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Most mouthwashes contain alcohol, a known cause of head and neck cancer (oral cavity, pharynx, larynx), likely through the carcinogenic activity of acetaldehyde, formed in the oral cavity from alcohol. We carried out a pooled analysis of 8981 cases of head and neck cancer and 10 090 controls from 12 case-control studies with comparable information on mouthwash use in the International Head and Neck Cancer Epidemiology Consortium. Logistic regression was used to assess the association of mouthwash use with cancers of the oral cavity, oropharynx, hypopharynx, and larynx, adjusting for study, age, sex, pack-years of tobacco smoking, number of alcoholic drinks/day, and education. Compared with never users of mouthwash, the odds ratio (OR) of all head and neck cancers was 1.01 [95% confidence interval (CI): 0.94-1.08] for ever users, based on 12 studies. The corresponding ORs of cancer of the oral cavity and oropharynx were 1.11 (95% CI: 1.00-1.23) and 1.28 (95% CI: 1.06-1.56), respectively. OR for all head and neck cancer was 1.15 (95% CI: 1.01-1.30) for use for more than 35 years, based on seven studies (P for linear trend=0.01), and OR 1.31 (95% CI: 1.09-1.58) for use more than one per day, based on five studies (P for linear trend

BackgroundCigarette smoking is a major risk factor for head and neck cancer (HNC). To our knowledge, low cigarette smoking (0-3, >3-5, >5-10 cigarettes per day.ResultsSmoking >0-3 cigarettes per day was associated with a 50% increased risk of HNC in the study population [odds ratio (OR) = 1.52, 95% confidence interval (CI): (1.21, 1.90). Smoking >3-5 cigarettes per day was associated in each subgroup from OR = 2.01 (95% CI: 1.22, 3.31) among never alcohol drinkers to OR = 2.74 (95% CI: 2.01, 3.74) among women and in each cancer site, particularly laryngeal cancer (OR = 3.48, 95% CI: 2.40, 5.05). However, the observed increased risk of HNC for low smoking frequency was not found among smokers with smoking duration shorter than 20 years.ConclusionOur results suggest a public health message that low frequency of cigarette consumption contributes to the development of HNC. However, smoking duration seems to play at least an equal or a stronger role in the development of HNC.

Low socioeconomic status has been reported to be associated with head and neck cancer risk. However, previous studies have been too small to examine the associations by cancer subsite, age, sex, global region and calendar time and to explain the association in terms of behavioral risk factors. Individual participant data of 23,964 cases with head and neck cancer and 31,954 controls from 31 studies in 27 countries pooled with random effects models. Overall, low education was associated with an increased risk of head and neck cancer (OR = 2.50; 95% CI = 2.02 - 3.09). Overall one-third of the increased risk was not explained by differences in the distribution of cigarette smoking and alcohol behaviors; and it remained elevated among never users of tobacco and nondrinkers (OR = 1.61; 95% CI = 1.13 - 2.31). More of the estimated education effect was not explained by cigarette smoking and alcohol behaviors: in women than in men, in older than younger groups, in the oropharynx than in other sites, in South/Central America than in Europe/North America and was strongest in countries with greater income inequality. Similar findings were observed for the estimated effect of low versus high household income. The lowest levels of income and educational attainment were associated with more than 2-fold increased risk of head and neck cancer, which is not entirely explained by differences in the distributions of behavioral risk factors for these cancers and which varies across cancer sites, sexes, countries and country income inequality levels.

