RESUMO
INTRODUCTION:: Rare cancers are a challenge for clinical practice as well as for epidemiology and public health. Studies on this subject are few and limited to the study of cases with scarce epidemiologic information. This study aimed to evaluate the incidence of rare cancers and to compare the demographic, anatomic, and histologic characteristics of rare and nonrare (common) cancers. METHODS:: Incidence data were obtained from the Population-based Cancer Registry of São Paulo, Brazil. Rare neoplasms were those defined in the RARECARE list, which takes into account an incidence lower than 6/100,000/year. RESULTS:: In São Paulo, 20.4% of tumors had an incidence lower than 6/100,000/year from 1997 to 2012, being therefore considered as rare tumors. We identified 11 entities with an incidence greater than 6/100,000/year (common neoplasms) and 186 entities with an incidence lower than 6/100,000/year (rare neoplasms). The mean annual incidence of all cancers was 365 per 100,000 in São Paulo between 1997 and 2012, and the incidence of all rare tumors was 74.5 per 100,000. CONCLUSIONS:: This study presents the burden of rare cancers in Brazil. It is expected to be an incentive for further studies of these entities in order to know the epidemiologic profile of rare tumors in Brazil and to provide a more effective diagnostic and therapeutic approach.
Assuntos
Neoplasias/epidemiologia , Doenças Raras/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Criança , Pré-Escolar , Feminino , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Adulto JovemRESUMO
Cancer survival among people with AIDS (PWA) has been described in developed countries, but there is lack of data from developing countries. The aim of this study was to evaluate survival after cancer diagnosis in PWA and compare it with people without AIDS (non-PWA) in São Paulo, Brazil. A probabilistic record linkage was carried out between the databases of the Population-based Cancer Registry of São Paulo (PBCR-SP) and the AIDS registry of SP (SINAN) to identify PWA who developed cancer. For comparison, non-PWA were frequency matched from the PBCR-SP by cancer site/type, sex, age, and period. Hazard ratio (HR) stratified by matching variables was estimated using a Cox proportional hazards model. A total of 1,294 PWA (20 patients with two primary site tumors) were included in the site/type-specific analyses. AIDS-defining cancers (ADC) comprised 51.9% of cases assessed. The all-cancer 5-year overall survival in PWA was 49.4% versus 72.7% in non-PWA (HR = 2.64; 95%CI = 2.39-2.91). Survival was impaired in PWA for both ADC (HR = 2.93; 95%CI = 2.49-3.45) and non-ADC (HR = 2.51; 95%CI = 2.21-2.84), including bladder (HR = 8.11; 95% CI = 2.09-31.52), lung (HR = 2.93; 95%CI = 1.97-4.36) and anal cancer (HR = 2.53; 95%CI = 1.63-3.94). These disparities were seen mainly in the first year after cancer diagnosis. The overall survival was significantly lower in PWA in comparison with non-PWA in São Paulo, as seen in high-income countries. Efforts to enhance early diagnosis and ensure proper cancer treatment in PWA should be emphasized.
Assuntos
Síndrome da Imunodeficiência Adquirida/mortalidade , Síndrome da Imunodeficiência Adquirida/patologia , Neoplasias/mortalidade , Neoplasias/virologia , Adulto , Brasil/epidemiologia , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Sistema de RegistrosRESUMO
Previous studies have reported an increased risk for certain types of cancer in the HIV-infected population. The aim of this study was to assess the risk for cancer in people with AIDS (PWA) in comparison with the general population in São Paulo (Brazil), between 1997 and 2012. A population-based registry linkage study was carried out to assess the risk for cancer, using a standardized incidence ratio (SIR) approach. A total of 480 102 person-years, of which 337 941 (70.4%) person-years were men, were included in the analysis. Around 2074 cancer cases were diagnosed among PWA, of which 51.0% were non-AIDS-defining cancers (NADC). The risk for AIDS-defining cancers and NADC in the male population with AIDS was significantly higher than that in the general population (SIR=27.74 and 1.87, respectively), as it was in the female population with AIDS compared with the general population (SIR=8.71 and 1.44, respectively). Most virus-related NADC occurred at elevated rates among PWA: anal cancer (SIR=33.02 in men and 11.21 in women), liver (SIR=4.35 in men and 4.84 in women), vulva and vagina (SIR=6.78 in women) and Hodgkin lymphoma (SIR=5.84 in men and 2.71 in women). Lung (SIR=2.24 in men and 2.60 in women) and central nervous system (SIR=1.92 in men and 3.48 in women) cancers also occurred at increased rates. Cancer burden among PWA in São Paulo was similar to that described in high-income countries such as the USA and Italy following the introduction of the highly active antiretroviral therapy. As coinfection with oncogenic viruses disproportionally affects this population, virus-related cancers accounted for a great share of excessive cases.
