ABSTRACT
Objective. To describe the behavior of breast cancer (BC)during the 1962-2012 period from information provided by the Cali Cancer Registry and the Municipal Health Secretariat of Cali. Materials and methods. The incidence trend (1962-2007) and mortality trend (1984-2012) for breast cancer was studied and relative survival (RS)(1995-2004) was estimated. Age-standardized incidence and mortality rates to the world population (ASIR(w)/ASMR(w)) were expressed per 100000 persons-year. Their temporal trend was examined with the annual percent of change (APC), and the Cox model was used to analyze the variables that influenced the survival of women with breast cancer. Results. The risk of breast cancer significantly increased in Cali through the 1962-2007 period, with an APC =1.7(95%CI:1.4-2.0). The ASIR(w) of BC increased from 27.1 in 1962 to 48.0 in 2007 and currently there are more than 500 cases reported annually. The mortality for BC has remained stable since 1984; in the 2009-2012 period, the ASMR(w) was 14.2. The 5-year RS was 69% (95%CI:66-71) from 2000-2004 and 62% (95%CI:59-65) from 1995-1999. The risk of death (HR) from BC was greater in persons from lower socioeconomic strata (SES) than from higher SES, HR=1.9(95%CI:1.3-2.9) and in those older than 70 years vs. <50, HR=1.6(95%CI:1.1-2.2). Conclusion. Mortality remained stable while incidence increased and survival improved, which may be associated with better detection and advances in treatment.
Objetivo. Describir el comportamiento del cáncer de mama (CaMa) entre 1962 y 2012 con la información del Registro Poblacional de Cáncer de Cali y de la Secretaría de Salud Municipal de Cali, Colombia. Material y métodos. Se estudió la tendencia de la incidencia (1962-2007) y mortalidad (1984-2012) por CaMa y se estimó la supervivencia relativa (SR) (1995-2004). Las tasas de incidencia y mortalidad estandarizadas por edad con población estándar mundial (TIEE(m)/TMEE(m)) se expresan por 100000 personas/año. Su tendencia temporal fue estudiada con el porcentaje de cambio anual (APC, por su sigla en inglés) y el modelo de Cox fue utilizado para analizar las variables que influyen en la supervivencia. Resultados. La TIEE(m) de CaMa aumentó de 27.1 en 1962 a 48.0 en 2007 y actualmente más de 500 casos son registrados anualmente, con un APC de 1.7(IC95%:1.4-2.0). La mortalidad por CaMa ha permanecido estable desde 1984; en el periodo 2009-2012 la TMEE(m) fue 14.2. La SR a cinco años fue 69% (IC95%:66-71) durante el periodo 2000-2004 y 62% (IC95%: 59-65) entre 1995 y 1999. El riesgo de morir (HR, por su sigla en inglés) por CaMa fue mayor en las personas de estratos socioeconómicos (ESE) bajos vs ESE altos, HR=1.9(IC95%:1.3-2.9) y en los mayores de 70 años vs los menores de 50, HR=1.6(95%CI:1.1-2.2). Conclusión. La mortalidad estable, con aumento de la incidencia y mejor supervivencia, puede estar asociada con una mejor detección y avances en el tratamiento.
Subject(s)
Animals , Mice , Rats , Carcinogens/pharmacokinetics , Epoxy Compounds/pharmacokinetics , Models, Biological , Glutathione/metabolismABSTRACT
Introdução: a mortalidade materna consiste em evento prioritário de saúde pública, afetando particularmente mulheres no ciclo gravídico puerperal de classes sociais mais desfavorecidas. Objetivo: analisar, a partir dos dados do Comitê Municipal de Prevenção à Mortalidade Materna de Juiz de Fora, os determinantes sociais envolvidos nesse evento, o perfil reprodutivo dessas mulheres, a acessibilidade e a qualidade dos serviços de saúde. Método: estudo retrospectivo, com análise dos 81 óbitos maternos de Juiz de Fora, entre 1996 e 2008. Foram consideradas como variáveis para análise: número de consultas e qualidade do pré-natal, período gestacional, tipo de parto, momento do óbito, causa básica da morte, local de ocorrência, além dos problemas e sugestões propostos pelo Comitê. Resultados: a RMM média entre 1996 e 2001 foi de 98,5 por 100.000 nascidos vivos, passando nos seis anos seguintes (2002 a 2007) para 77,8 por 100.000 nascidos vivos. Foi encontrada associação entre número de consultas pré-natais e cor (p=0,02) e também correlação (r=0,90, p-valor=0,01) entre áreas de exclusão social e número de óbitos maternos. Do total de óbitos, 74% foram declarados. A maioria dos óbitos ocorreu no puerpério (69,1%), foi do tipo obstétrico direto (63%) e 64% eram evitáveis. Conclusão: a elevada taxa de mortalidade materna associada a precárias condições socioeconômicas e ao potencial de evitabilidade de grande parte dos óbitos maternos revelam a necessidade de políticas públicas mais eficientes.
Introduction: Maternal death represents a priority public health issue that particularly affects socially unprivileged women in their pregnancy and puerperal period. Objective: To analyze the social determinants involved in this issue, the reproductive characteristics of these women and the access to and the quality of health services building on data provided by the Municipal Committee for Prevention of Maternal Death in the Municipality of Juiz de Fora. Method: This is a retrospective study that analyses 81 maternal deaths in Juiz de Fora from 1996 through 2008. The analysis included the following variables: number and quality of prenatal appointments, pregnancy duration, type of delivery, moment of death, basic cause of death, and place of death, as well as the issues and related suggestions pointed by the Municipal Committee. Results: The average maternal mortality rate from 1996 through 2001 was 98.5 per 100,000 live newborns, but decreased to 77.8/100,000 from 2002 to 2007. Significant correlations were found between prenatal appointments and skin color (p=0.02) as well as between zones of social exclusion and number of maternal deaths (r=0.90, p=0.01). Medical death certificate was provided in 70% of the cases. Most deaths took place during puerperium (69.1), were registered as direct obstetric death (63%) and were considered evitable (64%). Conclusion: The high maternal mortality rate associated with poor socioeconomic conditions and the meaningful occurrence of potentially evitable cases of death points to the need of more efficient public policies