RESUMO

PURPOSE: In Brazil, access to breast cancer screening outside of urban centers is limited. This study aims to describe the coverage and performance of a breast cancer screening program implemented with Mobile Screening Units (MSU) in northern São Paulo state. METHODS: This is a retrospective cohort study of a population-based mammography program targeting women ages 40-69 in 108 municipalities from 12/2010 to 07/2015. Screening coverage rates were estimated using the Brazil 2010 census data. We calculated performance measures for the number of exams, recalls, and detected cases of cancer. Screen-detected cases were compared to clinically detected cases using hospital cancer registry data and a propensity-score matching method. The down-staging of screen-detected cases relative to clinically detected cases was assessed using logistic regression to calculate risk ratios (RRs) with 95% confidence intervals. RESULTS: 122,634 women were screened through the MSU program, representing a cumulative coverage rate of 54.8% in the target population. For initial and subsequent rounds, recall rates were 12.25 and 6.10% and cancer detection rates were 3.63 (95% CI 3.23-4.10) and 1.94 (95% CI 1.59-2.41), respectively. 92.51% of referrals were successful. Screen-detected cases had more favorable prognoses than clinically detected cases, including smaller tumor size and a decreased risk of late-stage detection (RR 0.14 95% CI 0.074-0.25). CONCLUSIONS: MSUs are a feasible method for the delivery of mammography services in this setting. Patients who had breast cancer detected on an MSU had favorable prognostic factors when compared with clinically detected cases arising from the same target population.

Assuntos

Neoplasias da Mama/diagnóstico , Mamografia/métodos , Programas de Rastreamento/métodos , Adulto , Idoso , Brasil , Detecção Precoce de Câncer , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Sistema de Registros , Estudos Retrospectivos

RESUMO

OBJECTIVE: There are currently multiple tests available for cervical cancer screening and the existing screening policies vary from country to country. No single approach will satisfy the specific needs and variations in risk aversion of all populations, and screening algorithms should be tailored to specific groups. We performed long term risk stratification based on screening test results and compared the accuracy of different tests and their combinations. METHODS: A longitudinal cohort study of the natural history of HPV infection and cervical neoplasia enrolled 2462 women from a low-income population in Brazil. The interviews and cervical screening with cytology and HPV DNA testing were repeated according to a pre-established protocol and the subjects were referred for colposcopy and biopsy whenever high grade lesions were suspected. We compared the specificity, sensitivity and predictive values of each screening modality. Long term risk stratification was performed through time-to-event analyses using Kaplan-Meier analysis and Cox regression. RESULTS: The best optimization of sensitivity and specificity was achieved when using dual testing with cytology and HPV DNA testing, whereby the screening test is considered positive if either component yields an abnormal result. However, when allowing 12months for the detection of lesions, cytology alone performed nearly as well. Risk stratification revealed that HPV DNA testing was not beneficial for HSIL cases, whereas it was for ASCUS and, in some combinations, for negative and LSIL cytology. CONCLUSION: Our results suggest that some high risk populations may benefit equally from cytology or HPV DNA testing, and may require shorter intervals between repeat testing.

Assuntos

Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Adolescente , Adulto , Algoritmos , Brasil/epidemiologia , Estudos de Coortes , DNA Viral/análise , DNA Viral/genética , Feminino , Humanos , Estudos Longitudinais , Pessoa de Meia-Idade , Papillomaviridae/genética , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/epidemiologia , Infecções por Papillomavirus/patologia , Infecções por Papillomavirus/virologia , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/patologia , Neoplasias do Colo do Útero/virologia , Adulto Jovem

RESUMO

Interest in coinfection with multiple types of human papillomavirus (HPV) has increased in response to the possibility of vaccination and the discovery that the host immune response appears to be mainly type specific. This study attempts to document the occurrence of coinfection with multiple HPV types and to determine whether these coinfections predicted acquisition or persistence of other HPV types in a prospective cohort of women in Brazil. Multiple HPV types were detected at the same visit in one-fifth of all women who tested positive for HPV at any time. Acquisition of an HPV infection was more likely among women with any HPV type detected on study entry. Persistence of HPV infection, the true precursor of cervical abnormalities, was independent of coinfection with other HPV types. Given the increasing prominence of HPV vaccination as a potential preventive approach, it is imperative that additional insights on cross-type protection be obtained from longer-term longitudinal investigations.

