , Humanos , Neoplasias Pulmonares/genética , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/etiologia , Feminino , Masculino , Fumantes/estatística & dados numéricos , Pessoa de Meia-Idade , não Fumantes/estatística & dados numéricos , Idoso , Fumar/genética , Fumar/efeitos adversos , Fumar/epidemiologia , Mutação , Genômica/métodos , Adulto , Carcinoma Pulmonar de Células não Pequenas/genética , Carcinoma Pulmonar de Células não Pequenas/epidemiologia , Carcinoma Pulmonar de Células não Pequenas/patologia

RESUMO

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with tobacco smoking and biomass-burning smoke exposure. Toll-like receptor 4 (TLR4) single-nucleotide polymorphisms (SNPs) may contribute to its pathogenesis. The study aimed to assess the association of rs4986790 and rs4986791 in the TLR4 gene in a Mexican mestizo population with COPD secondary to tobacco smoking (COPD-TS) and biomass-burning smoke (COPD-BBS) and to evaluate whether the genotypes of risk affect cytokine serum levels. Materials and methods: We enrolled 2,092 participants and divided them into two comparisons according to their environmental exposure. SNPs were genotyped using TaqMan probes. Serum cytokine levels (IL-4, IL-5, IL-6, IL-10, and INF-γ) were quantified by ELISA. Results: The rs4986790 AA genotype in COPD-TS was associated with a higher COPD risk (OR = 3.53). Haplotype analysis confirmed this association, identifying a block containing the rs4986790 allele (A-C, OR = 3.11). COPD-TS exhibited elevated IL-6, IL-4, and IL-5 levels compared with smokers without COPD (SWOC), whereas COPD-BBS displayed higher IFN-γ, IL-6, and IL-10 levels. The AA carriers in the COPD-TS group had elevated IL-4, IL-5, and IFN-γ compared with carriers of AG or GG. Conclusion: The rs4986790 common allele and the A-C haplotype (rs4986790-rs4986791) were associated with a higher COPD risk in smokers; COPD patients carrying the AA genotype showed increased pro-inflammatory cytokines.

Assuntos

Genótipo , Interferon gama , Polimorfismo de Nucleotídeo Único , Doença Pulmonar Obstrutiva Crônica , Receptor 4 Toll-Like , Humanos , Doença Pulmonar Obstrutiva Crônica/genética , Doença Pulmonar Obstrutiva Crônica/etiologia , Masculino , Feminino , Receptor 4 Toll-Like/genética , Pessoa de Meia-Idade , Interferon gama/genética , Interferon gama/sangue , Idoso , Interleucina-4/genética , Interleucina-4/sangue , Biomassa , Predisposição Genética para Doença , Interleucina-5/genética , Interleucina-5/sangue , Fumaça/efeitos adversos , México , Adulto , Fumantes , Fumar/efeitos adversos

RESUMO

Smoking cessation is an important public health policy worldwide. However, as far as we know, there is a lack of screening of variables related to the success of therapeutic intervention (STI) in Brazilian smokers by machine learning (ML) algorithms. To address this gap in the literature, we evaluated the ability of eight ML algorithms to correctly predict the STI in Brazilian smokers who were treated at a smoking cessation program in Brazil between 2006 and 2017. The dataset was composed of 12 variables and the efficacies of the algorithms were measured by accuracy, sensitivity, specificity, positive predictive value (PPV) and area under the receiver operating characteristic curve. We plotted a decision tree flowchart and also measured the odds ratio (OR) between each independent variable and the outcome, and the importance of the variable for the best model based on PPV. The mean global values for the metrics described above were, respectively, 0.675±0.028, 0.803±0.078, 0.485±0.146, 0.705±0.035 and 0.680±0.033. Supporting vector machines performed the best algorithm with a PPV of 0.726±0.031. Smoking cessation drug use was the roof of decision tree with OR of 4.42 and importance of variable of 100.00. Increase in the number of relapses also promoted a positive outcome, while higher consumption of cigarettes resulted in the opposite. In summary, the best model predicted 72.6% of positive outcomes correctly. Smoking cessation drug use and higher number of relapses contributed to quit smoking, while higher consumption of cigarettes showed the opposite effect. There are important strategies to reduce the number of smokers and increase STI by increasing services and drug treatment for smokers.

