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1.
Br J Radiol ; 93(1105): 20180677, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31674803

RESUMEN

OBJECTIVES: Our aim was to compare cancer incidence in a cohort exposed in childhood (1950-63) to a therapeutic dose of radiation in the North of Portugal and followed-up until the end of 2012, with the incidence rates for the same age and sex in the general population. METHODS: A population-based North Region cancer registry (RORENO) was used to assess which members of the cohort developed cancer. The association between radiation exposure and overall and specific cancer sites was evaluated using standardised incidence ratios (SIR). RESULTS: Over the full follow-up period, 3357 individuals of the 5356 original tinea capitis (TC) cohort (63%) were retrieved in the RORENO, and 399 new cancer cases were identified, representing an increased risk of 49% when compared with the general population (SIR = 1.49; 95% CI: 1.35-1.64). The risk was slightly higher in males than in females (SIR = 1.65; 95% CI: 1.43-1.89 vs SIR = 1.35; CI = 1.17-1.55). The risk was slightly higher in the individuals exposed to a higher radiation dose (SIR = 1.78; 95% CI: 1.22-2.51 for ≥630 R vs SIR = 1.46; 95% CI: 1.31-1.62 for 325-475 R). In females, there was an excess cancer risk in all cancers with the higher radiation dose (SIR = 2.00; 95% CI: 1.21-3.13 for ≥630 R vs SIR = 1.30; 95% CI: 1.11-1.51 for 325-475 R) which was not observed in males, and for combined dose categories significantly raised SIRs for thyroid and head and neck cancer, suggesting a possible higher radiosensitivity of females. An increased risk was also observed for some cancers located far from the irradiated area. CONCLUSIONS: The results suggest an association between radiation exposure and later increased cancer risk for cancers located near the radiation exposed area, mainly thyroid, and head and neck cancers. Further studies are necessary to disentangle possible non-radiation causes for distant cancers increased risk. ADVANCES IN KNOWLEDGE: This paper shows a possible association between childhood X-ray epilation and increased risk of cancer which was not previously investigated in the Portuguese TC cohort.


Asunto(s)
Neoplasias Inducidas por Radiación/epidemiología , Tiña del Cuero Cabelludo/radioterapia , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Masculino , Portugal/epidemiología , Sistema de Registros , Factores de Riesgo
2.
Infect Agent Cancer ; 14: 35, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31719840

RESUMEN

Background: The Instituto Angolano de Controlo do Cancer (IACC) Cancer Registry in Luanda, Angola is the most ancient and organized hospital-based cancer registry in Angola and provides data on cancer cases treated in several hospital facilities in Luanda. Methods: Newly-diagnosed cancer cases (2012-2016) of IACC were collected. A total of 6638 malignant neoplasms were recorded. After excluding duplicates, missing data and non-melanoma skin cancers cases, a final number of 5609 cancer cases was considered valid for analysis. Results: From 5609 new cases, 2059 were males and 3550 females. Of all cases, 9.7% was in children below the age of 15 years. Most of the cases were residents from the Luanda district. The five most common cancers for all periods were breast (21.4%), cervix (16.8%), prostate (7.1%), non-Hodgkin lymphoma (4.5%) and Kaposi sarcoma (4.3%). For men, 19.3% of the cancers were prostate, 7.5% Kaposi sarcoma and 7.5% non-Hodgkin lymphoma. Cancers of the breast and cervix together accounted 60% of all cancers in females. Comparison of our data onto the 5 most frequent tumours, by sex, according to GLOBOCAN 2018 estimations for Angola, highlights the potential deviation from reality that estimates may have and reinforces the urgent need to build a truly population-based cancer registry in Luanda. Conclusion: To accomplish that task, it is mandatory to implement a more rigorous quality control program at the hospital-based cancer registry at IACC and to optimize the network of health institutions that actively working on and contributing to the cancer registry, in Luanda.

