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INTRODUCTION: The association between socioeconomic status and cancer prognosis has been demonstrated in several countries. Despite the existence of indirect evidence of this phenomenon in Brazil, few studies in this regard are available. OBJECTIVES: The objective of the present study is to analyse socioeconomic related survival gaps for patients diagnosed with breast, cervical, lung, prostate, and colorectal cancer in the cities of Aracaju (SE) and Curitiba (PR). METHODS: Using population-based data, we estimated net survival by tumour site, year of diagnosis, socioeconomic status and local of residence. Net survival estimation was done with multilevel parametric model allowing flexible spline functions do estimate excess mortality hazards. RESULTS: 28,005 cases were included in survival analysis. Five-year net survival showed positive association with SES. Intermunicipal survival gaps favouring Aracaju where prominent for breast (reaching 16,1% in 5 years) OBJECTIVES: Study the impact of socioeconomic factors on cancer survival in two Brazilian capitals. METHODS: Survival analysis using population-based cancer data including patients diagnosed with breast, lung, prostate, cervical and colorectal cancer between 1996 and 2012 in Aracaju and Curitiba. Outcomes were excessive mortality hazard (EMH) and 5- and 8-years net survival (NS). The association of race/skin color and socioeconomic level (SES) with EMH and net survival were analyzed using a multilevel regression model with flexible splines. RESULTS: 28,005 cases were included, 6636 from Aracaju and 21,369 from Curitiba. NS for all diseases studied increased more prominently for Curitiba population. We observed NS gap between the populations of Aracaju and Curitiba that increased or remained stable during the study period, with emphasis on the growth of the difference in NS of lung and colon cancer (among men). Only for cervical cancer and prostate cancer there was a reduction in the intermunicipal gaps. 5-year NS for breast cancer in Aracaju ranged from 55.2% to 73.4% according to SES. In Curitiba this variation was from 66.5% to 83.8%. CONCLUSION: The results of the present study suggests widening of socioeconomic and regional inequalities in the survival of patients with colorectal, breast, cervical, lung and prostate cancers in Brazil during the 1990 s and 2000 s.

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Dietary acid load (DAL) is recognized as a risk factor for several chronic disorders, including obesity, diabetes, and osteoporosis. Recent evidence suggests that an elevated DAL, as measured by the validated potential renal acid load (PRAL) and net endogenous acid production (NEAP) scores, could also increase the risk for several cancers. This narrative review summarizes the potential role of DAL in Uruguayan cancer patients and outlines the potentially involved pathophysiological pathways that mediate the role of DAL in both cancer development and growth. Although Uruguay is a developing country, its average diet is a heavily meat-based Western one, translating into a supraphysiological acid burden from diet. In recent years, we have published epidemiologic evidence based on ten case-control studies involving 3736 cancer cases and 9534 hospital-based controls. Odds ratios and 95% confidence intervals were estimated for each interest variable to analyze the association between the exposure levels of DAL scores and cancer, calculated by unconditional logistic regression. In a majority of the cases, the highest DAL scores tended to double the cancer risk as compared to the lowest category. We also found high risks for methionine intake, an acidifying amino acid found in higher concentrations in animal-based foods, which may increase cancer risks at least by a joint action based on the pH and the proliferation enhancing properties of the amino acid itself.

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BACKGROUND: Increased global cancer incidence rates have led to a growing demand for cancer diagnosis and treatment, as well as basic and clinical research on the subject. The expansion of clinical cancer trials beyond the borders of highly developed countries has aided the arrival of these assessments in South American countries. In this context, this study's objective is to highlight clinical cancer trial profiles developed and sponsored by pharmaceutical companies and conducted in South American countries from 2010 to 2020. METHODS: This study comprises descriptive and retrospective research conducted following a search for clinical trials (phases I, II and III), registered at clinicaltrials.gov, carried out in Latin American countries and sponsored by pharmaceutical companies ("Argentina", "Brazil", "Chile", "Peru", "Colombia", "Ecuador", "Uruguay", "Venezuela", "Paraguay", "Bolivia"), registered between 1 January 2010 and 31 December 2020. A total of 1451 clinical trials were retrieved, of which 200 trials unrelated to cancer were excluded and 646 duplicates were removed, leading to a final total of 605 clinical trials employing qualitative and quantitative analyses. RESULTS: A 122% increase in the number of clinical trial registrations from 2010 to 2020 was noted, with a prevalence of phase III studies (431 trials of a total of 605). Lung (119), breast (100), leukemia (42), prostate (39) and melanoma (32) were the main cancers tested for new drugs. CONCLUSIONS: The data reported herein indicate the need for strategic basic and clinical research planning that considers South American epidemic cancer profiles.

