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Agora exibindo 1 - 20 de 1851

The burden of pancreatic cancer in Latin America and the Caribbean: trends in incidence, mortality and DALYs from 1990 to 2019
(2025) Silva, Diego Rodrigues Mendonça e; Oliveira, Max Moura de; Fernandes, Gisele Aparecida; Curado, Maria Paula
mortality and disability-adjusted life years (DALYs), as well as the proportion of pancreatic cancer deaths attributable to behavioural and metabolic risk factors in Latin America and the Caribbean (LAC) countries. Methods: This study focuses on pancreatic cancer using the Global Burden of Disease 2019 study database. Results were described for 23 LAC countries for 1990–2019, evaluating their age-standardised incidence rates, mortality rates, DALYs, average annual percent change and the fraction of deaths attributable to behavioural and metabolic risk factors. Results: We observed that in LAC, pancreatic cancer incidence rates ranged from 1.2 in Haiti to 15.8/100,000 in Uruguay among men. The highest increase in incidence rate was observed in Trinidad and Tobago: 7.7% per year. The mortality rate was higher in Uruguay and lower in Haiti, for both sexes. The highest rise in the numbers of DALYs in 2019 was observed in Brazil and Mexico. The proportion of pancreatic cancer deaths attributable to smoking was reduced between 1990 and 2019 for both sexes in LAC countries; however, it increased for metabolic risk factors. Conclusion: The increasing trend in pancreatic cancer observed in LAC may be associated with a rise in risk factors such as high fasting plasma glucose and high body mass index in both sexes. This trend will likely have a substantial impact on the healthcare system in the coming decades.
Correction: exploring the link between dietary patterns and gastric adenocarcinoma in Brazil: a mediation analysis
(2025) Silva, Alex Richard Costa; Alicandro, Gianfranco; Guandalini, Valdete Regina; Grili, Patrícia Paula da Fonseca; Assumpção, Paulo Pimentel de; Barbosa, Mônica Santiago; Sant'Ana, Rosane Oliveira de; Coimbra, Felipe José Fernández; Curado, Maria Paula
Dietary vitamin D and gastric cancer risk within the stomach cancer pooling (stop) project
(2025) Santucci, Claudia; Natale, Arianna; Pelucchi, Claudio; Bonzi, Rossella; Lunet, Nuno Miguel de Sousa; Morais, Samantha Ferreira; Vioque López, Jesús; González Palacios, Sandra; Aragonés Sanz, Nuria; Castaño-Vinyals, Gemma; Curado, Maria Paula
Purpose The evidence regarding the role of vitamin D on gastric cancer (GC) is controversial. Within the Stomach cancer Pooling (StoP) Project, a global consortium of epidemiological studies on GC, we aimed to evaluate the relationship between dietary vitamin D and GC risk. Methods Five case–control studies were included in the analysis, accounting for 1875 cases and 5899 controls. Odds ratios (OR) of GC and the corresponding 95% confidence intervals (CI) for tertiles of vitamin D intake were computed using logistic regression models adjusted for relevant confounders, including energy intake. The pooled ORs were computed using random-effect models. Results The pooled OR of GC for the highest compared to the lowest tertile of vitamin D intake was 1.06 (95% CI 0.80– 1.39), with a p for heterogeneity of 0.019. No significant association was found across strata of sex, age, socioeconomic status, smoking status, alcohol intake, and vegetable and fruit consumption. Conclusions Our pooled analysis indicates that there is no association between dietary vitamin D and the risk of GC.
