Temporal trend and associated factors to advanced stage at diagnosis of cervical cancer: analysis of data from hospital based cancer registries in Brazil, 2000-2012

Renna Junior, Nelson Luiz; Silva, Gulnar Azevedo e

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Brasil

Epidemiologia e Serviços de Saúde

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Brasil

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ORIGINAL ARTICLE • Epidemiol. Serv. Saúde 27 (2) • 2018 • https://doi.org/10.5123/S1679-49742018000200003 copy

Temporal trend and associated factors to advanced stage at diagnosis of cervical cancer: analysis of data from hospital based cancer registries in Brazil, 2000-2012^* * This article is derived from the Master's thesis entitled 'Access to diagnosis and treatment of patients with breast cancer and cervical cancer in Brazil: an analysis of data from Cancer Hospital Registers', defended by Nelson Luiz Renna Junior to the Postgraduate Program in Collective Health of the Institute of Social Medicine of the State University of Rio de Janeiro (UERJ) in 2016.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To analyze the time trend and analyze the determinants of stage at diagnosis of cervical cancer in Brazil.

Methods:

Time trend analysis and cross-sectional study using data from hospital-based cancer registries (2000-2012); multinomial and joinpoint regression statistical models were used.

Results:

65.843 cases were analyzed; the median interval between diagnosis and treatment was 59 days; the percentage of advanced staging increased, annual percent change 1.10% (95%CI 0.80;1.50); women with higher education (compared to unlettered) had less odds of late stage diagnosis (OR=0.38; 95%CI 0.31;0.47); among indigenous (OR=2.38; 95%CI 1.06;5.33) and black women (OR=1.16; 95%CI 1.02;1.31), compared to white, and in the North region (OR=2.55; 95%CI 2.26;2.89), compared to the Southeast, the odds was higher; other factors positively related to advanced stage were 'age', 'histology', and marital status'.

Conclusion

Inequities affect the odds of late stage diagnosis of cervical cancer.

Keywords:
Uterine Cervical Neoplasms; Women's Health; Hospital Records; Health Services Accessibility; Medical Oncology

Sociodemographic characteristics	N	%
Education level
None	11,156	16.94
Incomplete primary education school	23,728	36.04
Complete primary education school	8,075	12.26
Secondary education	4,706	7.15
College education	1,053	1.60
No information	17,125	26.01
Region of hospital unit
Midwest	1,243	1.89
Northeast	20,547	31.21
North	6,371	9.68
Southeast	30,215	45.89
South	7,467	11.34
Region of birth
Midwest	1,265	2.01
Northeast	26,335	41.86
North	5,617	8.93
Southeast	22,579	35.89
South	6,952	11.05
Foreign	160	0.25
Region of birth differs from the federation unit of the hospital unit
No	46,058	69.95
Yes	16,690	25.35
No information	3,095	4.70
Smoking
Former smoker	1,401	2.86
Never	18,815	38.35
Yes	11,261	22.95
No information	17,583	35.84
Alcoholism
Former user	537	1.09
Never	23,256	47.40
Yes	3,792	7.73
No information	21,475	43.77
Marital status
Single	12,875	26.24
Married	22,155	45.16
Civil union	359	0.73
Divorced	2,762	6.04
Widow	2,762	5.63
No information	3,357	6.84
Ethnicity/skin color
Asian	460	0.94
White	15,972	32.56
Indigenous	143	0.29
Brown	24,947	50.85
Black	2,947	6.01
No information	4,591	9.36

Clinical characteristics and related to diagnosis and treatment	N	%
Treatment in the institution
Completed treatment	55,155	83.77
Not completed treatment	3,800	5.77
No information	6,888	10.46
Status of the disease at the end of the treatment
Without evidence of the disease	11,390	30.0
Partial Remission	1,673	2.54
Stable Disease	12,156	18.46
Disease progression	3,193	4.85
Outside therapeutic possibilities	618	0.94
Death	6,183	9.39
Not applicable	2,778	4.22
No information	27,852	30.0
Family history of cancer
No	17,497	35.66
Yes	9,846	20.07
No information	21,717	44.27
Prior diagnosis and treatment
With diagnosis and treatment	6,492	9.86
With diagnosis, without treatment	39,064	59.33
Without diagnosis	18,939	28.76
Without treatment	25,431	38.62
Histological type
Adenocarcinoma	7,651	11.62
Squamous	54,351	82.55
Adenosquamous	803	1.22
Invasive cancer, without specification	3,038	4.61
Stage at diagnosis
I	14,024	30.0
II	21,293	32.34
III	25,782	39.16
IV	4,744	7.21

