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Epidemiologic aspects of mortality from oral cancer: understanding the risks to enable the early detection of changes in communication

Abstract:

PURPOSE:

to characterize the epidemiology of oral cancer mortality in the city of Olinda, in the period from 2008 to 2012.

METHODS:

an epidemiological study, population-based, sectional-type, was conducted using data from the Mortality Information System of deaths from oral cancer in the period from 2008 to 2012 in residents of Olinda. The Specific Mortality Coefficient for oral cancer was calculated, and it were analyzed the variables gender, age group, race/skin color, education level, marital status, occupation, anatomic site of cancer and death occurrence location, and the percentage differences were tested using the Yates' corrected Chi-square (α = 5%). Prevalence ratio was measured (α = 5%).

RESULTS:

there were 87 deaths from mouth cancer, resulting in a Specific Mortality Coefficient of 21.5/100,000. There were more deaths among men, unmarried, black or brown skin color, with non-manual occupation, less than 7 years of education, with anatomical location of the tumor in the pharynx and tongue (p < 0,005). The highest prevalence rates were found among men (PR = 3,43), in manual workers (PR = 2.86) and in cases where the cancer occurred in the palate (PR = 4,5).

CONCLUSION:

the identification of epidemiological aspects that present the greatest risk for mortality from oral cancer will guide the planning of health interventions and Speech Therapy.

Keywords:
Mouth Neoplasms; Mortality Registries; Stomatognathic System

Resumo:

OBJETIVOS:

caracterizar os aspectos epidemiológicos da mortalidade por câncer de boca, no município de Olinda, no período de 2008 a 2012.

MÉTODOS:

foi realizado um estudo epidemiológico, de base populacional, do tipo seccional, a partir dos dados do Sistema de Informação de Mortalidade dos óbitos por câncer de boca no período de 2008 a 2012, em residentes de Olinda. Foi calculado o coeficiente de mortalidade específico por câncer de boca, e foram analisadas as variáveis sexo, faixa etária, raça/cor, grau de instrução, estado civil, ocupação, sitio anatômico do câncer e local de ocorrência do óbito, e as diferenças percentuais foram testadas pelo Qui-quadrado corrigido de Yates (α=5%). Foi mensurada a razão de prevalência (α=5%).

RESULTADOS:

ocorreram 87 óbitos por câncer de boca, perfazendo um coeficiente de mortalidade específico de 21,5/ 100.000 habitantes. Houve predomínio dos óbitos entre homens, não casados, em pretos ou pardos, com ocupação não braçal, escolaridade inferior a 7 anos de estudo, com localização anatômica do tumor em faringe e língua (p<0,005). As maiores razões de prevalência foram encontradas entre os homens (RP=3,43), em trabalhadores braçais (RP= 2,86) e nos casos em que o câncer ocorreu no palato (RP=4,5).

CONCLUSÃO:

a identificação dos aspectos epidemiológicos que apresentam os maiores riscos para a mortalidade por câncer de boca orientará o planejamento das intervenções em saúde e em Fonoaudiologia.

Descritores:
Neoplasias Bucais; Registros de Mortalidade; Sistema Estomatognático

Introduction

Cancer is recognized as a public health issue in Brazil, particularly due to two aspects: firstly, the increase in registered cases and mortality, proportional to demographic growth, population aging and socioeconomic development. Secondly, the challenge that it represents to the health system to guarantee effective and equal access of the people to diagnosis and treatment of the disease 1. Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Acesso à assistência oncológica: Origem dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama. Cad. Saúde Pública. 2011;27(2):317-26..

Among the most frequent types of cancer in the world, head and neck cancer are on sixth place, representing about 3% of every neoplasms. Of these, 40% occur on the mouth, 25% on the larynx, 15% on the pharynx and 20% on other anatomic sites, including salivary glands 2. INCA: Instituto Nacional de Câncer. Ações de enfermagem para o controle do câncer: uma proposta de integração ensino-serviço. / Instituto Nacional de Câncer. - 3r. ed. Rio de Janeiro: INCA; 2008.. On 2012, 300.000 new cases of mouth cancer occurred and 145.000 died because of it 3. INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014..

