RESUMO
Background: Exposure to recurrent infections in childhood was linked to an increased risk of cancer in adulthood. There is also evidence that a history of tonsillectomy, a procedure often performed in children with recurrent infections, is linked to an increased risk of leukemia and Hodgkin lymphoma. Tonsillectomy could be directly associated with cancer risk, or it could be a proxy for another risk factor such as recurrent infections and chronic inflammation. Nevertheless, the role of recurrent childhood infections and tonsillectomy on the one hand, and the risk of breast cancer (BC) in adulthood remain understudied. Our study aims to verify whether a history of tonsillectomy increases the risk of BC in women. Methods: A systematic review was performed using PubMed, Google Scholar, Scopus, Embase, and Web of Science databases from inception to January 25, 2022, to identify the studies which assessed the association between the history of tonsillectomy and BC in females. Odds ratio (OR) was calculated using the random/fixed-effects models to synthesize the associations between tonsillectomy and BC risk based on heterogeneity. Results: Eight studies included 2252 patients with breast cancer of which 1151 underwent tonsillectomy and 5314 controls of which 1725 had their tonsils removed. Patients with a history of tonsillectomy showed a higher subsequent risk of developing BC (OR, 1.24; 95% CI: 1.11-1.39) as compared to patients without a history of tonsillectomy. Influence analyses showed that no single study had a significant effect on the overall estimate or the heterogeneity. Conclusions: Our study revealed that a history of tonsillectomy is associated with an increased risk of breast cancer. These findings underscore the need for frequent follow-ups and screening of tonsillectomy patients to assess for the risk of BC.
RESUMO
Background: The Algerian COVID-19 vaccination campaign, which started at the end of January 2021, is marked by a slowly ascending curve despite the deployed resources. To tackle the issue, we assessed the levels and explored determinants of engagement toward the COVID-19 vaccine among the Algerian population. Methods: A nationwide, online-based cross-sectional study was conducted between March 27 and April 30, 2021. A two-stage stratified snowball sampling method was used to include an equivalent number of participants from the four cardinal regions of the country. A vaccine engagement scale was developed, defining vaccine engagement as a multidimensional parameter (5 items) that combined self-stated acceptance and willingness with perceived safety and efficacy of the vaccine. An Engagement score was calculated and the median was used to define engagement vs. non-engagement. Sociodemographic and clinical data, perceptions about COVID-19, and levels of adherence to preventive measures were analyzed as predictors for non-engagement. Results: We included 1,019 participants, 54% were female and 64% were aged 18-29 years. Overall, there were low rates of self-declared acceptance (26%) and willingness (21%) to take the vaccine, as well as low levels of agreement regarding vaccine safety (21%) and efficacy (30%). Thus, the vaccine engagement rate was estimated at 33.5%, and ranged between 29.6-38.5% depending on the region (p > 0.05). Non-engagement was independently associated with female gender (OR = 2.31, p < 0.001), low adherence level to preventive measures (OR = 6.93, p < 0.001), private-sector jobs (OR = 0.53, p = 0.038), perceived COVID-19 severity (OR = 0.66, p = 0.014), and fear from contracting the disease (OR = 0.56, p = 0.018). Concern about vaccine side effects (72.0%) and exigence for more efficacy and safety studies (48.3%) were the most commonly reported barrier and enabler for vaccine acceptance respectively; whereas beliefs in the conspiracy theory were reported by 23.4%. Conclusions: The very low rates of vaccine engagement among the Algerian population probably explain the slow ascension of the vaccination curve in the country. Vaccine awareness campaigns should be implemented to address the multiple misconceptions and enhance the levels of knowledge and perception both about the disease and the vaccine, by prioritizing target populations and engaging both healthcare workers and the general population.