Relationship between time from symptom's onset to diagnosis and prognosis in patients with symptomatic colorectal cancer.

BACKGROUND: Controversy exists regarding the relationship of the outcome of patients with colorectal cancer (CRC) with the time from symptom onset to diagnosis. The aim of this study is to investigate this association, with the assumption that this relationship was nonlinear and with adjustment for multiple confounders, such as tumor grade, symptoms, or admission to an emergency department. METHODS: This multicenter study with prospective follow-up was performed in five regions of Spain from 2010 to 2012. Symptomatic cases of incident CRC from a previous study were examined. At the time of diagnosis, each patient was interviewed, and the associated hospital and clinical records were reviewed. During follow-up, the clinical records were reviewed again to assess survival. Cox survival analysis with a restricted cubic spline was used to model overall and CRC-specific survival, with adjustment for variables related to the patient, health service, and tumor. RESULTS: A total of 795 patients had symptomatic CRC and 769 of them had complete data on diagnostic delay and survival. Univariate analysis indicated a lower HR for death in patients who had diagnostic intervals less than 4.2 months. However, after adjustment for variables related to the patient, tumor, and utilized health service, there was no relationship of the diagnostic delay with survival of patients with colon and rectal cancer, colon cancer alone, or rectal cancer alone. Cubic spline analysis indicated an inverse association of the diagnostic delay with 5-year survival. However, this association was not statistically significant. CONCLUSIONS: Our results indicated that the duration of diagnostic delay had no significant effect on the outcome of patients with CRC. We suggest that the most important determinant of the duration of diagnostic delay is the biological profile of the tumor. However, it remains the responsibility of community health centers and authorities to minimize diagnostic delays in patients with CRC and to implement initiatives that improve early diagnosis and provide better outcomes.

Short- and long-term survival after stroke in hospitalized patients in Chile: a nationwide 5-year study.

BACKGROUND: Short- and long-term stroke survival is a key indicator of hospital performance in stroke care. Our aim was to estimate short- and long-term survival rates in discharged patients diagnosed with ischemic stroke in Chile in a 5-year period and identify associated variables. MATERIALS AND METHODS: We included all discharged patients from all hospitals in Chile with main diagnosis of ischemic stroke from 2003 to 2007, which were identified through the National Hospital Discharge Registry. To establish survival, discharges were linked to deaths in the Deaths Registry. Kaplan-Meier survival curves were used to estimate the cumulative 7-day, 30-day, 1-year, and 3-year survival rates. Independent predictors of death (sex, age, geographical regions, and status insurance) were assessed by Cox proportional hazard regression model. RESULTS: A total of 51,130 with first-ever ischemic stroke patients were identified. Overall survival rate decreased from 88.9% (95% confidence interval [CI] 88.6-89.2) 7 days after hospital admission to 81.9% (95% CI 81.6-82.3), 69.9% (95% CI 69.5-70.3), and 61.2% (95% CI 60.7-61.6) after 30-day, 1-year, and 3-year, respectively. The multivariable model showed that the elderly patients (>80 years; hazard ratio [HR] 4.07; 95% CI 3.89-4.26) and hospital admission in the North (HR 1.14; 95% CI 1.09-1.20) and South area (HR 1.06; 95% CI 1.03-1.110) were associated with lower survival after stroke. Patients with private health insurance have a higher probability of survival than patients with public insurance (private insurance, HR .53; 95% CI .49-.56). CONCLUSIONS: Short- and long-term survival after ischemic stroke was heterogeneous by geographic regions and type of health insurance, regardless age and sex were the strongest predictors. This suggests an impact of socioeconomic factors and access to acute management of strokes on survival.

Intakes of Unprocessed and Minimally Processed and Ultraprocessed Food Are Associated with Diet Quality in Female and Male Health Professionals in the United States: A Prospective Analysis.

