Methodologies used to estimate tobacco-attributable mortality: a review

<p>Abstract</p> <p>Background</p> <p>One of the most important measures for ascertaining the impact of tobacco on a population is the estimation of the mortality attributable to its use. To measure this, a number of indirect methods of quantification are available, yet there is no consensus as to which furnishes the best information. This study sought to provide a critical overview of the different methods of attribution of mortality due to tobacco consumption.</p> <p>Method</p> <p>A search was made in the Medline database until March 2005 in order to obtain papers that addressed the methodology employed for attributing mortality to tobacco use.</p> <p>Results</p> <p>Of the total of 7 methods obtained, the most widely used were the prevalence methods, followed by the approach proposed by Peto et al, with the remainder being used in a minority of studies.</p> <p>Conclusion</p> <p>Different methodologies are used to estimate tobacco attributable mortality, but their methodological foundations are quite similar in all. Mainly, they are based on the calculation of proportional attributable fractions. All methods show limitations of one type or another, sometimes common to all methods and sometimes specific.</p

Conhecimento e prática sobre os fatores de risco para o câncer de mama entre mulheres de 40 a 69 anos Knowledge of and practices regarding risk factors for breast cancer in women aged between 40 and 69 years

OBJETIVO: investigar conhecimento e prática sobre os fatores de risco para o câncer de mama entre usuárias da Estratégia de Saúde da Família (ESF). MÉTODOS: estudo transversal com 393 mulheres com idades entre 40 e 69 anos usuárias da ESF na cidade de Dourados, MS. Realizou-se uma entrevista, por meio de um questionário semi-estruturado, investigando-se variáveis sociodemográficas, história familiar e conhecimento/prática sobre os fatores de risco para o câncer de mama. A descrição das variáveis foi feita através de frequência simples e porcentagem. A associação do conhecimento sobre os fatores de risco e as variáveis foram verificadas pelo teste exato de Fisher e qui-quadrado com nível de significância de 5%. RESULTADOS: a idade média foi de 52,5 ± 8,1 anos, o tempo médio de estudo foi de 4,4±3,6 anos, 52,4% das mulheres eram pardas/negras e 66,6% possuiam companheiro. Entre as mulheres, 86,5% receberam alguma informação sobre o câncer de mama. Os fatores de risco para a doença eram conhecidos por 54,2% das mulheres. O conhecimento sobre os fatores de risco associou-se com a história familiar (p=0,004) e anos de estudo (p=0,01). Diante dos fatores de risco conhecidos, a frequência de práticas preventivas entre as mulheres foi de 52,2%. CONCLUSÕES: a identificação de variáveis relacionadas a um menor conhecimento sobre a doença pode auxiliar na adoção de estratégias direcionadas aos grupos mais vulneráveis.<br>OBJECTIVES: to investigate knowledge of and practices regarding risk factors for breast cancer among users of the Family Health Strategy (FHS). METHODS: a cross-sectional study was carried out among 393 women aged between 40 and 69 years using the FHS in the city of Dourados, in the Brazilian State of Mato Grosso do Sul. An interview was conducted using a semi-structured questionnaire to investigate socio-demographic variables, family history and awareness/practices regarding the risk factors for breast cancer. The variables were described using simple frequency and a percentage. The association between awareness of the risk factors and the variables was confirmed using Fisher's exact test and the chi-square with a level of significance of 5%. RESULTS: the mean age was 52.5 ± 8.1 years, the mean years of schooling was 4.4±3.6 years, 52.4% of the women were black/colored and 66.6% had a partner. Of the women, 86.5% had received some information on breast cancer. The risk factors for the disease are known by 54.2% of the women. Awareness of the risk factors was associated with family history (p=0.004) and years of schooling (p=0.01). Where the risk factors were known, 52.2% of the women took preventive measures. CONCLUSION: the identification of variables related to greater awareness of the disease may facilitate the adoption of strategies aimed at the most vulnerable groups

The fraction of breast cancer attributable to smoking: The Norwegian women and cancer study 1991–2012

Background: Results from several recent cohort studies on smoking and breast cancer incidence and mortality suggest that the burden of smoking on society is underestimated. We estimated the fraction of breast cancer attributable to smoking in the Norwegian Women and Cancer Study, a nationally representative prospective cohort study. Methods: We followed 130 053 women, aged 34–70 years, who completed a baseline questionnaire between 1991 and 2007, through linkages to national registries through December 2012. We used Cox proportional hazards models to estimate hazard ratios (HRs) with 95% confidence intervals (CIs), while adjusting for confounders. Never smokers, excluding passive smokers, were used as the reference group in all main analyses. We estimated attributable fractions (AFs) % in smokers and in the population (PAFs) % with 95% CIs. Results: Altogether, 4132 women developed invasive breast cancer, confirmed by histology. Compared with never active, never passive smokers, ever (former and current) smokers had an overall risk of breast cancer that was 21% higher (HR¼1.21; 95% CI¼1.08–1.34). For ever smokers, the AF was 17.3% (95% CI ¼7.4–25.4) and for the population the PAF of breast cancer was 11.9% (95% CI¼5.3–18.1). For passive smokers, the PAF of breast cancer was 3.2% (95% CI¼1.0–5.4). When we applied PAF estimates for ever smoking on the 2907 new breast cancer cases among Norwegian women aged 35þ at diagnosis in 2012, this yielded 345 (95% CI¼154–526) breast cancer cases that could have been avoided in the absence of active smoking that year. Conclusions: In smokers, one in six and in the population, one in nine breast cancer cases could have been avoided in the absence of active smoking. Our findings support the notion that the global cancer burden due to smoking is substantially underestimated