3.
Eur J Cancer Prev ; 2019 Oct 22.
Artículo en Inglés | MEDLINE | ID: mdl-31651567

RESUMEN

Second primary cancers (SPCs) are an increasing concern among cancer survivors. In Northern Portugal, gastric cancer incidence is high, and alone corresponds to one in 10 SPCs diagnosed. Therefore, this study aims to estimate the contribution of gastric SPCs to the mortality of patients with a previous cancer. A population-based cohort of nongastric first primary cancer (FPC) patients from the North Region Cancer Registry of Portugal, diagnosed between 2000 and 2006, was followed for a gastric SPC until the end of 2012, and for death by any cause until the end of 2017. Patients with a gastric SPC (85 synchronous and 215 metachronous, diagnosed within one and >1 year after the FPC, respectively) were matched (1:3, by sex, five-year age group, year and site of FPC diagnosis) to those who did not develop a gastric SPC and were alive when the corresponding SPC was diagnosed. Significantly higher hazards for mortality [hazard ratio (95% confidence interval)] were observed among patients diagnosed with a synchronous [3.74 (2.69-5.21) in males and 3.36 (2.02-5.58) in females] or metachronous [6.93 (5.41-8.87) in males and 5.93 (4.04-8.72) in females] gastric SPC. The differences in the 10-year cumulative mortality between gastric SPC patients and those with no SPC were approximately 30% for synchronous and over 40% for metachronous gastric SPCs, corresponding to a 1.5- to 2-fold higher relative risk, respectively. In conclusion, cancer patients with a gastric SPC have a nearly two-fold higher risk of death over 10 years than those with a corresponding FPC only.

4.
Eur J Cancer Care (Engl) ; 28(4): e13026, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-30828907

RESUMEN

OBJECTIVE: We provide a real-world overview of multiple myeloma (MM) treatment patterns, outcomes and healthcare resource use (HRU) in Portugal. METHODS: Data were collected retrospectively from consecutive patients diagnosed/treated at the Portuguese Oncology Institute of Porto (IPO-Porto) between 2012 and 2015. Primary objectives were progression-free survival (PFS) and overall survival (OS), with treatment patterns and HRU secondary. Analysis was by line of therapy (LOT), and post hoc by age (<65/≥65 years). RESULTS: 165, 73 and 32 patients received first, second and third LOTs respectively (N = 187). OS probabilities were 91.5%, 83.2% (<65 years) and 86.6%, 65.3% (≥65 years) at 12, 24 months respectively. PFS decreased from the start of each LOT for both age groups and was less for patients ≥65 years. Younger patients received more combination treatment (immunomodulatory drugs + proteasome inhibitors) and stem cell transplants, and had higher mean costs than older patients (€81,213 vs. €36,864 where three LOTs were received). Cost drivers were medications, transplantations and hospitalisations. CONCLUSION: Our results suggest divergence between younger and older MM patients. Older patients had lower OS and PFS probabilities, HRU costs and fewer stem cell transplantations. The treatment patterns in each LOT may differ from other countries' findings, suggesting treatment heterogeneity.


Asunto(s)
Antineoplásicos/uso terapéutico , Costos de la Atención en Salud , Factores Inmunológicos/uso terapéutico , Mieloma Múltiple/terapia , Pautas de la Práctica en Medicina , Inhibidores de Proteasoma/uso terapéutico , Trasplante de Células Madre/estadística & datos numéricos , Factores de Edad , Anciano , Antineoplásicos/economía , Compuestos de Boro/economía , Compuestos de Boro/uso terapéutico , Bortezomib/economía , Bortezomib/uso terapéutico , Costos de los Medicamentos/estadística & datos numéricos , Femenino , Glicina/análogos & derivados , Glicina/economía , Glicina/uso terapéutico , Recursos en Salud/economía , Hospitalización/economía , Humanos , Factores Inmunológicos/economía , Lenalidomida/economía , Lenalidomida/uso terapéutico , Masculino , Persona de Mediana Edad , Mieloma Múltiple/economía , Portugal , Supervivencia sin Progresión , Inhibidores de Proteasoma/economía , Trasplante de Células Madre/economía , Tasa de Supervivencia , Talidomida/economía , Talidomida/uso terapéutico
5.
Dig Liver Dis ; 51(4): 584-588, 2019 04.
Artículo en Inglés | MEDLINE | ID: mdl-30591366

RESUMEN

BACKGROUND: The growing number of gastric cancers together with improved survival resulted in an increasing population of survivors at risk of multiple primary cancers. AIMS: To estimate the 10-year risk and survival of third primary cancers (TPCs) among gastric first primary cancers (FPCs). METHODS: Gastric FPCs from the Portuguese North Region Cancer Registry, diagnosed in 2000-2006 (n = 7409), were followed for a TPC (31/12/2012), and for all-cause death (31/12/2017). The cumulative incidence of TPCs was estimated. Patients with a TPC were matched (1:1, by sex, age group, years between FPC and second primary cancer [SPC] diagnosis, and SPC location) to FPC + SPC patients without a TPC. RESULTS: Overall, 25 (0.3% of FPCs and 6.8% of SPCs) TPCs were diagnosed. The most common sites were tobacco-related, mainly including digestive organs. Among all FPCs, 10-year cumulative incidence (95% confidence interval [CI]) of a TPC was 0.4% (0.2-0.5%) and among SPCs 7.6% (4.4-10.8%). For TPCs, compared to matched patients, age-adjusted hazard ratio (95%CI) for death was 1.68 (0.77-3.67). The 10-year cumulative mortality of TPCs and matched patients was 92.6% and 67.9%, respectively. CONCLUSIONS: A clustering of tobacco-related cancers was observed in TPCs, with a 10-year cumulative incidence of 0.4% among FPCs. TPCs had worse survival than patients without a TPC.