Assuntos

Papillomaviridae/classificação , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/virologia , Infecções Tumorais por Vírus/virologia , Doenças do Colo do Útero/virologia , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , DNA Viral/análise , Feminino , Humanos , Pessoa de Meia-Idade , Papillomaviridae/crescimento & desenvolvimento , Infecções por Papillomavirus/epidemiologia , Valor Preditivo dos Testes , Prevalência , Estudos Prospectivos , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/epidemiologia

RESUMO

OBJECTIVES: We investigated the effects of alcohol consumption on the risk of cancers of the upper aerodigestive tract (UADT) in a hospital-based case-control study in Brazil. METHODS: A total of 784 cases of cancers of the mouth, pharynx, and larynx and 1578 non-cancer controls matched on age, gender, hospital area, and admission period provided information on alcohol drinking, smoking, and other characteristics via interview. Using logistic regression, we evaluated the relative risks (RR) of UADT cancer for different beverage types based on cumulative ethanol content exposure and frequency of consumption. RESULTS: Relative to nondrinkers of any alcohol, risks of UADT cancers varied across sites both with increased exposure to ethanol and by alcohol type. RRs at equivalent levels of ethanol consumption were highest for cancers of the mouth for hard liquor (6.9 for > 100 kg lifetime consumption, 95% confidence interval (CI) = 2.8-17.1) and cachaça (4.5 for 101-500 kg, 95% CI = 2.2-9.0). Although RRs increased with frequency of drinks per week, when evaluated against higher proportional alcohol intake, reductions in risk were observed for beer and wine. CONCLUSION: Although methods of measurement can influence the interpretation of the carcinogenic nature of alcohols, increased RRs persisted with continued exposure for all types.

Assuntos

Consumo de Bebidas Alcoólicas/efeitos adversos , Bebidas Alcoólicas/efeitos adversos , Neoplasias Laríngeas/etiologia , Neoplasias Bucais/etiologia , Neoplasias Faríngeas/etiologia , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Feminino , Humanos , Neoplasias Laríngeas/epidemiologia , Masculino , Neoplasias Bucais/epidemiologia , Razão de Chances , Neoplasias Faríngeas/epidemiologia , Risco , Fatores de Risco , Fumar/efeitos adversos

RESUMO

Infection with high-risk human papillomavirus (HPV) is the major risk factor for the development of malignant lesions in the uterine cervix. Environmental, behavioral, and ill-defined genetic factors also have been implicated in the pathogenesis of this disease. Associations between human leukocyte antigens (HLAs) and cervical cancer, precursor lesions, and HPV infections have been reported in several populations. To verify whether HLA-DRB1, -DQA1, and -DQB1 diversity is related to cervical cancer in the Brazilian population, 161 cases and 257 controls were HLA typed. Variants of DQA1 and DQB1 promoter regions were also typed in 92 cases and 228 controls. Polymorphism in HLA genes and promoters was distinguished by PCR-based methods, and the magnitude of associations was determined by logistic regression analysis. DRB1*15 [confounder-adjusted odds ratio (OR), 2.24; 95% confidence interval (CI), 1.29-3.90], DRB1*1503 (OR, 2.52; 95% CI, 1.16-5.48), and haplotype DRB1*15-DQB1*0602 (OR, 2.04; 95% CI, 1.15-3.61) were positively associated with cervical cancer. When we considered only DR15 haplotypes that did not carry the DQB1*0602 allele, the risk attributed to DRB1*15 more than doubled. A negative association was found between DQB1*05 and cervical cancer (OR, 0.57; 95% CI, 0.35-0.92), and similar trends were observed for DQA1*0101/04, DRB1*0101, and DRB1*1302. HPV positivity among controls was associated with DRB1*1503 (OR, 4.60; 95% CI, 1.33-15.9), DRB1*0405 (OR, 6.21; 95% CI, 1.66-23.2), and DQB1*0602 (OR, 2.48; 95% CI, 1.06-5.80). We suggest that HLA class II polymorphisms are involved in genetic susceptibility to cervical cancer and HPV infection in a Brazilian population from an area with a high incidence of this neoplasia.