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OBJECTIVE: To assess the hypothesis that plexiform neurofibroma (PN) growth rates increase during puberty. STUDY DESIGN: PN growth rates before and during puberty were compared in a retrospective cohort of children with neurofibromatosis type 1 with puberty defined by Tanner staging. Of 33 potentially eligible patients, 25 had adequate quality magnetic resonance imaging for volumetric analysis and were included in ≥1 anchor cohort. Volumetric analysis was performed for all available imaging studies within the 4 years before and after puberty, and before and after 9- and 11-year-old anchor scans. Linear regression was performed to estimate the slope of change (PN growth rate); growth rates were compared with paired t test or Wilcoxon matched-pairs signed rank test. RESULTS: There were no significant difference in rates of PN growth in milliliters per month or milliliters per kilogram per month in the prepubertal vs pubertal periods (mean, 1.33 ± 1.67 vs 1.15 ± 1.38 [P = .139] and -0.003 ± 0.015 vs -0.002 ± 0.02 [P = .568]). Percent increases of PN volumes from baseline per month were significantly higher prepubertally (1.8% vs 0.84%; P = .041) and seemed to be related inversely to advancing age. CONCLUSIONS: Puberty and its associated hormonal changes do not seem to influence PN growth rate. These findings support those previously reported, but from a typical population of children with neurofibromatosis type 1 with puberty confirmed by Tanner staging.

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The global burden of cancer is on the rise, with varying national patterns. To gain a better understanding and control of cancer, it is essential to provide national estimates. Therefore, we present a comparative description of cancer incidence and mortality rates in Mexico from 1990 to 2019, by age and sex for 29 different cancer groups. Based on public data from the Global Burden of Disease Study 2019, we evaluated the national burden of cancer by analyzing counts and crude and age-standardized rates per 100,000 people with 95% uncertainty intervals for 2019 and trends using the annual percentage change from 1990 to 2019. In 2019, cancer resulted in 222,060 incident cases and 105,591 deaths. In 2019, the highest incidence of cancer was observed in non-melanoma skin cancer, prostate cancer, and breast cancer. Additionally, 53% of deaths were attributed to six cancer groups (lung, colorectal, stomach, prostate, breast, and pancreatic). From 1990 to 2019, there was an increasing trend in incidence and mortality rates, which varied by 10-436% among cancer groups. Furthermore, there were cancer-specific sex differences in crude and age-standardized rates. The results show an increase in the national cancer burden with sex-specific patterns of change. These findings can guide national efforts to reduce health loss due to cancer.

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OBJECTIVE: To evaluate the completeness and consistency of data from hospital-based cancer registries (HCRs) in a Brazilian state. METHODS: This retrospective descriptive study was based on secondary data from an HCR in the state of Espírito Santo (ES) between 2010 and 2017. The data were collected between August and November 2020 by the ES State Health Department (SESA/ES). Cancer data were obtained from the HCR of ES using the tumor registration form of the Brazilian Hospital Cancer Registry Integrator and complete databases within the SESA/ES. The incompleteness of the data was classified as excellent (<5%), good (between 5% and 10%), regular (between 10% and 20%), poor (between 20% and 50%), and very poor (>50%), according to the percentage of the absence of information. Descriptive statistical analyses were performed using Statistical Package for the Social Sciences (SPSS® Inc., Chicago, IL, USA) version 20.0. RESULTS: Complete data were observed for the variables of sex, date of the first hospital visit, and histological type of the primary tumor; that is, there were no missing data. Most epidemiological variables, including age, origin, date of first tumor diagnosis, previous diagnosis and treatment, location of the primary tumor, first treatment received at the hospital, date of death of the patient, and probable location of the primary tumor, were classified as having excellent completeness throughout the study period. However, the variables schooling, smoking, alcohol consumption, occupation, family history of cancer, and clinical staging of the tumor were classified as poor. CONCLUSION: Most epidemiological variables from the HCR in the state of ES, Brazil, showed excellent completeness. It is essential to elucidate the sociodemographic and clinical variables of epidemiological importance for a better understanding of the health-disease process.

