Socioeconomic, Clinical, and Molecular Features of Breast Cancer Influence Overall Survival of Latin American Women.

Molecular profile of breast cancer in Latin-American women was studied in five countries: Argentina, Brazil, Chile, Mexico, and Uruguay. Data about socioeconomic characteristics, risk factors, prognostic factors, and molecular subtypes were described, and the 60-month overall cumulative survival probabilities (OS) were estimated. From 2011 to 2013, 1,300 eligible Latin-American women 18 years or older, with a diagnosis of breast cancer in clinical stage II or III, and performance status ≦̸1 were invited to participate in a prospective cohort study. Face-to-face interviews were conducted, and clinical and outcome data, including death, were extracted from medical records. Unadjusted associations were evaluated by Chi-squared and Fisher's exact tests and the OS by Kaplan-Meier method. Log-rank test was used to determine differences between cumulative probability curves. Multivariable adjustment was carried out by entering potential confounders in the Cox regression model. The OS at 60 months was 83.9%. Multivariable-adjusted death hazard differences were found for women living in Argentina (2.27), Chile (1.95), and Uruguay (2.42) compared with Mexican women, for older (≥60 years) (1.84) compared with younger (≤40 years) women, for basal-like subtype (5.8), luminal B (2.43), and HER2-enriched (2.52) compared with luminal A subtype, and for tumor clinical stages IIB (1.91), IIIA (3.54), and IIIB (3.94) compared with stage IIA women. OS was associated with country of residence, PAM50 intrinsic subtype, age, and tumor stage at diagnosis. While the latter is known to be influenced by access to care, including cancer screening, timely diagnosis and treatment, including access to more effective treatment protocols, it may also influence epigenetic changes that, potentially, impact molecular subtypes. Data derived from heretofore understudied populations with unique geographic ancestry and sociocultural experiences are critical to furthering our understanding of this complexity.

Occupational socioeconomic risk associations for head and neck cancer in Europe and South America: individual participant data analysis of pooled case-control studies within the INHANCE Consortium.

BACKGROUND: The association between socioeconomic disadvantage (low education and/or income) and head and neck cancer is well established, with smoking and alcohol consumption explaining up to three-quarters of the risk. We aimed to investigate the nature of and explanations for head and neck cancer risk associated with occupational socioeconomic prestige (a perceptual measure of psychosocial status), occupational socioeconomic position and manual-work experience, and to assess the potential explanatory role of occupational exposures. METHODS: Pooled analysis included 5818 patients with head and neck cancer (and 7326 control participants) from five studies in Europe and South America. Lifetime job histories were coded to: (1) occupational social prestige-Treiman's Standard International Occupational Prestige Scale (SIOPS); (2) occupational socioeconomic position-International Socio-Economic Index (ISEI); and (3) manual/non-manual jobs. RESULTS: For the longest held job, adjusting for smoking, alcohol and nature of occupation, increased head and neck cancer risk estimates were observed for low SIOPS OR=1.88 (95% CI: 1.64 to 2.17), low ISEI OR=1.74 (95% CI: 1.51 to 1.99) and manual occupations OR=1.49 (95% CI: 1.35 to 1.64). Following mutual adjustment by socioeconomic exposures, risk associated with low SIOPS remained OR=1.59 (95% CI: 1.30 to 1.94). CONCLUSIONS: These findings indicate that low occupational socioeconomic prestige, position and manual work are associated with head and neck cancer, and such risks are only partly explained by smoking, alcohol and occupational exposures. Perceptual occupational psychosocial status (SIOPS) appears to be the strongest socioeconomic factor, relative to socioeconomic position and manual/non-manual work.

Predictors of Survival After Head and Neck Squamous Cell Carcinoma in South America: The InterCHANGE Study.

