Search

The incidence of oropharyngeal cancer is not well documented as it is rarely described according to the anatomic definition but usually grouped with oral cavity subsites. The aim of this study was to calculate oropharyngeal cancer incidence and compare it to oral cavity cancer incidence. Age-standardized incidence rates (ASR) of oropharyngeal cancer were calculated for the period between 1998 and 2002, based on data from Cancer Incidence in 5 Continents, Volume IX (CI5-IX). These ASRs were compared with previously published oral cavity cancer data. Among males, the highest ASRs were observed in France, Slovakia, Slovenia and Brazil. The highest oral cavity/oropharyngeal cancer rate ratio was observed in Pakistan, among males (6.2) and females (13.5). The results provide an overview of oropharyngeal cancer incidence and constitute a basis for the development of primary and secondary prevention, according to geographical variations and topography. [ABSTRACT FROM AUTHOR]

Background: The advanced stage of cancer is a determining factor in poor prognosis. Head and neck squamous cell carcinomas (HNSCC) are highly incident in Brazil, but similarly to many Low and Middle-Income Countries, data is limited regarding the proportion of tumours diagnosed at advanced clinical stages and the main factors associated with it. Therefore, this study aimed to identify the factors associated with advanced stage of HNSCC in Brazil., Methods: Cross-sectional study based on secondary data collected from Hospital-based Cancer Registries (HBCR) between 2000 and 2017. Descriptive data analysis and Poisson regression with robust variance were performed to determine prevalence ratios (PRs)., Findings: Among 145,365 HNSCC cases, 78.2% (90,267/115,371) were diagnosed at stages III or IV. The highest percentage of advanced-stage tumours were hypopharyngeal [91.3% (10,186/11,159)], followed by oropharyngeal [86.6% (28,578/32,991)], oral cavity [75.1% (27,121/36,120)], and laryngeal cancer [69.5% (24,382/35,101)]. We observed annual increase trends of 0.29% and 0.38% for oral cavity and oropharyngeal late-stage tumours, respectively. Patients younger than 50 years old, with a low education level, presenting a primary tumour located in the hypopharynx or oropharynx, and alcohol and tobacco consumers were positively associated with advanced stage. Furthermore, we observed a dose-response effect of a statistically significant reduction in the prevalence of cases diagnosed in advanced stages as the patients' age group or education level increased., Interpretation: Diagnosis of HNSCC at advanced clinical stages in Brazil was associated with age, primary tumour site, and socioeconomic factors that must be mitigated, allowing more universal and equitable access and diagnosis at earlier stages., Funding: No funding., Competing Interests: All authors declared no conflict of interest., (© 2024 The Author(s).)

The advanced stage at diagnosis of colorectal cancer (CRC) may be related to individual factors, socioeconomic conditions, and healthcare service availability. The objective of the study was to analyze the prevalence of advanced stage CRC at the time of diagnosis and its association with individual, contextual, socioeconomic, and healthcare service indicators. An observational, cross-sectional study was conducted, analyzing cases of malignant neoplasms of the colon and rectum in individuals of both sexes, aged between 18 and 99 years, diagnosed between 2010 and 2019 in Brazil (n = 69,047). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A Multilevel Poisson Regression model with random intercept was used. The prevalence of advanced stage CRC at diagnosis was 65.6%. Advanced stage was associated with older age groups prevalence ratio (PR) 4.40 and younger age groups (PR 1.84), low Human Development Index (HDI) (PR 1.22), and low density of family health strategy teams (PR 1.10). The study highlights the unequal distribution of social determinants of health in the diagnosis CRC in Brazil, revealing the need to evaluate and redirect public policies aimed at improving early detection and prevention of CRC in the country., (© 2024. The Author(s).)

