RESUMO
Trinidad and Tobago (TT) is the country with the highest breast cancer mortality in the Caribbean. It is unknown whether biological, behavioral, environmental, or clinical factors play a significant role in such outcome. A total of 2,614 incident cases, histologically confirmed and recorded in the TT cancer registries between 1995 and 2005, with follow-up through 2009 were analyzed. Half of the cases were diagnosed between the ages of 40-59 years, 12.5% before the age of 40 years; 45% of women were diagnosed at localized stage and 43.7% were hormone receptor positive. Women diagnosed with distant staging were more likely to undergo chemotherapy compared to those with localized staging (OR 1.39; 95% CI 1.01-1.89). Hormone receptor negative cases were significantly less likely to undergo radiation or surgery therapy (OR 0.66; 95% CI 0.56-0.79 and OR 0.67; 95% CI 0.51-0.88 respectively) compared to those who were hormone receptor positive, but more than 1.5 times as likely to undergo chemotherapy. In multivariate analyses, advanced stage disease and negative hormone receptor status were independently significantly associated with poorer survival outcome. No racial/ethnic differences were observed with respect to treatment or survival. Although access to breast cancer screening and treatment is free in Trinidad and Tobago, breast cancer diagnosis occurs at advanced stages; use of multimodality therapy as a first course of treatment is low.
Assuntos
Neoplasias da Mama/diagnóstico , Neoplasias da Mama/terapia , Adulto , Neoplasias da Mama/metabolismo , Neoplasias da Mama/patologia , Carcinoma/diagnóstico , Carcinoma/metabolismo , Carcinoma/patologia , Carcinoma/terapia , Terapia Combinada/estatística & dados numéricos , Diagnóstico Tardio , Feminino , Humanos , Pessoa de Meia-Idade , Receptores de Estrogênio/metabolismo , Receptores de Progesterona/metabolismo , Sistema de Registros , Trinidad e TobagoRESUMO
BACKGROUND: High-risk (HR) HPV genotypes other than 16 and 18 have been detected in a significant proportion of immunocompromised females. We aim to evaluate the frequency of HR HPV genotypes in a population of HIV-positive Caribbean women. METHODS: One hundred sixty-seven consecutive, non-pregnant, HIV-positive females ≥18 years were recruited in this study. Each participant received a vaginal examination, PAP smear, and completed a questionnaire. DNA was extracted for HPV testing in 86 patients. RESULTS: Mean age was 39.1 years for women positive for HR HPV and 43.1 years for women negative for HR HPV (P value â=â0.040). 78% (130/167) of the women had HR HPV infections; the prevalence of abnormal cervical cytology was 38% among women who were HR HPV-positive compared to women who were HR HPV-negative (22%). Fifty-one percent of the 86 women with available genotype carried infections with HPV 16 and/or HPV 18; genotypes of unknown risk were also frequently observed. Women who had a CD4+ count of ≤200 had 7 times increased odds of carrying HR HPV infection in comparison to women with CD4+>200. CONCLUSIONS: HR HPV infections in HIV infected females may consist of more than just HPV 16 and 18, but also HPV 52 and 58. Further studies are needed to determine whether HPV 52 and 58 play a significant role in the development of cervical cytological abnormalities in HIV+ women.
