Ethnic disparities in cancer mortality in the capital and northeast of the State of São Paulo, Brazil 2001-17.

PURPOSE: There is a paucity of studies investigating cancer disparities in groups defined by ethnicity in transitioning economies. We examined the influence of ethnicity on mortality for the leading cancer types in São Paulo, Brazil, comparing patterns in the capital and the northeast of the state. METHODS: Cancer deaths were obtained from a Brazilian public government database for the Barretos region (2003-2017) and the municipality of São Paulo (2001-2015). Age-standardized rates (ASR) per 100,000 persons-years, by cancer type and sex, for five self-declared racial classifications (white, black, eastern origin (Asian), mixed ethnicity (pardo), and indigenous Brazilians), were calculated using the world standard population. RESULTS: Black Brazilians had higher mortality rates for most common cancer types in Barretos, whereas in São Paulo, white Brazilians had higher rates of mortality from breast, colorectal, and lung cancer. In both regions, lung cancer was the leading cause of cancer death among white, black, and pardo Brazilians, with colorectal cancer deaths leading among Asian Brazilians. Black and pardo Brazilians had higher cervical cancer mortality rates than white Brazilians. CONCLUSION: There are substantial disparities in mortality from different cancers in São Paulo according to ethnicity, pointing to inequities in access to health care services.

Geographic variations in cancer incidence and mortality in the State of São Paulo, Brazil 2001-17.

BACKGROUND: Cancer is a leading cause of morbidity and mortality in Brazil and the burden is rising. To better inform tailored cancer actions, we compare incidence and mortality profiles according to small areas in the capital and northeast region of the State of São Paulo for the leading cancer types. METHODS: New cancer cases were obtained from cancer registries covering the department of Barretos (2003-2017) and the municipality of São Paulo (2001-2015). Cancer deaths for the same period were obtained from a Brazilian public government database. Age-standardized rates per 100,000 persons-years by cancer and sex are presented as thematic maps, by municipality for Barretos region, and by district for São Paulo. RESULTS: Prostate and breast cancer were the leading forms of cancer incidence in Barretos, with lung cancer leading in terms of cancer mortality in both regions. The highest incidence and mortality rates were seen in municipalities from the northeast of Barretos region in both sexes, while elevated incidence rates were mainly found in São Paulo districts with high and very high socioeconomic status (SES), with mortality rates more dispersed. Breast cancer incidence rates in São Paulo were 30 % higher than Barretos, notably in high and very high SES districts, while corresponding rates of cervical cancer conveyed the opposite profile, with elevated rates in low and medium SES districts. CONCLUSIONS: There is substantial diversity in the cancer profiles in the two regions, by cancer type and sex, with a clear relation between the cancer incidence and mortality patterns observed at the district level and corresponding SES in the capital.

The digital expression profile of BMP7, CDKN2C, HIST1H3G, and PKMYT1 genes improves high-grade cervical lesion detection in liquid-based cytology.

BACKGROUND: Some studies reported that differential gene expression could be used as a biomarker for high-grade cervical lesion identification. The aim was to evaluate the gene expression profile of cervical intraepithelial neoplasia (CIN) to identify a gene expression signature of CIN2+ in liquid-based cytology (LBC) samples. METHODS: LBC samples (n = 85) obtained from women who underwent colposcopy were included with benign (n = 13), CIN1 (n = 26), CIN2 (n = 16), and CIN3 (n = 30) diagnoses. After RNA isolation, gene expression profiling was performed using the nCounter PanCancer Pathways, which consists of 730 cancer-related genes. The genes identified were in silico expression evaluated using the UALCAN database. An accurate prediction model to discriminate CIN2+ from

Deterministic linkage for improving follow-up time in a Brazilian population-based cancer registry.

Population-based cancer registries (PBCR) are the primary source of cancer incidence and survival statistics. The loss to follow-up of these patients is concerning since it reduces the reliability of any statistical analysis. The linkage techniques have been increasingly used to improve data quality in various information systems. The linkage was performed between the databases of the PBCR-Barretos and the mortality database of the state of São Paulo. To evaluate the improvement in the follow-up time of patients, the comparability of the two databases, pre- and post linkage, was made. Three analyses were performed: a comparative analysis of the absolute number of deaths, a comparative analysis of the follow-up time of patients and the survival analysis. After linkage, there was an increase of 813 deaths. The follow-up time of patients was extended and observed in most types of tumours. The comparability of the survival analyses at both time points also showed a decrease in survival probabilities for all tumour types. Deterministic linkage is effective in updating the vital status of registered patients, improving patient follow-up time, and maintaining good quality data from PBCRs, consequently producing more reliable rates, as seen for the survival analyses.

Hotspot analysis by confocal microscopy can help to differentiate challenging melanocytic skin lesions.

Some melanocytic lesions do not present enough clinical and dermoscopic features to allow ruling out a possible melanoma diagnosis. These "doubtful melanocytic lesions" pose a very common and challenging scenario in clinical practice and were selected at this study for reflectance confocal microscopy evaluation and subsequent surgical excision for histopathological diagnosis. The study included 110 lesions and three confocal features were statistically able to distinguish benign melanocytic lesions from melanomas: "peripheral hotspot at dermo-epidermal junction", "nucleated roundish cells at the dermo-epidermal junction" and "sheet of cells". The finding of a peripheral hotspot (atypical cells in 1mm2) at the DEJ is highlighted because has not been previously reported in the literature as a confocal feature related to melanomas.

DNA Recovery Using Ethanol-Based Liquid Medium from FTA Card-Stored Samples for HPV Detection.