Systemic impact of Helicobacter pylori: a cross-sectional study
(2025) Ramos, Amanda Ferreira Paes Landim; Santiago, Silvana Barbosa; Moraes, Felipe Augusto de Sousa; Soares, Giovana Alice Sampaio; Fernandes, Gisele Aparecida; Curado, Maria Paula; Germano, Janaina Naiara; Barbosa, Mônica Santiago
Background and Aim: Helicobacter pylori is an oncobacteria that infects about half of the world's population and has a well-established role in the etiology of gastric diseases. Lately, this infection has also been associated with extragastric diseases, such as neuropsychiatric, cardiovascular, metabolic, hematological, and dermatological comorbidities. Elucidating risk factors for comorbidities can contribute to reducing mortality and public health costs. Therefore, the aim of this study is to investigate the association between H. pylori infection and extragastric comorbidities. Materials and Methods: This is a cross-sectional hospital-based case–control study that was conducted in Goiás from 2019 to 2022. The study patients were classified into H. pylori-negative and H. pylori-positive groups. Results: A total of 156 participants were included in the study, and the prevalence of the bacteria was 45.5%. In the H. pylori-positive group, the most frequent diseases were hypertension, anemia, rheumatic disease, and diabetes. The presence of comorbidities was similar between the groups, with the exception of psychiatric illnesses. The male patients were more likely to be infected with H. pylori (odds ratios [ORs] = 2.63, 95% CI: 1.26–5.50), while the H. pylori-positive group was less likely to have psychiatric illnesses (OR = 0.32, 95% CI: 0.11–0.92). Conclusion: The prevalence of H. pylori infection was 45.5%, and males were more likely to be infected by the bacteria. The most frequent comorbidities in the H. pylori-positive group were hypertension, anemia, rheumatic disease, and diabetes. H. pylori-negative patients were more likely to have psychiatric illnesses.
Advanced stage head and neck cancer diagnosis: HEADSpAcE consortium health systems benchmarking survey
(2025) Creaney, Grant; Goulart, Mariél de Aquino; McMahon, Alex; Paterson, Claire; McCaul, James; Perdomo, Sandra J.; Mendoza Torres, Laura Patricia; Vilches, Laia Alemany; Arantes, Lidia Maria Rebolho; Rodriguez Urrego, Paula Andrea; Curado, Maria Paula
Background: Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated. Methods: HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC. Results: Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, −0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, −0.05), and fully publicly funded systems (17%, 95% CI-0.29, −0.06). Several health systems factors had no routinely available data. Conclusions: Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis.
Incidence and trends of multiple myeloma (MM) in Brazil – 1988–2020
(2025) Oliveira, Dandara Menezes de Araujo; Mendoza López, Rossana Verónica; Aristizabal Arboleda, Lady Paola; Curado, Maria Paula
Background: Multiple myeloma (MM) is a chronic hematological malignancy caused by adifferentiated plasma cell disorder (Pawlyn, 2019). As a consequence of population aging, there has been an increase in incidence rates (Turesson et al 2018). In 2022, there were 187,744 new cases (Bray et al 2024). The incidence of MM in Brazil has not been estimated by the National Cancer Institute (INCA). Objective: To analyse the incidence rates and trends of MM across states in Brazil from Population-Based Cancer Registries (PBCRs). Methodology: Information was extracted from PBCR/INCA for the 1988–2020 period. Sociodemographic data were extracted from records of the Brazilian Institute of Geography and Statistics. Age-standardised incidence rates were calculated using the Segi global standard population. Trend analysis was performed using Join point Regression, version 4.7.0.0. Results: The highest incidence rates of MM in males were observed in the cities of Natal (Rio Grande do Norte state) and Jaú (São Paulo state) at 3.55/100,000 and 2.9/100,000, respectively. In females, rates were highest in the cities of Natal (Rio Grande do Norte state) and Aracajú (Sergipe state) at 2.66/100,000 and 2.21/100,000, respectively. Trends showed an annual increase of 10.45% in Campinas for males and 9.04% for females. Median age at diagnosis in Brazil was 65 years for both sexes, while the North region had the lowest average age at 63.2 years, and the South region the highest at 68.0 years. Porto Alegre city (Rio Grande do Sul state) had the highest average of 70.0 years for females and 67.1 for males, while Roraima had the lowest at 61.2 years for females and 54.2 for males. Conclusion: In Brazil, the average age of incidence varies by geographic region, but is higher among males. Incidence rates are highest in the Northeast and Southeast regions, whereas the greatest upward trends are in the Southeast and Midwest regions.
