Screening for lung cancer: 2023 guideline update from the American Cancer Society.

Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.

Mortalidad por tumores malignos

El cáncer constituye un serio problema de salud para la humanidad, ocupa la primera causa de morbimortalidad a nivel mundial y una de las principales causas de muerte en Cuba. Se realizó un estudio descriptivo, retrospectivo, con el objetivo de describir la mortalidad por tumores malignos en el municipio Yara, en el período enero-junio de 2022. El universo quedó constituido por 262 fallecidos y la muestra del estudio lo constituyeron los 54 fallecidos con código de causa básica de muerte por tumores malignos en el período de tiempo antes señalado, datos obtenidos a través del registro primario de defunciones del Departamento de estadística del Centro Municipal de Higiene y Epidemiología. Se utilizaron métodos de estadística descriptiva principalmente el porcentaje, se confeccionaron cuadros de distribución de frecuencia, Se determinaron las tasas de mortalidad bruta y por causa. En el período analizado ocurrieron 54 defunciones por tumores malignos, el grupo de edad más afectado fueron los mayores de 75, predominó el sexo masculino, el área de salud "Luis Enrique de la Paz Reina" aportó el mayor número de fallecidos, la zona rural prevaleció sobre la urbana, las localizaciones más frecuentes: próstata, pulmón, colon-recto, el mayor número de las defunciones ocurrieron en el domicilio. En el municipio Yara los tumores malignos ocupan la segunda causa de mortalidad, el mayor número de fallecidos ocurrió en pacientes de la tercera edad, el tumor de próstata fue el más representativo.

Cancer represents a serious health problem for humanity. It occupies the first cause of morbimortality world wide, and one of the main causes of death in Cuba. A descriptive, retrospective study was conducted in the municipality of Yara, in the period January-June 2022.The objective of this research was to describe mortality due to malignant tumors. The universe was constituted by 262 deceased. The sample of the study was constituted by the 54 deceased with code of the basic cause of death by malignant tumors in the aforementioned period. These data were obtained through the primary register of deaths of the Department of Statistics of the Municipal Center of Hygiene and Epidemiology. Descriptive statistical methods were used, mainly percentages. Frequency distribution tables were prepared, and crude mortality rates and mortality rates by cause were determined. During the period analyzed, 54 deaths occurred due to malignant tumors. The most affected age group was those older than 75 years, the male sex predominated. The "Luis Enrique de la Paz Reina" health area contributed the highest number of deaths. The rural area prevailed over the urban area. The most frequent locations were: prostate, lung and colon-rectum. The highest number of deaths occurred at home. In the municipality of Yara, malignant tumors are the second cause of mortality. Moreover, the highest number of deaths occurred in elderly patients, and prostate tumor was the most representative.

O cancro representa um grave problema de saúde para a humanidade. Ocupa a primeira causa de morbimortalidade em todo o mundo, e uma das principais causas de morte em Cuba. Foi realizado um estudo descritivo e retrospetivo no município de Yara, no período de janeiro a junho de 2022, como objetivo de descrever a mortalidade por tumores malignos. O universo foi constituído por 262 falecidos. A amostra do estudo foi constituída pelos 54 falecidos com código da causa básica de morte por tumores malignos no período supracitado. Estes dados foram obtidos através do registo primário de óbitos do Departamento de Estatística do Centro Municipal de Higiene e Epidemiologia. Foram utilizados métodos estatísticos descritivos, principalmente percentuais. Foram elaboradas tabelas de distribuição de freqüência e determinadas as taxas brutas de mortalidade e as taxas de mortalidade por causas. Durante o período analisado, ocorreram 54 mortes por tumores malignos, sendo o grupo etário mais afetado o dos maiores de 75 anos e predominando o sexo masculino. A área de saúde "Luis Enrique de la Paz" foi a que contribuiu com o maior número de mortes. A zona rural prevaleceu sobre a zona urbana. As localizações mais frequentes foram: próstata, pulmão e cólon-reto. O maior número de mortes ocorreu no domicílio. No município de Yara, os tumores malignos são a segunda causa de mortalidade. Alémdisso, o maior número de óbitos ocorreu em pacientes idosos, sendo o tumor de próstata o mais representativo.

Association of metastatic pattern in breast cancer with tumor and patient-specific factors: a nationwide autopsy study using artificial intelligence.

BACKGROUND: Metastatic spread is characterized by considerable heterogeneity in most cancers. With increasing treatment options for patients with metastatic disease, there is a need for insight into metastatic patterns of spread in breast cancer patients using large-scale studies. METHODS: Records of 2622 metastatic breast cancer patients who underwent autopsy (1974-2010) were retrieved from the nationwide Dutch pathology databank (PALGA). Natural language processing (NLP) and manual information extraction (IE) were applied to identify the tumors, patient characteristics, and locations of metastases. RESULTS: The accuracy (0.90) and recall (0.94) of the NLP model outperformed manual IE (on 132 randomly selected patients). Adenocarcinoma no special type more frequently metastasizes to the lung (55.7%) and liver (51.8%), whereas, invasive lobular carcinoma mostly spread to the bone (54.4%) and liver (43.8%), respectively. Patients with tumor grade III had a higher chance of developing bone metastases (61.6%). In a subgroup of patients, we found that ER+/HER2+ patients were more likely to metastasize to the liver and bone, compared to ER-/HER2+ patients. CONCLUSION: This is the first large-scale study that demonstrates that artificial intelligence methods are efficient for IE from Dutch databanks. Different histological subtypes show different frequencies and combinations of metastatic sites which may reflect the underlying biology of metastatic breast cancer.

