Assessing trends of breast cancer and carcinoma in situ to monitor screening policies in developing settings.

There have been arguments about the role of breast cancer screening at the population level, and some points of controversy have arisen, such the establishment of organized screening policies and the age at which to begin screening. The real benefit of screening has been questioned because the results of this practice may increase the diagnosis of indolent lesions without decreasing mortality due to breast cancer. The authors have proposed a study of incidence and mortality trends for breast cancer in a developing setting in Brazil to monitor the effectiveness of the official recommendations that prioritize the age group from 50 to 69 years. The database of the Cancer Registry and the Mortality Information System was used to calculate age-standardized and age-specific rates, which were then used to calculate incidence and mortality trends using the Joinpoint Regression Program. The results showed stability in trends across all ages and age-specific groups in both incidence and mortality. In conclusion, we found that incidence and mortality rates are compatible with those in regions with similar human development indexes, and trends have demonstrated stabilization. Thus, we do not endorse changes in the official recommendations to conduct screening for ages other than 50 to 69 years, nor should policy makers implement organized screening strategies.

Is a Family History of the Breast Cancer Related to Women's Cancer Prevention Behaviors?

Families share behavioral risk factors that can increase the risk of cancer development. We examined whether having a positive family breast cancer history is associated with health behaviors/screening practices. Analyses were based on a cross-sectional sample of 545 Brazilian National Cancer Institute Hospital patients with newly diagnosed breast cancer in 2013/2014. Women were categorized according to their breast cancer family history. Age-adjusted Poisson regressions with robust variance were performed to estimate the association between breast cancer family history and selected health-related behaviors and screening practices. About one fourth of women reported a positive family history of breast cancer. Contrary to expectation, we found that women with a family history of breast cancer did not report healthier behaviors more often than those without a family history. However, those with a family history were more likely to report a mammographic exam prior to the mammographic diagnosis. Our study suggests that having a family history of cancer is not sufficient to change women's behaviors about physical activity, weight control and diet, smoking, and drinking, but it seems to influence their breast cancer screening behavior. Our results suggest the need to increase women's information and/or understanding that healthier lifestyles contribute to cancer prevention.

Time trends for prostate cancer mortality in Brazil and its geographic regions: An age-period-cohort analysis.

BACKGROUND: In the 1980s, an increase in mortality rates for prostate cancer was observed in North America and developed European countries. In the 1990s, however, mortality rates decreased for these countries, an outcome related to early detection of the disease. Conversely, an upward trend in mortality rates was observed in Brazil. This study describe the trends in mortality for prostate cancer in Brazil and geographic regions (North, Northeast, South, Southeast, and Central-West) between 1980 until 2014 and analyze the influence of age, period, and cohort effects on mortality rates. METHODS: This time-series study used data from the Mortality Information System (SIM) and population data from Brazilian Institute for Geography and Statistics (IBGE). The effects on mortality rates were examined using age-period-cohort (APC) models. RESULTS: Crude and standardized mortality rates showed an upward trend for Brazil and its regions more than 2-fold the last 30 years. Age effects showed an increased risk of death in all regions. Period effects showed a higher risk of death in the finals periods for the North and Northeast. Cohort effects showed risk of death was higher for younger than older generations in Brazil and regions, mainly Northeast (RRAdjusted=3.12, 95% CI 1.29-1.41; RRAdjusted=0.28, 95% CI 0.26-0.30, respectively). CONCLUSION: The increase in prostate cancer mortality rates in Brazil and its regions was mainly due to population aging. The differences in mortality rates and APC effects between regions are related to demographic differences and access of health services across the country.

MYC Amplification as a Predictive Factor of Complete Pathologic Response to Docetaxel-based Neoadjuvant Chemotherapy for Breast Cancer.