Assuntos

Algoritmos , Fumantes , Humanos , Brasil/epidemiologia , Aprendizado de Máquina , Recidiva

RESUMO

INTRODUCTION: This study aimed to assess whether two established psychosocial predictors of smoking abstinence, nicotine dependence and time-discounting, also apply to a population of predominantly cigarette light smokers, which is the dominant pattern of smoking in countries like Mexico. Relatively infrequent smoking is increasingly prevalent, yet still harmful, making it important to understand the predictors of cessation in this population. AIMS AND METHODS: Mexican adult smokers recruited from an online consumer panel were surveyed every 4 months between November 2018 and July 2020. We considered respondents who reported a quit attempt in between surveys (n = 1288). Dependence was measured with a 10-item version of the Wisconsin Inventory of Smoking Dependence Motives (WISDM). Time-discounting was assessed with five branching questions about hypothetical reward scenarios. Logistic models regressed sustained quit attempts (≥30 days of abstinence) at time t + 1 on study variables at time t. RESULTS: We found strong interitem reliability (α = 0.92) and intraindividual consistency of our brief WISDM (ρ = 0.68), but moderate intraindividual consistency of the time-discounting measure (ρ = 0.48). Forty-eight percent of the sample reported sustained quit attempts, and 79% were non-daily or light daily smokers (≤5 cigarettes per day). Smokers with higher WISDM-10 had lower odds of sustained quitting and this result remained when controlling for smoking frequency and the Heaviness of Smoking Index (adjusted odds ratio [AOR] = 0.768). Time-discounting was unassociated with sustained quitting. CONCLUSIONS: Our findings suggest that a brief, 10-item multidimensional measure of dependence is useful for predicting sustained quitting in a context of relatively light smoking; time-discounting appears less relevant, although our results are not conclusive because of the low test-retest reliability of our measure. IMPLICATIONS: Given the increase in non-daily and light daily cigarette smoking in many countries, including in Mexico, and the health risks this still poses, it is important to understand the predictors of cessation among relatively light smokers. The WISDM-10 multidimensional measure seems to be a good instrument to assess dependence and predict successful quitting in this population, and possibly more appropriate than physical dependence measures. As such, it could help design and target more suitable cessation treatments for non-daily and daily light cigarette smokers. While this study did not find time-discounting to be a relevant predictor of smoking abstinence, future studies should explore other measures.

Assuntos

Comportamentos Relacionados com a Saúde , Fumantes , Adulto , Humanos , Estudos Longitudinais , Reprodutibilidade dos Testes , Fumar/epidemiologia

RESUMO

Introducción: La leucoplasia es la lesión potencialmente maligna más común de la mucosa bucal; el consumo de tabaco es el principal factor etiológico; se presentan distintos grados de displasia epitelial. Su estudio permite conocer mejor las manifestaciones clínicas e histopatológicas de esta enfermedad. Objetivo: Caracterizar clínica e histopatológicamente la leucoplasia homogénea bucal en pacientes fumadores de tabaco. Métodos: Se realizó un estudio descriptivo y transversal. El universo estuvo compuesto por 75 pacientes fumadores de tabaco y cigarros, atendidos en la consulta estomatológica del Policlínico de Especialidades del Hospital Clínico-Quirúrgico Saturnino Lora Torres de Santiago de Cuba. Mediante el examen clínico e histopatológico se diagnosticó leucoplasia homogénea bucal. Para la recolección del dato primario se confeccionó un modelo con las siguientes variables: grupo de edad, sexo, diagnóstico clínico, tiempo en el hábito de fumar, localización anatómica y estudio histopatológico de la enfermedad. Resultados: En la casuística prevaleció el sexo masculino (58,6 por ciento) y el grupo etario de 60 años y más (41,3 por ciento); la hiperparaqueratosis (64,0 por ciento), el infiltrado inflamatorio crónico ligero (60,0 por ciento) y la displasia epitelial leve (73,3 por ciento) fueron las alteraciones hísticas más comunes en fumadores con 21 y más años. La hipercromasia del núcleo (100,0 por ciento) y el pleomorfismo nuclear (96,80 por ciento) resultaron los cambios celulares más prominentes. Las alteraciones de los clavos interpapilares (92,0 por ciento), la hiperplasia del estrato basal (88,9 por ciento) y la pérdida de la polaridad (87,3 por ciento) resultaron los signos displásicos tisulares más significativos en la leucoplasia bucal y la mucosa de carrillo (40,0 por ciento) el sitio anatómico de mayor ocurrencia de lesiones. Conclusiones: Todos los pacientes fumadores de tabaco y cigarro presentaron, clínicamente, lesiones leucoplásicas bucales, confirmadas por el estudio histopatológico; el sexo masculino y el grupo de 60 y más años son los de mayor afectación. La hiperparaqueratosis, el infiltrado inflamatorio crónico ligero y la displasia epitelial leve fueron los de mayor predominio; la hipercromasia del núcleo y el pleomorfismo nuclear fueron los cambios celulares más prominentes. En el tejido displásico epitelial prevalecieron las alteraciones de los clavos interpapilares, la hiperplasia del estrato basal y la pérdida de la polaridad y el sitio más afectado, la mucosa de carrillo(AU)

