Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women.

Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.

Cutaneous melanoma in Argentina: an analysis of its characteristics and regional differences.

PURPOSE: This study aims to increase the knowledge about the characteristics of cutaneous melanoma in Argentina, their association with the risk of having Breslow ≥1 mm and mortality trends for the period 2002-2017. PATIENTS AND METHODS: Descriptive statistics and regression analyses were done for 10.199 cases within the Argentine Melanoma Registry in the period 2002-2018. Trends in age-standardised mortality rates (ASMR) were analysed using the Join point Regression Model. RESULTS: Cases showed lesions mainly located in males' trunk (37%) and in females' lower limbs (29%). The level of invasion was higher in males who also showed higher mortality. Cases from the North West and North East regions showed a major risk of Breslow >1 mm and harboured CM in lower limbs more frequently than in other regions. Nearly, 25% of tumours over 2 mm were in cases aged <50 years and 37.6% in patients ≥50 years. In the North West, North East and Patagonia, the frequency of cases in young people was higher than in older people. In 43% of cases, the melanoma subtype was not specified in the report. The number of superficial spreading melanomas, the most common histology, was nearly twice that of Nodular melanomas the following histology in importance (3,403 and 1,754, respectively). Melanoma mortality rates in all Argentine population increased in the elderly. Lower melanoma mortality rates were observed in the North West. In 2007-2017, ASMR decreased significantly in females (average 1.4% p/year) while it increased nonsignificantly in males (0.4% p/year).The tumours with the worst prognosis were associated with the elderly, males, nodular or acrolentiginous morphologies, residing somewhere other than Centro and Patagonia and with tumors located in the head/neck and legs. CONCLUSION: The geographical variations found for melanoma characteristics and their mortality in Argentina, makes it imperative that epidemiological research is continued to avoid generalisations and improve future preventive actions.

The burden of cutaneous melanoma and status of preventive measures in Central and South America.

RATIONALE AND OBJECTIVE: Very little is known about the burden of cutaneous melanoma in Central and South America, despite the existence of a reasonable amount of population-based data. We present data on melanoma incidence calculated in a standardized way for Central and South America, as well as an overview of primary and secondary prevention issues in the region. METHODS: Cancer registry data on all incident cases reported in the different registries present in Central and South America were combined to provide registry-based country estimates of age-standardized, sex-specific cutaneous melanoma incidence overall, and by histological subtype and anatomical site. A literature search provided additional information. RESULTS: Age-standardized incidence rates were between 1 and 5 per 100,000 and tended to be higher further away from the equator. Cutaneous melanomas of the acral type, mostly occurring on the lower limbs, are a distinguishing feature of melanoma in Central and South America in comparison with high-incidence areas. Several preventive measures, both primary and secondary, are in place, albeit largely without evaluation. CONCLUSION: Due to incomplete registration and different registration practices, reliable and comparable data on melanoma were difficult to obtain; thus it is likely that the true burden of melanoma in Central and South America has been underestimated. The different characteristics of the cutaneous melanoma patient population in terms of anatomical site and histological type distribution imply a need for adapted primary and secondary prevention measures. The generally high ambient ultraviolet radiation levels require sufficient sun protection measures.

Evaluación externa de registros de cáncer de base poblacional: la Guía REDEPICAN para América Latina / External evaluation of population-based cancer registries: the REDEPICAN Guide for Latin America

OBJETIVO: Evaluar la factibilidad y la adecuación de la Guía REDEPICAN (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) a la situación actual de los Registros de Cáncer de Base Poblacional (RCBP) en América Latina y el Caribe como herramienta útil para mejorar dichos registros. MÉTODOS: La Guía fue diseñada por expertos en registros de cáncer y auditorías sanitarias, y se establecieron siete dominios para evaluarla. Para cada dominio se eligieron varios criterios con sus correspondientes estándares. Se determinaron tres niveles de cumplimiento del estándar. Se organizaron dos cursos de formación de evaluadores externos y tres paneles de discusión con expertos. La Guía se probó en seis RCBP de América Latina y España. RESULTADOS: La Guía contiene 68 criterios, 10 de ellos considerados esenciales para un RCBP. De acuerdo con la puntuación alcanzada, el registro se considera como aceptable (41-199), bueno (200-299) o excelente (300-350). El dominio sobre Métodos de registro representa el 25% de la puntuación, seguido por la Exhaustividad y validez (19%), la Difusión de resultados (19%), la Estructura (13%), la Confidencialidad y aspectos éticos (11%), la Comparabilidad (9%) y el Manual de procedimiento (3%). El proyecto piloto permitió: 1) perfeccionar criterios y estándares, 2) ampliar el concepto de calidad para incorporar las necesidades de los clientes y 3) potenciar la sección de Difusión de resultados. Dos registros latinoamericanos evaluados mejoraron su calidad hasta alcanzar el estándar de la Agencia Internacional de Investigación sobre el Cáncer. CONCLUSIONES: La guía REDEPICAN se ha elaborado teniendo en cuenta el contexto de los registros en América Latina y constituye una herramienta útil y novedosa para la mejora de la calidad de los RCBP. Además está preparada para ser utilizada en otros países y registros.