BACKGROUND: Neoadjuvant chemotherapy is a standard treatment for stage II and III breast cancer. The identification of biomarkers that may help in the prediction of response to neoadjuvant therapies is necessary for a more precise definition of the best drug or drug combination to induce a better response. MATERIAL AND METHODS: We assessed the role of Ki67, hormone receptors expression, HER2, MYC genes and their protein status, and KRAS codon 12 mutations as predictor factors of pathologic response to anthracycline-cyclophosphamide (AC) followed by taxane docetaxel (T) neoadjuvant chemotherapy (AC+T regimen) in 51 patients with invasive ductal breast cancer. RESULTS: After neoadjuvant chemotherapy, 82.4% of patients showed pathologic partial response, with only 9.8% showing pathologic complete response. In multivariate analysis, MYC immunoreactivity and high MYC gain defined as MYC/nucleus ≥ 5 were significant predictor factors for pathologic partial response. Using the receiver operating characteristic curve analysis, the ratio of 2.5 MYC/CEP8 (sensitivity of 80% and specificity of 89.1%) or 7 MYC/nuclei copies (sensitivity of 80% and specificity of 73.9%) as the best cutoff in predicting a pathologic complete response was identified. Thus, MYC may have a role in chemosensitivity to AC and/or docetaxel drugs. Additionally, MYC amplification may be a predictor factor of pathologic response to the AC+T regimen in patients with breast cancer. Moreover, patients with an increased number of MYC copies showed pathologic complete response to this neoadjuvant treatment more frequently. CONCLUSION: The analysis of MYC amplification may help in the identification of patients that may have a better response to AC+T treatment.

Understanding the relationship between sales of legal cigarettes and deaths: A case-study in Brazil.

Brazil has experienced a large decline in cigarette consumption in the last 25years. However, the most recent annual reports from the tobacco industry market leader in Brazil did not show a decrease in its gross profits. This is particularly important because tobacco industry donations/sponsorships come directly from the industry's reported gross-profits and are used to subvert health policies. The aim of the present study was to estimate (i) tobacco industry's gross-profit from legal cigarettes sales, and (ii) all-cause smoking-attributable deaths (SADs) among current Brazilian smokers who consumed legal cigarettes in 2013. We collected information on prevalence of legal cigarette use, cigarette consumption, price per cigarette pack among individuals aged ≥35years from the Global Adult Tobacco Survey, legal cigarettes sales (e.g., average costs and total volume of sales) provided by the Federal Secretariat of Revenues, and population mortality from the available vital statistics. With a gross-profit of US$1.378 billion (1.307-1.434) from sales of 54.6 billion sticks of cigarettes (53.4-55.5) to 8,424,510 smokers aged 35years and older in Brazil in 2013, cumulative SADs were estimated at 96,012 (85,647-107,654) (around 34% of cumulative SADs also including current smoking of illegal cigarettes and past smoking), i.e., one SAD was equivalent to a gross-profit of US$14,352 (12,140-16,743). Our results revealed the association between sales of cigarettes, gross-profits, and deaths in Brazil. As tobacco industry donations/sponsorships originate from industry's gross profits, which, in turn, depend on cigarette sales, our findings may be useful for increasing "moral pressure" on individuals and institutions and help countries in stopping tobacco industry interference in health policies.

Race and Tobacco Use: A Global Perspective.

These findings suggest that there are no "fixed" racial patterns of tobacco use around the globe. Cross-country differences in tobacco use among races could be modified by cultural influences, domestic tobacco control, or socioeconomic factors. There is need for enhanced efforts to monitor tobacco use by race/ethnicity to identify existing and emerging patterns in tobacco use by race, as well as identify opportunities for interventions. Tailored interventions to reduce tobacco use within different settings and countries may help reduce tobacco use among racial/ethnic minorities. Implementation of comprehensive tobacco control measures could be facilitated by community-based efforts, ensuring that disadvantaged populations are engaged as partners to adapt tobacco control policies and interventions to local contexts and health equity issues.

Smokers in Brazil: who are they?