BackgroundIncreasing incidence of head and neck cancer (HNC) in young adults has been reported. We aimed to compare the role of major risk factors and family history of cancer in HNC in young adults and older patients.MethodsWe pooled data from 25 case-control studies and conducted separate analyses for adults ≤ 45 years old ('young adults', 2010 cases and 4042 controls) and >45 years old ('older adults', 17700 cases and 22 704 controls). Using logistic regression with studies treated as random effects, we estimated adjusted odds ratios (ORs) and 95% confidence intervals (CIs).ResultsThe young group of cases had a higher proportion of oral tongue cancer (16.0% in women; 11.0% in men) and unspecified oral cavity / oropharynx cancer (16.2%; 11.1%) and a lower proportion of larynx cancer (12.1%; 16.6%) than older adult cases. The proportions of never smokers or never drinkers among female cases were higher than among male cases in both age groups. Positive associations with HNC and duration or pack-years of smoking and drinking were similar across age groups. However, the attributable fractions (AFs) for smoking and drinking were lower in young when compared with older adults (AFs for smoking in young women, older women, young men and older men, respectively, = 19.9% (95% CI=9.8%, 27.9%), 48.9% (46.6%, 50.8%), 46.2% (38.5%, 52.5%), 64.3% (62.2%, 66.4%); AFs for drinking=5.3% (-11.2%, 18.0%), 20.0% (14.5%, 25.0%), 21.5% (5.0%, 34.9%) and 50.4% (46.1%, 54.3%). A family history of early-onset cancer was associated with HNC risk in the young [OR=2.27 (95% CI=1.26, 4.10)], but not in the older adults [OR=1.10 (0.91, 1.31)]. The attributable fraction for family history of early-onset cancer was 23.2% (8.60% to 31.4%) in young compared with 2.20% (-2.41%, 5.80%) in older adults.ConclusionsDifferences in HNC aetiology according to age group may exist. The lower AF of cigarette smoking and alcohol drinking in young adults may be due to the reduced length of exposure due to the lower age. Other characteristics, such as those that are inherited, may play a more important role in HNC in young adults compared with older adults.

Several epidemiological studies have shown a positive association between adult height and cancer incidence. The only study conducted among women on mouth and pharynx cancer risk, however, reported an inverse association. This study aims to investigate the association between height and the risk of head and neck cancer (HNC) within a large international consortium of HNC. We analyzed pooled individual-level data from 24 case-control studies participating in the International Head and Neck Cancer Epidemiology Consortium. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated separately for men and women for associations between height and HNC risk. Educational level, tobacco smoking, and alcohol consumption were included in all regression models. Stratified analyses by HNC subsites were performed. This project included 17,666 cases and 28,198 controls. We found an inverse association between height and HNC (adjusted OR per 10 cm height = 0.91, 95% CI 0.86-0.95 for men; adjusted OR = 0.86, 95% CI 0.79-0.93 for women). In men, the estimated OR did vary by educational level, smoking status, geographic area, and control source. No differences by subsites were detected. Adult height is inversely associated with HNC risk. As height can be considered a marker of childhood illness and low energy intake, the inverse association is consistent with prior studies showing that HNC occur more frequently among deprived individuals. Further studies designed to elucidate the mechanism of such association would be warranted.

BackgroundThe incidence of oropharyngeal and oral tongue cancers has increased over the last 20 years which parallels increased use of marijuana among individuals born after 1950.MethodsA pooled analysis was conducted comprising individual-level data from nine case-control studies from the United States and Latin America in the INHANCE consortium. Self-reported information on marijuana smoking, demographic, and behavioral factors was obtained from 1,921 oropharyngeal cases, 356 oral tongue cases, and 7,639 controls.ResultsCompared with never marijuana smokers, ever marijuana smokers had an elevated risk of oropharyngeal [adjusted OR (aOR), 1.24; 95% confidence interval (CI): 1.06-1.47] and a reduced risk of oral tongue cancer (aOR, 0.47; 95% CI, 0.29, 0.75). The risk of oropharyngeal cancer remained elevated among never tobacco and alcohol users. The risk of oral tongue cancer was reduced among never users of tobacco and alcohol. Sensitivity analysis adjusting for potential confounding by HPV exposure attenuated the association of marijuana use with oropharyngeal cancer (aOR, 0.99; 95% CI, 0.71-1.25), but had no effect on the oral tongue cancer association.ConclusionsThese results suggest that the association of marijuana use with head and neck carcinoma may differ by tumor site.ImpactThe associations of marijuana use with oropharyngeal and oral tongue cancer are consistent with both possible pro- and anticarcinogenic effects of cannabinoids. Additional work is needed to rule out various sources of bias, including residual confounding by HPV infection and misclassification of marijuana exposure.

