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Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis

OBJECTIVE: Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012. DESIGN: Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, h...

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Autores principales: Diniz, Carmen Simone Grilo, Pellini, Alessandra Cristina Guedes, Ribeiro, Adeylson Guimarães, Tedardi, Marcello Vannucci, de Miranda, Marina Jorge, Touso, Michelle Mosna, Baquero, Oswaldo Santos, dos Santos, Patrícia Carlos, Chiaravalloti-Neto, Francisco
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629728/
https://www.ncbi.nlm.nih.gov/pubmed/28838894
http://dx.doi.org/10.1136/bmjopen-2017-016395
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author Diniz, Carmen Simone Grilo
Pellini, Alessandra Cristina Guedes
Ribeiro, Adeylson Guimarães
Tedardi, Marcello Vannucci
de Miranda, Marina Jorge
Touso, Michelle Mosna
Baquero, Oswaldo Santos
dos Santos, Patrícia Carlos
Chiaravalloti-Neto, Francisco
author_facet Diniz, Carmen Simone Grilo
Pellini, Alessandra Cristina Guedes
Ribeiro, Adeylson Guimarães
Tedardi, Marcello Vannucci
de Miranda, Marina Jorge
Touso, Michelle Mosna
Baquero, Oswaldo Santos
dos Santos, Patrícia Carlos
Chiaravalloti-Neto, Francisco
author_sort Diniz, Carmen Simone Grilo
collection PubMed
description OBJECTIVE: Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012. DESIGN: Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis. SETTINGS: The female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System). PARTICIPANTS: Women 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012. MAIN OUTCOME MEASURES: Mortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard. RESULTS: In the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006). CONCLUSIONS: The findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association.
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spelling pubmed-56297282017-10-11 Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis Diniz, Carmen Simone Grilo Pellini, Alessandra Cristina Guedes Ribeiro, Adeylson Guimarães Tedardi, Marcello Vannucci de Miranda, Marina Jorge Touso, Michelle Mosna Baquero, Oswaldo Santos dos Santos, Patrícia Carlos Chiaravalloti-Neto, Francisco BMJ Open Epidemiology OBJECTIVE: Identify the factors associated with the age-standardised breast cancer mortality rate in the municipalities of State of São Paulo (SSP), Brazil, in the period from 2006 to 2012. DESIGN: Ecological study of the breast cancer mortality rate standardised by age, as the dependent variable, having each of the 645 municipalities in the SSP as the unit of analysis. SETTINGS: The female resident population aged 15 years or older, by age group and municipality, in 2009 (mid-term), obtained from public dataset (Informatics Department of the Unified Health System). PARTICIPANTS: Women 15 years or older who died of breast cancer in the SSP were selected for the calculation of the breast cancer mortality rate, according to the municipality and age group, from 2006 to 2012. MAIN OUTCOME MEASURES: Mortality rates for each municipality calculated by the direct standardisation method, using the age structure of the population of SSP in 2009 as the standard. RESULTS: In the final linear regression model, breast cancer mortality, in the municipal level, was directly associated with rates of nulliparity (p<0.0001), mammography (p<0.0001) and private healthcare (p=0.006). CONCLUSIONS: The findings that mammography ratio was associated, in the municipal level, with increased mortality add to the evidence of a probable overestimation of benefits and underestimation of risks associated with this form of screening. The same paradoxical trend of increased mortality with screening was found in recent individual-level studies, indicating the need to expand informed choice for patients, primary prevention actions and individualised screening. Additional studies should be conducted to explore if there is a causality link in this association. BMJ Publishing Group 2017-08-23 /pmc/articles/PMC5629728/ /pubmed/28838894 http://dx.doi.org/10.1136/bmjopen-2017-016395 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted. This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Epidemiology
Diniz, Carmen Simone Grilo
Pellini, Alessandra Cristina Guedes
Ribeiro, Adeylson Guimarães
Tedardi, Marcello Vannucci
de Miranda, Marina Jorge
Touso, Michelle Mosna
Baquero, Oswaldo Santos
dos Santos, Patrícia Carlos
Chiaravalloti-Neto, Francisco
Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title_full Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title_fullStr Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title_full_unstemmed Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title_short Breast cancer mortality and associated factors in São Paulo State, Brazil: an ecological analysis
title_sort breast cancer mortality and associated factors in são paulo state, brazil: an ecological analysis
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629728/
https://www.ncbi.nlm.nih.gov/pubmed/28838894
http://dx.doi.org/10.1136/bmjopen-2017-016395
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