Assuntos

Genes MHC da Classe II/genética , Infecções por Papillomavirus/complicações , Polimorfismo Genético , Infecções Tumorais por Vírus/complicações , Neoplasias do Colo do Útero/genética , Neoplasias do Colo do Útero/virologia , Adolescente , Adulto , Idoso , Brasil/epidemiologia , Feminino , Predisposição Genética para Doença , Humanos , Incidência , Pessoa de Meia-Idade , Papillomaviridae , Reação em Cadeia da Polimerase , Fatores de Risco , Neoplasias do Colo do Útero/epidemiologia

RESUMO

The authors investigated the joint effects of tobacco and alcohol consumption on the risk of squamous cell carcinomas of the upper aero-digestive tract (UADT) using data from a hospital-based case-control study conducted in southern Brazil, 1986-1989. A total of 784 cases of cancers of the mouth, pharynx, and larynx and 1,578 non-cancer controls matched on age, sex, hospital catchment area, and period of admission were interviewed about their smoking and drinking habits and other characteristics. Using logistic regression, evidence was found for interaction between the cumulative exposures for smoking and alcohol on UADT cancer risk. The joint effects for pharyngeal cancers exceeded the levels expected under a multiplicative model for moderate smokers (p = 0.007). There was little statistical evidence, however, for interaction on cancers of the mouth (p = 0.28) or larynx (p = 0.95). Among never smokers, heavy drinkers had 9.2 times (95% confidence interval 1.7, 48.5) greater risk of cancers of mouth, pharynx, and supraglottis than never drinkers, with a dose-response trend (p = 0.013) with cumulative consumption. The authors conclude that the interaction occurring in the pharynx between smoking and alcohol on UADT cancers is not uniform, with varying effects depending on the level of smoking exposure. Alcohol may act as both a promoter for tobacco and as an independent risk factor.

Assuntos

Consumo de Bebidas Alcoólicas/efeitos adversos , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias Laríngeas/epidemiologia , Neoplasias Bucais/epidemiologia , Neoplasias Faríngeas/epidemiologia , Fumar/efeitos adversos , Brasil/epidemiologia , Estudos de Casos e Controles , Intervalos de Confiança , Interpretação Estatística de Dados , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Fatores de Risco

RESUMO

Acquisition and clearance of cervical human papillomavirus (HPV) infection were analyzed among 1425 low-income women attending a maternal and child health program in São Paulo, Brazil. Specimens collected every 4 months were tested by a polymerase chain reaction protocol (MY09/11). In all, 357 subjects were positive at least once. There were 1.3% new infections per month, with 38% cumulative positivity after 18 months. Of 177 positive subjects at enrollment, only 35% remained infected after 12 months. The monthly clearance rate was higher for nononcogenic types (12.2%; 95% confidence interval [CI], 9.6-15.4) than for oncogenic HPV infections (9.5%; 95% CI, 7.5-11.9). Median retention times were 8.1 months (95% CI, 7.8-8.3) for oncogenic types and 4.8 months (95% CI, 3.9-5.6) for nononcogenic HPV infections. The mean infection durations were 8.2 and 13.5 months for nononcogenic and oncogenic types, respectively. Although a woman's age did not affect mean duration for oncogenic types (13-14 months), nononcogenic-type infections lasted longer (10. 2 months) among younger (<35 years old) than in older women (5.6 months).

