Abstract:
BACKGROUND:Policies for early detection of breast cancer, including clinical breast examinations and mammographic screening, were introduced in Brazil in 2004, but their effect on disease stage at diagnosis is unclear. We aimed to assess whether these policies have led to a decrease in the prevalence of late-stage breast cancer at diagnosis. METHODS:In this case only analysis, using an anonymised nationwide hospital based-cancer registry network, we identified women aged 18-89 years who had been diagnosed with an invasive breast cancer in Brazil during 2001-14. We extracted individual patient-level data on patient demographics, tumour variables, and health-care provider variables for the centre where the patient was diagnosed. Our objectives were to estimate the prevalence of late-stage breast cancer (TNM stage III or IV) at diagnosis overall, across age groups, and by ethnoracial and social strata (ie, self-reported ethnoracial group, as white, black, brown, Asian, or Indigenous, and educational level, marital status, and region of residence) across the study period, and compare these estimates with international data from high-income countries (Norway and the USA). We used logistic regression to estimate odds ratios (ORs) for late-stage versus early-stage (TNM stage I or II) breast cancer at diagnosis in relation to relevant exposures, either minimally adjusted (for age, year of diagnosis, and region of residence) or fully adjusted (for all patient, tumour, and health-care provider variables). FINDINGS:We identified 247 719 women who were diagnosed with invasive breast cancer between Jan 1, 2001, and Dec 31, 2014, with a mean age at diagnosis of 55·4 years (SD 13·3), of whom 36·2% (n=89 550) identified as white, 29·8% (n=73 826) as black or brown, and 0·7% (n=1639) as Asian or Indigenous. Prevalence of late-stage breast cancer at diagnosis remained high throughout 2001-14, at approximately 40%, was inversely associated with educational level (p value for linear trend <0·0001), and was higher for women who identified as black (minimally adjusted OR 1·61, 95% CI 1·53-1·70; fully adjusted OR 1·45, 95% CI 1·38-1·54) and brown (minimally adjusted OR 1·26, 95% CI 1·22-1·30; fully adjusted OR 1·18, 1·14-1·23) than those who identified as white. The predicted prevalence of late-stage cancer at diagnosis was highest for women who were black or brown with little or no formal education (48·8%, 95% CI 48·2-49·5) and lowest for women who were white with university education (29·4%, 28·2-30·6), but both these prevalences were higher than that of all women diagnosed with breast cancer in Norway before the introduction of mammography screening (ie, 16·3%, 95% CI 15·4%-17·2% in 1970-74). Similar ethnoracial and social patterns emerged in analyses restricted to the age group targeted by screening (50-69 years). INTERPRETATION:The persistently high prevalence of late-stage breast cancer at diagnosis across all ethnoracial and social strata in Brazil, although more substantially among the most disadvantaged populations, implies that early detection policies might have had little effect on breast cancer mortality so far, and highlights the need to focus primarily on timely diagnosis of symptomatic breast cancer rather than on screening for asymptomatic disease. FUNDING:Newton Fund, Research Councils UK, and Conselho Nacional das Fundações Estaduais de Amparo à Pesquisa.
journal_name
Lancet Glob Healthjournal_title
The Lancet. Global healthauthors
Dos-Santos-Silva I,De Stavola BL,Renna NL Junior,Nogueira MC,Aquino EML,Bustamante-Teixeira MT,Azevedo E Silva Gdoi
10.1016/S2214-109X(19)30151-2subject
Has Abstractpub_date
2019-06-01 00:00:00pages
e784-e797issue
6issn
2214-109Xpii
S2214-109X(19)30151-2journal_volume
7pub_type
杂志文章abstract:BACKGROUND:No study of long-term protection following killed oral cholera vaccination has been done outside of the historically cholera-endemic areas of south Asia, or has examined protection after a single-dose vaccination regimen. To address this, we examined the duration of protection of the standard two-dose regime...
journal_title:The Lancet. Global health
pub_type: 杂志文章
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abstract:BACKGROUND:Faltering in linear growth and neurobehavioural development during early childhood are often assumed to have common causes because of their consistent association. This notion has contributed to a global focus on the promotion of nutrition during pregnancy and childhood to improve both conditions. Our aim wa...
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abstract:BACKGROUND:As of 2018, the rubella vaccine had been incorporated into the national immunisation schedule of 168 countries, representing 87% of the world's population. Countries have used different strategies to reduce the burden of congenital rubella syndrome (CRS), such as vaccinating only females. Given the different...
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abstract:BACKGROUND:A quarter of a century ago, two global events-the International Conference on Population and Development in Cairo, and the Fourth World Conference on Women in Beijing-placed gender equality and reproductive health and rights at the centre of the development agenda. Progress towards these goals has been slowe...
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abstract:BACKGROUND:In malarious areas, pregnant women are more likely to have detectable malaria than are their non-pregnant peers, and the excess risk of infection varies with gravidity. Pregnant women attending antenatal clinic for their first visit are a potential pragmatic sentinel group to track the intensity of malaria t...
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pub_type: 杂志文章,meta分析,评审
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abstract:BACKGROUND:Low birthweight (LBW) of less than 2500 g is an important marker of maternal and fetal health, predicting mortality, stunting, and adult-onset chronic conditions. Global nutrition targets set at the World Health Assembly in 2012 include an ambitious 30% reduction in LBW prevalence between 2012 and 2025. Esti...
