Strategies to improve diagnosis and access to treatment of retinoblastoma in low- and middle-income countries: A systematic review.

Retinoblastoma, the most common intraocular tumor in childhood, still faces challenges in diagnosis and treatment, particularly in low- and middle-income countries. Identifying strategies to improve the time to diagnosis and access to treatment is crucial to enhance survival rates and preserve ocular health. We conducted a systematic review to identify interventions that have demonstrated potential in addressing these challenges. We performed a comprehensive search across databases until March 2023. Out of the studies reviewed, 21 met the inclusion criteria and were categorized into five main areas: surveillance strategies, genetic counseling, education, public assistance, and international partnership. Despite the obstacles faced, the initiatives identified in this review present acts toward improving the time to diagnosis and access to treatment for retinoblastoma. Based on the extracted data, we propose a comprehensive chain of initiatives. We firmly believe that implementing this chain of initiatives can lead to improved clinical outcomes for retinoblastoma patients.

Ethnic disparities in cancer mortality in the capital and northeast of the State of São Paulo, Brazil 2001-17.

PURPOSE: There is a paucity of studies investigating cancer disparities in groups defined by ethnicity in transitioning economies. We examined the influence of ethnicity on mortality for the leading cancer types in São Paulo, Brazil, comparing patterns in the capital and the northeast of the state. METHODS: Cancer deaths were obtained from a Brazilian public government database for the Barretos region (2003-2017) and the municipality of São Paulo (2001-2015). Age-standardized rates (ASR) per 100,000 persons-years, by cancer type and sex, for five self-declared racial classifications (white, black, eastern origin (Asian), mixed ethnicity (pardo), and indigenous Brazilians), were calculated using the world standard population. RESULTS: Black Brazilians had higher mortality rates for most common cancer types in Barretos, whereas in São Paulo, white Brazilians had higher rates of mortality from breast, colorectal, and lung cancer. In both regions, lung cancer was the leading cause of cancer death among white, black, and pardo Brazilians, with colorectal cancer deaths leading among Asian Brazilians. Black and pardo Brazilians had higher cervical cancer mortality rates than white Brazilians. CONCLUSION: There are substantial disparities in mortality from different cancers in São Paulo according to ethnicity, pointing to inequities in access to health care services.

Cancer mortality and premature deaths among hairdressers in Brazil.

Hairdresser is an occupation classified by the International Agency for Research on Cancer as probably carcinogenic (Group 2A) for lung and bladder cancer, but evidence is accumulating on its association with other cancer types. To our knowledge, this is the first study aimed to compare the cancer mortality and premature mortality between hairdressers and other workers in Brazil. METHODS: In this exploratory study, information on deaths by selected cancers that occurred in Brazil, from 1996 to 2020, among workers aged 20-70y, with identified occupation was gathered from the Brazilian Mortality Information System. Sociodemographic characteristics, sex-specific mortality ratio, and Years of Potential Life Lost (YPLL) were compared between hairdressers, service workers, and general workers. We used logistic regression models to estimate crude (ORC) and adjusted (ORADJ) odds ratios. Models were adjusted by age, educational level, and ethnicity. We also used Poisson regression models to compare the YPLL rates across the occupational groups. RESULTS: From 1996 to 2020, 23 557 deaths occurred among hairdressers, 576 428 among service workers, and 13 332 996 among general workers in Brazil. Higher mortality ORs and YPLL were observed for several types of cancer among hairdressers, compared to service and general workers, especially for women. Hairdressers' mortality was significantly higher among whites, women, younger workers, and those who completed high school. Female hairdressers had significantly higher odds of dying from cancer of the digestive, respiratory, reproductive, urinary, and hematological systems, both in crude and adjusted models. For male hairdressers, higher odds were found only for urinary tract and bladder cancer, while other significant associations indicated lower mortality than the comparison groups. YPLL analyses revealed significant premature deaths among Brazilian hairdressers. In women, this was more evident among those who died of neoplasms of salivary glands, bones and articular cartilages, and acute lymphoid leukemia; in men, tongue, pharynx, and thyroid. CONCLUSIONS: Our results suggest that Brazilian female hairdressers are more likely to die from several cancers, with potential consequences on premature deaths. Causal associations to occupational risks, such as exposure to chemicals, should be investigated by observational epidemiologic studies. Meanwhile, it is important to promote public policies, regulations, and Occupational Safety and Health (OSH) strategies to protect hairdressers' health, mitigate occupational risks, and ensure safe workplaces.

