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Brazil

Cancer Statistics
Population in 2012: 198.4m
People newly diagnosed with cancer (excluding NMSC) / yr: 437,600
Age-standardised rate, incidence per 100,000 people/yr: 205.5
Risk of getting cancer before age 75:20.8%
People dying from cancer /yr: 224,700
Data from IARC GlobalCan (2012)

Cancer Organisations & Resources
Latest Research Publications from Brazil

Cancer Organisations & Resources (12 links)


Latest Research Publications from Brazil

Luz JH, Luz PM, Martin HS, et al.
DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center.
Cancer Imaging. 2017; 17(1):5 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity.
METHODS: This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a "demand schedule". Tumor response and time to progression were evaluated along the two-year follow up period.
RESULTS: Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively.
CONCLUSION: Transarterial chemoembolization with drug-eluting microspheres is able to deliver significant tumor response and progression free survival rate with acceptable toxicity. Larger studies are needed to identify exactly which subset of advanced hepatocellular patients may benefit from this treatment.
TRIAL REGISTRATION: study ID ISRCTN16295622. Registered October 14th 2016. Retrospectively registered. Website registration: http://www.isrctn.com/ISRCTN16295622.

Oliveira CC, Maciel-Guerra H, Kucko L, et al.
Double-hit lymphomas: clinical, morphological, immunohistochemical and cytogenetic study in a series of Brazilian patients with high-grade non-Hodgkin lymphoma.
Diagn Pathol. 2017; 12(1):3 [PubMed] Free Access to Full Article Related Publications
BACKGROUND: Double-hit lymphomas (DHL) are rare high-grade neoplasms characterized by two translocations: one involving the gene MYC and another involving genes BCL2 or BCL6, whose diagnosis depends on cytogenetic examination. This research studied DHL and morphological and/or immunophenotypic factors associated with the detection of these translocations in a group of high-grade non-Hodgkin lymphoma cases.
METHOD: Clinical and morphological reviews of 120 cases diagnosed with diffuse large B-cell lymphoma and Burkitt lymphoma were conducted. Immunohistochemistry (CD20, CD79a, PAX5, CD10, Bcl6, Bcl2, MUM1, TDT and Myc) and fluorescence in situ hybridization for detection of MYC, BCL2 and BCL6 gene translocations were performed in a tissue microarray platform.
RESULTS: Three cases of DHL were detected: two with translocations of MYC and BCL2 and one with translocations of MYC and BCL6, all leading to death in less than six months. Among 90 cytogenetically evaluable biopsies, associations were determined between immunohistochemistry and fluorescence in situ hybridization for MYC (p = 0.036) and BCL2 (p = 0.001). However, these showed only regular agreement, indicated by Kappa values of 0.23 [0.0;0.49] and 0.35 [0.13;0.56], respectively. "Starry sky" morphology was strongly associated with MYC positivity (p = 0.01). The detection of three cases of DHL, all resulting in death, confirms the rarity and aggressiveness of this neoplasm.
CONCLUSIONS: The "starry sky" morphological pattern and immunohistochemical expression of Myc and Bcl2 represent possible selection factors for additional cytogenetic diagnostic testing.

Oliveira JS, Ferreira RS, Santos LM, et al.
Self-declared ethnicity and genomic ancestry in prostate cancer patients from Brazil.
Genet Mol Res. 2016; 15(4) [PubMed] Related Publications
Some studies of polymorphisms in prostate cancer (PCa) analyze individuals in a uniform manner, regardless of genetic ancestry. However, PCa aggressiveness differs between subjects of African descent and those of European extraction. Thus, genetic ancestry analysis may be used to detect population stratification in case-control association studies. We genotyped 11 ancestry informative markers to estimate the contributions of African, European, and Amerindian ancestries in a case-control sample of 213 individuals from Bahia State, Northeast Brazil, including 104 PCa patients. We compared this data with self-reported ancestry and the stratification of cases by PCa aggressiveness according to Gleason score. A larger African genetic contribution (44%) was detected among cases, and a greater European contribution (61%) among controls. Self-declaration data revealed that 74% of PCa patients considered themselves non-white (black and brown), and 41.3% of controls viewed themselves as white. Our data showed a higher degree of European ancestry among fast-growing cancer cases than those of intermediate and slow development. This differs from many previous studies, in which the prevalence of African ancestry has been reported for all grades. Differences were observed between degrees of PCa aggressiveness in terms of genetic ancestry. In particular, the greater European contribution among patients with high-grade PCa indicates that a population's genetic structure can influence case-control studies. This investigation contributes to our understanding of the genetic basis of tumor aggressiveness among groups of different genetic ancestries, especially admixed populations, and has significant implications for the assessment of inter-population heterogeneity in drug treatment effects.

Thuler LC, Pombo-de-Oliveira MS
Acute promyelocytic leukaemia is highly frequent among acute myeloid leukaemias in Brazil: a hospital-based cancer registry study from 2001 to 2012.
Ann Hematol. 2017; 96(3):355-362 [PubMed] Related Publications
The WHO classification that defines subtypes of acute myeloid leukaemias (AMLs) is relatively unexplored at the population-based level. This study aimed to examine the frequency of acute promyelocytic leukaemia (APL or AML-M3) in Brazil. Data were extracted from 239 cancer centres (2001-2012) and categorized according to the International Classification of Diseases for Oncology (CID-O 3.0) and WHO classification (n = 9116). CID-O3 code 9866 identified 614 APL patients. AML not otherwise specified (NOS) was frequent, and the APL group represented the main subtype specified. The mean age of APL was lower than that of other AMLs (31.5, standard deviation (SD) 18.6 versus 40.9, SD 24.6; p < 0.001); there was a high frequency of APL in the 13-21-year-old (11.8 %) and ≤12.9-year-old (6.4 %) age groups. Time taken to begin treatment (as ≤14 days versus >14 days) and induction death rate were lower in APL than in other AML subtypes (p < 0.001). This report provides additional evidence on the distribution of APL among cases of AML in Brazil.

