Lung cancer in Brazil

Luiz Henrique Araujo, Clarissa Baldotto, Gilberto de Castro Jr, Artur Katz, Carlos Gil Ferreira, Clarissa Mathias, Eldsamira Mascarenhas, Gilberto de Lima Lopes, Heloisa Carvalho, Jaques Tabacof, Jeovany Martínez-Mesa, Luciano de Souza Viana, Marcelo de Souza Cruz, Mauro Zukin, Pedro De Marchi, Ricardo Mingarini Terra, Ronaldo Albuquerque Ribeiro, Vladmir Cláudio Cordeiro de Lima, Gustavo Werutsky, Carlos Henrique Barrios, Grupo Brasileiro de Oncologia Torácica, Luiz Henrique Araujo, Clarissa Baldotto, Gilberto de Castro Jr, Artur Katz, Carlos Gil Ferreira, Clarissa Mathias, Eldsamira Mascarenhas, Gilberto de Lima Lopes, Heloisa Carvalho, Jaques Tabacof, Jeovany Martínez-Mesa, Luciano de Souza Viana, Marcelo de Souza Cruz, Mauro Zukin, Pedro De Marchi, Ricardo Mingarini Terra, Ronaldo Albuquerque Ribeiro, Vladmir Cláudio Cordeiro de Lima, Gustavo Werutsky, Carlos Henrique Barrios, Grupo Brasileiro de Oncologia Torácica

Abstract

Lung cancer is one of the most incident types of cancer and a leading cause of cancer mortality in Brazil. We reviewed the current status of lung cancer by searching relevant data on prevention, diagnosis, and treatment in the country. This review highlights several issues that need to be addressed, including smoking control, patient lack of awareness, late diagnosis, and disparities in the access to cancer health care facilities in Brazil. We propose strategies to help overcome these limitations and challenge health care providers, as well as the society and governmental representatives, to work together and to take a step forward in fighting lung cancer.

Figures

Figure 1. Brazilian National Cancer Institute estimate…
Figure 1. Brazilian National Cancer Institute estimate for new cancer cases in 2016 by gender. Adapted from Instituto Nacional de Câncer José Alencar Gomes da Silva.
Figure 2. Crude and age-adjusted lung cancer…
Figure 2. Crude and age-adjusted lung cancer mortality rates by gender. Brazil, 1980-2007.
Figure 3. Prevalence of EGFR mutations around…
Figure 3. Prevalence of EGFR mutations around the world. EGFR mutations are in general more prevalent in Asian countries, whereas Latin American countries tend to have an intermediate prevalence between Asia and Europe/North-America. NR: not reported. Adapted from Werustky et al.

