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Objective: To identify delays in the health care system experienced by children and adolescents and young adults (AYA; aged 0–29 years) with osteosarcoma and Ewing sarcoma using information from the Brazilian hospital-based cancer registries. Methods: Patient data were extracted from 161 Brazilian hospital-based cancer registries between 2007 and 2011. Hospital, diagnosis, and treatment delays were analyzed in patients without a previous histopathological diagnosis. Referral, hospital, and health care delays were calculated for patients with a previous histopathological diagnosis. The time interval was measured in days. Results: There was no difference between genders in overall delays. All delays increased at older ages. Patients without a previous histopathological diagnosis had the longest hospital delay when compared to patients with a previous histopathological diagnosis before first contact with the cancer center. Patients with Ewing sarcoma had longer referral and health care delays than those with osteosarcoma who had a previous histopathological diagnosis before first contact with the cancer center. The North and Northeast regions had the longest diagnosis delay, while the Northeast and Southeast regions had the longest treatment delay. Conclusion: Health care delay among patients with a previous diagnosis was longer, and was probably associated with the time taken for to referral to cancer centers. Patients without a previous histopathological diagnosis had longer hospital delays, which could be associated with possible difficulties regarding demand and high-cost procedures. Despite limitations, this study helps provide initial knowledge about the healthcare pathway delays for patients with bone cancer inside several Brazilian hospitals. Resumo: Objetivo: Identificar atrasos no sistema de saúde em crianças e adolescentes e adultos jovens (AAJ; até 29 anos) com osteossarcoma e sarcoma de Ewing com informações dos registros de câncer de base hospitalar do Brasil. Métodos: Os dados dos pacientes foram extraídos de 161 registros de câncer de base hospitalar brasileiros entre 2007 e 2011. Os atrasos no hospital, no diagnóstico e no tratamento foram analisados em pacientes sem um diagnóstico histopatológico anterior. Os atrasos no encaminhamento, no hospital e no sistema de saúde foram calculados para pacientes com diagnóstico histopatológico anterior. O intervalo de tempo foi medido em dias. Resultados: Não houve diferença entre os sexos nos atrasos em geral. Todos os atrasos aumentaram na faixa etária mais velha. Os pacientes sem um diagnóstico histopatológico anterior apresentaram o atraso hospitalar mais longo em comparação com os pacientes com diagnóstico histopatológico anterior antes do primeiro contato com o centro de câncer. Os pacientes com sarcoma de Ewing apresentaram atrasos no encaminhamento e no sistema de saúde mais longos do que os com osteossarcoma, que apresentaram diagnóstico histopatológico anterior antes do primeiro contato com o centro oncológico. As regiões Norte e Nordeste apresentaram o atraso mais longo no diagnóstico, ao passo que as regiões Nordeste e Sul apresentaram o atraso mais longo no tratamento. Conclusão: O atraso no sistema de saúde entre os pacientes com diagnóstico anterior foi maior e provavelmente associado ao tempo de encaminhamento para os centros oncológicos. Os pacientes sem um diagnóstico histopatológico anterior apresentaram atrasos mais longos no hospital, o que pode ser associado a possíveis dificuldades com relação à demanda e aos procedimentos de alto custo. Apesar das limitações, nosso estudo ajuda a fornecer um conhecimento inicial sobre os atrasos no sistema de saúde para tratamento de pacientes com câncer em vários hospitais brasileiros. Keywords: Brazil, Diagnosis delay, Treatment delay, Health care system, Bone tumors, Palavras-chave: Brasil, Atraso no diagnóstico, Atraso no tratamento, Sistema de saúde, Tumores ósseos

