JOSE ELUF NETO
Projetos de Pesquisa
Unidades Organizacionais
LIM/38 - Laboratório de Epidemiologia e Imunobiologia, Hospital das Clínicas, Faculdade de Medicina - Líder
54 resultados
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Agora exibindo 1 - 10 de 54
- Follow-up of women screened for cervical cancer in S & atilde;o Paulo, Brazil: An analysis of the times to diagnostic investigation and treatment(2021) RIBEIRO, Caroline Madalena; SILVA, Isabel dos Santos; NETO, Jose Eluf; CURY, Lise Cristina Pereira Baltar; SILVA, Gulnar Azevedo eBackground: Cervical cancer incidence and mortality rates are higher in Brazil than in western countries. Access to cytology-based screening has increased in the country in recent decades, but few studies have assessed the quality of the follow-up care of women with abnormal screening tests that require further investigation. Methods: A record-linkage cohort study was conducted in Sa & tilde;o Paulo state. Women aged 25+ years, who were screened in 2010, and whose test revealed a high-grade, or more severe, lesion were eligible. Follow-up information on diagnostic investigations, treatments and mortality was obtained through record-linkage of health databases. The Kaplan-Meier method was used to estimate median times between screening and diagnostic investigation, and diagnosis and treatment initiation. Cox survival models were used to identify correlates of the length of these time intervals. Results: 4300 women had a high-grade, or more severe, test result. Of these, 2788 (64.8 %) had a diagnostic investigation record, 1763 (41 %) a confirmed diagnosis of a precursor lesion or cancer, and 1247 (70.7 %) a treatment record. The median time to diagnosis was 190 days, with the probability of undergoing a diagnostic investigation within 30 days of the abnormal screening test being 7%. The median time to treatment was 81 days, with the probability of undergoing treatment within 60 days of a confirmed diagnosis being 44 %. Delays in diagnosis and treatment were associated with area-based healthcare indicators. Conclusion: Times to diagnosis and treatment were long, well above recommendations. Strategies to improve follow-up care must be prioritized to ensure screening reduces cervical cancer incidence and mortality.
- Factors influencing HPV vaccine delivery by healthcare professionals at public health posts in Sao Paulo, Brazil(2017) FIGUEROA-DOWNING, Daniella; BAGGIO, Maria Luiza; BAKER, Misha L.; CHIANG, Ellen Dias De Oliveira; VILLA, Luisa L.; NETO, Jose Eluf; EVANS, Dabney P.; BEDNARCZYK, Robert A.Objective: To assess the association between Brazilian healthcare providers' characteristics and their knowledge, perceptions, and practices regarding the HPV vaccine. Methods: An observational cross-sectional study was conducted at five public health posts in Sao Paulo between July 28 and August 8, 2014. Healthcare professionals directly involved in patient care were asked to complete a written survey. Factors associated with routine verification of HPV vaccination status were evaluated using Poisson regression. Results: Among 200 participants included, 74 (38.5%) reported never and 70 (36.5%) reported always asking about HPV immunization status. Doctors were significantly less likely to report always asking than were community health agents (5/39 [12.8%] vs 32/60 [53.3%]; adjusted prevalence ratio [aPR] 0.25 [95% confidence interval (CI) 0.07-0.91]). Knowledge about the correct dosing schedule was associated with-always rather than never verifying vaccination status (aPR 2.46 [95% CI 1.06-5.70]). Conclusion: Knowledge and attitude played secondary roles in influencing HPV vaccine verification. Community health agents were crucial for vaccine promotion; continued education and support of this group is essential for the sustained success of HPV immunization efforts in Brazil.