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In 2019, the Global Burden of Disease (GBD) estimated that prostate cancer (PC) was the 16th most common cause of death globally in males. In Mexico, PC epidemiology has been studied by a number of metrics and over various periods, although without including the most up-to-date estimates. Herein, we describe and compare the burdens and trends of PC in Mexico and its 32 states from 2000 to 2019. For this study, we extracted online available data from the GBD 2019 to estimate the crude and age-standardized rates (ASR per 100,000 people) of the incidence and mortality of PC. In Mexico, PC caused 27.1 thousand (95% uncertainty intervals, 20.6-36.0 thousand) incident cases and 9.2 thousand (7.7-12.7 thousand) deaths in males of all ages in 2019. Among the states, Sinaloa had the greatest ASR of incidence, and Guerrero had the highest mortality. The burden of PC showed an increasing trend, although the magnitude of change differed between metrics and locations. We found both an increasing national trend and subnational variation in the burden of PC. Our results confirm the need for updated and timely estimates to design effective diagnostic and treatment campaigns in locations where the burden of PC is the highest.

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Background: A one-third reduction in premature mortality (30-69 years) from chronic noncommunicable diseases is goal 3.4 of the United Nations Sustainable Development Goals (UN SDG). The burden of NCDs is expected to continue to increase in low- and middle-income countries, including Brazil. Objectives: The aim of this study was to assess geographical and temporal patterns in premature cancer mortality in Brazil between 2001 and 2015 and to predict this to 2030 in order to benchmark against the 3.4 SDG target. Methods: We used data on deaths from cancer in those aged 30-69, by age group, sex and cancer site, between 2001 and 2015 from the National Mortality Information System of Brazil (SIM). After correcting for ill-defined causes, crude and world age-standardised mortality rates per 100,000 inhabitants were calculated nationally and for the 5 regions. Predictions were calculated using NordPred, up to 2030. Results: The difference in observed (2011-2015) and predicted (2026-2030) mortality was compared against the SDG 3.4 target. Between 2011-2015 and 2026-2030 a 12.0% reduction in premature cancer age-standardised mortality rate among males and 4.6% reduction among females is predicted nationally. Across regions this varied from 2.8% among females in North region to 14.7% among males in South region. Lung cancer mortality rates are predicted to decrease among males but not among females nationally (men 28%, females 1.1% increase) and in all regions. Cervical cancer mortality rates are projected to remain very high in the North. Colorectal cancer mortality rates will increase for both sexes in all regions except the Southeast. Conclusions and recommendation: Cancer premature mortality is expected to decrease in Brazil, but the extent of the decrease will be far from the SDG 3.4 target. Nationally, only male lung cancer will be close to reaching the SDG 3.4 target, reflecting the government's long-term efforts to reduce tobacco consumption. Projected colorectal cancer mortality increases likely reflect the epidemiological transition. This and, cervical cancer control will continue to be major challenges. These results will help inform strategic planning for cancer primary prevention, early detection and treatment programs; such initiatives should take cognizance of the regional differences highlighted here.