BACKGROUND: Brazil has experienced a large decline in smoking prevalence due to several tobacco control policies that were implemented in the past 25 years. Previous population-wide studies found a consistent reduction over time in daily cigarette consumption among all socioeconomic groups. OBJECTIVE: To examine changes between 2008 and 2013 in tobacco behaviours and health-related conditions of smokers. METHODS: We used data obtained from two nationally-representative surveys conducted in 2008 and 2013 to estimate the prevalence of self-reported psychological and physical morbidity, and nicotine dependence markers, stratified by gender and sociodemographic groups. Generalised linear models were used to understand whether absolute differences in prevalence rates over time differed by categories of selected variables. RESULTS: For both genders, as smoking prevalence declined in Brazil, there has been an increase in the proportion of ever smokers who have quit. In addition, remaining smokers seem to be making more quitting attempts. Among men with low educational level or younger than 25 years-old, as compared to their counterparts, cessation rate showed an even greater increase over time. Moreover, the proportion of light smokers, which represent the vast majority of smokers, did not decrease. The percentage of poor health-conditions among remaining smokers nevertheless increased, particularly among women, which can make future cessation more challenging. CONCLUSIONS: In Brazil, quitting rate is increasing, thus suggesting that tobacco control interventions implemented in Brazil in the past years seem to be effectively reaching the smoking population. This is strong evidence against the 'hardening hypothesis', which posits that remaining smokers decrease their willingness and ability to quit.

Profile of patients with lung cancer assisted at the National Cancer Institute, according to their smoking status, from 2000 to 2007.

INTRODUCTION: Tobacco use is directly related to the future incidence of lung cancer. In Brazil, a growing tendency in age-adjusted lung cancer mortality rates was observed in recent years. OBJECTIVE: To describe the profile of patients with lung cancer diagnosed and treated at the National Cancer Institute (INCA) in Rio de Janeiro, Brazil, between 2000 and 2007 according to their smoking status. METHODS: An observational study was conducted using INCA's database of cancer cases. To assess whether the observed differences among the categories of sociodemographic variables, characterization of the tumor, and assistance - pertaining to smokers and non-smokers - were statistically significant, a chi-square test was applied. A multiple correspondence analysis was carried out to identify the main characteristics of smokers and non-smokers. RESULTS: There was a prevalence of smokers (90.5% of 1131 patients included in the study). The first two dimensions of the multivariate analysis explained 72.8% of data variability. Four groups of patients were identified, namely smokers, non-smokers, small-cell tumors, and tumors in early stages. CONCLUSION: Smoking cessation must be stimulated in a disseminated manner in the population in order to avoid new cases of lung cancer. The Tumors in Initial Stages Group stood out with greater chances of cure.

The First National Survey of Indigenous People's Health and Nutrition in Brazil: rationale, methodology, and overview of results.

BACKGROUND: Although case studies indicate that indigenous peoples in Brazil often suffer from higher morbidity and mortality rates than the national population, they were not included systematically in any previous national health survey. Reported here for the first time, the First National Survey of Indigenous People's Health and Nutrition in Brazil was conducted in 2008-2009 to obtain baseline information based on a nationwide representative sample. This paper presents the study's rationale, design and methods, and selected results. METHODS: The survey sought to characterize nutritional status and other health measures in indigenous children less than 5 years of age and indigenous women from 14 to 49 years of age on the basis of a survey employing a representative probabilistic sample of the indigenous population residing in villages in Brazil, according to four major regions (North, Northeast, Central-West, and South/Southeast). Interviews, clinical measurements, and secondary data collection in the field addressed the major topics: nutritional status, prevalence of hypertension and diabetes mellitus in women, child hospitalization, prevalence of tuberculosis and malaria in women, access to health services and programs, and characteristics of the domestic economy and diet. RESULTS: The study obtained data for 113 villages (91.9% of the planned sample), 5,305 households (93.5%), 6,692 women (101.3%), and 6,128 children (93.1%). Multiple household variables followed a pattern of greater economic autonomy and lower socioeconomic status in the North as compared to other regions. For non-pregnant women, elevated prevalence rates were encountered for overweight (30.3%), obesity (15.8%), anemia (32.7%), and hypertension (13.2%). Among children, elevated prevalence rates were observed for height-for-age deficit (25.7%), anemia (51.2%), hospitalizations during the prior 12 months (19.3%), and diarrhea during the prior week (23.6%). CONCLUSIONS: The clinical-epidemiological parameters evaluated for indigenous women point to the accentuated occurrence of nutrition transition in all regions of Brazil. Many outcomes also reflected a pattern whereby indigenous women's and children's health indicators were worse than those documented for the national Brazilian population, with important regional variations. Observed disparities in health indicators underscore that basic healthcare and sanitation services are not yet as widely available in Brazil's indigenous communities as they are in the rest of the country.