Background The increasing incidence of thyroid cancer has been described worldwide. Overdiagnosis, improved imaging, and increased environmental risk factors have contributed to the rising incidence. The objective of this study was to analyze the population incidence rate and trends during the period of 2000-2013 in children, adolescents and young adults (AYAs) in Brazil. Methods Data were extracted from 11 population-based cancer registries (PBCRs) encompassing the five geographic regions of Brazil. Incidence rates per million in children (0-14) and AYAs (15-39) according to world population were analyzed according to sex, age, and type of carcinoma. Incidence trends were evaluated using joinpoint regression. Results During 2000 to 2013, we identified 11,081 children and AYAs (0-39 years) with thyroid carcinoma in 11 PBCRs, with an age-adjusted incidence rate (AAIR) of 42 cases per million. Females had a higher AAIR of 66 cases per million versus 14 cases per million in males. Age-specific incidence rate (ASR) increased with age. Geographic variation was also observed; the Midwest and Southeast regions had the highest ASR in all age groups. The lowest ASR in all age groups was seen in the North region. Papillary subtype was the most common. Overall, the incidence rates in children and AYAs significantly increased from 0.2 in 2000 to 2.8 in 2013 and from 47.1 to 115.3, respectively, with an annual average percent change of 18.8 [8.1; 30.6] for children and 7.9 [CI 5.6; 10.3] for AYAs. Conclusions Rates of thyroid cancer, particularly the papillary subtype, are steadily increasing in children and AYAs, especially among females. There are variations among geographic areas. This increased incidence is unlikely to be explained by screening, as children less than 14 years of age do not typically undergo medical surveillance. Environmental risk factors must be investigated.

OBJECTIVES: Bone cancers occur frequently in children, adolescents, and young adults aging 15 to 29 years. Osteosarcoma and Ewing sarcoma are the most frequent subtypes in this population. The aim of this study was to describe incidence and mortality trends of bone cancers among Brazilian children, adolescents and young adults. METHODS: Incidence information was obtained from 23 population-based cancer registries. Mortality data were extracted from the Atlas of Cancer Mortality from 1979 to 2013. Specific and adjusted rates per million were analyzed according to gender, morphology and age at diagnosis. Median rates were used as a measure of central tendency. Joinpoint regression was applied to analyze trends. RESULTS: Median incidence rates were 5.74 and 11.25 cases per million in children and young adults respectively. Osteosarcoma in the 15-19 years aged group had the highest incidence rates. Stable incidence rates were observed among five registries in 0-14 year's age group. Four registries had a decreased incidence trend among adolescents and young adults. Median mortality rates were 1.22 and 5.07 deaths per million in children and young adults respectively. Increased mortality was observed on the North and Northeast regions. Decreased mortality trends were seen in the South (children) and Southeast (adolescents and young adults). CONCLUSION: Osteosarcoma and Ewing Sarcoma are the most incident bone cancers in all Brazilian regions. Bone cancers showed incidence and mortality patterns variation within the geographic regions and across age groups, although not significant. Despite limitations, it is crucial to monitor cancer epidemiology trends across geographic Brazilian regions.

Rare childhood cancer is challenging to define. The Italian Pediatric Rare Tumor (TREP) Study considers rare tumors to include solid malignancies characterized by an annual incidence rate of2 cases per 1 million and not enrolled in clinical trials. The objective of the current study was to analyze the population incidence rate of rare tumors among children and adolescents (those aged birth-19 years) in Brazil.Incidence data were obtained from 19 population-based cancer registries covering the 5 geographic regions in Brazil. Newly diagnosed cases were selected according to the TREP definition, using the International Classification of Diseases for Oncology. To calculate the crude incidence rate, the numbers of incident children and adolescents with a specific rare cancer were divided by the corresponding person-years lived for the population aged20 years during the same period.Two tumors had an incidence rate that was2 cases per 1 million (thyroid and skin cancers) in adolescents only. Several tumors demonstrated variations in incidence across the Brazilian regions. Adrenocortical carcinoma had a high incidence rate (4 cases per 1 million) in the south region among children aged10 years. Thyroid and skin carcinoma had higher incidence rates in the midwest, southeast, and south regions.Due to the extraordinary rarity of these events, networking is important for improving basic research, clinical studies, and trials. Centralization of diagnosis is the only way to improve the diagnosis and treatment of children affected by these rare diseases. The registration and surveillance of rare pediatric cancers are crucial from a public health point of view, and therefore the quality of registration has to be improved.