Cancer mortality in workers at risk of occupational exposure to ionizing radiation in a company in the nuclear sector headquarters in São Paulo / Mortalidade por câncer em trabalhadores com risco de exposição ocupacional à radiação ionizante em empresa do setor nuclear sediada em São Paulo

ABSTRACT Objective: To compare cancer mortality among workers exposed to gamma and X radiation and the general population of the city of São Paulo, as well as that of the subgroup monitored with those not monitored for gamma and X radiation in a work unit with ionizing radiation based in the city of São Paulo. Methods: Between 2016 and 2021, a retrospective open cohort study was carried out with workers who were employed from 08/31/1956 to 12/31/2016 based on data collected at the company and in official institutions. Standardized mortality ratios (SMR) were calculated by sex, age and calendar period of cancers grouped according to type, risk factor and organ system in two analyses: in the external analysis, the mortality of the study population was compared with that of the general population of the city of São Paulo; In the internal analysis, the mortality of the monitored subgroup was compared with that of the subgroup not monitored for gamma and X radiation. Results: The external mortality analysis showed SMR=0.224 (95%CI 0.208-0.240) and the healthy worker effect, while the internal mortality analysis showed SMR=0.685 (95%CI 0.618-0.758). Conclusion: This study showed lower cancer mortality among exposed workers when compared to mortality in the general population and the healthy worker effect. Among workers monitored for gamma and X radiation, cancer mortality was lower when compared to those not monitored.

RESUMO Objetivo: Comparar a mortalidade por câncer entre trabalhadores expostos à radiação gama e X e a população geral do município de São Paulo, bem como a do subgrupo monitorado com o não monitorado para radiação gama e X em uma unidade de trabalho sediada no município de São Paulo. Métodos: Entre 2016 e 2021 foi realizado estudo de coorte aberta retrospectiva com trabalhadores que tiveram vínculo empregatício desde 31/08/1956 até 31/12/2016 a partir de dados coletados na empresa e em instituições oficiais. Foram calculadas as razões de mortalidade padronizadas (RMP) por sexo, idade e período calendário de cânceres agrupados segundo o tipo, o fator de risco e o sistema orgânico em duas análises: na análise externa, comparou-se a mortalidade da população de estudo com a da população geral do município de São Paulo; já na análise interna, comparou-se a mortalidade do subgrupo monitorado com a do subgrupo não monitorado para radiação gama e X. Resultados: A análise externa de mortalidade mostrou RMP=0,224 (IC95% 0,208-0,240) e o efeito do trabalhador sadio, enquanto a análise interna de mortalidade mostrou RMP = 0,685 (IC95% 0,618-0,758). Conclusão: Este estudo mostrou menor mortalidade por câncer entre os trabalhadores expostos quando comparada com a mortalidade da população geral e o efeito do trabalhador sadio. Entre os trabalhadores monitorados para radiação gama e X, a mortalidade por câncer foi menor quando comparada com a dos não monitorados.

Design of an interface to communicate artificial intelligence-based prognosis for patients with advanced solid tumors: a user-centered approach.

OBJECTIVES: To design an interface to support communication of machine learning (ML)-based prognosis for patients with advanced solid tumors, incorporating oncologists' needs and feedback throughout design. MATERIALS AND METHODS: Using an interdisciplinary user-centered design approach, we performed 5 rounds of iterative design to refine an interface, involving expert review based on usability heuristics, input from a color-blind adult, and 13 individual semi-structured interviews with oncologists. Individual interviews included patient vignettes and a series of interfaces populated with representative patient data and predicted survival for each treatment decision point when a new line of therapy (LoT) was being considered. Ongoing feedback informed design decisions, and directed qualitative content analysis of interview transcripts was used to evaluate usability and identify enhancement requirements. RESULTS: Design processes resulted in an interface with 7 sections, each addressing user-focused questions, supporting oncologists to "tell a story" as they discuss prognosis during a clinical encounter. The iteratively enhanced interface both triggered and reflected design decisions relevant when attempting to communicate ML-based prognosis, and exposed misassumptions. Clinicians requested enhancements that emphasized interpretability over explainability. Qualitative findings confirmed that previously identified issues were resolved and clarified necessary enhancements (eg, use months not days) and concerns about usability and trust (eg, address LoT received elsewhere). Appropriate use should be in the context of a conversation with an oncologist. CONCLUSION: User-centered design, ongoing clinical input, and a visualization to communicate ML-related outcomes are important elements for designing any decision support tool enabled by artificial intelligence, particularly when communicating prognosis risk.