References

    1. World Health Organization . International Agency for Research on Cancer (IARC) Lyon: IARC; 2016.
    1. GBD 2015 Mortality and Causes of Death Collaborators Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016;388(10053):1459–1544. doi: 10.1016/S0140-6736(16)31012-1.
    1. Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva . Estimativa 2016: Incidência de Câncer no Brasil. Rio de Janeiro: INCA; 2015.
    1. Allemani C, Weir HK, Carreira H, Harewood R, Spika D, Wang XS, et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2) Lancet. 2015;385(9972):977–1010. doi: 10.1016/S0140-6736(14)62038-9.
    1. Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva . Estatísticas do Câncer: Mortalidade. Rio de Janeiro: INCA;
    1. Boing AF, Rossi TF. Temporal trend in and spatial distribution of lung cancer mortality in. Brazil between 1979 and. 2004:magnitude–magnitude. doi: 10.1590/S1806-37132007000500009.
    1. Souza MC, Vasconcelos AG, Cruz OG. Trends in lung cancer mortality in Brazil from the 1980s into the early 21st century age-period-cohort analysis. Cad Saude Publica. 2012;28(1):21–30. doi: 10.1590/S0102-311X2012000100003.
    1. Ministério do Planejamento, Orçamento e Gestão. Instituto Brasileiro de Geografia e Estatística . Pesquisa Nacional por Amostra de Domicílios. Rio de Janeiro: IBGE; 2008.
    1. Levy D, de Almeida LM, Szklo A. The Brazil SimSmoke policy simulation model the effect of strong tobacco control policies on smoking prevalence and smoking-attributable deaths in a middle income nation. PLoS Med. 2012;9(11):e1001336. doi: 10.1371/journal.pmed.1001336.
    1. Brasil. Ministério da Saúde. Secretaria de Vigilância em Saúde. Departamento de Vigilância de Doenças e Agravos não Transmissíveis e Promoção de Saúde . Vigitel Brasil 2016: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico. Brasília: o Ministério; 2017.
    1. Monteiro CA, Cavalcante TM, Moura EC, Claro RM, Szwarcwald CL. Population-based evidence of a strong decline in the prevalence of smokers in Brazil (1989-2003) Bull World Health Organ. 2007;85(7):527–534. doi: 10.2471/BLT.06.039073.
    1. Brasil. Ministério da Saúde. Instituto Nacional de Câncer José Alencar Gomes da Silva . Vigescola - Vigilância de tabagismo em escolares. Dados e fatos de 17 cidades brasileiras. Rio de Janeiro: INCA; 2006.
    1. Azevedo E Silva G, de Moura L, Curado MP, Gomes Fda S, Otero U, Rezende LF, et al. The Fraction of Cancer Attributable to Ways of Life, Infections, Occupation, and Environmental Agents in Brazil in 2020. PLoS One. 2016;11(2):e0148761. doi: 10.1371/journal.pone.0148761.
    1. Secretaria de Estado da Saúde de São Paulo. Fundação Oncocentro de São Paulo
    1. National Cancer Institute. Surveillance, Epidemiology, and End Results Program . Câncer Stat Facts: Lung and Bronchus Cancer. Bethesda: National Cancer Institute;
    1. Cancer Research UK . Lung Cancer Statistics. London: Cancer Research UK;
    1. dos Santos RS, Franceschini JP, Chate RC, Ghefter MC, Kay F, Trajano AL. Do Current Lung Cancer Screening Guidelines Apply for Populations With High Prevalence of Granulomatous Disease Results From the First Brazilian Lung Cancer Screening Trial (BRELT1) Ann Thorac Surg. 2016;101(2):481–486. doi: 10.1016/j.athoracsur.2015.07.013.
    1. Ismael GF, Coradazzi AL, A F, Neto, Abdalla KC, Milhomem PM, Oliveira JS. Aspectos clínicos e histopatológicos em câncer de pulmão análise dos dados de uma instituição no interior paulista entre 1997 e 2008. J Bras Oncol Clin. 2010;7(22):72–78.
    1. Younes RN, Deutsch F, Badra C, Gross J, Haddad F, Deheinzelin D. Nonsmall cell lung cancer evaluation of 737 consecutive patients in a single institution. Rev Hosp Clin Fac Med Sao Paulo. 2004;59(3):119–127. doi: 10.1590/S0041-87812004000300005.
    1. Westphal FL, Lima LC, Andrade EO, Lima Netto JC, Silva AS, Carvalho BC. Characteristics of patients with lung cancer in the city of Manaus, Brazil. J Bras Pneumol, 2009;35(2):157–163. doi: 10.1590/S1806-37132009000200009.
    1. Barros JA, Valladares G, Faria AR, Fugita EM, Ruiz AP, Vianna AG. Early diagnosis of lung cancer the great challenge. Epidemiological variables, clinical variables, staging and treatment. J Bras Pneumol. 2006;32(3):221–227. doi: 10.1590/S1806-37132006000300008.