It is considered mouth cancer the one located in the oral cavity, including oropharynx, and in all the structures inside it. It is the sixth most frequent case in Brazil and the fourth in Northeast region2. INCA: Instituto Nacional de Câncer. Ações de enfermagem para o controle do câncer: uma proposta de integração ensino-serviço. / Instituto Nacional de Câncer. - 3r. ed. Rio de Janeiro: INCA; 2008. 4. Santos FD, Montovani J, Soares CT, Carvalho LR. Expressão da P53 no tumor e no epitélio oral em pacientes com câncer de boca e faringe. Arquivos Int Otorrinolaringol [serial on the Internet]. 2011 Mar [cited 2014 Set 08]; 15 (01): [about 6 p.]. Available from: http://www.scielo.br/scielo.php?pid=S1809-48722011000100006&script=sci_arttext
http://www.scielo.br/scielo.php?pid=S180...
, being considered the most common head and neck cancer when excluded the non-melanoma skin cancer. In 2014, there was an estimated amount of 15.290 new cases of mouth cancer in Brazil, being 11.280 in men and 4.010 in women. These values correspond to an estimated risk of 11,54 new cases for every 100.000 men and 3,92 for every 100.000 women 3. INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014. 5. Campos RJDS, Leite ICG. Qualidade de vida e voz pós-radioterapia: repercussões para a fonoaudiologia. Rev CEFAC. 2010;12(4):671-7..

Mouth cancer is recognized as the most serious disease to affect the mouth, causing 4.891 deaths in 2010, 3.882 men and 1.009 women, placed third on the rank of lethality by neoplasms 2. INCA: Instituto Nacional de Câncer. Ações de enfermagem para o controle do câncer: uma proposta de integração ensino-serviço. / Instituto Nacional de Câncer. - 3r. ed. Rio de Janeiro: INCA; 2008. 6. BRASIL, Ministério da Saúde. Instituto Nacional de Câncer. Estimativa 2010: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2009.. The death rates by mouth cancer on males have presented a decrease in most countries, but such values are still high in Brazil 3. INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014..

Despite the seriousness of the disease, the early detection through clinical exams on mouth tissues can discover potentially malignant abnormalities that, when discovered in early stages, enables a less aggressive treatment and a better prognosis 3. INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014..

In Brazil, the tongue is the structure with most occurrence of mouth cancer, with 32% of cases, followed by the oropharynx (18,5%) and the floor of the mouth (12,4%). Epidermoid carcinoma is the most frequent tissue type 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5..

Nowadays, cancer is the third major death cause in Brazil, behind heart conditions and external causes. When considering individuals older than 40 years, cancer becomes the second major death cause, preceded only by heart conditions 8. Oliveira Junior FJM, Cesse EAP. Morbimortalidade do câncer na cidade do Recife na década de 90. Rev. Bras Cancerol. 2005;51(3):201-8. 9. BRASIL, Ministério da Saúde. DATASUS. Informações de Saúde. Mortalidade, 2014. [cited 2014 mar 07]. Available from: http://www.datasus.gov.br/cgi/sim/dxopcao.htm.
http://www.datasus.gov.br/cgi/sim/dxopca...
. The death rates represent the main indicator of a society's health status. In general, malignant neoplasms represent an important cause of morbidity and mortality among chronic and degenerative diseases, stimulating scientific production and, with that, the development of specific actions for the control of these conditions by health services 6. BRASIL, Ministério da Saúde. Instituto Nacional de Câncer. Estimativa 2010: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2009. 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5..

Therefore, this paper aims to characterize the epidemiological aspects of death by mouth cancer in the city of Olinda, for the period from 2008 to 2012.

Methods

This is an epidemiological study, population-based, sectional, developed in the city of Olinda. Olinda is located in the Metropolitan Region of Recife, in the State of Pernambuco, with 379.271 inhabitants. The city presented, in 2010, an average house income of 621,73 reais, and 39,33% of the population received an average of 1/2 a minimal wage, with an unemployment rate of 13,01% and an illiteracy rate of 6,5% 1010 . IBGE: Instituto Brasileiro de Geografia e Estatística. Estimativas populacionais para o TCU em 2012. [cited 2014 abr 20]; Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?ibge/cnv/poptpe.def.
http://tabnet.datasus.gov.br/cgi/tabcgi....
1111 . OLINDA, Secretaria de Saúde de Olinda [internet]. Sala de Situação de Olinda -2012. [cited 2013 Apr 18]; Available from: http://www.saudeolinda.blogspot.com.br/.
http://www.saudeolinda.blogspot.com.br/...
.

This research was approved by the Ethics Committee in Research of the Higher Education Foundation of Olinda (Funeso), under the CAAE number 21394913.9.0000.5194 and report number 420.224/2013.

The population of this study was formed by the universe of deaths which had mouth cancer (CID C00 to C14) as basic death cause, on the period from 2008 to 2012, residents in Olinda.

The data was extracted from the Mortality Information System (SIM), with the consent of the city's Secretary of Health. The period was analyzed in an aggregated form to control the random fluctuations due to the small numbers, according to research strategy already validated by other authors 1212 . Loyola E, Castillho-Salgado C, Aguilar PN, Vidaurre M, Mujica OJ, Piedra RM. Geographic information systems as a tool for monitoring health inequalities. Rev. panam. salud pública. 2002;12(6):415-28. 1616 . Alvarez G. Infant mortality and urban marginalization: a spatial analisys of their relationship in a medium sized city in northwest Mexico. Rev. panam. salud pública. 2009;26(1):31-8..