Assuntos
Síndrome da Imunodeficiência Adquirida/complicações , Neoplasias/epidemiologia , Neoplasias/etiologia , Adulto , Brasil/epidemiologia , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Prognóstico , Sistema de Registros , Fatores de Risco , Fatores de TempoRESUMO
People living with AIDS are at increased risk of developing certain cancers. Since the introduction of the highly active antiretroviral therapy (HAART), the incidence of AIDS-defining cancers (ADCs) has decreased in high-income countries. The objective of this study was to analyse trends in ADCs and non-AIDS-defining cancers (NADCs) in HIV-positive people with a diagnosis of AIDS, in comparison to the general population, in São Paulo, Brazil. A probabilistic record linkage between the 'Population-based Cancer Registry of São Paulo' and the AIDS notification database (SINAN) was conducted. Cancer trends were assessed by annual per cent change (APC). In people with AIDS, 2074 cancers were diagnosed. Among men with AIDS, the most frequent cancer was Kaposi's sarcoma (469; 31.1%), followed by non-Hodgkin lymphoma (NHL; 304; 20.1%). A decline was seen for ADCs (APC = -14.1%). All NADCs have increased (APC = 7.4%/year) significantly since the mid-2000s driven by the significant upward trends of anal (APC = 24.6%/year) and lung cancers (APC = 15.9%/year). In contrast, in men from the general population, decreasing trends were observed for these cancers. For women with AIDS, the most frequent cancer was cervical (114; 20.2%), followed by NHL (96; 17.0%). Significant declining trends were seen for both ADCs (APC = -15.6%/year) and all NADCs (APC = -15.8%/year), a comparable pattern to that found for the general female population. Trends in cancers among people with AIDS in São Paulo showed similar patterns to those found in developed countries. Although ADCs have significantly decreased, probably due to the introduction of HAART, NADCs in men have shown an opposite upward trend.
Assuntos
Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Neoplasias/epidemiologia , Neoplasias/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia Antirretroviral de Alta Atividade , Brasil/epidemiologia , Comorbidade , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Incidência , Neoplasias Pulmonares/epidemiologia , Linfoma Relacionado a AIDS/epidemiologia , Linfoma não Hodgkin/epidemiologia , Masculino , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Fatores de Risco , Sarcoma de Kaposi/epidemiologia , Adulto JovemRESUMO
As condições de vida em que um adolescente se desenvolve determinam suas escolhas e influenciam sua vida sexual. O presente estudo visou caracterizar o cotidiano e vida sexual de 108 adolescentes entre 11 e 15 anos de idade, residentes em Serra Pelada, município de Curionópolis, PA, através de análise quantitativa e qualitativa de dados, diferenciando-os quanto ao gênero. Os resultados mostraram a forte presença das relações de gênero em alguns casos. Foi encontrada alguma relação entre religião e vida sexual somente no sexo feminino, em que se observa que 58,5% delas eram adeptas a alguma religião e 66,7% não haviam iniciado a vida sexual aos 12 anos ou menos. Quando questionados se mantinham, ou não, relações sexuais enquanto namoravam, 93,6% das meninas afirmaram que não, enquanto 59,6% dos meninos disseram o mesmo, mostrando que as meninas evitam mais a relação sexual. A grande maioria das meninas afirmou ter feito uso de método para evitar filho na primeira relação, enquanto mais de 50% dos meninos afirmaram o contrário. Essa diferença reflete que a responsabilidade da contracepção é julgada como pertencente ao sexo feminino. Cerca de 70% das meninas afirmam ter a intenção de se casar com a pessoa com quem tem relação sexual atualmente, enquanto 60% dos meninos afirmam o contrário, o que mostra que as meninas se mostram mais receosas quanto a ter filho cedo, em relação aos garotos, e mostram-se mais abertas ao compromisso(AU)