    1. Novaes FT, Cataneo DC, Ruiz RL, Junior, Defaveri J, Michelin OC, Cataneo AJ. Lung cancer histology, staging, treatment and survival. J Bras Pneumol. 2008;34(8):595–600. doi: 10.1590/S1806-37132008000800009.
    1. Araujo LH, Baldotto CS, Zukin M, Vieira FM, Victorino AP, Rocha VR. Survival and prognostic factors in patients with non-small cell lung cancer treated in private health care. Rev Bras Epidemiol. 2014;17(4):1001–1014. doi: 10.1590/1809-4503201400040017.
    1. Mascarenhas E, Lessa G. Perfil clínico e sócio-demográfico de pacientes com câncer de pulmão não-pequenas células atendidos num serviço privado. J Bras Oncol Clin. 2010;7(22):49–54.
    1. Freitas ED. Aspectos epidemiológicos do câncer de pulmão em uma instituição privada. J Bras Oncol Clin. 2010;7(22):55–59.
    1. Caires-Lima R, Takahashi TK, Mak MP, Roiteberg FS, Teixeira CH, Mesquita CS. Referral of lung cancer patients to specialized clinical oncology care Instituto do Câncer do Estado de São Paulo 2010-2011. J Thorac Oncol. 2012;7(7):S111–S111.
    1. Lewis DR, Check DP, Caporaso NE, Travis WD, Devesa SS. US lung cancer trends by histologic type. Cancer. 2014;120(18):2883–2892. doi: 10.1002/cncr.28749.
    1. Costa G, Thuler LC, Ferreira CG. Epidemiological changes in the histological subtypes of 35,018 non-small-cell lung cancer cases in Brazil. Lung Cancer. 2016;97:66–72. doi: 10.1016/j.lungcan.2016.04.019.
    1. de Souza MC, Vasconcelos AG, Rebelo MS, Rebelo PA, Cruz OG. Profile of patients with lung cancer assisted at the National Cancer Institute, according to their smoking status, from 2000 to 2007. Rev Bras Epidemiol. 2014;17(1):175–188. doi: 10.1590/1415-790X201400010014ENG.
    1. Ministério do Planejamento.Orçamento e Gestão . Escassez e fatura: distribuição da oferta de equipamentos de diagnóstico por imagem no Brasil. Indicadores sociodemográficos e de saúde no Brasil. Rio de Janeiro: 2009.
    1. Zamboni M, Monteiro AS. Bronchoscopy in Brazil. J Bras Pneumol. 2004;30(5):419–425. doi: 10.1590/S1806-37132004000500004.
    1. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S. British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults accredited by NICE. Thorax. 2013;68(1):i1–i44. doi: 10.1136/thoraxjnl-2013-203618.
    1. Du Rand IA, Blaikley J, Booton R, Chaudhuri N, Gupta V, Khalid S. Summary of the British Thoracic Society guideline for diagnostic flexible bronchoscopy in adults. Thorax. 2013;68(8):786–787. doi: 10.1136/thoraxjnl-2013-203629.
    1. Lannes D, Monteiro AS, Toscano E, Cavalcanti A, Nascimento M, de Biasi P. Transbronchial needle aspiration of hilar and mediastinal lymph nodes [Article in Portuguese] Rev Port. Pneumol. 2007;13(5):651–658. doi: 10.1016/S2173-5115(07)70360-3.
    1. Lima CD, Nunes RA, Saito EH, Higa C, Cardona ZJ, Santos DB. Results and complications of CT-guided transthoracic fine-needle aspiration biopsy of pulmonary lesions. J Bras Pneumol. 2011;37(2):209–216. doi: 10.1590/S1806-37132011000200011.
    1. Tedde ML, Figueiredo VR, Terra RM, Minamoto H, Jatene FB. Endobronchial ultrasound-guided transbronchial needle aspiration in the diagnosis and staging of mediastinal lymphadenopathy initial experience in Brazil. J Bras Pneumol. 2012;38(1):33–40. doi: 10.1590/S1806-37132012000100006.
    1. Figueiredo VR, Jacomelli M, Rodrigues AJ, Canzian M, Cardoso PF, Jatene FB. Current status and clinical applicability of endobronchial ultrasound-guided transbronchial needle aspiration. J Bras Pneumol. 2013;39(2):226–237. doi: 10.1590/S1806-37132013000200015.
    1. de Lima Lopes G, Jr, Segel JE, Tan DS, Do YK, Mok T, Finkelstein EA. Cost-effectiveness of epidermal growth factor receptor mutation testing and first-line treatment with gefitinib for patients with advanced adenocarcinoma of the lung. Cancer. 2012;118(4):1032–1039. doi: 10.1002/cncr.26372.
    1. Ferreira CG. Lung cancer in developing countries access to molecular testing. Am Soc Clin Oncol Educ Book. 2013:327–331. doi: 10.1200/EdBook_AM.2013.33.327.
    1. Pontes LB, Bacchi CE, Queiroga EM, Piha T, Miranda PA, Freire S, et al. EGFR mutation screening in non-small cell lung cancer: results from an access program in Brazil. J Clin Oncol. 32:1526–1526.