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OBJECTIVE: To study the impact of socio-economic status and ethno-racial strata on excess mortality hazard and net survival of women with breast cancer in two Brazilian state capitals. METHOD: We conducted a survival analysis with individual data from population-based cancer registries including women with breast cancer diagnosed between 1996 and 2012 in Aracaju and Curitiba. The main outcomes were the excess mortality hazard (EMH) and net survival. The associations of age, year of diagnosis, disease stage, race/skin colour and socioeconomic status (SES) with the excess mortality hazard and net survival were analysed using multi-level spline regression models, modelled as cubic splines with knots at 1 and 5 years of follow-up. RESULTS: A total of 2045 women in Aracaju and 7872 in Curitiba were included in the analyses. The EMH was higher for women with lower SES and for black and brown women in both municipalities. The greatest difference in excess mortality was seen between the most deprived women and the most affluent women in Curitiba, hazard ratio (HR) 1.93 (95%CI 1.63-2.28). For race/skin colour, the greatest ratio was found in Curitiba (HR 1.35, 95%CI 1.09-1.66) for black women compared with white women. The most important socio-economic difference in net survival was seen in Aracaju. Age-standardised net survival at five years was 55.7% for the most deprived women and 67.2% for the most affluent. Net survival at eight years was 48.3% and 61.0%, respectively. Net survival in Curitiba was higher than in Aracaju in all SES groups." CONCLUSION: Our findings suggest the presence of contrasting breast cancer survival expectancy in Aracaju and Curitiba, highlighting regional inequalities in access to health care. Lower survival among brown and black women, and those in lower SES groups indicates that early detection, early diagnosis and timely access to treatment must be prioritized to reduce inequalities in outcome among Brazilian women.

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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.

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BACKGROUND: The main evidence regarding social inequalities in cancer risk comes from industrialized countries. The aim of this manuscript was to analyze the association between cancer incidence and socioeconomic position (SEP) in a middle-income country (Costa Rica) between 2011 and 2015. METHODS: An ecological study at the level of the electoral district was conducted. The 477 districts were divided by area and wealth using the 2011 Census. The sample was defined using the National Electoral Rolls used for presidential elections of 2006 and 2010 (N = 2 798 517). 44 799 cancer cases were included coming from the Costa Rican Cancer Registry. Cox models were used. RESULTS: All cancer sites combined, we observed a positive gradient, with incidence being lower in the poorest districts than in the wealthiest (HRQ2 = 0.98 [0.93-1.03], HRQ3 = 0.92 [0.85-0.99], HRQ4 = 0.83 [0.77-0.88]). For colon, skin, breast, prostate, thyroid and other cancer sites, a positive social gradient was observed. For stomach, lung, and cervical (invasive or in-situ) cancers, a negative social gradient was found. For uterine cancer and lymphoma (no-Hodgkin), there was no significant relationship between wealth and incidence. For skin cancer, incidence was higher in rural as compared to urban areas after adjustment for wealth. For lung, cervical and uterine cancer, incidence was lower in rural as compared to urban area after adjustment for wealth. CONCLUSIONS: The all-cancer combined results were in contradiction with the international literature but confirmed recent study results in Costa Rica. It confirmed the importance of studying socioeconomic inequalities in middle-income countries.

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BACKGROUND: The first large-scale genome-wide association study of gallbladder cancer (GBC) recently identified and validated three susceptibility variants in the ABCB1 and ABCB4 genes for individuals of Indian descent. We investigated whether these variants were also associated with GBC risk in Chileans, who show the highest incidence of GBC worldwide, and in Europeans with a low GBC incidence. METHODS: This population-based study analysed genotype data from retrospective Chilean case-control (255 cases, 2042 controls) and prospective European cohort (108 cases, 181 controls) samples consistently with the original publication. RESULTS: Our results confirmed the reported associations for Chileans with similar risk effects. Particularly strong associations (per-allele odds ratios close to 2) were observed for Chileans with high Native American (=Mapuche) ancestry. No associations were noticed for Europeans, but the statistical power was low. CONCLUSION: Taking full advantage of genetic and ethnic differences in GBC risk may improve the efficiency of current prevention programs.