PURPOSE: Head and neck squamous cell carcinoma (HNSCC) incidence is high in South America, where recent data on survival are sparse. We investigated the main predictors of HNSCC survival in Brazil, Argentina, Uruguay, and Colombia. METHODS: Sociodemographic and lifestyle information was obtained from standardized interviews, and clinicopathologic data were extracted from medical records and pathologic reports. The Kaplan-Meier method and Cox regression were used for statistical analyses. RESULTS: Of 1,463 patients, 378 had a larynx cancer (LC), 78 hypopharynx cancer (HC), 599 oral cavity cancer (OC), and 408 oropharynx cancer (OPC). Most patients (55.5%) were diagnosed with stage IV disease, ranging from 47.6% for LC to 70.8% for OPC. Three-year survival rates were 56.0% for LC, 54.7% for OC, 48.0% for OPC, and 37.8% for HC. In multivariable models, patients with stage IV disease had approximately 7.6 (LC/HC), 11.7 (OC), and 3.5 (OPC) times higher mortality than patients with stage I disease. Current and former drinkers with LC or HC had approximately 2 times higher mortality than never-drinkers. In addition, older age at diagnosis was independently associated with worse survival for all sites. In a subset analysis of 198 patients with OPC with available human papillomavirus (HPV) type 16 data, those with HPV-unrelated OPC had a significantly worse 3-year survival compared with those with HPV-related OPC (44.6% v 75.6%, respectively), corresponding to a 3.4 times higher mortality. CONCLUSION: Late stage at diagnosis was the strongest predictor of lower HNSCC survival. Early cancer detection and reduction of harmful alcohol use are fundamental to decrease the high burden of HNSCC in South America.

Circulating 92-kilodalton matrix metalloproteinase (MMP-9) activity is enhanced in the euglobulin plasma fraction of head and neck squamous cell carcinoma.

BACKGROUND: Cancer lethality is usually the result of local invasion and metastasis of neoplastic cells from the primary tumor. Because of their ability to degrade extracellular matrix components (EMC), matrix metalloproteinases (MMPs) have been implicated in the breakdown of basement membranes and underlying stroma, thereby facilitating tumor growth and invasion. METHODS: The authors quantitated, by gelatin zymography and densitometric analysis, MMP activity in the euglobulin plasma fraction of 50 healthy controls and 91 head and neck squamous cell carcinoma (HNSCC) patients (51 from the larynx and 40 from the oropharynx). RESULTS: The median value for 92-kilodalton (kD) MMP (MMP-9) activity was increased significantly in laryngeal (Md 2.1 arbitrary units (AU)/mL plasma; range, 0.2-6.4) and oropharyngeal patients (Md 2.08 AU/mL; range, 0.0-5.0) with respect to the controls (Md 0.48 AU/mL; range, 0.0-1.8). Both groups of cancer patients showed a similar behavior. Multivariate analysis indicated that circulating 92-kD MMP activity was not predicted by the clinical-pathologic parameters such as tumor stage, histologic grade, and metastatic lymph nodes. There was no association between high levels of MMP-9 activity and either cigarette smoking or alcohol consumption, major risk factors for developing HNSCC. CONCLUSIONS: The authors found a significant increase of MMP-9 plasma activity both in laryngeal and oropharyngeal squamous cell carcinoma patients as compared with healthy controls. Further studies are necessary to establish its usefulness in the clinical management of these patients.

Environmental and occupational cancer in Argentina; a case-control lung cancer study

Analiza los riesgos para cáncer de pulmón asociados con exposiciones ocupacionales, en un país en vías de desarrollo donde el cáncer de pulmón es la primera causa de mortalidad por cáncer en hombres. Incluyó 200 hombres con esta patología y 397 controles hospitalarios. El OR para fumadores actuales fue 8,5, mientras que los ex-fumadores mostraron un OR de 5,3. La fracción atribuible al hábito de fumar fue de 85 por ciento. Se observaron riesgos estadísticamente significativos para: empleo en la industria de bebidas alcohólicas (4,5, 95 por ciento CI:1,02-20,2), aserradores (4,6, 95 por ciento CI:1,1-18,4), industrias químicas, plásticos (1,8 95 por ciento CI:1,04-3,2), cerámica, loza, vidrio o productos minerales no metálicos (3,4, 95 por ciento CI:1,1-10,6). Otros riesgos elevados, pero sin significación estadística, fueron encontrados para la industtria y el trabajo en la reparación del calzado de cuero (2,1, 95 por ciento CI:0,8-5,4), la industria de la goma (3,4, 95 por ciento CI:0,9-12,4), el grupo de metalúrgicos que incluye los soldadores (1,9, 95 por ciento CI:0,8-4,4), los mecánicos de automotores (2,0, 95 por ciento CI:0,9-4,2), los trabajadores en servicios de limpieza (1,9, 95 por ciento CI:0,8-4,5) y los trabajadores agrícolas (2,4, 95 por ciento CI:0,9-6,0). Si bien algunos de los presentes resultados pueden ser debidos al azar, la mayoría son consistentes con los obtenidos en investigaciones previas en otros países.