    1. Bacchi CE, Ciol H, Queiroga EM, Benine LC, Silva LH, Ojopi EB. Epidermal growth factor receptor and KRAS mutations in Brazilian lung cancer patients. Clinics (Sao Paulo) 2012;67(5):419–424. doi: 10.6061/clinics/2012(05)03.
    1. Melo AC, Inada HK, Barros M, Terra SB, Ligorio C, Sugawara E. Non-small cell lung cancer genotyping in a Brazilian cohort.; 14th World Conference on Lung Cancer; Aurora(USA): IASLC; 2011.
    1. Domingues PM, Montella T, Zukin M, Baldotto C, Ferreira C. Epidemiology and clinical outcomes of epidermal growth factor receptor (EGFR) mutant patients at the Brazilian National Cancer Institute (INCA); 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. De Sa VK, Nascimento EC, Meireles SI, Capelozzi VL. Epidermal growth factor receptor mutations in primary and metastatic adenocarcinomas from a tertiary hospital in São Paulo, Brazil.; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Yen C, Bitton RC, De Lima LGCA, Amadio AV, Takahashi TK, Marini AM. Characterization of EGFR activating mutations in Brazilian patients with pulmonary adenocarcinoma; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Saito A, Lima VCC, Dettino ALA, Macedo MP, Cunha IW, Dal Molin GZ. Patterns of EGFR mutations in a cohort of 395 patients from a single institution in Brazil.; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. de Melo AC, Karen de Sá V, Sternberg C, Olivieri ER, Werneck da Cunha I, Fabro AT, et al. Mutational Profile and New IASLC/ATS/ERS Classification Provide Additional Prognostic Information about Lung Adenocarcinoma A Study of 125 Patients from Brazil. Oncology. 2015;89(3):175–186. doi: 10.1159/000376552.
    1. Gomes JR, Amarante MP, D'Alpino RD, Moreira RB, Souza TT, Lino AR, et al. Mutation profile in non-small cell lung cancer: analysis of a Brazilian population. J Clin Oncol. 2015;33:e19115
    1. Werutsky G, Debiasi M, Sampaio FHD, Nunes PRS, Filho, Lopes GDL., Junior Global epidemiology of EGFR mutation in advanced non-small cell lung cancer.; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Melo AC. Estudo epidemiológico de biomarcadores em câncer de pulmão não pequenas células. Rio de Janeiro: Instituto Nacional de Câncer; 2011.
    1. Lopes LF, Bacchi CE. Anaplastic lymphoma kinase gene rearrangement in non-small-cell lung cancer in a Brazilian population. Clinics (Sao Paulo) 2012;67(7):845–847. doi: 10.6061/clinics/2012(07)23.
    1. Departamento de Informática do SUS - DATASUS . Assistência à Saúde. Brasília: Ministério da Saúde;
    1. Conselho Regional de Medicina do Estado de São Paulo . Demografia Médica no Brasil. São Paulo: CREMESP;
    1. Tedde ML, Petrere O, Jr, Pinto DR, Filho, Pereira ST, Monteiro R, Sassaki AM. General thoracic surgery workforce training, migration and practice profile in Brazil. Eur J Cardiothorac Surg. 2015;47(1):e19–e24. doi: 10.1093/ejcts/ezu411.
    1. Sánchez PG, Vendrame GS, Madke GR, Pilla ES, Camargo Jde J, Andrade CF. Lobectomy for treating bronchial carcinoma analysis of comorbidities and their impact on postoperative morbidity and mortality. J Bras Pneumol. 2006;32(6):495–504. doi: 10.1590/S1806-37132006000600005.
    1. Stanzani F, Paisani Dde M, Oliveira Ad, Souza RC, Perfeito JA, Faresin SM. Morbidity, mortality, and categorization of the risk of perioperative complications in lung cancer patients. J Bras Pneumol. 2014;40(1):21–29. doi: 10.1590/S1806-37132014000100004.
    1. Allen MS, Darling GE, Pechet TT, Mitchell JD, Herndon 2nd JE, Landreneau RJ. Morbidity and mortality of major pulmonary resections in patients with early-stage lung cancer initial results of the randomized, prospective ACOSOG Z0030 trial. Ann Thorac Surg. 2006;81(3):1013–1019. doi: 10.1016/j.athoracsur.2005.06.066.
    1. Brasil. Ministério da Ciência, Tecnologia, Inovações e Comunicações. Comissão Nacional de Energia Nuclear . Instalações Autorizadas. Brasília: CNEN; c2015.
    1. Sociedade Brasileira de Radioterapia . Panorama da radioterapia no Brasil. São Paulo: a Sociedade;
    1. Moraes FY, Marta GN, Hanna SA, Leite ET, Ferrigno R, da Silva JL. Brazil's Challenges and Opportunities. Int J Radiat Oncol Biol Phys. 2015;92(4):707–712. doi: 10.1016/j.ijrobp.2014.12.063.