Assuntos
Coinfecção/virologia , Infecções por HIV/virologia , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Infecções por Papillomavirus/virologia , Adulto , Idoso , Bahamas/epidemiologia , Colo do Útero/patologia , Colo do Útero/virologia , Coinfecção/epidemiologia , Feminino , Genótipo , Infecções por HIV/epidemiologia , Humanos , Pessoa de Meia-Idade , Infecções por Papillomavirus/epidemiologia , Prevalência , Risco , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/virologia , Adulto JovemRESUMO
Trinidad and Tobago (TT) experiences the highest breast cancer mortality in the Caribbean; the distribution of traditional breast cancer risk factors in this population has not been analyzed. Data on women who underwent breast cancer screening at the TT Cancer Society between January 2009-December 2011(N = 2,689) were retrospectively collected. The screening detected 131 incident breast cancers; variables significantly associated with breast cancer diagnosis were, a positive family history of breast cancer (adjusted odds ratio [ORadj]: 1.55; 95% CI 1.00-2.41), presence of symptoms (ORadj: 1.91; 95% CI 1.25-2.92), and previous breast surgery (ORadj: 1.67; 95% CI 0.97-2.88). Breast cancer was significantly associated with increased breast density. Among healthy women, breast density was positively associated with nulliparity (ORadj: 1.46, 1.37, 2.52 respectively for density level 2, 3 and 4 vs. 1) and previous breast surgeries (ORadj: 2.27, 3.09 and 4.13 respectively for density level 2, 3 and 4 vs. 1). This analysis confirms that breast density is an important predictor of newly diagnosed breast cancer in this Caribbean population. Screening is still a diagnostic tool rather than a preventive measure in TT.
Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Mamografia/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/prevenção & controle , Intervalos de Confiança , Bases de Dados Factuais , Países em Desenvolvimento , Detecção Precoce de Câncer/métodos , Feminino , Serviços de Saúde do Indígena/organização & administração , Humanos , Modelos Logísticos , Mamografia/métodos , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Análise Multivariada , Razão de Chances , Prevenção Primária/organização & administração , Estudos Retrospectivos , Medição de Risco , Trinidad e Tobago , Adulto JovemRESUMO
OBJECTIVE: To compare knowledge and attitudes of human papillomavirus (HPV) and the vaccine between different cultures of African descent. METHODS: A cross-sectional survey of 555 African-Americans and Afro-Caribbeans residing in the US and the Bahamas (BHM) was conducted. RESULTS: General knowledge about HPV and the HPV vaccine differed between the two countries significantly. Bahamian respondents were less likely to have higher numbers of correct knowledge answers when compared to Americans (Adjusted Odds Ratio [Adj. OR] 0.47, 95% Confidence Interval [CI] 0.30-0.75). Older age, regardless of location, was also associated with answering fewer questions correctly (Adj. OR 0.61, 95% CI 0.40-0.92). Attitudes related to HPV vaccination were similar between the US and BHM, but nearly 80% of BHM respondents felt that children should not be able to receive the vaccine without parental consent compared to 57% of American respondents. CONCLUSIONS: Grave lack of knowledge, safety and cost concerns, and influence of parental restrictions may negatively impact vaccine uptake among African-American and Afro-Caribbean persons. Interventions to increase the vaccine uptake in the Caribbean must include medical provider and parental involvement. Effective strategies for education and increasing vaccine uptake in BHM are crucial for decreasing cervical cancer burden in the Caribbean.
Assuntos
População Negra , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Infecções por Papillomavirus/etnologia , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Adolescente , Adulto , Bahamas , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Estados UnidosRESUMO
INTRODUCTION: Endometrial cancer (EC) is the most common gynecologic cancer in the United States. Racial disparities in the incidence and mortality of this cancer are apparent; black women are less likely to develop this malignancy, and yet are more likely to die when diagnosed. Racial differences of second primary cancer (SPC) have not been examined and are the goal of this study. METHODS: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results database, SPC risk in white and black EC cases was compared to the general population and to women with other primary cancers. Standardized incidence ratios (SIRs) of SPC (overall and by tumor site) with 95% confidence intervals were calculated. Poisson regression was used to estimate the race-specific risk of SPC in EC cases treated with radiotherapy vs. non-irradiated cases. RESULTS: The analysis included 11,047 EC cases diagnosed between 1973 and 2007 that developed a SPC. Overall risk of SPC in white EC cases was significantly lower than the general population (SIR=0.85, 95% CI: 0.84, 0.87), but significantly higher in black EC cases (SIR=1.19, 95% CI: 1.08, 1.31). White EC cases treated with radiotherapy were more likely to develop SPC compared to non-irradiated cases (IRR=1.18, 95% CI: 1.14, 1.23). CONCLUSIONS: This is the first analysis of race-specific SPC risk in EC cases and it suggests differences between white and black cases. Although exploratory, these data provide important clues about the etiology of SPC in patients with EC. This analysis also highlights the need for careful monitoring following diagnosis and treatment of EC.