We investigated the association between diet and head and neck cancer (HNC) risk using data from the International Head and Neck Cancer Epidemiology (INHANCE) consortium. The INHANCE pooled data included 22 case-control studies with 14,520 cases and 22,737 controls. Center-specific quartiles among the controls were used for food groups, and frequencies per week were used for single food items. A dietary pattern score combining high fruit and vegetable intake and low red meat intake was created. Odds ratios (OR) and 95% confidence intervals (CI) for the dietary items on the risk of HNC were estimated with a two-stage random-effects logistic regression model. An inverse association was observed for higher-frequency intake of fruit (4th vs. 1st quartile OR = 0.52, 95% CI = 0.43-0.62, p (trend) < 0.01) and vegetables (OR = 0.66, 95% CI = 0.49-0.90, p (trend) = 0.01). Intake of red meat (OR = 1.40, 95% CI = 1.13-1.74, p (trend) = 0.13) and processed meat (OR = 1.37, 95% CI = 1.14-1.65, p (trend) < 0.01) was positively associated with HNC risk. Higher dietary pattern scores, reflecting high fruit/vegetable and low red meat intake, were associated with reduced HNC risk (per score increment OR = 0.90, 95% CI = 0.84-0.97).

BackgroundSexual contact may be the means by which head and neck cancer patients are exposed to human papillomavirus (HPV).MethodsWe undertook a pooled analysis of four population-based and four hospital-based case-control studies from the International Head and Neck Cancer Epidemiology (INHANCE) consortium, with participants from Argentina, Australia, Brazil, Canada, Cuba, India, Italy, Spain, Poland, Puerto Rico, Russia and the USA. The study included 5642 head and neck cancer cases and 6069 controls. We calculated odds ratios (ORs) of associations between cancer and specific sexual behaviours, including practice of oral sex, number of lifetime sexual partners and oral sex partners, age at sexual debut, a history of same-sex contact and a history of oral-anal contact. Findings were stratified by sex and disease subsite.ResultsCancer of the oropharynx was associated with having a history of six or more lifetime sexual partners [OR = 1.25, 95% confidence interval (CI) 1.01, 1.54] and four or more lifetime oral sex partners (OR = 2.25, 95% CI 1.42, 3.58). Cancer of the tonsil was associated with four or more lifetime oral sex partners (OR = 3.36, 95 % CI 1.32, 8.53), and, among men, with ever having oral sex (OR = 1.59, 95% CI 1.09, 2.33) and with an earlier age at sexual debut (OR = 2.36, 95% CI 1.37, 5.05). Cancer of the base of the tongue was associated with ever having oral sex among women (OR = 4.32, 95% CI 1.06, 17.6), having two sexual partners in comparison with only one (OR = 2.02, 95% CI 1.19, 3.46) and, among men, with a history of same-sex sexual contact (OR = 8.89, 95% CI 2.14, 36.8).ConclusionsSexual behaviours are associated with cancer risk at the head and neck cancer subsites that have previously been associated with HPV infection.