OBJECTIVE: Evaluate the feasibility of the REDEPICAN Guide (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) and its adaptation to the current situation of population-based cancer registries (PBCRs) in Latin America and the Caribbean as a useful tool to improve these registries. METHODS: Experts in cancer registries and health audits designed the guide and developed seven domains to evaluate in PBCRs. Several criteria were selected for each domain, with corresponding standards, scored according to three levels of compliance. Two training courses for external evaluators and three discussion panels for experts were organized. The guide was tested in six PBCRs in Latin America and Spain. RESULTS: The guide contains 68 criteria, 10 of which are considered essential for a PBCR. Based on its score, a registry is regarded as acceptable (41-199), good (200-299), or excellent (300-350). The registry methods domain accounts for 25% of the score, followed by completeness and validity (19%), dissemination of outcomes (19%), structure (13%), confidentiality and ethical aspects (11%), comparability (9%), and the procedures manual (3%). The pilot project enabled (1) enhancement of criteria and standards, (2) expansion of the quality concept to include client needs, and (3) strengthening the dissemination of outcomes section. Two of the Latin American registries that were evaluated improved their quality, meeting the standards of the International Agency for Research on Cancer. CONCLUSIONS: Development of the REDEPICAN Guide has taken into account the context of the registries in Latin America and is a useful and innovative tool for improving the quality of PBCRs. Furthermore, it is ready for use in other countries and registries.

Childhood cancer: incidence and early deaths in Argentina, 2000-2008.

INTRODUCTION: Knowledge on the epidemiology of childhood cancer in Latin America is limited. The Argentinean Oncopaediatric Registry (ROHA) has been active since 2000. Data for 2000-2008 are described in the present work. MATERIALS AND METHODS: ROHA is fed from a network of paediatric units and population-based cancer registries. Cases are coded by the International Classification of Childhood Cancer. RESULTS: A total of 11447 children aged 0-14 diagnosed with cancer were reported. Histologically verified cases and cases identified only through death certificates were respectively 91% and 6%. The annual age of standardised incidence rate of all cancers was 128.5 per million. Proportions of leukaemia's, lymphoma's and Central Nervous System tumours were 37%, 13% and 18%. The distribution of rates of acute lymphatic leukaemia by the year of age showed a peak around age 3. Eighty percent of the patients are treated in public hospital and around 35% migrate for some of the treatment. Deaths within a month of diagnosis were 5% in 2000 and 3% in 2008. CONCLUSIONS: Childhood cancer incidence in Argentina is somewhat lower than in North American and in Western European countries: the deficit is mainly due to tumours of the Central Nervous system and other solid tumours. Childhood cancer incidence did not show any tendency to increase. The possible excess of Hodgkin lymphoma in the Northeast region requires additional studies. Early deaths after diagnosis indicate an unsatisfactory state of the overall organisation of childhood cancer care. Data from ROHA are used for decision making at local and national levels.

[External evaluation of population-based cancer registries: the REDEPICAN Guide for Latin America]. / Evaluación externa de registros de cáncer de base poblacional: la Guía REDEPICAN para América Latina.

OBJECTIVE: Evaluate the feasibility of the REDEPICAN Guide (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) and its adaptation to the current situation of population-based cancer registries (PBCRs) in Latin America and the Caribbean as a useful tool to improve these registries. METHODS: Experts in cancer registries and health audits designed the guide and developed seven domains to evaluate in PBCRs. Several criteria were selected for each domain, with corresponding standards, scored according to three levels of compliance. Two training courses for external evaluators and three discussion panels for experts were organized. The guide was tested in six PBCRs in Latin America and Spain. RESULTS: The guide contains 68 criteria, 10 of which are considered essential for a PBCR. Based on its score, a registry is regarded as acceptable (41-199), good (200-299), or excellent (300-350). The registry methods domain accounts for 25% of the score, followed by completeness and validity (19%), dissemination of outcomes (19%), structure (13%), confidentiality and ethical aspects (11%), comparability (9%), and the procedures manual (3%). The pilot project enabled (1) enhancement of criteria and standards, (2) expansion of the quality concept to include client needs, and (3) strengthening the dissemination of outcomes section. Two of the Latin American registries that were evaluated improved their quality, meeting the standards of the International Agency for Research on Cancer. CONCLUSIONS: Development of the REDEPICAN Guide has taken into account the context of the registries in Latin America and is a useful and innovative tool for improving the quality of PBCRs. Furthermore, it is ready for use in other countries and registries.