Demographic and clinical characteristics	Localized disease		Advanced disease
Demographic and clinical characteristics	Crude analysis OR^a (95%CI^b )	Adjusted analysis OR^a (95%CI^b )	Crude analysis OR^a (95%CI^b )	Adjusted analysis OR^a (95%CI^b )
Age (in years)
<30	1.00	1.00	1.00	1.00
30-34	1.06 (0.93;1.22)	1.01 (0.86;1.18)	0.94 (0.83;1.06)	0.90 (0.78;1.05)
35-39	1.15 (1.01;1.31)	1.11 (0.96;1.30)	1.01 (0.89;1.13)	0.98 (0.85;1.13)
40-44	1.33 (1.18;1.51)	1.27 (1.09;1.47)	1.21 (1.08;1.36)	1.15 (1.00;1.32)
45-49	1.44 (1.27;1.63)	1.46 (1.26;1.69)	1.51 (1.35;2.70)	1.51 (1.32;1.73)
50-54	1.81 (1.59;2.05)	1.80 (1.55;2.09)	1.96 (1.74;2.20)	1.84 (1.60;2.12)
55-59	2.00 (1.76;2.27)	1.94 (1.66;2.25)	2.05 (1.83;2.31)	1.89 (1.64;2.18)
60-64	2.11 (1.85;2.40)	1.96 (1.68;2.29)	2.14 (1.89;2.41)	1.86 (1.61;2.15)
65-69	2.35 (2.05;2.69)	2.40 (2.04;2.82)	2.23 (1.57;2.53)	2.09 (1.79;2.44)
≥70	2.46 (2.17;2.79)	2.38 (2.05;2.78)	2.72 (2.42;3.06)	2.35 (2.04;2.71)
Education level
None	1.00	1.00	1.00	1.00
Incomplete primary education school	0.66 (0.62;0.71)	0.86 (0.80;0.93)	0.60 (0.56;0.64)	0.73 (0.68;0.78)
Complete primary education school	0.60 (0.56;0.66)	0.88 (0.80;0.96)	0.53 (0.49;0.58)	0.69 (0.63;0.75)
Secondary education	0.46 (0.34;0.40)	0.76 (0.69;0.84)	0.37 (0.34;0.40)	0.53 (0.48;0.59)
College education	0.37 (0.31;0.43)	0.65 (0.54;0.77)	0.31 (0.26;0.36)	0.45 (0.39;0.53)
Region of the hospital
Southeast	1.00	1.00	1.00	1.00
Midwest	1.51 (1.09;1.78)	1.63 (1.32;2.00)	1.48 (1.27;1.73)	1.29 (1.06;1.58)
Northeast	2.13 (2.03;2.24)	1.88 (1.77;2.00)	1.67 (1.59;1.75)	1.32 (1.25;1.40)
North	2.31 (2.13;2.49)	2.48 (2.28;2.71)	1.55 (1.44;1.62)	1.63 (1.50;1.78)
South	1.46 (1.35;1.57)	1.49 (1.35;1.65)	1.74 (1.62;1.86)	1.71 (1.55;1.87)
Place of birth
Same state of the treatment	1.00	1.00	1.00	1.00
Different state of the treatment	0.89 (0.85;0.93)	0.98 (0.92;1.03)	0.86 (0.82;0.90)	0.91 (0.86;0.96)
Histological type
Squamous tumours	1.00	1.00	1.00	1.00
Adenocarcinomas	0.58 (0.54;0.61)	0.63 (0.59;0.68)	0.45 (0.43;0.48)	0.48 (0.44;0.51)
Others	0.79 (0.72;0.87)	0.83 (0.74;0.94)	1.08 (0.99;1.18)	1.15 (1.03;1.29)
Year of diagnosis
2000-2005	1.00	1.00	1.00	1.00
2006-2012	0.97 (0.93;1.01)	1.03 (0.98;1.09)	1.15 (1.11;1.20)	1.26 (1.20;1.33)