Thyroid Cancer Incidence and Mortality by Socioeconomic Level in the State of São Paulo, Brazil 2001-2017.

OBJECTIVE: Thyroid cancer is rising largely due to greater detection of indolent or slow-growing tumors; we sought to compare the incidence and mortality profiles of thyroid cancer in the State of São Paulo by socioeconomic status (SES). METHODS: Data on thyroid cancer cases diagnosed from 2003 to 2017 in the Barretos Region and from 2001 to 2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding death data were obtained from a Brazilian public government database. Age-standardized rates were calculated and presented as thematic maps. The rates were also calculated by SES and spatial autocorrelation was assessed by global and local indices. RESULTS: There were 419 cases of thyroid cancer and 21 deaths in Barretos, contrasting with the highly populated São Paulo, with 30 489 cases and 673 deaths. The overall incidence rates in São Paulo (15.9) were three times higher than in Barretos (5.7), while incidence rates in women were close to five times higher in Barretos and four times higher in São Paulo than in men. Mortality rates were, in relative terms, very low in both regions. A clear stepwise gradient of increasing thyroid cancer incidence with increasing SES was observed in São Paulo, with rates in very high SES districts four times those of low SES (31.6 vs 8.1). In contrast, the incidence rates in Barretos presented little variation across SES levels. CONCLUSION: Thyroid cancer incidence varied markedly by SES in São Paulo, with incidence rates rising with increasing socioeconomic index. Overdiagnosis is likely to account for a large proportion of the thyroid cancer burden in the capital.

Colorectal cancer spatial pattern in the northeast region of São Paulo, Brazil.

Background: This study examined the spatial pattern of the colorectal cancer (CRC) in the 18 municipalities that compose the Regional Health Department of Barretos (RHD-V), which is in the northeast of the state of São Paulo, Brazil. Methods: All incident cases and deaths from CRC between 2002 and 2016 were included. Age-standardized rates (ASR) for incidence and mortality per 100,000 person-years were used to evaluate the spatial distribution for the total and five-year periods. The lethality rates were also assessed. Excess risk maps compared the observed and expected events. Age-standardized net survival was used to evaluate CRC survival. Results: For CRC incidence, the ASR value for the general population over the entire period (2002-2016) was 17.7 (95% CI: 16.7, 18.6), ranging from 16.7 (95% CI: 14.9, 18.4) (2002-2006) to 20.0 (95% CI: 18.3, 21.7) (2012-2016) per 100,000. When males and females were compared, the ASR was 20.1 (95% CI: 18.6, 21.6) and 15.7 (95% CI: 14.5, 17.0) per 100,000, respectively. For CRC mortality (2002-2016), the ASR was 8.2 (95% CI: 7.6, 8.9), ranging from 9.0 (95% CI: 7.8, 10.3) (2002-2006) to 8.2 (95% CI: 7.2, 9.3) (2012-2016) per 100,000. Overall, the excess risk up to 2.0 was more frequent. In terms of survival, municipalities with large port populations had lower survival in comparison with medium port. Conclusions: This study showed a variation in CRC incidence and mortality, with differences considering five-year periods and gender, being the incidence higher in males than females in the entire period, with mortality equivalent to half the incidence. The survival was lower in municipalities with large port populations in comparison with medium port. Knowing spatial patterns of incidence, mortality, lethality, and survival can be necessary to support policymakers to advance or implement effective cancer control programs.

Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer is a leading cause of morbidity and mortality in Brazil and the burden is rising. To better inform tailored cancer actions, we compare incidence and mortality profiles according to small areas in the capital and northeast region of the State of São Paulo for the leading cancer types. METHODS: New cancer cases were obtained from cancer registries covering the department of Barretos (2003-2017) and the municipality of São Paulo (2001-2015). Cancer deaths for the same period were obtained from a Brazilian public government database. Age-standardized rates per 100,000 persons-years by cancer and sex are presented as thematic maps, by municipality for Barretos region, and by district for São Paulo. RESULTS: Prostate and breast cancer were the leading forms of cancer incidence in Barretos, with lung cancer leading in terms of cancer mortality in both regions. The highest incidence and mortality rates were seen in municipalities from the northeast of Barretos region in both sexes, while elevated incidence rates were mainly found in São Paulo districts with high and very high socioeconomic status (SES), with mortality rates more dispersed. Breast cancer incidence rates in São Paulo were 30 % higher than Barretos, notably in high and very high SES districts, while corresponding rates of cervical cancer conveyed the opposite profile, with elevated rates in low and medium SES districts. CONCLUSIONS: There is substantial diversity in the cancer profiles in the two regions, by cancer type and sex, with a clear relation between the cancer incidence and mortality patterns observed at the district level and corresponding SES in the capital.

Cancer inequalities in incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer disparities exist between and within countries; we sought to compare cancer-specific incidence and mortality according to area-level socioeconomic status (SES) in the State of São Paulo, Brazil. METHODS: Cancer cases diagnosed 2003-2017 in the Barretos region and 2001-2015 in the municipality of São Paulo were obtained from the respective cancer registries. Corresponding cancer deaths were obtained from a Brazilian public government database. Age-standardized rates for all cancer combined and the six most common cancers were calculated by SES quartiles. RESULTS: There were 14,628 cancer cases and 7513 cancer deaths in Barretos, and 472,712 corresponding cases and 194,705 deaths in São Paulo. A clear SES-cancer gradient was seen in São Paulo, with rates varying from 188.4 to 333.1 in low to high SES areas, respectively. There was a lesser social gradient for mortality, with rates in low to high SES areas ranging from 86.4 to 98.0 in Barretos, and from 99.2 to 100.1 in São Paulo. The magnitude of the incidence rates rose markedly with increasing SES in São Paulo city for colorectal, lung, female breast, and prostate cancer. Conversely, both cervical cancer incidence and mortality rose with lower levels of SES in both regions. CONCLUSIONS: A clear SES association was seen for cancers of the prostate, female breast, colorectum, and lung for São Paulo. This study offers a better understanding of the cancer incidence and mortality profile according to SES within a highly populated Brazilian state.

Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors. / Variabilidade espacial intraurbana da mortalidade por câncer de mama e do colo do útero no município de São Paulo: análise dos fatores associados.

OBJECTIVE: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. METHODS: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. RESULTS: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). CONCLUSION: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.

OBJETIVO: Identificar a variabilidade espacial da mortalidade por câncer de mama e colo do útero e avaliar fatores associados à mortalidade por esses cânceres no município de São Paulo. MÉTODOS: Entre 2009 e 2016 foram registrados, no Sistema de Informações sobre Mortalidade, 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais. Os registros foram geocodificados por endereço de residência e agregados segundo território adstrito. Foram realizadas modelagens de regressão espacial utilizando-se a abordagem bayesiana com estrutura de Besag-York-Mollié para verificar a associação dos óbitos com indicadores selecionados. RESULTADOS: As taxas de mortalidade por esses cânceres apresentaram padrões espaciais inversos. As variáveis associadas à mortalidade por câncer de mama foram: tempo de deslocamento para o trabalho entre uma e duas horas (risco relativo ­ RR 0,97; intervalo de credibilidade ­ IC95% 0,93­1,00); mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94­0,99) e óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00­1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87­0,98); rendimento domiciliar até três salários-mínimos (RR 1,27; IC95% 1,18­1,37); e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01­1,18). CONCLUSÃO: Foram calculados os RR preditos para a mortalidade por esses cânceres, que estiveram associados às condições socioeconômicas das áreas de abrangência.

Variabilidade espacial intraurbana da mortalidade por câncer de mama e do colo do útero no município de São Paulo: análise dos fatores associados / Intra-urban spatial variability of breast and cervical cancer mortality in the city of São Paulo: analysis of associated factors

