RESUMO
OBJECTIVE: Major changes in the incidence of the most common histological types of lung and bronchus cancer have been observed around the world. Herein we report the overall incidence, stage at diagnosis and overall mortality of lung and bronchus cancer in Puerto Rico, and the incidence of the different histologic types. METHODS: Aggregate lung and bronchus cancer data from 1987 to 2003 were obtained from the Puerto Rico Central Cancer Registry. Incidence and mortality rates were age-standardized by the direct method to the 2000 standard population of the United States. For the incidence (overall, by histologic type, and by sex), and mortality we calculated the annual percent change (APC) using the Joinpoint Regression Program. RESULTS: There were 9,886 cases of lung and bronchus cancer (6,772 men, 3,114 women), for an overall age-adjusted incidence of 18.8 per 100,000. The incidence decreased significantly for the whole group, falling from 18.9 per 100,000 in 1987 to 17.1 in 2003 (APC: -0.74, p < 0.05); for men, incidence decreased from 28.1 per 100,000 to 24.4 (APC: -1.02, p < 0.05) over the same period of time. The mortality rate has decreased overall (APC: -0.62, p < 0.05) and in men (APC: -0.71, p < 0.05). Squamous cell carcinoma was the most common histologic type in 1987, but it decreased from 6.2 per 100,000 in 1987 to 3.5 in 2003 (APC: -3.86, p < 0.05), while adenocarcinoma increased from 3.7 per 100,000 to 4.6 (APC: +1.51, p < 0.05). CONCLUSION: In Puerto Rico, over the period of 1987 to 2003, squamous cell carcinoma of the lung and bronchus decreased, while adenocarcinoma increased. As of 1999, the most common type of lung and bronchus cancer is adenocarcinoma. Both the incidence and the mortality of lung and bronchus cancer decreased for men but not for women.
Assuntos
Neoplasias Brônquicas/epidemiologia , Neoplasias Pulmonares/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias Brônquicas/mortalidade , Neoplasias Brônquicas/patologia , Feminino , Humanos , Incidência , Neoplasias Pulmonares/mortalidade , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Porto Rico/epidemiologia , Distribuição por Sexo , Fatores de TempoRESUMO
INTRODUCTION: Dyspnea is a common and disabling symptom for patients with chronic lung diseases. The Medical Research Council Dyspnea Scale (MRC) and the Oxygen Cost Diagram (OCD) are widely used instruments validated in English to measure breathlessness. OBJECTIVE: To translate and culturally adapt the MRC and the OCD for its use in Puerto Rico. METHOD: The scales were translated to Spanish and back translated. They were tested in patients attending a pulmonary clinic to assess its relevance and comprehension. Subjects answered the instruments, had a structured clinical interview and provided feedback. A multidisciplinary committee analyzed the source of misunderstanding using the input of the subjects, the clinical physicians, and the evaluators; made adjustments, and retested the instruments until inconsistencies were not observed. RESULTS: Placing emphasis on time spent walking instead of distance traveled improved the discrimination between grade two and three in the MRC. In the OCD, placing the activities to the right side eased the interpretation of the scale. Numerical symbols were eliminated to minimize discomfort in the severely impaired subjects reluctant to mark the line near zero. Reversing the order of both scales encouraged a thorough reading of the activities from minimal to high energy demanding eliciting a more fitting response compared to structured clinical interview especially in the severely ill patient. CONCLUSION: Using cross-cultural research methodologies to translate the MRC and OCD allowed the identification of differences in conceptualization when assessing the severity of dyspnea in Puerto Rico. Further testing is needed to confirm psychometric properties.