Asunto(s)
Neoplasias Primarias Múltiples/mortalidad , Neoplasias Primarias Secundarias/mortalidad , Neoplasias Gástricas/mortalidad , Uso de Tabaco/efectos adversos , Anciano , Causas de Muerte , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Sistema de Registros , Factores de Riesgo , Análisis de Supervivencia
6.
Gac Sanit ; 2018 Dec 04.
Artículo en Inglés | MEDLINE | ID: mdl-30527910

RESUMEN

OBJECTIVE: To compare the incidence rates of gastric cancer among cancer survivors with those in the general population, and estimate the probability of a gastric second primary cancer being diagnosed 10 years after any other first primary cancer. METHOD: A cohort of first primary cancers (other than gastric) diagnosed in Northern Portugal between 2000 and 2006 (n=64,648) was followed until 31/12/2012 for gastric second primary cancers. Incidence rates, standardized incidence ratios and the cumulative incidence of gastric second primary cancers were calculated. RESULTS: Overall, 330 patients developed gastric second primary cancers (21.2% within two months). The incidence rate of gastric second primary cancers was higher within two months of the first primary cancer (standardized incidence ratios: 5.20 in males and 7.89 in females), particularly among survivors of cancers of the oesophagus, colon and rectum, than in the remaining period (standardized incidence ratios: 0.64 in males and 0.74 in females). The 10-year risk of a gastric second primary cancer was 0.6% (males: 0.7%; females: 0.4%). CONCLUSION: The incidence rate of gastric second primary cancers among cancer survivors was higher than in the general population only soon after the first primary cancer, and lower thereafter. Despite the high mortality, the probability of a gastric second primary cancer within 10-years of the first primary cancer was 0.6%.

7.
Ecancermedicalscience ; 12: 855, 2018.
Artículo en Inglés | MEDLINE | ID: mdl-30093917

RESUMEN

Background: Oral cancer represents a serious public health problem worldwide. Our aim was to analyse the survival probabilities and trends of patients presenting with lip, oral cavity and oropharynx cancers, who were residents in the north of Portugal. Methods: Using cancer-registry data, we conducted a population-based study of lip, oral cavity and oropharynx cancers diagnosed in the period 2000-2009, among residents in the north of Portugal. Net survival was estimated using the Pohar-Perme estimator. Excess hazard ratios (for gender, age group, tumour location, stage, residence area and period of diagnosis) were estimated using flexible parametric models. Results: A total of 2,947 cases (79.5% males) were included of which 18.5% were located on the lip, 56.2% in the oral cavity and 25.3% in the oropharynx. A large proportion of patients were diagnosed in stages III and IV (18.6% and 48.7%, respectively). The 5-year net survival (5yr-NS) for all three cancer sites together was 46% (95%CI 44-48), being 88% (95%CI 83-94), 41% (95%CI 38-43) and 27% (95%CI 23-30) for lip, oral cavity and oropharynx cancer, respectively. The 5yr-NS stratified by tumour stage was 84% (95%CI 78-90) for stage I, 69% (95%CI 63-76) for stage II, 42% (95%CI 37-47) for stage III and 19% (95%CI 16-21) for stage IV. When comparing the periods 2000-4 and 2005-9, no overall improvements in survival were observed. However, when analysed by stage, a significant reduction in the adjusted excess mortality was observed for stages II (p = 0.021) and III (p < 0.001). Conclusion: More than half of the oral cavity and oropharynx cancers were diagnosed in advanced stages of the disease, having a low survival probability. Improvements in survival in the first decade of this century were limited to stages II and III, which were the result of changes in hospital cancer care practices.