This study aimed to estimate the prevalence of multimorbidity in Brazilian individuals and its association with sociodemographic and lifestyle factors. This cross-sectional study used data from the National Health Survey conducted in 2019 with 88,531 Brazilian adults Multimorbidity is the presence of two or more non-communicable chronic diseases. Associated factors were assessed by calculating the prevalence ratio (PR) obtained using Poisson regression with robust variance. Multimorbidity was estimated in 29.9% (95%CI: 29.33% to 30.48%) of Brazilian individuals. In the multiple models, the prevalence was high in women (PR: 1.37; 95%CI: 1.32 to 1.42), individuals over 60 years (PR: 4.26; 95%CI: 3.87 to 4.69), non-employed (PR: 1.20; 95%CI: 1.15 to 1.26), individuals with obesity (PR: 1.49; 95%CI: 1.43 to 1.56), and smokers (PR: 1.24; 95%CI: 1.19 to 1.29). This study identified a high prevalence of multimorbidity and its association with sociodemographic and lifestyle factors. The monitoring of these outcomes may support the development of policies and services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Silva da Silveira et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: We provide a comprehensive view of the impact of alcohol consumption, tobacco smoking, excess body weight, and human papillomavirus (HPV) infection on cancer mortality and years of life lost (YLLs) in Brazil, Russia, India, China, South Africa, the United Kingdom (UK), and United States (US)., Methods: We collected population attributable fractions of the four risk factors from global population-based studies and applied these to estimates of cancer deaths in 2020 to obtain potentially preventable cancer deaths and their 95% confidence intervals (CIs). Using life tables, we calculated the number and age-standardised rates of YLLs (ASYR)., Findings: In Brazil, Russia, India, China, South Africa, the UK, and the US in 2020, an estimated 5.9 million (3.3 million-8.6 million) YLLs from cancer were attributable to alcohol consumption, 20.8 million (17.0 million-24.6 million) YLLs to tobacco smoking, 3.1 million (2.4 million-3.8 million) YLLs to excess body weight, and 4.0 million (3.9 million-4.2 million) YLLs to HPV infection. The ASYR from cancer due to alcohol consumption was highest in China (351.4 YLLs per 100,000 population [95% CI 194.5-519.2]) and lowest in the US (113.5 [69.6-157.1]) and India (115.4 [49.7-172.7). For tobacco smoking, China (1159.9 [950.6-1361.8]) had the highest ASYR followed by Russia (996.8 [831.0-1154.5). For excess body weight, Russia and the US had the highest ASYRs (385.1 [280.6-481.2] and 369.4 [299.6-433.6], respectively). The highest ASYR due to HPV infection was in South Africa (457.1 [453.3-462.6]). ASYRs for alcohol consumption and tobacco smoking were higher among men than women, whereas women had higher ASYRs for excess body weight and HPV infection., Interpretation: Our findings demonstrate the importance of cancer control efforts to reduce the burden of cancer death and YLLs due to modifiable cancer risk factors and promote the use of YLLs to summarise disease burden., Funding: Cancer Research UK., Competing Interests: The authors have no conflicts of interest to declare. Where authors are identified as personnel of the International Agency for Research on Cancer/World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer/World Health Organization., (© 2023 Published by Elsevier Ltd.)

Background: About half of cancer deaths in Brazil occur among individuals of working-age (under 65 years for men, under 60 for women), resulting in a substantial economic impact for the country. We aimed to estimate the years of potential productive life lost (YPPLL) and value the productivity lost due to premature deaths from cancer between 2001 and 2015 and the projected to 2030., Methods: We used the Human Capital Approach to estimate the productivity losses corresponding to YPPLL for cancer deaths in working age people (15-64 years). Mortality data were obtained from the Mortality Information System from 2001 to 2015 and projected between 2016 and 2030. Economic data were obtained from the Continuous National Household Sample Survey and forecasted to 2030. Productivity lost was calculated as the monetary value arising from YPPLL in Int$(2016)., Results: Between 2001 and 2030, a total of 2.3 million premature deaths from all cancers combined were observed and forecasted in Brazil (57% men, 43% women), corresponding to 32 million YPPLL and Int$141.3 billion in productivity losses (men: Int$102.5 billion, women: Int$38.8 billion). Between 2001 and 2030, among men, lung (Int$ 12.6 billion), stomach (Int$ 10.6 billion) and colorectal (Int$ 9.4 billion) cancers were expected to contribute to the greatest productivity losses; and among women, it will be for breast (Int$ 10.0 billion), cervical (Int$ 6.4 billion) and colorectal (Int$ 3.2 billion) cancers., Conclusions: Many preventable cancers result in high lost productivity, suggesting measure to reduce smoking prevalence, alcohol consumption, physical inactivity and inadequate diet, improving screening programs and increasing vaccination coverage for human papillomavirus and hepatitis B would have a positive impact on the economy, as well as reducing morbidity and mortality from cancer., Competing Interests: Declaration of Competing Interest This study was funded by the MSD Independent Oncology Policy Grant Program. The sponsor was not involved in the study design, in collection, analysis and interpretation of data; in the writing of the manuscript and in the decision to submit the manuscript for publication. IARC disclaimer: Where authors are identified as personnel of the International Agency for Research on Cancer / World Health Organization, the authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy or views of the International Agency for Research on Cancer / World Health Organization., (Copyright © 2023. Published by Elsevier Ltd.)