Body mass index and gastric cancer risk: results from the Stomach Cancer Pooling Project Consortium
(2025) Pastorino, Roberta; Marafon, Denise Pires; Gris, Angelica Valz; Lentini, Nicolò; Cristiano, Antonio; Aragonés Sanz, Nuria; Martín Sánchez, Vicente; Zaridze, David Georgievich; Maximovich, Dmistry; Vioque López, Jesús; Curado, Maria Paula
Background: Body mass index (BMI) has been associated with gastric cancer (GC), though results are conflicting regarding the GC subsites of cardia and non-cardia. This study aims to evaluate the associations between BMI and GC risk, focusing on these distinct anatomical subsites. Methods: We pooled data from seven case–control studies from the Stomach Cancer Pooling (StoP) Project. Pooled odds ratios (ORs) and the corresponding 95% confidence intervals (CIs) of GC risk across BMI categories (normal weight, overweight, obesity) were calculated by pooling study-specific ORs through random-effects meta-analytic models. The dose–response relationship between BMI and the risk of GC cancer was assessed by using a one-stage mixed-effects logistic regression model. Results were stratified according to cardia and non-cardia GC. Results: The analysis comprised 1478 GC cases, including 511 cardia and 967 non-cardia cases, and 6671 controls. There was an increased risk of cardia GC among obese patients (OR 1.57, 95% CI 1.20–2.06), while no association was found for non-cardia GC (OR 0.82, 95% CI 0.66– 1.01). Restricting the analysis to population-based studies, the association for cardia GC became stronger for obese (OR 1.65, 95% CI 1.09– 2.48) and overweight (OR 1.62, 95% CI 1.10–2.39) patients. The dose–response meta-analysis showed an increased risk of cardia GC with increasing BMI values, ranging from a null effect at a BMI of 21.75 to an OR of 2.06 (95% CI 1.22–3.48) for a BMI of ≥40. Conclusion: Our results indicate an association between higher BMI categories and the risk of cardia GC, whereas no association was found with non-cardia GC.
Overall and disease-free survival in patients with HPV-positive and HPV-negative oropharyngeal cancer
(2025) Abreu, Matheus de; Oliveira, Dandara Menezes de Araujo; Bastos Neto, Bartolomeu Conceição; Germano, Janaina Naiara; Kowalski, Luiz Paulo; Curado, Maria Paula
Objective: To analyze the overall and disease-free survival of patients with oropharyngeal squamous cell carcinoma. Methods: Sociodemographic and clinical data, HPV status, and alcohol/tobacco consumption were assessed among patients treated at AC Camargo Cancer Center, São Paulo, Brazil. Absolute and relative frequencies, overall survival, and disease-free survival at 5 and 7 years were calculated using Kaplan-Meier analysis, and Cox regression was used to estimate the risk of death. Results: The 7-year overall survival rate was 61.6% for patients with oropharyngeal squamous cell carcinoma (67.5% for HPV-positive cases and 51.1% for HPV-negative cases). Among HPV-positive cases, the risk of death was 5.29-fold higher for smokers than that for non-smokers (p<0.001) and 4.42-fold higher for patients with metastasis than that for those without (p=0.108). Among HPV-cases, those with clinical stage T3/T4 disease had a 1.8-fold higher risk of death than those with T1/T2 disease (p=0.039), and those with metastasis exhibited a 4.62-fold higher risk than those without (p<0.001). The 7-year diseasefree survival rate for oropharyngeal squamous cell carcinoma was 88.6% (90.1% for HPV-positive cases and 85.9% for HPV-negative cases). Among HPV-positive cases, patients with metastasis had an 11.75-fold higher risk of recurrence than those without (p<0.001); among HPV-negative cases, patients with metastasis had a 4.62-fold higher risk than those without (p=0.004). Conclusion: Patients with HPV-positive oropharyngeal squamous cell carcinoma had higher overall survival and increased recurrence rates within the first 3 years but lower recurrence rates beyond 5 years than patients with HPV-negative disease. More frequent follow-ups after 5 years are recommended for patients with HPV-positive disease. Tobacco and alcohol consumption negatively affect the overall survival of patients with HPV-positive oropharyngeal squamous cell carcinoma.
