Audrey Tieko Tsunoda

Exploring cervical cancer mortality in Brazil: an ecological study on socioeconomic and healthcare factors

To evaluate the correlation between socioeconomic and healthcare factors and cervical cancer mortality rates, as well as the accessibility to prevention and treatment across Brazilian states and macroregions. The aim is to highlight the multifaceted challenge of addressing cervical cancer mortality, particularly in low-and middle-income countries. This ecological study analyzed public data from the Brazilian National Institute of Cancer (INCA), the National Institute of Geography and Statistics (IBGE), and the Brazilian Ministry of Health. Data were collected on indicators such as the Human Development Index (HDI), physician density, average household income, human papillomavirus (HPV) vaccine coverage, Pap smear screening rates, radiotherapy machine density, and non-White population rates by state and macroregion across Brazil. Spearman's rank correlation test and simple linear regression analysis were employed. Cervical cancer mortality rates are statistically lower in women with health insurance, positive self-perception of health, located in states with a higher HDI, higher per capita household income, greater density of physicians, and higher availability of radiotherapy machines. In contrast, mortality rates proportionally increase according to poverty levels, as expected, and rates of non-White population. Considering public health, HDI scores significantly affected Pap smear test coverage, the number of radiotherapy machines, and HPV vaccine uptake. The North and the Southeast regions have, respectively, the lowest and the highest socioeconomic indicators, proportional to their mortality rates. No significant correlation was found between mortality rates and HPV vaccine or Pap smear coverage. Cervical cancer mortality in Brazil is significantly influenced by socioeconomic and healthcare disparities. This study provides a data-driven basis for public health strategies that address both medical and social determinants of health.

Reconsidering adjuvant radiotherapy in intermediate-risk cervical cancer: findings from the CIRCOL study group

To evaluate survival outcomes associated with intermediate-risk factors in patients who underwent radical hysterectomy for cervical cancer, with a focus on the role of adjuvant radiotherapy. A multicenter retrospective cohort database comprising 1280 patients who underwent radical hysterectomy for cervical cancer was analyzed. For inclusion, patients had tumors ≤4 cm (International Federation of Gynecology and Obstetrics 2018 stages Ia2-Ib2) and were treated surgically between January 2000 and December 2017. Patients with lymph node metastasis, positive surgical margins, or parametrial involvement were excluded. Intermediate-risk factors were defined as tumor size >2 cm to ≤4 cm, stromal invasion ≥10 mm, and presence of lymphovascular space invasion. A total of 759 patients met inclusion criteria, of whom 158 (20.8%) received external beam radiotherapy. Patients who received external beam radiotherapy were older, more often underwent open surgery, and exhibited a higher incidence of adverse pathological features, including larger tumors, deeper stromal invasion, and lymphovascular space invasion. In multivariate analysis, tumor size >2 cm (HR 5.25, 95% CI 1.86 to 14.8) and stromal invasion ≥10 mm (HR 2.68, 95% CI 1.14 to 6.30) were independently associated with increased recurrence risk. No variables were independently associated with cancer-specific mortality. The presence of ≥2 intermediate-risk factors significantly increased the risk of recurrence (HR 3.48, 95% CI 2.05 to 5.91) and cancer-related death (HR 2.47, 95% CI 1.04 to 2.89), regardless of radiotherapy use. Tumor size and depth of stromal invasion were associated with increased recurrence risks. Adjuvant radiotherapy was not associated with improved survival outcomes in patients with intermediate-risk features.

Quality of Life Post Cervical Cancer Treatment: A Comparison Between Radical Surgery Approach and Radiotherapy and Chemotherapy

ABSTRACTIntroductionThe assessment of quality of life (QoL) in women with cervical cancer is crucial due to the profound changes they undergo during and after treatment. Often, the significance of sexual factors is underestimated, likely due to societal taboos surrounding such discussions.ObjectiveThis study aimed to determine the long‐term QoL outcomes, particularly focusing on sexuality, among three therapeutic approaches for cervical cancer: chemotherapy, radiotherapy, and brachytherapy; isolated hysterectomy; and hysterectomy combined with radiotherapy.MethodsConducted from November 2022 to July 2023, this cross‐sectional study involved 131 cervical cancer patients. Their QoL was assessed using the MDASI, FACIT‐Cx, and risk factor questionnaires. Results were compared across the three treatment groups, revealing notable differences.ResultsPatients undergoing chemo/radio/brachytherapy showed significantly lower QoL scores compared to those undergoing isolated hysterectomy. This was evident in reduced scores across FACIT‐Cx subscales for physical well‐being, specific concerns, and FACIT‐total (p < 0.05). The MDASI results similarly indicated greater symptoms and interference in daily activities for the chemo/radio/brachytherapy group.ConclusionIn conclusion, isolated hysterectomy, demonstrated superior QoL outcomes compared to chemo/radio/brachytherapy. Furthermore, the study underscored the importance of addressing sexual concerns in QoL assessments of cervical cancer survivors, emphasizing the need for comprehensive care to enhance overall well‐being posttreatment.