The spectrum of cancers commonly found in adolescents and young adults (AYAs) differs from those in children and adults; therefore, the childhood classification is not appropriate for this population. Here we used a newly proposed classification system to reclassify cases of AYAs from Brazilian population-based cancer registries (PBCRs) in 5 geographic regions of Brazil. We aimed to describe the cancer incidence rates within this age group according to PBCR. Using the world population, incidence rates per million were analyzed in each diagnostic subgroup according to sex and age at diagnosis (15 to 19 y, 20 to 24 y, and 25 to 29 y). The median incidence rate was 232.31 per million for females and 218.07 per million for males. Incidence increased with age, with the highest rate observed for 25- to 29-year-olds in both sexes. Carcinomas, lymphomas, and skin tumors were most frequent among AYAs. High incidence rates of cervix-uterus carcinoma were observed in most PBCRs. AYAs present epidemiological characteristics that differ from those of children, reinforcing the need for a new classification. This study describes, for the first time, the cancer incidence rate in AYAs in Brazil, and we believe that our findings represent the Brazilian profile.

High incidence rates for cervical cancer in adolescents and young adults (AYAs: 15-29 years) make this the most common carcinoma in Brazil. Our aim was to analyze the incidence trends for cervical cancer (CC) and in situ neoplasia (IsN) among this age group.Incidence data were extracted from 21 Brazilian population-based cancer registries (PBCRs). Tumors with behavior code/3 (malignant) were classified as CC. Tumors with behavior code/2 were classified as IsN. Age-adjusted and age-specific incidence rates were calculated for individuals aged 15-19 years, 20-24 years, and 25-29 years. Incidence trends were evaluated by joinpoint regression analyses.The median incidence rate of CC for AYA in Brazil was 3.63 per 100,000, with the highest rate observed in Recife (27.50 per 100,000). Significant increase in incidence for CC was identified in two PBCRs, with decreased rates for three PBCRs. The median incidence rate of IsN was 16.78 per 100,000 and was highest in Roraima (93.37 per 100,000). Increased incidence rates for IsN were identified in six PBCRs, with significant decreases in two PBCRs.The incidence rate for CC among AYA in Brazil is high and warrants intervention in terms of both prevention and control.

Objective: Approximately 6% of all cancers arise in adolescents and young adults. Currently, the ward type best placed to treat this patient group remains controversial. The aim of this study was to evaluate exactly where adolescents and young adults with cancer are treated in Brazil. Methods: Data were extracted from 271 Brazilian hospital-based cancer registries (2007–2011), including all five national regions (North, Northeast, Midwest, South, and Southeast). Variables included gender, age, ethnicity, National Code of Health Establishment, hospital unit state, and region. Tumors were classified according to the World Health Organization classification for adolescents and young adults with cancer. Odds ratios with 95% confidence intervals were computed by unconditional logistic regression. Results: Most patients were managed on medical oncology wards, followed by pediatric oncology and then by non-specialist wards. Of patients aged 15–19 years, 49% were managed on pediatric wards; most of the older patients (96%; aged 20–24) were managed on adult wards. Patients were more likely to be seen in medical oncology wards as their age increased (OR = 2.03 [1.98–2.09]), or if they were based in the South (OR = 1.50 [1.29–1.73]). Conversely, bone tumors were less likely to be treated (decreased OR) on medical oncology wards, regardless of age, gender, and region. Conclusion: An elevated risk of treatment on medical oncology wards was observed for older patients and those treated in the South. Bone tumors were generally treated in pediatric oncology wards, while skin cancers were treated in medical oncology wards, regardless of age, gender, and region. Resumo: Objetivo: Aproximadamente 6% de todos os cânceres surgem em adolescentes e adultos jovens. Atualmente, o melhor tipo de enfermaria para tratar esse grupo de pacientes continua sendo controverso. O objetivo deste estudo foi avaliar exatamente onde os adolescentes e adultos jovens com câncer são tratados no Brasil. Métodos: Foram coletados dados de 271 registros de câncer de base hospitalar (2007-2011), inclusive de todas as cinco regiões nacionais (Norte, Nordeste, Centro-Oeste, Sul e Sudeste). As variáveis incluíram sexo, idade, etnia, o Código Nacional de Estabelecimento de Saúde e o estado e a região da unidade hospitalar. Os tumores foram classificados de acordo com a classificação da Organização Mundial de Saúde para adolescentes e adultos jovens com câncer. As razões de chance com intervalos de confiança de 95% foram calculadas por regressão logística incondicional. Resultados: A maioria dos pacientes foi tratada em enfermaria de oncologia médica, seguido da enfermaria de oncologia pediátrica e, então, a enfermaria sem especialidade. 49% dos pacientes com idades entre 15-19 anos foram tratados em enfermarias pediátricas; os pacientes mais velhos (96%, com idades entre 20-24) foram tratados em enfermarias de adultos. Os pacientes apresentaram maior propensão a serem vistos em enfermarias de oncologia conforme mais velhos (RC = 2,03 [1,98-2,09]) ou caso morassem na região Sul (RC = 1,50 [1,29-1,73]). Por outro lado, os tumores ósseos mostraram menor propensão a tratamento (redução da RC) em enfermarias de oncologia, independentemente da idade, sexo e região. Conclusão: Foi visto um risco elevado de tratamento, em enfermarias de oncologia, de pacientes mais velhos e os tratados na região Sul. Os tumores ósseos foram, em geral, tratados em enfermarias de oncologia pediátrica, ao passo que os cânceres de pele foram tratados em enfermarias de oncologia médica, independentemente da idade, sexo e região. Keywords: Adolescents and young adults, Cancer, Site of care, Palavras-chave: Adolescentes e adultos jovens, Câncer, Local de atendimento