Challenges and opportunities in head and neck cancer research in developing countries: insights from a fireside chat
(2025) Chaves, Aline Lauda Freitas; Kowalski, Luiz Paulo; Marta, Gustavo Nader; Silva, Alan Roger dos Santos; Muniz, Luciana Vieira; Mak, Milena Perez; Gössling, Gustavo Cartaxo de Lima; Guimarães, Vítor Souza; Castro Júnior, Dálvaro Oliveira de; Curado, Maria Paula
Head and neck squamous cell carcinoma (HNSCC) represents a significant public health burden in developing countries, where access to early diagnosis, comprehensive care, and research infrastructure is limited. This article synthesizes the insights generated during a Fireside Chat convened by members of the Latin American Cooperative Oncology Group (LACOG)—Head and Neck and the Brazilian Group of Head and Neck Cancer (GBCP), with the participation of international expert Professor Hisham Mehanna. The discussion addressed key challenges and opportunities in clinical and translational research within resource-constrained settings. Major themes included the unmet needs of patients with HNSCC, particularly regarding treatment-related toxicities and the need for biomarker-driven, personalized approaches. Barriers to research in low- and middle-income countries were explored, including patient comorbidities, late-stage presentation, and regulatory hurdles. The group emphasized the importance of pragmatic, context-sensitive research that reflects local disease burden, health care structures, and cultural factors. Capacity building, multidisciplinary teamwork, and in- tegration of translational science into clinical care were highlighted as essential for advancing outcomes. The manuscript also outlines the preparedness of Brazilian centers for early-phase trials, strategies to enhance patient recruitment, and mechanisms to strengthen collaboration among researchers, governmental agencies, and industry. Successful models from LACOG and GBCP were presented to illustrate local leadership in advancing HNSCC research. Ultimately, the authors advocate for a coordinated national research agenda that positions Brazil and similar nations as meaningful contributors to the global head and neck cancer research landscape, fostering innovation while addressing the realities of under-represented populations.
Geographic and age variations in mutational processes in colorectal cancer
(2025) Díaz-Gay, Marcos; Moody, Sarah; Santos, Wellington dos; Kazachkova, Mariya; Abbasi, Ammal; Steele, Christopher D.; Vangara, Raviteja; Senkin, Sergey; Jingwei, Wang; Fitzgerald, Stephen; Bergstrom, Erik N.; Curado, Maria Paula
Incidence rates of colorectal cancer vary geographically and have changed over time1. Notably, in the past two decades, the incidence of early-onset colorectal cancer, which affects individuals below 50 years of age, has doubled in many countries2-5. The reasons for this increase are unknown. Here we investigate whether mutational processes contribute to geographic and age-related differences by examining 981 colorectal cancer genomes from 11 countries. No major differences were found in microsatellite-unstable cancers, but variations in mutation burden and signatures were observed in the 802 microsatellite-stable cases. Multiple signatures, most with unknown aetiologies, exhibited varying prevalence in Argentina, Brazil, Colombia, Russia and Thailand, indicating geographically diverse levels of mutagenic exposure. Signatures SBS88 and ID18, caused by the bacteria-produced mutagen colibactin6,7, had higher mutation loads in countries with higher colorectal cancer incidence rates. SBS88 and ID18 were also enriched in early-onset colorectal cancers, being 3.3 times more common in individuals who were diagnosed before 40 years of age than in those over 70 years of age, and were imprinted early during colorectal cancer development. Colibactin exposure was further linked to APC driver mutations, with ID18 being responsible for about 25% of APC driver indels in colibactin-positive cases. This study reveals geographic and age-related variations in colorectal cancer mutational processes, and suggests that mutagenic exposure to colibactin-producing bacteria in early life may contribute to the increasing incidence of early-onset colorectal cancer.
Fish consumption and gastric cancer within the Stomach cancer Pooling (StoP) Project
(2025) Franchi, Carlotta; Ardoino, Ilaria; Mandelli, Sara; Patel, Linia; Pelucchi, Claudio; Bonzi, Rossella; Camargo Bohórquez, María Constanza; Rabkin, Charles S.; Lião, Linda M.; Sinha, Rashmi; Curado, Maria Paula
Gastric cancer is among the most common cancer and cause of cancer death. We conducted a metaanalysis of 25 case–control studies from the Stomach cancer Pooling Project to assess the association between fish or canned fish consumption and the risk of gastric cancer. 10,431 cases and 24,903 controls were available. We found no association between fish consumption and risk of gastric cancer (pooled odds ratios (OR)=0.99; 95% confidence interval (CI) 0.86–1.13, for at least one serving/week vs none). Geographical differences were found: in Asia an increased intake of fish was associated with a lower stomach cancer risk. In the sensitivity analyses, fish consumption was associated to a lower risk of gastric cancer in models adjusted for family history of gastric cancer (OR=0.80, 95% CI 0.72–0.89) and Helicobacter Pylori infection (OR=0.72, 95% CI 0.60–0.88), but not for body mass index or energy intake. Seven studies collected information on canned fish (4525 cases and 8073 controls). No association was found for canned fish (OR=0.96, 95% CI 0.82–1.13). In conclusion, our results provide evidence that fish and canned fish intake are not associated with gastric cancer risk, although geographical differences have been highlighted, with a lower risk of gastric cancer in Asia.