Tendência temporal de mortalidade por câncer de cabeça e pescoço no Brasil entre os anos de 2000 e 2020 / Temporal trend of mortality from head and neck cancer in Brazil between 2000 and 2020 / Tendencia temporal en la mortalidad de la cabeza y el cáncer de cuello en Brasil entre 2000 y 2020

Analisar a tendência temporal de mortalidade por câncer de cabeça e pescoço no Brasil e em suas regiões geográficas entre os anos de 2000 a 2020. Métodos: Foram analisados os números de óbitos por neoplasias malignas de cabeça e pescoço (CID-10: C00-C14; C30-C32) disponibilizados no portal oficial do Ministério da Saúde do Brasil para o período, bem como os dados sobre população residente. O padrão temporal e geográfico foi analisado através da taxa de mortalidade padronizada por idade (TMPI) e avaliado em modelo de regressão por pontos de inflexão. Resultados: No Brasil, a TMPI permaneceu estável independente do sexo (AAPC: -0,3; IC95: -1,0-0,3) no período avaliado. O estudo das regiões brasileiras evidenciou crescimento médio da TMPI independente do sexo nas regiões Nordeste (AAPC: 2,8; IC95: 2,1-3,5) e Norte (AAPC: 1,3; IC95: 0,8-1,9), em oposição ao decréscimo anual médio no Sul (AAPC: -1,4; IC95: -2,7--0,3) e no Sudeste (AAPC: -1,5; IC95: -1,9--1,1). No Centro-Oeste, a TMPI também apresentou decréscimo anual médio no grupo feminino (AAPC: -1,8; IC95: -2,8--0,8), embora tenha permanecido estável no grupo masculino e independente do sexo. Considerações finais: A compreensão desses dados pode auxiliar o estudo e implementação de estratégias de enfrentamento para esse grupo de doenças de acordo com as necessidades específicas de cada grupo e região.

To analyze the temporal trend of mortality from head and neck cancer in Brazil and its geographical regions between the years 2000 to 2020. Methods: We analyzed the number of deaths due to malignant neoplasms of the head and neck (ICD- 10: C00-C14; C30-C32) available on the official portal of the Brazilian Ministry of Health for the period, as well as the data on resident population. The temporal and geographical pattern was analyzed using the standardized mortality rate by age (TMPI) and evaluated in an inflection point regression model. Results: In Brazil, TMPI remained stable independent of gender (AAPC: -0.3; IC95: -1.0-0.3) in the evaluated period. The study of the Brazilian regions showed average growth of the TMPI independent of sex in the Northeast (AAPC: 2.8; 95 CI: 2.1-3.5) and North (AAPC: 1.3; 95 CI: 0.8-1.9) regions, as opposed to the average annual decrease in the South (AAPC: -1.4; 95 CI: -2.7-0.3) and in the Southeast (AAPC: -1.5; 95 CI: -1.9-1.1). In the Midwest, the TMPI also showed an average annual decrease in the female group (AAPC: -1.8; IC95: -2.8­0.8), although it remained stable in the male group and independent of the sex. Final Considerations: Understanding this data can assist in the study and implementation of coping strategies for this group of diseases according to the specific needs of each group and region.

Análisis de la tendencia temporal de la mortalidad por cáncer de cabeza y cuello en Brasil y sus regiones geográficas entre los años 2000 y 2020. Métodos: Se analizó el número de muertes por neoplasias malignas de cabeza y cuello (CID-10: C00- C14; C30-C32), que se publicó en el portal oficial del Ministerio de Salud del Brasil para el período, así como en los datos sobre la población residente. El patrón temporal y geográfico se analizó a través de la tasa de mortalidad estandarizada por edad (TMPI) y se evaluó como modelo de regresión por puntos de inflexión. Resultados: En el Brasil, la TMPI se mantuvo estable, independiente del género (AAPC: -0,3; IC95: -1,0-0,3) en el período evaluado. El estudio de las regiones brasileñas mostró un crecimiento medio de la TMPI independiente de género en el noreste (APC: 2,8; IC95: 2,1-3,5) y en el norte (AAPC: 1,3; IC95: 0,8-1,9), frente a la disminución media anual en el sur (AAPC: -1,4; CI95: -2,7­0,3) y en el sudeste (AAPC: -1,5; IC95: -1,9-1,1). En el Medio Oeste, el IPM también mostró una disminución promedio anual en el grupo femenino (AAPC: -1,8; IC95: -2,8-0,8), aunque se mantuvo estable en el grupo independiente masculino y de género. Consideraciones finales: la comprensión de estos datos puede ayudar a estudiar y aplicar estrategias para tratar este grupo de enfermedades de acuerdo con las necesidades específicas de cada grupo y región.