Assuntos

Colo do Útero/virologia , Papillomaviridae/isolamento & purificação , Infecções por Papillomavirus/epidemiologia , Infecções Tumorais por Vírus/epidemiologia , Doenças do Colo do Útero/epidemiologia , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Papillomaviridae/classificação , Infecções por Papillomavirus/imunologia , Infecções por Papillomavirus/virologia , Prevalência , Fatores de Risco , Infecções Tumorais por Vírus/imunologia , Infecções Tumorais por Vírus/virologia , Doenças do Colo do Útero/imunologia , Doenças do Colo do Útero/virologia , Neoplasias do Colo do Útero/etiologia , Neoplasias do Colo do Útero/virologia

RESUMO

Tobacco smoking has long been identified as the most important risk factor for upper aero-digestive tract cancers. To investigate the effect of different tobacco types and the benefit of smoking cessation, we analyzed data from a case-control study of 784 cases of mouth, pharynx, and larynx cancers and 1,578 non-cancer controls in three metropolitan hospital areas in Brazil. Subjects were interviewed as to their smoking and drinking habits, demographics, environmental exposures, occupational history, health characteristics, and diet. Controlling for total tobacco and alcohol consumption, risks for ex-smokers compared with current smokers decreased substantially with time since cessation of the habit. Compared with never smokers, ex-smokers of >20 years had a relative risk (RR) of 1.98 [95% confidence interval (CI) = 1.0-3.8] for all upper aerodigestive tract cancers. RRs for long-term (>20 years) ex-smokers tended to be lower for mouth (RR = 1.61) and pharynx (RR = 1.52) than for larynx (RR = 3.63) cancers. The benefit of quitting was strongest for commercial cigarettes (RR = 1.45, 95% CI = 0.7-3.0) for ex-smokers of >10 years, as compared with smoking of black tobacco (RR = 2.57, 95% CI = 1.4-4.6), cigars (RR = 2.59, 95% CI = 0.6-11.6), and pipe tobacco (RR = 3.40, 95% CI = 1.3-8.8).

Assuntos

Neoplasias de Cabeça e Pescoço/epidemiologia , Nicotiana , Plantas Tóxicas , Abandono do Hábito de Fumar , Brasil/epidemiologia , Humanos , Neoplasias Laríngeas/epidemiologia , Neoplasias Bucais/epidemiologia , Neoplasias Faríngeas/epidemiologia , Medição de Risco , Fatores Socioeconômicos

RESUMO

The Brazilian Wilms' Tumour Study Group carried out a hospital-based multicentre case-control study of potential risk factors for the disease between April 1987 and January 1989. The parents of 109 cases of Wilms' tumour (WT) were interviewed when they were admitted to hospital for diagnosis and treatment. Also interviewed were the parents of two controls per case, matched for age, sex and interviewer, who were admitted to the same or nearby hospitals for treatment of non-neoplastic conditions. Odds ratios adjusted for family income and parental education were calculated by conditional logistic regression. Among cases diagnosed before 25 months of age there was a marked gradient of increasing risk of WT with increasing maternal age at the time of the child's birth. There was no increased risk for cases diagnosed after 25 months of age. The effects of paternal age were less marked. Possible explanations for these results are discussed.

Assuntos

Neoplasias Renais/epidemiologia , Idade Materna , Idade Paterna , Tumor de Wilms/epidemiologia , Adulto , Idade de Início , Brasil/epidemiologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Lactente , Recém-Nascido , Neoplasias Renais/etiologia , Modelos Logísticos , Masculino , Razão de Chances , Fatores de Risco , Fatores Socioeconômicos , Tumor de Wilms/etiologia

RESUMO

The Brazilian Wilms' Tumour Study Group carried out a hospital-based multicentre case-control study of potential risk factors for the disease between April 1987 and January 1989. The parents of 109 cases of Wilms' tumour (WT) were interviewed when they were admitted to hospital for diagnosis and treatment. Also interviewed were the parents of two controls per case, matched for age, sex and interviewer, who were admitted to the same or nearby hospitals for treatment of non-neoplastic conditions. Odds ratios adjusted for family income and parental education were calculated by conditional logistic regression. Among cases diagnosed before 25 months of age there was a marked gradient of increasing risk of WT with increasing maternal age at the time of the child's birth. There was no increased risk for cases diagnosed after 25 months of age. The effects of paternal age were less marked. Possible explanations for these results are discussed.