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Introduction: Leukoplakia is the most common potentially malignant lesion of the buccal mucosa; tobacco use is the main etiological factor; different degrees of epithelial dysplasia are present. Its study allows a better understanding of the clinical and histopathological manifestations of this disease. Objective: To clinically and histopathologically characterize homogeneous buccal leukoplakia in patients who smoke tobacco. Methods: A descriptive and cross-sectional study was performed. The universe was composed of 75 patients who smoked tobacco and cigars, attended in the stomatological consultation of the Specialties Polyclinic of the Clinical-Surgical Hospital Saturnino Lora Torres of Santiago de Cuba. By means of clinical and histopathological examination, homogeneous buccal leukoplakia was diagnosed. For the collection of the primary data, a model was made with the following variables: age group, sex, clinical diagnosis, time in smoking habit, anatomical location and histopathological study of the disease. Results: Male sex (58.6 percent)) and age group 60 years and older (41.3 percent) prevailed in the casuistry; hyperkeratosis (64.0 percent)), mild chronic inflammatory infiltrate (60.0 percent)) and mild epithelial dysplasia (73.3 percent)) were the most common histopathological alterations in smokers aged 21 years and older. Hyperchromasia of the nucleus (100.0 percent)) and nuclear pleomorphism (96.80 percent)) were the most prominent cellular changes. Interpapillary nail alterations (92.0 percent)), stratum basale hyperplasia (88.9 percent)) and loss of polarity (87.3 percent)) resulted the most significant tissue dysplastic signs in buccal leukoplakia and cheek mucosa (40.0 percent)) the anatomical site of highest occurrence of lesions. Conclusions: All tobacco and cigarette smoking patients presented, clinically, buccal leukoplastic lesions, confirmed by histopathological study; male sex and the 60 and older age group are the most affected. Hyperparapokeratosis, mild chronic inflammatory infiltrate and mild epithelial dysplasia were the most predominant; hyperchromasia of the nucleus and nuclear pleomorphism were the most prominent cellular changes. In the epithelial dysplastic tissue, interpapillary nail alterations, hyperplasia of the stratum basale and loss of polarity prevailed and the most affected site, the cheek mucosa(AU)

Assuntos

Humanos , Masculino , Pessoa de Meia-Idade , Leucoplasia Oral , Diagnóstico Clínico , Fumar Cigarros , Fumantes , Estudos Transversais