RESUMO
BACKGROUND: Prostate cancer mortality rates for African-Americans are much higher than Caucasians and a similar trend is observed for prostate cancer survival. Data on recently immigrated African-descent men are lacking. METHODS: Using cancer registry data from Brooklyn, NY and two countries in the Caribbean (Guyana and Trinidad and Tobago), survival rates were estimated. We also examined whether Black race or Caribbean birthplace predict prostate cancer survival among males living in the United States (US). RESULTS: The Caribbean cases were diagnosed at a later age than those in the US (Guyana: 74.5 years, Trinidad and Tobago: 72.4 years, Brooklyn: 65.8 years). Patients in the Caribbean had a worse 5-year survival rate compared to those in the US (41.6% vs. 84.4%) but for immigrant Caribbean-born males living in the US the 5-year survival rate was not significantly different from African-Americans (78.1%, 95% CI: 70.9-83.7% vs. 81.4%, 95% CI: 69.5-89.1%, P = 0.792). The risk of death for Caribbean-born was more than three times higher than US-born men (HR: 3.43, 95% CI: 2.17-5.44, adjusted for ethnicity, stage, and mean age of diagnosis). A mean age of diagnosis >65 years old and stage IV disease, but not ethnicity, were found to be independently associated with the risk of death. CONCLUSION: The survival disadvantage for Caribbean-born patients may be partly due to later diagnosis. Interventions focused on screening, education about the disease and early detection could potentially reduce cancer mortality in this population.
Assuntos
Negro ou Afro-Americano/estatística & dados numéricos , Neoplasias da Próstata/mortalidade , Adulto , África/etnologia , Idoso , Idoso de 80 Anos ou mais , Guiana/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Modelos de Riscos Proporcionais , Neoplasias da Próstata/etnologia , Fatores de Risco , Trinidad e Tobago/epidemiologiaRESUMO
In order to shed light on genetic and environmental factors contributing to breast cancer health disparities, anonymous data from the cancer registry in Brooklyn, NY and two countries in the Caribbean, have been analyzed and compared. De-identified data were obtained on 3,710 women from three cancer registries in Brooklyn (New York), Guyana, and Trinidad, all having been diagnosed with breast cancer between 1995 and 2007, with follow-up through to early 2009. There was a significant difference in breast cancer survival according to race, place of birth, and place of residence. Women of African origin had a significantly worse survival than White women. Women born in the Caribbean had significantly worse survival in comparison to their counterpart born in the US, independently from their ethnic background (adjusted hazard ratio: 1.6; 95% CI: 1.2-2.1). A significant lower breast cancer survival was observed in African Caribbean women living in the Caribbean (HR: 1.8; 95% CI: 1.6-2.1) versus African-Caribbean women born in the Caribbean and living in the US (HR: 1.3; 95% CI 1.1-1.7), versus African-descent women born and living in the US. This study suggests that biological, behavioral, environmental, and clinical factors play a significant role in the observed difference in breast cancer outcome in women of Afro Caribbean descent.