In-hospital mortality in patients with lower gastrointestinal bleeding: development and validation of a prediction score
(2025) Dajti, Elton; Frazzoni, Leonardo; Castellet Farrús, Sílvia; Guardiola Capon, Jordi; Sinagra, Emanuele; Ferrara, Francesco; Gkolfakis, Paraskevas; Duboc, Marine Camus; Anderloni, Andrea; Curado, Maria Paula
Background Lower gastrointestinal bleeding (LGIB) is a common condition linked to increased morbidity, health- care costs, and mortality. Currently, no prospectively vali- dated prognostic model exists to predict mortality in patients with LGIB. Our aim was to develop and validate a risk score that could accurately predict in-hospital mortality of patients admitted for LGIB. Methods Patient data from a nationwide cohort study in 15 centers in Italy (2019–2020) were used to derive the risk score, the Acute Lower gastrointestinal Bleeding and In-hospital mortality (ALIBI) score; the model was then externally validated in a cohort of consecutive patients hos- pitalized for LGIB in 12 centers from six countries (Italy, Spain, France, Greece, Iran, and Brazil) from 2022 to 2024. The main outcome was in-hospital mortality; we also reported rebleeding rates and the in-hospital mortality rate stratified by risk score and timing of colonoscopy. Results Among 1198 patients in the derivation cohort, 105 (8.8%) re-bled and 41 (3.4%) died. Age, Charlson Co- morbidity Index, in-hospital onset, hemodynamic instabil- ity, and creatinine level were independent predictors of in- hospital mortality. The model demonstrated excellent dis- crimination (area under the receiver operating curve [AUR- OC] 0.81, 95%CI 0.75–0.87) and calibration. In the valida- tion cohort (n = 752 patients), the model's good discrimina- tion (AUROC 0.79, 95%CI 0.72–0.86) and calibration were confirmed. Patients were categorized as low (0–4 points; 1% mortality), intermediate (5–9 points; 4.6% mortality), or high risk (10–13 points; 19.1% mortality). Conclusion A new validated score effectively predicts in- hospital mortality in patients with LGIB, aiding in their risk stratification and management.
Conditional survival of children, adolescents and young adults (0–24 years) diagnosed with leukaemia during 2000–2014 world-wide: (CONCORD-3)
(2025) Ssenyonga, Naomi; Stiller, C. A.; Marcos-Gragera, Rafael; Kuehni, Claudia Elisabeth; Saint-Jacques, Nathalie; Bulliard, Jean-Luc; Redaniel, Maria Theresa; Nakata, Kayo; Schwartz, Stephen Marc; Curado, Maria Paula
Background: Population-based survival estimates provide valuable insights into cancer care patterns world-wide. Access to optimal treatment leads to better outcomes, however, treatment pathways vary globally. Conditional survival is the probability that patients who have already survived for a given number of years since diagnosis will live for an additional number of years. It is a useful proxy to assess the success of initial treatment or remission of leukaemia. Methods: We analysed data for 164,563 patients aged 0–24 years diagnosed during 2000–2014, from 258 population-based cancer registries in 61 countries. Using the Pohar-Perme estimator, we estimated net survival at five years, conditional on surviving at least one year, and at 10 years conditional on surviving five years. To control for background mortality, we used life tables of all-cause mortality by single year of age, sex, country and calendar year. All-ages survival estimates were standardised to the marginal age distribution. Findings: During 2010–2014, age-standardised five-year conditional net survival ranged from 61.8 % in Mexico to 90 % or more in 20 countries. By 2010–2014, five-year conditional survival in most high-income countries exceeded 90 % for children, but not for older patients, and for acute myeloid leukaemia it was typically 5–10 % lower than for lymphoid leukaemia. Ten-year conditional survival was 90 % or higher in most countries, with less variation world-wide. Interpretation: World-wide variation in survival was less marked for patients who survived the first year(s) after diagnosis. Notable gains occurred in countries with initially lower five-year survival (e.g., China or Mexico), where legislative changes contributed to improved access to treatment for young patients with cancer. None- theless, inequalities persisted between high-income and low- and middle-income countries. Population-based cancer registry data remain essential to monitor further improvements.