The aim of this study was to describe the incidence distribution of colorectal cancer in Fortaleza, Ceará State, and Porto Alegre, Rio Grande do Sul State, Brazil, and the time trend in the disease from 1990 to 1999. Mean annual age-adjusted incidence rates and estimated annual percent change were calculated by gender, using population-based cancer registries. EAPC showed an increase in the rates in Porto Alegre and Fortaleza for men, +4.2% (p = 0.14) and +9.3% (p < 0.001), and women, +4.6% (p = 0.11) and +5.3% (p = 0.15), respectively. The mean adjusted incidence rates were three times higher in Porto Alegre than in Fortaleza both for men (25.1 vs. 8.6/100 thousand) and women (19.9 vs. 7.1/100 thousand). This rise in incidence rates may be due to early cancer detection strategies, lifestyle changes, and alterations in the population age structure. A population profile similar to that of developed countries may explain the higher incidence rates in Porto Alegre. However, Fortaleza showed the largest increases during the period studied. O objetivo foi descrever a distribuição da incidência de câncer de cólon e reto em Fortaleza, Ceará, e Porto Alegre, Rio Grande do Sul, no Brasil, e a tendência temporal da doença entre 1990-1999. Foram calculadas taxas médias anuais de incidência ajustadas por idade e a variação percentual anual estimada (estimated annual percent change - EAPC) das taxas, por sexo, utilizando-se os registros de câncer de base populacional. O EAPC apontou aumento das taxas em Porto Alegre e Fortaleza para homens, +4,2% (p = 0,14) e +9,3% (p < 0,001), e mulheres, +4,6% (p = 0,11) e +5,3% (p = 0,15), respectivamente. As taxas médias de incidência ajustadas foram cerca de três vezes maiores em Porto Alegre do que em Fortaleza, tanto para homens (25,1 vs. 8,6/100 mil) quanto para mulheres (19,9 vs. 7,1/100 mil). O aumento das taxas de incidência pode ser devido a estratégias de detecção precoce do câncer, mudanças no estilo de vida das pessoas e a alterações da estrutura etária da população. Um perfil populacional semelhante ao de países desenvolvidos pode justificar as maiores taxas de incidência encontradas em Porto Alegre. Apesar disso, Fortaleza apresentou os maiores incrementos para o período.

Background : Population-based cancer registries (PBCR) are important in cancer epidemiology as they provide the basis for monitoring cancer incidence. Childhood acute lymphoblastic leukemia (ALL) is said to have lower incidence in developing countries, which has implications for its pathogenesis, but there are few studies concerning the completeness of cancer registries in developing countries. This study analyzes the number of cases and incidence of childhood acute lymphoblastic leukemia in three different cities in Brazil and estimates underreporting cases and possible PBCR failures. Methods : We evaluated the completeness of PBCR and the incidence rates of childhood ALL from three different Brazilian cities using the two-source capture–recapture method. The sources used were a population-based registry and databases from a diagnosis reference laboratory in 2001 and the Chapman's formula was used to calculate the estimates. Results : The estimated incidence was 5.76, 6.32 and 5.48 per 100,000 inhabitants for Salvador, Recife and Belo Horizonte, respectively. The estimated completeness of childhood ALL in PBCRs was 15.5%, 35.4% and 29.2%, respectively, for Salvador, Recife and Belo Horizonte. Conclusions : There was a high estimated underreporting of childhood leukemia cases in some Brazilian cities. The relationship between information systems and the capture–recapture method application improved epidemiological estimates. Childhood acute lymphoblastic leukemia incidence rates are similar to those of developed countries.