RESUMO

Importance: It is estimated that, from 2023 to 2025, lung cancer (LC) will be the second most frequent cancer in Brazil, but the country does not have an LC screening (LCS) policy. Objective: To compare the number of individuals eligible for screening, 5-year preventable LC deaths, and years of life gained (YLG) if LC death is averted by LCS, considering 3 eligibility strategies by sociodemographic characteristics. Design, Setting, and Participants: This comparative effectiveness research study assessed 3 LCS criteria by applying a modified version of the LC-Death Risk Assessment Tool (LCDRAT) and the LC-Risk Assessment Tool (LCRAT). Data are from the 2019 Brazilian National Household Survey. Participants included ever-smokers aged 50 to 80 years. Data analysis was performed from February to May 2023. Exposures: Exposures included ever-smokers aged 50 to 80 years, US Preventive Services Task Force (USPSTF) 2013 guidelines (ever-smokers aged 55 to 80 years with ≥30 pack-years and <15 years since cessation), and USPSTF 2021 guidelines (ever-smokers aged 50 to 80 years with 20 pack-years and <15 years since cessation). Main Outcomes and Measures: The primary outcomes were the numbers of individuals eligible for LCS, the 5-year preventable deaths attributable to LC, and the number of YLGs if death due to LC was averted by LCS. Results: In Brazil, the eligible population for LCS was 27 280 920 ever-smokers aged 50 to 80 years (13 387 552 female [49.1%]; 13 249 531 [48.6%] aged 50-60 years; 394 994 Asian or Indigenous [1.4%]; 3 111 676 Black [11.4%]; 10 942 640 Pardo [40.1%]; 12 830 904 White [47.0%]; 12 428 536 [45.6%] with an incomplete middle school education; and 12 860 132 [47.1%] living in the Southeast region); 5 144 322 individuals met the USPSTF 2013 criteria for LCS (2 090 636 female [40.6%]; 2 290 219 [44.5%] aged 61-70 years; 66 430 Asian or Indigenous [1.3%]; 491 527 Black [9.6%]; 2 073 836 Pardo [40.3%]; 2 512 529 [48.8%] White; 2 436 221 [47.4%] with an incomplete middle school education; and 2 577 300 [50.1%] living in the Southeast region), and 8 380 279 individuals met the USPSTF 2021 LCS criteria (3 507 760 female [41.9%]; 4 352 740 [51.9%] aged 50-60 years; 119 925 Asian or Indigenous [1.4%]; 839 171 Black [10.0%]; 3 330 497 Pardo [39.7%]; 4 090 687 [48.8%] White; 4 022 784 [48.0%] with an incomplete middle school education; and 4 162 070 [49.7%] living in the Southeast region). The number needed to screen to prevent 1 death was 177 individuals according to the USPSTF 2013 criteria and 242 individuals according to the USPSTF 2021 criteria. The YLG was 23 for all ever-smokers, 19 for the USPSTF 2013 criteria, and 21 for the USPSTF 2021 criteria. Being Black, having less than a high school education, and living in the North and Northeast regions were associated with increased 5-year risk of LC death. Conclusions and Relevance: In this comparative effectiveness study, USPSTF 2021 criteria were better than USPSTF 2013 in reducing disparities in LC death rates. Nonetheless, the risk of LC death remained unequal, and these results underscore the importance of identifying an appropriate approach for high-risk populations for LCS, considering the local epidemiological context.

Assuntos

Neoplasias Pulmonares , Humanos , Feminino , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/epidemiologia , Brasil/epidemiologia , Detecção Precoce de Câncer , Fatores de Risco , Fumantes

RESUMO

OBJECTIVE: According to the literature, depression and tobacco use are closely linked. This study's main objectives were to provide the first population-based epidemiological profile of smokers with depression (SWD) who were 18 years and older and living in Puerto Rico (PR) from 2018 to 2020 and identify any statistically significant differences between SWD and smokers without depression (SWOD). METHODS: A descriptive cross-sectional study was carried out using PR Behavioral Risk Factor Surveillance System (PRBRFSS) data (2018-2020). Univariate analysis was performed to obtain an epidemiological profile of smokers who had depression. Likewise, using bivariate analysis, SWD and SWOD were compared to identify statistically significant differences in terms of chronic conditions, risk factors, and quit attempts. RESULTS: Depression prevalence among smokers 18 years and over in PR from 2018-2020 was 23.7%. Smokers with depression were more likely to be physically inactive (P < .001), overweight or obese (P < .001), have arthritis (P < .001), chronic obstructive pulmonary disease (P < .001), asthma (P < .001), high cholesterol (P < .001), hypertension (P < .001), coronary heart disease (P < .001), diabetes (P < .001), stroke (P < .001), and heart attack (P < .001) compared with SWOD. Likewise, SWD made more quitting attempts in the past year than did SWOD (P < .001). CONCLUSION: Our results indicate that SWD should be targeted in any health-based tobacco-control efforts to develop evidence-based strategies to reduce or eliminate tobacco use in this same population.

Assuntos

Depressão , Fumantes , Humanos , Adolescente , Adulto , Porto Rico/epidemiologia , Depressão/epidemiologia , Estudos Transversais , Uso de Tabaco/epidemiologia