Freitas VG, Focchi GR, Pereira ER, et al.
HPV genotyping and p16 expression in Xingu Indigenous Park, Brazil.
Genet Mol Res. 2016; 15(3) [PubMed] Related Publications
The association between high-risk human papillomavirus (HPV) genotypes and p16 expression in indigenous women from the Xingu Indigenous Park, Brazil, was unknown. This study evaluated p16 expression in women with a histological diagnosis of cervical intraepithelial neoplasia (CIN) 3 or higher and correlated this expression with HPV genotypes to determine possible discrepancies in the expression of this marker. We evaluated 37 previously collected samples with different HPV genotypes and high-grade lesions diagnosed based on cytology, histology, and colposcopy. Immunohistochemical analysis was performed using paraffin-embedded tissue sections and the CINtec® Histology Kit. p16 protein expression was investigated by immunostaining with an anti-p16 antibody. HPV genotyping was performed by reverse hybridization. The age of the study population ranged from 22-75 years (43.81 ± 15.89 years) and parity ranged from 1-11 (5.92 ± 2.58). Thirteen different HPV genotypes were found using the INNO-LiPA kit. Single and multiple infections by HPV were found with prevalence of single infections (P = 0.029). Comparison between HPV genotype and simple or multiple infections was highly significant; it was observed more HPV 52 followed by HPV 16 in single infections (P < 0.001). p16 expression was predominantly diffuse, which was observed in 91.7% of lesions, whereas 8.3% were focal (P < 0.001). HPV 52, HPV 16 and 31 were the most prevalent HPV types in high-grade CIN in these indigenous women. Diffuse p16 expression in high-grade CIN was not influenced by the viral genotype; however, more studies are necessary to further our understanding of this restricted group.

Silla L, Dulley F, Saboya R, et al.
Brazilian guidelines on hematopoietic stem cell transplantation in acute myeloid leukemia.
Eur J Haematol. 2017; 98(2):177-183 [PubMed] Related Publications
INTRODUCTION/OBJECTIVES: Acute myeloid leukemia (AML) accounts for 90% of all cases of acute leukemia in adults. In Brazil, the mortality from myeloid leukemia is 1.74/100 000 men and 1.37/100 000 women. Our aim was to review and update guidelines of the Brazilian Society of Bone Marrow Transplantation on indications of hematopoietic stem cell transplantation (HSCT) for the treatment AML.
CONCLUSIONS: (i) Allo-HSCT is recommended for high-risk AML (IA); (ii) allo-HSCT is recommended for AML of intermediate risk (IA); (iii) allo-HSCT is recommended for AML relapsed/refractory (C4); (iv) auto-HSCT is recommended for AML after 1 consolidation (C4); (v) auto-HSCT is recommended for AML in CR1 (higher than QT in the Brazilian experience) (C4); (vi) auto-HSCT is accepted for AML M3 in second molecular complete remission (2B); (vii) peripheral blood instead of Bone Marrow HSC for advanced disease (2A); (viii) recommended conditioning protocols: Bu-Cy/Bu-Mel, Bu-Flu, TBI-Cy. In umbilical cord HSCT, consider ATG-based protocols (2A); (ix) allogeneic HSCT for the treatment of AML can be used in patients between 60 and 80 yr with good performance status and the absence of significant comorbidities (C4).

Rovere RK, A Sde L, Demarchi V, Stein CE
Sentinel Lymph Node in Melanoma -  a Study Conducted in the South of Brazil.
Klin Onkol. 2016; 29(4):274-8 [PubMed] Related Publications
BACKGROUND: The presence or absence of lymph node metastases is a very important prognostic factor for survival and recurrence in patients with cutaneous melanoma. Controversies remain among specialists about whether it is advisable or not to perform a sentinel lymph node biopsy in patients with melanoma, although it is currently supported by most standard guidelines. We performed this study to identify which patients are more prone to having a positive lymph node test result in a population with high melanoma rates in the south of Brazil.
MATERIALS AND METHODS: We performed the study with 62 consecutive patients who underwent sentinel lymph node biopsies from 2003 to the early months of 2015 in the city of Blumenau - Santa Catarina, Brazil.
RESULTS: Breslow thickness, ulceration, nodular subtype, and Clark level IV were associated with positive sentinel lymph node group status (p 0.05).
DISCUSSION: Although there is still a controversy over whether or not this procedure should be performed, most guidelines still support its application. To lower the economical and physical impact, however, it is worthwhile to determine which patients are more prone to acquiring positive lymph node at presentation and, perhaps, in the future, indicate surgery for this particular group, who could benefit most from further treatment options.
KEY WORDS: melanoma - sentinel lymph node biopsy - prognosis.