Os tumores cerebrais são raros, mas sua incidência e mortalidade vêm aumentando ao longo das últimas décadas em vários países, inclusive no Brasil, particularmente entre idosos. O presente artigo descreve o perfil da mortalidade desses tumores no país, analisando a distribuição de suas taxas segundo sexo, idade, topografia e natureza tumoral entre 1980 e 1998. As taxas de mortalidade por esta neoplasia, ajustadas por idade pela população mundial, cresceram de 2,24/100 mil para 3,35/100 mil, correspondendo a um aumento de 50%. Estas foram mais elevadas na infância que na adolescência, aumentando posteriormente com a idade e alcançando níveis altos nos mais idosos, sendo o crescimento médio nos maiores de 70 anos de 6% ao ano ao longo da série estudada. São analisadas as taxas de tumores do encéfalo e das meninges cerebrais para o país e para capitais selecionadas. A constatação do aumento dessas taxas demanda a elaboração de estudos com vistas a elucidar o papel de novas tecnologias diagnósticas, assim como de potenciais fatores de risco ambientais.

As estatísticas de mortalidade constituem uma fonte bastante utilizada em estudos epidemiológicos de neoplasias. Com o objetivo de avaliar a confiabilidade e a validade da causa básica de morte "câncer de boca", no Município do Rio de Janeiro, selecionou-se no banco de dados da Secretaria Municipal de Saúde, todas as declarações de óbito (DOs) com essa causa básica, no ano de 1999. As DOs foram submetidas à nova codificação da causa básica, por técnico independente, e construiu-se formulário padronizado para coleta de dados clínicos e laboratoriais para a confirmação do diagnóstico nos prontuários médicos de cada caso. Foi considerado como padrão-ouro o diagnóstico de câncer de boca formulado com base no exame histopatológico e/ou história clínica. Observou-se concordância simples de 95,1% e coeficiente kappa de 0,93. O valor preditivo positivo correspondeu a 86,5%. Conclui-se que as estatísticas de mortalidade por neoplasia de boca no Município do Rio de Janeiro são confiáveis e que é boa a validade desta causa básica, possivelmente, por se tratar de sítio de fácil acesso para a inspeção direta e com maior facilidade de confirmação clínica.

The observation of reproductive disturbances in humans and in the wildlife has been reported in the last decade in different countries. Exposure to different chemicals possibly acting in the endocrine system or endocrine disruptors, including pesticides, has been a hypothesis raised to explain the observed changes. This paper aimed to present results of an epidemiological ecologic study carried out to explore population data on pesticides exposure in selected Brazilian states in the eighties and human reproductive outcomes in the nineties. Pearson correlation coefficients were ascertained between available data pesticides sales in eleven states in Brazil in 1985 and selected further reproductive outcomes or their surrogates. Moderate to high correlations were observed to infertility, testis, breast, prostate and ovarian cancer mortality. Despite the restrains of ecologic studies to establish cause-effect relationships, the observed results are in agreement with evidence supporting a possible association between pesticides exposure and the analyzed reproductive outcomes.

The article presents preliminary data from a prospective investigation in a sample of healthy 14-17-year-old students from a technical school in Sao Paulo, Brazil. Ninety-six Tanner stage 5 and thirty-one Tanner stage 4 adolescents were evaluated: testicular volume was measured using a Prader orchidometer, and semen analysis was performed according to standard procedures. Median testicular volume was 20.0ml among Tanner 5 students and 15.0ml in Tanner 4 students in both the right and left testes. No significant differences were found in sperm volume or motility. Median concentration was 66.0 million/ml for Tanner 5 and 47.0 million/ml for Tanner 4 subjects. Morphological patterns showed abnormal forms in 81.9% of Tanner 5 and 93.6% of Tanner 4 adolescents. Oligospermia (sperm concentration < 5 million/ml) was observed in 7.3% of Tanner stage 5 and 12.9% of Tanner stage 4 individuals. Azoospermia was observed in 3 students (1.8%), with counts less than 1.0 in 8 students (4.8%). The authors discuss the observed results, analyzing the potential implications arising from biological development and potential environmental exposures.

