Estudo do perfil epidemiológico reprodutivo e hábitos de vida das mulheres indígenas não aldeadas do Amazonas e seu provável impacto na mortalidade por câncer de mama
Data
2023-08-01
Autores
Guimarães, Lilian Cristina de Souza 
Orientadores
Nazário, Afonso Celso Pinto
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Introdução: A elevada e crescente incidência de câncer de mama é realidade na quase totolidade do planeta. Todavia, a baixa mortalidade por esta neoplasia entre as indígenas do Amazonas, Brasil, é fato intrigante. Apesar de terem menor esperança de vida ao nascer, a magnitude da baixa mortalidade é ainda maior. As indígenas vêm sendo inseridas na comunidade não indígena de forma gradativa e a realidade da baixa mortalidade por câncer de mama pode estar em risco de não ser verdadeira no futuro caso a justificativa esteja no seu perfil epidemiológico reprodutivo e estilo de vida Objetivo: O trabalho busca encontrar variáveis que possam justificar o fato de a indígena do Amazonas morrer menos de câncer de mama quando comparada à não indígena. Para tal, avaliar os fatores epidemiológicos reprodutivos e estilo de vida em mulheres indígenas não aldeadas e comparar com os mesmos dados em mulheres não indígenas. Métodos: Trata-se de estudo transversal, composto de amostra por conveniência em que foi oferecida participação no estudo a todas indígenas atendidas no Ambulatório de Mastologia do Hospital Universitário Getúlio Vargas da Universidade Federal do Amazonas no período de setembro de 2020 a março de 2023. Houve a participação de 126 mulheres: 39 indígenas não aldeadas que vivem em Manaus há mais de 5 anos e se encontram integradas a sociedade, 47 indígenas não aldeadas que vivem em populações ribeirinhas e interiores do Amazonas - ou em Manaus há menos de 5 anos - e 40 não indígenas. Questionário em formato de entrevista foi aplicado com objetivo de avaliar aspectos epidemiológicos e reprodutivos – idade, escolaridade, IMC, menarca, paridade, idade da primeira gestação, amamentação, uso de medicações hormonais - e estilo de vida - tabagismo, consumo de bebidas alcoólicas, hábitos alimentares, atividade física, uso de ervas, raízes e sementes com finalidade terapêutica e prática de hábitos devocionais religiosos. Resultados: Não houve diferença de média de idade, IMC, escolaridade, menarca e paridade entre as pacientes entrevistadas. As indígenas residentes em Manaus apresentaram menor idade de primeira gestação quando comparadas às não indígenas. A variável “tempo de amamentação” não atingiu significância estatística, mas demonstrou índice bastante próximo (p 0,058) e tendência em comprovar que indígenas, independente de local de residência, amamentam por mais tempo. As mulheres não indígenas apresentaram maior tempo de uso de medicações hormonais quando comparadas com indígenas residentes em Manaus; apresentaram maior taxa de exame físico realizado por profissional médico e maior acesso a exames de imagem mamária quando comparadas com ambos os grupos de indígenas. Não houve diferença na avaliação de hábito de consumo de leite, açúcar, frutas, verduras e legumes entre os grupos. Quanto ao hábito de consumo de carnes, as indígenas residentes em populações ribeirinhas e interiores mostraram porcentagens maiores de consumo esporádico de carne bovina (53,2% versus 20%), de consumo esporádico de animais silvestres (51,1% versus 12,5%) e de consumo diário de carnes brancas (29,8% versus 5%) comparativamente às não indígenas. Por outro lado, mulheres não indígenas apresentaram maior porcentagem de nunca ter consumido carne de animais silvestres quando comparadas às indígenas, independente do local de residência. Em mulheres indígenas de populações ribeirinhas, houve menor porcentagem de prática religiosa/espiritual (72,3%) comparativamente aos dois outros grupos (acima de 92%). O consumo de uso de ervas, raízes ou sementes com finalidade terapêutica foi mais observado em indígenas residentes em Manaus quando comparadas às não indígenas. Não houve diferença estatística em relação ao hábito do fumo, ingestão de bebidas alcoólicas ou prática de atividade física entre os grupos. Conclusão: Não foram encontradas variáveis epidemiológicas ou de estilo de vida em ambos os grupos de indígenas que justifiquem o motivo da baixa mortalidade por câncer de mama nessas mulheres. Todavia, apesar da variável “tempo de amamentação” não ter atingido significância estatística, demonstrou índice bastante próximo (p 0,058) e tendência em comprovar que indígenas, independente do local de residência, amamentam por mais tempo, que usufruem desse fator de proteção contra a neoplasia maligna da mama e que têm, nessa variável, uma das possíveis explicações para a baixa mortalidade por câncer de mama.