BACKGROUND: High unprocessed and minimally processed food (UMP) intake has been associated with high-quality diets, whereas the opposite has been shown for ultraprocessed food (UPF). Nevertheless, the association between UMP and UPF consumption and diet quality over the long-term warrants further examination. OBJECTIVE: This study aimed to assess whether UMP and UPF intake are associated with three diet-quality metrics in female and male health professionals from two US cohorts over 3 decades of follow-up. DESIGN: This was a cohort study, including data from the Nurses' Health Study (NHS), from 1986 to 2010 (N = 51,956) and the Health Professionals Follow-up Study (HPFS) from 1986 to 2006 (n = 31,307). PARTICIPANTS AND SETTING: Participants were invited in 1976 (NHS) and 1986 (HPFS) to respond to mailed questionnaires every 2 to 4 years and diet was assessed with a semi-quantitative food frequency questionnaire every 4 years. MAIN EXPOSURE MEASURES: UMP and UPF intake were calculated using the NOVA classification. STATISTICAL ANALYSES: Generalized estimating equations for marginal means and repeated cross-sectional associations between diet-quality metrics and quintiles of UMP and UPF. Diets were assessed every 4 years from 1986 to 2010. RESULTS: With increasing quintiles of UMP intakes, the Alternate Healthy Eating Index-2010 increased 7.1% (3.80 points, 95% CI 3.66 to 3.93) in the NHS and 10.1% (5.75 points, 95% CI 5.52 to 5.98) in the HPFS; the Mediterranean diet index increased 11.7% (0.50 points, 95% CI 0.47 to 0.52) in the NHS and 14.0% (0.64 points, 95% CI 0.60 to 0.68) in the HPFS; and the Dietary Approaches To Stop Hypertension diet score increased 7.5% (1.81 points, 95% CI 1.76 to 1.87) in the NHS and 10.6% (2.66 points, 95% CI 2.57 to 2.76) in the HPFS. In the fifth quintile of UPF intake compared with the first, the Alternate Healthy Eating Index-2010 was -9.3% (-4.60 points, 95% CI -4.73 to -4.47) lower in the NHS and -13.7% (-6.89 points, 95% CI -7.12 to -6.66) lower in the HPFS; the Mediterranean diet index was -14.7% (-0.55 points, 95% CI -0.57 to -0.53) lower in the NHS, and -19.0% (-0.74 points, 95% CI -0.78 to -0.70) lower in the HPFS; and the Dietary Approaches To Stop Hypertension diet score was -8.1% (-1.81 points, 95% CI -1.86 to -1.76) lower in the NHS and -12.8% (-2.84 points, 95% CI -2.93 to -2.74) lower in the HPFS. CONCLUSIONS: Consumption of UMP was associated with better dietary quality, whereas consumption of UPF was associated with poorer dietary quality.

Effect of false-positive results on reattendance at breast cancer screening programmes in Spain.

BACKGROUND: Mammography is the only breast screening method, we are aware of today, which is able to reduce mortality from breast cancer. Nevertheless, this procedure carries an inherent risk of false-positive screening mammogram. The association between these results and reattendance at the next scheduled screening mammogram is controversial. The aim of this study was to examine the effect of a false-positive screening mammogram and women's characteristics on reattendance in eight regional population-based breast cancer screening programmes in Spain. METHODS: This study included 1 383 032 women aged 44-67 years who were initially screened for breast cancer between 1990 and 2004. To investigate factors associated with reattendance, logistic regression models were used. RESULTS: The mean age of women at first screening was 53.6 years (SD = 6.1 years). Of 120 800 women with a false-positive screening mammogram, 78.3% returned for a subsequent screening mammogram compared with 81.9% of those with a negative result (P < 0.001). Multivariate analysis showed that women with a false-positive result at first screening mammogram were less likely to reattend (OR = 0.71; 95% CI 0.70-0.73) and that the likelihood was lower in those who had undergone invasive additional tests (OR = 0.56; 95% CI 0.53-0.59). CONCLUSION: A false-positive screening mammogram in the first screening negatively affected attendance at the subsequent screening. The results of this study could be useful to improve the screening process and to increase women's compliance.

The psychological impact of a false-positive screening mammogram in Barcelona.

The purpose of this study was to ascertain the psychological impact of mammographic screening for women who receive negative results and for those who need additional non-invasive and invasive complementary investigations to exclude breast cancer (false positives). One hundred fifty women who attended a breast cancer screening programme in Barcelona, aged 50-69 years, were included in this study: 50 with negative results and 100 with false positive mammograms (50 underwent non-invasive and 50 underwent invasive complementary investigations). Participants worried little until they underwent mammography, but worries increased when a telephone call notified the women of the need for further testing. A substantial proportion of women requiring further assessment reported that they were at least somewhat worried about having breast cancer throughout the screening process (P < 0.0001). Nevertheless, levels of anxiety and depression, measured by the Hospital Anxiety and Depression Scale, showed no statistically significant differences among the three groups. In conclusion, although the women showed no psychological morbidity, there is a substantial psychological response in those with an abnormal screening mammogram.