Este trabalho busca retratar a distribuição de intercorrências nas comunidades indígenas no Brasil associadas à geração e à distribuição da energia elétrica. De acordo com dados da Fundação Nacional do Índio, há 156 áreas geograficamente distribuídas no país caracterizadas por afetarem, presente ou futuramente, assentamentos indígenas através da expansão do setor elétrico - 65% das quais situadas na Região Norte. As principais reclamações destas comunidades dizem respeito aos efeitos diretos acarretados pelo alagamento originado com a construção das barragens hidroelétricas: submersão de territórios sagrados (como cemitérios); proliferação de mosquitos (ampliando a difusão da malária e de outras doenças infecciosas); escassez de caça; restrição das terras para a agricultura; e a criação de condições facilitadoras da invasão de terras indígenas. O cenário de perspectivas futuras é esboçado em quadro marcado pelo planejamento da construção de novas usinas hidrelétricas - em especial, na região amazônica - com possíveis efeitos similares nas comunidades indígenas.

Com o objetivo de conhecer o estado nutricional dos membros da Área Indígena Mãe-Maria em Bom Jesus do Tocantins, Pará, um estudo descritivo foi realizado com a participação de 90,8% (278 pessoas) de seus integrantes. Os indicadores de massa corporal conforme estatura e de estatura segundo idade, bem como o índice de massa corporal consoante sexo (IMC), foram determinados para crianças e adultos, respectivamente, além das médias de peso e estatura em adolescentes. Comparativamente às curvas normatizadas da população norte-americana (NCHS), notou-se prevalência de sobrepeso e de desnutrição crônica da ordem de 6,7 e 8,6%, respectivamente, nas 104 crianças menores de dez anos avaliadas. As médias de peso encontradas nos adolescentes indígenas e na população NCHS foram relativamente similares, sendo as médias de estatura menores entre os primeiros. A prevalência de sobrepeso (IMC 25-29) em homens e mulheres adultos foi de 23,7 e 50,0%, respectivamente, detectando-se prevalência de obesidade (IMC > 30) da ordem de 12,5% entre as últimas.

Com o objetivo de se avaliar a distribuição de fatores de risco em mulheres indígenas Teréna no Estado do Mato Grosso do Sul, duas amostras destas foram entrevistadas, respectivamente em 1995 (330 mulheres voluntárias de dez aldeias teréna de área rural) e em 1997 (quarenta mulheres da Aldeia de Limão Verde). Os padrões de vida reprodutiva, dieta, antecedentes patológicos pessoais e familiares foram levantados, bem como a determinação do índice de massa corporal (IMC). Na maior amostra, observou-se que a idade média à menarca foi de 12,3 anos (30% das mulheres referindo-a aos 13 anos ou mais), 86% das mulheres com antecedentes de uma ou mais gestações (42% com cinco ou mais), 71% com antecedentes de três ou mais gestações, idade média à primeira gestação de 18,9 anos (3.8% com 28 anos ou mais), aleitamento materno com duração média de 84 meses, e 70% das mulheres menopausadas antes dos cinqüenta anos de idade. O padrão referido de dieta na menor amostra revela elevado consumo de frutas, legumes, raízes e macarrão, com ingestão escassa de carne vermelha e frango, observando-se que 50% (IC 95%: 34.1-65.9) das mulheres apresentaram sobrepeso (IMC 25-29) e 27% (IC 95%: 15.1-44.1) obesidade (IMC > 29).