Demographic and clinical characteristics	Localized disease		Advanced disease
Demographic and clinical characteristics	Crude analysis OR^a (95%CI^b )	Adjusted analysis OR^a (95%CI^b )	Crude analysis OR^a (95%CI^b )	Adjusted analysis OR^a (95%CI^b )
Age (in years)
<30	1.00	1.00	1.00	1.00
30-34	1.03 (0.88;1.20)	1.04 (0.86;1.26)	0.91 (0.78;1.06)	0.99 (0.82;1.19)
35-39	1.04 (0.90;1.21)	1.06 (0.89;1.27)	0.95 (0.82;1.09)	1.02 (0.86;1.21)
40-44	1.17 (1.01;1.35)	1.18 (0.99;1.41)	1.09 (0.95;1.26)	1.15 (0.97;1.36)
45-49	1.35 (1.17;1.57)	1.47 (1.24;1.76)	1.46 (1.28;1.68)	1.65 (1.39;1.95)
50-54	1.66 (1.43;1.93)	1.77 (1.48;2.12)	1.86 (1.62;2.14)	1.99 (1.68;2.37)
55-59	1.75 (1.50;2.03)	1.84 (1.53;2.21)	1.88 (1.63;2.16)	2.04 (1.71;2.43)
60-64	1.91 (1.64;2.23)	1.87 (1.55;2.26)	1.96 (1.69;2.27)	1.89 (1.57;2.26)
65-69	2.19 (1.87;2.57)	2.32 (1.90;2.83)	2.10 (1.80;2.44)	2.21 (1.83;2.69)
≥70	2.19 (1.88;2.54)	2.16 (1.78;2.60)	2.43 (2.10;2.80)	2.24 (1.87;2.69)
Education level
None	1.00	1.00	1.00	1.00
Incomplete primary education school	0.66 (0.63;0.73)	0.68 (0.76;0.90)	0.60 (0.33;0.40)	0.61 (0.65;0.77)
Complete primary education school	0.64 (0.59;0.71)	0.88 (0.79;0.98)	0.55 (0.50;0.60)	0.69 (0.63;0.77)
Secondary education	0.47 (0.42;0.52)	0.67 (0.59;0.76)	0.36 (0.34;0.40)	0.47 (0.42;0.53)
College education	0.39 (0.32;0.48)	0.57 (0.46;0.70)	0.30 (0.25;0.36)	0.38 (0.31;0.47)
Region of the hospital
Southeast	1	1	1	1
Midwest	1.21 (1.02;1.43)	1.37 (1.10;1.71)	1.32 (1.13;1.55)	1.15 (0.93;1.42)
Northeast	1.70 (1.60;1.81)	1.64 (1.52;1.77)	1.49 (1.41;1.58)	1.26 (1.17;1.35)
North	1.84 (1.69;2.00)	3.41 (3.01;3.86)	1.38 (1.27;1.50)	2.55 (2.26;2.89)
South	1.26 (1.07;1.26)	1.42 (1.25;1.60)	1.55 (1.44;1.67)	1.93 (1.72;2.16)
Place of birth
Same state of the treatment	1.00	1.00	1.00	1.00
Different state of the treatment	0.99 (0.93;1.05)	0.93 (0.86;0.99)	0.86 (0.85;0.95)	0.90 (0.83;0.95)
Histological type
Squamous tumours	1.00	1.00	1.00	1.00
Adenocarcinomas	0.62 (0.57;0.67)	0.67 (0.61;0.74)	0.46 (0.43;0.50)	0.48 (0.44;0.52)
Others	0.72 (0.64;0.82)	0.74 (0.63;0.86)	0.96 (0.86;1.08)	0.97 (0.84;1.13)
Year of diagnosis
2000-2005	1.00	1.00	1.00	1.00
2006-2012	0.99 (0.94;1.04)	0.99 (0.92;1.05)	1.22 (1.17;1.29)	1.23 (1.16;1.31)
Ethnicity/skin color
White	1.00	1.00	1.00	1.00
Asian	1.05 (0.81;1.37)	0.77 (0.57;1.03)	1.00 (0.78;1.28)	0.94 (0.78;1.28)
Indigenous	1.49 (0.85;2.62)	1.66 (0.72;3.81)	2.08 (1.24;3.52)	2.38 (1.06;5.33)
Brown	1.24 (1.17;1.31)	0.91 (0.84;0.98)	1.13 (1.07;1.19)	0.99 (0.92;1.07)
Black	1.00 (0.89;1.12)	0.90 (0.79;1.03)	1.19 (1.07;1.32)	1.16 (1.02;1.31)
Marital status
Married	1.00	1.00	1.00	1.00
Divorced	0.92 (0.82;1.03)	1.05 (0.92;1.20)	1.16 (1.04;1.29)	1.29 (1.13;1.46)
Single	0.98 (0.92;1.04)	1.06 (0.99;1.14)	1.28 (1.20;1.35)	1.46 (1.36;1.57)
Widow	1.36 (1.26;1.47)	1.11 (1.01;1.23)	1.66 (1.57;1.79)	1.34 (1.22;1.48)

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[1] Correspondence: Nelson Luiz Renna Junior - Rua São Francisco Xavier, no 524, Bloco E, 7º andar, Maracanã, Rio de Janeiro, RJ, Brasil E-mail: nelsonrenna@gmail.com