Borghesan DH, Agnolo CM, Gravena AA, et al.
Risk Factors for Breast Cancer in Postmenopausal Women in Brazil.
Asian Pac J Cancer Prev. 2016; 17(7):3587-93 [PubMed] Related Publications
PURPOSE: To analyze risk factors for postmenopausal breast cancer.
METHODS: The present casecontrol study included 600 women treated at a cancer center reference hospital in a municipality in the South of Brazil.
RESULTS: Totals of 100 patients and 500 control subjects were evaluated. The mean age of the women was 52.5 ± 11.9 years; the average was 57.4 ± 11.8 years, and the average age of the control subjects was 51.5 ± 11.7 years. The risk factors for breast cancer that were considered included an age ≥ 40 years, postmenopausal status, a body mass index (BMI) ≥ 30 kg/m2, and reduced physical activity. Variables like postmenopausal status and an obese BMI were associated with cases of breast cancer. Women who were postmenopausal or obese were 3.80 or 1.80 times more likely to develop breast cancer, respectively, and physically inactive women were 1.72 times more likely to develop breast cancer.
CONCLUSIONS: Obesity and postmenopausal status are associated with the occurrence of breast cancer in this population. Being over 40 years of age was also a statistically significant factor for postmenopausal women.

Braga A, Burlá M, Freitas F, et al.
Centralized Coordination of Decentralized Assistance for Patients with Gestational Trophoblastic Disease in Brazil: A Viable Strategy for Developing Countries.
J Reprod Med. 2016 May-Jun; 61(5-6):224-9 [PubMed] Related Publications
OBJECTIVE: To report on the Brazilian Association of Gestational Trophoblastic Disease's (GTD) formation of a network of regional care at specialized centers for women with GTD.
STUDY DESIGN: We developed a questionnaire composed of 15 questions, which was sent by email to the 38 Brazilian GTD Reference Center (BGTDRC) Directors who are members of the Brazilian Association of GTD, in order to characterize the professionals involved in the care of patients with GTD and the type of assistance provided.
RESULTS: The Directors of the BGTDRCs are usually specialists in Gynecology and Obstetrics (97%), with a median experience of a decade in treating women with GTD. The BGTDRCs are linked to university hospitals in 75% of centers and provide completely free medical care in 87%. However, 52% of centers do not perform chemotherapy in their reference center, and patients are referred elsewhere for chemotherapy. Despite some difficulties, the rate of patients lost to follow-up before human chorionic gonadotropin remission is 9%, and the GTD mortality rate is 0.9%.
CONCLUSION: Due to large regional disparities, the BGTDRCs are not uniformly organized. However, under the coordination of the Brazilian Association of GTD there is now strong communication and collaboration among reference centers, which has significantly advanced both patient care and research into the management of these diseases.

Malta DC, Abreu DM, Moura Ld, et al.
Trends in corrected lung cancer mortality rates in Brazil and regions.
Rev Saude Publica. 2016; 50 [PubMed] Free Access to Full Article Related Publications
OBJECTIVE: To describe the trend in cancer mortality rates in Brazil and regions before and after correction for underreporting of deaths and redistribution of ill-defined and nonspecific causes.
METHODS: The study used data of deaths from lung cancer among the population aged from 30 to 69 years, notified to the Mortality Information System between 1996 and 2011, corrected for underreporting of deaths, non-registered sex and age , and causes with ill-defined or garbage codes according to sex, age, and region. Standardized rates were calculated by age for raw and corrected data. An analysis of time trend in lung cancer mortality was carried out using the regression model with autoregressive errors.
RESULTS: Lung cancer in Brazil presented higher rates among men compared to women, and the South region showed the highest death risk in 1996 and 2011. Mortality showed a trend of reduction for males and increase for women.
CONCLUSIONS: Lung cancer in Brazil presented different distribution patterns according to sex, with higher rates among men and a reduction in the mortality trend for men and increase for women.
OBJETIVO: Descrever a tendência da mortalidade por câncer de pulmão no Brasil e regiões, antes e após as correções por sub-registro de óbitos, redistribuição de causas mal definidas e causas inespecíficas.

Oliveira RC, Rêgo MA
MORTALITY RISK OF COLORECTAL CANCER IN BRAZIL FROM 1980 TO 2013.
Arq Gastroenterol. 2016 Apr-Jun; 53(2):76-83 [PubMed] Related Publications
BACKGROUND -: Colorectal cancer is one of the most common cancer worldwide, and variation in its mortality rates indicates the importance of environmental factors in its occurrence. While trend studies have indicated a reduction in colorectal cancer mortality rates in most developed countries, the same trends have not been observed in developing countries. Moreover, trends may differ when analyzed by age and sex.
OBJECTIVE: - The present study aimed to analyze the trends in risk of colorectal cancer death in Brazil based on sex and age group.
METHODS -: Death records were obtained from the Mortality Information System of the Ministry of Health. The risk of death and the average annual percent changes (AAPC) in the mortality rates were estimated using joinpoint analysis of long-term trends from 1980 to 2013. All of the statistical tests were two-sided and had a significance level of 5%.
RESULTS: - Colorectal cancer mortality rates were found to have increased in the last 15 years for both sexes and for all age ranges. The rate ratio (RR) was statistically higher at ages 70 to 79 for men (RR: 1.37; 95% CI: 1.26; 1.49) compared to women (RR: 1.14; 95% CI: 1.06; 1.24). Increases in AAPC were observed in both sexes. Although men presented higher percent changes (AAPC: 1.8; 95% CI: 1.1; 2.6) compared to women (AAPC: 1.2; 95% CI: 0.4; 2.0), this difference was not statistically significant. Growth trends in mortality rates occurred in all age groups except for in women over 70.
CONCLUSION: - Unlike Europe and the US, Brazil has shown increases in death rates due to colorectal cancer in the last three decades; however, more favorable trends were observed in women over 70 years old. The promotion of healthier lifestyles in addition to early diagnosis and improved treatment should guide the public health policies targeting reductions in colorectal cancer.

