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      The epidemiology of laryngeal cancer in Brazil Translated title: Epidemiologia do câncer de laringe no Brasil

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          Abstract

          The city of São Paulo exhibits one of the highest incidences of laryngeal cancer in world and Brazil presents remarkable occurrence, compared with other Latin American countries. Around 8,000 new cases and 3,000 deaths by laryngeal cancer occur annually in the Brazilian population. In the city of São Paulo, incidence rates for laryngeal cancer among males have been decreasing since the late 1980s while, among females, the rates have shown a stable trend. This phenomenon is probably the expression of changes in gender behavior related to tobacco smoking. Several risk factors are involved in the genesis of laryngeal cancer. The most important are tobacco smoking and alcohol intake, but occupational hazards have also been associated with the disease, such as asbestos, strong inorganic acids, cement dust and free crystalline silica. Additionally, salted meat and total fat intake have been linked to elevated risk of laryngeal cancer. Conversely, several studies have confirmed that fruits, raw leaf vegetables and legumes protect against this cancer. Some researchers have postulated a possible association between laryngeal squamous cell carcinoma and human papilloma virus (HPV), but this is not universally accepted. Gastroesophageal reflux disease is weakly, but consistently correlated with laryngeal cancer. Familial cancer clusters, particularly of head and neck tumors, seem to increase the risk of laryngeal cancer. Some genetic polymorphisms, such as of genes that code for xenobiotic-metabolizing enzymes, have shown elevated risk for laryngeal cancer according to recent studies. Public health policies regarding the control of tobacco smoking and alcohol consumption, and also surveillance of carcinogen exposure in occupational settings, could have an impact on laryngeal cancer. No proposals for screening have been recommended for laryngeal cancer, but one diagnostic goal should be to avoid treatment delay when suspected symptoms have been observed.

          Translated abstract

          A cidade de São Paulo apresenta uma das mais altas incidências de câncer de laringe no mundo e o Brasil uma ocorrência expressiva quando comparada com outros países da América Latina. Em torno de 8.000 casos novos e 3.000 mortes pela doença atingem anualmente a população brasileira. Na cidade de São Paulo, as taxas de incidência por câncer de laringe mostram-se decrescentes desde o final da década de 1980, porém, entre as mulheres as taxas revelam-se estáveis. Estas tendências, possivelmente, expressam as mudanças no comportamento de homens e mulheres em relação ao consumo de cigarros. Vários fatores de risco são relacionados ao câncer de laringe. Os mais importantes são tabagismo e consumo bebidas alcoólicas, porém exposições a cancerígenos ocupacionais também são associadas à doença, como o amianto, os ácidos inorgânicos fortes, a poeira de cimento e a sílica cristalina livre. O consumo de carne salgada e gorduras está relacionado com excesso de risco de câncer de laringe. Por outro lado, vários estudos têm confirmado que frutas, vegetais crus e legumes protegem contra este câncer. Há referências da possível associação entre carcinoma espinocelular de laringe e o papiloma vírus humano (HPV), mas este fato não está comprovado. O refluxo gastro-intestinal relaciona-se de forma tênue, porém consistente com o câncer de laringe. Aglomeração de câncer na família, particularmente de tumores de cabeça e pescoço, aumenta o risco de câncer da laringe. Polimorfismos genéticos, especialmente de genes envolvidos na ação de enzimas responsáveis pela metabolização de cancerígenos, apresentam associação com o câncer de laringe de acordo com estudos recentes. Políticas de controle do tabagismo e consumo excessivo de álcool, bem como a vigilância de exposições a cancerígenos ocupacionais, terão benéficas repercussões no câncer de laringe. Não há recomendação para o rastreamento de câncer da laringe, todavia uma vez realizado o diagnóstico o tratamento médico imediato influenciará na sobrevida do paciente.

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          Most cited references 93

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          Câncer no Brasil: Dados dos Registros de Base Populacional

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              Occupational exposures and squamous cell carcinoma of the oral cavity, pharynx, larynx, and oesophagus: a case-control study in Sweden.

              This community based case-referent study was initiated to investigate aetiological factors for squamous cell carcinoma of the upper gastrointestinal tract. The study was based on all Swedish men aged 40-79 living in two regions of Sweden during 1988-90. Within that base, efforts were made to identify all incident cases of squamous cell carcinoma of the oral cavity, oropharynx and hypopharynx, larynx, and oesophagus. Referents were selected as a stratified (age, region) random sample of the base. The response was 90% among cases and 85% among referents. There were 545 cases and 641 referents in the final study group. The study subjects were interviewed about several lifestyle factors and a life history of occupations and work tasks. The exposure to 17 specific agents were coded by an occupational hygienist. The relative risk (RR) of cancer was calculated by logistic regression, standardising for age, geographical region, and alcohol and tobacco consumption. Exposure to asbestos was associated with an increased risk of laryngeal cancer, and a dose-response relation was present. The RR was 1.8 (95% confidence interval (95% CI) 1.1 to 3.0) in the highest exposure group. More than eight years of exposure to welding fumes was associated with an increased risk of pharyngeal cancer (RR 2.3 (1.1 to 4.7)), and laryngeal cancer (RR 2.0 (1.0 to 3.7)). There were indications of a dose-response for duration of exposure. Associations were also found for high exposure to polycyclic aromatic hydrocarbons (PAHs) and oesophageal cancer, RR 1.9 (1.1 to 3.2). Exposure to wood dust was associated with a decreased risk of cancer at the studied sites. Some of the present findings confirm known or suspected associations--such as asbestos and laryngeal cancer. The study indicates that welding may cause an increased risk of pharyngeal as well as laryngeal cancer. The findings corroborate an association between exposure to PAHs and oesophageal cancer.
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                Author and article information

                Contributors
                Role: ND
                Journal
                spmj
                Sao Paulo Medical Journal
                Sao Paulo Med. J.
                Associação Paulista de Medicina - APM (São Paulo )
                1806-9460
                2004
                : 122
                : 5
                : 188-194
                Affiliations
                [1 ] Universidade de São Paulo Brazil
                Article
                S1516-31802004000500002
                10.1590/S1516-31802004000500002
                Product
                Product Information: website
                Categories
                MEDICINE, GENERAL & INTERNAL

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