8.
Eur J Cancer Prev ; 27(3): 213-220, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29324583

RESUMEN

Variations in the exposure to risk factors may be used to explain past cancer trends and to predict its future burden. This study aimed to develop a model to describe and predict the variation of esophageal cancer incidence in 1995-2005, taking into account changes in exposures to risk factors. We adapted an existing model to calculate the expected variation in the number of esophageal cancer cases, between 1995 and 2005, in Australia, Japan, Italy, Portugal, the UK, and the USA, because of changes in exposures to risk factors, taking into account the corresponding lag times. Analyses were based on country-specific data of cancer incidence and exposures to risk factors. We computed 95% credibility intervals through Monte Carlo simulation methods. Absolute deviations between the number of cases predicted and those observed in 2005 ranged between 1.8% in Japan and 23.6% in the UK among men and 0.0% in Japan and 18.0% in Australia among women. In Italy and Japan, deviations did not exceed 3%. The UK registered the worst model performance. The variation in esophageal cancer incidence was mainly influenced by changes in fruit and red meat intake, and BMI. For nearly half of the sex-specific and histological type-specific predictions performed, credibility intervals included the observed number of cases. This study proposes a framework for the analysis of the contribution of changes in exposure to different factors to esophageal cancer incidence trends and for long-term predictions at a population level.


Asunto(s)
Dieta/efectos adversos , Neoplasias Esofágicas/diagnóstico , Neoplasias Esofágicas/epidemiología , Método de Montecarlo , Adolescente , Adulto , Anciano , Australia/epidemiología , Índice de Masa Corporal , Dieta/tendencias , Neoplasias Esofágicas/prevención & control , Femenino , Humanos , Incidencia , Italia/epidemiología , Japón/epidemiología , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Valor Predictivo de las Pruebas , Sistema de Registros , Factores de Riesgo , Reino Unido/epidemiología , Estados Unidos/epidemiología , Adulto Joven
9.
Clin Colorectal Cancer ; 17(1): e129-e142, 2018 03.
Artículo en Inglés | MEDLINE | ID: mdl-29074354

RESUMEN

BACKGROUND: Neoadjuvant therapy improves survival of patients with clinical stage II and III rectal cancer in clinical trials. In this study, we investigated the administration of neoadjuvant radiotherapy (neo-RT) and neoadjuvant chemoradiotherapy (neo-CRT) and its association with survival in resected patients in 2 European countries (The Netherlands and Sweden) and at 3 specialist centers. MATERIALS AND METHODS: Administration of neoadjuvant treatment (all registries) and overall survival after surgery in The Netherlands and Sweden were assessed. Hazard ratios (HRs) were obtained using Cox regression adjusted for potential confounders. RESULTS: A total of 16,095 rectal cancer patients with clinical stage II and III were eligible for analyses. Large variations in administration of neo-RT and neo-CRT were observed. Elderly patients less often received neo-RT and neo-CRT. Patients with stage III disease received neo-CRT more frequently than neo-RT. Administration of neo-RT versus surgery without neoadjuvant treatment was significantly associated with improved survival in The Netherlands (HR, 0.62; 95% confidence interval [CI], 0.53-0.73) as well as in Sweden (HR, 0.79; 95% CI, 0.69-0.90). Administration of neo-CRT was associated with enhanced survival in The Netherlands (HR, 0.62; 95% CI, 0.50-0.78) but not in Sweden (HR, 0.97; 95% CI, 0.80-1.18). The mortality of patients treated with neo-CRT compared with neo-RT showed inconsistent results in population-based centers. CONCLUSIONS: Our results support an association of neo-RT with enhanced survival among stage II and III rectal cancer patients. Comparing neo-CRT with neo-RT, larger variations and inconsistent results with respect to survival were observed across centers.


Asunto(s)
Quimioradioterapia Adyuvante/métodos , Terapia Neoadyuvante/métodos , Neoplasias del Recto/terapia , Adulto , Anciano , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Neoplasias del Recto/mortalidad , Sistema de Registros , Resultado del Tratamiento
11.
Cancer Epidemiol ; 50(Pt A): 85-91, 2017 10.
Artículo en Inglés | MEDLINE | ID: mdl-28843176

RESUMEN

BACKGROUND: The growing number of incident cases of gastric cancer along with improved survival result in a rising population of survivors at risk of second primary cancers (SPC). We estimated the cumulative incidence of metachronous (diagnosed >2months after first primary cancer [FPC]) SPC in gastric FPC patients and compared the incidence of metachronous SPC with that expected in the general population. METHODS: A cohort of gastric FPC patients from the North Region Cancer Registry of Portugal, diagnosed in 2000-2006 (n=7427) was followed to 31 December 2010 for synchronous and metachronous SPCs. Cumulative incidence of metachronous SPCs taking into account death as a competing event and standardized incidence ratios (SIR) of metachronous SPCs were estimated. RESULTS: Overall, 331 (4.5%) patients developed an SPC (26.9% synchronous and 73.1% metachronous). Over half of the SPCs occurred in digestive organs. Among men, the most frequent were colon, prostate, and trachea, bronchus and lung; in women, colon, breast and thyroid were the most common. The 10-year cumulative incidence of metachronous SPC for males was 5.7% and for females 3.5%. The SIR for all cancers was 1.30 in males and 1.20 in females. Among both sexes, significantly higher SIRs were observed for cancers of the oesophagus (males: 4.99; females: 8.03), small intestine (males: 11.04; females: 13.09) and colon (males: 2.42; females: 2.58). CONCLUSIONS: Patients with a gastric FPC were found to be at increased risk of developing SPC, mainly in digestive organs, when compared to the general population. Close surveillance of these patients may allow early detection of SPC.