Souza RH, Maluf EM, Sartor MC, Carvalho DS
COLORECTAL CANCER: factors related to late diagnosis in users of the public health system treated at an Universitary Hospital in Curitiba, Paraná State, Brazil.
Arq Gastroenterol. 2016 Apr-Jun; 53(2):68-75 [PubMed] Related Publications
BACKGROUND: - The fourth most frequent tumor in the world, colorectal cancer is commonly diagnosed at an advanced stage.
OBJECTIVE: - To analyze factors that interfere in the diagnosis of colorectal cancer in users of the Public Health System treated at an universitary hospital in Curitiba, Paraná State, Brazil.
METHODS: - Cross-sectional, quantitative and descriptive study with 120 patients treated at the institution between 2012 and 2013. Data collection, carried out by means of medical record appointments and patients' interviews, addressed sociodemographic variables; clinical profile; timespan between symptoms, examination, diagnosis, treatment onset and difficulties encountered. Statistical analyses were performed by means of Stata 8.0.
RESULTS: - Abdominal pain was the most frequent complaint and rectal bleeding presented the highest chance of advanced colorectal cancer diagnosis. From 52.5% of patients with late diagnosis of colorectal cancer, 81% reported difficulties in the health system.
CONCLUSION: - Results suggest that late diagnosis is due to symptom absence in the early stage of the disease, patients' lack of perception about the severity of the symptoms, need of better of health teams to search early diagnosis. Educational interventions are deemed necessary to the population and health teams, besides actions prioritizing the access to diagnostic testing for serious illnesses.

Klimczak PF, Ventury DH, Faucz FR, et al.
Association of a PARK2 Germline Variant and Epithelial Ovarian Cancer in a Southern Brazilian Population.
Oncology. 2016; 91(2):101-5 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
Ovarian cancer (OC) is the eighth most common cancer among women in Brazil and seventh in the world population. OC has a high mortality rate and is difficult to diagnose. Currently, OC detection most often occurs at an advanced stage of the disease due to its silent progression, which contributes to the high mortality rate. Available genetic markers are not considered specifically enough for an initial and definite diagnosis. The association with new genes involved with OC can provide a better understanding of this pathology as well as contribute to the development of a marker scenario, providing an improvement in the treatment and survival of patients. The aim of this study was to examine the potential association between the PARK2 gene and epithelial ovarian cancer (EOC). Accordingly, we conducted a study for which 25 patients and 87 controls were recruited. Linkage disequilibrium analysis showed that the four studied tag SNPs (rs2803073, rs6930532, rs1040079, and rs2276201) were independent. Our results using the multivariate analysis between the additive and dominant model demonstrated that tag SNP rs2803073 of PARK2 is associated with susceptibility to EOC (p = 0.018, OR = 0.42). These findings suggest that hereditary variation in the PARK2 gene could influence EOC development mechanisms.

Tustumi F, Takeda FR, Kimura CM, et al.
ESOPHAGEAL CARCINOMA: IS SQUAMOUS CELL CARCINOMA DIFFERENT DISEASE COMPARED TO ADENOCARCINOMA? A transversal study in a quaternary high volume hospital in Brazil.
Arq Gastroenterol. 2016 Jan-Mar; 53(1):44-8 [PubMed] Related Publications
BACKGROUND: Esophageal cancer is one of the leading causes of mortality among the neoplasms that affect the gastrointestinal tract. There are several factors that contribute for development of an epidemiological esophageal cancer profile in a population.
OBJECTIVE: This study aims to describe both clinically and epidemiologically the population of patients with diagnosis of esophageal cancer treated in a quaternary attention institute for cancer from January, 2009 to December, 2011, in Sao Paulo, Brazil.
METHODS: The charts of all patients diagnosed with esophageal cancer from January, 2009, to December, 2011, in a Sao Paulo (Brazil) quaternary oncology institute were retrospectively reviewed.
RESULTS: Squamous cell cancer made up to 80% of the cases of esophageal cancer. Average age at diagnosis was 60.66 years old for esophageal adenocarcinoma and 62 for squamous cell cancer, average time from the beginning of symptoms to the diagnosis was 3.52 months for esophageal adenocarcinoma and 4.2 months for squamous cell cancer. Average time for initiating treatment when esophageal cancer is diagnosed was 4 months for esophageal adenocarcinoma and 4.42 months for squamous cell cancer. There was a clear association between squamous cell cancer and head and neck cancers, as well as certain habits, such as smoking and alcoholism, while adenocarcinoma cancer showed more association with gastric cancer and gastroesophageal reflux disease. Tumoral bleeding and pneumonia were the main causes of death. No difference in survival rate was noted between the two groups.
CONCLUSION: Adenocarcinoma and squamous cell carcinoma are different diseases, but both are diagnosed in advanced stages in Brazil, compromising the patients' possibilities of cure.

Riechelmann R, Coutinho AK, Weschenfelder RF, et al.
GUIDELINE FOR THE MANAGEMENT OF BILE DUCT CANCERS BY THE BRAZILIAN GASTROINTESTINAL TUMOR GROUP.
Arq Gastroenterol. 2016 Jan-Mar; 53(1):5-9 [PubMed] Related Publications
The Brazilian Gastrointestinal Tumor Group developed guidelines for the surgical and clinical management of patients with billiary cancers. The multidisciplinary panel was composed of experts in the field of radiology, medical oncology, surgical oncology, radiotherapy, endoscopy and pathology. The panel utilized the most recent literature to develop a series of evidence-based recommendations on different treatment and diagnostic strategies for cholangiocarcinomas and gallbladder cancers.

