Multilevel analysis of social determinants of advanced stage colorectal cancer diagnosis.

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country.

Inequalities in Temporal Effects on Cervical Cancer Mortality in States in Different Geographic Regions of Brazil: An Ecological Study.

Cervical cancer is a public health issue with high disease burden and mortality in Brazil. The objectives of the present study were, firstly, to analyze age, period, and cohort effects on cervical cancer mortality in women 20 years old or older from 1980 to 2019 in the North, South, and Southeast Regions of Brazil; and secondly, to evaluate whether the implementation of a national screening program and the expansion of access to public health services impacted the examined period and reduced the risk of death compared with previous years and among younger cohorts. The effects were estimated by applying Poisson regression models with estimable functions. The highest mortality rate per 100,000 women was found in Amazonas (24.13), and the lowest in São Paulo (10.56). A positive gradient was obtained for death rates as women's age increased. The states in the most developed regions (South and Southeast) showed a reduction in the risk of death in the period that followed the implementation of the screening program and in the cohort from the 1960s onwards. The North Region showed a decreased risk of death only in Amapá (2000-2004) and Tocantins (1995-2004; 2010-2019). The findings indicate that health inequities remain in Brazil and suggest that the health system has limitations in terms of decreasing mortality associated with this type of cancer in regions of lower socioeconomic development.

Completeness of cervical cancer staging information in Brazil: A national hospital-based study.

BACKGROUND: Cancer staging information in Hospital Cancer Registries (HCR) is essential for cancer care quality evaluations. This study aimed to analyze the completeness of cervical cancer staging in Brazilian HCR and identify individual and contextual factors associated with unknown staging. METHODS: The outcome analyzed was missing or unknown staging (Malignant Tumor Classification System and/or International Federation of Gynecology and Obstetrics) in 2006-2015. Individual data on cancer cases were collected from the HCR Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil, the National Registry of Health Facilities, and the Outpatient Information System. The random intercept multilevel Poisson regression model was performed to identify the factors associated with the outcome. RESULTS: The prevalence of unknown staging data was 32.4% (95% confidence interval [CI], 32.1-32.7). Women aged 18-29 years (prevalence ratio [PR], 1.48; 95% CI, 1.42-1.54), referred by the public health system (PR, 1.16; 95% CI, 1.11-1.21), living in states with a low density of oncologists (PR, 1.70; 95% CI, 1.62-1.79), and with a low cytopathological testing rate (PR, 1.69; 95% CI, 1.57-1.82) showed a higher prevalence of unknown tumor staging data. A lower level of education (PR, 0.91; 95% CI, 0.84-0.98) was associated with complete staging data. CONCLUSIONS: Individual and contextual factors were associated with missing staging data. It is necessary to improve information on cancer in the HCRs by improving the awareness and training of Brazilian cancer care professionals.

Spatial assessment of advanced-stage diagnosis and lung cancer mortality in Brazil.

The high incidence and mortality rates make lung cancer a global public health issue. Socioeconomic conditions and the provision of health services may be associated with this reality. This study investigates the spatial distribution of advanced-stage diagnosis and mortality due to lung cancer and its association with the healthcare services supply and demographic and socioeconomic indicators in Brazil. This is an ecological study with 161 Intermediate Regions of Urban Articulation. Mortality data were extracted from the Mortality Information System, and the cases of lung cancer were obtained from the Integrator of Hospital-Based Cancer Registries from 2011 to 2015. Analyses employed Moran's I, local indicators of spatial association, and the multivariable model. The proportion of advanced-stage diagnosis was 85.28% (95% CI 83.31-87.10) and was positively associated with the aging rate (Moran's I 0.11; p = 0.02), per capita income (Moran's I 0.05; p = 0.01) and negatively associated with Gini Index (Moran's I -0.16; p = 0.01). The mean age-adjusted mortality rates was 12.82 deaths/100,000 inhabitants (SD 5.12). The age-adjusted mortality rates for lung cancer presented a positive and statistically significant spatial association with all demographic, socioeconomic and healthcare services supply indicators, except for the "density of family health teams" (Moran's I -0.02 p = 0.28). The multivariable model for the mortality rates was constituted by the variables "Density of facilities licensed in oncology", "Per capita income", and "Health plan coverage". The per capita income presented positive association and health plan coverage negative association with age-adjusted mortality rates. Both associations were statistically significant. The variable density of facilities licensed in oncology showed no significant association with age-adjusted mortality rates. There is a high proportion of advanced-stage diagnosis across the Brazilian territory and inequalities in lung cancer mortality, which are correlated with the most developed areas of the country.

