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      Analysis of the effects of the age-period-birth cohort on cervical cancer mortality in the Brazilian Northeast

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          Abstract

          Cervical cancer (CC) is a public health problem with a high disease burden and mortality in developing countries. In Brazil, areas with low human development index have the highest incidence rates of Brazil and upward temporal trend for this disease. The Northeast region has the second highest incidence of cervical cancer (20.47 new cases / 100,000 women). In this region, the mortality rates are similar to rates in countries that do not have a health system with a universal access screening program, as in Brazil. Thus, this study aimed to analyze the effects of age, period and birth cohorts on mortality from cervical cancer in the Northeast region of Brazil. Estimable functions predicted the effects of age, period and birth cohort. The average mortality rate was 10.35 deaths per 100,000 women during the period analyzed (1980–2014). The highest mortality rate per 100,000 women was observed in Maranhão (24.39 deaths), and the lowest mortality rate was observed in Bahia (11.24 deaths). According to the period effects, only the state of Rio Grande do Norte showed a reduction in mortality risk in the five years of the 2000s. There was a reduction in mortality risk for birth cohorts of women after the 1950s, except in Maranhão State, which showed an increasing trend in mortality risk for younger generations. We found that the high rates of cervical cancer mortality in the states of northeastern Brazil remain constant over time. Even after an increase in access to health services in the 2000s, associated with increased access to the cancer care network, which includes early detection (Pap Test), cervical cancer treatment and palliative care. However, it is important to note that the decreased risk of death and the mortality rates from CC among women born after the 1960s may be correlated with increased screening coverage, as well as increased access to health services for cancer treatment observed in younger women.

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          Overdiagnosis and overtreatment in cancer: an opportunity for improvement.

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            Models for temporal variation in cancer rates. I: Age-period and age-cohort models.

            A main concern of descriptive epidemiologists is the presentation and interpretation of temporal variations in cancer rates. In its simplest form, this problem is that of the analysis of a set of rates arranged in a two-way table by age group and calendar period. We review the modern approach to the analysis of such data which justifies traditional methods of age standardization in terms of the multiplicative risk model. We discuss the use of this model when the temporal variations are due to purely secular (period) influences and when they are attributable to generational (cohort) influences. Finally we demonstrate the serious difficulties which attend the interpretation of regular trends. The methods described are illustrated by examples for incidence rates of bladder cancer in Birmingham, U.K., mortality from bladder cancer in Italy, and mortality from lung cancer in Belgium.
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              Trends of cervical cancer mortality in the member states of the European Union.

              Cervical cancer mortality can be avoided to a large extent by screening and treatment of screen-detected cervical lesions. However, in 2004, more than 16,000 women died from cervical cancer in the European Union (EU). In the current paper, we analyse cervical cancer mortality trends in the 27 member states since 1970 and, subsequently, try to explain how screening and other factors have driven changes. Data on number of deaths from uterine cancers and overall female populations from EU member states were extracted from the World Health Organisation mortality database. Three different reallocation rules were applied to correct cervical cancer mortality for inaccuracies in certification of cause of death of not otherwise specified uterine cancer. Joinpoint regression was used to study annual variation of corrected cervical cancer mortality in all member states. We distinguished the 15 old from the 12 new member states, which acceded to the EU in 2004 or later. For Finland, France and Romania, age-specific trends by calendar period and the standardised cohort mortality ratios by birth cohort were analysed. Corrected age-standardised cervical cancer mortality rates have decreased significantly over the past decades in the old member states. Member states in Eastern Europe and also the Baltic states showed mortality rates that decreased at a lower intensity (Czech Republic, Poland), remained constant at a high rate (Estonia, Slovakia) or even increased (Bulgaria, Latvia, Lithuania, Romania). The standardised cohort mortality ratio indicated that mortality does not decrease further or even increase among women born after 1940. Remarkable contrasts were observed on cervical cancer mortality, in particular, between the old and new member states of the EU, which might probably be explained by differences in preventive strategies. This contrast might increase in the future, unless adequate preventive measures are adopted.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: InvestigationRole: ValidationRole: VisualizationRole: Writing – original draft
                Role: ConceptualizationRole: Data curationRole: InvestigationRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ValidationRole: VisualizationRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: VisualizationRole: Writing – review & editing
                Role: InvestigationRole: ValidationRole: Writing – original draft
                Role: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: InvestigationRole: ValidationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                19 February 2020
                2020
                : 15
                : 2
                : e0226258
                Affiliations
                [1 ] Health School, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
                [2 ] Department of Nursing, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
                [3 ] Cancer Hospital III, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
                [4 ] Joaquim Venâncio Polytechnic School, Oswaldo Cruz Foundation, Rio de Janeiro, Rio de Janeiro, Brazil
                [5 ] Collective Health Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
                [6 ] Biologist, specialist in management in Health Systems and Services, State Secretariat of Espírito Santo, Vitória, Espírito Santo, Brazil
                [7 ] Assistance Coordination, National Cancer Institute, Rio de Janeiro, Rio de Janeiro, Brazil
                [8 ] René Rachou Institute, Oswaldo Cruz Foundation, Belo Horizonte, Minas Gerais, Brazil
                London School of Hygiene and Tropical Medicine, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-1722-5703
                http://orcid.org/0000-0002-0570-1944
                http://orcid.org/0000-0002-6595-6105
                Article
                PONE-D-19-11022
                10.1371/journal.pone.0226258
                7029866
                32074101
                0d571a23-11b9-4c9c-8459-34935b5fbb7a
                © 2020 Meira et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 17 April 2019
                : 23 November 2019
                Page count
                Figures: 8, Tables: 2, Pages: 25
                Funding
                This article is a product of a project coordinated by the main author, Meira KC, and funded by the National Scientific and Technological Development (CNPQ) ( http://www.cnpq.br/) and Coordination for the Improvement of Higher Education, for promoting this research (CAPES-Financing Code 001). The funders had no role in study design, data collection.
                Categories
                Research Article
                Biology and Life Sciences
                Population Biology
                Population Metrics
                Death Rates
                Medicine and Health Sciences
                Oncology
                Cancers and Neoplasms
                Gynecological Tumors
                Cervical Cancer
                People and places
                Geographical locations
                South America
                Brazil
                Medicine and Health Sciences
                Health Care
                Socioeconomic Aspects of Health
                Medicine and Health Sciences
                Public and Occupational Health
                Socioeconomic Aspects of Health
                People and Places
                Population Groupings
                Age Groups
                Medicine and Health Sciences
                Oncology
                Cancer Treatment
                Medicine and Health Sciences
                Diagnostic Medicine
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Cancer Screening
                Medicine and Health Sciences
                Diagnostic Medicine
                Cancer Detection and Diagnosis
                Medicine and Health Sciences
                Oncology
                Cancer Detection and Diagnosis
                Custom metadata
                All data used in this study are freely accessible in the Mortality Information System, available at http://www2.datasus.gov.br/DATASUS/index.php ( http://www2.datasus.gov.br/DATASUS/index.php?area=0205). Other researchers will have equal access to this data in the same manner as the authors.

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