The Medical Burden of Heart Failure: A Comparative Delineation with Cancer in Brazil

Abstract Background: Due to its poor prognosis and mortality rates, heart failure (HF) has been recognized as a malignant condition, comparable to some cancers in developed countries. Objectives: To compare mortality from HF and prevalent cancers using data from a nationwide database in Brazil. Methods: This was a descriptive, cross-sectional study using secondary data obtained from Brazilian administrative databases of death records and hospitalization claims maintained by the Ministry of Health. Data were analyzed according to main diagnosis, year of occurrence (2005-2015), sex and age group. Descriptive analyses of absolute number of events, hospitalization rate, mortality rate, and in-hospital mortality rate were performed. Results: The selected cancers accounted for higher mortality, lower hospitalization and higher in-hospital mortality rates than HF. In a group analysis, HF showed mortality rates of 100-150 per 100,000 inhabitants over the period, lower than the selected cancers. However, HF had a higher mortality rate than each type of cancer, even when compared to the most prevalent and deadly ones. Regarding hospitalization rates, HF was associated with a higher risk of hospitalization when compared to cancer-related conditions as a group. Conclusions: Our findings indicate that HF has an important impact on mortality, hospitalization and in-hospital mortality, comparable to or even worse than some types of cancer, representing a potential burden to the healthcare system.

Association Between Water Intake and Mortality Risk-Evidence From a National Prospective Study.

Background: Few studies have explored the association between water intake and mortality risk, and the findings were inconsistent. Objective: This study aimed to explore the water intake-mortality association, utilizing the data from the National Health and Nutrition Examination Survey (NHANES) and the 2015 public-linked mortality files released by the National Center for Health Statistics. Methods: We used the diet- and mortality-linked data of a total of 35,463 adults (17,234 men) aged ≥20 years in the NHANESs 1999-2014 to perform a prospective study. The multivariate-adjusted Cox proportional hazards model was used to explore the associations of the amount of water intake (expressed by total water, plain water, beverage, and food water) and water intake proportion (expressed by the percentage of each kind of water) with mortality risks due to all causes, malignant neoplasms/cancer, and heart disease. The restricted cubic spline plots were adopted to clarify the dose-response relationships among them. Results: With a median of 88 months (interquartile range: 49-136 months) follow-up, a total of 4,915 all-cause deaths occurred, including 1,073 and 861 deaths from malignant neoplasms/cancer and heart disease, respectively. The amount of water intake in either type was negatively associated with all-cause mortality risk. Additionally, the negative linear dose-response relationships of water intake and all-cause mortality risk were found for all types of water except for food water, which followed a non-linear pattern. Similarly, compared to the lowest quartile (beverage water intake: <676 g/day; food water intake: <532 g/day), beverage and food water intakes in the range of 1,033-1,524 and 1,612-3,802 g/day were associated with decreased malignant neoplasms/cancer mortality risk. A U-shaped dose-response relationship was found for beverage water intake and malignant neoplasms/cancer mortality risk and a negative linear dose-response relationship was found for food water intake and malignant neoplasms/cancer mortality risk. Coffee and/or tea consumption was/were negatively associated with mortality risks due to all causes and malignant neoplasms/cancer. No significant associations of water intake proportion and mortality risks were found. Conclusion: Our findings demonstrated that higher water intake is associated with lower mortality risks among the United States population.

Enhanced Recovery After Surgery (ERAS) in Surgical Oncology.

PURPOSE OF THE REVIEW: The objective of this review is to address the rationale behind the application of the Enhanced Recovery After Surgery (ERAS) protocols that could improve oncologic outcomes in adult patients undergoing major surgery. RECENT FINDINGS: The implementation of ERAS protocols has been associated with fewer postoperative complications as well as decreased return to intended oncologic treatment (RIOT). However, few studies have analyzed the influence of the application of ERAS protocols and long-term oncologic outcomes, although some of its individual elements have been associated with improvements in oncologic outcomes, including overall survival and disease-free survival. Targeted long-term follow-up studies in specific oncologic procedures are required to determine whether ERAS application results in improved oncologic outcomes.

Depth of invasion in early oral cancers- is it an independent prognostic factor?

INTRODUCTION: Depth of invasion (DOI) has been incorporated into oral cancer staging. Increasing DOI is known to be associated with an increased propensity to neck metastasis and adverse tumor factors and hence may not be an independent prognosticator but a surrogate for a biologically aggressive tumor. METHODS: 570 patients, median follow up 79.01 months from a previously reported randomized trial (NCT00193765) designed to establish appropriate neck treatment [elective neck dissection (END) vs therapeutic neck dissection (TND)] in clinically node-negative early oral cancers were restaged (nT) according to AJCC TNM 8th edition. Overall survival (OS) was estimated for the entire cohort, END, and TND arms. Multivariate analysis performed for stratification and prognostic factors, and interaction term between revised T-stage and neck treatment, for tumours with DOI≤10mm. Presence of adverse factors was compared between nT3 (DOI>10 mm) and those with DOI≤10 mm. RESULTS: Stage migration occurred in 44.38% of patients. 5-Year OS was nT1-79%, nT2-69.4% and nT3-53.8%, (p < 0.001). In TND arm 5-year OS was nT1-81.1% versus nT2-65%,p = 0.004, while that in END arm was nT1 -76.9% versus nT2 -73.7%,p = 0.73. There was a significant interaction between T stage and neck treatment (p = 0.03). T3 tumors (>10 mm) were associated with a higher proportion of adverse factors (occult nodal metastasis, p = 0.035; LVE/PNI, p = 0.001). CONCLUSION: Elective neck treatment negates the prognostic impact of DOI for early oral cancers (T1/T2 DOI≤10 mm). T3 tumors with DOI>10 mm have a higher association with other adverse risk factors resulting in poorer outcomes in spite of elective neck dissection.