Sex and age differences in mortality trends of gastric cancer among Hispanic/Latino populations in the United States, Latin America, and the Caribbean.

Background: An up-to-date analysis of gastric cancer mortality among Hispanic/Latino populations is required for estimating disease burden and assessing the effectiveness of clinical and preventive strategies. Methods: We retrieved gastric cancer deaths between 1997 and 2017 (as available) from the Surveillance, Epidemiology, and End Results Program (United States Hispanics) and the World Health Organization databases (Puerto Rico, 16 Latin American and Caribbean countries). Joinpoint regression analysis was used to examine trends in age-standardized mortality rates (ASMR; per 100 000 person-years) and calculate average annual percent changes (AAPCs) by country (or territory), age group (25-49 and ≥50 years), and sex. Trends were compared to assess slope parallelism. Findings: In 2017, Chile (31·8), Colombia (24·3) and Costa Rica (24·3) had the highest ASMR of gastric cancer for men, while Guatemala (17·2), Peru (13·5), and Costa Rica (13·3) had the highest ASMR for women. Small-to-moderate mortality declines (AAPCs ranged -4 to -0.5%) were observed between 1997 and 2017. In almost all countries, trends decreased among individuals aged ≥50 years. However, age-specific trends were not parallel (p-values <0.05) in Brazil, Colombia, Mexico, the United States, and Venezuela for both men and women, and in five additional countries for only women; with a few countries showing stable or slightly increasing trends for individuals aged 25-49 years. Interpretation: Overall gastric cancer mortality rates in Hispanics/Latinos declined in the last two decades. However, there was a notable variation in trends by country, sex, and age group. Continued and targeted prevention efforts are needed to reduce the disease burden in these vulnerable populations. Funding: Universidad Cientifica del Sur, Peru, and National Cancer Institute, United States.

COVID-19 no Brasil: tendências, desafios e perspectivas após 18 meses de pandemia / COVID-19 in Brazil: trends, challenges, and perspectives after 18 months of the pandemic / COVID-19 en Brasil: tendencias, desafíos y perspectivas después de 18 meses de pandemia

RESUMO Objetivo. Analisar as tendências de incidência e mortalidade por COVID-19 no Brasil, nas unidades da federação e nas capitais. Método. Realizou-se um estudo ecológico com dados de incidência e de mortalidade por COVID-19 referentes ao período de 25 de fevereiro de 2020 (primeiro caso notificado no Brasil) a 31 de julho de 2021. Os dados foram agrupados por mês para cálculo das taxas brutas (por 100 000 habitantes) e avaliação das tendências temporais das unidades da federação e de suas capitais. As modificações significativas nas tendências temporais foram analisadas pelo método de regressão por joinpoint. Resultados. Foram identificadas duas ondas de novos casos e óbitos. As unidades da federação com as maiores taxas de incidência foram Amapá, Rio Grande do Norte, Rondônia e Roraima; Amazonas e Rondônia tiveram as maiores taxas de mortalidade. Em geral, as taxas de incidência e mortalidade foram piores na segunda onda. Na primeira onda, a média de meses até o início de uma redução de casos novos foi maior nas capitais, enquanto na segunda onda, o início da redução demorou mais nos estados. Quanto aos óbitos, as capitais necessitaram de menos tempo para apresentar redução tanto na primeira quanto na segunda onda. Conclusão. A heterogeneidade regional detectada reforça a ideia de que a incidência e a mortalidade por COVID-19 estão associadas a fatores políticos, geográficos, culturais, sociais e econômicos.

ABSTRACT Objective. To analyze the incidence and mortality trends from COVID-19 in Brazil as well as in federation units and their capitals. Method. An ecological study was performed using COVID-19 incidence and mortality data covering the period from 25 February 2020 (first case recorded in Brazil) to 31 July 2021. Data were grouped by month for calculation of crude rates (by 100 000 population) and assessment of time trends in federation units and capitals. Significant changes in time trends were analyzed by joinpoint regression. Results. Two waves of new cases and deaths were identified. The highest incidence rates were recorded in the states of Amapá, Rio Grande do Norte, Rondônia, and Roraima. The states of Amazonas and Rondônia had the highest mortality rates. In general, incidence and mortality rates were worse in the second wave. In the first wave, the mean number of months until the onset of reduction in new cases was higher in capitals, whereas in the second wave the onset of reduction in new cases took longer in the federation units. The decline in mortality began earlier in capital cities in both waves. Conclusion. The regional differences detected underscore the notion that COVID-19 incidence and mortality are associated with political, geographic, cultural, social, and economic factors.