Melanoma cutáneo: mortalidad y características de los tumores incidentes en los dos extremos de la vida en la Argentina / Cutaneous melanoma in argentina: mortality and primary tumor

Objetivos. Conocer y comparar en la Argentina, en los jóvenes y adultos, la mortalidad por melanoma cutáneo (MC) y las características de casos incidentes para aportar información útil en el diseño y evaluación de acciones de prevención. Diseño. descriptivo y retrospectivo. Métodos. Se consideraron para el estudio: los jóvenes < 30 años (J) y adultos > 74 años (AM). Los datos de las defunciones para el cálculo de tasas de mortalidad en los períodos 1981-89, 90-98 y 99-07 fueron proporcionados por la Dirección de Estadísticas e Información de Salud del Ministerio de Salud. La información sobre los casos incidentes se obtuvieron del Registro Argentino de Melanoma Cutáneo (RAMC) para el período enero 2002- diciembre 2009. De ellos se estudió la localización, el espesor de Breslow y el tipo histológico.Resultados. En los sucesivos períodos las muertes por MC en J de ambos sexos fue 97, 93 y 123, y en AM 416, 654 y 1.307, respectivamente. En los AM las tasas de mortalidad aumentaron en el tiempo, y fueron siempre menores para las mujeres que para losvarones (varones: 6,3 muertes por MC promedio por cada 100.000 individuos por año en 81-89 a 13,4/100.000 99-07; mujeres: 4,4/100.000 81-89 a 7,5/100.000 en 99-07). El RAMC registró 4.100 casos, 258 fueron en J y 665 en AM. Fueron mujeres el 63% en J y el 47% en AM (p< 0,05). En las mujeres, el 56% de los MC en J y el 36% en AM tuvieron Breslow ≤ 1,00 mm (p< 0,004). En las mujeres predominaron las lesiones en piernas (el 43,4% en J y el 42,2% en AM), mientras que en los hombres fueron el 19,8% y el 12,4% respectivamente (p< 0,005). Conclusión. En las mujeres jóvenes, el menor espesor de Breslow al momento del diagnóstico y las menores tasas de mortalidad por MC con menor incremento temporal de las mismas podrían ser reflejo de una mayor influencia de las acciones de prevención y una mayor atención del propio cuerpo y de la salud por parte del género femenino. Cabe esperar que la continuidad de las actividades del ...

Objectives. To compare mortality rates and main features of cutaneous malignant melanoma(CMM) between two age groups in Argentina (young and elderly patients), in order to increaseknowledge as well as improve planning and preventive actions for this disease.Study design. descriptive and retrospective.Methods. Group J was defined as patients younger than 30 years of age and Group AM patientsover 74 years old. Death reports for periods 1981-89 / 90-98 / 99-07 were provided by theDepartment of Statistics of the Health Ministry and incident cases between 2002 and December2009 by the Argentine Registry of Cutaneous Malignant Melanoma (RAMC). Tumor location,Breslow thickness index and histopathology characteristics were analyzed for all cases.Results. For successive periods, the total number of CMM-associated deaths for both gendersin Group J was 97, 93 and 123 respectively; while these figures were for Group AM 416, 654 and1,307 respectively. On older patients an increase in mortality rates was observed over elapsedtime, being always lower for women than for men (mortality rates for men were 6.3 /100,000population per year during the period of 1981-1989 and 13.4/100,000 between the years1999-2007. Mortality rates for women were: 4.4/100,000 during 1981-1989 and 7.5/100,000and in 1999-2007). RAMC registered 4,100 new cases, of which 258 belonged to Group J and665 to Group AM. Women comprised 63% on group J and 47% on group AM (p<0, 05). Womencomprised 56% of CMM in Group J and 36% on Group AM, having a Breslow tumor thickness≤ 1.00mm (p<0,004). Primary tumors located on lower limbs were more frequently observedamong women (43.4% and 42.2% for Group J and AM respectively), whereas on men this was19.8% and 12.4%, respectively (p<0,005)...