RESUMO Objetivo: Identificar a variabilidade espacial da mortalidade por câncer de mama e colo do útero e avaliar fatores associados à mortalidade por esses cânceres no município de São Paulo. Métodos: Entre 2009 e 2016 foram registrados, no Sistema de Informações sobre Mortalidade, 10.124 óbitos por câncer de mama e 2.116 óbitos por câncer do colo do útero em mulheres com 20 anos e mais. Os registros foram geocodificados por endereço de residência e agregados segundo território adstrito. Foram realizadas modelagens de regressão espacial utilizando-se a abordagem bayesiana com estrutura de Besag-York-Mollié para verificar a associação dos óbitos com indicadores selecionados. Resultados: As taxas de mortalidade por esses cânceres apresentaram padrões espaciais inversos. As variáveis associadas à mortalidade por câncer de mama foram: tempo de deslocamento para o trabalho entre uma e duas horas (risco relativo — RR 0,97; intervalo de credibilidade — IC95% 0,93-1,00); mulheres responsáveis pelo domicílio (RR 0,97; IC95% 0,94-0,99) e óbitos por câncer de mama ocorridos em estabelecimentos privados (RR 1,04; IC95% 1,00-1,07). À mortalidade por câncer do colo do útero, estiveram associados: tempo de deslocamento para o trabalho entre meia e uma hora (RR 0,92; IC95% 0,87-0,98); rendimento domiciliar até três salários-mínimos (RR 1,27; IC95% 1,18-1,37); e razão de menores de um ano em relação à população feminina de 15 a 49 anos (RR 1,09; IC95% 1,01-1,18). Conclusão: Foram calculados os RR preditos para a mortalidade por esses cânceres, que estiveram associados às condições socioeconômicas das áreas de abrangência.

ABSTRACT Objective: To identify spatial variability of mortality from breast and cervical cancer and to assess factors associated in the city of São Paulo. Methods: Between 2009 and 2016, 10,124 deaths from breast cancer and 2,116 deaths from cervical cancer were recorded in the Mortality Information System among women aged 20 years and over. The records were geocoded by address of residence and grouped according to Primary Health Care coverage areas. A spatial regression modeling was put together using the Bayesian approach with a Besag-York-Mollié structure to verify the association of deaths with selected indicators. Results: Mortality rates from these types of cancer showed inverse spatial patterns. These variables were associated with breast cancer mortality: travel time between one and two hours to work (RR - relative risk: 0.97; 95%CI - credible interval: 0.93-1.00); women being the head of the household (RR 0.97; 95%CI 0.94-0.99) and deaths from breast cancer in private health institutions (RR 1.04; 95%CI 1.00-1.07). The following variables were associated with mortality from cervical cancer: travel time to work between half an hour and one hour (RR 0.92; 95%CI 0.87-0.98); per capita household income of up to 3 minimum wages (RR 1.27; 95%CI 1.18-1.37) and ratio of children under one year of age related to the female population aged 15 to 49 years (RR 1.09; 95%CI 1.01-1.18). Conclusion: The predicted RR for mortality from these cancers were calculated and associated with the socioeconomic conditions of the areas covered.

The biobank of barretos cancer hospital: 14 years of experience in cancer research.

Despite the developments in cancer research over years, cancer is still one of the leading causes of death worldwide. In Brazil, the number of cancer cases for the several next years (2020-2022) is expected to increase up to 625,000. Thus, translational research has been vital to determine the potential risk, prognostic, and predictive biomarkers in cancer. Therefore, Barretos Cancer Hospital implemented a biobank (BB-BCH) in 2006, which is responsible for processing, storage, and provision of biological materials from cancer and non-cancer participants. Hence, this article aimed to describe BB-BCH's history, experiences, and outcomes and explore its impact on Brazilian translational oncology research scenario. BB-BCH has a multidisciplinary team who are responsible for guaranteeing the quality of all processes as recommended by international guidelines for biobanks. Furthermore, BB-BCH has ample equipment to ensure the quality of all material requested by researchers as genetic material (DNA and RNA) and/or entire biospecimens. From 2006 to 2019, BB-BCH contained 252,069 samples from 44,933 participants, the whole collection is represented by 15 different types of biospecimens collected from them. According to our data, the most collected and stored topography in men is head and neck (29%); in women is breast (28%); and in children is torso and limb (27%) samples. Finally, we supported national and international consortia and projects such as The Cancer Genome Atlas. BB-BCH is a vital knowledge source for scientific community, enabling the development of high-quality studies, with a wide variety of tumor categories and high national representativeness of Brazilian population.