Asunto(s)
Neoplasias Primarias Secundarias/epidemiología , Neoplasias Gástricas/epidemiología , Anciano , Supervivientes de Cáncer , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Sistema de Registros , Factores de Riesgo
12.
Eur J Cancer Prev ; 26 Joining forces for better cancer registration in Europe: S170-S175, 2017 09.
Artículo en Inglés | MEDLINE | ID: mdl-28590274

RESUMEN

The aim of this study was to evaluate net survival from cancer diagnosed during the period 2001-2010 in the north region of Portugal to identify the tumours that need actions to improve the outcomes. Data were retrieved from the North Region Cancer Registry of Portugal database. The top 20 cancer sites in adults were considered: oesophagus, stomach, colon, rectum, pancreas, liver, larynx, lung, skin melanoma, breast, cervix, corpus uteri, ovary, prostate, kidney, bladder, brain and central nervous system, thyroid, non-Hodgkin lymphoma and multiple myeloma. Net survival was estimated using the Pohar-Perme estimator. The effect of diagnosis period was evaluated using flexible parametric models adjusted for age and sex where appropriate. Thyroid and prostate cancers presented the best 5-year survival (>90%), whereas oesophagus, pancreas, liver and lung cancers the worst 5-year survival (<20%). The largest increase in survival was observed for the larynx. A significant decrease in age-adjusted and sex-adjusted excess mortality was observed for stomach, colon, pancreas, larynx, melanoma, breast, brain and central nervous system, thyroid, non-Hodgkin lymphoma and multiple myeloma. For the other cancer sites, no significant trends were observed. For some of these sites, the downward trend in excess mortality was only observed in the short term. An important picture of population-based cancer survival outcomes for the first decade of the millennium in the north region of Portugal was presented in this study. It has been shown that improvements in survival were not universal for all cancer sites. These results should be used to highlight tumours where intervention is needed the most.


Asunto(s)
Bases de Datos Factuales/estadística & datos numéricos , Neoplasias/mortalidad , Sistema de Registros/estadística & datos numéricos , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Neoplasias/diagnóstico , Portugal/epidemiología , Tasa de Supervivencia/tendencias
13.
Mol Cancer ; 16(1): 26, 2017 01 31.
Artículo en Inglés | MEDLINE | ID: mdl-28143614

RESUMEN

BACKGROUND: Contemporary challenges of prostate cancer (PCa) include overdiagnosis and overtreatment, entailing the need for novel clinical tools to improve risk stratification and therapy selection. PCa diagnosis and prognostication might be perfected using epigenetic biomarkers, among which aberrant DNA methylation of microRNA promoters has not been systematically explored. Herein, we identified aberrantly methylated microRNAs promoters in PCa and assessed its diagnostic and prognostic biomarker potential. METHODS: Using HumanMethylation450 BeadChip-based analysis differentially methylated CpGs in microRNA promoters were identified. Promoter methylation of six microRNAs (miR-34b/c, miR-129-2, miR-152, miR-193b, miR-663a and miR-1258) was analyzed by qMSP in three sets (180 prostatectomies, 95 urine sediments and 74 prostate biopsies). Biomarkers' diagnostic (validity estimates) and prognostic [disease-free (DFS) and disease-specific survival (DSS)] performance was assessed. RESULTS: Significantly higher promoter methylation levels in PCa were confirmed for six candidate microRNAs. Except for miR-152, all displayed AUC values higher than 0.90, with miR-1258 and miR-193b disclosing the best performance (AUC = 0.99 and AUC = 0.96, respectively). In urine samples, miR-193b showed the best performance (91.6% sensitivity, 95.7% specificity, AUC = 0.96). Moreover, higher miR-129-2 independently predicted for shorter DSS and miR-34b/c methylation levels independently predicted for shorter DFS and DSS. CONCLUSIONS: Quantitative miR-193b, miR-129-2 and miR-34b/c promoter methylation might be clinically useful PCa biomarkers for non-invasive detection/diagnosis and prognostication, both in tissue and urine samples.