Many variables were analyzed, such as social (gender, age, race/skin color, instruction level, marital status and occupation), clinical (anatomic site of the cancer) and of access to health services (place of death and its relation to the Unified Health System - SUS). They were described through absolute and relative frequencies and had the percentage difference tested by Yates' chi-squared test, with α = 5%.

The specific coefficient of mortality by death cause was calculated, age-adjusted, using the method of direct standardization, taking Brazil's population as standard. This standardization was used as a way to control possible interferences of population distribution in the city.

Lately, the mortality coefficients for mouth cancer were calculated for the variables gender, age, instruction level, occupation, marital status, race/skin color and frequency site of the primary tumor, measuring the prevalence rate, with α = 5%. As exposure variables, there are: male 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 1717 . Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41., older than 40 years 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 1717 . Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999. 2020 . Moraes TMN. Câncer de Boca: Avaliação do conhecimento dos cirurgiões dentistas quanto aos fatores de risco e procedimentos de diagnósticos. [Dissertação]. São Paulo (SP): Faculdade de Odontologia da USP; 2003. 2323 . Melo MCB, Lorenzato FRB, Filho JEC, Melo ZM, Cardoso SO. A Família e o processo de adoecer de câncer bucal. Rev. Psicol. Estudo. 2005;10(3):413-9., white 1717 . Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999. 2121 . Souza A, Stevaux OM, Santos GG, Marcucci G. Epidemiologia do câncer epidermóide da mucosa bucal - Contribuição ao estudo sobre três variáveis: Sexo, faixa- etária e raça. Rev. de Odontol. UNICID. 1996;8:127-34. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41., up to seven years of study7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5., physical workers2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 2323 . Melo MCB, Lorenzato FRB, Filho JEC, Melo ZM, Cardoso SO. A Família e o processo de adoecer de câncer bucal. Rev. Psicol. Estudo. 2005;10(3):413-9., married2323 . Melo MCB, Lorenzato FRB, Filho JEC, Melo ZM, Cardoso SO. A Família e o processo de adoecer de câncer bucal. Rev. Psicol. Estudo. 2005;10(3):413-9. 2424 . IBGE: Instituto Brasileiro de Geografia e Estatística. Banco de dados agregados do Sistema IBGE de Recuperação Automática - SIDRA. [cited 2014 feb 13]; Availabre from: http://www.sidra.ibge.gov.br/.
http://www.sidra.ibge.gov.br/...
, tongue as most frequent site 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 2020 . Moraes TMN. Câncer de Boca: Avaliação do conhecimento dos cirurgiões dentistas quanto aos fatores de risco e procedimentos de diagnósticos. [Dissertação]. São Paulo (SP): Faculdade de Odontologia da USP; 2003. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41..

For the stratification of the population, according to such categories, we used data from the Brazilian Institute of Geography and Statistics (IBGE), provided by the aggregated databank from the IBGE System of Automatic Recovery (Sidra) 2424 . IBGE: Instituto Brasileiro de Geografia e Estatística. Banco de dados agregados do Sistema IBGE de Recuperação Automática - SIDRA. [cited 2014 feb 13]; Availabre from: http://www.sidra.ibge.gov.br/.
http://www.sidra.ibge.gov.br/...
.

The data processing and analysis were performed by Tabwin, version 3.4, and by Bioestat, version 5.0; the data was presented as a table.

Results

On the period from 2008 to 2012, there were 87 deaths by mouth cancer in Olinda, creating a cause-specific standardized mortality ratio of 21,5/100.000 inhabitants. From the total amount, 74,7% occurred on male individuals (p < 0,0001), 50,57% on non-married (p < 0,0001), 57,47% on older than 60 years, 62,07% on black or pardo (p < 0,0001), 58,62% had a non-physical occupation (p < 0,0001) and 47,13% had less than seven years of study (p < 0,0001). It is important to stress the high level of ignorability of this last variable (37,93%).

In relation to the anatomic site of the mouth cancer, 33,33% was located in the pharynx and 31,03% on the tongue (p < 0,0001). 85,06% of the deaths happened in health facilities, being 83,78% of those services provided by SUS or convened to it (p < 0,0001).

Among the measured prevalence ratios, there is emphasis on male gender, (PR = 3,43; p < 0,001), individuals who are 60 years or older (PR = 2,78; p < 0,001), with less than seven years of study (PR = 3,09; p = 0,002), married (PR = 2,10; p = 0,001), with physical occupations (PR = 2,86; p < 0,001) and with the tongue as the most frequent site (PR = 2,86 related to lip and PR = 4,5 related to palate; p < 0,0001; p = 0,0002), as shown on Table 1.