Assuntos
População Negra/estatística & dados numéricos , Neoplasias da Mama/etnologia , Neoplasias da Mama/mortalidade , Características de Residência/estatística & dados numéricos , Adulto , Idoso , Distribuição de Qui-Quadrado , Feminino , Guiana/epidemiologia , Humanos , Estimativa de Kaplan-Meier , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Prognóstico , Modelos de Riscos Proporcionais , Sistema de Registros , Medição de Risco , Fatores de Risco , Fatores de Tempo , Trinidad e Tobago/epidemiologia , População Branca/estatística & dados numéricosRESUMO
Lung cancer is the leading cause of cancer mortality worldwide. A possible carcinogenic role of human papillomavirus (HPV) has been investigated for >20 years and has major clinical and public health implications. We performed a meta-analysis to assess the prevalence of HPV16 and HPV18 in primary lung cancers (2435 subjects from 37 published studies). The overall HPV prevalence ranged from 0.0 to 78.3% with large heterogeneity across geographic regions and histological tissue types. A higher proportion, 50% (7/14), of the European studies reported low or no HPV prevalence (0-10%) compared with the Asian studies, 22% (4/18). When the analysis was limited to HPV16 and HPV18 prevalence, a higher prevalence in Asia (HPV16 = 11.6% and HPV18 = 8.8%) than in Europe (HPV16 = 3.5% and HPV18 = 3.6%) was observed. Studies using HPV-specific primers resulted in higher prevalence rates than consensus HPV primers (HPV16: Asia = 13% and Europe = 6%; HPV18: Asia = 13% and Europe = 5%). Further studies are needed to elucidate the role of HPV in lung carcinogenesis with careful thought given to study design and laboratory detection methods for a more accurate assessment of HPV status in lung tumors.
Assuntos
Papillomavirus Humano 16/isolamento & purificação , Papillomavirus Humano 18/isolamento & purificação , Neoplasias Pulmonares/virologia , Infecções por Papillomavirus/epidemiologia , Ásia/epidemiologia , Povo Asiático/genética , Europa (Continente)/epidemiologia , Papillomavirus Humano 16/genética , Papillomavirus Humano 18/genética , Humanos , Neoplasias Pulmonares/complicações , Neoplasias Pulmonares/epidemiologia , América do Norte/epidemiologia , Infecções por Papillomavirus/complicações , Reação em Cadeia da Polimerase , América do Sul/epidemiologia , População Branca/genéticaRESUMO
Human herpesvirus 8 (HHV-8) infection is present in 22.9% of Tobago men. However, seroprevalence and modes of transmission of HHV-8 among Tobago women are not known. HHV-8 seropositivity rates in Tobago women were examined and compared rates to Tobago men of similar ages. To assess possible modes of transmission, sexual behavior among Tobago women was examined to determine its association with HHV-8 seropositivity. A cross-sectional study was conducted in 213 Tobago women, ages 18-65 years, who participated in the Tobago Cervical and Oral Cancer Screening Study. HHV-8 seropositivity was determined by a monoclonal immunofluorescence assay. Age-specific rates were compared to those previously observed in men. Logistic regression analyses were performed to determine the association between HHV-8 seropositivity and sexual behavior among the women. HHV-8 seroprevalence among Tobago women was 14.1% (95% CI, 10-19%), with no significant difference with men of similar age (P-value = 0.741). Age Assuntos
Anticorpos Antivirais/sangue
, Infecções por Herpesviridae/transmissão
, Herpesvirus Humano 8/imunologia
, Herpesvirus Humano 8/isolamento & purificação
, Estilo de Vida
, Comportamento Sexual
, Doenças Virais Sexualmente Transmissíveis/transmissão
, Adolescente
, Adulto
, Idoso
, Linhagem Celular
, Estudos Transversais
, Feminino
, Infecções por Herpesviridae/virologia
, Herpesvirus Humano 8/genética
, Humanos
, Masculino
, Pessoa de Meia-Idade
, Fatores de Risco
, Estudos Soroepidemiológicos
, Doenças Virais Sexualmente Transmissíveis/virologia
, Trinidad e Tobago/epidemiologia
, Adulto Jovem
RESUMO
Primary vesicoureteral reflux (VUR), one of the principal causes of chronic renal failure (CRF), occurs as a result of two distinct and sex-related mechanisms: congenital renal hypoplasia, which is prevalent in males, and acquired renal scarring in females. We used data from the ItalKid Project, a prospective population-based CRF registry of patients undergoing conservative treatment, to evaluate the gender distribution and severity of primary VUR, the age at diagnosis, and the diagnostic and therapeutic methods adopted in children with CRF. The prevalence of males (77.5%), the severity of VUR (grade IV-V), and the early age at diagnosis (18% prenatally) seem to suggest that congenital renal damage is the major cause of pediatric CRF.