Sobrevida en adultos mayores con cáncer colorrectal: una revisión bibliográfica / Survival in older adults with colorectal cancer: a literature review

RESUMEN Fundamento: el cáncer colorrectal es la neoplasia maligna más frecuente que se puede presentar en el sistema digestivo. Se ha observado un incremento gradual en América Latina, Cuba presenta indicadores de salud similares a las naciones desarrolladas, el cáncer colorrectal constituye la tercera causa de muerte entre las enfermedades malignas. Objetivo: proporcionar una recopilación teórica y actualizada de investigaciones relacionadas con la sobrevida en adultos mayores con cáncer colorrectal. Métodos: se realizó una revisión bibliográfica con el método de análisis bibliográfico sin restricciones de idioma, se consultaron las bases de datos Lilacs, Medline, PubMed y SciELO. Se utilizaron como palabras claves: sobrevida, cáncer colorrectal, adulto mayor. Resultados: el cáncer colorrectal puede cursar asintomático, la sintomatología y los signos también dependerán de la localización del tumor. En su mayoría, se detecta en la etapa sintomática, un 50 % de estos pacientes de diagnóstico tardío se encuentran en un estadio avanzado del tumor. La sobrevida de los adultos mayores con cáncer colorrectal depende también de su forma de presentación y calidad de vida. Conclusiones: la sobrevida en adultos mayores con cáncer colorrectal está influenciada por la edad del paciente, estadio en el momento del diagnóstico, forma de presentación de la enfermedad nosológica, abordaje quirúrgico, estilo y calidad de vida antes y después de ser diagnosticado.

ABSTRACT Background: colorectal cancer is the most common malignant neoplasia that can occur in the digestive system. There has been a gradual increase in Latin America, Cuba presents health indicators similar to developed nations, and colorectal cancer is the third cause of death. Objective: to provide a theoretical and updated collection of research related to survival in older adults with colorectal cancer. Methods: a bibliographic review was carried out with the bibliographic analysis method without language restrictions, the Lilacs, Medline, PubMed and SciELO databases were consulted. They were used as keywords: survival, colorectal cancer, elderly. Results: colorectal cancer can be asymptomatic, the symptoms and signs will also depend on the location of the tumor. Colorectal cancer, for the most part, is detected in the symptomatic stage, 50% of these late diagnosis patients are in an advanced stage of the tumor. The survival of older adults with colorectal cancer also depends on their presentation and quality of life. Conclusions: survival in older adults with colorectal cancer is influenced by the patient's age, stage at the time of diagnosis, presentation of the nosological entity, surgical approach, style and quality of life before and after being diagnosed.

Excess deaths from all causes and by COVID-19 in Brazil in 2020

ABSTRACT OBJECTIVE To estimate the 2020 all-cause and COVID-19 excess mortality according to sex, age, race/color, and state, and to compare mortality rates by selected causes with that of the five previous years in Brazil. METHODS Data from the Mortality Information System were used. Expected deaths for 2020 were estimated from 2015 to 2019 data using a negative binomial log-linear model. RESULTS Excess deaths in Brazil in 2020 amounted to 13.7%, and the ratio of excess deaths to COVID-19 deaths was 0.90. Reductions in deaths from cardiovascular diseases (CVD), respiratory diseases, and external causes, and an increase in ill-defined causes were all noted. Excess deaths were also found to be heterogeneous, being higher in the Northern, Center-Western, and Northeastern states. In some states, the number of COVID-19 deaths was lower than that of excess deaths, whereas the opposite occurred in others. Moreover, excess deaths were higher in men aged 20 to 59, and in black, yellow, or indigenous individuals. Meanwhile, excess mortality was lower in women, in individuals aged 80 years or older, and in whites. Additionally, deaths among those aged 0 to 19 were 7.2% lower than expected, with reduction in mortality from respiratory diseases and external causes. There was also a drop in mortality due to external causes in men and in those aged 20 to 39 years. Moreover, reductions in deaths from CVD and neoplasms were noted in some states and groups. CONCLUSION There is evidence of underreporting of COVID-19 deaths and of the possible impact of restrictive measures in the reduction of deaths from external causes and respiratory diseases. The impacts of COVID-19 on mortality were heterogeneous among the states and groups, revealing that regional, demographic, socioeconomic, and racial differences expose individuals in distinct ways to the risk of death from both COVID-19 and other causes.

Epidemiological Characteristics and Survival in Patients with De Novo Metastatic Prostate Cancer.