Cutaneous melanoma in Latin America: the need for more data / El melanoma cutâneo en América Latina: la necesidad de mßs datos

OBJECTIVE: To identify the scientific literature on cutaneous melanoma in Latin America and compile all available epidemiologic data to demonstrate the need for reliable regional and country-specific data on incidence and mortality estimates. METHODS: Literature searches were conducted in PubMed, Embase, LILACS, and Google Scholar databases for epidemiologic studies from 1 January 2000 to 31 October 2010 related to melanoma in Argentina, Brazil, Colombia, Mexico, Puerto Rico, and Venezuela. A final search on melanoma cases was carried out using country-specific population-based cancer registries. No statistical analyses were conducted. RESULTS: For all six countries, most epidemiological research on cutaneous melanoma consists of hospital-based or case-control studies. Very few studies report incidence and mortality rates. Attempts to estimate disease rates have relied on national incidence and mortality data and information extracted from cancer registries. While predominance of European ancestry is a known risk factor for developing melanoma, the association of melanoma and ethnicity is not well-documented in some of the populations reviewed. Latin Americans are frequently exposed to ultraviolet (UV) radiation due to the tropical weather, high altitude, and thinning ozone layer in some regions. Tanned skin is viewed as healthy and beautiful. While melanoma public health campaigns have been under way in Latin America for decades, increasing melanoma awareness remains imperative. CONCLUSIONS: There is an urgent need to collect accurate epidemiologic melanoma data in Latin America. Future research in the region should include more comprehensive, countryspecific, population-based studies to allow for comparative evaluation of incidence and mortality rates.

OBJETIVO: Identificar la literatura científica sobre el melanoma cutßneo en América Latina y recopilar todos los datos epidemiológicos disponibles, con objeto de demostrar la necesidad de información fiable a escala regional y de país sobre los datos de incidencia y mortalidad. MÉTODOS: Se realizaron búsquedas bibliogrßficas en las bases de datos PubMed, Embase, LILACS y Google Scholar para encontrar estudios epidemiológicos relacionados con el melanoma llevados a cabo del 1 de enero del 2000 al 31 de octubre del 2010 en Argentina, Brasil, Colombia, México, Puerto Rico y Venezuela. Se efectuó una búsqueda final de casos de melanoma mediante la consulta de los registros poblacionales de cßncer de cada país. No se realizó ningún anßlisis estadístico. RESULTADOS: En los seis países, la mayor parte de la investigación epidemiológica sobre el melanoma cutßneo consiste en estudios hospitalarios o estudios de casos y testigos. Muy pocos estudios informan sobre las tasas de incidencia y mortalidad. Los intentos de calcular las tasas de la enfermedad se han basado en los datos nacionales de incidencia y mortalidad, y en la información extraída de los registros de cßncer. Aunque el predominio de la ascendencia europea constituye un conocido factor de riesgo de melanoma, la asociación entre el melanoma y el grupo étnico no puede demostrarse adecuadamente en algunas de las poblaciones estudiadas. Los latinoamericanos estßn frecuentemente expuestos a la radiación ultravioleta como consecuencia del clima tropical, la elevada altitud y la disminución de la capa de ozono en algunas regiones. La piel bronceada se considera como saludable y bella. Aunque hace decenios que se llevan a cabo campa±as de salud pública dedicadas al melanoma en América Latina, es indispensable incrementar la conciencia de esta enfermedad. Conclusiones: Existe la urgente necesidad de recopilar datos epidemiológicos precisos sobre el melanoma en América Latina. Las futuras actividades...

Cutaneous melanoma in Latin America: the need for more data.

OBJECTIVE: To identify the scientific literature on cutaneous melanoma in Latin America and compile all available epidemiologic data to demonstrate the need for reliable regional and country-specific data on incidence and mortality estimates. METHODS: Literature searches were conducted in PubMed, Embase, LILACS, and Google Scholar databases for epidemiologic studies from 1 January 2000 to 31 October 2010 related to melanoma in Argentina, Brazil, Colombia, Mexico, Puerto Rico, and Venezuela. A final search on melanoma cases was carried out using country-specific population-based cancer registries. No statistical analyses were conducted. RESULTS: For all six countries, most epidemiological research on cutaneous melanoma consists of hospital-based or case-control studies. Very few studies report incidence and mortality rates. Attempts to estimate disease rates have relied on national incidence and mortality data and information extracted from cancer registries. While predominance of European ancestry is a known risk factor for developing melanoma, the association of melanoma and ethnicity is not well-documented in some of the populations reviewed. Latin Americans are frequently exposed to ultraviolet (UV) radiation due to the tropical weather, high altitude, and thinning ozone layer in some regions. Tanned skin is viewed as healthy and beautiful. While melanoma public health campaigns have been under way in Latin America for decades, increasing melanoma awareness remains imperative. CONCLUSIONS: There is an urgent need to collect accurate epidemiologic melanoma data in Latin America. Future research in the region should include more comprehensive, country-specific, population-based studies to allow for comparative evaluation of incidence and mortality rates.