Assuntos

Humanos , Fatores de Risco , Tumor de Wilms

RESUMO

We examined the relationship between dental health variables and risk of upper aerodigestive tract (UADT) cancers in a case-control study in Southern Brazil. The study population included 717 cases of cancers of the mouth, pharynx, and larynx and 1434 controls matched on age, gender, period of admission and study site. The association with dental factors was investigated by conditional logistic regression using extensive adjustment for a priori and empirical confounders, including tobacco and alcohol consumption, diet and sociodemographic variables. Lifetime use of dentures was not associated with risk of any UADT cancer, but history of oral sores secondary to ill-fitting dentures was associated with cancers of the mouth (odds ratio [OR] = 2.3, 95% confidence interval [CI] 1.2-4.6) and of the pharynx (OR = 2.7, 95% CI 1.1-6.2) among those using dentures. The association for mouth cancers was restricted primarily to an increased risk of tongue neoplasms (OR = 9.1, 95% CI 1.9-43.4). Less than daily tooth brushing frequency was also associated with risk of cancer of the tongue (OR = 2.1, 95% CI 1.0-4.3) and of other parts of the mouth (OR = 2.4, 95% CI 1.0-5.4). Having broken teeth was not significantly associated with risk of UADT cancer of any site. We conclude that poor oral hygiene due to infrequent tooth brushing and sores caused by dentures are risk factors for cancer of the mouth and that these associations are unlikely to be due to insufficient control of confounding.

Assuntos

Carcinoma de Células Escamosas/etiologia , Neoplasias Laríngeas/etiologia , Neoplasias Bucais/etiologia , Higiene Bucal , Neoplasias Faríngeas/etiologia , Adulto , Idoso , Brasil/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Estudos de Casos e Controles , Inquéritos de Saúde Bucal , Dentaduras , Feminino , Humanos , Neoplasias Laríngeas/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Neoplasias Faríngeas/epidemiologia , Fatores de Risco , Escovação Dentária

RESUMO

We examined the relationship between dental health variables and risk of upper aerodigestive tract (UADT) cancers in a case-control study in Southern Brazil. The study population included 717 cases of cancers of the mouth, pharynx, and larynx and 1434 controls matched on age, gender, period of admission and study site. The association with dental factors was investigated by conditional logistic regression using extensive adjustment for a priori and empirical confounders, including tobacco and alcohol consumption, diet and sociodemographic variables. Lifetime use of dentures was not associated with risk of any UADT cancer, but history of oral sores secondary to ill-fitting dentures was associated with cancers of the mouth (odds ratio [OR] = 2.3, 95 per cent confidence interval [CI] 1.2-4.6) and of the pharynx (OR = 2.7, 95 per cent CI 1.1-6.2) among those using dentures...

Assuntos

Neoplasias Bucais/diagnóstico , Neoplasias Bucais/etiologia , Prótese Dentária/efeitos adversos , Sistema Estomatognático/fisiopatologia , Sistema Estomatognático/lesões , Alcoolismo/complicações , Brasil/epidemiologia , Doenças da Boca , Higiene Bucal/efeitos adversos , Próteses e Implantes , Prótese Dentária/efeitos adversos , Fatores de Risco , Nicotiana/efeitos adversos , Doenças Dentárias