OBJECTIVES: Childhood cancer mortality has substantially declined worldwide as a result of significant advances in global cancer care. Because limited information is available in Brazil, we analyzed trends in childhood cancer mortality in five Brazilian regions over 29 years. METHODS: Data from children 0-14 years old were extracted from the Health Mortality Information System for 1979 through 2008. Age-adjusted mortality rates, crude mortality rates, and age-specific mortality rates by geographic region of Brazil and for the entire country were analyzed for all cancers and leukemia. Mortality trends were evaluated for all childhood cancers and leukemia using joinpoint regression. RESULTS: Mortality declined significantly for the entire period (1979-2008) for children with leukemia. Childhood cancer mortality rates declined in the South and Southeast, remained stable in the Middle West, and increased in the North and Northeast. Although the mortality rates did not unilaterally decrease in all regions, the age-adjusted mortality rates were relatively similar among the five Brazilian regions from 2006-2008. CONCLUSIONS: Childhood cancer mortality declined 1.2 to 1.6% per year in the South and Southeast regions.

Resource-rich countries tend to have a higher incidence of childhood acute lymphoblastic leukemia (ALL), whereas lower rates are seen in more deprived countries. This study describes the incidence of childhood acute leukemia in Brazil, an upper middle-income country, based on data from 16 population-based cancer registries (PBCRs).Data were examined from 16 PBCRs in Brazilian cities located in five geographical regions during the period from 1997 to 2004. Incidence rates were analyzed according to gender, age, and type of leukemia. The Wilcoxon test was performed to evaluate for gender-age based difference between by leukemia type.The median age-adjusted incidence rate (AAIR) of leukemia in children aged 0-14 years old was 53.3 per million. A different AAIR was found regarding ALL and myeloproliferative disorders (MPD) that ranged from 24.8 to 76.84 per 1,000,000 children. Manaus, although located in a poor area of Brazil, exhibited the highest AAIR (56.6 per million) of ALL. Goiania had the highest AAIR (24.5 per million) of MPD. The median age-specific incidence rate (ASIR) for the 16 Brazilian PBCRs demonstrated a marked peak in incidence of ALL at age 3 years old, in both genders.This population-based study of childhood leukemia demonstrates that substantial regional differences exist regarding the incidence of acute leukemia in Brazil, which warrants further ecological study.

Background Childhood cancer differs from most common adult cancers, suggesting a distinct aetiology for some types of childhood cancer. Our objective in this study was to test the difference in incidence rates of 4 non-CNS embryonic tumours and their correlation with socioeconomic status (SES) in Brazil. Methods Data was obtained from 13 Brazilian population-based cancer registries (PBCRs) of neuroblastoma (NB), Wilms'tumour (WT), retinoblastoma (RB), and hepatoblastoma (HB). Incidence rates by tumour type, age, and gender were calculated per one million children. Correlations between social exclusion index (SEI) as an indicator of socioeconomic status (SES) and incidence rates was investigated using the Spearman's test. Results WT, RB, and HB presented with the highest age-adjusted incidence rates (AAIRs) in 1 to 4 year old of both genders, whereas NB presented the highest AAIR in ≤11 month-olds. However, differences in the incidence rates among PBCRs were observed. Higher incidence rates were found for WT and RB, whereas lower incidence rates were observed for NB. Higher SEI was correlated with higher incidences of NB (0.731; p = 0.0117), whereas no SEI correlation was observed between incidence rates for WT, RB, and HB. In two Brazilian cities, the incidence rates of NB and RB were directly correlated with SEI; NB had the highest incidence rates (14.2, 95% CI, 8.6-19.7), and RB the lowest (3.5, 95% CI, 0.7-6.3) in Curitiba (SEI, 0.730). In Natal (SEI, 0.595), we observed just the opposite; the highest incidence rate was for RB and the lowest was for NB (4.6, 95% CI, 0.1-9.1). Conclusion Regional variations of SES and the incidence of embryonal tumours were observed, particularly incidence rates for NB and RB. Further studies are necessary to investigate risk factors for embryonic tumours in Brazil.