Background: The friction cost approach (FCA) offers an alternative to the dominant human capital approach to value productivity losses. Application of the FCA in practice is limited largely due to data availability. Recent attempts have tried to standardise the estimation of friction periods across Europe, but to date, this has not been attempted elsewhere. Our aim was to estimate friction periods for 17 Organisation for Economic Co-operation and Development (OECD) member countries between 2010 and 2021 based on routinely published data., Methods: We derived friction period estimates for Australia, Austria, Canada, Czechia, Finland, Germany, Hungary, Japan, Korea, Luxembourg, Norway, Poland, Portugal, Sweden, Switzerland, the United Kingdom and the United States. Vacancy stock and flow data was sourced from the OECD's short-term labour situation database from 2010 to 2021, and included the impact of Covid-19 on the labour market. The estimated friction periods were applied to cost cancer-related premature mortality for the United States as an illustrative case., Results: The average friction period in the five non-European countries (Australia, Canada, Korea, Japan and the United States) was 61.0 days (SD 9.4) (range between 44.8 days in Korea and 82.2 days in Canada) and the average friction period in the 12 European countries was 60.6 days (SD 14.8) (range between 34.1 days in Switzerland and 137.3 days in Czechia). In both cases, the outbreak of Covid-19 increased the length of the friction period. Our illustrative case revealed that productivity costs in the US were over a third lower using the study-specific friction period (56 days) compared with the conventionally assumed 90-day friction period applied in the literature as a default measure., Conclusions: Our results expand the potential application of the FCA outside of Europe and will support greater utilisation of the FCA and wider inclusion of productivity costs in societal-based economic evaluations based on the use of widely available and updated key labour market variables in our selected countries., (© 2023. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

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., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 De Camargo Cancela, Bezerra de Souza, Leite Martins, Borges, Schilithz, Hanly, Sharp, Pearce and Soejomataram.)

Background: Cancer staging information in Hospital Cancer Registries (HCR) is essential for cancer care quality evaluations. This study aimed to analyze the completeness of cervical cancer staging in Brazilian HCR and identify individual and contextual factors associated with unknown staging., Methods: The outcome analyzed was missing or unknown staging (Malignant Tumor Classification System and/or International Federation of Gynecology and Obstetrics) in 2006-2015. Individual data on cancer cases were collected from the HCR Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil, the National Registry of Health Facilities, and the Outpatient Information System. The random intercept multilevel Poisson regression model was performed to identify the factors associated with the outcome., Results: The prevalence of unknown staging data was 32.4% (95% confidence interval [CI], 32.1-32.7). Women aged 18-29 years (prevalence ratio [PR], 1.48; 95% CI, 1.42-1.54), referred by the public health system (PR, 1.16; 95% CI, 1.11-1.21), living in states with a low density of oncologists (PR, 1.70; 95% CI, 1.62-1.79), and with a low cytopathological testing rate (PR, 1.69; 95% CI, 1.57-1.82) showed a higher prevalence of unknown tumor staging data. A lower level of education (PR, 0.91; 95% CI, 0.84-0.98) was associated with complete staging data., Conclusions: Individual and contextual factors were associated with missing staging data. It is necessary to improve information on cancer in the HCRs by improving the awareness and training of Brazilian cancer care professionals., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

The COVID-19 pandemic has caused disruptions to national health systems and impacted health outcomes worldwide. However, the extent to which surveillance systems, such as population-based cancer registration, have been affected was not reported. Here we sought to evaluate the effect of the pandemic on registry operations across different areas and development levels worldwide. We investigated the impact of COVID-19 on three main areas of cancer registry operations: staffing, financing and data collection. An online survey was administered to 750 member registries of the International Association for Cancer Registries. Among 212 responding registries from 90 countries, 65.6% reported a disruption in operations, ranging between 45% in south-eastern Asia and 87% in the Latin America and Caribbean. Active data collection was disrupted more than case notifications or hybrid methods. In countries categorized with low Human Development Index (HDI), a greater number of registries reported a negative impact (81.3%) than in very high HDI countries (57.8%). This contrast was highest in term of impact on financing: 9/16 (56%) registries in low HDI countries reported a current or an expected decline in funding, compared to 7/108 (7%) in very high HDI countries. With many cancer registries worldwide reporting disruption to their operations during the early COVID-19 pandemic, urgent actions are needed to ensure their continuity. Governmental commitment to support future registry operations as an asset to disease control, alongside a move toward electronic reporting systems will help to ensure the sustainability of cancer surveillance worldwide., (© 2021 UICC.)

Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control., (© 2020 UICC.)