Pink October and mammograms: when health communication misses the target. / Outubro Rosa e mamografias: quando a comunicação em saúde erra o alvo.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

Impact of COVID-19 Pandemic on Cancer-Related Hospitalizations in Brazil.

BACKGROUND: Alongside the SARS-CoV-2 (COVID-19) pandemic, Brazil also faces an ongoing rise in cancer burden. In 2020, there were approximately 592 000 new cancer cases and 260 000 cancer deaths. Considering the heterogeneities across Brazil, this study aimed to estimate the impact of the COVID-19 pandemic on cancer-related hospital admissions at a national and regional level. METHODS: The national, regional, and state-specific monthly average of cancer-related hospital admission rates per 100 000 inhabitants and 95% confidence intervals (95% CIs) were calculated from March to July (2019: pre-COVID-19; and 2020: COVID-19 period). Thematic maps were constructed to compare the rates between periods and regions. RESULTS: Cancer-related hospital admissions were reduced by 26% and 28% for clinical and surgical purposes, respectively. In Brazil, the average hospitalization rates decreased from 13.9 in 2019 to 10.2 in 2020 per 100,000 inhabitants, representing a rate difference of -3.7 (per 100,000 inhabitants; 95% CI: -3.9 to -3.5) for cancer-related (clinical) hospital admissions. Surgical hospital admissions showed a rate decline of -5.8 per 100,000 (95% CI: -6.0 to -5.5). The reduction in cancer-related admissions for the surgical procedure varies across regions ranging between -2.2 and -10.8 per 100 000 inhabitants, with the most significant decrease observed in the south and southeastern Brazil. CONCLUSIONS: We observed a substantial decrease in cancer-related hospital admissions during the COVID-19 pandemic with marked differences across regions. Delays in treatment may negatively impact cancer survival in the future; hence, cancer control strategies to mitigate the impact are needed.

HPV-Induced Oropharyngeal Squamous Cell Carcinomas in Brazil: Prevalence, Trend, Clinical, and Epidemiologic Characterization.

BACKGROUND: Tobacco or human papillomavirus (HPV)-related oropharyngeal squamous cell carcinomas (OPSCC) represent different clinical and epidemiologic entities. This study investigated the prevalence of HPV-positive and HPV-negative OPSCC in a reference cancer hospital in Brazil and its association with clinical and demographic data, as well as its impact on overall survival. METHODS: HPV infection was determined by p16-IHC in pre-treatment formalin-fixed paraffin-embedded samples from all patients with OPSCC diagnosed at Barretos Cancer Hospital between 2008 and 2018. The prevalence of HPV-positive cases and its temporal trend was assessed, and the association of clinical and demographic data with HPV infection and the impact on patient overall survival was evaluated. RESULTS: A total of 797 patients with OPSCC were included in the study. The prevalence of HPV-associated tumors in the period was 20.6% [95% confidence interval, 17.5-24.0] with a significant trend for increase of HPV-positive cases over the years (annual percentage change = 12.87). In a multivariate analysis, the variables gender, level of education, smoking, tumor sublocation, region of Brazil, and tumor staging had a significant impact in HPV positivity, and a greater overall survival (OS) was observed in HPV-positive patients (5-year OS: 47.9% vs. 22.0%; P = 0.0001). CONCLUSIONS: This study represents the largest cohort of Brazilian patients with OPSCC characterized according to HPV status. We report significant differences in demographics and clinical presentation according to HPV status, and an increasing trend in prevalence for HPV-induced tumors. IMPACT: These findings can potentially contribute to a better stratification and management of patients as well as assist in prevention strategies.

Risk of cardiovascular mortality, stroke and coronary heart mortality associated with aircraft noise around Congonhas airport, São Paulo, Brazil: a small-area study.