- Critical Analyses of the Introduction of Liquid-Based Cytology in a Public Health Service of the State of Sao Paulo, Brazil(2015) LONGATTO-FILHO, Adhemar; LEVI, Jose Eduardo; MARTINS, Toni Ricardo; COHEN, Diane; CURY, Lise; VILLA, Luisa Lina; ELUF-NETO, JoseObjective: The aim of this study was to compare the performance of the current conventional Pap smear with liquidbased cytology (LBC) preparations. Study Design: Women routinely undergoing their cytopathological and histopathological examinations at Fundacao Oncocentro de Sao Paulo (FOSP) were recruited for LBC. Conventional smears were analyzed from women from other areas of the State of Sao Paulo with similar sociodemographic characteristics. Results: A total of 218,594 cases were analyzed, consisting of 206,999 conventional smears and 11,595 LBC. Among the conventional smears, 3.0% were of unsatisfactory preparation; conversely, unsatisfactory LBC preparations accounted for 0.3%. The ASC-H (atypical squamous cells -cannot exclude high-grade squamous intraepithelial lesion) frequency did not demonstrate any differences between the twomethods. In contrast, the incidence of ASC-US (atypical squamous cells of undetermined significance) was almost twice as frequent between LBC and conventional smears, at 2.9 versus 1.6%, respectively. An equal percentage of highgrade squamous intraepithelial lesions were observed for the two methods, but not for low-grade squamous intraepithelial lesions, which were more significantly observed in LBC preparations than in conventional smears (2.2 vs. 0.7%). The index of positivity was importantly enhanced from 3.0% (conventional smears) to 5.7% (LBC). Conclusions : LBC performed better than conventional smears, and we are truly confident that LBC can improve public health strategies aimed at reducing cervical lesions through prevention programs. (C) 2015 S. Karger AG, Basel
- Cigarette, Cigar, and Pipe Smoking and the Risk of Head and Neck Cancers: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium(2013) WYSS, Annah; HASHIBE, Mia; CHUANG, Shu-Chun; LEE, Yuan-Chin Amy; ZHANG, Zuo-Feng; YU, Guo-Pei; WINN, Deborah M.; WEI, Qingyi; TALAMINI, Renato; SZESZENIA-DABROWSKA, Neonila; STURGIS, Erich M.; SMITH, Elaine; SHANGINA, Oxana; SCHWARTZ, Stephen M.; SCHANTZ, Stimson; RUDNAI, Peter; PURDUE, Mark P.; ELUF-NETO, Jose; MUSCAT, Joshua; MORGENSTERN, Hal; MICHALUART JR., Pedro; MENEZES, Ana; MATOS, Elena; MATES, Ioan Nicolae; LISSOWSKA, Jolanta; LEVI, Fabio; LAZARUS, Philip; VECCHIA, Carlo La; KOIFMAN, Sergio; HERRERO, Rolando; HAYES, Richard B.; FRANCESCHI, Silvia; WUENSCH-FILHO, Victor; FERNANDEZ, Leticia; FABIANOVA, Eleonora; DAUDT, Alexander W.; MASO, Luigino Dal; CURADO, Maria Paula; CHEN, Chu; CASTELLSAGUE, Xavier; CARVALHO, Marcos Brasilino de; CADONI, Gabriella; BOCCIA, Stefania; BRENNAN, Paul; BOFFETTA, Paolo; OLSHAN, Andrew F.Cigar and pipe smoking are considered risk factors for head and neck cancers, but the magnitude of effect estimates for these products has been imprecisely estimated. By using pooled data from the International Head and Neck Cancer Epidemiology (INHANCE) Consortium (comprising 13,935 cases and 18,691 controls in 19 studies from 1981 to 2007), we applied hierarchical logistic regression to more precisely estimate odds ratios and 95% confidence intervals for cigarette, cigar, and pipe smoking separately, compared with reference groups of those who had never smoked each single product. Odds ratios for cigar and pipe smoking were stratified by ever cigarette smoking. We also considered effect estimates of smoking a single product exclusively versus never having smoked any product (reference group). Among never cigarette smokers, the odds ratio for ever cigar smoking was 2.54 (95% confidence interval (CI): 1.93, 3.34), and the odds ratio for ever pipe smoking was 2.08 (95% CI: 1.55, 2.81). These odds ratios increased with increasing frequency and duration of smoking (P-trend <= 0.0001). Odds ratios for cigar and pipe smoking were not elevated among ever cigarette smokers. Head and neck cancer risk was elevated for those who reported exclusive cigar smoking (odds ratio = 3.49, 95% CI: 2.58, 4.73) or exclusive pipe smoking (odds ratio = 3.71, 95% CI: 2.59, 5.33). These results suggest that cigar and pipe smoking are independently associated with increased risk of head and neck cancers.
