Knowledge of and access to screening in women with carcinoma of the cervix ín Brazil

In order to assess the level of knowledge of screening for carcinoma of the cervix among women presenting with this condition, a survey of a consecutive series of patients was undertaken. AH 266 patients presenting at this hospital during 1988 for the treatment of carcinoma of the cervix completed a structured questionnaire about cervical câncer screening. A percentage of 68.8% patients had never been screened. Those patients who had not previously had a cervical smear test were more likely to be in the older age groups (over 45 years) and to come from low income groups with poor educatlon and poor access to medicai facilities. Even among patients who had previousiy had contacts with the medicai profession, only a minority (approximately 40%) had undergone cervical screening at any time. Since carcinoma of the cervix is currently the commonest malignant neoplasm in women in Brazil, it is evident that an urgent campaign is necessary to educate both the public and the medical profession in cervical screening, hopefully to reduce the very high rate of Invasive carcinoma of the cervix in this country

Gastos Não Médicos de Pacientes com Câncer

Os autores, preocupados com gastos não médicos como transporte, alimentação, hospedagem, etc., de pacientes com câncer nos seus deslocamentos até o Hospital São Judas Tadeu, Barretos, SP, resolveram fazer um estudo deste problema. Um questionário foi aplicado a 114 pacientes que faziam quimioterapia ambulatorialmente, no período de janeiro a maio de 1985. A análise mostrou que os gastos relativos com transporte, alimentação e perda do dia de trabalho foram respectivamente de 80%, 11% e 9%. Os fatores que mais influenciaram estes resultados foram diferentes distâncias da residência do paciente ao Hospital e diferentes meios de transporte. Concluiu-se, também, que os pacientes com baixa renda mensal apresentavam despesas aproximadamente iguais aos de alta renda. Considerando os sofrimentos do paciente com câncer e de seus familiares, além da alta significância dos gastos encontrados, a situação requer maior atenção dos Órgãos governamentais competentes

Prevalência do tabagismo e seus determinantes em algumas escolas de Barretos - São Paulo em 1996.

Inquérito sobre o vício de fumar entre escolares de 5ª à 8ª séries do primeiro grau e do colegial, do 2“grau, foi realizado em Barretos, SP, em 1996. De 12.072 alunos matriculados em todas as escolas, 4.599 (38,1%) participaram da pesquisa. O questionário anônimo aplicado avaliou vários aspectos do tabagismo, do efeito da propaganda, da prática de esportes e da presença de fumantes no domicílio. Observou-se que 7,2% eram fumantes atuais, não ocorrendo diferença quanto ao sexo; ocorreu aumento progressivo da prevalência com a idade, chegando a 16,6% entre os maiores de 18 anos; encontrada maior prevalência entre estudantes do curso noturno; entre os de nível sócio-ecônomico mais elevado (classes A e B) e entre os que não referiram praticar quaisquer esportes; foi observado que o início do vício de fumar ocorre com maior freqüência após os 12 anos; que 78,1% dos fumantes referiram consumo de até 10 cigarros ao dia, sendo maior o consumo no sexo masculino; ocorreu maior prevalência entre alunos que referiram ter uma ou mais pessoas fumantes na família. Como conclusões identificou-se a necessidade de repetir esses estudos em diferentes cidades do Brasil, realizar campanhas antitabágicas nas escolas e estimular o governo a introduzir o tema nos currículos a nível do primeiro grau

Identification of hereditary cancer in the general population: development and validation of a screening questionnaire for obtaining the family history of cancer

One of the challenges for Latin American countries is to include in their healthcare systems technologies that can be applied to hereditary cancer detection and management. The aim of the study is to create and validate a questionnaire to identify individuals with possible risk for hereditary cancer predisposition syndromes (HCPS), using different strategies in a Cancer Prevention Service in Brazil. The primary screening questionnaire (PSQ) was developed to identify families at-risk for HCPS. The PSQ was validated using discrimination measures, and the reproducibility was estimated through kappa coefficient. Patients with at least one affirmative answer had the pedigree drawn using three alternative interview approaches: in-person, by telephone, or letter. Validation of these approaches was done. Kappa and intraclass correlation coefficients were used to analyze data’s reproducibility considering the presence of clinical criteria for HCPS. The PSQ was applied to a convenience sample of 20,000 women of which 3121 (15.6%) answered at least one affirmative question and 1938 had their pedigrees drawn. The PSQ showed sensitivity and specificity scores of 94.4% and 75%, respectively, and a kappa of 0.64. The strategies for pedigree drawing had reproducibility coefficients of 0.976 and 0.850 for the telephone and letter approaches, respectively. Pedigree analysis allowed us to identify 465 individuals (24.0%) fulfilling at least one clinical criterion for HCPS. The PSQ fulfills its function, allowing the identification of HCPS at-risk families. The use of alternative screening methods may reduce the number of excluded at-risk individuals/families who live in locations where oncogenetic services are not established.Research supported by Barretos Cancer Hospital. EIP has a grant from FAPESP (FAPESP, SP, Brazil, #2013/24633-2). N Campacci is supported by a PhD fellowship from FAPESP (FAPESP, SP, Brazil, #2015/02444-9).info:eu-repo/semantics/publishedVersio

Retrospective analysis of breast cancer prognosis among young and older women in a Brazilian cohort of 738 patients, 1985-2002