RESUMO

OBJECTIVE: To investigate the role of tumor persistence in patients submitted to irradiation therapy and radical hysterectomy. DESIGN: A retrospective analysis of prognostic factors. LOCATION: Hospital A.C. Camargo, São Paulo, Brazil, a private non-profitmaking foundation and tertiary referral centre. PATIENTS: A total of 629 cases of invasive squamous cell carcinoma of the cervix were studied. Criteria for inclusion in the study were: confirmed histological diagnosis of squamous cell carcinoma and no previous treatment (except for preoperative radiotherapy carried out at the Hospital A.C. Camargo itself). At the end of the follow-up period, 410 patients (65%) had no evidence of disease and 219 (34.8%) had died because of the tumor. INTERVENTION: The patients were submitted to radical surgery and radiation therapy, separately or in combination between 1953 and 1982. MAIN OUTCOMES MEASURES: Multivariate analysis of the different variables was performed according to the Cox regression method. RESULTS: The variables of prognostic value were, in decreasing order of importance: the decade of patient admission (p = 0.0001), the modality of therapy employed (p = 0.0005), the presence of residual tumor in the surgical specimens (p = 0.0055) and the clinical stage of the disease (p = 0.0575). CONCLUSION: Radiation therapy controlled a considerable number of local tumors and pelvic lymph nodes but not all of them in every patient. There is a specific group of patients for whom radical surgery is necessary to achieve control of the disease.

Assuntos

Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/cirurgia , Histerectomia , Neoplasias do Colo do Útero/radioterapia , Neoplasias do Colo do Útero/cirurgia , Braquiterapia , Carcinoma de Células Escamosas/mortalidade , Feminino , Seguimentos , Humanos , Análise Multivariada , Prognóstico , Radioterapia Adjuvante , Indução de Remissão , Estudos Retrospectivos , Taxa de Sobrevida , Neoplasias do Colo do Útero/mortalidade

RESUMO

BACKGROUND: Incidence rates for cancers of the upper aero-digestive tract in Southern Brazil are among the highest in the world. A case-control study was designed to identify the main risk factors for carcinomas of mouth, pharynx, and larynx in the region. We tested the hypothesis of whether use of wood stoves is associated with these cancers. METHODS: Information on known and potential risk factors was obtained from interviews with 784 cases and 1568 non-cancer controls. We estimated the effect of use of wood stove by conditional logistic regression, with adjustment for smoking, alcohol consumption and for other sociodemographic and dietary variables chosen as empirical confounders based on a change-in-estimate criterion. RESULTS: After extensive adjustment for all the empirical confounders the odds ratio (OR) for all upper aero-digestive tract cancers was 2.68 (95% confidence interval [CI] : 2.2-3.3). Increased risks were also seen in site-specific analyses for mouth (OR = 2.73; 95% CI: 1.8-4.2), pharyngeal (OR = 3.82; 95% CI: 2.0-7.4), and laryngeal carcinomas (OR = 2.34; 95% CI: 1.2-4.7). Significant risk elevations remained for each of the three anatomic sites and for all sites combined even after we purposefully biased the analyses towards the null hypothesis by adjusting the effect of wood stove use only for positive empirical confounders. CONCLUSIONS: The association of use of wood stoves with cancers of the upper aero-digestive tract is genuine and unlikely to result from insufficient control of confounding. Due to its high prevalence, use of wood stoves may be linked to as many as 30% of all cancers occurring in the region.

Assuntos

Poluição do Ar em Ambientes Fechados/efeitos adversos , Neoplasias Bucais/etiologia , Neoplasias Otorrinolaringológicas/etiologia , Fumaça/efeitos adversos , Madeira , Idoso , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias Bucais/epidemiologia , Razão de Chances , Neoplasias Otorrinolaringológicas/epidemiologia , Estudos Retrospectivos , Fatores de Risco , População Urbana

RESUMO

We evaluated the risk of Wilms' tumor in the offspring of women taking various medications during pregnancy in a case, control study conducted in Brazil. The study accrued 109 cases and 218 age- and gender-matched hospital controls. After adjustment for known confounders, we found a strong association with ingestion of dipyrone (odds ratio = 10.9; 95% confidence interval = 2.4-50) particularly in women from low-income families. Although dipyrone-containing analgesics are banned in Europe and North America, they are widely prescribed in Brazil and are given as free samples in neighborhood clinics providing free health care. The strong effect specific to low-income women may result from higher individual consumption compared with women at higher income levels.