Table 1:
Epidemiological characteristics of deaths by mouth cancer on the years from 2008 to 2012, Olinda-PE

Discussion

The results of this study allowed to characterize individuals who died because of mouth cancer, showing the most exposed population to this condition. In relation to the variable gender, it was seen that, throughout the studied period, there were more death on males (74,71%), presenting a prevalence ratio of death by mouth cancer of 3,43 (p < 0,001) times higher on men in relation to women, a factor that could be related to the lifestyle of this group, with habits such as smoking and drinking, that when combined can enhance the risk. However, studies have pointed towards growth on the prevalence of such tumors on females, particularly because of changes on the female behavior in the last decades 1818 . Dedivitis RA, França CM, Mafra ACB, Guimarães FT, Guimarães AV. Características clínico- epidemiológicas no carcinoma espinocelular de boca e orofaringe. Rev. Bras. Otorrinolaringol. 2004;70(1):35-40.. The death ratio by gender for this study was 3:1, similar to other studies that depict higher proportion of death by mouth cancer among males 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 1717 . Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999. 1919 . Loranzi RL. Incidência e risco acumulado de câncer de boca no município de São Paulo. [Dissertação].São Paulo (SP): Universidade de São Paulo; 2003. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 2525 . Pernambuco LA, Vilela MBR. Estudo da mortalidade por câncer de laringe no estado de Pernambuco - 2000-2004. Rev. Bras. Otorrinolaringol. 2009;2(75):222-7. 2929 . Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5.. Analyzing data related to death rates according to age group, there was no statistically significant difference between the age intervals (p = 0,2), as found in another similar study 2626 . Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52.. All deaths happened on individuals older than 40 years, with a prevalence ratio of 2,78 (p < 0,001) times higher among individuals who are 60 years or older, a finding also seen in other studies that highlight the occurrence of cases on individuals older than 50 years 1818 . Dedivitis RA, França CM, Mafra ACB, Guimarães FT, Guimarães AV. Características clínico- epidemiológicas no carcinoma espinocelular de boca e orofaringe. Rev. Bras. Otorrinolaringol. 2004;70(1):35-40. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 2626 . Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52. 2828 . Marques LU, Eluf-Neto J, Figueiredo RAO, Góis-Filho JF, Kowalski LP, Carvalho MB et al. Saúde bucal, Práticas de higiene bucal e Ocorrência de Câncer da Cavidade oral. Rev Saúde Pública. 2008;42(3):471-9.. There are molecular reasons, related to the mechanisms of carcinogenesis and proliferation of the tumor cell, associated to the decline of the immune system that favor the higher risk of cancer in individuals older than 60 years. With the aging of the population, it is expected a considerable increase on cancer cases among the elderly population 2929 . Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 3131 . Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128-36..

Most cases consisted of black or pardo individuals (62,07%), disagreeing with other studies that had identified higher representation of morbidity among white individuals 1717 . Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 2626 . Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52. 2828 . Marques LU, Eluf-Neto J, Figueiredo RAO, Góis-Filho JF, Kowalski LP, Carvalho MB et al. Saúde bucal, Práticas de higiene bucal e Ocorrência de Câncer da Cavidade oral. Rev Saúde Pública. 2008;42(3):471-9.. Nonetheless, scientific evidence also points that black or pardo people, when compared to white people, tend to live farther from health services, usually due to unfavorable socioeconomic conditions, making it more difficult to have early diagnosis and specific treatment, leading to an unpleasant end for the disease 1. Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Acesso à assistência oncológica: Origem dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama. Cad. Saúde Pública. 2011;27(2):317-26. 3232 . Holmes JA, Carpenter WR, Wu Y, Hendrix LH, Peacock S, Massing M et al. Impact of distance to a urologist on early diagnosis of prostate cancer among black and white patients. J Urol. 2012;187(3):883-8..

The study also showed that, in the studied population, there's no difference for the death prevalence by death cancer regarding skin color (PR = 0). Possibly there are more people living in Northeast region in Brazil who are identified as pardo 2525 . Pernambuco LA, Vilela MBR. Estudo da mortalidade por câncer de laringe no estado de Pernambuco - 2000-2004. Rev. Bras. Otorrinolaringol. 2009;2(75):222-7..

Concerning education, most deaths occurred among those with less than seven years of study (47,13%), with death by mouth cancer prevalence three times higher than with other individuals (p = 0,002), results similar to likewise studies 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 2626 . Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52. 2929 . Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5.. Such aspect has also been observed in other kinds of cancer. In a research with women with breast cancer, it was detected that the survival rate of those with higher degrees of education was greater than those with less years of study 3333 . Schneides IJC, D'orsi E. Sobrevida em cinco anos e fatores prognósticos em mulheres com câncer de mama em Santa Catarina, Brasil. Cad. Saúde Pública. 2009;25(6):1285-96..