This study aimed to identify Brazilian dietary patterns and their associations with health, lifestyle and sociodemographic characteristics. Data from the Brazilian National Health Survey conducted in 2013 were used. A questionnaire was applied containing 22 items related to dietary consumption. Dietary patterns were determined through factor analysis (FA). Poisson regression models, with robust variance, were used to identify associations between dietary patterns and independents variables. Statistical significance was defined as p-value<0.05. Data were analysed for 60,202 adults (estimated population size: 146,308,458). FA identified three dietary patterns: healthy, protein, and western. The younger age group (18-24 years) had a lower adherence to the healthy pattern (PR:0.53; 95%CI:0.49-0.58) and greater adherence to the protein (PR:1.52; 95%CI:1.42-1.62) and western (PR:1.80; 95%CI:1.68-1.93) patterns compared to the elderly (≥60 years). Women had a greater association with the healthy pattern (PR:1.32; 95%CI:1.28-1.38) and lower association with the protein pattern (PR:0.80; 95%CI:0.77-0.82) compared to men. Illiterate participants showed lower adherence to the healthy (PR:0.58; 95%CI:0.53-0.63) and western (PR:0.54; 95%CI:0.48-0.62) patterns compared to those with higher educational levels. Smokers had lower adherence to the healthy (PR:0.76; 95%CI:0.71-0.81) and higher adherence to the protein (PR:1.14; 95%CI:1.11-1.19) patterns compared to non-smokers. Participants with poor/very poor self-rated health status had a lower adherence to the healthy (PR:0.79; 95%CI:0.73-0.86) and western (PR:0.81; 95%CI:0.73-0.89) patterns compared to those in a very good/good self-rated health status. Multimorbidity was positively associated with the healthy pattern (PR:1.18; 95%CI:1.11-1.26) and inversely associated with the protein pattern (PR:0.88; 95%CI:0.80-0.96) compared to participants without comorbidities. We suggest that strategies to promote healthy eating should consider health, lifestyle and sociodemographic characteristics in the Brazilian population., Competing Interests: The authors have declared that no competing interests exist.

Aims: To estimate the prevalence of multimorbidity among European community-dwelling adults, as well as to analyse the association with gender, age, education, self-rated health, loneliness, quality of life, size of social network, Body Mass Index (BMI) and disability., Methods: A cross-sectional study based on wave 6 (2015) of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 63,844) from 17 European countries were selected. Multimorbidity was defined as presenting two or more health conditions. The independent variables were gender, age group, educational level, self-rated health, loneliness, size of network, quality of life, BMI and disability (1+ limitations of basic activities of daily living). Poisson regression models with robust variance were fit for bivariate and multivariate analysis., Results: The prevalence of multimorbidity was 28.2% (confidence interval-CI 95%: 27.5.8-29.0) among men and 34.5% (CI95%: 34.1-35.4) among women. The most common health conditions were cardiometabolic and osteoarticular diseases in both genders, and emotional disorders in younger women. A large variability in the prevalence of multimorbidity in European countries was verified, even between countries of the same region., Conclusions: Multimorbidity was associated with sociodemographic and physical characteristics, self-rated health, quality of life and loneliness., Competing Interests: The authors have declared that no competing interests exist.

The advanced-stage diagnosis of breast cancer reveals the inequalities associated with socioeconomic conditions and the offer of health services. This study analyzes the prevalence of advanced breast cancer and its relationship with individual and contextual socioeconomic indicators and offer of health service. A cross-sectional study is presented herein, on the assessment of malignant breast neoplasms in women diagnosed between 2006 and 2015 (n = 195,201). Data were collected from the Hospital Cancer Registry (HCR), Atlas of Human Development in Brazil, and from the National Registry of Health Institutions (NRHI). A multilevel Poisson Regression was carried out with random intercept. The prevalence of advanced breast cancer diagnosis was 40.0%. Advanced staging was associated with younger age groups (PR 1.41), race/nonwhite (PR 1.13), lower education levels (PR 1.38), and public access to health services (PR 1.25). There was also an association with a low density of mammographic equipment (PR 1.08), and with low indices of local social inequality (PR 1.33) and human development (PR 0.80). This study maps and highlights the causes related to inequalities in the diagnosis of advanced breast cancer in Brazil, and presents essential data to reorient public policies and health-related actions to strengthen the control of breast cancer in Brazil.

Background: The objective of this work was to analyse the prevalence trends of multimorbidity among European community-dwelling adults., Methods: A temporal series study based on waves 1, 2, 4, 5, 6 and 7 of the Survey of Health, Ageing and Retirement in Europe (SHARE) was conducted, and community-dwelling participants aged 50+ (n = 274,614) from 15 European countries were selected for the period 2004-2017. Prevalence, adjusted by age, Average Annual Percentage Change (APC) and 95% confidence interval (95% CI) were all calculated. Trend analyses were realised by period, age groups and groups of diseases., Results: The results showed a large variability in the prevalence of multimorbidity in adults aged 50 and over among European countries. Increase in the prevalence of multimorbidity in the countries of central Europe (Austria, Belgium, Czech Republic, France, Germany and Switzerland) and Spain in both sexes, and in the Netherlands among men. Stability was observed in northern and eastern European countries. Musculoskeletal and neurodegenerative groups showed more significant changes in the trend analyses., Conclusions: This information can be useful for policy makers when planning health promotion and prevention policies addressing modifiable risk factors in health.