Assuntos

Anti-Inflamatórios não Esteroides/efeitos adversos , Dipirona/efeitos adversos , Neoplasias Renais/induzido quimicamente , Efeitos Tardios da Exposição Pré-Natal , Tumor de Wilms/induzido quimicamente , Antieméticos/efeitos adversos , Feminino , Humanos , Renda , Masculino , Metoclopramida/efeitos adversos , Medicamentos sem Prescrição , Razão de Chances , Pobreza , Gravidez , Fatores de Risco

RESUMO

We evaluated the risk of Wilms' tumor in the offspring of women taking various medications during pregnancy in a case, control study conducted in Brazil. The study accrued 109 cases and 218 age- and gender-matched hospital controls. After adjustment for known confounders, we found a strong association with ingestion of dipyrone (odds ratio = 10.9; 95% confidence interval = 2.4-50) particularly in women from low-income families. Although dipyrone-containing analgesics are banned in Europe and North America, they are widely prescribed in Brazil and are given as free samples in neighborhood clinics providing free health care. The strong effect specific to low-income women may result from higher individual consumption compared with women at higher income levels.

Assuntos

Dipirona , Neoplasias , Gravidez , Complicações na Gravidez , Tumor de Wilms

RESUMO

To determine the role of familial factors in head and neck cancer, we analysed data from a hospital-based case-control study of squamous cell carcinoma of the head and neck in Brazil. There were 754 cases of squamous cell carcinoma of the head and neck (SCCHN) and 1,507 age- and gender-matched hospital-based controls with non-malignant diseases. Subjects provided information on the occurrence of cancer in first-degree relatives, as well as about other risk factors, including tobacco and alcohol consumption. Relative risks (RRs) were estimated for developing mouth, pharynx and larynx cancer when cancers in relatives were observed. RRs were adjusted for age, sex, city of admission and alcohol and tobacco consumption. The RR for developing SCCHN if a first-degree relative had cancer at any site was significantly elevated at 1.97. The RR was 3.65 (95% CI: 1.97-6.76) if the relative had head and neck cancer. Significantly elevated risks for developing head and neck cancer were associated with siblings with head and neck cancer (RR = 8.57) and, to a lesser extent, with fathers with head and neck cancer (RR = 2.49). There was no significantly increased risk associated with mothers with head and neck cancer, but these tumours were rare among mothers. Our data show that familial, possibly genetic, factors are important in the aetiology of head and neck cancer.

Assuntos

Carcinoma de Células Escamosas/etiologia , Neoplasias de Cabeça e Pescoço/etiologia , Adulto , Idoso , Brasil/epidemiologia , Carcinoma de Células Escamosas/epidemiologia , Carcinoma de Células Escamosas/genética , Estudos de Casos e Controles , Família , Feminino , Neoplasias de Cabeça e Pescoço/epidemiologia , Neoplasias de Cabeça e Pescoço/genética , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco

RESUMO

A series of 103 cases of laryngeal carcinoma subjected either to a unilateral or to a bilateral comprehensive neck dissection was reviewed with reference to risk factors influencing regional lymph node metastasis. The sensitivity of clinical examination was only 67.4%, while the specificity was 88.3%. Most metastases were in the upper and middle jugular chain of nodes (levels 2 and 3). Only patients with positive nodes at levels 2, 3, and/or 4 had histologically positive nodes at levels 1 or 5. Selected demographic, clinical, and pathologic variables were analyzed with respect to their potential predictive value regarding the risk of histologically proven neck node metastasis. Logistic regression analysis demonstrated that tumor site and histologic grade were the most important predictors of lymph node metastasis. Considering only NO cases, the likelihood of occult metastasis was significantly affected exclusively by tumor site (higher risk for supraglottic lesions).