Generally, there is a connection between the level of education and death by mouth cancer, showing that less favored groups tend to experience higher contact with risk factors, such as inadequate nutrition and low mouth health conditions, alto presenting greater difficulty of access to health services and information about the disease. However, the results and conclusions for this variable must be interpreted cautiously, having in mind the high proportion of registries classified as ignored(37,93%).

About the marital status, on the sum of the years, it was found higher death rate among non-married (50,57%), something different from other studies, in which morbidity 2323 . Melo MCB, Lorenzato FRB, Filho JEC, Melo ZM, Cardoso SO. A Família e o processo de adoecer de câncer bucal. Rev. Psicol. Estudo. 2005;10(3):413-9. and mortality by larynx cancer was more frequent among married individuals 2525 . Pernambuco LA, Vilela MBR. Estudo da mortalidade por câncer de laringe no estado de Pernambuco - 2000-2004. Rev. Bras. Otorrinolaringol. 2009;2(75):222-7.. Nevertheless, this study showed that, for mouth cancer, the death risk is higher among married people (PR = 2,10; p = 0,001). Just like level of education, marital status is a risk factor for mouth cancer occurrence. For this research, no reference could establish a direct link between the death occurrence and the individual's marital status, leading that this information is more related to life quality aspects.

Regarding occupation, most deaths occurred on people whose jobs were not related to physical labor (58,62%), but the death rate was 2,86 times higher among physical workers (p < 0,001). Because it is a urban, touristic and residential area, the local population is usually involved in activities related to sales, education and tourism, a difference considering other studies that found a link between mouth and pharynx cancer and other fields of work, like fishing, agriculture, painting, butchery, construction, driving, plumbing, carpet installing, and other activities that demand physical work7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 2626 . Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52..

It was possible to verify that most individuals presented tumor on the pharynx (33,33%), followed by the tongue (31,03%), areas more exposed to the risk factors associated to this type of cancer, like smoking, drinking and infections caused by human papillomavirus (HPV). When comparing to the death prevalence of lip and palate cancer, tongue cancer has a prevalence of 13,5 and 4,5 times higher, respectively (p < 0,0001; p = 0,0002). The tumor in these positions may favor clinical signs of the disease that reflect on speech articulation, and also difficulties on swallowing. Similar results were found on other studies, which point that smoking and drinking, when combined, raises 30 times the risk of mouth cancer, especially on the tongue, pharynx and larynx 3. INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014. 2020 . Moraes TMN. Câncer de Boca: Avaliação do conhecimento dos cirurgiões dentistas quanto aos fatores de risco e procedimentos de diagnósticos. [Dissertação]. São Paulo (SP): Faculdade de Odontologia da USP; 2003. 2222 . Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41. 3434 . Cruz ACS, Franzolin SOB, Pereira AAC, Beijo LA, Hannerman JAC, Cruz JRS. Carcinoma de células escamosas da boca: Concordância diagnóstica em exames realizados no laboratório de anatomia patológica da Universidade Federal de Alfenas. Rev. Bras. Cancerol. 2012;58(4):655-61..

Most registered deaths occurred inside health facilities (85,06%), a fact directly related to the malign and progressive nature of the condition, that during its evolution compromises important systems for the maintenance of vital functions, leading the individual to seek medical care; therefore, it is expected a higher amount of registered deaths in specialized facilities. Of these deaths, 83,78% happened in services provided by Brazil's Unified Health System (SUS) or convened to it. Cancer treatment is widely performed by SUS, which has reference hospitals for the attendance of the disease, from the diagnosis to the specific treatment, providing care for people of every socioeconomical classes 1. Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Acesso à assistência oncológica: Origem dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama. Cad. Saúde Pública. 2011;27(2):317-26..

It was also shown that 14,94% of deaths occurred in the individuals' houses, an aspect that can be justified by the fact that, in many cases of cancer, due to unviability of submitting to more aggressive treatments or not presenting healing perspective, many patients return to their houses and start palliative care, aiming to raise life quality and to have a humanized death. It is up to the attending doctor the decision of letting the patient leave the hospital; however, researches show that patients, when terminal, decide not remain in the hospital 3535 . Baliza MF, Bousso RS, Spineli VMCD, Silva L, Poles K. Cuidados paliativos no domicílio: percepção de enfermeiras da Estratégia Saúde da Família. Acta paul enferm [serial on the Internet]. 2012 n.spe2 [cited 2014 Set 08]; 25 (2): [about 5 p.]. Available from: http://www.scielo.br/scielo.php?pid=S0103-21002012000900003&script=sci_arttext&tlng=pt
http://www.scielo.br/scielo.php?pid=S010...
3737 . Silva KL, Sena RR, Leite JCA, Seixas CT, Gonçalves AM. Internação domiciliar no Sistema Único de Saúde. Rev de Saúde Pública. 2005;9(3):391-7.. Nonetheless, this study is limited to only indicate possible explanations, for its data source was the information system and not direct interviews to health services users. There is also the possibility that the death occurred at home because of difficulty to attend to the public health system, characterizing a system flaw and not a choice by the patient and its family.