Tendencia de la mortalidad por càncer en Argentina, Cuba y Uruguay en un período de 15 años / Fifteen-year trends in cancer mortality in Argentina, Cuba and Uruguay

El càncer es la segunda causa de muerte en Argentina, Cuba y Uruguay durante la última década, la mortalidad por càncer ha mostrado una tendencia hacia la disminución en los países màs desarrollados. Objetivos: describir la tendencia temporal de la mortalidad por sitios seleccionados de càncer en Argentina, Cuba y Uruguay durante 1990-2005. Para cada sitio de càncer, sexo y país se calcularon las tasas específicas por grupos de edad y ajustadas por el método directo (a la población mundial). Para identificar los puntos de cambio estadísticamente significativos en la tendencia de las tasas ajustadas se utilizó el anàlisis de regresión lineal segmentada; se estimó el porcentaje de cambio anual. Excepto para Cuba, la mortalidad por todas las causas decreció durante el período. Pulmón: se observó una tendencia decreciente en hombres en Argentina y Uruguay (porcentaje estimado de cambio anual: -2,25 y -1,28 por ciento respectivamente), y creciente en mujeres (porcentaje estimado de cambio anual: 1,75; 2,83 y 3,02) en Argentina, Uruguay y Cuba, respectivamente. Mama: tendencia decreciente en los tres países. Próstata: es el segundo tumor en importancia en Cuba y Uruguay, tercero en Argentina. Un cambio negativo en la tendencia se observó desde 1993 (Cuba) y 1998 (Argentina). Colon/recto: tasas decrecientes en Argentina en ambos sexos y estables en Cuba y Uruguay. Esófago: mortalidad decreciente en Argentina y Uruguay. Útero: en los tres países la mortalidad por Útero no especificado fue similar a cuello, disminuyó para Argentina y Uruguay, mientras aumentó en Cuba. El càncer de cuerpo disminuyó en Argentina. La mortalidad en Cuba refleja un aumento para los tumores tabaco-relacionados. Mayor calidad de la certificación de muerte podría enmascarar una tendencia negativa de la mortalidad por cßncer de cuello de útero. Las tendencias negativas en càncer de próstata podrían ser resultado de avances en ...

Cancer is the second cause of death in Argentina, Cuba and Uruguay during the last decade, cancer mortality has shown a decrease trend in developed countries. Objective To describe mortality trends over time by cancer site in Argentina, Cuba and Uruguay during 1990-2005. For each cancer site, country and gender, age-group specific and standardised (overall) rates were calculated by direct method (using the world standard population). The jointpoint regression analysis was used to identify the best-fitting points were a statistically significant change in the trend occurred and annual percent change was also estimated. Total cancer mortality rates decline during the whole period excepting for Cuba. Lung: a negative tendency was observed in men in Argentina and Uruguay (annual percent change: -2.25 and -1.28 percent respectively), and increased in women (annual percent change: 1,75, 2,83 and 3,02) in Argentina, Uruguay and Cuba respectively. Breast: Negative trends were observed in the three countries. Prostate: it is the second cause of mortality in men in Cuba and Uruguay , and third in Argentina. A negative change in the tendency was observed from 1993 (Cuba) and 1998 (Argentina). Colon/recto: Decreasing rates were shown in Argentina in both sexes whereas not changes were noted in Cuba and Uruguay. Esophagus: Negative trends were detected in Argentina and Uruguay. Uterus: in the three countries mortality for Uterus non-specified was similar to cervix, diminishing for Argentina and Uruguay, while increased in Cuba. Body of uterus mortality diminished in Argentina. Conclusions Mortality trends in Cuba indicate an increasing for the tobacco related-cancer. Enhancing quality of death certification could mask a negative tendency of the mortality for cervix cancer. Negative trends in prostate cancer might be view from the impact of advances in diagnosis and treatment...

Cancer and yerba mate consumption: a review of possible associations.

OBJECTIVE: To identify any possible link between mate consumption and cancer, mainly of the esophagus, larynx, and oral cavity. METHODS: A review of literature, published through August 2008, pertaining to the carcinogenic risk of mate consumption was undertaken by searching the two databases, MEDLINE and TOXLINE, for relevant articles. The bibliographies of the articles were examined for additional relevant sources. In addition, a search on the name of each author having published on the topic was conducted. The epidemiological studies are presented by cancer site; experimental works are examined in dedicated sections; and the discussion combines epidemiological and experimental evidence. RESULTS: Almost all epidemiological studies shared similar methodology: hospital-based, case-control studies where participants were personally interviewed on the main risk factors, using similar questionnaires. Several studies found an association between the temperature of the mate infusion and oral, esophageal, and/or laryngeal cancer risks; while a few focused on carcinogenic contaminants introduced during the industrial processing of the leaves. The cancer most frequently mentioned in association with hot mate with bombilla (drunk through a metal straw) was the esophagus. Size, exposure assessment, methods of analysis, and quality were different among the studies reviewed. The results varied greatly. The higher risk estimate (odds ratio = 34.6) was found for women who drank 1 L or more daily; for men it was only 4.8. Risk increased with duration, daily quantity, and temperature at drinking. The synergic action between mate, alcohol, and tobacco was a clear result in several studies, and in some, nutritional deficiencies and poor oral hygiene played a role. No increased risk was associated with cold mate beverages. CONCLUSIONS: The role of hot mate in increasing the risk of cancer of esophagus, larynx, and oral cavity seems to be supported by several epidemiological studies. The temperature could act by damaging the mucosa or accelerating metabolic reactions, including those with carcinogenic substances in tobacco and alcohol. However, there is no sound population-based case-control study on mate consumption as a risk factor for cancer. This, coupled with the range of results on mate risk, make assessing the etiological fraction difficult. More research needs to be done before a definitive statement can be made regarding cancer risk associated with any of the various forms of mate consumption. Future research should include population-based studies; collection of data on consumption of tobacco, alcohol, hot drinks, fresh fruit, and vegetables; and, a method to precisely measure volume and temperature of mate intake.