Objective: Analyze cervical and breast cancer mortality in Brazil and its relationship with socioeconomic population indicators and availability of health services in the period 2011-2015., Methods: An ecological study is presented herein. Mortality data were extracted from the Mortality Information System, based on ICD-10, per area of residence and age group, for the period 2011-2015. Socioeconomic variables were extracted from the Brazilian Human Development Atlas, and the National Register of Health Facilities (CNES) provided data on the density of physicians and health services. Statistical analysis was carried out using the Chi-squared test and Poisson regression, with robust variance and 95 % confidence level., Results: The median age-standardized mortality rates for cervical and breast cancers were, respectively, 5.95 (± 3.97) and 10.65 (± 3.12) per 100,000 women. High cervical cancer mortality rates presented a statistically significant association with GINI Index (p=0.000) and Human Development Index - HDI (p=0.030). High breast cancer mortality rates were positively associated with the variables "number of general physicians per 100,000 inhabitants" (p = 0.005) and "Number of licensed oncology centers per 1,000,000 inhabitants" (p = 0.002)., Conclusion: The importance of organization and equity in the access to health services is highlighted herein, enabling the reorientation of public policies aimed at the minimization of health disparities., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

Background: Digital rectal examination (DRE) is one of the most common strategies for prostate cancer early detection. However, the use for screening purposes has a controversial benefit and potential harms can occur due to false-positive results, overdiagnosis and overtreatment. The objective of this study is to calculate the prevalence and identify factors associated with the receipt of DRE in Brazilian men., Methods: We selected men older than 40 from a nationwide population-based survey (13,625 individuals) excluding those with prostate cancer diagnosis. Information was extracted from the most recent database of the Brazilian National Health Survey (PNS 2013). Statistical analysis was carried out to calculate incidence rate ratios, with 95% confidence intervals and p values, through multivariate analysis with Poisson regression and robust variance., Results: Men having private health insurance (63.3%; CI = 60.5-66.0) presented higher prevalence of DRE than those in the public health system (41.6%; CI = 39.8-43.4). The results show a positive association between DRE and men having private health insurance, aged 60-69, living with a spouse, never smokers, and living in urban areas. Among public health services users, this positive association was observed among men aged 70-79, living with a spouse, having bad/very bad health self-perception, abstainers, ex-smokers, with undergraduate studies, presenting four or more comorbidities, and residing in urban areas., Conclusions: Prostate cancer screening with DRE is quite frequent in Brazil, specially among men with private health plans and better access to health services, healthier lifestyle and at more advanced ages, characteristics which increase the risk of overdiagnosis and overtreatment.

Multimorbidity patterns of a population can be influenced by socioeconomic and lifestyle-related factors. Some of these factors are preventable when healthy habits are promoted to the population. This study analyzed the main grouping patterns of chronic diseases and the relationship with socioeconomic and lifestyle-related factors of the Brazilian population (over the age of 18), based on a population-based survey (2013 National Health Survey). A total of 60,202 participants were included. Cluster analysis was carried out to identify the combinations of chronic diseases. Bivariate and multivariate analyses were carried out to verify the relationship between disease clusters and independent variables, utilizing Poisson's regression with robust variance, considering a 95% confidence interval. Cluster analysis revealed four disease clusters:cardiometabolic diseases/cancer, mental/occupational diseases, musculoskeletal diseases and respiratory diseases, all significantly associated with the female gender, current/past smoking habits and overweight/obesity in multivariate analyses. These aspects must be considered when planning health services and developing strategies and guidelines for the prevention and treatment of multiple chronic conditions., Competing Interests: The authors have declared that no competing interests exist.

Background: Over two-thirds of the world's cancer deaths occur in economically developing countries; however, the societal costs of cancer have rarely been assessed in these settings. Our aim was to estimate the value of productivity lost in 2012 due to cancer-related premature mortality in the major developing economies of Brazil, the Russian Federation, India, China and South Africa (BRICS)., Methods: We applied an incidence-based method using the human capital approach. We used annual adult cancer deaths from GLOBOCAN2012 to estimate the years of productive life lost between cancer death and pensionable age in each country, valued using national and international data for wages, and workforce statistics. Sensitivity analyses examined various methodological assumptions., Results: The total cost of lost productivity due to premature cancer mortality in the BRICS countries in 2012 was $46·3 billion, representing 0·33% of their combined gross domestic product. The largest total productivity loss was in China ($28 billion), while South Africa had the highest cost per cancer death ($101,000). Total productivity losses were greatest for lung cancer in Brazil, the Russian Federation and South Africa; liver cancer in China; and lip and oral cavity cancers in India., Conclusion: Locally-tailored strategies are required to reduce the economic burden of cancer in developing economies. Focussing on tobacco control, vaccination programs and cancer screening, combined with access to adequate treatment, could yield significant gains for both public health and economic performance of the BRICS countries., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Background: The aim of this study was to investigate inequalities in survival for non-Hodgkin's lymphoma (NHL), distinguishing between direct and indirect effects of patient, social and process-of-care factors., Methods: All cases of NHL diagnosed in Ireland in 2004-2008 were included. Variables describing patient, cancer, stage and process of care were included in a discrete-time model of survival using Structural Equation Modelling software., Results: Emergency admissions were more common in patients with co-morbid conditions or with more aggressive cancers, and less frequent for patients from more affluent areas. Aggressive morphology, female sex, emergency admission, increasing age, comorbidity, treatment in a high caseload hospital and late stage were associated with increased hazard of mortality. Private patients had a reduced hazard of mortality, mediated by systemic therapy, admission to high caseload hospitals and fewer emergency admissions., Discussion: The higher rate of emergency presentation, and consequent poorer survival, of uninsured patients, suggests they face barriers to early presentation. Social, educational and cultural factors may also discourage disadvantaged patients from consulting with early symptoms of NHL. Non-insured patients, who present later and have more emergency admissions would benefit from better access to diagnostic services. Older patients remain disadvantaged by sub-optimal treatment, treatment in non-specialist centres and emergency admission., Competing Interests: The authors have declared that no competing interests exist.