This study aims to estimate a population-based cancer incidence among indigenous populations in the State of Acre, Brazilian Western Amazon, to provide knowledge about cancer epidemiological profiles contributing to healthcare policies and service planning. Although cancer epidemiology in Brazil is well described through incidence and mortality estimate in the general population, cancer estimates among indigenous peoples are still unknown. This is a descriptive study of cancer incidence among the indigenous population (2000–2012) in the State of Acre, Brazil. The sources used were population-based cancer registries of Goiânia, hospital-based cancer registry of Acre, São Paulo, and Porto Velho; Special Indigenous Health Districts databases of Acre, Goiânia, and São Paulo; Mortality Information System, and Rio Branco's public and private laboratories' reports. Standardized Incidence Ratio (SIR) was calculated using cancer incidence rates of Goiânia as reference. From 137 cancer cases, 51.8% occurred in women and 32.1% in people aged 70 +. Among men, the most frequent cancer sites were stomach (25.8%), liver (15.1%), colorectal (7.6%), leukemia (7.6%), and prostate (6.1%). Among women, the most frequent were cervical (50.7%), stomach (8.5%), leukemia (5.6%), liver (4.3%), and breast (4.3%). Among men, there was an excess of cancer cases for stomach (SIR=1.75; 95%CI:1.67–1.83), liver (SIR=1.77; 95%CI:1.66–1.88), and leukemia (SIR=1.64; 95%CI:1.49–1.78). In women, an excess of cancer cases was observed for cervical (SIR=4.49; 95%CI:4.34–4.64) and liver (SIR=2.11; 95%CI:1.88–2.34). A lower cancer incidence for prostate (SIR=0.06; 95%CI:0.05–0.07) and female breast (SIR=0.12; 95%CI:0.11–0.14) was observed. Cervical, stomach, and liver cancers corresponded to 52% of the cases and were highly incident among the Brazilian indigenous population of Western Amazon compared to non-indigenous counterparts. Despite the low frequency of breast and prostate cancer, the fact they were present among indigenous peoples suggests a complex epidemiological transition framework in these populations. [ABSTRACT FROM AUTHOR]

Pesticide exposure is a public health concern worldwide. In Brazil, a study conducted in two stages among small-scale fruit farmers revealed that 19% of them had reported at least one [...]

Smoking has become a major public health problem in Latin America, and its scope varies from country to country. Despite difficulties in obtaining methodologically consistent data for the region, we analyzed the results from prevalence surveys in 14 Latin American countries. Smoking prevalence among men varied from 24.1% (Paraguay) to 66.3% (Dominican Republic) and among women from 5.5% (Paraguay) to 26,6% (Uruguay). By applying point prevalence data to the stage model of the tobacco epidemic in developed countries, we concluded that the Latin American countries are in stage 2, i.e., with a clearly rising prevalence among men, a prevalence for women that is beginning to increase, and mortality attributable to smoking among men still not reflecting peak prevalence. None of the countries analyzed appeared to have reached stage 3, in which one observes a downward trend in prevalence of smoking among men and peak prevalence among women, with broad impact on tobacco-related mortality. The only exception appears to be Paraguay, which is still emerging from stage 1, i.e., with low prevalence rates among men, too. Nevertheless, high lung cancer mortality rates in Uruguay and Argentina are comparable to those of the developed countries.

Antecedents of familial aggregation of breast and ovarian cancer are observed in only 5-8% of all breast cancer cases. Nevertheless, this variable displays one of the highest risk ratios associated to breast cancer outcome. Despite recent identification of genetic mutations associated with familial aggregation of these tumors, mainly at BRCA1 and BRCA2 genes, knowledge on the interaction between environmental agents in these families remains quite unclear. In this paper we ascertained the correlation among ages of the onset of breast/ovarian cancer in 260 Brazilian families with those cancer aggregation. Further we estimated the median age of the onset of breast cancer among four generations. We observed that the higher the number of family cancer cases, the highest is the correlation of ages for the onset of breast cancer. We also observed a 8-10 year decline in the mean age-of-onset of breast/ovarian cancer from one generation to another in the studied families. If these results could be confirmed elsewhere, we believe that the hypothesis of interaction between environmental risks factors in families indeed showing breast/ovarian cancer aggregation is reinforced.