The life conditions in which an adolescent develops determine his choices and influence his sexual life. The present study aimed to characterize the daily activities and sexual life of 108 adolescents aged between 11 and 15 years, living in Serra Pelada, a municipality of Curion¢polis, state of Par , through a quantitative and qualitative data analysis, distinguishing them according to gender. Results showed the strong presence of gender relations in some cases. Some relation was found between religion and sexual life only in the female sex: 58.5 percent of them followed some religion and 66.7 percent had not initiated sexual life at the age of 12 or below. When the adolescents were asked whether they had sexual intercourse with their boyfriends or girlfriends, 93.6 percent of the girls answered they did not, while 59.6 percent of the boys answered the same, showing that the girls avoid more the sexual intercourse. The great majority of the girls stated they used a contraceptive method in the first intercourse, while more than 50 percent of the boys said the opposite. This difference reveals that the responsibility for contraception is deemed as belonging to the female sex. Approximately 70 percent of the girls state they intend to marry the person with whom they are currently having sexual intercourse, while 60 percent of the boys say the opposite, which shows that the girls are more afraid to have children early, and more open to commitments.(AU)
RESUMO
As condições de vida em que um adolescente se desenvolve determinam suas escolhas e influenciam sua vida sexual. O presente estudo visou caracterizar o cotidiano e vida sexual de 108 adolescentes entre 11 e 15 anos de idade, residentes em Serra Pelada, município de Curionópolis, PA, através de análise quantitativa e qualitativa de dados, diferenciando-os quanto ao gênero. Os resultados mostraram a forte presença das relações de gênero em alguns casos. Foi encontrada alguma relação entre religião e vida sexual somente no sexo feminino, em que se observa que 58,5 porcento delas eram adeptas a alguma religião e 66,7 porcento não haviam iniciado a vida sexual aos 12 anos ou menos. Quando questionados se mantinham, ou não, relações sexuais enquanto namoravam, 93,6 porcento das meninas afirmaram que não, enquanto 59,6 porcento dos meninos disseram o mesmo, mostrando que as meninas evitam mais a relação sexual. A grande maioria das meninas afirmou ter feito uso de método para evitar filho na primeira relação, enquanto mais de 50 porcento dos meninos afirmaram o contrário. Essa diferença reflete que a responsabilidade da contracepção é julgada como pertencente ao sexo feminino. Cerca de 70 porcento das meninas afirmam ter a intenção de se casar com a pessoa com quem tem relação sexual atualmente, enquanto 60 porcento dos meninos afirmam o contrário, o que mostra que as meninas se mostram mais receosas quanto a ter filho cedo, em relação aos garotos, e mostram-se mais abertas ao compromisso.
The life conditions in which an adolescent develops determine his choices and influence his sexual life. The present study aimed to characterize the daily activities and sexual life of 108 adolescents aged between 11 and 15 years, living in Serra Pelada, a municipality of Curionópolis, state of Pará, through a quantitative and qualitative data analysis, distinguishing them according to gender. Results showed the strong presence of gender relations in some cases. Some relation was found between religion and sexual life only in the female sex: 58.5% of them followed some religion and 66.7% had not initiated sexual life at the age of 12 or below. When the adolescents were asked whether they had sexual intercourse with their boyfriends or girlfriends, 93.6% of the girls answered they did not, while 59.6% of the boys answered the same, showing that the girls avoid more the sexual intercourse. The great majority of the girls stated they used a contraceptive method in the first intercourse, while more than 50% of the boys said the opposite. This difference reveals that the responsibility for contraception is deemed as belonging to the female sex. Approximately 70% of the girls state they intend to marry the person with whom they are currently having sexual intercourse, while 60% of the boys say the opposite, which shows that the girls are more afraid to have children early, and more open to commitments.