Invasive breast cancer (BC) is infrequent among women aged.5.40 years, however, the disease outlook in these younger patients is generally worse than among older women. The present study aimed to compare socio-demographic, clinical and pathological characteristics, and their association with long-term survival, between two random cohorts of young (<= 40 years) and older (50-69 years) Brazilian patients with BC. The cohort comprised of 738 randomly selected women who were diagnosed with BC at Barretos Cancer Hospital, Pio XII Foundation (Barretos, Brazil) between January 1985 and December 2002; the patients included young women (n=376) and older women (n=362). The current analysis suggested that BC in young women is associated with numerous pathological features of aggressiveness. Second cancer and bilateral BC were independent predictors of a poor outcome in the younger group. Furthermore, C-erB-2 was positively correlated with poor outcome in the older group, whereas estrogen receptor status and TNM stage were associated with disease prognosis in both groups. The overall survival rates of the two age groups were similar except when analyzed according the treatment period (1997-2002). Although patients aged <= 40 years harbored tumors with more aggressive clinicopathological characteristics, these characteristics were not independent predictors of overall survival. The present study indicates that medical advances associated with prevention of breast cancer may improve screening programs, which may therefore increase early diagnosis and subsequently lower mortality rates.The authors thank the Public Ministry of Labor (Research, Prevention and Education of Occupational Cancer) in Campinas, Brazil, and the Lions Club of Brazil for partial financial support of the present study and Dr. Vinicius de Lima Vazquez (Department of Skin cancer and Melanoma, Barretos Cancer Hospital, Pio XII Foundation, Barretos, Brazil) for assistance with the statistical analysis. The abstract was previously published in The Breast 23 (Suppl): S11, 2014.info:eu-repo/semantics/publishedVersio

Mammography-based screening program: preliminary results from a first 2-year round in a Brazilian region using mobile and fixed units

RLH, TBS and ALF made substantial contributions to the conception and design of the article, the acquisition, analysis and interpretation of the data, and drafting of the article. ECM, JSCM and NB made substantial contributions to the conception and design of the study.Background: Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer deaths among women worldwide. The use of mobile mammography units to offer screening to women living in remote areas is a rational strategy to increase the number of women examined. This study aimed to evaluate results from the first 2 years of a government-organized mammography screening program implemented with a mobile unit (MU) and a fixed unit (FU) in a rural county in Brazil. The program offered breast cancer screening to women living in Barretos and the surrounding area. Methods: Based on epidemiologic data, 54 238 women, aged 40 to 69 years, were eligible for breast cancer screening. The study included women examined from April 1, 2003 to March 31, 2005. The chi-square test and Bonferroni correction analyses were used to evaluate the frequencies of tumors and the importance of clinical parameters and tumor characteristics. Significance was set at p < 0.05. Results: Overall, 17 964 women underwent mammography. This represented 33.1% of eligible women in the area. A mean of 18.6 and 26.3 women per day were examined in the FU and MU, respectively. Seventy six patients were diagnosed with breast cancer (41 (54%) in the MU). This represented 4.2 cases of breast cancer per 1000 examinations. The number of cancers detected was significantly higher in women aged 60 to 69 years than in those aged 50 to 59 years (p < 0.001) or 40 to 49 years (p < 0.001). No difference was observed between women aged 40 to 49 years and those aged 50 to 59 years (p = 0.164). The proportion of tumors in the early (EC 0 and EC I) and advanced (CS III and CS IV) stages of development were 43.4% and 15.8%, respectively. Conclusions: Preliminary results indicate that this mammography screening program is feasible for implementation in a rural Brazilian territory and favor program continuation

Effectiveness of the Mobile Unit in Breast and Cervical Cancer Screening

Objetivo: Em razao da ausencia ou poucos conhecimentos sobre os aspectos relacionados com o uso da Unidade Movel na busca (UM) na busca ativa do cancer de mama e de colo uterino no Brasil, decidiu-se realizar um modelo de rastreamento oportunistico para estes canceres utilizando a UM. Metodo: No periodo de Maio 2003 a Maio 2004 foram estudas mulheres dos 40 aos 69 anos para o exame de mamografia e dos 21 aos 69 anos para o exame citologico cervical dentro da UM proximos aos seus domicilios. Durante este periodo, a UM circulava por estas cidades a cada 3 meses, ficando de 3 a 5 dias em cada municipio, conforme o numero de mulheres e uma enfermeira responsavel do municipio era entao designada para fazer a divulgacao da visita. Foi desenvolvido modelo analitico de decisao para estimar as probabilidades de desfechos e de custos no rastreamento do cancer de mama pela UM versus estadiamento pelo Registro Hospitalar de Cancer desta regiao de 2000 a 2002. Resultados: Dos 9560 exames disponiveis, 7192 (75,2%) realizaram o exame mamografico comparado com 2964 (31,0%) que realizaram o exame citologico cervicovaginal. O principal motivo de convencimento para as mulheres fazerem o exame foi a visita domiciliar realizado pelo Agente Comunitario. Foram diagnosticados 22 casos de cancer de mama e 3 casos de cancer de colo uterino. O custo incremental por caso de cancer de mama detectado em estadio precoce foi de R$ 1.326,54. A efetividade em detectar o cancer de mama em estadiamento clinico precoce (EC 0 e I u TNM/UICC), foi de 45,5% pela UM comparado com 14,5% nos 3 anos anteriores a este projeto. Conclusao: Verificou-se que, o uso da Unidade Movel e custo-efetivo para o rastreamento do cancer de mama. Ha boa adesao da populacao principalmente a de baixo nivel socioeconomico e proporciona um aumento consideravel da capacidade de deteccao de cancer de mama e colo uterino, bem como um aumento substancial da proporcao de casos em fases iniciais. Devido a falta do funcionamento adequado do Sistema de Saúde do Brasil em seus diferentes niveis, nos parece que o uso da UM e uma estrategia interessante de ser utilizada neste paisBV UNIFESP: Teses e dissertaçõe