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Socioeconomic inequalities in cancer mortality have been described for a range of cancers sites worldwide, using diverse measures of socioeconomic position (SEP). These studies have shown a negative social gradient where lower SEP was associated with greater odds of having cancer, particularly in men. However, there is a lack of information regarding low and middle-income countries. The objective of our study was to analyze the relationship between the socioeconomic characteristics of patients' residential districts and mortality due to cancer in Costa Rica between 2011 and 2017. An ecological study at the level of the district of residence was conducted using the multilevel mixed-effects Poisson regression. All cancer-caused deaths between January 1, 2011 and December 31, 2017 were included (n = 32,117). Eleven cancer sites were analyzed independently. The 477 Costa Rican districts were divided by area (urban/mixed/rural) and wealth using census data. All-cancer combined a significant association between cancer mortality and wealth was found. Cancer mortality was lower in the poorest as compared to the richest districts (IRRQ4 = 0.79 [0.73-0.86]). The majority of cancer sites followed a similar pattern, showing a positive social gradient. These results contradict the international literature mostly conducted in high-income countries. These findings confirmed the importance of conducting studies in middle-income countries, since the socioeconomic and cultural contexts are different from those in high-income countries, which influence the social distribution of lifestyles and risk behaviors.

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OBJECTIVES: Delivering health care timely and geographically accessible are determining factors for the prognosis of children with cancer. This study analyzed geographic access and timeliness to diagnostic services in Colombia. METHODS: In this Colombian national childhood cancer database-based study, patients and their diagnostic facilities were individually and separately space positioned. Distances between the household to the diagnostic facility, and between the clinical date of suspicion and diagnosis were determined. Using exploratory data analysis, we obtained a probability density function (lambda), which expressed a correlation percentage between the residential location of the patient and either travel time or timeliness of treatment. RESULTS: 27 % of the sample of 731 patients had access to diagnostic centres in less than 30 min. The travel-distance to diagnostic centres was lowest in the Caribe and Andina Regions (43 % and 32 % distances up to 30 km respectively). However, in Amazonía and Orinoquía Regions, 87 % and 81 % had to travel more than 90 km - representing very long travel times. For more than 23 % of patients, time to diagnosis was more than 90 days, in Orinoquía, this was above 90 days for 1/3 of patients. Despite relatively short travel distances in the Caribe-Region, for 61 % time to diagnosis exceeded 30 days. CONCLUSIONS: This study identified clear shortcomings in the Colombian Health System related to the quality of childhood cancer-related health care in terms of timeliness, cancer networks, and geographic access. These inequities not only depend on sociodemographic-characteristics and should be intervened upon.

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BACKGROUND AND OBJECTIVES: Imprisoned women have higher rates of abnormalities at cervical screening and some studies suggest that cervical cancer is the most common cancer in this population. The aim of this work was to summarise the current evidence on the prevalence of human papilloma virus (HPV) infection, cervical cancer and precancerous lesions in women in prison worldwide and to compare these rates with the general population. METHODS: We systematically searched and reviewed published and unpublished data reporting the prevalence of any HPV infection, cervical intraepithelial neoplasia (CIN) and cervical cancer in imprisoned women. We created forest plots with prevalence estimates from studies with comparable outcomes and of prevalence ratios using data from national screening programmes as a comparison group. FINDINGS: A total of 53 533 imprisoned women from 10 countries and 35 studies were included in the review. The prevalence of HPV among prisoners ranged from 10.5% to 55.4% with significant heterogeneity. The prevalence of CIN diagnosed by cytology in prisoners ranged from 0% to 22%. Ratios comparing the prevalence of CIN in imprisoned women to that in the community ranged from 1.13 to 5.46. Cancer prevalence estimates were at least 100 times higher than in populations participating in national screening programmes. CONCLUSION: Imprisoned women are at higher risk of cervical cancer than the general population. There is a high prevalence of HPV infection and precancerous lesions in this population. Targeted programmes for control of risk factors and the development of more effective cervical screening programmes are recommended. PROSPERO REGISTRATION NUMBER: CRD42014009690.