A case study was carried out to explore the occurrence of a cancer cluster in 1992 among young indian adults living in an Amazonian village near two 500 kV power transmission lines that began operating a decade ago. Current blood levels of DDT and organophosphorus pesticides and metal levels in hair samples were measured. Extremely low magnetic field exposure was determined during current daily activities carried out by the Indian villagers. Taking into account the cancer incidence rates in different Brazilian cities, the probability of the occurrence of this cluster by chance was considered remote (p< 0.003, Poisson distribution). High blood levels of p,p'-DDT (median levels ranging from 26 to 58 ppb) were observed. As a whole, this community showed a pattern of low exposure to organophosphorus pesticides, and high recent exposure was only observed in a few blood samples. Continuous exposure to extremely low electromagnetic fields originated in the power transmission lines (which reached 95.0 mG under the lines) was observed on several opportunities during daily activities carried out by Indian villagers. Further observational studies should evaluate the interaction between exposure to extremely low electromagnetic fields and prior exposure to tumor initiators in cancer development.

A qualidade dos dados é questão central para o desenvolvimento de estudos epidemiológicos, especialmente quando se utiliza um banco de dados secundários. Este estudo tem por objetivo avaliar a confiabilidade da estatística de mortalidade por câncer de estômago no Município do Rio de Janeiro. Uma amostra aleatória simples de 97 das 645 declarações de óbito atribuídas à neoplasia de estômago em 1990, foi submetida à revisão do prontuário hospitalar para confirmação clínico-laboratorial, através de preenchimento de formulário específico para este estudo. A partir deste formulário, duas médicas completaram novo atestado de óbito, de forma independente, permitindo a análise da confiabilidade do instrumento. Foram estudados 86 casos, pois não foi possível encontrar dados para os demais, constituindo uma perda de 11,3%. A análise da confiabilidade do formulário de pesquisa apresentou concordância de 90,7% (kappa = 0,73) quanto ao diagnóstico de neoplasia de estômago entre as duas médicas. A validade foi calculada pelo valor preditivo positivo, que resultou em 90,7%. Oito casos foram descartados após revisão de dados clínicos laboratoriais. O estudo permite concluir que a estatística de mortalidade por neoplasia de estômago no Município do Rio de Janeiro é suficientemente válida para ser utilizada em estudos epidemiológicos.

Os registros de mortalidade são muito utilizados em estudos epidemiológicos, especialmente na área das neoplasias. Este estudo tem por objetivo avaliar a confiabilidade e validade da estatística de mortalidade por neoplasias no Estado do Rio de Janeiro, com base em uma amostra aleatória sistemática de 394 das 12.615 declarações de óbito por neoplasias de 1990, submetida à nova classificação da causa básica por técnico independente. Encontrou-se uma concordância de 90,1% no conjunto das neoplasias, com coeficiente kappa de 0,89 (95% IC 0,86-0,92) para terceiro dígito, subindo para 0,95 (95% IC 0,94-0,96) ao se restringir à Lista Brasileira para Mortalidade, que é utilizada para as publicações oficiais. Para esta amostra, o valor preditivo positivo foi de 95,7%. O estudo conclui que a estatística de mortalidade por neoplasia no Estado do Rio de Janeiro apresenta alto grau de confiabilidade, o que assegura sua qualidade para o uso em estudos epidemiológicos.

Contrary to many industrialized countries in which a sharp decline in stomach cancer incidence has been observed, Brazil still shows intermediate to high incidence rates. An ecologic analysis was performed to explore variables possibly associated with the development of stomach cancer. Cluster analysis, principal component analysis, and factor analysis were carried out with population data, including the following: stomach cancer incidence rates in the early 1990s obtained from population-based cancer registries in Porto Alegre, Campinas, Fortaleza, Belém, and Goiânia; and data from a Brazilian national survey on family expenditures (several diet consumption items and availability of home refrigerators) carried out in 1974-75. The results suggested that past availability of a home refrigerator, i.e. food preservation, may have played an important role in currently observed differences in stomach cancer incidence among the various populations studied in Brazil. Differences in living standards among populations in these cities also appear to have played an important role in the observed incidence differences.