It is necessary to highlight the importance of recognition by professionals that work with oral functions of possible epidemiological aspects that expose certain groups to death by mouth cancer. The evolution to communicative loss and other unwanted sequelae, like death, can be avoided or softened when a professional recognizes precociously neoplastic lesions and their effects. Depending on the affected areas and the reparation surgery, individuals could present organic and functional alterations, such as trouble on mobility and on the performance of orofacial structures and functions: speech articulation, voice and deglutition 3838 . Nemr K, Lehn C. Voz em câncer de cabeça e pescoço. In: Ferreira LP, Befi-Lopes DM, Limongi SCO. Tratado de fonoaudiologia. São Paulo: Rocca; 2004. P 102-17..

These communication alterations may be related to deterioration due treatment sequelae, being also possible a link to the adaptations developed in the attempt of overcoming limitations imposed by treatments. The tumor size and its anatomic location influence directly in the individual's communication ability, varying according to the insertion site, possibly causing hearing deterioration, facial paralysis, trismus, dysarthria, dysphagia and changes on the voice resonance 7. Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5. 2828 . Marques LU, Eluf-Neto J, Figueiredo RAO, Góis-Filho JF, Kowalski LP, Carvalho MB et al. Saúde bucal, Práticas de higiene bucal e Ocorrência de Câncer da Cavidade oral. Rev Saúde Pública. 2008;42(3):471-9. 3838 . Nemr K, Lehn C. Voz em câncer de cabeça e pescoço. In: Ferreira LP, Befi-Lopes DM, Limongi SCO. Tratado de fonoaudiologia. São Paulo: Rocca; 2004. P 102-17. 3939 . Felix JD, Zandonade E, Amorim MHC, Castro DS. Avaliação da completitude das variáveis epidemiológicas do Sistema de Informação sobre Mortalidade em mulheres com óbito por câncer de mama na Região Sudeste, Brasil (1998 - 2007). Rev. Ciências e Saúde Coletiva. 2012;17(4):945-53..

Conclusion

It was verified that, on the period from 2008 to 2012, there were 87 deaths by mouth cancer in Olinda (CME 21,5/100.000), with prevalence among males (74,7%), not married (50,57%), older than 60 years (57,47%), black or pardo (62,07%), with nonphysical occupation (58,62%), with less than seven years of study (47,13%) and with tumor located on the pharynx (33,33%) and on the tongue (31,03%). These deaths occurred in health facilities (85,06%), 83,78% of these being services provided by SUS of convened to it.

The identification of epidemiological aspects that present most risks for death by mouth cancer will guide the planning of interventions in health and in Speech Therapy, reducing changes in oral communication and the number of deaths by this type of cancer.