RESUMEN Objetivo. Analizar las tendencias de la incidencia de COVID-19 y la mortalidad por esta enfermedad en Brasil (unidades federativas y capitales). Método. Se realizó un estudio ecológico con datos sobre incidencia de COVID-19 y la mortalidad por esta enfermedad en el período comprendido entre el 25 de febrero del 2020 (fecha del primer caso notificado en Brasil) y el 31 de julio del 2021. Los datos se agruparon por mes para calcular las tasas brutas (por 100 000 habitantes) y evaluar las tendencias temporales observadas en las unidades federativas y sus capitales. Las modificaciones significativas en las tendencias temporales se analizaron con el método de regresión de punto de inflexión (joinpoint). Resultados. Se identificaron dos olas de casos nuevos y muertes. Las unidades federativas con las mayores tasas de incidencia fueron Amapá, Rio Grande do Norte, Rondônia y Roraima; Amazonas y Rondônia tuvieron las mayores tasas de mortalidad. En general, la incidencia y la mortalidad fueron peores en la segunda ola. En la primera ola, el promedio de meses transcurridos hasta que empezó a reducirse el número de casos nuevos fue mayor en las capitales, mientras que, en la segunda ola, fue mayor en los estados. En ambas olas, el número de muertes se redujo en menos tiempo en las capitales. Conclusión. La heterogeneidad regional detectada refuerza la idea de que la incidencia de la COVID-19 y la mortalidad por esta enfermedad guardan relación con factores políticos, geográficos, culturales, sociales y económicos.

Incidence and mortality from thyroid cancer in Latin America.

OBJECTIVE: To describe trends in thyroid cancer incidence and mortality in Latin America. METHODS: Ecological study of time series, with incidence data from the International Agency for Research on Cancer for the 1990-2012 period and mortality data of 16 countries obtained from WHO for the 1995-2013 period. The trends of incidence rates were analysed by the Joinpoint regression. Average annual percentage change and 95% confidence intervals were calculated for incidence and mortality. RESULTS: Incidence and mortality from thyroid cancer in Latin America were higher in women, with the highest incidence rate in women in Quito (Ecuador) aged 40-59 years: 42.2 new cases per 100 000 inhabitants, and mortality of 4.8/100 000 in women over 60. Thyroid cancer incidence increased in women of all age groups in Cali (Colombia), Costa Rica and Quito (Ecuador); and in men in Costa Rica. Incidence rates were stable above the age of 60 years in Cali, in Goiania (Brazil), Quito (Ecuador) and Valdivia (Chile) in men, and in women in Goiania (Brazil) and Valdivia (Chile). Mortality among women increased in Ecuador (AAPC = 3.28 CI 95% 1.36; 5.24), Guatemala (AAPC = 6.14 CI 95% 2.81; 9.58) and Mexico (AAPC = 0.67 CI 95% 0.16; 1.18). CONCLUSIONS: Thyroid cancer incidence in Latin America is high and rising in women. Mortality remains stable in most countries of Latin America.

Spatial distribution of advanced stage diagnosis and mortality of breast cancer: Socioeconomic and health service offer inequalities in Brazil.

Breast cancer presents high incidence and mortality rates, being considered an important public health issue. Analyze the spatial distribution pattern of late stage diagnosis and mortality for breast cancer and its correlation with socioeconomic and health service offer-related population indicators. Ecological study, developed with 161 Intermediate Region of Urban Articulation (IRUA). Mortality data were collected from the Mortality Information System (MIS). Tumor staging data were extracted from the Hospital Cancer Registry (HCR). Socioeconomic variables were obtained from the Atlas of Human Development in Brazil; data on medical density and health services were collected from the National Registry of Health Institutions (NRHI) and Supplementary National Health Agency. Global Moran's Index and Local Indicator of Spatial Association (LISA) were utilized to verify the existence of territorial clusters. Multivariate analysis used models with global spatial effects. The proportion of late stage diagnosis of breast cancer was 39.7% (IC 39.4-40.0). The mean mortality rate for breast cancer, adjusted by the standard world population was 10.65 per 100,000 women (± 3.12). The proportion of late stage diagnosis presented positive spatial correlation with Gini's Index (p = 0.001) and negative with the density of gynecologist doctors (p = 0.009). The adjusted mortality rates presented a positive spatial correlation with the Human Development Index (p<0.001) and density of gynecologist doctors (p<0.001). Socioeconomic and health service offer-related inequalities of the Brazilian territory are determinants of the spatial pattern of breast cancer morbimortality in Brazil.