Colorectal cancer survival: results from a hospital-based cancer registry.

INTRODUCTION: colorectal cancer is one of the most common malignancies in developed countries. Data on specific and 10-year survival are scarce. This study analyzes overall and disease-specific survival for patients with colorectal cancer and assesses the value of clinical factors on disease-specific survival. METHODS: a retrospective cohort study of newly diagnosed invasive colorectal cancer cases diagnosed from 1992 to 2007 were identified through the Hospital del Mar Cancer Registry. Five-and 10-year survival functions were estimated using Kaplan-Meier method. Cox proportional hazard models were used to assess prognostic factors. RESULTS: a total of 2,080 patients with colorectal cancer were identified. The median age at diagnosis was 72 years and 58.5%were men. By the end of the follow-up period (December 2008), 1,225 patients had died and 68.4% of deaths were due to colorectal cancer. The 5- and 10-year cancer-specific survival rates were 55.5% (95%CI 53.9-57.9%) and 48.5% (95%CI 45.6-51.3%), respectively. The 5-year specific survival rate improved in the last period (2003-2007) (60.4%, 95%CI 55.4-65.0) compared with 1992-1997(53.4%; 95%CI 49.2-57.4) and 1998-2002 (52.0%; 95%CI 47.8-56.2). Various factors were independently associated with excess CRC mortality: male sex (HR 1.21), age at diagnosis > 75 years(HR 1.97), rectal location (HR 1.33), more advanced stages (stage IV: HR 18.54), poorly differentiated/undifferentiated tumors (HR 1.80), and admission through the emergency department (HR 1.52). CONCLUSIONS: cancer-specific survival improved from 1992 to 2007. This improvement could be due to more effective treatment, since changes in stage distribution or age at diagnosis were not observed during the study period. Overall survival rates should notably improve with the implementation of a population-based colorectal cancer screening program in Spain.

Impact of educational level and travel burden on breast cancer stage at diagnosis in the state of Sao Paulo, Brazil.

We describe the characteristics of cases of breast cancer among women assisted at hospitals affiliated to the public health system in the state of São Paulo (Brazil), analysing the effects of level of education and travel burden to point of treatment. We conducted a retrospective analysis of invasive breast cancer among women diagnosed between 2000 and 2015. Data were extracted from the hospital-based cancer registries of Fundação Oncocentro de São Paulo-FOSP. The outcome was clinical stage at diagnosis (stage III-IV versus I-II). The explanatory variables were educational level and travel burden. Odds ratios (OR) and 95% confidence intervals (95% CI) were estimated. Multiple imputations were used for missing educational level (31%). The study included 81,669 women with invasive breast cancer diagnosed between 2000 and 2015. The mean age of patients at diagnosis was 56.8 years (standard deviation 13.6 years). 38% of patients were at an advanced stage at diagnosis (stage III-IV). Women with lower levels of education and those who received cancer care in municipalities other than where they lived were more likely to be diagnosed at an advanced stage. In conclusion, promotion of breast cancer awareness and improving pathways to expedite breast cancer diagnosis and treatment could help identify breast tumors at earlier stages.

Impact of the Dry Law on road traffic mortality in Brazilian states: an interrupted time series analysis. / Impacto da Lei Seca sobre a mortalidade no trânsito nas unidades federativas do Brasil: uma análise de série temporal interrompida.

OBJECTIVE: To assess the impact of 2008 Public Law number 11,705, also known as Dry Law (DL-08), on mortality from road traffic accidents (RTA), in each of the 27 Brazilian Federative Units (BFUs). METHODS: Ecological study of interrupted time series with RTA data from 2002 to 2015, totalizing 168 months. Data were obtained from the Mortality Information System, the Brazilian Institute of Geography and Statistics, and from the National Traffic Department. Autoregressive integrated moving average (ARIMA) models were adjusted to assess the impact of DL-08 in each BFUs. RESULTS: After the implementation of the DL-08, there was a significant decrease in mortality from RTA in the state of Santa Catarina (pre DL-08 = 2.60 ± 0.30 and post DL-08 = 2.32 ± 0.35; p < 0.001) and in the Federal District (pre DL-08 = 2.22 ± 0.40 and post DL-08 = 1.76 ± 0.35; p = 0.002), a significant increase in mortality in the states of Acre, Amazonas, Rondônia, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe and Mato Grosso, and a stability in the other states. The sensitivity analysis conducted over a shorter time series with 24 months showed results similar to those obtained with the 168-month series for most of the 27 BFUs. CONCLUSION: The DL-08 had a heterogeneous impact on mortality from traffic accidents on BFUs.