Assuntos

Neoplasias Laríngeas/patologia , Reações Falso-Negativas , Feminino , Humanos , Incidência , Neoplasias Laríngeas/epidemiologia , Neoplasias Laríngeas/terapia , Laringectomia , Modelos Logísticos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Recidiva Local de Neoplasia/epidemiologia , Valor Preditivo dos Testes , Radioterapia Adjuvante , Fatores de Risco , Sensibilidade e Especificidade

RESUMO

Wilms' tumor is one of the most common abdominal childhood malignancies. Wilms' tumor rates in Brazil are among the highest in the world. This prompted the Brazilian Wilms' Tumor Study Group to conduct a hospital-based, multicenter, case-control investigation of environmental risk factors for the disease. Between April 1987 and January 1989, the authors collected information on relevant occupational exposures by interviewing the parents of 109 Wilms' tumor cases admitted to hospitals in Sao Paulo, Salvador, Belo Horizonte, and Jau. Also interviewed were the parents of 218 age- and sex-matched control children who had been admitted for treatment of nonneoplastic diseases to the same or nearby hospitals. Odds ratios (ORs) adjusted for income and education were calculated by conditional logistic regression. Consistently elevated risks were seen for farm work involving frequent use of pesticides by both the father (OR = 3.24, 95% confidence interval (CI) 1.2-9.0) and the mother (OR = 128.6, 95% CI 6.4-2,569). These risk elevations were restricted to cases diagnosed after 2 years of age (ORs > 4), for paternal exposure, and after 4 years of age (OR = 14.8, 95% CI 2.2-98.8), for maternal exposure. Risk elevations were also more pronounced among boys (paternal exposure OR = 8.56, 95% CI 2.1-35.1; maternal exposure OR = 4.60, 95% CI 0.8-26.4) than among girls (paternal exposure OR = 1.31, 95% CI 0.4-4.1; maternal exposure OR = 2.03, 95% CI 0.5-8.9).

Assuntos

Neoplasias Renais/epidemiologia , Exposição Materna , Exposição Paterna , Praguicidas/intoxicação , Tumor de Wilms/etiologia , Fatores Etários , Agricultura , Brasil/epidemiologia , Pré-Escolar , Feminino , Humanos , Neoplasias Renais/etiologia , Masculino , Exposição Ocupacional , Fatores de Risco , Fatores Sexuais , Fatores Socioeconômicos , Tumor de Wilms/epidemiologia

RESUMO

Wilms' tumor is one of the most common abdominal childhood malignancies. Wilms' tumor rates in Brazil are among the highest in the world. This prompted the Brazilian Wilms' Tumor Study Group to conduct a hospital-based, multicenter, case-control investigation of environmental risk factors for the disease. Between April 1987 and January 1989, the authors collected information on relevant occupational exposures by interviewing the parents of 109 Wilms' tumor cases admitted to hospitals in Sao Paulo, Salvador, Belo Horizonte, and Jau. Also interviewed were the parents of 218 age- and sex-matched control children who had been admitted for treatment of nonneoplastic diseases to the same or nearby hospitals. Odds ratios (ORs) adjusted for income and education were calculated by conditional logistic regression. Consistently elevated risks were seen for farm work involving frequent use of pesticides by both the father (OR = 3.24, 95% confidence interval (CI) 1.2-9.0) and the mother (OR = 128.6, 95% CI 6.4-2,569). These risk elevations were restricted to cases diagnosed after 2 years of age (ORs > 4), for paternal exposure, and after 4 years of age (OR = 14.8, 95% CI 2.2-98.8), for maternal exposure. Risk elevations were also more pronounced among boys (paternal exposure OR = 8.56, 95% CI 2.1-35.1; maternal exposure OR = 4.60, 95% CI 0.8-26.4) than among girls (paternal exposure OR = 1.31, 95% CI 0.4-4.1; maternal exposure OR = 2.03, 95% CI 0.5-8.9).

Assuntos

Neoplasias , Exposição a Praguicidas , Assunção de Riscos , Tumor de Wilms