Evolving survival patterns in pancreatic adenocarcinoma: a 23-year retrospective observational analysis
(2025) Felismino, Tiago Cordeiro; Silva, Diego Rodrigues Mendonça e; Brito, Angelo Borsarelli Carvalho de; Silva, Virgílio Souza e; Durant, Laís Corsino; Ribeiro, Héber Salvador de Castro; Diniz, Alessandro Landskron; Farias, Igor Correia de; Godoy, André Luís de; Torres, Silvio Melo; Curado, Maria Paula
Background: Pancreatic adenocarcinoma (PA) remains one of the most lethal malignancies. However, treatment options have expanded. Since 2011, FOLFIRINOX (fluorouracil, leucovorin, oxaliplatin, and irinotecan) and nab-paclitaxel plus gemcitabine have demonstrated superior outcomes over gemcitabine for advanced disease and have become standard chemotherapy regimens. This study aimed to analyze 23-year survival trends in PA at a Brazilian cancer center, focusing on comparisons between the pre- and post-FOLFIRINOX eras. Methods: This retrospective study analyzed patients diagnosed and treated at a large cancer center from 2000 to 2023, examining survival trends and changes in clinicopathological features and treatment across two 12-year periods: Period 1 (2000–2011), before FOLFIRINOX, and Period 2 (2012–2023), after FOLFIRINOX incorporation. The primary objective was to compare overall survival rates between the two time periods. The secondary objective was to evaluate changes in clinicopathological characteristics and treatment modalities. Results: A total of 1,078 patients were included in this analysis, with 274 patients in Period 1 and 804 patients in Period 2. The proportion of female patients increased in Period 2 (43.8% in Period 1 vs. 50.9% in Period 2, P=0.051), and the median age at diagnosis rose from 62.5 to 66 years (P<0.001). Early-stage tumors (stages I–II) were more frequently diagnosed in Period 2 (16% vs. 29.8%, P<0.001). Chemotherapy use increased from 70.1% (192 patients) in Period 1 to 83.2% (669 patients) in Period 2 (P<0.001), while multimodal therapy (surgery + chemotherapy) rose from 11.3% to 16.7% (P<0.001). Median overall survival (mOS) improved from 7.29 months in Period 1 to 13.24 months in Period 2 (P<0.001), with the 5-year survival increasing from 5.2% to 14.3%. Among the early-stage patients, mOS increased from 19.7 to 34.4 months (P=0.01). No survival difference was observed for stage III disease (mOS: 16.7 vs. 14.8 months, P=0.76), while outcomes for stage IV improved (mOS: 4.76 vs. 9.99 months, P<0.001). Conclusions: This 23-year analysis highlights the evolving treatment landscape and improved outcomes in PA with the introduction of more effective therapies.
The complexity of tobacco smoke-induced mutagenesis in head and neck cancer
(2025) Moody, Laura Torrens Sara; Carvalho, Ana Carolina de Souza; Kazachkova, Mariya; Curado, Maria Paula; Cheema, Saamin; Senkin, Sergey; Cattiaux, Thomas; Penha, Ricardo Cortez Cardoso; Atkins, Joshua Ronald; Abedi-Ardekani, Behnoush
Tobacco smoke, alone or combined with alcohol, is the predominant cause of head and neck cancer (HNC). We explore how tobacco exposure contributes to cancer development by mutational signature analysis of 265 whole-genome sequenced HNC samples from eight countries. Six tobacco-associated mutational signatures were detected, including some not previously reported. Differences in HNC incidence between countries corresponded with differences in mutation burdens of tobacco-associated signatures, consistent with the dominant role of tobacco in HNC causation. Differences were found in the burden of tobacco-associated signatures between anatomical subsites, suggesting that tissue-specific factors modulate mutagenesis. We identified an association between tobacco smoking and alcohol-related signatures, indicating a combined effect of these exposures. Tobacco smoking was associated with differences in the mutational spectra, repertoire of driver mutations in cancer genes and patterns of copy number change. Our results demonstrate the multiple pathways by which tobacco smoke can influence the evolution of cancer cell clones.