OBJETIVO: Analisar o impacto da Lei 11.705, conhecida por "Lei Seca" (LS-08), sobre a mortalidade por acidentes de trânsito (AT) em cada uma das 27 unidades federativas (UF) do Brasil. MÉTODO: Estudo ecológico de séries temporais interrompidas com dados de AT entre 2002 a 2015, totalizando 168 meses. Os dados foram obtidos do Sistema de Informações sobre Mortalidade, do Instituto Brasileiro de Geografia e Estatística e do Departamento Nacional de Trânsito. Foram ajustados modelos auto-regressivos integrados de médias móveis (ARIMA) para analisar o impacto da LS-08 em cada UF. RESULTADOS: Após a implantação da LS-08, a mortalidade por AT diminuiu significativamente no estado de Santa Catarina (pré-LS-08 = 2,60 ± 0,30 e pós-LS-08 = 2,32 ± 0,35; p < 0,001) e no Distrito Federal (pré-LS-08 = 2,22 ± 0,40 e pós-LS-08 = 1,76 ± 0,35; p = 0,002), aumentou significativamente nos estados do Acre, Amazonas, Rondônia, Maranhão, Piauí, Ceará, Rio Grande do Norte, Paraíba, Pernambuco, Alagoas, Sergipe e Mato Grosso e permaneceu estável nos demais. Análise de sensibilidade conduzida sob uma série temporal mais curta, com 24 meses, apresentou resultados semelhantes aos obtidos com a série de 168 meses para a maioria das 27 UF. CONCLUSÃO: A LS-08 exerceu impacto heterogêneo sobre a mortalidade por AT entre as UF.

Metformin for the treatment of breast cancer: protocol for a scoping review of randomised clinical trials.

INTRODUCTION: Innovation through the repurposing of generic drugs encloses several advantages when compared with the process of developing new drugs from scratch. Metformin is an established and inexpensive antidiabetic drug for which anticancer properties have been hypothesised. A systematic review of observational studies found promising results for metformin related to breast cancer in women with diabetes. Although the number of randomised clinical trials of metformin for the treatment of breast cancer increased over the last decades, the overall landscape of those studies in this heterogeneous field remains unclear. Hence, we designed the present scoping review protocol to map the literature on randomised clinical trials of metformin in the treatment of breast cancer to determine the value and scope of future systematic reviews on this subject and identify research gaps. METHODS: We will search MEDLINE (via PubMed), EMBASE, CENTRAL, LILACS, Web of Science and sources of grey literature. We will include any randomised clinical trial of metformin for the treatment of breast cancer in adult women, and will not impose restrictions regarding context, language or publication date. Two independent reviewers will screen and select studies, and chart the data. We will structure the presentation of our results based on the molecular types of breast cancer, their stages and treatment modalities. ETHICS AND DISSEMINATION: As a literature review, this study is exempt from ethics approval. Findings will be disseminated through presentations in conferences and a peer-reviewed publication. OPEN SCIENCE FRAMEWORK REGISTRATION: osf.io/yquba.

Diagnosis delay and follow-up strategies in colorectal cancer. Prognosis implications: a study protocol.

BACKGROUND: Controversy exists with regard to the impact that the different components of diagnosis delay may have on the degree of invasion and prognosis in patients with colorectal cancer. The follow-up strategies after treatment also vary considerably. The aims of this study are: a) to determine if the symptoms-to-diagnosis interval and the treatment delay modify the survival of patients with colorectal cancer, and b) to determine if different follow-up strategies are associated with a higher survival rate. METHODS/DESIGN: Multi-centre study with prospective follow-up in five regions in Spain (Galicia, Balearic Islands, Catalonia, Aragón and Valencia) during the period 2010-2012. Incident cases are included with anatomopathological confirmation of colorectal cancer (International Classification of Diseases 9th revision codes 153-154) that formed a part of a previous study (n = 953).At the time of diagnosis, each patient was given a structured interview. Their clinical records will be reviewed during the follow-up period in order to obtain information on the explorations and tests carried out after treatment, and the progress of these patients.Symptoms-to-diagnosis interval is defined as the time calculated from the diagnosis of cancer and the first symptoms attributed to cancer. Treatment delay is defined as the time elapsed between diagnosis and treatment. In non-metastatic patients treated with curative intention, information will be obtained during the follow-up period on consultations performed in the digestive, surgery and oncology departments, as well as the endoscopies, tumour markers and imaging procedures carried out.Local recurrence, development of metastases in the follow-up, appearance of a new tumour and mortality will be included as outcome variables.Actuarial survival analysis with Kaplan-Meier curves, Cox regression and competitive risk survival analysis will be performed. DISCUSSION: This study will make it possible to verify if the different components of delay have an impact on survival rate in colon cancer and rectal cancer. In consequence, this multi-centre study will be able to detect the variability present in the follow-up of patients with colorectal cancer, and if this variability modifies the prognosis. Ideally, this study could determine which follow-up strategies are associated with a better prognosis in colorectal cancer.