BACKGROUND: Noise pollution is increasingly recognised as a public health hazard, yet limited evidence is available from low- and middle-income countries (LMIC), particularly for specific sources. Here, we investigated the association between day-night average (Ldn) aircraft noise and the risk of death due to cardiovascular disease (CVD), stroke and coronary heart disease (CHD) at small-area level around São Paulo's Congonhas airport, Brazil during the period 2011-2016. METHODS: We selected 3259 census tracts across 16 districts partially or entirely exposed to ≥50 dB aircraft noise levels around the Congonhas airport, using pre-modelled 5 dB Ldn noise  bands (≤50 dB to > 65 dB). We estimated the average noise exposure per census tract using area-weighting. Age, sex and calendar year-specific death counts for CVD, stroke and CHD were calculated by census tract, according to the residential address at time of death. We fitted Poisson regression models to quantify the risk associated with aircraft noise exposure, adjusting for age, sex, calendar year and area-level covariates including socioeconomic development, ethnicity, smoking and road traffic related noise and air pollution. RESULTS: After accounting for all covariates, areas exposed to the highest levels of noise (> 65 dB) showed a relative risk (RR) for CVD and CHD of 1.06 (95% CI: 0.94; 1.20) and 1.11 (95%CI: 0.96; 1.27), respectively, compared to those exposed to reference noise levels (≤50 dB). The RR for stroke ranged between 1.05 (95%CI: 0.95;1.16) and 0.91 (95%CI: 0.78;1.11) for all the noise levels assessed. We found a statistically significant positive trend for CVD and CHD mortality risk with increasing levels of noise (p = 0.043 and p = 0.005, respectively). No significant linear trend was found for stroke. Risk estimates were generally higher after excluding road traffic density, suggesting that road traffic air and noise pollution are potentially important confounders. CONCLUSIONS: This study provides some evidence that aircraft noise is associated with increased risk of CVD and CHD mortality in a middle-income setting. More research is needed to validate these results in other LMIC settings and to further explore the influence of residual confounding and ecological bias. Remarkably, 60% of the study population living near the Congonhas airport (~ 1.5 million) were exposed to aircraft noise levels > 50 dB, well above those recommended by the WHO (45 dB), highlighting the need for public health interventions.

Oncology palliative care: access barriers: bibliometric study.

OBJECTIVE: To perform a bibliometric analysis of studies that evaluated the barriers to access to cancer palliative care (PC). METHODS: This was a bibliometric review using MEDLINE; EMBASE; Web Of Science; LILACS and the Cochrane Library. A search was conducted with the terms Barriers, Palliative Care and Cancer. Articles whose objectives targeted barriers to access to PC were considered, regardless of the year of publication. The setting is articles published from 1987 to 2020. RESULTS: A total of 6158 articles were identified, of which 217 were eligible for analysis. The USA and UK being the countries with the largest number of articles on the subject (n=101, n=18, respectively). After expert analysis, the barriers were grouped into nine categories. CONCLUSIONS: Barriers related to symptom control were identified in 19% of the eligible articles, along with barriers related to health, which with 24% of occurrence in the articles, were the most frequently cited barriers. Countries which have implemented PC for some time were those with the greatest number of publications and in journals with the highest impact factors. Cross-sectional study design continues to be the most frequently used in publications.

Residential traffic exposure and lymphohematopoietic malignancies among children in the city of São Paulo, Brazil: An ecological study.

BACKGROUND: Despite widespread evidence that air pollution is carcinogenic, there is little evidence from low-middle income countries, especially related to childhood malignancies. We examined the role of traffic related pollution on lymphohematopoietic malignancies among under-14 s in Sao Paulo. METHODS: All incident cases between 2002 and 2011 were collected from a population-based registry. Exposures were assigned on residential address at diagnosis via traffic density database (for the year 2008) and a satellite derived NO2 land use regression model (averaged between 1997 and 2011). Incidence rate ratios (IRRs) were calculated via Poisson Regression adjusted by age, gender and socioeconomic status (SES), with additional stratification by SES. RESULTS: A positive association between traffic and NO2 with some lymphohematopoietic malignancies was observed with the degree of effect differing by SES. For example, lymphoid leukemia IRRs in the lower SES group were 1.21 (95 % CI: 1.06, 1.39) for traffic density and 1.38 (95 % CI: 1.13, 1.68) for NO2. In the higher group they were 1.06 (95 % CI: 1.00, 1.14) and 1.37 (95 % CI: 1.16, 1.62). CONCLUSION: NO2 and traffic density were associated with Hodgkin lymphoma and lymphoid leukemia among children in São Paulo. Differing IRRs by gender and SES group indicate differences in underlying risk and/or exposure profiles.