    1. Siqueira GS, Carvalho HA, Neves-Junior WF, Arruda FF, Correa SF, Silva JL. Atualização de Análise Institucional de Radioterapia Estereotáctica Extracraniana em Tumores de Pulmão não Pequenas Células em Estádio Inicial em Pacientes Inoperáveis. Rev Bras Cancerol. 2011;57(4):570–570.
    1. Domingues PM, Zylberberg R, da Matta de Castro T, Baldotto CS, de Lima Araujo LH. Survival data in elderly patients with locally advanced non-small cell lung cancer. Med Oncol. 2013;30(1):449–449. doi: 10.1007/s12032-012-0449-8.
    1. Carvalho H, Saito NH, Gomes HC, Aquilar PB, Nadalin W. Hypofractionated radiotherapy in advanced lung cancer. Radiol Bras. 1996;29(2):81–84.
    1. Gabrielli FC, Abreu CE, Carvalho HA. Radioterapia torácica paliativa hipofracionada conformacional experiência e resultados do Hospital Sírio-Libanês. Rev Bras Cancerol. 2011;57:566–566.
    1. Sociedade Brasileira de Radioterapia . Braquiterapia no Brasil: análise do perfil dos centros de tratamento. São Paulo: a Sociedade; 2015.
    1. de Aquino Gorayeb MM, Gregório MG, de Oliveira EQ, Aisen S, Carvalho Hde A. High-dose-rate brachytherapy in symptom palliation due to malignant endobronchial obstruction a quantitative assessment. Brachytherapy. 2013;12(5):471–478. doi: 10.1016/j.brachy.2012.10.007.
    1. Barrios P, Debiasi M, Lopes G, Barrios C. Impact of regulatory delays for cancer treatments in Brazil: An estimate of life-years lost due to the lack of approval of crizotinib for the treatment of ALK-positive lung cancer patients.; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Younes RN, Pereira JR, Fares AL, Gross JL. Chemotherapy beyond first-line in stage IV metastatic non-small cell lung cancer. Rev Assoc Med Bras (1992) 2011;57(6):686–691. doi: 10.1590/S0104-42302011000600017.
    1. Naime FF, Younes RN, Kersten BG, Anelli A, Beato CA, Andrade RM. Metastatic non-small cell lung cancer in Brazil treatment heterogeneity in routine clinical practice. Clinics (Sao Paulo) 2007;62(4):397–404. doi: 10.1590/S1807-59322007000400005.
    1. Zukin M, Barrios CH, Pereira JR, Ribeiro Rde A, Beato CA, do Nascimento YN. Randomized phase III trial of single-agent pemetrexed versus carboplatin and pemetrexed in patients with advanced non-small-cell lung cancer and Eastern Cooperative Oncology Group performance status of 2. J Clin Oncol. 2013;31(23):2849–2853. doi: 10.1200/JCO.2012.48.1911.
    1. Pereira JR, Martins SJ, Nikaedo SM, Ikari FK. Chemotherapy with cisplatin and vinorelbine for elderly patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) BMC Cancer. 2004;4:69–69. doi: 10.1186/1471-2407-4-69.
    1. Caires-Lima R. Erlotinib in metastatic pulmonary adenocarcinomas harbouring EGFR activating mutations in São Paulo--Brazil; 15th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Freitas HC, Saito AO, Santos FN, Cunha IW, Dettino ALA, Macedo MP. Treatment and clinical evolution of a cohort of 105 EGFR mutant patients from a single institution; 16th World Conference on Lung Cancer; Aurora(USA): IASLC; 2015.
    1. Zylberberg R, Reinart T, Carbone DP, Araujo LH. Clinical outcomes and prognostic factors of patients with advanced non-small cell lung treated in clinical trials in Brazil: A single institution experience. J Clin Oncol. 2014;32:e19144
    1. Leite GM, França MVS, Santana LM, Taveira MC, Zanardo G, Teles LT, et al. Descrição epidemiológica e clínica dos pacientes com câncer de pulmão tratados no Hospital Universitário de Brasília; XVIII Congresso da Sociedade Brasileira de Oncologia Clínica; Brasília: São Paulo: Sociedade Brasileira de Oncologia Clínica; 2013.
    1. Pereira AA, Martins SJ, Lessa RC, Pinto FA, Gagliato DM, Santos ES, et al. Comparison of bevacizumab versus pemetrexed in combination with platinum-based doublets in first-line treatment of advanced non-small cell lung cancer. J Clin Oncol. 2012;30:e18078
    1. Jardim DL, Gagliato Dde M, Ribeiro KB, Shimada AK, Katz A. Bevacizumab as first-line therapy in advanced non-small-cell lung cancer a Brazilian center experience. Drugs R D. 2012;12(4):207–216. doi: 10.2165/11636760-000000000-00000.

Source: PubMed

3
購読する