Large-scale evaluation of candidate genes identifies associations between VEGF polymorphisms and bladder cancer risk.

Common genetic variation could alter the risk for developing bladder cancer. We conducted a large-scale evaluation of single nucleotide polymorphisms (SNPs) in candidate genes for cancer to identify common variants that influence bladder cancer risk. An Illumina GoldenGate assay was used to genotype 1,433 SNPs within or near 386 genes in 1,086 cases and 1,033 controls in Spain. The most significant finding was in the 5' UTR of VEGF (rs25648, p for likelihood ratio test, 2 degrees of freedom = 1 x 10(-5)). To further investigate the region, we analyzed 29 additional SNPs in VEGF, selected to saturate the promoter and 5' UTR and to tag common genetic variation in this gene. Three additional SNPs in the promoter region (rs833052, rs1109324, and rs1547651) were associated with increased risk for bladder cancer: odds ratio (95% confidence interval): 2.52 (1.06-5.97), 2.74 (1.26-5.98), and 3.02 (1.36-6.63), respectively; and a polymorphism in intron 2 (rs3024994) was associated with reduced risk: 0.65 (0.46-0.91). Two of the promoter SNPs and the intron 2 SNP showed linkage disequilibrium with rs25648. Haplotype analyses revealed three blocks of linkage disequilibrium with significant associations for two blocks including the promoter and 5' UTR (global p = 0.02 and 0.009, respectively). These findings are biologically plausible since VEGF is critical in angiogenesis, which is important for tumor growth, its elevated expression in bladder tumors correlates with tumor progression, and specific 5' UTR haplotypes have been shown to influence promoter activity. Associations between bladder cancer risk and other genes in this report were not robust based on false discovery rate calculations. In conclusion, this large-scale evaluation of candidate cancer genes has identified common genetic variants in the regulatory regions of VEGF that could be associated with bladder cancer risk.

Factors associated with time interval between the onset of symptoms and first medical visit in women with breast cancer.

Women presenting with advanced breast cancer tumors are common in Brazil. Little is known about factors contributing to the delay in seeking care. The aim of this study was to identify factors associated with longer time intervals between the onset of breast cancer symptoms and the first medical visit in the Federal District, Brazil. The analysis included 444 symptomatic women with incident breast cancer, interviewed between September, 2012 and September, 2014, during their admission for breast cancer treatment in nine public hospitals in the Federal District. Patients with metastatic disease at diagnosis were not included in this study. The outcome was time interval between symptom onset and the first medical visit, whether > 90 (34% of patients) or ≤ 90 days. Logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (95%CI). In the multivariate analysis, the > 90 day interval was significantly associated with patients not performing mammography and/or breast ultrasound in the two years prior to breast cancer diagnosis (OR = 1.97; 95%CI: 1.26-3.08), and with more advanced stages (OR = 1.72; 95%CI: 1.10-2.72). Furthermore, there was a lower chance of delay in patients with higher levels of education (OR = 0.95; 95%CI: 0.91-0.99). A relatively high proportion of breast cancer patients in the Brazilian Federal District experienced delay to attend the first medical consultation after the symptoms onset. Increasing breast cancer awareness, especially among women with low educational levels and those not participating in mammography screening programs could contribute to reduce this delay.

Translation and cultural adaptation into Brazilian Portuguese of the Finnish Diabetes Risk Score (FINDRISC) and reliability assessment.