Introduction: The high and growing incidence of breast cancer is a reality in almost all of the planet. However, the low mortality from this neoplasm among the indigenous people of Amazonas, Brazil, is an intriguing fact. Despite having lower life expectancy at birth, the magnitude of low mortality is even greater. Indigenous women have been gradually included in the non-indigenous community and the reality of low mortality from breast cancer may be at risk of not being true in the future if the justification lies in their reproductive epidemiological profile and lifestyle Objective: The work seeks to find variables that can justify the fact that the indigenous woman from the Amazon dies less from breast cancer when compared to the non-indigenous woman. To this end, evaluate reproductive epidemiological factors and lifestyle in non-village indigenous women and compare them with the same data in non-indigenous women. Methods: This is a cross-sectional study, consisting of a convenience sample in which all indigenous people treated at the Mastology Outpatient Clinic of the Getúlio Vargas University Hospital of the Federal University of Amazonas were offered participation in the study from September 2020 to March 2023. There was the participation of 126 women: 39 non-village indigenous people who have lived in Manaus for more than 5 years and are integrated into society, 47 non-village indigenous people who live in riverside and interior populations of Amazonas - or in Manaus for less than 5 years - and 40 non-indigenous. A questionnaire in interview format was applied with the objective of evaluating epidemiological and reproductive aspects - age, education, BMI, menarche, parity, age at first pregnancy, breastfeeding, use of hormonal medications - and lifestyle - smoking, consumption of alcoholic beverages, eating habits, physical activity, use of herbs, roots and seeds for therapeutic purposes and practice of religious devotional habits. Results: Results: There was no difference in mean age, BMI, education, menarche and parity between the interviewed patients. Indigenous women living in Manaus had a lower age at first pregnancy when compared to non-indigenous women. The variable “breastfeeding time” did not reach statistical significance, but demonstrated a very close index (p 0.058) and a tendency to prove that indigenous people, regardless of place of residence, breastfeed for longer. Non-indigenous women had longer use of hormonal medications when compared to indigenous women living in Manaus; had a higher rate of physical examination performed by a medical professional and greater access to breast imaging exams when compared to both groups of indigenous people. There was no difference in the assessment of the habit of consumption of milk, sugar, fruits, vegetables and legumes between the groups. Regarding meat consumption habits, indigenous women living in riverside and interior populations showed higher percentages of sporadic consumption of beef (53.2% versus 20%), of sporadic consumption of wild animals (51.1% versus 12.5% %) and daily consumption of white meat (29.8% versus 5%) compared to non-indigenous people. On the other hand, non-indigenous women had a higher percentage of never having consumed wild animal meat when compared to indigenous women, regardless of their place of residence. Among indigenous women from riverside populations, there was a lower percentage of religious/spiritual practice (72.3%) compared to the two other groups (above 92%). The consumption of herbs, roots or seeds for therapeutic purposes was more observed among indigenous people living in Manaus when compared to non-indigenous people. There was no statistical difference in relation to smoking habits, alcohol intake or physical activity between the groups. Conclusion: No epidemiological or lifestyle variables were found in both groups of indigenous people that justify the low mortality from breast cancer in these women. However, although the variable “breastfeeding time” did not reach statistical significance, it demonstrated a very close index (p 0.058) and a tendency to prove that indigenous people, regardless of their place of residence, breastfeed for longer, benefiting from this protective factor against malignant neoplasm of the breast and which have, in this variable, one of the possible explanations for the low mortality from breast cancer.