Cancer and yerba mate consumption: a review of possible associations / Cáncer y consumo de yerba mate: revisión de posibles asociaciones

OBJECTIVE: To identify any possible link between mate consumption and cancer, mainly of the esophagus, larynx, and oral cavity. METHODS: A review of literature, published through August 2008, pertaining to the carcinogenic risk of mate consumption was undertaken by searching the two databases, MEDLINE and TOXLINE, for relevant articles. The bibliographies of the articles were examined for additional relevant sources. In addition, a search on the name of each author having published on the topic was conducted. The epidemiological studies are presented by cancer site; experimental works are examined in dedicated sections; and the discussion combines epidemiological and experimental evidence. RESULTS: Almost all epidemiological studies shared similar methodology: hospital-based, case-control studies where participants were personally interviewed on the main risk factors, using similar questionnaires. Several studies found an association between the temperature of the mate infusion and oral, esophageal, and/or laryngeal cancer risks; while a few focused on carcinogenic contaminants introduced during the industrial processing of the leaves. The cancer most frequently mentioned in association with hot mate with bombilla (drunk through a metal straw) was the esophagus. Size, exposure assessment, methods of analysis, and quality were different among the studies reviewed. The results varied greatly. The higher risk estimate (odds ratio = 34.6) was found for women who drank 1 L or more daily; for men it was only 4.8. Risk increased with duration, daily quantity, and temperature at drinking. The synergic action between mate, alcohol, and tobacco was a clear result in several studies, and in some, nutritional deficiencies and poor oral hygiene played a role. No increased risk was associated with cold mate beverages. CONCLUSIONS: The role of hot mate in increasing the risk of cancer of esophagus, larynx, and oral cavity seems to be supported by several...

OBJETIVO: Identificar posibles vínculos entre el consumo de mate y el cáncer, en particular de esófago, laringe y cavidad bucal. MÉTODOS: Se realizó una revisión de la bibliografía publicada hasta agosto de 2008 sobre el riesgo carcinogénico del consumo de mate en dos bases de datos, MEDLINE y TOXLINE. Se revisaron las referencias bibliográficas de los artículos para encontrar fuentes adicionales y se buscó por cada autor que hubiera publicado sobre el tema. Los estudios epidemiológicos se presentan según la localización del cáncer, los trabajos experimentales se examinan en secciones separadas y en la discusión se combinaron los datos epidemiológicos y experimentales. RESULTADOS: Casi todos los estudios epidemiológicos siguieron la misma metodología: estudios de casos y controles basados en hospitales donde se entrevistaba personalmente a los participantes acerca de los principales factores de riesgo mediante cuestionarios similares. En algunos estudios se encontró una asociación entre la temperatura de la infusión de mate y el riesgo de cáncer bucal, de esófago y de laringe, mientras que unos pocos se concentraron en los contaminantes carcinogénicos introducidos durante el procesamiento industrial de las hojas. El tipo de cáncer más frecuentemente mencionado en asociación con el mate caliente en bombilla (tomado a través de una cañita metálica) fue el de esófago. El tamaño de la muestra, la evaluación de la exposición, el método de análisis y la calidad variaron de un estudio a otro. Los resultados variaron considerablemente. Se estimó un mayor riesgo (razón de posibilidades = 34,6) en las mujeres que tomaban 1 L diario o más; en los hombres este riesgo fue solo de 4,8. El riesgo aumentó con el tiempo de consumo, la cantidad diaria y la temperatura de la infusión consumida. En algunos estudios se observó una clara sinergia entre el consumo de mate, alcohol y tabaco, mientras que en otros las deficiencias nutricionales y la inadecuada...

Is 2,3,5-pyrroletricarboxylic acid in hair a better risk indicator for melanoma than traditional epidemiologic measures for skin phenotype?