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O carcinoma espinocelular (CEC) é a neoplasia maligna mais comum da boca e orofaringe, correspondendo ao quinto tipo de câncer mais comum entre os homens no Brasil, assim como na região sudeste. É considerado um problema de saúde pública, principalmente porque a maioria dos pacientes é diagnosticada em estágio avançado da doença, implicando em morbidade e mortalidade significativas. Muito embora os avanços no diagnóstico e tratamento de diversos tipos de câncer resultarem em prevenção, diagnóstico precoce e aumento de sobrevida, para o CEC de boca e orofaringe não são observadas melhorias dos indicadores epidemiológicos ao longo do tempo. O objetivo do presente trabalho foi descrever o perfil dos pacientes provenientes da Serviço Público de Saúde do município do Rio de Janeiro diagnosticados com câncer de boca e orofaringe no Laboratório de Patologia Oral da Faculdade de Odontologia da UFRJ no período de Janeiro de 2013 a Dezembro de 2019. Os seguintes dados foram coletados das fichas de requisição do exame histopatológico: sexo, idade, hábitos/ tabagismo e etilismo, tempo de evolução da lesão, localização da lesão, bairro de residência do paciente, área programática da residência do paciente e área programática da Unidade de Saúde. Um total de 438 pacientes foi incluído no estudo de acordo com os critérios estabelecidos. Em relação ao sexo, houve um predomínio do sexo masculino (74%), sendo a faixa etária mais acometida a de 60 a 69 anos (40,6%), com média de idade de 63 anos. A maioria dos pacientes era tabagista (56,4%) e 39,7% dos pacientes eram etilistas, embora esta informação estivesse ausente em muitas fichas (41,8%). O tempo de evolução da maioria das lesões foi de 1 a 3 meses (37,7%) e a língua móvel foi a localização anatômica mais frequente (34,7%), seguida da orofaringe (18,9%). O bairro de Santa Cruz apresentou o maior número de pacientes (7,1%) e a área programática de maior incidência de casos diagnosticados de CEC foi a AP 3.1 com 32,2% das biópsias sendo realizadas em unidades de saúde desta região. Os estudos epidemiológicos são de grande relevância para que se possa estimar a magnitude do problema em uma determinada região e caracterizar o perfil dos pacientes acometidos. Os resultados do presente trabalho poderem contribuir para a elaboração de políticas de saúde mais intensas direcionadas aos grupos mais afetados e às áreas de maior frequência da doença na cidade do Rio de Janeiro. (AU)

Squamous cell carcinoma (SCC) is the most commom malignant neoplasm of the mouth and oropharynx, corresponding to the fifth most common type of cancer among men in Brazil, as well as in the southeast region. It is considered a public health problem, mainly because most patients are diagnosed at an advanced stage of the disease, resulting in significant morbidity and mortality. Although advances in the diagnosis and treatment of several types of cancer result in prevention, early diagnosis and increased survival, for SCC of the mouth there are no improvements in epidemiological indicators over time. The aim of this study was to describe the profile of the patients from the Public Health Network of the Rio de Janeiro diagnosed with oral cancer at the Pathology Laboratory of the Faculty of Dentistry at UFRJ in the period from January 2013 to December 2019. The following data were collected from the request forms for the histopathological examination: sex, age, habits/ smoking and drinking, time of the evolution of the lesion, location of the lesion, neighborhood of the patient's residence, programmatic area of the patient's residence and programmatic area of the Health Unit. A total of 438 patients were found according to the established inclusion criteria. Regarding gender, there was a predominance of males (74%), the most affected age group was 60 to 69 years (40,6%), most patients were smokers (56,4%) and 39,7% of the patients were alcoholic, although most of the forms did not provide this information (41,8%). The time for the evolution of most injuries was 1 to 3 months (37,7%), the mobile tongue was the most frequent anatomical location (34,7%), followed by the oropharynx (18,9%), the neighborhood of Santa Cruz showed the highest number of cases (7,1%) and programmatic area of greatest incidence for the diagnosis of SCC was AP 3.1 with 32,2% of the biopsies being performed in health units in this region. Epidemiological studies are of great relevance in order to estimate the magnitude of the problem in given region and to characterize the profile of affected patients. The results of this study can contribute to the development of more intense health policies aimed at the most affected groups and areas of higher frequency of the disease in the city of Rio de Janeiro. (AU)