Young women (20-39 years-old) with breast cancer are diagnosed with more aggressive tumours and consequently have poorer survival. However, there is an evidence gap as to whether age has an independent effect on survival of pre-menopausal women diagnosed with HR+/Her2- tumours. The aim of this population-based study was to compare characteristics at diagnosis, determinants of treatment and survival in women aged 20-39 and 40-49 years diagnosed with HR+/Her2- tumours. From the National Cancer Registry Ireland, we identified women aged 20-49 diagnosed with a first invasive HR+/Her2- breast cancer during 2002-2008. Women aged 20-39 were compared to those aged 40-49 years. Poisson regression with robust error variance was used to explore the impact of age on treatment receipt. Associations between age and survival from all causes was investigated using Cox models. In multivariate models, women aged 20-39 significantly more often having no cancer-directed surgery (IRR=1.49, 95%CI 1.07, 2.08). In those having surgery, younger age was associated with significantly higher likelihood of receiving chemotherapy; age was not associated with receipt of adjuvant radiotherapy or endocrine therapy. Women aged 20-39 undergoing surgery were significantly more likely to die than women aged 40-49 (HR=1.84, 95%CI: 1.31, 2.59). Age is an independent prognostic factor in younger women diagnosed with HR+/Her2- breast cancer, supporting the hypothesis that breast cancer in women under 40 has more aggressive behaviour, even within HR+/Her2- tumours. Future research should explore the reasons for poorer survival in order to inform strategies to improve outcomes in this age group., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: Analysis of laryngeal cancer mortality trends in Brazil and its geographic regions for the period 1996-2010 and calculation of mortality predictions for the period 2011-2030., Study Design: An epidemiologic, ecologic, demographic-based study, which utilized information from the Mortality Information System on all cancer-related deaths in Brazil, is presented here. Mortality trends were analyzed by Joinpoint regression, and Nordpred was utilized for the calculation of predictions., Results: When comparing the last observed period and the last predicted period for men, an increase of 10,588 deaths is expected, representing an increase of 69%. For women, the expected increase in the number of deaths will be 2217, representing an increase of 104%. Laryngeal cancer mortality rates will increase in the North and Northeast regions for men and in the Northeast and Southeast regions for women., Conclusions: Despite the current high mortality for laryngeal cancer, rates will continue to increase until 2030 in Brazil., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Emergency presentation of rectal cancer carries a relatively poor prognosis, but the roles and interactions of causative factors remain unclear. We describe an innovative statistical approach which distinguishes between direct and indirect effects of a number of contextual, patient and tumour factors on emergency presentation and outcome of rectal cancer. All patients diagnosed with rectal cancer in Ireland 2004-2008 were included. Registry information, linked to hospital discharge data, provided data on patient demographics, comorbidity and health insurance; population density and deprivation of area of residence; tumour type, site, grade and stage; treatment type and optimality; and emergency presentation and hospital caseload. Data were modelled using a structural equation model with a discrete-time survival outcome, allowing us to estimate direct and mediated effects of the above factors on hazard, and their inter-relationships. Two thousand seven hundred and fifty patients were included in the analysis. Around 12% had emergency presentations, which increased hazard by 80%. Affluence, private patient status and being married reduced hazard indirectly by reducing emergency presentation. Older patients had more emergency presentations, while married patients, private patients or those living in less deprived areas had fewer than expected. Patients presenting as an emergency were less likely to receive optimal treatment or to have this in a high caseload hospital. Apart from stage, emergency admission was the strongest determinant of poor survival. The factors contributing to emergency admission in this study are similar to those associated with diagnostic delay. The socio-economic gradient found suggests that patient education and earlier access to endoscopic investigation for public patients could reduce emergency presentation., (© 2016 UICC.)