Outubro Rosa e mamografias: quando a comunicação em saúde erra o alvo / Octubre Rosa y mamografías: cuando la comunicación en salud confunde el objetivo / Pink October and mammograms: when health communication misses the target

O câncer de mama é o tipo de câncer mais diagnosticado e a principal causa de morte por câncer na população feminina. As mamografias de rastreamento e o tratamento precoce são geralmente os meios mais utilizados na tentativa de reduzir essa mortalidade e são incentivados no Outubro Rosa, uma campanha de divulgação anual. Contudo, estudos recentes têm relacionado o aumento do rastreamento com uma maior morbimortalidade em razão do sobrediagnóstico e do sobretratamento. No presente estudo, avaliaram-se as buscas relativas ao câncer de mama e à mamografia no Google Trends, entre 2004 e 2019, em termos da tendência, da sazonalidade e da distribuição nas Unidades Federativas brasileiras. Avaliou-se também a correlação entre a quantidade de buscas no Google Trends e a quantidade de exames de rastreamento mamográfico. As duas séries tiveram um padrão sazonal com picos em outubro, e houve excesso de exames realizados fora da faixa etária recomendada. O Outubro Rosa transmitiu informações de saúde, as popularizou e induziu comportamentos relativos a informações transmitidas; três aspectos desejáveis na comunicação e na educação em saúde. Porém, gerou um excesso de mamografias de rastreamento e não incentivou a autonomia e o consentimento livre e esclarecido. O Outubro Rosa mostrou o potencial da comunicação em saúde para massas e a necessidade de que as mensagens sejam alinhadas com as melhores evidências científicas.

El cáncer de mama es el tipo de cáncer más diagnosticado y la principal causa de muerte por cáncer en la población femenina. Las mamografías de rastreo y el tratamiento precoz son generalmente los medios más utilizados en la tentativa de reducir esa mortalidad, y son incentivados en el Octubre Rosa, una campaña de divulgación anual. No obstante, estudios recientes han relacionado el aumento del rastreo con una mayor morbimortalidad, debido al sobrediagnóstico y al sobretratamiento. En el presente estudio se evaluaron las búsquedas relativas al cáncer de mama, y a la mamografía en Google Trends entre 2004 y 2019, en términos de tendencia, de estacionalidad y de su distribución en las Unidades Federativas brasileñas. Se evaluó también la correlación entre la cantidad de búsquedas en Google Trends y la cantidad de exámenes de rastreo mamográfico. Las dos series tuvieron un patrón estacional con picos en octubre, y hubo un exceso de exámenes realizados fuera de la franja etaria recomendada. Octubre Rosa transmitió información de salud, la popularizó e indujo a comportamientos relacionados con la información transmitida; tres aspectos deseables en la comunicación y educación en salud. Sin embargo, generó un exceso de mamografías de rastreo y no incentivó la autonomía y el consentimiento libre e informado. Octubre Rosa mostró el potencial de la comunicación en salud para las masas y la necesidad de que los mensajes estén alineados con mejores evidencias científicas.

Breast cancer is the most frequently diagnosed type of cancer and is the leading cause of death from cancer in the female population. Screening mammograms and early treatment are the most frequently used means to attempt to reduce this mortality and are promoted during Pink October, an annual awareness-raising campaign. However, recent studies have correlated the increase in screening with higher morbidity and mortality, due to overdiagnosis and overtreatment. The current study assessed searches related to breast cancer and mammogram in Google Trends from 2004 to 2019 in terms of trend, seasonality, and distribution in Brazilian states. The study also evaluatedH the correlation between the number of searches in Google Trends and the number of screening mammograms. The two series showed a seasonal pattern with peaks in October, and there was an excess in tests performed outside the recommended age bracket. Pink October transmitted and popularized health information and induced behaviors related to this information, which are three desirable aspects in health communication and education. However, the campaign also generated an excess in screening mammograms and did not encourage autonomy and free and informed consent. Pink October revealed both the potential of mass communication in health and the need for messages to be aligned with the best available scientific evidence.

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo.

OBJECTIVE: To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS: This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability). RESULTS: The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION: The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.

Bayesian modeling of hematologic cancer and vehicular air pollution among young people in the city of São Paulo, Brazil.