Incidencia de cáncer infantil en las provincias de Tucumán y Jujuy (1985-1994) / Childhood cancer incidence in Tucuman and Jujuy provinces (1985-1994)

Introducción: Presentamos datos de la incidencia de cáncer pediátrico en las provincias de Tucumán y Jujuy en 1985-1994. El Registro ce Cáncer Pediátrido de Tucumán, establecido en el Hospital del Niño Jesús, tiene información de todos los casos de la provincia desde 1980 y, en Jujuy, existe un registro de todos los tumores infantiles desde 1983 en el Hospital de Niños de San Salvador de Jujuy. Métodos: Las fuentes de información incluyeron establecimientos públicos y privados. Para codificar el sitio y la histología usamos la Clasificación Internacional de Enfermedades para Oncología. Resultados: En Tucumán se registraron 273 pacientes. Para ambos sexos, la tasa ajustada de incidencia anual para todos los sitios, por millón, fue de 81,6 para los varones y de 60,2 para las mujeres. Las tasas para los diversos grupos fueron: leucemias 29,2 (linfocítica aguda 23,3); linfomas 14,3 (Hodgkin 2,7 y no Hodgkin 7,2); sistema nervioso central (SNC) 4,0; sistema nervioso (SN) simpático 2,8; retinoblastoma 3,4; tumores renales 5,4; hígado 1,1; tumores óseos 2,0; sarcoma tejidos blandos 5,0; tumores de células germinales y gonadales 2,6; neoplasmas epiteliales 0,2 y otros 1,1. En Jujuy, en el mismo período se registraron 136 pacientes. La incidencia anual para todos los sitios, por millón, fue 68,5 para los varones y 70,1 para las mujeres. Las tasas fueron: leucemias 33,4 (linfocíticas aguda 27,7); linfomas 7,1 (Hodgkin 3,9 y no Hodgkin 2,2); SNC 8,2; SN simpático 4,4; retinoblastoma 3,3; tumores renales 3,8; hígado 0,6; tumores óseos 2,5; sarcoma tejidos blandos 2,9; tumores de células germinales y gonadales 2,1 y neoplasmas epiteliales 0,9. Conclusiones: En ambas provincias las tasa de incidencia de linfomas, tumores del SNC y neuroblastoma fueron bajas. El registro durante un período más prolongado permitirá confirmar estos resultados

Incidencia de cáncer infantil en las provincias de Tucumán y Jujuy (1985-1994) / Childhood cancer incidence in Tucuman and Jujuy provinces (1985-1994)

Introducción: Presentamos datos de la incidencia de cáncer pediátrico en las provincias de Tucumán y Jujuy en 1985-1994. El Registro ce Cáncer Pediátrido de Tucumán, establecido en el Hospital del Niño Jesús, tiene información de todos los casos de la provincia desde 1980 y, en Jujuy, existe un registro de todos los tumores infantiles desde 1983 en el Hospital de Niños de San Salvador de Jujuy. Métodos: Las fuentes de información incluyeron establecimientos públicos y privados. Para codificar el sitio y la histología usamos la Clasificación Internacional de Enfermedades para Oncología. Resultados: En Tucumán se registraron 273 pacientes. Para ambos sexos, la tasa ajustada de incidencia anual para todos los sitios, por millón, fue de 81,6 para los varones y de 60,2 para las mujeres. Las tasas para los diversos grupos fueron: leucemias 29,2 (linfocítica aguda 23,3); linfomas 14,3 (Hodgkin 2,7 y no Hodgkin 7,2); sistema nervioso central (SNC) 4,0; sistema nervioso (SN) simpático 2,8; retinoblastoma 3,4; tumores renales 5,4; hígado 1,1; tumores óseos 2,0; sarcoma tejidos blandos 5,0; tumores de células germinales y gonadales 2,6; neoplasmas epiteliales 0,2 y otros 1,1. En Jujuy, en el mismo período se registraron 136 pacientes. La incidencia anual para todos los sitios, por millón, fue 68,5 para los varones y 70,1 para las mujeres. Las tasas fueron: leucemias 33,4 (linfocíticas aguda 27,7); linfomas 7,1 (Hodgkin 3,9 y no Hodgkin 2,2); SNC 8,2; SN simpático 4,4; retinoblastoma 3,3; tumores renales 3,8; hígado 0,6; tumores óseos 2,5; sarcoma tejidos blandos 2,9; tumores de células germinales y gonadales 2,1 y neoplasmas epiteliales 0,9. Conclusiones: En ambas provincias las tasa de incidencia de linfomas, tumores del SNC y neuroblastoma fueron bajas. El registro durante un período más prolongado permitirá confirmar estos resultados (AU)