Background: A wide-ranging debate has taken place in recent years on mediation analysis and causal modelling, raising profound theoretical, philosophical and methodological questions. The authors build on the results of these discussions to work towards an integrated approach to the analysis of research questions that situate survival outcomes in relation to complex causal pathways with multiple mediators. The background to this contribution is the increasingly urgent need for policy-relevant research on the nature of inequalities in health and healthcare., Methods: The authors begin by summarising debates on causal inference, mediated effects and statistical models, showing that these three strands of research have powerful synergies. They review a range of approaches which seek to extend existing survival models to obtain valid estimates of mediation effects. They then argue for an alternative strategy, which involves integrating survival outcomes within Structural Equation Models via the discrete-time survival model. This approach can provide an integrated framework for studying mediation effects in relation to survival outcomes, an issue of great relevance in applied health research. The authors provide an example of how these techniques can be used to explore whether the social class position of patients has a significant indirect effect on the hazard of death from colon cancer., Results: The results suggest that the indirect effects of social class on survival are substantial and negative (-0.23 overall). In addition to the substantial direct effect of this variable (-0.60), its indirect effects account for more than one quarter of the total effect. The two main pathways for this indirect effect, via emergency admission (-0.12), on the one hand, and hospital caseload, on the other, (-0.10) are of similar size., Conclusions: The discrete-time survival model provides an attractive way of integrating time-to-event data within the field of Structural Equation Modelling. The authors demonstrate the efficacy of this approach in identifying complex causal pathways that mediate the effects of a socio-economic baseline covariate on the hazard of death from colon cancer. The results show that this approach has the potential to shed light on a class of research questions which is of particular relevance in health research.

Introduction: Receptor status determines of breast cancer treatment and prognosis. In a population-based study, we investigated predictors of receptor test receipt., Materials and Methods: Invasive breast cancers diagnosed 2006-2008 were abstracted from the National Cancer Registry Ireland. Modified Poisson regression with robust error variance was used to identify socio-demographic, health service and clinical predictors of not undergoing ER, PR or HER2 testing., Results: 7619 breast cancers were included. 7% were not tested for any receptor. 92%, 80% and 86% had oestrogen (ER), progesterone (PR) and human epidermal growth factor 2 (HER2) tests, respectively; 73% were tested for all three. For all three tests, unmarried women were significantly less likely to be tested than married women. Current smokers significantly more often had ER and PR tests. Women treated in a high-volume hospital significantly more often had ER and HER2 tests., Conclusion: After adjusting for clinical factors, socio-demographic and service-related factors significantly predicted receptor test receipt. Some factors deserve further investigation, especially marital status. In the interests of equity, the reasons underlying these associations should be further investigated., (Copyright © 2015 Elsevier Ltd. All rights reserved.)

Breast-conserving surgery (BCS) is increasingly used for breast cancer treatment. One of the disadvantages of BCS is the risk of re-operation, associated with additional costs to the woman, health service and society. Hospital and surgeon caseload have been associated with better outcomes in breast cancer. Whether these are related to re-operation rates is not clear. In women who underwent BCS initially, we aimed to quantify re-operation rates and identify the factors related to the risk of undergoing subsequent (i) re-operation and (ii) total mastectomy (TM). From the National Cancer Registry Ireland, we identified women diagnosed with a first invasive breast cancer during 2002-2008, and who initially had BCS. Poisson regression with robust error variance was used to identify factors significantly associated with (i) re-operation (vs no re-operation) or (ii) re-operation by TM (vs re-operation by BCS). 16,551 women were diagnosed with invasive breast cancer and 8,318 underwent initial BCS. Of these, 17 % had one or more subsequent re-operations and, of these, 62 % had TM. Surgeon and hospital volume significantly predicted subsequent re-operation after adjustment for socio-demographic and clinical variables. Women having surgery in lower-volume hospitals by low-volume surgeons significantly increased the risk of re-operation [incidence rate ratio (IRR) = 1.56; 95 % CI 1.33-1.83] compared to those operated in higher-volume hospitals by a higher-volume surgeon. Risk of subsequent TM was increased by 22 % (95 % CI 1.10-1.35) and 21 % (95 % CI 1.09-1.33), if women were operated by a lower or intermediate-volume surgeon. The fact that factors related to healthcare organisation/service provision are associated with re-operations suggests that it may be possible to reduce the overall re-operation rate. The high frequency of subsequent TM raises questions about strategies for selecting women for initial BCS. Our results may inform the development of information strategies to help ensure that women are aware of risks of re-operation following BCS and hence, make appropriate treatment choices.