Prevalence of multimorbidity and associated factors in the Brazilian working population.

INTRODUCTION: According to the World Health Organization (2018), recent changes in the epidemiological profile of working populations point to an increase in non-communicable chronic illnesses and a decrease in communicable chronic illnesses. OBJECTIVES: To estimate the prevalence of multimorbidity in the Brazilian working population (≥18 years) and identify associated factors based on data from the 2013 national health survey (Pesquisa Nacional de Saúde). METHODS: This was a cross sectional study based on data from the 2013 national health survey, which included n = 47,629 people aged 18 years or older. As part of the survey, participants were asked whether they had ever been diagnosed with any of several chronic diseases. The prevalence of multimorbidity in this population and its association with socioeconomic, lifestyle and occupational characteristics were examined. Bivariate analyses were used to calculate prevalence ratios and 95% confidence intervals. Multivariate analyses were conducted using Poisson regression and Wald's tests to estimate the coefficients of significant variables. RESULTS: The prevalence of multimorbidity was 19.98% (95% confidence interval: 19.29%-20.70%). Higher rates of multimorbidity were associated with female gender, age 60 years or older, living with a spouse, past history of smoking, low education levels (illiterate/primary), living in urban areas, having medical or dental insurance and a history of work accidents. CONCLUSIONS: The prevalence of multimorbidity in the Brazilian population is low. When present, multimorbidity is associated with specific occupational, socioeconomic and lifestyle characteristics.

A multilevel assessment of the social determinants associated with the late stage diagnosis of breast cancer.

The advanced-stage diagnosis of breast cancer reveals the inequalities associated with socioeconomic conditions and the offer of health services. This study analyzes the prevalence of advanced breast cancer and its relationship with individual and contextual socioeconomic indicators and offer of health service. A cross-sectional study is presented herein, on the assessment of malignant breast neoplasms in women diagnosed between 2006 and 2015 (n = 195,201). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A multilevel Poisson Regression was carried out with random intercept. The prevalence of advanced breast cancer diagnosis was 40.0%. Advanced staging was associated with younger age groups (PR 1.41), race/nonwhite (PR 1.13), lower education levels (PR 1.38), and public access to health services (PR 1.25). There was also an association with a low density of mammographic equipment (PR 1.08), and with low indices of local social inequality (PR 1.33) and human development (PR 0.80). This study maps and highlights the causes related to inequalities in the diagnosis of advanced breast cancer in Brazil, and presents essential data to reorient public policies and health-related actions to strengthen the control of breast cancer in Brazil.

Leukemia mortality in children from Latin America: trends and predictions to 2030.

BACKGROUND: Reports suggest that Latin American and Caribbean (LAC) countries have not reduced leukemia mortality compared to high-income countries. However, updated trends remain largely unknown in the region. Given that leukemia is the leading cause of cancer-related death in LAC children, we evaluated mortality trends in children (0-14y) from 15 LAC countries for the period 2000-2017 and predicted mortality to 2030. METHODS: We retrieved cancer mortality data using the World Health Organization Mortality Database. Mortality rates (standardized to the world standard SEGI population) were analyzed for 15 LAC countries. We evaluated the average mortality rates for the last 5 years (2013-2017). Joinpoint regression analysis was used to evaluate leukemia mortality trends and provide an estimated annual percent change (EAPC). Nordpred was utilized for the calculation of predictions until 2030. RESULTS: Between 2013 and 2017, the highest mortality rates were reported in Venezuela, Ecuador, Nicaragua, Mexico, and Peru. Upward mortality trends were reported in Nicaragua (EAPC by 2.9% in boys, and EAPC by 2.0% in girls), and Peru (EAPC by 1.4% in both sexes). Puerto Rico experienced large declines in mortality among both boys (EAPC by - 9.7%), and girls (EAPC by - 6.0%). Leukemia mortality will increase in Argentina, Ecuador, Guatemala, Panama, Peru, and Uruguay by 2030. CONCLUSION: Leukemia mortality is predicted to increase in some LAC countries by 2030. Interventions to prevent this outcome should be tailor to reduce the socioeconomic inequalities and ensure universal healthcare coverage.