Referências

  • 1
    Oliveira EXG, Melo ECP, Pinheiro RS, Noronha CP, Carvalho MS. Acesso à assistência oncológica: Origem dos fluxos origem-destino das internações e dos atendimentos ambulatoriais. O caso do câncer de mama. Cad. Saúde Pública. 2011;27(2):317-26.
  • 2
    INCA: Instituto Nacional de Câncer. Ações de enfermagem para o controle do câncer: uma proposta de integração ensino-serviço. / Instituto Nacional de Câncer. - 3r. ed. Rio de Janeiro: INCA; 2008.
  • 3
    INCA: Instituto Nacional de Câncer. Estimativa 2014: Incidência de câncer no Brasil. Coordenação de prevenção e vigilância. Rio de Janeiro: INCA, 2014.
  • 4
    Santos FD, Montovani J, Soares CT, Carvalho LR. Expressão da P53 no tumor e no epitélio oral em pacientes com câncer de boca e faringe. Arquivos Int Otorrinolaringol [serial on the Internet]. 2011 Mar [cited 2014 Set 08]; 15 (01): [about 6 p.]. Available from: http://www.scielo.br/scielo.php?pid=S1809-48722011000100006&script=sci_arttext
    » http://www.scielo.br/scielo.php?pid=S1809-48722011000100006&script=sci_arttext
  • 5
    Campos RJDS, Leite ICG. Qualidade de vida e voz pós-radioterapia: repercussões para a fonoaudiologia. Rev CEFAC. 2010;12(4):671-7.
  • 6
    BRASIL, Ministério da Saúde. Instituto Nacional de Câncer. Estimativa 2010: incidência de câncer no Brasil. Rio de Janeiro: INCA, 2009.
  • 7
    Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5.
  • 8
    Oliveira Junior FJM, Cesse EAP. Morbimortalidade do câncer na cidade do Recife na década de 90. Rev. Bras Cancerol. 2005;51(3):201-8.
  • 9
    BRASIL, Ministério da Saúde. DATASUS. Informações de Saúde. Mortalidade, 2014. [cited 2014 mar 07]. Available from: http://www.datasus.gov.br/cgi/sim/dxopcao.htm.
    » http://www.datasus.gov.br/cgi/sim/dxopcao.htm
  • 10
    IBGE: Instituto Brasileiro de Geografia e Estatística. Estimativas populacionais para o TCU em 2012. [cited 2014 abr 20]; Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?ibge/cnv/poptpe.def.
    » http://tabnet.datasus.gov.br/cgi/tabcgi.exe?ibge/cnv/poptpe.def
  • 11
    OLINDA, Secretaria de Saúde de Olinda [internet]. Sala de Situação de Olinda -2012. [cited 2013 Apr 18]; Available from: http://www.saudeolinda.blogspot.com.br/.
    » http://www.saudeolinda.blogspot.com.br/
  • 12
    Loyola E, Castillho-Salgado C, Aguilar PN, Vidaurre M, Mujica OJ, Piedra RM. Geographic information systems as a tool for monitoring health inequalities. Rev. panam. salud pública. 2002;12(6):415-28.
  • 13
    Vilela MBR, Bonfim C, Medeiros Z. Mortalidade infantil por doenças infecciosas e parasitárias: reflexo das desigualdades sociais em um município do Nordeste do Brasil. Rev. bras. saúde mater. infant. 2008;8(4):445.
  • 14
    Nolasco A. Preventable avoidable mortality: Evolution of socioeconomic inequalities in urban areas in Spain, 1996-2003. Health place. 2009;15(3):732-41.
  • 15
    Grandy SC, Enander H. Geographic analysis of low birthweight and infant mortality in Michigan using automated zoning methodology. Int. J. Health Geogr. 2009;8(1):10.
  • 16
    Alvarez G. Infant mortality and urban marginalization: a spatial analisys of their relationship in a medium sized city in northwest Mexico. Rev. panam. salud pública. 2009;26(1):31-8.
  • 17
    Camarini ET. Estudos epidemiológicos dos carcinomas espinocelulares de boca dos pacientes atendidos nas cidades de Baurú e Jaú, Estado de São Paulo, Brasil. [Dissertação]. Baurú (SP): Faculdade de Odontologia de Baurú; 1999.
  • 18
    Dedivitis RA, França CM, Mafra ACB, Guimarães FT, Guimarães AV. Características clínico- epidemiológicas no carcinoma espinocelular de boca e orofaringe. Rev. Bras. Otorrinolaringol. 2004;70(1):35-40.
  • 19
    Loranzi RL. Incidência e risco acumulado de câncer de boca no município de São Paulo. [Dissertação].São Paulo (SP): Universidade de São Paulo; 2003.
  • 20
    Moraes TMN. Câncer de Boca: Avaliação do conhecimento dos cirurgiões dentistas quanto aos fatores de risco e procedimentos de diagnósticos. [Dissertação]. São Paulo (SP): Faculdade de Odontologia da USP; 2003.
  • 21
    Souza A, Stevaux OM, Santos GG, Marcucci G. Epidemiologia do câncer epidermóide da mucosa bucal - Contribuição ao estudo sobre três variáveis: Sexo, faixa- etária e raça. Rev. de Odontol. UNICID. 1996;8:127-34.
  • 22