- European ancestry and polymorphisms in DNA repair genes modify the risk of melanoma: A case-control study in a high UV index region in Brazil(2011) GONCALVES, Fernanda T.; FRANCISCO, Guilherme; SOUZA, Sonia P. de; LUIZ, Olinda C.; FESTA-NETO, Cyro; SANCHES, Jose A.; CHAMMAS, Roger; GATTAS, Gilka J. F.; ELUF-NETO, JoseBackground: UV radiation is the major environmental factor related to development of cutaneous melanoma. Besides sun exposure and the influence of latitude, some host characteristics such as skin phototype and hair and eye color are also risk factors for melanoma. Polymorphisms in DNA repair genes could be good candidates for susceptibility genes, mainly in geographical regions exposed to high solar radiation. Objective: Evaluate the role of host characteristic.; and DNA repair polymorphism in melanoma risk in Brazil. Methods: We carried out a hospital-based case-control study in Brazil to evaluate the contribution of host factors and polymorphisms in DNA repair to melanoma risk. A total of 412 patients (202 with melanoma and 210 controls) were analyzed regarding host characteristics for melanoma risk as well as for 11 polymorphisms in DNA repair genes. Results: We found an association of host characteristics with melanoma development, such as eye and hair color, fair skin, history of pigmented lesions removed, sunburns in childhood and adolescence, and also European ancestry. Regarding DNA repair gene polymorphisms, we found protection for the XPG 1104 His/His genotype (OR 0.32; 95% CI 0.13-0.75), and increased risk for three polymorphisms in the XPC gene (PAT+; IV-6A and 939Gln), which represent a haplotype for XPC. Melanoma risk was higher in individuals carrying the complete XPC haplotype than each individual polymorphism (OR 3.64; 95% CI 1.77-7.48). Conclusions: Our data indicate that the host factors European ancestry and XPC polymorphisms contributed to melanoma risk in a region exposed to high sun radiation.
- Genome-wide association study of HPV seropositivity(2011) CHEN, Dan; MCKAY, James D.; CLIFFORD, Gary; GABORIEAU, Valerie; CHABRIER, Amelie; WATERBOER, Tim; ZARIDZE, David; LISSOWSKA, Jolanta; RUDNAI, Peter; FABIANOVA, Eleonora; BENCKO, Vladimir; JANOUT, Vladimir; FORETOVA, Lenka; MATES, Ioan Nicolae; SZESZENIA-DABROWSKA, Neonila; CURADO, Maria Paula; KOIFMAN, Sergio; MENEZES, Ana; WUENSCH-FILHO, Victor; ELUF-NETO, Jose; GARROTE, Leticia Fernandez; MATOS, Elena; ZELENIKA, Diana; BOLAND, Anne; BOFFETTA, Paolo; PAWLITA, Michael; LATHROP, Mark; BRENNAN, PaulHigh-risk alpha mucosal types of human papillomavirus (HPV) cause anogenital and oropharyngeal cancers, whereas beta cutaneous HPV types (e.g. HPV8) have been implicated in non-melanoma skin cancer. Although antibodies against the capsid protein L1 of HPV are considered as markers of cumulative exposure, not all infected persons seroconvert. To identify common genetic variants that influence HPV seroconversion, we performed a two-stage genome-wide association study. Genome-wide genotyping of 316 015 single nucleotide polymorphisms was carried out using the Illumina HumanHap300 BeadChip in 4811 subjects from a central European case-control study of lung, head and neck and kidney cancer that had serology data available on 13 HPV types. Only one association met genome-wide significance criteria, namely that between HPV8 seropositivity and rs9357152 [odds ratio (OR) = 1.37, 95% confidence interval (CI) = 1.24-1.50 for the minor allele G; P = 1.2 x 10(-10)], a common genetic variant (minor allele frequency = 0.33) located within the major histocompatibility complex (MHC) II region at 6p21.32. This association was subsequently replicated in an independent set of 2344 subjects from a Latin American case-control study of head and neck cancer (OR = 1.35, 95% CI = 1.18-1.56, P = 2.2 x 10(-5)), yielding P = 1.3 x 10(-14) in the combined analysis (P-heterogeneity = 0.87). No heterogeneity was noted by cancer status (controls/lung cancer cases/head and neck cancer cases/kidney cancer cases). This study provides a proof of principle that genetic variation plays a role in antibody reactivity to HPV infection.
- Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases(2018) REZENDE, Leandro Fornias Machado de; SA, Thiago Herick de; MARKOZANNES, Georgios; REY-LOPEZ, Juan Pablo; LEE, I-Min; TSILIDIS, Konstantinos K.; IOANNIDIS, John P. A.; ELUF-NETO, JoseObjective To provide an overview of the breadth and validity of claimed associations between physical activity and risk of developing or dying from cancer. Design Umbrella review. Data sources We searched Medline, Embase, Cochrane Database and Web of Science. Eligibility criteria for selecting studies Systematic reviews about physical activity and cancer incidence and cancer mortality in different body sites among general population. Results We included 19 reviews covering 22 cancer sites, 26 exposure-outcome pairs metaanalyses and 541 original studies. Physical activity was associated with lower risk of seven cancer sites (colon, breast, endometrial, lung, oesophageal, pancreas and meningioma). Only colon (a protective association with recreational physical activity) and breast cancer (a protective association with overall physical activity) were supported by strong evidence and highly suggestive evidence, respectively. Evidence from endometrial, lung, oesophageal, pancreas and meningioma presented hints of uncertainty and bias in the literature (eg, not reaching P values < 10(-6)) showing large between-study heterogeneity and/or not demonstrating a definite direction for the effect when 95% prediction intervals were considered. Four of the 26 meta-analyses showed small study effects and 4 showed excess significance. Conclusion Physical activity is associated with a lower risk of several cancers, but only colon and breast cancer associations were supported by strong or highly suggestive evidence, respectively. Evidence from other cancer sites was less consistent, presenting hints of uncertainty and/or bias.
- Clinically significant changes in health-related quality of life in head and neck cancer patients following intensive nutritional care during radiotherapy(2022) FARIA, Sheilla de Oliveira; LIMA, Graziele Aparecida Simoes; CARVALHO, Andre Lopes; MARTA, Gustavo Nader; HOWELL, Doris; ELUF-NETO, JosePurpose: This study aimed to explore whether adherence to intensive nutritional care during radiotherapy would avoid a meaningful worsening in quality of life in head and neck cancer patients; and whether adherence was associated with better nutritional outcomes. Methods: Observational prospective study that assessed head and neck cancer patients treated with radiotherapy at a large oncology hospital, between August 2018 and April 2019. The main outcome was minimal clinically important difference in quality of life, assessed with EORTC QLQ-C30 and EORTC QLQ H&N35, between baseline and 12 weeks. To illustrate clinically significant changes in quality of life over timeby adherence, a heat map analysis was performed. We also evaluated nutritional outcomes. Results: Eighty patients were included, half of them (53.8%) were considered adherent. There were no significant difference in quality of life between groups at baseline, with the exception of swallowing (p = 0.029) and coughing (p < 0.01). After treatment, the heat map demonstrated that adherent patients had nonsignificant clinical change in function scales, while non-adherent patients had a clinically significant worsening in physical, cognitive and social function. The prevalence of malnutrition increased significantly only in non-adherent patients (p < 0.01). Conclusion: Adherence to intensive nutritional care may be able to avoid a meaningful worsening in quality of life and result in better nutritional outcomes in head and neck cancer patients. Our results may help to increase the awareness of the assessment of adherence and minimal clinically important difference in quality of life for research purposes and clinical practice.