The real-world outcomes of patients with metastatic prostate cancer (mPCa) are largely unexplored. We investigated the trends in overall survival (OS) and cancer-specific survival (CSS) in patients with de novo mPCa according to distinct time periods. The U.S. Surveillance, Epidemiology, and End Results (SEER) Research Data (2000-2017) were analyzed using the SEER*Stat software. The Kaplan-Meier method and Cox regression were used. Patients with de novo mPCa were allocated to three cohorts based on the year of diagnosis: A (2000-2003), B (2004-2010), and C (2011-2014). The maximum follow-up was fixed to 5 years. Overall, 26,434 patients were included. Age, race, and metastatic stage (M1) significantly affected OS and CSS. After adjustment for age and race, patients in Cohort C showed a 9% reduced risk of death (hazard ratio (HR): 0.91 (95% confidence interval [CI] 0.87-0.95), p < 0.001) and an 8% reduced risk of cancer-specific death (HR: 0.92 (95% CI 0.88-0.96), p < 0.001) compared with those in Cohort A. After adjustment for age, race, and metastatic stage, patients in Cohort C showed an improvement in OS and CSS compared with Cohort B (HR: 0.94 (95% CI 0.91-0.97), p = 0.001; HR: 0.89 (95% CI 0.85-0.92), p < 0.001). Patients with M1c disease had a more pronounced improvement in OS and CSS compared with the other stages. No differences were found between Cohorts B and C. In conclusion, the real-world survival of de novo mPCa remains poor, with a median OS and CSS improvement of only 4 months in the latest years.

Eight-year follow-up of locally advanced lymphoepithelioma-like carcinoma at upper urinary tract: A case report.

BACKGROUND: Urinary tract lymphoepithelioma-like carcinoma is rarely seen. Although it is termed after lymphoepithelioma at the nasopharynx, it behaves more like high grade urothelial carcinoma by immunohistochemical features. Most published literatures focused on its rarity but few discussed results of long-term follow-ups. As no available guidelines are applicable, we postulated that principles should be similar to that of urothelial carcinoma at urinary tract. As of now, this work features the longest follow-up of this cancer at the upper urinary tract. CASE SUMMARY: A 63-year-old female had a chief complaint of intermittent left flank pain for 2 mo, along with accompanying symptoms including vomiting and body weight loss, about 7 kg over 2 mo. Laboratory data showed normocytic anemia, mildly poor renal function, and hyperparathyroidism. Urine analysis showed mild hematuria. Computed tomography showed a 4.2-cm-width irregular mass over left renal pelvic and enlarged lymph node at the left renal hilum. Whole-body bone scan was negative of active bone lesions. Biopsy from ureteroscopy showed urothelial carcinoma. Specimen from laparoscopic nephroureterectomy with bladder cuff resection showed lymphoepithelioma-like carcinoma with muscular invasion (pT3). She took adjuvant chemotherapies of 2 cycles and full courses of radiation therapy. No recurrence was observed with designed investigative programs. CONCLUSION: Locally advanced urinary tract lymphoepithelioma-like carcinoma could benefit from nephroureterectomy and bladder cuff excision in terms of recurrence-free survival.

Morbidade hospitalar e mortalidade por câncer colorretal: implicações para a saúde pública no Brasil / Hospital morbidity and colorectal cancer mortality: implications for public health in brazil

ABSTRACT BACKGROUND: Colorectal cancer is a serious public health problem and one of the most common cancer worldwide. Countries around the world have shown different trends. While incidence and mortality rates for colorectal cancer are on an upward trend in developing countries, these rates have been on a downward trend in most developed countries. OBJECTIVE: To analyze the temporal trend of morbimortality by colorectal cancer in Brazil between 2002 and 2016. METHODS: Descriptive, time series research. Data were extracted from the national information systems for hospitalizations and deaths of the respective years. RESULTS: There were increasing trends in hospital morbidity and mortality from colorectal cancer in all regions of the country, with the very elderly individuals dying at a higher rate. Women (52.1%) were more affected than men, but death rates were higher for males aged 60 years or more. Regional disparities were evident, with almost 80% of deaths occurring in the South and Southeast, with the largest annual increase in the South and the lowest in the North. Regarding hospitalization, South and Southeast presented higher annual growths. CONCLUSION: These data add knowledge about the profile of public hospitalizations and deaths, reaffirming that colorectal cancer contributes to an important burden of disease and mortality in Brazil. These elements have implications for the review of colorectal cancer prevention and control strategies, as well as for public health investments.

RESUMO CONTEXTO: O câncer colorretal é um grave problema de saúde pública e um dos tipos mais comuns de câncer no mundo. Diferentes tendências têm sido observadas nos países ao redor do mundo. Enquanto as taxas de incidência e mortalidade por câncer colorretal apresentam tendência crescente em países em desenvolvimento, essas taxas têm se mantido em tendência decrescente nos países mais desenvolvidos. OBJETIVO: Analisar a tendência temporal de morbimortalidade por câncer colorretal no Brasil, entre 2002 e 2016. MÉTODOS: Pesquisa descritiva de série temporal. Os dados foram extraídos dos sistemas nacionais de informação de Internações Hospitalares e Mortalidade, nos anos respectivos. RESULTADOS: Observou-se tendência crescente da morbidade hospitalar e mortalidade por câncer colorretal em todas as regiões do país, constatando-se que morrem mais idosos em idade avançada. As mulheres (52,1%) foram mais acometidas do que os homens, porém as taxas de óbito foram maiores para o sexo masculino a partir dos 60 anos de idade. As disparidades regionais ficaram evidentes, sendo que quase 80% das mortes ocorreram nas regiões Sul e Sudeste, com maior incremento anual na região Sul e menor na região Norte. Em relação à hospitalização, Sul e Sudeste apresentaram maior crescimento anual. CONCLUSÃO: Os dados agregam conhecimento sobre o perfil das hospitalizações públicas e mortes, reafirmando que o câncer colorretal contribui para uma importante carga de doença e mortalidade no Brasil. Esses elementos trazem implicações para a revisão das estratégias de prevenção e controle do câncer colorretal, bem como para os investimentos na saúde pública.