    Souza RM, Sakae TM, Guedes AL. Características clínico-epidemiológicas de pacientes portadores de carcinomas da cavidade oral e orofaringe em clínica privada no sul do Brasil. Arquivos Catarinenses de Medicina. 2008;37(2):32-41.
  • 23
    Melo MCB, Lorenzato FRB, Filho JEC, Melo ZM, Cardoso SO. A Família e o processo de adoecer de câncer bucal. Rev. Psicol. Estudo. 2005;10(3):413-9.
  • 24
    IBGE: Instituto Brasileiro de Geografia e Estatística. Banco de dados agregados do Sistema IBGE de Recuperação Automática - SIDRA. [cited 2014 feb 13]; Availabre from: http://www.sidra.ibge.gov.br/.
    » http://www.sidra.ibge.gov.br/
  • 25
    Pernambuco LA, Vilela MBR. Estudo da mortalidade por câncer de laringe no estado de Pernambuco - 2000-2004. Rev. Bras. Otorrinolaringol. 2009;2(75):222-7.
  • 26
    Andreotti M, Rodrigues AN, Cardoso LM, Figueiredo RAO, Eluf-Neto J, Wunsch-Filho V. Ocupação e câncer da cavidade oral e orofaringe. Cad. Saúde Pública. 2006;22(3):543-52.
  • 27
    Marchioni DML, Fisberg RM, Góis Filho JF, Kowalshill, LP, Carvalho MB, Abrahão M et al. Fatores dietéticos e câncer oral: estudo de caso-controle na Região metropolitana de São Paulo, Brasil. Rev. Saúde Pública. 2007;23(3):553-64.
  • 28
    Marques LU, Eluf-Neto J, Figueiredo RAO, Góis-Filho JF, Kowalski LP, Carvalho MB et al. Saúde bucal, Práticas de higiene bucal e Ocorrência de Câncer da Cavidade oral. Rev Saúde Pública. 2008;42(3):471-9.
  • 29
    Melo LC, Silva MC, Bernardo JMP, Marques EB, Leite ICG. Perfil epidemiológico de casos incidentes de câncer de boca e faringe. RGO - Rev. Gaúcha Odontol. 2010;58(3):351-5.
  • 30
    Kurtz JE, Heitz D, Enderlin P, Imbert F, Nehme H, Bergerat JP, Dufour P. Geriatric oncology, general practitioners and specialists: current opinions and unmet needs. Crit Rev Oncol Hematol. 2010;75(1):47-57.
  • 31
    Yancik R, Ries LA. Cancer in older persons: an international issue in an aging world. Semin Oncol. 2004;31(2):128-36.
  • 32
    Holmes JA, Carpenter WR, Wu Y, Hendrix LH, Peacock S, Massing M et al. Impact of distance to a urologist on early diagnosis of prostate cancer among black and white patients. J Urol. 2012;187(3):883-8.
  • 33
    Schneides IJC, D'orsi E. Sobrevida em cinco anos e fatores prognósticos em mulheres com câncer de mama em Santa Catarina, Brasil. Cad. Saúde Pública. 2009;25(6):1285-96.
  • 34
    Cruz ACS, Franzolin SOB, Pereira AAC, Beijo LA, Hannerman JAC, Cruz JRS. Carcinoma de células escamosas da boca: Concordância diagnóstica em exames realizados no laboratório de anatomia patológica da Universidade Federal de Alfenas. Rev. Bras. Cancerol. 2012;58(4):655-61.
  • 35
    Baliza MF, Bousso RS, Spineli VMCD, Silva L, Poles K. Cuidados paliativos no domicílio: percepção de enfermeiras da Estratégia Saúde da Família. Acta paul enferm [serial on the Internet]. 2012 n.spe2 [cited 2014 Set 08]; 25 (2): [about 5 p.]. Available from: http://www.scielo.br/scielo.php?pid=S0103-21002012000900003&script=sci_arttext&tlng=pt
    » http://www.scielo.br/scielo.php?pid=S0103-21002012000900003&script=sci_arttext&tlng=pt
  • 36
    Brumley R, Enguidanos S, Jamilson P, Seitz R, Morgenstem N, Saito S. Increased satisfaction with care and lower costs: results of a randomized trial of in-home palliative care. J Am Geriatr Soc. 2007;55(7):993-1000.
  • 37
    Silva KL, Sena RR, Leite JCA, Seixas CT, Gonçalves AM. Internação domiciliar no Sistema Único de Saúde. Rev de Saúde Pública. 2005;9(3):391-7.
  • 38
    Nemr K, Lehn C. Voz em câncer de cabeça e pescoço. In: Ferreira LP, Befi-Lopes DM, Limongi SCO. Tratado de fonoaudiologia. São Paulo: Rocca; 2004. P 102-17.
  • 39
    Felix JD, Zandonade E, Amorim MHC, Castro DS. Avaliação da completitude das variáveis epidemiológicas do Sistema de Informação sobre Mortalidade em mulheres com óbito por câncer de mama na Região Sudeste, Brasil (1998 - 2007). Rev. Ciências e Saúde Coletiva. 2012;17(4):945-53.
  • Information source: Secretary of Health of Olinda-PE

Publication Dates

  • Publication in this collection
    Aug 2015

History

  • Received
    05 Aug 2014
  • Accepted
    16 Dec 2014
ABRAMO Associação Brasileira de Motricidade Orofacial Rua Uruguaiana, 516, Cep 13026-001 Campinas SP Brasil, Tel.: +55 19 3254-0342 - São Paulo - SP - Brazil
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