- High-Risk HPV Testing in Primary Screening for Cervical Cancer in the Public Health System, Sao Paulo, Brazil(2019) LEVI, Jose Eduardo; MARTINS, Toni Ricardo; LONGATTO-FILHO, Adhemar; COHEN, Diane Dede; CURY, Use; FUZA, Luiz Mario; VILLA, Luisa L.; ELUF-NETO, JoseEvery year there are approximately 16,000 new cases of cervical cancer in Brazil. Novel screening technologies may reduce this number by expanding the population coverage but also by improving the detection rate of precursor lesions. We aimed to evaluate human papillomaviruses (HPV)-DNA testing in the context of routine cervical cancer screening in the public health system of the city of Sao Paulo, Brazil. Women participating in the primary screening program were invited to enroll. Liquid-based cytology samples were collected and cytology and Hr-HPV DNA testing were performed in parallel. Cytologists were blind to I IPV results. Women older than 24 years with a positive high-risk HPV test and/or cytology class >= ASC-US were referred to colposcopy. From December 2014 to December 2016, 16,102 women joined the study. High-risk human papillomavirus (HR HPV) DNA prevalence was 14.9%, whereas cytologic abnormalities were found in 7,2% of the women. Per protocol, 1,592 Hr-HPV+ women, in addition to 72 patients with cytologic classification > low-grade squamous intraepithelial lesion (LSIL) were referred. A total of 80 cervical intraepithelial neoplasia (CIN2(+)) cases were diagnosed, 79 were Hr-HPV DNA(+) and 18 had normal cytology. Hr-HPV DNA detected a significant number of patients with premalignant lesions missed by cytology and all 16 CIN3(+) cases were Hr-HPV DNA(+). HPV genotyping may be useful in the management of Hr-HPV+ women, reducing the burden of colposcopic referral for those harboring genotypes with a weaker association to CIN3(+). Use of HPV-DNA testing was shown to be feasible and advantageous over current cytologic screening in the public health system.
- Arg72Pro TP53 polymorphism and cancer susceptibility: a comprehensive meta-analysis of 302 case-control studies(2011) FRANCISCO, Guilherme; MENEZES, Paulo Rossi; ELUF-NETO, Jose; CHAMMAS, RogerArg72Pro is a common polymorphism in TP53, showing differences in its biological functions. Case-control studies have been performed to elucidate the role of Arg72Pro in cancer, although the results are conflicting and heterogeneous. Here, we analyzed pooled data from case-control studies to determine the role of Arg72Pro in different cancer sites. We performed a systematic review and meta-analysis of 302 case-control studies that analyzed Arg72Pro in cancer susceptibility. Odds ratios were estimated for different tumor sites using distinct genetic models, and the heterogeneity between studies was explored using I(2) values and meta-regression. We adopted quality criteria to classify the studies. Subgroup analyses were done for tumor sites according to ethnicity, histological, and anatomical sites. Results indicated that Arg72Pro is associated with higher susceptibility to cancer in some tumor sites, mainly hepatocarcinoma. For some tumor sites, quality of studies was associated with the size of genetic association, mainly in cervical, head and neck, gastric, and lung cancer. However, study quality did not explain the observed heterogeneity substantially. Meta-regression showed that ethnicity, allelic frequency and genotyping method were responsible for a substantial part of the heterogeneity observed. Our results suggest ethnicity and histological and anatomical sites may modulate the penetrance of Arg72Pro in cancer susceptibility. This meta-analysis denotes the importance for more studies with good quality and that the covariates responsible for heterogeneity should be controlled to obtain a more conclusive response about the function of Arg72Pro in cancer.