Analysis of the effects of the age-period-birth cohort on cervical cancer mortality in the Brazilian Northeast.

Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980-2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.

Digital rectal examination and its associated factors in the early detection of prostate cancer: a cross-sectional population-based study.

BACKGROUND: Digital rectal examination (DRE) is one of the most common strategies for prostate cancer early detection. However, the use for screening purposes has a controversial benefit and potential harms can occur due to false-positive results, overdiagnosis and overtreatment. The objective of this study is to calculate the prevalence and identify factors associated with the receipt of DRE in Brazilian men. METHODS: We selected men older than 40 from a nationwide population-based survey (13,625 individuals) excluding those with prostate cancer diagnosis. Information was extracted from the most recent database of the Brazilian National Health Survey (PNS 2013). Statistical analysis was carried out to calculate incidence rate ratios, with 95% confidence intervals and p values, through multivariate analysis with Poisson regression and robust variance. RESULTS: Men having private health insurance (63.3%; CI = 60.5-66.0) presented higher prevalence of DRE than those in the public health system (41.6%; CI = 39.8-43.4). The results show a positive association between DRE and men having private health insurance, aged 60-69, living with a spouse, never smokers, and living in urban areas. Among public health services users, this positive association was observed among men aged 70-79, living with a spouse, having bad/very bad health self-perception, abstainers, ex-smokers, with undergraduate studies, presenting four or more comorbidities, and residing in urban areas. CONCLUSIONS: Prostate cancer screening with DRE is quite frequent in Brazil, specially among men with private health plans and better access to health services, healthier lifestyle and at more advanced ages, characteristics which increase the risk of overdiagnosis and overtreatment.

Testicular Cancer mortality in Brazil: trends and predictions until 2030.

BACKGROUND: Despite the fact that testicular cancer presents good prognosis, wide variations in mortality rates have been reported internationally. In Brazil, mortality trends and estimates have not been fully assessed. The objective of the study presented herein is to analyze the mortality trends for testicular cancer in Brazil in the period 2001-2015 and calculate mortality predictions for the period 2016-2030. METHODS: This is a population-based ecological study that utilized information of the Mortality Information System, on testicular cancer-related deaths in Brazil. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions. RESULTS: The mortality rate for men, standardized to the world population, varied between 0.36/100,000 for the year 2001, to 0.41/100,000 for the year 2015. There was an increasing trend for Brazil (APC = 1.3% CI95% 0.6; 2.0) and the Southeast region (APC = 1.5% CI95%0.2; 2.7). When analyzing Brazilian data for the period 2016-2030, predictions indicate 2888 deaths due to testicular cancer, which corresponds to a 26.6% change when compared to the 2011-2015 period. This change is mostly explained by an increase in the risk of death (14.2%) when compared with modifications in the demographic structure (12.4%). CONCLUSIONS: Testicular cancer mortality in Brazil presents increasing trends, and until 2030 these rates continue to increase.

Lifestyle factors and high body mass index are associated with different multimorbidity clusters in the Brazilian population.

Multimorbidity patterns of a population can be influenced by socioeconomic and lifestyle-related factors. Some of these factors are preventable when healthy habits are promoted to the population. This study analyzed the main grouping patterns of chronic diseases and the relationship with socioeconomic and lifestyle-related factors of the Brazilian population (over the age of 18), based on a population-based survey (2013 National Health Survey). A total of 60,202 participants were included. Cluster analysis was carried out to identify the combinations of chronic diseases. Bivariate and multivariate analyses were carried out to verify the relationship between disease clusters and independent variables, utilizing Poisson's regression with robust variance, considering a 95% confidence interval. Cluster analysis revealed four disease clusters:cardiometabolic diseases/cancer, mental/occupational diseases, musculoskeletal diseases and respiratory diseases, all significantly associated with the female gender, current/past smoking habits and overweight/obesity in multivariate analyses. These aspects must be considered when planning health services and developing strategies and guidelines for the prevention and treatment of multiple chronic conditions.