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A cross-sectional, retrospective cohort study was carried out to describe the profile of breast cancer patients aged 40 years or less diagnosed and treated at the CECON/FCECON Foundation from 2003 to 2013. The following were evaluated: age, staging, place of origin and diagnostic accuracy, through search of records in patients' records. Data were computed in a database and analyzed through descriptive statistics. There were 211 patients under 40 years with breast cancer in the study period, representing 9.83%. The most affected age group was between 35 and 40 years. Regarding clinical staging, 57 cases were at stage IIA at diagnosis. About the method of screening, 71 patients performed it through clinical examination or self-examination and, in relation to the provenance, 48 cases were from other states. It is necessary to improve diagnosis in this age group and that the institutional care be directed to the patients of their original states

Um estudo de coorte retrospectivo, de corte transversal, foi realizado para descrever o perfil de pacientes com câncer de mama com 40 anos ou menos diagnosticados e tratados na Fundação CECON/FCECON de 2003 a 2013. Foram avaliados: idade, estadiamento, local de origem e acurácia diagnóstica, através da busca de registros nos prontuários dos pacientes. Os dados foram computados em um banco de dados e analisados por meio de análise estatística descritiva. Havia 211 pacientes com menos de 40 anos com câncer de mama no período do estudo, representando 9,83%. A faixa etária mais afetada foi entre 35 e 40 anos. Em relação ao estadiamento clínico, 57 casos estavam no estágio IIA no momento do diagnóstico. Sobre o método de triagem, 71 pacientes realizaram o exame clínico ou o autoexame, e em relação à procedência, 48 casos foram de outros estados. É necessário melhorar o diagnóstico nessa faixa etária e direcionar o cuidado institucional seja aos pacientes de seus estados originais.

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PURPOSE: The third most frequently diagnosed cancer in Europe in 2018 was lung cancer; it is also the leading cause of cancer death in Europe. We studied patient and tumor characteristics, and patterns of healthcare provision explaining regional variability in lung cancer survival in southern Spain. METHODS: A population-based cohort study included all 1196 incident first invasive primary lung cancer (C33-C34 according to ICD-10) cases diagnosed between 2010 and 2011 with follow-up until April 2015. Data were drawn from local population-based cancer registries and patients' hospital medical records from all public and private hospitals from two regions in southern Spain. RESULTS: There was evidence of regional differences in lung cancer late diagnosis (58% stage IV in Granada vs. 65% in Huelva, p value < 0.001). Among patients with stage I, only 67% received surgery compared with 0.6% of patients with stage IV. Patients treated with a combination of radiotherapy, chemotherapy, and surgery had a 2-year mortality risk reduction of 94% compared with patients who did not receive any treatment (excess mortality risk 0.06; 95% CI 0.02-0.16). Geographical differences in survival were observed between the two regions: 35% vs. 26% at 1-year since diagnosis. CONCLUSIONS: The observed geographic differences in survival between regions are due in part to the late cancer diagnosis which determines the use of less effective therapeutic options. Results from our study justify the need for promoting lung cancer early detection strategies and the harmonization of the best practice in lung cancer management and treatment.

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Cancer control is a wider concept than oncology, and includes comprehensive actions for prevention, early diagnosis, treatment, services organization, and education, aiming to modify hard indicators such as incidence, mortality rates, and survival at a population scale. Based on these concepts, organized national cancer programs appeared in several countries in the second half of the 20th century. But at the same time, scientific efforts began to modify the landscape of cancer control. Evidence of mortality reductions began to appear, cancer-driving mutations became measurable, many novel drugs were registered, the methodology of clinical trials spread through health systems, targeted drugs and immunotherapy entered into the mainstream of therapeutics, and treatment goals started to shift from cure to chronic control. The implementation and impact of organized interventions for cancer control show variations according to the context of diverse countries, and scientists and health decision makers can learn from studying these diverse experiences. Among the salient features of cancer control in Cuba are the simultaneous development of a primary care network with abundant human resources and a national biotechnology industry with capacity to provide both generic and innovating drugs and diagnostic systems. The program intentionally assumes the goal of accelerating the transformation of advanced cancer into a chronic disease susceptible of long-term control. The implications of this strategy for population interventions and for scientific research are discussed.

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