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更新日期:2019-07-01 00:00:00
abstract:BACKGROUND:Global rollout of dolutegravir-based antiretroviral therapy (ART) has been hampered in part by insufficient safety data in pregnancy. We compared birth outcomes among women initiating dolutegravir-based ART with those among women initiating efavirenz-based ART in pregnancy in Botswana. METHODS:In this obser...
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abstract:BACKGROUND:Understanding the effects of socioeconomic disparities in health outcomes is important to implement specific preventive actions. We assessed socioeconomic disparities in mortality indicators in a rural South African population over the period 2001-13. METHODS:We used data from 21 villages of the Agincourt H...
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更新日期:2017-09-01 00:00:00
abstract:BACKGROUND:More timely estimates of malaria prevalence are needed to inform optimal control strategies and measure progress. Since 2014, Tanzania has implemented nationwide malaria screening for all pregnant women within the antenatal care system. We aimed to compare malaria test results during antenatal care to two po...
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更新日期:2019-12-01 00:00:00
abstract:BACKGROUND:People who inject drugs (PWID) are a key population affected by the global HIV and hepatitis C virus (HCV) epidemics. HIV and HCV prevention interventions for PWID include needle and syringe programmes (NSP), opioid substitution therapy (OST), HIV counselling and testing, HIV antiretroviral therapy (ART), an...
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abstract:BACKGROUND:Attainment of universal health coverage is a global health priority. The Myanmar Government has committed to attainment of universal health coverage by 2030, but progress so far has not been assessed. We aimed to estimate national and subnational health service coverage and financial risk protection. METHOD...
journal_title:The Lancet. Global health
pub_type: 评论,杂志文章
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更新日期:2018-09-01 00:00:00
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pub_type: 杂志文章
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更新日期:2018-03-01 00:00:00
abstract:BACKGROUND:Bereavement increases children's risk for psychological disorders, highlighting the need for effective interventions, especially in areas where orphanhood is common. We aimed to assess the effects of an eight-session support group intervention on the psychological health of bereaved female adolescents in Sou...
journal_title:The Lancet. Global health
pub_type: 杂志文章,随机对照试验
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更新日期:2017-06-01 00:00:00
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更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:As the incomes of many AIDS-burdened countries grow and donors' budgets for helping to fight the disease tighten, national governments and external funding partners increasingly face the following question: what is the capacity of countries that are highly affected by AIDS to finance their responses from dom...
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更新日期:2015-01-01 00:00:00
abstract:BACKGROUND:Lymphatic filariasis is a neglected tropical disease that can cause permanent disability through disruption of the lymphatic system. This disease is caused by parasitic filarial worms that are transmitted by mosquitos. Mass drug administration (MDA) of antihelmintics is recommended by WHO to eliminate lympha...
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更新日期:2020-09-01 00:00:00
abstract:BACKGROUND:The effects of political regimes on health are unclear because empirical evidence is neither strong nor robust. Traditional econometric tools do not allow the direction of causality to be established clearly. We used a new method to investigate whether political transition into democracy affected child morta...
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pub_type: 杂志文章
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journal_title:The Lancet. Global health
pub_type: 杂志文章
doi:10.1016/S2214-109X(17)30246-2
更新日期:2017-08-01 00:00:00
abstract::Child stunting is a global problem and is only modestly responsive to dietary interventions. Numerous observational studies have shown that water quality, sanitation, and handwashing (WASH) in a household are strongly associated with linear growth of children living in the same household. We have completed three rando...
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更新日期:2013-12-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Amid rapid urbanisation, the HIV epidemic, and increasing rates of non-communicable diseases, people in sub-Saharan Africa are especially vulnerable to kidney disease. Little is known about the epidemiology of chronic kidney disease (CKD) in sub-Saharan Africa, so we did a systematic review and meta-analysis...
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更新日期:2014-03-01 00:00:00
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更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:On Dec 1, 2006, Mexico's public health-care insurance scheme, Seguro Popular, implemented the Medical Insurance Century XXI (SMSXXI) programme, to provide insurance to children younger than 5 years without social security. SMSXXI aims to increase access to health services, decrease out-of-pocket health expen...
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pub_type: 杂志文章
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更新日期:2019-10-01 00:00:00
abstract:BACKGROUND:The need for multiple clinical visits remains a barrier to women accessing safe legal medical abortion services. Alternatives to routine clinic follow-up visits have not been assessed in rural low-resource settings. We compared the effectiveness of standard clinic follow-up versus home assessment of outcome ...
journal_title:The Lancet. Global health
pub_type: 杂志文章,多中心研究,随机对照试验
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更新日期:2015-09-01 00:00:00
abstract:BACKGROUND:The way in which a government chooses to finance a health intervention can affect the uptake of health interventions and consequently the extent of health gains. In addition to health gains, some policies such as public finance can insure against catastrophic health expenditures. We aimed to evaluate the hea...
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更新日期:2015-05-01 00:00:00
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更新日期:2016-11-01 00:00:00
abstract:BACKGROUND:Detection of dengue virus antibodies is important for understanding future dengue virus risk and for prevaccination screening. We aimed to evaluate the performance of a dengue IgG indirect ELISA in determining dengue seroprevalence in a cohort of children in the Philippines, using a focus reduction neutralis...
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更新日期:2021-01-01 00:00:00