RESUMO

OBJECTIVES: This study aimed to examine changes in the proportion of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019. STUDY DESIGN: Serial cross-sectional study. METHODS: Data from two nationally representative cross-sectional surveys were used to examine changes over time in the proportions of smokers who were seen by a doctor or other healthcare provider for any health concern and were advised to quit smoking ('Advice_HP'). An additional dichotomous variable ('AdviceAccess_HP') was created and included smokers who were not seen by a doctor or other healthcare provider in the past 12 months in the 'no advice' received category. Crude and adjusted absolute differences in prevalence rates of smokers who were advised to quit smoking by health professionals as part of routine consultations or interactions with their patients between 2008 and 2019 were evaluated using a generalised linear model. RESULTS: The proportion of smokers who were seen by a health professional for any health concern increased from 58.8% in 2008 to 88.7% in 2019. The proportion of 'AdviceAccess_HP' increased from 33.6% in 2008 to 45.2% in 2019; however, the proportion of 'Advice_HP' decreased from 57.1% in 2008 to 51.0% in 2019. After adjustment for sociodemographic and smoking behaviour characteristics, differences remained virtually unchanged. In 2019, health professionals missed the opportunity to provide around 10 million smokers with brief advice to stop smoking. CONCLUSIONS: Monitoring the actions needed to encourage smoking cessation is critical for achieving the United Nations sustainable development goals. Primary healthcare workers should serve as role models for patients and provide brief advice that increases the likelihood of successfully quitting tobacco use, particularly in low- and middle-income countries.

Assuntos

Abandono do Hábito de Fumar , Humanos , Fumantes , Estudos Transversais , Brasil/epidemiologia , Pessoal de Saúde

RESUMO

Cigarette smoking remains an important health concern and is still a leading cause of preventable mortality. Nicotine is the substance responsible for sustained tobacco use and dependence. Identification of biomarkers underlying nicotine dependence behavior is important to identify people at risk for this dependence. In the present study, we identified biochemical and genetic biomarkers of nicotine dependence detected by the Fagerström Test for Nicotine Dependence (FTDN) in Mexican smokers. The nicotine metabolites nicotine-N'-oxide, trans-3'-hydroxycotinine-glucuronide (3HC-O-Gluc), and nicotine-N-Gluc (Gluc) were useful to differentiate nicotine-dependent from non-dependent subjects (p < .0001) with an area under the curve (AUC) of 0.7818. Genetic variants in CYP2A6, FMO3, and UGT2B7 (rs2431413, rs28363545, and rs7439326, respectively) were associated with nicotine dependence (p = .03, p = .01, p = .01, respectively). Variations in the enzymatic activity of CYP2A6 were associated with altered nicotine-N'-oxide and 3HC-O-Gluc levels. Decreased urinary levels of 3HC-O-Gluc and increased nicotine-N'-oxide were associated with a decrease in the functional activity of CYP2A6. A strong positive correlation was observed between the ratio of urinary 3HC/cotinine, a measure of CYP2A6 activity, and the levels of 3HC-O-Gluc (p < .0001, r = .6835), while a strong negative correlation was observed with nicotine-N'-oxide (p < .0001, r = .6522) in nicotine-dependent subjects. No correlations were observed in non-nicotine-dependent subjects. These data suggest that particular urinary nicotine metabolites and genetic variants involved in nicotine metabolism are useful to identify subjects with nicotine dependence in the Mexican population.

Assuntos

Nicotina , Tabagismo , Humanos , Nicotina/metabolismo , Tabagismo/genética , Fumantes , Marcadores Genéticos , Óxidos

RESUMO

OBJECTIVE: To estimate the prevalence of adult smokers in the 26 capitals and the Federal District according to the Brazilian Deprivation Index (Índice Brasileiro de Privação - IBP). METHODS: Dataset on smoking were obtained from the Surveillance of Risk and Protective Factors for Noncommunicable Diseases by Survey (Vigitel) system for the 26 capitals and the Federal District, in the period from 2010 to 2013. The IBP classifies the census sectors according to indicators such as: income less than ½ minimum wage, illiterate population and without sanitary sewage. In the North and Northeast regions, the census sectors were grouped into four categories (low, medium, high and very high deprivation) and in the South, Southeast and Midwest regions into three (low, medium and high deprivation). Prevalence estimates of adult smokers were obtained using the indirect estimation method in small areas. To calculate the prevalence ratios, Poisson models are used. RESULTS: The positive association between prevalence and deprivation of census sector categories was found in 16 (59.3%) of the 27 cities. In nine (33.3%) cities, the sectors with the greatest deprivation had a higher prevalence of smokers when compared to those with the least deprivation, and in two (7.4%) there were no differences. In Aracaju, Belém, Fortaleza, João Pessoa, Macapá and Salvador, the prevalence of adult smokers was three times higher in the group of sectors with greater deprivation compared to those with less deprivation. CONCLUSION: Sectors with greater social deprivation had a higher prevalence of smoking, compared with less deprivation, pointing to social inequalities.

Assuntos

Fumantes , Fumar , Humanos , Adulto , Brasil/epidemiologia , Prevalência , Fumar/epidemiologia , Fatores Socioeconômicos