Body Image of Women Submitted to Breast Cancer Treatment

Background: The study of body image includes the perception of women regarding the physical appearance of their own body. The objective of the present study was to verify the prevalence of body image dissatisfaction and its associated factors in women submitted to breast cancer treatment. Methods: A cross-sectional study carried out with 103 female residents of the municipality of Natal (Northeast Brazil), diagnosed with breast cancer who had undergone cancer treatment for at least 12 months prior to the study, and remained under clinical monitoring. The variable body image was measured through the validated Body Image Scale (BIS). Socioeconomic variables and clinical history were also collected through an individual interview with each participant. The Pearson's chi-squared test (Fisher's Exact) was utilized for bivariate analysis, calculating the prevalence ratio with 95% confidence interval. Poisson regression with robust variance was utilized for multivariate analysis. The statistical significance considered was 0.05. Results: The prevalence of body image dissatisfaction was 74.8% CI (65%-82%). Statistically significant associations were observed between body image and multi-professional follow-up (p=0.009) and return to employment after treatment (p=0.022). Conclusion: It was concluded that women who reported employment after cancer treatment presented more alterations in self-perception concerning their appearance. Patients who did not receive multi-professional follow-up reported negative body image, evidencing the need for strategies that increase and improve healthcare, aiming to meet the demands of this population.

Inequalities in esophageal cancer mortality in Brazil: Temporal trends and projections.

The main objective of the study was to analyze the effect of age, period and birth cohort on esophageal cancer mortality in Brazil and its geographic regions, per sex. An ecological study is presented herein, which evaluated the deaths by esophageal cancer and the distribution, per geographic region. Poisson Regression was utilized to calculate the effects of age, period and birth cohort, and projections were made with the statistical software R, using the age-period-cohort model. Projection of data covered the period 2015-2029. Regarding the geographic regions of Brazil, a decrease was verified, throughout time, for the mortality rates of the South and Southeast regions, for men and women. For the North, Northeast and Midwest regions, an increase was evidenced in mortality rates, mainly for men, after the 2000's. Regarding the projections, a progressive increase of mortality rates was verified for the Northeast and North regions. Divergences evidenced for observed and projected esophageal cancer mortality rates revealed inequalities among the geographic regions of Brazil.

Functional Disability in Women Submitted to Breast Cancer Treatment

The objective of the study presented herein was to verify the prevalence of functional disability and its associated factors in women submitted to breast cancer treatment. A cross-sectional study was carried out, in 101 women diagnosed with malignant breast cancer neoplasm, who underwent cancer treatment at least 12 months before the study, and remained under clinical monitoring. Functional disability was measured by the DASH instrument. Data collection included variables related to socioeconomic characteristics, life habits, health conditions, clinical tumor characteristics and therapeutic approach. Bivariate analysis was carried out by Pearson's chi-square test or Fisher's exact test, calculating the prevalence ratio with a 95% confidence interval. Multivariate analysis utilized Poisson's Regression with robust variance. A statistical significance of 0.05 was considered. Prevalence of functional disability in the studied sample was 22.8% (CI95% 13.9-31.6). Functional disability was statistically significantly associated with age (p = 0.035) and access to health services (p = 0.028). It was concluded that younger patients suffered higher impact of breast cancer treatment on disability. Regarding access to health services, women that received public clinical monitoring reported higher occurrences of functional disability. This pointed towards the necessity of more organized, less bureaucratic, and effective health services in the assistance network, directed to the minimization of the impacts of cancer treatment on health and life conditions of breast cancer survivors.

Prognostic Factors of Oral Squamous Cell Carcinoma in Young Patients: A Systematic Review.

PURPOSE: The objective of this review was to identify clinical and pathologic factors related to the prognosis of oral squamous cell carcinoma in young patients. MATERIALS AND METHODS: We conducted a literature search of articles indexed in PubMed (MEDLINE), Scopus, and Science Direct. Prospective and retrospective cohort studies published in English, Portuguese, or Spanish were included. An age threshold of 45 years was established for the purpose of selection. RESULTS: A total of 14,746 articles were retrieved, and 11 relevant studies were selected. The total sample comprised 2,317 patients, and there was a predominance of male patients. The tongue was the most commonly affected anatomic site. The prevalence of tobacco use ranged from 9.0 to 85.7%, and alcohol consumption was observed in 26.1 to 78.6% of the cases studied. Tobacco use and alcohol consumption were the main risk factors in young patients. Regarding tumor-node-metastasis stage, most studies found a predominance of cases diagnosed in early stages (I and II). The studies varied widely in terms of histologic grade of malignancy and locoregional recurrences. Regional lymph node metastases had a negative impact on overall and specific survival rates. CONCLUSIONS: Our findings suggest a lack of solid evidence of differences in the prognosis of oral squamous cell carcinoma between young and older patients. This may reflect variations in the samples studied, including the prevalence of risk factors, access to health care services, and time since diagnosis.