Oropharyngeal cancer incidence and trends in Brazil
(2025) Aristizabal Arboleda, Lady Paola; Souza, Dyego Leandro Bezerra de; Silva, Diego Rodrigues Mendonça e; Curado, Maria Paula
Background: Oropharyngeal cancer incidence is rising globally, predominantly in high-income countries, because of human papillomavirus infection. However, further data on oropharyngeal cancer incidence in Brazil is needed. The aim of this study was to estimate the incidence, trends, and predictions of oropharyngeal cancer in Brazilian population-based cancer registries (PBCR) by period, sex, and topography. Methods: Data on oropharyngeal cancer were collected from PBCRs (1988–2020). Age-standardized rates were calculated from 2000 onward using the 2010 Brazilian census and world standard population. Annual average percent change was analyzed using the joinpoint regression model. Predictions up to 2034 were made using the Nordpred program and the age–period–cohort model. Results: A total of 17,980 oropharyngeal cancer cases were recorded across 30 PBCRs (1988–2020). Most cases involved males (81.58%) ages 55 to 59 years (17.06%). The oropharynx not otherwise specified (40.58%), base of the tongue (24.98%), and tonsils (22.52%) were the sites most affected. The highest incidence rates were found in the southeastern and southern regions (3.1–9.4/100,000). Incidence trends increased for 10 PBCR regions in males and 6 regions in females. Predictions up until 2034 indicate decreasing trends for females and increasing trends for males in the north and south of Brazil. Conclusions: The incidence of oropharyngeal cancer in Brazil differs among regions, with higher rates observed in the south and southeast. The prevalence of the human papillomavirusattributable fraction for oropharyngeal cancer is unknown. Impact: Analysis of oropharyngeal cancer incidence rates and regional trends aims to better understand the epidemiology of this malignancy in the Brazilian population.
Overall survival of patients with second primary breast cancer associated with molecular subtype and epidemiological profile at a cancer center
(2026) Rocha, Ariane Silva da; Fernandes, Gisele Aparecida; Osório, Cynthia Aparecida Bueno de Toledo; Freitas-Junior, Ruffo; Curado, Maria Paula
Background The most prevalent cancer diagnosed in women in 2022 was breast cancer, with an estimated 2.26 million new cases worldwide. Among women with breast cancer, second primary breast carcinoma is the most common malignancy. The present study aimed to analyze the overall survival of second primary breast cancer patients at a cancer center. Methods A retrospective cohort study of women with second primary breast cancer, diagnosed between 2000 and 2015, was conducted. The cases were drawn from the Hospital Cancer Registry (HCR) and second primary breast cancer was classified according to the rules for these cancers. Survival curves were estimated using the Kaplan–Meier method. Results A total of 11.922 women with breast cancer were identified between 2000 and 2015. Of these, 3.24% (375) had second primary breast cancer, comprising 60.8% (228) synchronous and 39.2% (147) metachronous tumors. The 5-year survival rate was 86.5% (CI 79.69–91.21%) for women with synchronous breast cancer and 82.1% (CI 73.71–88.10%) for metachronous cancer cases. Both groups had a 10-year survival rate of 69%. Conclusion Overall survival of patients with second primary breast cancer was similar for both synchronous and metachronous tumors. Second primary tumors in this cohort appeared to occur sporadically, as patients were predominantly over 50 years of age with luminal B phenotype in the contralateral breast. Future studies should investigate the presence of associated genetic syndromes in these patients.