Asunto(s)
Metilación de ADN , MicroARNs/genética , MicroARNs/orina , Neoplasias de la Próstata/clasificación , Anciano , Anciano de 80 o más Años , Biomarcadores de Tumor/genética , Islas de CpG , Supervivencia sin Enfermedad , Humanos , Masculino , Persona de Mediana Edad , Análisis de Secuencia por Matrices de Oligonucleótidos , Pronóstico , Regiones Promotoras Genéticas , Neoplasias de la Próstata/genética , Neoplasias de la Próstata/orina , Análisis de Supervivencia
14.
Tumori ; 103(2): 155-163, 2017 Mar 24.
Artículo en Inglés | MEDLINE | ID: mdl-27647232

RESUMEN

INTRODUCTION: Gastric cancer (GC) and esophageal cancer (EC) share risk factors, and the incidence trends reflect differences in etiology according to their subtypes. We aimed to describe the incidence trends of GC (by topography) and EC (by histological type) in northern Portugal for 1994-2009 and to estimate the incidence for 2015. We further analyzed exposure to the main risk factors for these cancers in the region over the last decades. METHODS: GC and EC data were obtained from the North Region Cancer Registry of Portugal (RORENO). Joinpoint regression was used to compute annual percent changes (APC) in incidence trends. Poisson regression yielded estimates for 2015. A literature review up to 2014 provided data on exposure to risk factors. RESULTS: GC rates decreased in 1994-2009 (men, APC = -1.3; women, APC = -1.6); GC, unspecified subtype, had the steepest decline since the early 2000s (men, APC = -4.9; women, APC = -6.3). The incidence for 2015 will increase for EC in men (up to ≈190 cases) and stabilize in women (≈30) and for GC (≈730 men, ≈500 women). Increasing prevalence of tobacco smoking among women and overweight/obesity, fairly stable prevalence of alcohol, fruit and vegetable consumption, and no trend for Helicobacter pylori infection were observed. CONCLUSIONS: The declining incidence of GC unspecified subtype indicated an improvement in cancer registration accuracy, but precluded a sound assessment of trends by subtype. Variations in the prevalence of exposure to some risk factors were consistent with observed incidence trends, and future studies should aim to quantify their contribution to the GC and EC burden in the region.


Asunto(s)
Neoplasias Esofágicas/epidemiología , Neoplasias Esofágicas/etiología , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/etiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Sistema de Registros , Factores de Riesgo , Adulto Joven
15.
BMC Cancer ; 16: 608, 2016 08 05.
Artículo en Inglés | MEDLINE | ID: mdl-27495309

RESUMEN

BACKGROUND: Association between cancer survival and socioeconomic status has been reported in various countries but it has never been studied in Portugal. We aimed here to study the role of education and socioeconomic deprivation level on survival from colorectal cancer in the North Region of Portugal using a population-based cancer registry dataset. METHODS: We analysed a cohort of patients aged 15-84 years, diagnosed with a colorectal cancer in the North Region of Portugal between 2000 and 2002. Education and socioeconomic deprivation level was assigned to each patient based on their area of residence. We measured socioeconomic deprivation using the recently developed European Deprivation Index. Net survival was estimated using Pohar-Perme estimator and age-adjusted excess hazard ratios were estimated using parametric flexible models. Since no deprivation-specific life tables were available, we performed a sensitivity analysis to test the robustness of the results to life tables adjusted for education and socioeconomic deprivation level. RESULTS: A total of 4,105 cases were included in the analysis. In male patients (56.3 %), a pattern of worse 5- and 10-year net survival in the less educated (survival gap between extreme education groups: -7 % and -10 % at 5 and 10 years, respectively) and more deprived groups (survival gap between extreme EDI groups: -5 % both at 5 and 10 years) was observed when using general life tables. No such clear pattern was found among female patients. In both sexes, when likely differences in background mortality by education or deprivation were accounted for in the sensitivity analysis, any differences in net survival between education or deprivation groups vanished. CONCLUSIONS: Our study shows that observed differences in survival by education and EDI level are most likely attributable to inequalities in background survival. Also, it confirms the importance of using the relevant life tables and of performing sensitivity analysis when evaluating socioeconomic inequalities in cancer survival. Comparison studies of different healthcare systems organization should be performed to better understand its influence on cancer survival inequalities.