This study aims to assess type of melanin as a risk indicator for skin tumors, in a sample of melanoma cases and controls within a larger multicenter study (Helios 2), held in Europe and South America in 2001-2002. In each case and control, the melanin content in hair was assessed by three methods: 1) the amount of 2,3,5-pyrroletricarboxylic acid (PTCA); 2) the absorbance ratio with ultraviolet spectroscopy; and 3) the spectra of near-infrared spectroscopy. Statistical analysis was performed in a Bayesian setting, defining priors for confounders and effect modifiers from the larger study data set. Subjects with values of PTCA of less than 85 ng/mg carried an increased risk (26 vs. seven discordant pairs: odds ratio = 4.4, 95% confidence interval: 1.52, 14.54), adjusted by hair color, eye color, and number of nevi (n = > or =40). The absorbance ratio showed a weaker and nonsignificant odds ratio of 1.5. After correction by misclassification, near-infrared spectroscopy was associated with an odds ratio of 2.3 (95% confidence interval: 1.36, 4.22). The amount of PTCA is thus a strong and independent risk indicator for melanoma. Incorporating PTCA determination into epidemiologic studies is therefore recommended.

Melanoma, Parkinson's disease and levodopa: causal or spurious link? A review of the literature.

Since the early 1970s, a number of case reports have suggested that levodopa therapy for Parkinson's disease increases the risk of cutaneous malignant melanoma. As yet, no formal epidemiological study has been conducted to verify this hypothesis. To elucidate the relationship between levodopa and the risk of cutaneous malignant melanoma, a systematic literature search using computerized bibliographic databases was done. This review presents the case history evidence for and against the hypothesis of a causal association, and explores possible epidemiological, genetic, social, biochemical and toxicological factors that may increase the risk of melanoma in Parkinson's disease patients. All the case reports in the literature were considered. We concluded that (1) there is no epidemiological or experimental evidence of a causal role of levodopa in increasing the risk of melanoma incidence or progression; (2) there is good evidence of an excess risk of melanoma in patients with Parkinson's disease; (3) there is good evidence of a protective effect of tobacco smoking on the risk for Parkinson's disease; (4) there is good evidence of positive correlation between social class and melanoma risk; (5) the relationship between the risk of Parkinson's disease and the risk of melanoma may be due to a common genetic profile or it can be attributed to a confounding role of social class, associated with both melanoma and Parkinson's disease possibly through an inverse relationship with tobacco smoking.

PTCA determination in human hair: reliability and analytical aspects.

BACKGROUND: In this study we analysed the reliability of HPLC determination of 2.3.5-pyrroletricarboxylic acid (PTCA). This product derives from oxidation of melanin in human hair, and is a good candidate as a risk marker for skin tumors. MATERIAL/METHODS: We determined PTCA in 100 melanoma cases and 100 controls, 21 replicates from six different reference hairs, two trace elements, and one reference sample (brown hair). RESULTS: Work-up procedures showed an almost perfect reproducibility with an Intraclass Correlation Coefficient (ICC) of 0.990. We noticed a low, detectable, but not statistically significant decrease in reproducibility proportional to the amount of PTCA. Agreement between determination following injection of the same solution in HPLC column was also high, with an overall ICC of 0.986. Simultaneous analysis of reproducibility showed a partial ICC for work-up (0.986), for injection (0.987), and an overall standardised ICC (0.975). The analysis of the two reference tracers in successive tests showed a weak, not statistically significant, decreasing linear drift, possibly due to various factors, such as aging of chemical solutions and HPLC columns. CONCLUSIONS: PTCA extracted from human hair through oxidation and determined with HPLC can be considered a reliable marker as a candidate for identifying persons at high risk for melanoma.

Near infrared spectroscopy as a tool for the determination of eumelanin in human hair.

Eumelanins are brown-black pigments present in the hair and in the epidermis which are acknowledged as protection factors against cell damage caused by ultraviolet radiation. The quantity of eumelanin present in hair has recently been put forward as a means of identifying subjects with a higher risk of skin tumours. For epidemiological studies, chromatographic methods of determining pyrrole-2,3,5-tricarboxylic acid (PTCA; the principal marker of eumelanin) are long, laborious and unsuitable for screening large populations. We suggest near infrared (NIR) spectroscopy as an alternative method of analysing eumelanin in hair samples. PCTA was determined on 93 samples of hair by means of oxidizing with hydrogen peroxide in a basic environment followed by chromatographic separation. The same 93 samples were then subjected to NIR spectrophotometric analysis. The spectra were obtained in reflectance mode on hair samples which had not undergone any preliminary treatment, but had simply been pressed and placed on the measuring window of the spectrophotometer. The PTCA values obtained by means of HPLC were correlated with the near infrared spectrum of the respective samples. A correlation between the PTCA values obtained by means of HPLC and the PTCA values obtained from an analysis of the spectra was obtained using the principal component regression (PCR) algorithm. The correlation obtained has a coefficient of regression (R(2)) of 0.89 and a standard error of prediction (SEP) of 13.8 for a mean value of 108.6 ng PTCA/mg hair. Some considerations about the accuracy of the obtained correlation and the main sources of error are made and some validation results are shown.