Analysis of the Breast Cancer Mortality Rate in Portugal Over a Decade: Spatiotemporal Clustering Analysis.

INTRODUCTION: Breast cancer is the first cause of cancer-related death in Portuguese women. This study aimed to characterize female breast cancer mortality in Portugal in the period between 2002 and 2013, with a special focus on spatiotemporal patterns. MATERIAL AND METHODS: The breast cancer mortality rate was studied using descriptive analysis (unadjusted and age-adjusted), and spatiotemporal clustering analyses. RESULTS: In 2002 - 2013 the breast cancer mortality rate was 28.47/100 000 inhabitants and the age-adjusted mortality rate was 19.46/100 000 inhabitants. In this period the Lisbon region (urban), Alentejo and Algarve (rural) presented higher breast cancer mortality rate, but Madeira (urban), Lisbon and Algarve had higher age-adjusted mortality rate. In the spatiotemporal analysis, the overall mortality rate showed an increasing trend of 1.218%/year, without spatial variations. Also, different patterns were detected in the < 50, 50 - 64 and ≥ 65 age-groups (+ 0.725%, - 1.781% and + 0.896%, respectively). One temporal (2004 - 2006) and one spatiotemporal cluster (North coast) presented significantly lower mortality rate than expected for the period and/or area (26.2 and 16.1/100 000 inhabitants, respectively). Conversely, two spatiotemporal clusters, located in the city of Lisbon (2002 - 2007) and in the Centre region (2008 - 2013), presented significantly higher breast cancer mortality rate than expected (48.6 and 34.9/100 000 inhabitants, relative risk: 1.74 and 1.26, respectively). DISCUSSION: The annual female crude and adjusted breast cancer mortality rate matched previous publications. However the annual increase detected in the unadjusted rate clashes with the published literature. Overall, the presence of spatiotemporal clusters supports the uneven distribution of the breast cancer mortality reported previously in the different Portuguese regions. CONCLUSION: This study identified areas and trends of the female breast cancer mortality rate, showing high spatiotemporal variations that must support further detailed studies/interventions.

Introdução: O cancro da mama é a primeira causa de morte relacionada com cancro em mulheres portuguesas. Este estudo pretende caracterizar a mortalidade feminina por cancro da mama em Portugal no período de 2002 a 2013, com enfoque nos padrões espácio-temporais. Material e Métodos: A taxa de mortalidade por cancro da mama foi estudada com recurso a análise descritiva (bruta e ajustada para a idade), e análise de clustering espácio-temporal. Resultados: Em 2002 ­ 2013 a taxa de mortalidade por cancro da mama foi 28,47/100 000 habitantes e a taxa de mortalidade ajustada pela idade foi de 19,46/100 000 habitantes. Neste período a região de Lisboa (urbana), Alentejo e Algarve (rural) apresentaram taxas de mortalidade mais elevadas, mas após ajustamento pela idade a Madeira (urbana), Lisboa e Algarve demonstraram taxas de mortalidade superiores. Na análise espácio-temporal, a taxa de mortalidade geral apresentou um crescimento de 1,218%/ano, sem variações espaciais. Adicionalmente, padrões diferentes foram detetados nos grupos de mulheres com < 50, 50 - 64 e ≥ 65 anos (+ 0,725%, - 1,781% e + 0,896%, respetivamente). Um cluster temporal (2004 ­ 2006) e um espácio-temporal (costa Norte) apresentaram taxa de mortalidade significativamente mais baixas que o esperado para o período e/ou área (26,2 e16,1/100 000 habitantes, respetivamente). Por outro lado, dois clusters espácio-temporais, localizados na cidade de Lisboa (2002 ­ 2007) e na zona Centro (2008 ­ 2013), apresentaram taxas de mortalidade por cancro da mama superiores às expectáveis (48,6 e 34,9/100 000 habitantes, risco relativo: 1,74 e 1,26, respetivamente). Discussão: A taxa anual bruta e ajustada para a idade de mortalidade por cancro da mama aproximam-se das anteriormente publicadas. No entanto, o aumento anual nas taxas brutas contrasta com a literatura neste tópico. A presença de clusters espácio-temporais suporta a distribuição variável da taxa de mortalidade por cancro da mama nas diferentes regiões do país. Conclusão: Este estudo identificou áreas e tendências na taxa de mortalidade feminina por cancro da mama, demonstrando variações espácio-temporais nesta taxa que suportam estudos e intervenções mais detalhadas nesta área.