Vale DB, Sauvaget C, Muwonge R, et al.
Disparities in time trends of cervical cancer mortality rates in Brazil.
Cancer Causes Control. 2016; 27(7):889-96 [PubMed] Related Publications
PURPOSE: This study aimed to correct and describe cervical cancer mortality rates and trends by regions and age-groups in Brazil. It may help planning and implementing policies for cervical cancer control.
METHODS: Data from 2003 to 2012 were accessed through the centralized national mortality database. Correction of the age-specific mortality rates was done by proportional redistribution of ill-defined causes of death and deaths coded as 'uterine, part unspecified'. Annual percentage change (APC) was obtained by trend analysis (Joinpoint regression).
RESULTS: In the 10-year period, cancer and ill-defined causes corresponded, respectively, to 18.9 and 10.8 % of all deaths (except injuries). The proportion of ill-defined causes was reduced by more than a half in the period. The age-standardized cervical cancer mortality rate was 7.2 per 100,000 women-years after correction. The total increase in rates after corrections was 50.5 %. A significant decreasing trend in rates was observed at the national level (APC = -0.17, p < 0.001). North was the only region that did not show a decreasing significant trend (APC + 0.07, p = 0.28). Decreasing trends were restricted to age-groups over 40 years.
CONCLUSIONS: A consistent decreasing trend of cervical cancer mortality rates in Brazil from 2003 to 2012 was observed, although this was not consistent in all regions and restricted to older age-groups. Quality of data needs to be improved. Cancer control policies may consider the differences in access to care and the characteristics of regions to improve their efficiency.

da Conceição Nunes J, de Araujo GV, Viana MT, Sarinho ES
Association of atopic diseases and parvovirus B19 with acute lymphoblastic leukemia in childhood and adolescence in the northeast of Brazil.
Int J Clin Oncol. 2016; 21(5):989-995 [PubMed] Related Publications
BACKGROUND: Several factors related to the immune system, such as a history of allergies and virus infections, may be associated with acute lymphoblastic leukemia (ALL). The purpose of this study was to analyze whether the presence of atopic diseases and previous infection with parvovirus B19 and Epstein-Barr virus (EBV) are associated with the development of ALL.
METHODS: This case-control study was performed in two tertiary hospitals located in northeastern Brazil. The study population included 60 patients who were diagnosed with non-T-cell ALL using myelogram and immunophenotyping and 120 patients in the control group. Atopy was evaluated via a parent questionnaire and medical records. Total immunoglobulin (Ig)E and IgG levels of parvovirus B19 and EBV were measured in the serum. Logistic regression was performed to assess the association between variables and odds of ALL.
RESULTS: We identified a significant inverse association between rhinitis, urticaria and elevated IgE serum levels with ALL. A history of parvovirus B19 infection showed a significant association with this type of cancer [OR (95 % CI) 2.00 (1.94-4.26); P = 0.050]. In logistic regression, the presence of atopy was a protective factor [OR (95 % CI) 0.57 (0.38-0.83); P = 0.004], and the presence of IgG for parvovirus B19 was an important risk factor for ALL [OR (95 % CI) 2.20 (1.02-4.76); P = 0.043].
CONCLUSIONS: These results suggest that atopic diseases and elevated total IgE levels are associated with a potential protective effect on the development of ALL. Previous infection with parvovirus B19 contributed to ALL susceptibility.

Siegel P, da Motta PM, da Silva LG, et al.
Reiki for Cancer Patients Undergoing Chemotherapy in a Brazilian Hospital: A Pilot Study.
Holist Nurs Pract. 2016 May-Jun; 30(3):174-82 [PubMed] Related Publications
The purpose of this pilot study was to explore whether individualized Reiki given to cancer patients at a Brazilian hospital improved symptoms and well-being. Data from 36 patients who received 5 Reiki sessions were collected using the MYMOP and were compared before and after their treatment and also with 14 patients who did not receive Reiki and who acted as a comparison group. Twenty-one patients reported feeling better, 12 felt worse, and 3 reported no change. Of the comparison group, 6 patients reported feeling better and 8 felt worse. The Reiki practice delivered as part of the integrative care in oncology did produce clinically significant effects, although not statistically significant results, for more than half of the patients undergoing cancer treatment.

Araújo OC, Rosa AS, Fernandes A, et al.
RASSF1A and DOK1 Promoter Methylation Levels in Hepatocellular Carcinoma, Cirrhotic and Non-Cirrhotic Liver, and Correlation with Liver Cancer in Brazilian Patients.
PLoS One. 2016; 11(4):e0153796 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
Hepatocellular carcinoma (HCC) is the second most common cause of cancer mortality worldwide. Most cases of HCC are associated with cirrhosis related to chronic hepatitis B virus or hepatitis C virus infections. Hypermethylation of promoter regions is the main epigenetic mechanism of gene silencing and has been involved in HCC development. The aim of this study was to determine whether aberrant methylation of RASSF1A and DOK1 gene promoters is associated with the progression of liver disease in Brazilian patients. Methylation levels were measured by pyrosequencing in 41 (20 HCC, 9 cirrhotic, and 12 non-cirrhotic) liver tissue samples. Mean rates of methylation in RASSF1A and DOK1 were 16.2% and 12.0% in non-cirrhotic, 26.1% and 19.6% in cirrhotic, and 59.1% and 56.0% in HCC tissues, respectively, showing a gradual increase according to the progression of the disease, with significantly higher levels in tumor tissues. In addition, hypermethylation of RASSF1A and DOK1 was found in the vast majority (88%) of the HCC cases. Interestingly, DOK1 methylation levels in HCC samples were significantly higher in the group of younger (<40 years) patients, and higher in moderately differentiated than in poorly differentiated tumors (p < 0.05). Our results reinforce the hypothesis that hypermethylation of RASSF1A and DOK1 contributes to hepatocarcinogenesis and is associated to clinicopathological characteristics. RASSF1A and DOK1 promoter hypermethylation may be a valuable biomarker for early diagnosis of HCC and a potential molecular target for epigenetic-based therapy.