Asunto(s)
Neoplasias Colorrectales/mortalidad , Disparidades en Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Escolaridad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Clase Social , Adulto Joven
16.
Medicine (Baltimore) ; 95(22): e3812, 2016 May.
Artículo en Inglés | MEDLINE | ID: mdl-27258522

RESUMEN

Minimally invasive surgery (MIS) of colorectal cancer (CRC) was first introduced over 20 years ago and recently has gained increasing acceptance and usage beyond clinical trials. However, data on dissemination of the method across countries and on long-term outcomes are still sparse.In the context of a European collaborative study, a total of 112,023 CRC cases from 3 population-based (N = 109,695) and 4 institute-based clinical cancer registries (N = 2328) were studied and compared on the utilization of MIS versus open surgery. Cox regression models were applied to study associations between surgery type and survival of patients from the population-based registries. The study considered adjustment for potential confounders.The percentage of CRC patients undergoing MIS differed substantially between centers and generally increased over time. MIS was significantly less often used in stage II to IV colon cancer compared with stage I in most centers. MIS tended to be less often used in older (70+) than in younger colon cancer patients. MIS tended to be more often used in women than in men with rectal cancer. MIS was associated with significantly reduced mortality among colon cancer patients in the Netherlands (hazard ratio [HR] 0.66, 95% confidence interval [CI] (0.63-0.69), Sweden (HR 0.68, 95% CI 0.60-0.76), and Norway (HR 0.73, 95% CI 0.67-0.79). Likewise, MIS was associated with reduced mortality of rectal cancer patients in the Netherlands (HR 0.74, 95% CI 0.68-0.80) and Sweden (HR 0.77, 95% CI 0.66-0.90).Utilization of MIS in CRC resection is increasing, but large variation between European countries and clinical centers prevails. Our results support association of MIS with substantially enhanced survival among colon cancer patients. Further studies controlling for selection bias and residual confounding are needed to establish role of MIS in survival of patients.


Asunto(s)
Colectomía/métodos , Neoplasias del Colon/cirugía , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Neoplasias del Recto/cirugía , Factores de Edad , Anciano , Anciano de 80 o más Años , Neoplasias del Colon/mortalidad , Europa (Continente) , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Modelos de Riesgos Proporcionales , Neoplasias del Recto/mortalidad , Sistema de Registros , Factores Sexuales , Resultado del Tratamiento
17.
Eur J Cancer Prev ; 25(5): 472-80, 2016 09.
Artículo en Inglés | MEDLINE | ID: mdl-26317384

RESUMEN

Decision making towards cancer prevention and control requires monitoring of trends in cancer incidence and accurate estimation of its burden in different settings. We aimed to estimate the number of incident cases in northern Portugal for 2015 and 2020 (all cancers except nonmelanoma skin and for the 15 most frequent tumours). Cancer cases diagnosed in 1994-2009 were collected by the North Region Cancer Registry of Portugal (RORENO) and corresponding population figures were obtained from Statistics Portugal. JoinPoint regression was used to analyse incidence trends. Population projections until 2020 were derived by RORENO. Predictions were performed using the Poisson regression models proposed by Dyba and Hakulinen. The number of incident cases is expected to increase by 18.7% in 2015 and by 37.6% in 2020, with lower increments among men than among women. For most cancers considered, the number of cases will keep rising up to 2020, although decreasing trends of age-standardized rates are expected for some tumours. Cervix was the only cancer with a decreasing number of incident cases in the entire period. Thyroid and lung cancers were among those with the steepest increases in the number of incident cases expected for 2020, especially among women. In 2020, the top five cancers are expected to account for 82 and 62% of all cases diagnosed in men and women, respectively. This study contributes to a broader understanding of cancer burden in the north of Portugal and provides the basis for keeping population-based incidence estimates up to date.


Asunto(s)
Neoplasias/epidemiología , Sistema de Registros/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Pronóstico , Adulto Joven
18.
J Cancer Surviv ; 10(1): 142-52, 2016 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-26159159

RESUMEN

PURPOSE: Longitudinal studies are needed to characterise the burden of second primary malignancies among cancer survivors. Therefore, we quantified the incidence rate and cumulative incidence of second primary cancers (SPC) and standardised incidence ratios (SIR) in a population-based cohort of subjects diagnosed with a first primary cancer (FPC). METHODS: We evaluated a cohort of cancer patients from the Portuguese North Region Cancer Registry (RORENO), with the first diagnosis in 2000-2003 (n = 39451), to estimate the incidence rate and cumulative incidence of SPC and standardised incidence ratios (SIR), for different periods of follow-up, up to 5 years; SPC were defined according to the International Association of Cancer Registries and the International Agency for Research on Cancer guidelines. RESULTS: The incidence rate of SPC was more than 5-fold higher in the first 2 months of follow-up than in the period between 2 months and 5 years (metachronous SPC), across which the incidence rates were relatively stable. Cancer survivors had an overall higher incidence rate of cancer than the general population (SIR = 1.31 (95 % confidence interval (CI), 1.25-1.38)), although that difference faded when only metachronous SPC were considered (SIR = 1.02 (95 % CI, 0.96-1.08)). Cancer incidence rates were higher among female lung FPC survivors and lower in prostate FPC cancer survivors than in the general population. The 5-year cumulative risk of developing a metachronous SPC was 3.0 % and reached nearly 5.0 % among patients with FPC associated with lower risk of death. CONCLUSIONS: Cancer survivors had higher incident rates of cancer that the general population, especially due to diagnoses in the first months following the FPC. Nevertheless, after this period SPC remain frequent events among cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS: SPC constitute an important dimension of the burden of cancer survivorship, and this needs to be taken into account when defining strategies for surveillance, prevention and counselling.