Smoking behavior and its determinants among women in Concordia, Argentina.

This study assessed smoking, sexual, and reproductive behaviors as determinants of smoking behavior in women from Concordia, Province of Entre Ríos, Argentina, a population with a low incidence of lung cancer and a high incidence of cervical cancer. Interviewers administered structured, close-ended questionnaires to 1,028 women, aged at least 15 years, living in a random sample of households. We calculated the prevalence of smoking-related variables by age group and used a multivariate logistic regression model to identify various behavioral determinants of smoking. Overall, 36% of the women reported having ever smoked, and 23% were current smokers. At least 50% of the women who ever smoked in each age group smoked less than 10 cigarettes per day. The main determinants of ever having smoked were single marital status (OR=1.64, 95% CI=1.01-2.66) and reporting two or more lifetime sexual partners (two or three: OR=2.25, 95% CI=1.63-3.07; four: OR=3.54, 95% CI=2.10-5.08). No association with socioeconomic level, reproductive characteristics, or variables related to health behavior was observed. We conclude that the prevalence of smoking was high, particularly among women aged 35-54 years, and was strongly associated with sexual behavior. Although women seem to be starting to smoke at younger ages compared with women in the past, the younger cohorts do not seem to be taking up the practice to the same extent as the older cohorts. Antismoking interventions and appropriate control measures are still necessary.

Prevalence of human papillomavirus infection among women in Concordia, Argentina: a population-based study.

BACKGROUND: Preparing for HPV vaccine programs, studies are needed of HPV infection in different populations. GOAL: The goal was to evaluate HPV prevalence and determinants in Concordia, Argentina. STUDY DESIGN: A stratified random sample of 1786 households was obtained. Consenting women aged > or =15 years were interviewed and underwent examination, including colposcopy. Cells were collected for a Papanicolaou smear and HPV DNA testing with GP5+/6+ primer-mediated PCR-EIA. RESULTS: PCR was performed on specimens from 987 women. Prevalence among women reporting no previous sexual activity was 3%, and among sexually active women it was 17.7%, peaking at <25 years of age and decreasing to a minimum at > or =65 years of age. However, low-risk types had similar prevalence (approximately 5%) in all age groups. HPV16 (4.0%), HPV35 (2.6%), and other high-risk types were the most common. Almost half of infections were multiple. Younger women initiated sexual activity earlier and had more partners. The main determinants of HPV detection were lifetime number of sex partners and vaginal discharge. CONCLUSION: A clear pattern of decreasing prevalence of HPV with age was observed. This could be explained by development of immunity against specific types over time or related to a cohort effect associated with a recent spread of HPV in this population after recent changes in sexual behavior.

Circulating 92-kilodalton matrix metalloproteinase (MMP-9) activity is enhanced in the euglobulin plasma fraction of head and neck squamous cell carcinoma.

BACKGROUND: Cancer lethality is usually the result of local invasion and metastasis of neoplastic cells from the primary tumor. Because of their ability to degrade extracellular matrix components (EMC), matrix metalloproteinases (MMPs) have been implicated in the breakdown of basement membranes and underlying stroma, thereby facilitating tumor growth and invasion. METHODS: The authors quantitated, by gelatin zymography and densitometric analysis, MMP activity in the euglobulin plasma fraction of 50 healthy controls and 91 head and neck squamous cell carcinoma (HNSCC) patients (51 from the larynx and 40 from the oropharynx). RESULTS: The median value for 92-kilodalton (kD) MMP (MMP-9) activity was increased significantly in laryngeal (Md 2.1 arbitrary units (AU)/mL plasma; range, 0.2-6.4) and oropharyngeal patients (Md 2.08 AU/mL; range, 0.0-5.0) with respect to the controls (Md 0.48 AU/mL; range, 0.0-1.8). Both groups of cancer patients showed a similar behavior. Multivariate analysis indicated that circulating 92-kD MMP activity was not predicted by the clinical-pathologic parameters such as tumor stage, histologic grade, and metastatic lymph nodes. There was no association between high levels of MMP-9 activity and either cigarette smoking or alcohol consumption, major risk factors for developing HNSCC. CONCLUSIONS: The authors found a significant increase of MMP-9 plasma activity both in laryngeal and oropharyngeal squamous cell carcinoma patients as compared with healthy controls. Further studies are necessary to establish its usefulness in the clinical management of these patients.