INTRODUCTION: The Finnish Diabetes Risk Score (FINDRISC) is a tool that was initially developed to predict the risk of developing type 2 diabetes mellitus in adults. This tool is simple, quick to apply, non-invasive, and low-cost. The aims of this study were to perform a translation and cultural adaptation of the original version of FINDRISC into Brazilian Portuguese and to assess test-retest reliability. METHODOLOGY: This work was done following the ISPOR Principles of Good Practice for the Translation and Cultural Adaptation Process for Patient-Reported Outcomes Measures. Once the final Brazilian Portuguese version (FINDRISC-Br) was developed, the reliability assessment was performed using a non-random sample of 83 individuals attending a primary care health center. Each participant was interviewed by trained registered dieticians on two occasions with a mean interval of 14 days. The reliability assessment was performed by analyzing the level of agreement between the test-retest responses of FINDRISC-Br using Cohen's kappa coefficient and the intraclass correlation coefficient (ICC). RESULTS: The steps of ISPOR guidelines were consecutively followed without major problems. Regarding the reliability assessment, the questionnaire as a whole presented adequate reliability (Cohen's kappa = 0.82, 95%CI 0.72 - 0.92 and ICC = 0.94, 95%CI 0.91 - 0.96). CONCLUSION: FINDRISC was translated into Brazilian Portuguese and culturally adapted following standard procedures. FINDRISC-Br has thus become available for use and has potential as a screening tool in different Brazilian settings and applications.

TGFB1 and TGFBR1 polymorphic variants in relationship to bladder cancer risk and prognosis.

The transforming growth factor-beta (TGF-beta) signalling pathway plays an important role in tumor development and progression. We aimed at analyzing whether 7 different common variants in genes coding for 2 key members of the TGF-beta signalling pathway (TGFB1 and TGFBR1) are associated with bladder cancer risk and prognosis. A total of 1,157 cases with urothelial cell carcinoma of the bladder and 1,157 matched controls where genotyped for 3 single nucleotide polymorphisms (SNPs) in TGFB1 (rs1982073, rs1800472, rs1800471) and an additional 3 SNPs and 1 indel polymorphism in TGFBR1 (rs868, rs928180, rs334358 and rs11466445, respectively). In the case-control study, we estimated odds ratios and 95% confidence intervals for each individual genetic variant using unconditional logistic regression adjusting for age, gender, study area and smoking status. Survival analysis was performed using the Kaplan-Meier method and Cox models. The endpoints of interest were tumor relapse, progression and death from bladder cancer. All the SNPs analyzed showed a similar distribution among cases and controls. The distribution of the TGFBR1*6A allele (rs11466445) was also similar among cases and controls, indicating no association with bladder cancer risk. Similarly, none of the haplotypes was significantly associated with bladder cancer risk. Among patients with muscle-invasive tumors, we found a significant association between TGFBR1-rs868 and disease-specific mortality with an allele dosage effect (p-trend=0.003). In conclusion, the genetic variants analyzed were not associated with an increased risk of bladder cancer. The association of TGFBR1-rs868 with outcome should be validated in independent patient series.

Coffee consumption, genetic susceptibility and bladder cancer risk.

OBJECTIVE: We evaluated the bladder cancer risk associated with coffee consumption in a case-control study in Spain and examined the gene-environment interactions for genetic variants of caffeine-metabolizing enzymes. METHODS: The analyses included 1,136 incident cases with urothelial carcinoma of the urinary bladder and 1,138 controls. Odds ratios (OR) and 95% confidence intervals (CI) were adjusted for area, age, gender, amount of cigarette smoking, and years since quitting among former smokers. RESULTS: The OR (95% CI) for ever consumed coffee was 1.25 (0.95-1.64). For consumers of 1, 2, 3, and 4 or more cups/day relative to never drinkers, OR were, respectively, 1.24 (0.92-1.66), 1.11 (95% CI 0.82-1.51), 1.57 (1.13-2.19), and 1.27 (0.88-1.81). Coffee consumption was higher in smokers compared to never smokers. The OR for drinking at least 4 cups/day was 1.13 (0.61-2.09) in current smokers, 1.57 (0.86-2.90) in former smokers, and 1.23 (0.55-2.76) in never smokers. Gene-coffee interactions evaluated in NAT2, CYP1A2, and CYP2E1-02 and CYP1A1 were not identified after adjusting for multiple testing. CONCLUSION: We observed a modest increased bladder cancer risk among coffee drinkers that may, in part, be explained by residual confounding by smoking. The findings from the gene-coffee interactions need replication in further studies.

Clinical pathways of breast cancer patients treated in the Federal District, Brazil.