Hoelzle CR, Magalhães KC, Carvalho SS, et al.
Matrix metalloproteinase 9 -1562C/T polymorphism increased protein levels in patients with colorectal cancer in a sample from southeastern Brazil.
Genet Mol Res. 2016; 15(1) [PubMed] Related Publications
We examined whether the allelic and/or genotypic profile of locus -1562C/T of the matrix metalloproteinase (MMP-9) gene influences the protein expression levels of MMP-9 in patients with colorectal cancer (CRC) compared with controls. A total of 104 patients with CRC and 84 controls were evaluated. Peripheral blood was collected from both groups and DNA extraction was performed for -1562C/T genotyping; the plasma was used for MMP-9 quantification. The CT genotype was associated with increased MMP-9 expression (P = 0.0211). High levels of protein, independently of polymorphisms, were observed in the patient group (P < 0.0001) compared to controls. Mucinous tumors with signet ring cells were more frequent in females (P = 0.0177). Overall, patients older than 50 years showed a significant risk of developing CRC (P = 0.0001). MMP-9 plasma expression was increased in patients with CRC compared to controls, particularly in those with the heterozygous -1562CT genotype.

Romeiro Lopes TC, Franca Gravena AA, Demitto Mde O, et al.
Mammographic Screening of Women Attending a Reference Service Center in Southern Brazil.
Asian Pac J Cancer Prev. 2016; 17(3):1385-91 [PubMed] Related Publications
BACKGROUND: To investigate the prevalence of and factors associated with performance of annual mammography by women above 40 years of age.
MATERIALS AND METHODS: This cross-sectional retrospective study was conducted at an oncology reference service in Southern Brazil from October 2013 to October 2014 with 525 women aged 40 years or older.
RESULTS: The prevalence of annual mammography was 54.1%; annual mammographic screening was performed for women without private medical insurance, who were under hormone replacement therapy and who had used contraception in the past. An association was found between non-performance of breast clinical and self-examination and non-performance of mammographic screening.
CONCLUSIONS: Use of mammography for breast cancer screening in the public health care setting proved to be accessible; nevertheless, the proportion of screened women was low, and they exhibited poor adherence to the basic measures of care recommended for breast assessment. Thus, control of breast cancer requires implementing actions targeting the population most vulnerable to non-adherence to screening in addition to continuously monitoring and assessing that population to reduce the prevalence of this disease.

Velasques K, Michels LR, Colome LM, Haas SE
Educational Activities for Rural and Urban Students to Prevent Skin Cancer in Rio Grande do Sul, Brazil.
Asian Pac J Cancer Prev. 2016; 17(3):1201-7 [PubMed] Related Publications
BACKGROUND: Excessive exposure to the sun during childhood is strongly associated with the development of skin cancer in the future. The only way to prevent the development of skin cancer is to protect against ultraviolet radiation, which can be achieved through strategic awareness during childhood and adolescence.
OBJECTIVE: The aim of this work was to evaluate the impact of educational activities for rural and urban students to promote the use of sunscreens and prevent skin cancer.
MATERIALS AND METHODS: This study was carried out with students (9-12 years) of rural (n=70) and urban (n=70) schools in Rio Grande do Sul state, Brazil. The educational interventions were lectures and games. The impact of this strategy was evaluated through the application of a questionnaire before and after the interventions.
RESULTS: Before the intervention, it was found around 50% of rural and urban students were not aware of the damage caused by sun exposure, often exposing themselves to UV radiation without use sunscreen ( ~ 25 %) and at the most critical times of the day/year. After the lectures we observed an improvement in the behavior of the students with regard to sun exposure and knowledge about skin cancer.
CONCLUSIONS: The results of this study emphasize the importance of prevention strategies for skin cancer and promoting the use of sunscreens based educational strategies. The interventions were of great value in relation to disseminating knowledge on the subject.