Introduction: The high and growing incidence of breast cancer is a reality in almost all of the planet. However, the low mortality from this neoplasm among the indigenous people of Amazonas, Brazil, is an intriguing fact. Despite having lower life expectancy at birth, the magnitude of low mortality is even greater. Indigenous women have been gradually included in the non-indigenous community and the reality of low mortality from breast cancer may be at risk of not being true in the future if the justification lies in their reproductive epidemiological profile and lifestyle Objective: The work seeks to find variables that can justify the fact that the indigenous woman from the Amazon dies less from breast cancer when compared to the non-indigenous woman. To this end, evaluate reproductive epidemiological factors and lifestyle in non-village indigenous women and compare them with the same data in non-indigenous women. Methods: This is a cross-sectional study, consisting of a convenience sample in which all indigenous people treated at the Mastology Outpatient Clinic of the Getúlio Vargas University Hospital of the Federal University of Amazonas were offered participation in the study from September 2020 to March 2023. There was the participation of 126 women: 39 non-village indigenous people who have lived in Manaus for more than 5 years and are integrated into society, 47 non-village indigenous people who live in riverside and interior populations of Amazonas - or in Manaus for less than 5 years - and 40 non-indigenous. A questionnaire in interview format was applied with the objective of evaluating epidemiological and reproductive aspects - age, education, BMI, menarche, parity, age at first pregnancy, breastfeeding, use of hormonal medications - and lifestyle - smoking, consumption of alcoholic beverages, eating habits, physical activity, use of herbs, roots and seeds for therapeutic purposes and practice of religious devotional habits. Results: Results: There was no difference in mean age, BMI, education, menarche and parity between the interviewed patients. Indigenous women living in Manaus had a lower age at first pregnancy when compared to non-indigenous women. The variable “breastfeeding time” did not reach statistical significance, but demonstrated a very close index (p 0.058) and a tendency to prove that indigenous people, regardless of place of residence, breastfeed for longer. Non-indigenous women had longer use of hormonal medications when compared to indigenous women living in Manaus; had a higher rate of physical examination performed by a medical professional and greater access to breast imaging exams when compared to both groups of indigenous people. There was no difference in the assessment of the habit of consumption of milk, sugar, fruits, vegetables and legumes between the groups. Regarding meat consumption habits, indigenous women living in riverside and interior populations showed higher percentages of sporadic consumption of beef (53.2% versus 20%), of sporadic consumption of wild animals (51.1% versus 12.5% %) and daily consumption of white meat (29.8% versus 5%) compared to non-indigenous people. On the other hand, non-indigenous women had a higher percentage of never having consumed wild animal meat when compared to indigenous women, regardless of their place of residence. Among indigenous women from riverside populations, there was a lower percentage of religious/spiritual practice (72.3%) compared to the two other groups (above 92%). The consumption of herbs, roots or seeds for therapeutic purposes was more observed among indigenous people living in Manaus when compared to non-indigenous people. There was no statistical difference in relation to smoking habits, alcohol intake or physical activity between the groups. Conclusion: No epidemiological or lifestyle variables were found in both groups of indigenous people that justify the low mortality from breast cancer in these women. However, although the variable “breastfeeding time” did not reach statistical significance, it demonstrated a very close index (p 0.058) and a tendency to prove that indigenous people, regardless of their place of residence, breastfeed for longer, benefiting from this protective factor against malignant neoplasm of the breast and which have, in this variable, one of the possible explanations for the low mortality from breast cancer.
Descrição
Citação
GUIMARÃES, Lilian Cristina de Souza. Estudo do perfil epidemiológico reprodutivo e hábitos de vida das mulheres indígenas não aldeadas do Amazonas e seu provável impacto na mortalidade por câncer de mama. 2023. 84 f. Dissertação (Mestrado em Ginecologia) - Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP). São Paulo, 2023.