Trends in Mortality Rates from Cardiovascular Disease and Cancer between 2000 and 2015 in the Most Populous Capital Cities of the Five Regions of Brazil / Tendência das Taxas de Mortalidade por Doença Cardiovascular e Câncer entre 2000 e 2015 nas Capitais mais Populosas das Cinco Regiões do Brasil

Abstract Background: In many cities around the world, the mortality rate from cancer (CA) has exceeded that from disease of the circulatory system (DCS). Objectives: To compare the mortality curves from DCS and CA in the most populous capital cities of the five regions of Brazil. Methods: Data of mortality rates from DCS and CA between 2000 and 2015 were collected from the Mortality Information System of Manaus, Salvador, Goiania, Sao Paulo and Curitiba, and categorized by age range into early (30-69 years) and late (≥ 70 years), and by gender of the individuals. Chapters II and IX of the International Classification of Diseases-10 were used for the analysis of causes of deaths. The Joinpoint regression model was used to assess the tendency of the estimated annual percentage change of mortality rate, and the Monte Carlo permutation test was used to detect when changes occurred. Statistical significance was set at 5%. Results: There was a consistent decrease in early and late mortality from DCS in both genders in the cities studied, except for late mortality in men in Manaus. There was a tendency of decrease of mortality rates from CA in São Paulo and Curitiba, and of increase in the rates from CA in Goiania. In Salvador, there was a decrease in early mortality from CA in men and women and an increase in late mortality in both genders. Conclusion: There was a progressive and marked decrease in the mortality rate from DCS and a maintenance or slight increase in CA mortality in the five capital cities studied. These phenomena may lead to the intersection of the curves, with predominance of mortality from CA (old and new cases).

Resumo Fundamento: Em muitas cidades no mundo, a taxa de mortalidade por câncer (CA) ultrapassou aquela por doenças do aparelho circulatório (DAC). Objetivos: Comparar as curvas de mortalidade por DAC e CA nas capitais mais populosas das cinco regiões brasileiras. Métodos: Dados de mortalidade por DAC e CA entre 2000 e 2015 foram coletadas no Sistema de Informações sobre Mortalidade das capitais mais populosas das cinco regiões do Brasil: Manaus, Salvador, Goiânia, São Paulo e Curitiba. Os dados foram categorizados por faixas etárias dos indivíduos em precoce (30-69 anos) e tardia (≥70 anos), e por gênero. Foram considerados os capítulos II e IX da Classificação Internacional de Doenças-10 para análise das causas de óbito. A tendência na estimativa de mudança percentual foi calculada pelo modelo de regressão Joinpoint 4.6.0.0. e a detecção das mudanças das taxas pelo teste de permutação Monte Carlo. Nível de significância estatística de 5%. Resultados: Observou-se queda consistente das mortalidades precoce e tardia por DAC, em ambos os gêneros, nas capitais estudadas, com exceção da mortalidade tardia em homens em Manaus. Houve tendência de queda das taxas de mortalidade por CA em São Paulo e Curitiba, e de aumento da taxa de mortalidade por CA em Goiânia. Em Salvador, houve queda na mortalidade precoce por CA em homens e mulheres e incremento na mortalidade tardia em ambos os gêneros. Conclusão: Houve queda progressiva e expressiva da taxa de mortalidade por DAC nas cinco capitais em oposição à manutenção ou discreta elevação da mortalidade por CA. Tais fenômenos concorrem para o cruzamento das curvas com predomínio da mortalidade por CA (já ocorrido ou casos novos).

Sex Differences in Urothelial Bladder Cancer Survival.

BACKGROUND: While urinary bladder cancer is consistently more common in men worldwide, women have poorer prognosis. The aim of this study was to outline sex differences in prognostic factors and clinical management and to explore whether these can explain the poorer urinary bladder cancer outcome in women. PATIENTS AND METHODS: We performed a population-based cohort study including all patients diagnosed with urothelial bladder cancer between 1997 and 2014 at age 18 to 89 who had data recorded in the Swedish Urinary Bladder Cancer Register (n = 36,344). Female-to-male odds ratios for clinical management parameters were estimated by logistic regression. To quantify sex differences in bladder cancer-specific survival, we estimated empirical survival proportions and mortality rates as well as applied flexible parametric models to estimate female-to-male hazard ratios and survival proportions over follow-up. Adjusted models included age, year, World Health Organization grade, stage, marital status, education, health care region, birth country, and comorbidity. RESULTS: Except for an adverse stage distribution in women, we found no evidence of unequal clinical management. Among those diagnosed with bladder cancer, women had a higher bladder cancer mortality (adjusted hazard ratio, 1.15; 95% confidence interval, 1.08-1.23) driven by muscle-invasive tumors (adjusted hazard ratio, 1.24; 95% confidence interval, 1.14-1.34). The female survival disadvantage was confined to the first 2 years after diagnosis. CONCLUSION: The excess bladder cancer mortality in women is limited to those diagnosed with muscle-invasive tumors and cannot be explained by the examined clinicopathologic factors. Further investigations of sex differences in therapeutic procedures and outcomes, including complications, of muscle-invasive bladder cancer, must be performed.