Selistre SG, Maestri MK, Santos-Silva P, et al.
Retinoblastoma in a pediatric oncology reference center in Southern Brazil.
BMC Pediatr. 2016; 16:48 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
BACKGROUND: Retinoblastoma (Rb) is the most common intraocular tumor diagnosed in children in Brazil. However, detailed information is lacking regarding patient clinical demographics. This study aimed to determine the clinical profile of patients with Rb who were treated in a public university hospital in southern Brazil from 1983 to 2012.
METHODS: Patients' medical records were reviewed to retrospectively identify patients with a principal diagnosis of Rb. Rb was classified as hereditary or non-hereditary. Clinical staging was reviewed by an ophthalmologist. Statistical analysis was performed using SPSS.
RESULTS: Of 165 patients with a diagnosis of Rb during this period, 140 were included in the study. Disease was unilateral in 65.0 % of patients, bilateral in 32.9 %, and trilateral in 2.1 %. The mean age at onset of the first sign/symptom was 18.1 month, and 35.7 % of patients were diagnosed during the first year of life. The most common presenting signs were leukocoria (73.6 %) and strabismus (20.7 %). The mean age at diagnosis was 23.5 months, and time to diagnosis was 5.4 months. In patients with clinical features of hereditary Rb, both onset of the first sign/symptom and diagnosis were at an earlier age than in patients without these features (12.3 vs 21.6 months [P = 0.001] and 15.9 vs 28.0 months [P < 0.001], respectively). However, there was no significant difference in overall survival between the two groups. Ocular stage at diagnosis was advanced in 76.5 % (Reese V) and 78.1 % (International Classification D or E). Of patients with unilateral and bilateral disease, 35.2 % and 34.8 %, respectively, had extraocular disease at diagnosis; 10.7 % had metastatic disease at diagnosis. Enucleation was observed in 88.1 % and exenteration in 11.9 % of patients; 93.6 % patients were followed until 2012, and 22.9 % relapsed. Overall survival was 86.4 %.
CONCLUSIONS: Most Rb diagnoses are still diagnosed in advanced stages of the disease, considerably reducing overall survival time and the rate of eye and vision preservation.

Castro LG, Bakos RM, Duprat Neto JP, et al.
Brazilian guidelines for diagnosis, treatment and follow-up of primary cutaneous melanoma - Part II.
An Bras Dermatol. 2016 Jan-Feb; 91(1):49-58 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
The last Brazilian guidelines on melanoma were published in 2002. Development in diagnosis and treatment made updating necessary. The coordinators elaborated ten clinical questions, based on PICO system. A Medline search, according to specific MeSH terms for each of the 10 questions was performed and articles selected were classified from A to D according to level of scientific evidence. Based on the results, recommendations were defined and classified according to scientific strength. The present Guidelines were divided in two parts for editorial and publication reasons. In this second part, the following clinical questions were answered: 1) which patients with primary cutaneous melanoma benefit from sentinel lymph node biopsy? 2) Follow-up with body mapping is indicated for which patients? 3) Is preventive excision of acral nevi beneficious to patients? 4) Is preventive excision of giant congenital nevi beneficious to patients? 5) How should stages 0 and I primary cutaneous melanoma patients be followed?

Rovere RK, de Souza ME, Cidral DL, et al.
Melanoma patterns of distant relapse: a study of 108 cases from a South Brazilian center.
An Bras Dermatol. 2016 Jan-Feb; 91(1):40-3 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
BACKGROUND: The incidence of cutaneous melanoma has increased over the last decades. Recurrences occur most frequently within the first 2-3 years after diagnosis but patients carry a lifelong risk of relapse. Nevertheless, there is no consensus in the literature on what screening tests patients should undergo.
OBJECTIVES: To evaluate the most common melanoma metastasis sites among a South Brazilian population from a city with one of the highest melanoma rates, and establish the best screening method for these patients.
METHODS: A cross-sectional retrospective study of 108 consecutive melanoma patients followed up at a center from 2009 to 2013. Data were collected on demographic and tumoral characteristics, as well as the site of the first diagnosed metastasis.
RESULTS: Patients were divided into 3 groups for analytical purposes: Non-visceral metastases (48% of patients), visceral metastasis (39%) and brain metastasis (13%). We tried to correlate age, gender, mean Breslow thickness, mitosis and death rates with the aforementioned groups but none showed any statistically significant association.
CONCLUSION: Melanoma patients must be monitored to detect early relapse and subsequent effective treatment but the best follow-up strategy remains to be established.

Piña AR, Jimenez LS, Mariano FV, et al.
Human papillomavirus in tonsillar squamous cell carcinomas from Guatemala and Brazil.
Oral Surg Oral Med Oral Pathol Oral Radiol. 2016; 121(4):412-8 [PubMed] Related Publications
OBJECTIVES: A subgroup of tonsillar squamous cell carcinoma (SCC) is associated with human papillomavirus (HPV). Nevertheless, the prevalence of HPV seems to be variable in different regions and ethnic groups. There are no reports of HPV in tonsillar carcinomas in Guatemala, and data from Brazil are scarce. The aim of this study is to analyze and compare HPV presence in samples of tonsillar SCC from these countries.
STUDY DESIGN: This study describes the histologic features, expression of p16 by immunohistochemistry (IHC), and HPV by in situ hybridization (ISH) in 13 Guatemalan and 13 Brazilian patients.
RESULTS: All cases of tonsillar SCC from Guatemala were positive for p16, 92% expressed HPV by ISH, and 75% corresponded to the high-risk genotype 16/18. From the Brazilian patients, only four expressed p16, and all were negative for HPV.
CONCLUSIONS: Cases from Guatemala, which were mostly nonkeratinizing SCC and originated from the crypt/reticular epithelium of the tonsil, had high-risk integrated HPV, whereas in Brazilian cases, which were mostly keratinizing SCC that originated from the surface epithelium, there was no association with HPV.