Asunto(s)
Neoplasias Primarias Secundarias/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Lactante , Recién Nacido , Neoplasias Pulmonares/epidemiología , Masculino , Persona de Mediana Edad , Portugal/epidemiología , Neoplasias de la Próstata/epidemiología , Sobrevivientes/estadística & datos numéricos , Adulto Joven
19.
Cancer Epidemiol ; 39(5): 783-9, 2015 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-26315486

RESUMEN

OBJECTIVE: To evaluate the first 10 years of operation of the population-based breast cancer screening programme implemented in the Northern Region of Portugal, using selected recommended standard performance indicators. METHODS: Data from women aged 50-69 screened with two-view mammography, biennially, in the period 2000-2009, were included. Main performance indicators were compared with the recommended levels of the European Guidelines. RESULTS: A total of 202,039 screening examinations were performed, 71,731 (35.5%) in the initial screening and 130,308 (64.5%) in the subsequent screening. Coverage rate by examination reached 74.3% of the target population, in the last period evaluated. Recall rates were 8.1% and 2.4% and cancer detection rates were 4.4/1000 and 2.9/1000 respectively, for initial and subsequent screenings. The breast cancer detection rate, expressed as a multiple of the background expected incidence was 3.1 in initial screen and 2.2 in subsequent screen. The incidence of invasive interval cancers met the desirable recommended levels both the first and second years since last screening examination, in the initial and subsequent screenings. Invasive tumours <15mm were 50.4% and 53.8% of the invasive cancers detected in initial and subsequent screenings. Less favourable size, grading and biomarkers expression were found in interval cancers compared to screen-detected cancers. CONCLUSIONS: Breast cancer screening programme in the Northern Region of Portugal was well accepted by the population. Most of the performance indicators were consistent with the desirable levels of the European Guidelines, which indicate an effective screening programme. Future research should verify the consistency of some of these results by using updated information from a larger population.


Asunto(s)
Neoplasias de la Mama/diagnóstico por imagen , Detección Precóz del Cáncer , Mamografía , Aceptación de la Atención de Salud/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Anciano , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/patología , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Incidencia , Mamografía/métodos , Mamografía/estadística & datos numéricos , Tamizaje Masivo/métodos , Persona de Mediana Edad , Portugal/epidemiología , Evaluación de Programas y Proyectos de Salud
20.
PLoS One ; 10(7): e0132728, 2015.
Artículo en Inglés | MEDLINE | ID: mdl-26176944

RESUMEN

The HOXB13 germline variant G84E (rs138213197) was recently described in men of European descent, with the highest prevalence in Northern Europe. The G84E mutation has not been found in patients of African or Asian ancestry, which may carry other HOXB13 variants, indicating allelic heterogeneity depending on the population. In order to gain insight into the full scope of coding HOXB13 mutations in Portuguese prostate cancer patients, we decided to sequence the entire coding region of the HOXB13 gene in 462 early-onset or familial/hereditary cases. Additionally, we searched for somatic HOXB13 mutations in 178 prostate carcinomas to evaluate their prevalence in prostate carcinogenesis. Three different patients were found to carry in their germline DNA two novel missense variants, which were not identified in 132 control subjects. Both variants are predicted to be deleterious by different in silico tools. No somatic mutations were found. These findings further support the hypothesis that different rare HOXB13 mutations may be found in different ethnic groups. Detection of mutations predisposing to prostate cancer may require re-sequencing rather than genotyping, as appropriate to the population under investigation.


Asunto(s)
Adenocarcinoma/genética , Mutación de Línea Germinal , Proteínas de Homeodominio/genética , Neoplasias de la Próstata/genética , Adenocarcinoma/epidemiología , Adulto , Anciano , Secuencia de Aminoácidos , Secuencia de Bases , Estudios de Casos y Controles , Análisis Mutacional de ADN , Frecuencia de los Genes , Predisposición Genética a la Enfermedad , Genotipo , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Linaje , Portugal , Prevalencia , Neoplasias de la Próstata/epidemiología , Factores de Riesgo
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