OBJECTIVE: To identify the clinical pathways of women with breast cancer treated in public hospitals, and to analyze the factors that influence the time interval between the first appointment and the start of therapy. METHODS: A cross-sectional study was conducted with 600 women with breast cancer treated in nine public hospitals in the Brazilian Federal District. Patients were interviewed between September 2012 and September 2014. Simple and multiple logistic regression models were adjusted to evaluate the variables associated with the time interval studied. The most frequent pathway was the one that started in primary care with following care in the therapy service (28.9%). In the multiple adjustment, factors associated to a longer time interval between the first appointment and therapy were: lower family income (OR = 1.89; 95%CI 1.32-2.68), the first appointment in public services (OR = 1.78; 95%CI 1.20-2.64), care in more than two health services in the clinical pathway (OR = 1.71; 95%CI 1.19-2.44); and obtaining the anatomopathological analysis of the biopsy in public services instead of private health services (OR = 1.87; 95%CI 1.29-2.71). Independently, the implementation of specialist appointment scheduling, with care regulation, was associated with a shorter time interval between first appointment and therapy (OR = 0.33; 95%CI 0.16-0.65). CONCLUSIONS: We observed that multiple pathways were covered by women with breast cancer treated in public services of the Federal District. Socioeconomic iniquities and several aspectos of the pathways covered were associated with a longer time interval between the first appointment and the start of breast cancer therapy.

Risk of bladder cancer associated with family history of cancer: do low-penetrance polymorphisms account for the increase in risk?

The relationship between family history of cancer in first-degree relatives and risk of bladder cancer was examined in the Spanish Bladder Cancer Study. Information on family history of cancer was obtained for 1,158 newly diagnosed bladder cancer cases and 1,244 controls included in 18 hospitals between 1998 and 2001. A total of 464 (40.1%) cases and 436 (35.1%) controls reported a family history of cancer in >/=1 relative [odds ratio (OR), 1.32; 95% confidence interval (95% CI), 1.11-1.59]; the OR was 1.23 (95% CI, 1.01-1.50) among those with only one relative affected and 1.67 (95% CI, 1.23-2.29) among those with >/=2 affected relatives (P(trend) = 0.0004). A greater risk of bladder cancer was observed among those diagnosed at age

Estratificação de risco para diabetes tipo 2 com base no Findrisc e fatores associados / Risk stratification for type 2 diabetes according to the Findrisc and associated factors / Estratificación del riesgo para diabetes tipo 2 según el Findrisc y factores asociados

Os objetivos deste estudo são estratificar os usuários de um centro de atenção primária segundo o risco de desenvolver diabetes mellitus tipo 2 (DM2), utilizando o Escore Finlandês de Risco de Diabetes (Findrisc), e avaliar fatores associados ao risco elevado de desenvolver DM2. Trata-se de um estudo transversal, com amostra aleatória de duzentos adultos, não diabéticos, de um centro de saúde escola. Utilizou-se regressão logística para investigar fatores associados ao escore elevado (≥ 15 pontos) no Findrisc. Observou-se que 33,5% apresentavam risco discretamente aumentado, 17% risco moderado e 34,5% risco alto/muito alto para desenvolver DM2. Aqueles com menor escolaridade (OR: 3,21; IC: 1,52-6,77) e com histórico de hipercolesterolemia (OR: 2,47; IC: 1,27-4,81) exibiram maior chance de apresentar escore elevado. Em conclusão, a frequência de indivíduos com risco alto/muito alto de desenvolver DM2 foi elevada na população estudada, e o menor nível de escolaridade e o histórico de hipercolesterolemia estavam associados ao escore elevado no Findrisc.

The aim of this study was to stratify users of a primary care center according to the risk of developing type II diabetes mellitus (T2DM) using the Finnish Diabetes Risk Score (FINDRISC) questionnaire and to assess factors associated with elevated risk for T2DM. We conducted a cross-sectional study, with a random sample of 200 non-diabetic adults attending a school primary care center. Logistic regression was used to investigate factors associated with elevated FINDRISC scores (≥ 15 points). We observed that 33.5% of subjects had a slightly elevated risk, 17.0% moderate risk, and 34.5% high/very high risk of developing T2DM. Those with a low level of education (OR: 3.21; 95%CI: 1.52-6.77) and with a history of hypercholesterolemia (OR: 2.47; 95%CI: 1.27-4.81) were more likely to have an elevated score. In conclusion, the frequency of individuals at high/very high risk of developing T2DM was high in the population studied, and the lower level of education and history of hypercholesterolemia were associated with elevated FINDRISC score.