Population-based screening for early detection and treatment of colorectal cancer (CRC) and precursor lesions, using evidence-based methods, can be effective in populations with a significant burden of the disease provided the services are of high quality. Multidisciplinary, evidence-based guidelines for quality assurance in CRC screening and diagnosis have been developed by experts in a project co-financed by the European Union. The 450-page guidelines were published in book format by the European Commission in 2010.  They include 10 chapters and over 250 recommendations, individually graded according to the strength of the recommendation and the supporting evidence. Adoption of the recommendations can improve and maintain the quality and effectiveness of an entire screening process, including identification and invitation of the target population, diagnosis and management of the disease and appropriate surveillance in people with detected lesions. To make the principles, recommendations and standards in the guidelines known to a wider professional and scientific community and to facilitate their use in the scientific literature, the original content is presented in journal format in an open-access Supplement of Endoscopy. The editors have prepared the present overview to inform readers of the comprehensive scope and content of the guidelines.

Background: The purpose of this study was to analyze and compare incidence trends of oral cavity and oropharyngeal cancers, using data from population-based Spanish cancer registries., Methods: Adjusted rates were calculated using the standard world population, and incidence trends were analyzed for individual and pooled registries using joinpoint regression., Results: Analysis of 7 pooled registries revealed a statistically significant reduction in the incidence of oral cavity cancer in men (annual percent change [APC] = -3.1) and a nonsignificant decrease in women (APC = -4.5) over the period from 1991 to 2001. For oropharyngeal cancer, the trend was for a statistically significant increase in men in 4 registries., Conclusion: There is growing evidence that the incidence of oral cavity cancer is in decline, while the incidence of oropharyngeal cancer has been increasing over the past 3 decades, especially in developed countries, and this study reinforces such evidence., (Copyright © 2011 Wiley Periodicals, Inc.)

The classification of sites in tumors of the oral cavity, oropharynx, pharynx, and hypopharynx varies in the literature. More than 90% of these tumors of the mucosal lining are classified as squamous cell carcinoma developed from premalignant lesions such as leukoplakia and erythroleukoplakia. These carcinomas are associated to environmental and lifestyle risk factors, among which tobacco and alcohol play a major role. In addition to tobacco smoking, tobacco chewing is another risk factor as well as chewing betel quid and areca nut in Asia. Certain strains of virus, such as the sexually transmitted human papilloma virus, also play a carcinogenetic role. The temporal trends in incidence of these tumors relate to environmental factors; there is an increase in tendency in countries without prevention and a decrease in countries having an active policy of prevention of alcohol and tobacco consumption. In contrast, an increased incidence occurs in the world at tumor sites related to human papilloma virus infection in relation to changes in sexual habits.

Population-based cancer registries (PBCRs) are instruments to provide cancer incidence to promote cancer control and etiological research. A setting of mandatory (standard) variables is routinely collected for patient and tumor. One recommended variable is tumor stage, which supplies information on disease status and is an essential prognostic factor. However, it is not considered as necessary information to be collected by the PBCR. There are studies showing the value of stage as a prognostic variable to evaluate survival, socio-economic status, race and ethnics differences. Our aim is to analyze the feasibility of PBCRs in abstracting TNM for oral cavity and oropharynx. These topographies were selected due to the clinical accessibility of stage tumors by visual inspection and palpation. About 23% of the PBCRs who contributed to CI5-IX indicated their collection of TNM stage for all cancer sites. We analyzed 23,935 cases of oral cavity (OCC) and oropharynx cancer (OPC) from 13 PBCRs. Complete TNM stage for OCC was 52.7% for males and 47.6% for females; for OPC, it was 56% in both genders. Incomplete stage on OCC and OPC ranged from 22 to 25%. Missing was about 18-27% (most common in oral cavity). Missing stage was significantly higher in males for OCC aged > or =70 years, OR 1,64 (1.39-1.94). Our results demonstrate that OPC tend to have more stage, when compared with OCC. Even if it can be diagnosed by visual inspection, these results highlight the fact that information on stage can be a reliable indicator of access to healthcare and diagnosis awareness. Our results demonstrate that is feasible for PBCR to collect stage, although improving completeness of this information needs further technical training and international recommendation to adopt TNM stage as a standard variable for the PBCRs.

Background: The incidence of oral cavity cancer (OCC) is not well documented because it is rarely described in accord with the anatomic definition but is usually grouped with oropharyngeal subsites. We studied the incidence of OCC in developed and in developing countries., Methods: The age-standardized and age-specific incidence rates of OCC were calculated for the period 1998-2002, using the topographic definition used by the Union Internationale Contre le Cancer (UICC), based on data from CI5-IX., Results: The highest rates are observed in Pakistan, Brazil, India, and France and were consistent with country-specific risk factors and their prevalence., Conclusions: In developing countries, people are exposed to a wider range of risk factors, starting at younger ages, and primary prevention measures and policies are needed. Awareness of professionals must be improved to identify people at risk and target them for prevention and to minimize the consequences of OCC.