Daniel Gonçalves Kischinhevsky

Social inequities and clinical outcomes in young women with cervical cancer: Real-world evidence

Objective To assess the influence of social inequities and clinicopathological factors on survival outcomes in young women with cervical cancer treated at a comprehensive public cancer center in Brazil. Methods This retrospective analysis reviewed the medical records of women aged 18–39 diagnosed with cervical cancer at the Brazilian National Cancer Institute between January 2017 and December 2021, assessing demographic characteristics and survival outcomes. Results This analysis included 475 patients with a mean age of 33.6 years, with the majority being non-white (67.7%), never married women (68.0%), and having a low education level (< 8 years) (86.1%). Multivariate analysis indicated that a lower education level was associated with advanced stage (p = 0.001). Recurrence or progression occurred in 224 patients (47.2%), mainly as distant metastases (56.7%). The median progression-free survival (PFS) was 19.8 months, with two-year rates of 81.6%, 45.7%, 28.2%, and 6.2% for stages I, II, III, and IV, respectively. Shorter PFS was correlated with lower education level (p = 0.009), alcohol consumption (p = 0.026), undifferentiated carcinoma (p = 0.007), and advanced disease stage (p < 0.001). The median overall survival (OS) was 35.1 months, with five-year rates of 82.9%, 42.7%, 23.7%, and 9.7% for stages I, II, III, and IV, respectively. Factors associated with shorter OS included lower education level (p = 0.005), undifferentiated carcinoma (p = 0.006), and advanced stage (p < 0.001). Conclusion Undifferentiated carcinomas and advanced stages negatively influence the prognosis of young women with cervical cancer. Social factors may also be correlated with poorer outcomes, especially alcohol consumption and lower education levels.

Epidemiology of Cervical Cancer in Brazil: Age-Specific Trends From 2000 to 2018

PURPOSE Cervical cancer (CC) remains a significant public health challenge in low- and middle-income countries (LMICs), including Brazil. While global incidence has declined, age-specific variations may mask emerging trends among younger women. This study aimed to evaluate trends and age-specific changes in CC incidence in Brazil between 2000 and 2018. MATERIALS AND METHODS Incidence data and age at diagnosis were obtained from Brazilian Population-Based Cancer Registries (PBCRs) for the period 2000-2018. Temporal trends were evaluated using Joinpoint regression to estimate annual percent changes (APCs) and average APCs (AAPCs). RESULTS Between 2000 and 2018, 66,358 CC cases were identified across 33 PBCRs. The median age at diagnosis was 51 years (IQR, 40-63), declining from 52 years in 2000 to 48 years in 2018. The overall adjusted incidence showed a significant decline between 2000 and 2013 (APC: –4.5% [95% CI, –5.3 to –3.7]; P < .001) followed by a nonsignificant increase from 2013 to 2018 (APC: 3.1 [95% CI, –1.6 to 8.1]; P = .20). Age-stratified analyses revealed rising trends among women age 25-44 years, suggesting a transition to younger age at diagnosis. CONCLUSION The observed decrease in median age and rising incidence among women younger than 45 years indicate a potential epidemiologic shift in CC in Brazil. These findings highlight the need to strengthen national screening programs, expand human papillomavirus (HPV) vaccination coverage, and incorporate molecular HPV testing into prevention strategies.