El objetivo de este estudio fue estratificar a los usuarios de un centro de atención primaria según el riesgo de desarrollar diabetes mellitus tipo 2 (DM2) mediante el cuestionario Finnish Diabetes Risk Score (FINDRISC), así como evaluar los factores asociados con un mayor riesgo de desarrollar DM2. Se trata de un estudio transversal con una muestra aleatoria de 200 adultos no diabéticos de un centro clínico de salud. Se utilizó regresión logística para investigar los elevados factores asociados con FINDRISC (≥ 15 puntos). Se observó que el 33,5% de los sujetos presentaron un riesgo ligeramente aumentado, el 17,0% riesgo moderado y el 34,5% riesgo alto/muy alto de desarrollar DM2. Aquellos con menos nivel educativo (OR: 3,21; IC: 1,52-6,77) y con antecedentes de hipercolesterolemia (OR: 2,47; IC: 1,27-4,81) tenían mayor probabilidad de tener un puntaje elevado. Se concluye que la frecuencia de individuos con riesgo alto/muy alto de desarrollar DM2 fue alta en la población estudiada, y que el menor nivel educativo y antecedentes de hipercolesterolemia se asociaron con un puntaje elevado en el FINDRISC.

Lymphedema Predictor Factors after Breast Cancer Surgery: A Survival Analysis.

BACKGROUND: Factors associated with lymphedema development after breast cancer surgery are not well established. The purpose is to assess the value of patient, disease and treatment-related factors predicting lymphedema development. METHODS AND RESULTS: This study included 371 women with primary invasive breast cancer treated surgically between 2005 and 2009 with follow-up until December 2011. At each follow-up visit, both upper limb circumferences were measured at seven points to calculate the upper limb volume. Kaplan-Meier and Cox regression models for survival were applied. By the end of the follow-up period, 33.4% of women (n=124) had developed lymphedema. According to volume, lymphedema at diagnosis was mild in 78.5%, moderate in 19.0%, and severe in 2.5% of them. A 77.4% of lymphedema had enough clinical relevance to be treated. The probability of developing lymphedema within 12, 24, and 36 months post-surgery was 28.7% (95%CI 24.1-34.0%), 34.6% (95%CI 29.5-40.2%), and 38.3% (95%CI 32.8-44.3%), respectively. High stages, axillary lymph node dissection, chemotherapy, radiotherapy, and postoperative seroma were predictors of lymphedema in the bivariate survival analysis. Only axillary lymph node dissection and radiotherapy maintained their significance in the multivariate model. When the analysis was restricted to patients who underwent axillary lymph node dissection, the number of nodes excised did not influence the occurrence of lymphedema. CONCLUSIONS: Axillary lymph node dissection and radiotherapy affected lymphedema development. This study provides support that breast cancer patients with such characteristics should be closely monitored, especially during the first year after surgery.

The effect of smoking on prostate cancer survival: a cohort analysis in Barcelona.

The aim of this study was to analyse the effect of smoking on prostate cancer-specific mortality and all-cause mortality. A retrospective cohort study was conducted with 1109 patients with prostate cancer diagnosed from 1992 to 2008, identified through the Hospital del Mar Cancer Registry (Barcelona, Spain). Information on smoking habits was retrieved from clinical records and patients were classified into three categories: never smoker, exsmoker and current smoker. Patients were followed up until December 2011. Survival curves were plotted using Kaplan-Meier methods. Cox models were used to estimate hazard ratios and 95% confidence intervals. Median age at diagnosis was 70.6 years and 16.7% of patients had stage IV tumours. During the follow-up period, 466 deaths occurred, 36.1% of them being specifically due to prostate cancer. The median follow-up time of the censored patients was 5.8 years. There was a significant difference in disease-specific survival between never smokers, exsmokers and current smokers (P=0.0001). Current smokers presented a worse 5-year survival rate (82.9%) compared with exsmokers (88.9%) and never smokers (89.6%). In the multivariate analysis, after adjusting for age, disease stage, Gleason score and prostate-specific antigen, the hazard ratio for smokers was 1.80 (95% confidence interval: 1.04-3.13) compared with never smokers. In the exsmokers group the risk for prostate cancer-specific mortality was very similar to that of never smokers. However, the statistical difference disappeared when we stratified by stage (I-III and IV). In conclusion, smoking was identified as an independent and negative prognostic factor for prostate cancer-specific and all-cause mortality. These findings suggest that smoking-cessation programmes could be beneficial for prostate cancer patients.