Ribeiro MH, da Silva MA, Muniz Filho WE, et al.
Family history in breast cancer in São Luís, Maranhão, Brazil.
BMC Res Notes. 2016; 9:155 [PubMed] Article available free on PMC after 10/06/2017 Related Publications
BACKGROUND: Familial cancer includes some types of cancer aggregation without a well-defined inheritance pattern. Cancer genetics is an essential component of clinical practice in oncology. In Brazil, breast cancer is the leading cause of death in women. In Maranhão, studies on genetic predisposition are necessary to investigate the incidence and mortality rates. The aim of this study was to investigate familial cancer among relatives of women who died of breast cancer in São Luís, Brazil, constructing a pedigree to identify families with a hereditary predisposition, an important step in the early diagnosis of malignant tumors.
METHODS: The city of São Luís is located on the Island of Maranhão, northeastern Brazil, with a population of 997,098 inhabitants mainly comprising blacks and mulattoes, including descendants of runaway slaves from the Amazon region itself. Data for pedigree construction were obtained from the records of 54 patients seen at the Aldenora Bello Institute of Oncology, São Luís, between 2000 and 2007, as well as by interview with relatives of the patients.
RESULTS: The mean patient age at diagnosis was 39.5 years. Most women were mulattoes (36/54, 66.6%). A history of cancer was observed in 18 families, with 16 families possessing cases of cancer among first-degree relatives and five among second-degree relatives.
CONCLUSION: A concentration of cancer cases was found in families of patients diagnosed until the age of 40, a finding demonstrating the importance of a family history prior to genetic counseling.

Strauss E, Ferreira Ade S, França AV, et al.
Diagnosis and treatment of benign liver nodules: Brazilian Society of Hepatology (SBH) recommendations.
Arq Gastroenterol. 2015; 52 Suppl 1:47-54 [PubMed] Related Publications
Space-occupying lesions of the liver may be cystic or solid. Ultrasonography is an extremely useful method for initial screening, and suffices for diagnosis of simple hepatic cysts. Complex cysts and solid masses require computed tomography or magnetic resonance imaging for confirmation. Wide surgical excision is indicated in cystadenoma or cystadenocarcinoma. Clinical and epidemiological data are important, as nodules in noncirrhotic livers are more likely to be benign. Hemangiomas, the most common benign tumors, require no follow-up after diagnostic confirmation if they are small and asymptomatic. Patients with giant, symptomatic hemangiomas or compression of adjacent structures should be referred to hepatobiliary centers for potential surgery. The genetic heterogeneity of hepatocellular adenomas and their epidemiology and prognosis prompted classification of these tumors into four subtypes based on histology and immunohistochemistry. The major complications of hepatocellular adenomas are rupture with bleeding and malignant transformation. Rupture occurs in approximately 30% of cases. The main risk factors are tumors size >5 cm and inflammatory subtype. Hepatocellular adenomas may enlarge during pregnancy due to marked hormonal stimulation. As oral contraceptive pills and anabolic steroids have associated with hepatocellular adenomas growth, particularly of the hepatocyte nuclear factor-1alfa subtype, these drugs should be discontinued. Focal nodular hyperplasia is the second most common benign tumor of the liver. It is most frequent in women aged 20 to 60, and 70% to 90% of cases are asymptomatic. In the absence of a central scar and/or other hallmarks of Focal nodular hyperplasia, with uncertainty between this diagnosis and hepatocellular adenoma, liver-specific contrast agents are indicated.

Carrillo FJ, Mattos AA, Vianey AF, et al.
Brazilian society of hepatology recommendations for the diagnosis and treatment of hepatocellular carcinoma.
Arq Gastroenterol. 2015; 52 Suppl 1:2-14 [PubMed] Related Publications
Hepatocellular carcinoma is a malignancy of global importance and is associated with a high rate of mortality. Recent advances in the diagnosis and treatment of this disease make it imperative to update the recommendations on the management of the disease. In order to draw evidence-based recommendations concering the diagnosis and management of hepatocellular carcinoma, the Brazilian Society of Hepatology has sponsored a single-topic meeting in João Pessoa (PB). All the invited pannelists were asked to make a systematic review of the literature and to present topics related to the risk factors for its development, methods of screening, radiological diagnosis, staging systems, curative and palliative treatments and hepatocellular carcinoma in noncirrhotic liver. After the meeting, all panelists gathered together for the discussion of the topics and the elaboration of those recommendations. The text was subsequently submitted for suggestions and approval of all members of the Brazilian Society of Hepatology through its homepage. The present paper is the final version of the reviewed manuscript containing the recommendations of the Brazilian Society of Hepatology.

Balmant NV, de Souza Reis R, Pinto Oliveira JF, et al.
Cancer Incidence Among Adolescents and Young Adults (15 to 29 Years) in Brazil.
J Pediatr Hematol Oncol. 2016; 38(3):e88-96 [PubMed] Related Publications
The spectrum of cancers commonly found in adolescents and young adults (AYAs) differs from those in children and adults; therefore, the childhood classification is not appropriate for this population. Here we used a newly proposed classification system to reclassify cases of AYAs from Brazilian population-based cancer registries (PBCRs) in 5 geographic regions of Brazil. We aimed to describe the cancer incidence rates within this age group according to PBCR. Using the world population, incidence rates per million were analyzed in each diagnostic subgroup according to sex and age at diagnosis (15 to 19 y, 20 to 24 y, and 25 to 29 y). The median incidence rate was 232.31 per million for females and 218.07 per million for males. Incidence increased with age, with the highest rate observed for 25- to 29-year-olds in both sexes. Carcinomas, lymphomas, and skin tumors were most frequent among AYAs. High incidence rates of cervix-uterus carcinoma were observed in most PBCRs. AYAs present epidemiological characteristics that differ from those of children, reinforcing the need for a new classification. This study describes, for the first time, the cancer incidence rate in AYAs in Brazil, and we believe that our findings represent the Brazilian profile.

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