Calcium intake and gastric cancer risk: a systematic review and dose–response meta-analysis of observational studies
(2025) Silva, Alex Richard Costa; Fagundes, Marcela de Araújo; Guandalini, Valdete Regina; Curado, Maria Paula
Calcium has been proposed as a protective factor against certain types of cancer, but findings related to gastric cancer (GC) are inconsistent. This meta-analysis aimed to assess the association between calcium intake and the risk of GC. A comprehensive search was conducted in PubMed, Scopus, EMBASE, LILACS, and Web of Science for cohort and case-control studies published up to August 19, 2024. The quality of the studies was assessed using the Newcastle–Ottawa Scale. Publication bias was tested using Egger’s and Begg’s tests. Relative risks (RRs) and 95 % confidence intervals (CIs) were pooled through a random-effects model. Given the substantial heterogeneity and potential variation in intake levels across populations, a dose-response analysis was conducted to explore potential trends across the full range of calcium consumption. Thirteen studies involving 1,610,992 participants met the inclusion criteria. A non-significant inverse association was observed between total calcium intake and GC risk when comparing the highest vs lowest intake categories (RR: 0.85; 95 % CI: 0.70–1.05). While this categorical comparison was not statistically significant, the dose-response analysis revealed a significant linear protective effect, with a 10 % reduction in risk per 300 mg/day increase in dietary calcium intake (RR: 0.90; 95 % CI: 0.82–0.99). To account for potential variations across intake levels, a non-linear model was also applied, indicating a clearer risk reduction above 400 mg/day (p for non-linearity < 0.001). Overall, this dose-response meta-analysis suggests that higher dietary calcium intake may have a protective effect against GC, reinforcing the importance of considering calcium in dietary strategies for GC prevention, although more studies are needed to confirm these findings.
Global burden and international trends of laryngeal cancer incidence: a population-based study of recorded data and national estimates
(2025) Cunha, Amanda Ramos da; Rumgay, Harriet; Vignat, Jerome; Laversanne, Mathieu; Colombet, Murielle; Curado, Maria Paula; Garvey, Gail; Laskar, Sarbani Ghosh; O'Sullivan, Brian
Laryngeal cancer shows considerable variation in global incidence, which has primarily been studied through national estimates. This study aims to analyse the global incidence of laryngeal cancer, comparing estimated and high-quality recorded data, and examine temporal trends to inform targeted prevention strategies. Estimated incidence rates for 2022 were obtained from the GLOBOCAN 2022 database for 185 countries. Recorded incidence data from population-based cancer registries (PBCRs) for the five-years period 2013–2017 were sourced from Cancer Incidence in Five Continents (CI5-XII). Temporal trends and the Estimated Annual Percent Change were assessed for 34 countries using the Global Cancer Observatory – Cancer Over Time database. The highest estimated age-standardized incidence rates (ASIRs) were observed in Cuba, Moldova, and Romania, particularly among males: 14.8, 12.2, and 10.3 per 100,000, respectively. Recorded data showed significant regional variability, with the highest ASIRs for males in Pskov, Russia (13.3 per 100,000) and the Azores, Portugal (11.8 per 100,000). Most countries exhibited a decline in laryngeal cancer rates among males, while trends among females remained largely stable. Our findings underscore the importance of PBCRs in identifying high-risk populations for developing laryngeal cancer. While national estimates are essential for understanding the global distribution of laryngeal cancer and other malignancies, they may overlook subnational variations. Expanding the coverage and quality of PBCRs is crucial for improving cancer surveillance and enhancing prevention and control efforts at national and global level
Cross-cancer survival prediction using machine learning models
(2026) Cardoso, Lucas Buk; Egydio, Jones Eduardo; Toporcov, Tatiana Natasha; Utida, Nanci Yumi; Curado, Maria Paula; Fernandes, Gisele Aparecida; Ribeiro, Adeylson Guimarães; Chin, Bryan Gilvaz; Parro, Vanderlei Cunha
Among the many challenges faced by healthcare systems, cancer remains one of the most urgent. This makes the application of artificial intelligence a critical tool for enhancing early detection and optimizing treatment strategies, especially given the growing volume of patient data being collected. In this study, machine learning models trained on data for a specific type of cancer were employed to predict three-year survival after diagnosis for other cancer types. Two groups were considered: the most frequent cancers and those related to the digestive system. The data were extracted from the Hospital Based Cancer Registries of São Paulo, covering 2000 to 2019, with a consistent selection protocol across all cancer types to enable cross-prediction. XGBoost and LightGBM algorithms were used, choosing the best-performing model for predictions across different topographies. Using a combined dataset of oral cavity, esophageal, and stomach cancers, the model achieved a balanced accuracy of 80.18%, compared with 79.92% for the stomach-specific model. Statistical testing showed no significant difference between these values, suggesting comparable predictive performance. These results illustrate the potential of cross-prediction, especially for rare cancer types where data scarcity represents a significant challenge.

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