INTRODUCTION: Alternative methods of dry storage and transportation may be a viable alternative to the use of liquid storage medium for cervical samples, especially for screening programs in places with few resources. OBJECTIVE: The objective of this study is to verify the viability and efficacy of human papillomavirus DNA (HPV-DNA) detection in cervical cell samples collected and stored on a Flinders Technology Associates (FTA) card (Whatman Indicating FTA® Elute Micro Card) and subsequently recovered in ethanol-based liquid medium and to compare the results to those obtained using samples stored directly in ethanol-based liquid medium. STUDY DESIGN: Thirty-four women submitted to ETZ (excision of the transformation zone of the cervix) were included in this study. Before ETZ, 2 samples of exfoliated cervical cells were collected from each woman by a doctor and stored in ethanol-based liquid medium and on an FTA card. DNA recovery from FTA samples was performed using ethanol-based liquid medium. Detection of HPV-DNA in the samples was performed using the Cobas® 4800 HPV Test Platform. RESULTS AND CONCLUSIONS: The HPV-DNA detection positivity rates were 70.6% for the samples collected directly in liquid medium and 64.7% for the samples stored on the FTA card, with high detection accuracy in the DNA samples recovered from the FTA card (area under the curve = 0.958; 95% confidence interval = 0.890-1.000). The concordance between the results obtained using the 2 storage media was 94.1% (Kappa = 0.866). These preliminary results suggest that collection of cervical material on an FTA card may be an alternative to storage in liquid medium since the liquid medium has some limitations. In addition, DNA recovery from the card using ethanol-based liquid medium streamlines the workflow in the laboratory and reduces the cost associated with reagents, thereby facilitating access to the HPV test in places with few resources and potentially improving cervical cancer screening.

Comparison of the Cervex-Brush® Combi and the Cytobrush+Ayres Spatula Combination for Cervical Sampling in Liquid-Based Cytology.

OBJECTIVES: To compare the performance of two cervical collection devices (Cytobrush+Ayres spatula and Cervex-Brush® Combi) for cellular sampling, transformation zone representation and accuracy in diagnosing cervical intraepithelial neoplasia (CIN) 2+. METHODS: Cervical samples were collected from patients referred to the colposcopy unit of the Barretos Cancer Hospital between September 2013 and October 2014 using one of the two sampling devices. Additionally, colposcopy was performed with or without cervical biopsy and/or endocervical curettage. RESULTS: Biopsy was performed in 670 of the 1,235 patients submitted to colposcopy (54.2%). The Cervex-Brush® Combi was more effective than the Cytobrush with respect to endocervical cells sampling (82.7% versus 74.6%; p = 0.001). Sensitivity was also higher with the Cervex-Brush® Combi (48.6% versus 33.9%; p = 0.023) for predicting CIN2+ when high-grade squamous intraepithelial lesions were detected at cytology. CONCLUSIONS: Cervex-Brush® Combi was more effective than Cytobrush+Ayres Spatula for endocervical cells sampling and also had a slightly higher accuracy in predicting histologically CIN2+ lesions in patients with diagnosis of HSIL in cytology.

Quantitative Study of Brunner's Glands in the Human Duodenal Submucosa / Estudio cuantitativo de las Glándulas de Brunner en la Submucosa Duodenal Humana

The existence of Brunner's glands (BGs) in the duodenal submucosa is uncontestable, but their exact distribution along the full extent of the duodenal wall is unknown. Objective: To verify the BGs distribution along the human duodenum. Material and method: Twenty normal duodenums were examined. Two samples were removed from each of the four anatomical portions of the duodenum using a scalpel, in such a way that the whole circumference of each portion was excised. Sections were prepared and stained with hematoxylin-eosin. Twelve microscope fields were examined on each duodenal section. The mean numbers of glandular points per field were computed and compared, for the 12 microscope fields of each duodenal section examined. Results: The first duodenal portion presented large quantities of BGs in all of the fields examined. The second duodenal portion also showed the presence of BGs in all the fields examined, albeit in smaller quantities than in the first portion. In the third duodenal portion, BGs were present in six of the duodenums examined. In the fourth duodenal portion, there was a minimal quantity of glands, all located in only ten of the duodenums studied. Conclusions: BGs are present in the submucosa of all duodenal portions, with the greatest concentration in the first portion. Their concentration decreases significantly in the second portion of the duodenum. Furthermore, they become even fewer in number in the third portion and are minimally present in the fourth portion.

La presencia de las glándulas de Brunner en la submucosa duodenal es innegable, pero se desconoce su exacta distribución a lo largo de toda la extensión de la pared duodenal. El objetivo del presente estudio fue analizar la distribución de las glándulas duodenales de Brunner (GDB) en la submucosa de duodenos humanos. Para ello, se examinaron 20 duodenos normales en los que fueron seccionados 22cm de cada porción duodenal, retirados con bisturí, de forma tal, que toda la circunferencia de cada segmento fuese extraída. Cada porción seleccionada fue preparada, teñida con hematoxilina-eosina y observada en 12 campos microscópicos diferentes. Las medias de los puntos glandulares por campo fueron computadas y comparadas para 12 campos microscópicos de cada porción del duodeno examinado. El primer segmento duodenal presenta un gran número de GDB en todos los campos microscópicos examinados. El segundo segmento también mostró la presencia de GDB, aunque el número encontrado fue menor. En el tercer segmento GDB fueron encontradas en 6 de los duodenos estudiados. En el cuarto segmento, el número de GDB fue aún menor y se encontraron solamente en 10 de los duodenos analizados. Así, la presencia de GDB ocurre en la submucosa de todos los segmentos duodenales y la mayor incidencia se encuentra en la primera porción, disminuyendo significativamente en la segunda, mucho más en la tercera, siendo mínima en la cuarta.