Association between Literacy, Compliance with Prostate Cancer Screening, and Cancer Aggressiveness: Results from a Brazilian Screening Study

Purpose Little is known about the effects of literacy levels on prostate cancer screening. This study evaluates the association between literacy, compliance with screening, and biopsy findings in a large Brazilian screening study. Materials and Methods We analyzed 17,571 men screened for PCa with digital rectal examination (DRE) and total and free prostate-specific antigen (PSA) from January 2004 to December 2007. Of those, 17,558 men had information regarding literate status. Full urological evaluation in a specialized cancer center was recommended in the case of: a) suspicious DRE, b) PSA > 4.0 ng/mL, or c) PSA 2.5-3.9 ng/mL and free/total PSA (f/tPSA) ratio < 15%. Transrectal ultrasound guided prostate biopsy (14 cores) was performed upon confirmation of these findings after the patient's consent. Patients' compliance with screening recommendations and biopsy results were evaluated according to literacy levels. Results an abnormal PSA, a suspicious DRE, or both were present in 73.2%, 19.7%, and 7.1% of those men who underwent biopsy, respectively. PCa was diagnosed in 652 men (3.7%). Previous PSAs or DREs were less common among illiterate men (p < 0.0001). Additionally, illiterate men were less prone to attend to further evaluations due to an abnormal PSA or DRE (p < 0.0001). PSA levels > 10 mg/mL (p = 0.03), clinical stage > T2a (p = 0.005), and biopsy Gleason > 7 (p = 0.02) were more common among illiterate men. Conclusions In a screened population, literacy levels were associated with prior PCa evaluations and with compliance with screening protocols. Illiterate men were at higher risk of being diagnosed with more advanced and aggressive PCa. .

Melanoma de mucosa oral, genital e anorretal / Melanoma of oral, genital and anorectal mucous membrane

Entre 1970 e 1997, 411 pacientes com diagnóstico de melanoma foram atendidos no Hospital São Judas Tadeu de Barretos. Destes, 7 (1,7 porcento) eram de mucosa e os respectivos prontuários foram analisados para este trabalho. Quanto à localização, eram anorretal; 2 eram vulvovaginal, e 1 localizava-se no palato; havia seis pacientes do sexo feminino e um masculino variando as idades de 31 a 81 anos (média= 61 anos). Apenas um paciente apresentou tumor localizado (está com quase 5 anos de sobrevida), 4 tinham doença regional (todos faleceram antes de 3 anos após o diagnóstico) e dois tinham metástases (óbitos ocorridos antes de um ano após diagnóstico). Os tratamentos variaram de conformidade com o estadiamento da doença. Os dados evidenciam o prognóstico ruim da moléstia, que se apresenta, usualmente em estádios avançados e, freqüentemente, com metástases.