Traffic-related air pollution is being associated with hematologic cancer in young individuals. This study performed a spatial analysis of the hematologic cancer incidence and mortality among younger people, using a Bayesian approach, to associate with traffic density in the city of São Paulo, Brazil. Two databases were employed: incidence (2002-2011) and mortality (2002-2013). The relationships between the cases of hematologic cancer and the covariates - traffic density, the Municipal Human Development Index (MHDI), and population density - were evaluated using a Besag-York-Mollié ecological model with relative risks (RRs) estimates. Per 1-unit standard-deviation increase in traffic density, in the MHDI, and in population density, the RR for the incidence was 1.06 (95% CI: 0.97-1.14), 1.28 (95% CI: 1.16-1.42), and 1.01 (95% CI: 0.94-1.08), respectively. For mortality, no covariates were considered risk factors. Our findings suggest significant association between living in regions with better socioeconomic conditions, where traffic density is usually higher, and risk of hematologic cancer in younger people.

Spatial pattern of mortality from breast and cervical cancer in the city of São Paulo / Padrão espacial da mortalidade por câncer de mama e colo do útero na cidade de São Paulo

ABSTRACT OBJECTIVE To verify the spatial pattern of mortality from breast and cervical cancer in areas of primary health care, considering socioeconomic conditions. METHODS This is an ecological study, from January 2000 to December 2016. The study area is the municipality of São Paulo, Brazil, and its 456 coverage areas of primary health units. Information on deaths of women aged 20 years or over were geocoded according to residence address. We calculated mortality rates, standardized by age, and smoothed by the local empirical Bayesian method, and grouped into three or two years to reduce the random fluctuation of the data. In addition, bivariate global and local Moran indexes were calculated to verify the existence of spatial agglomeration of standardized mortality rates with a domain of socioeconomic condition, elaborated based on the Índice Paulista de Vulnerabilidade Social (IPVS - São Paulo Index of Social Vulnerability). RESULTS The success rate of geocoding was 98.9%. Mortality from breast cancer, without stratification by time, showed a pattern with higher rates located in central regions with better socioeconomic conditions. It showed a decrease at the end of the period and a change in spatial pattern, with increased mortality in peripheral regions. On the other hand, mortality from cervical cancer remained with the highest rates in peripheral regions with worse socioeconomic conditions, despite being reduced over time. CONCLUSION The spatial pattern of mortality from the studied cancers, over time, suggests association with the best socioeconomic conditions of the municipality, either as protection (cervical) or risk (breast). This knowledge may direct resources to prevent and promote health in the territories.

RESUMO OBJETIVOS Verificar o padrão espacial da mortalidade pelos cânceres de mama e do colo do útero, em áreas da atenção primária à saúde, levando em consideração as condições socioeconômicas. MÉTODOS O estudo é ecológico, de janeiro de 2000 a dezembro de 2016. A área de estudo é o município de São Paulo, Brasil, e suas 456 áreas de abrangência das unidades básicas de saúde. As informações sobre óbitos de mulheres com 20 anos ou mais de idade foram geocodificadas segundo endereço de residência. Foram calculadas as taxas de mortalidade, padronizadas por idade, e suavizadas pelo método bayesiano empírico local, além de agrupadas em três ou dois anos para reduzir a flutuação aleatória dos dados. Além disso, foram calculados os índices de Moran global e local bivariados, para verificar a existência de aglomeração espacial das taxas de mortalidade padronizadas com um domínio de condição socioeconômica, elaborado a partir do Índice Paulista de Vulnerabilidade Social. RESULTADOS A taxa de sucesso da geocodificação foi de 98,9%. A mortalidade por câncer de mama, sem estratificação por tempo, apresentou um padrão com maiores taxas localizadas nas regiões centrais e com melhores condições socioeconômicas. Apresentou queda ao final do período e mudança de padrão espacial, com aumento da mortalidade nas regiões periféricas. Já a mortalidade por câncer do colo do útero manteve-se com as maiores taxas nas regiões periféricas e com piores condições socioeconômicas, apesar de apresentar redução ao longo do tempo. CONCLUSÃO O padrão espacial da mortalidade pelos cânceres do estudo, ao longo do tempo, sugere associação com as melhores condições socioeconômicas do município, seja como proteção (colo) ou risco (mama). Esse conhecimento pode direcionar recursos para a prevenção e a promoção da saúde nos territórios.