Jessé Lopes da Silva

Racial Disparities in Endometrial Cancer Incidence and Outcomes in Brazil: Insights From Population-Based Registries

PURPOSE This study aimed to examine trends in the incidence and mortality rates of endometrial cancer (EC) across ethnic groups in Brazil and to analyze the demographic and clinicopathological characteristics associated with these trends. METHODS The incidence of EC was analyzed from 2010 to 2015 using data from Brazilian Population–Based Cancer Registries (PBCRs), including crude rates and annual percentage changes (APCs). Clinical and sociodemographic information from 2000 to 2019 was gathered from Hospital-Based Cancer Registries. Mortality data between 2000 and 2021 were obtained from the National Mortality Information System, allowing for comparisons between White women and Black women. RESULTS From 2010 to 2015, a total of 32,831 new cases of EC were reported across 13 PBCRs, with Black patients accounting for 35.7% of these cases. The median age at diagnosis was 63 years, with Black women diagnosed at a younger age than White women. Black patients experienced a significant increase in incidence rate (APC +6.7% v +3.0%). A greater proportion of Black patients lived without partners (54.0%), had higher rates of alcohol consumption (15%) and smoking (25.8%), and resided in less developed regions (54.6%) with lower education levels (77.5%). From 2000 to 2021, Brazil recorded 72,189 EC-related deaths, showing higher mortality rates among White women (3.8 per 100,000) than Black women (2.4 per 100,000), although the downward trend was steeper among White women (–1.2%) than Black women (–0.6%). CONCLUSION Racial disparities in EC incidence and mortality in Brazil may be closely linked to unfavorable sociodemographic factors faced by Black women. Targeted public health initiatives are critical for improving early detection and access to equitable care for Black women.

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.

Population-Based Trends in Cervical Cancer Incidence and Mortality in Brazil: Focusing on Black and Indigenous Population Disparities

This study aimed to explore trends in cervical cancer (CC) incidence and mortality rates according to race/skin color in Brazil focusing on the seriousness of the racial disparity. Data from Brazilian Population-Based Cancer Registries (PBCRs) were analyzed for trends in incidence between 2010 and 2015. For mortality, data from the National Mortality Information System were retrieved between 2000 and 2020. A self-declaration on race/skin color was collected following the classification proposed by the Brazilian Institute of Geography and Statistics - white, black, brown/mixed race, yellow, or indigenous. For the analysis, black and brown/mixed race were grouped as black. Between 2010 and 2015, 10,844 new cases of CC were registered in the participating PBCRs, distributed among white women (49.6%), black (48.0%), and other race/skin color (2.3%). Compared with white counterparts, black women had a 44% higher risk of incident CC. As for mortality, between 2000 and 2020, 108,590 deaths from CC occurred nationwide. The mean age-adjusted mortality rates according to race/skin color were 3.7/100,000 for white, 4.2/100,000 for black, 2.8 for yellow, and 6.7 for indigenous women. Taking the mortality rates in white women as a reference, there was a 27% increase in death risk in black women (RR = 1.27) and 82% in indigenous women (RR = 1.82). These findings suggest that the higher rates of incidence and mortality from CC in vulnerable populations of black and more impactfully indigenous women in Brazil remain alarming. More efficient HPV vaccination strategies synchronized with well-conducted Pap smear-based screening should be prioritized in these more vulnerable populations.

Single-cell resolution characterization of myeloid-derived cell states with implication in cancer outcome

AbstractTumor-associated myeloid-derived cells (MDCs) significantly impact cancer prognosis and treatment responses due to their remarkable plasticity and tumorigenic behaviors. Here, we integrate single-cell RNA-sequencing data from different cancer types, identifying 29 MDC subpopulations within the tumor microenvironment. Our analysis reveals abnormally expanded MDC subpopulations across various tumors and distinguishes cell states that have often been grouped together, such as TREM2+ and FOLR2+ subpopulations. Using deconvolution approaches, we identify five subpopulations as independent prognostic markers, including states co-expressing TREM2 and PD-1, and FOLR2 and PDL-2. Additionally, TREM2 alone does not reliably predict cancer prognosis, as other TREM2+ macrophages show varied associations with prognosis depending on local cues. Validation in independent cohorts confirms that FOLR2-expressing macrophages correlate with poor clinical outcomes in ovarian and triple-negative breast cancers. This comprehensive MDC atlas offers valuable insights and a foundation for futher analyses, advancing strategies for treating solid cancers.