Carolina Wiesner

Seguimiento de mujeres con anormalidad citológica de cuello uterino, en Colombia

OBJECTIVE Evaluating the opportunity and access to diagnosis and treatment for females having had an abnormal Pap smear (high-grade epithelial lesion and cervical cancer) in Colombia from June 2005 to June 2006. MATERIALS AND METHODS This was a retrospective appraisal using a semi-closed survey of females having had an abnormal Pap smear with high squamous intraepithelial lesions or cervical cancer living in four Colombian departments. These areas were conveniently selected according to their different mortality rates. A descriptive analysis was made and the departments differences compared. RESULTS It was found that 27 % of females having high-grade squamous intraepithelial lesion or cervical cancer had no access to any of the diagnostic or therapeutic services. Health service administration problems and clinical and cultural ones affecting the females in the study could explain such results. DISCUSSION Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998–2007

Background There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage. Methods Population mortality data (1998–2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25–64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality. Results We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. Conclusions There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality.

HPV vaccine introduction at the local level in a developing country: attitudes and criteria among key actors

In most developing countries, HPV vaccines have been licensed but there are no national policy recommendations, nor is it clear how decisions on the introduction of this new vaccine are made. Decentralization processes in many Latin American countries favor decision-making at the local level. Through a qualitative study we explored knowledge regarding the HPV vaccine and the criteria that influence decision-making among local health actors in four regions of Colombia. We conducted a total of 14 in-depths interviews with different actors; for the analysis we performed content analysis. Results indicate that decision-making on the HPV vaccine at the local level has mainly been driven by pressure from local political actors, in a setting where there is low technical knowledge of the vaccine. This increases the risk of initiatives that may foster inequity. Local decisions and initiatives need to be strengthened technically and supported by national-level decisions, guidelines and follow-up.

Aceptabilidad de la vacuna contra el Virus Papiloma Humano en padres de adolescentes, en Colombia

Objetivo La vacuna contra el VPH es una nueva tecnologia disponible para el control del cancer de cuello uterino. Se espera, que en el menor tiempo posible esta vacuna pueda tener cobertura universal. Este articulo presenta la aceptabilidad que tiene los padres de adolescentes en Colombia hacia la vacuna contra el VPH y hace una aproximacion a sus determinantes. Metodos Estudio cualitativo en cuatro regiones en Colombia. Se realizaron 17 grupos focales con padres de ninas y ninos entre 11 a 14 anos estudiantes de colegios publicos y privado. Se realizo analisis de contenido por etapas: lectura abierta, codificacion, analisis estructural e interpretacion critica. Se compararon los resultados por region. Resultados El 85 % de los convocados participaron. Los padres de colegios oficiales, estaban dispuestos a vacunar a su hija (o) s y harian un esfuerzo frente a los altos costos de la vacuna. Vacunar a la edad de 12 anos para prevenir una infeccion de transmision sexual, genera resistencia. Los padres de colegios privados fueron mas criticos y expresaron una menor aceptabilidad. En dos regiones consideran que vacunar tiene el riesgo de promover la promiscuidad. Conclusiones La aceptabilidad a la vacuna varia en relacion con el contexto sociocultural y educativo. Promover la vacuna para prevenir una infeccion de transmision sexual en ninas muy jovenes (<12 anos) puede generar obstaculos para su aceptabilidad; se recomienda promoverla para prevencion del cancer de cuello uterino.

Conocimientos, aceptabilidad y actitudes sobre la vacuna contra el VPH en médicos generales, ginecólogos y pediatras en Colombia

Resumen Objetivo Explorar en medicos generales, ginecologos y pediatras colombianos sus conocimientos generales sobre el virus del papiloma humano (VPH), asi como la actitud, disposicion personal y percepcion que tienen sobre la vacuna contra el VPH. Metodo Estudio exploratorio con metodologia cualitativa en cuatro regiones de Colombia. En cada una se conformo un grupo focal con medicos generales, ginecologos y pediatras. Todas las sesiones se grabaron y se transcribieron. Se realizo un analisis de contenido siguiendo las etapas de lectura abierta, codificacion, analisis estructural e interpretacion critica. Resultados Los medicos generales tienen bajos conocimientos del VPH y de la vacuna, mientras que los ginecologos y los pediatras tienen buenos y excelentes conocimientos, respectivamente. Muchos de los medicos ven una oportunidad de negocio en esta vacuna; en dos regiones son muy escepticos sobre la introduccion de la vacuna por la ausencia de proteccion total y por la dificultad de llegar a la poblacion mas necesitada. Conclusiones En el ambito medico hay confusion sobre las distintas vacunas, se requiere profundizar en los conocimientos y hay necesidad de dar recomendaciones e indicaciones claras a los medicos. Debe brindarse amplia capacitacion y educacion, particularmente a los medicos generales, en relacion con el VPH, la vacuna y la necesidad de continuar tamizando.

La oferta de servicios para tamización de cáncer de cuello uterino en Colombia

Resumen Objetivo Evaluar la oferta de servicios para tamizaje y diagnostico definitivo en Colombia como uno de los componentes que podrian explicar el bajo impacto sobre la mortalidad por cancer de cuello uterino en el pais. Metodos Estudio descriptivo mediante encuestas a una muestra de instituciones que toman citologias y a la totalidad de laboratorios de lectura y centros de colposcopia-biopsia en cuatro departamentos de Colombia seleccionados por conveniencia. El diseno de la muestra fue probabilistico, proporcional al tamano de los municipios, y aleatorio simple, en instituciones. Se compararon las diferencias entre los departamentos. Con base en estandares nacionales e internacionales se evaluo el cumplimiento de indicadores y criterios de calidad en terminos de estructura, procesos y resultado. Resultados Se encontro que el recurso humano parece ser suficiente, pero no se realiza seguimiento a mujeres con anormalidad citologica. Los sistemas de informacion son insuficientes. Se identificaron problemas en la calidad de la lectura de citologias. Las metas programaticas de cobertura se cumplen, aunque su medicion no se hace teniendo en cuenta el esquema de tamizacion. Conclusiones Se encuentran problemas de oferta en terminos de estructura, proceso y resultado. Las deficiencias encontradas explican, en parte, el bajo impacto que se ha tenido sobre la mortalidad por cancer de cuello uterino en Colombia. La oferta de servicios de tamizaje y diagnostico no estan estructurados como un programa organizado.

Active Versus Passive Cancer Registry Methods Make the Difference: Case Report From Colombia

It makes complete sense that prevalence data vary widely between the GLOBOCAN methods and the Cuenta de Alto Costo (CAC). The first is on the basis of models that calculate prevalence as a result of regional observed incidencedata and cancer survival rates from other countries, and the CAC relies onpassive reporting by patients’private insurancecompanies (EPS). If all patientsareknown bytheEPSandtheir reportsachieve100%coverage, then the CAC prevalence data should be correct.

Impact of operational factors on HPV positivity rates in an HPV‐based screening study in Colombia

To assess the effect of operational factors on the positivity rates of three HPV assays.

Public health and epidemiology of cancer in Colombia

Understanding the epidemiology of cancer has been a relatively recent challenge for health systems of middle and low-income countries, since the predominant pathological profiles, up to the second half of the XX century, had been acute and communicable diseases and therefore cancer was not given sufficient visibility1. The epidemiology of communicable diseases requires a specific epidemiological approach, with information that is almost in real time, or maximum up to one year; it also requires information based on the classification of the causal agent, with the primary objective of controlling epidemiological outbreaks2. In contrast, the objectives of the epidemiological surveillance of cancer are: monitoring the behavior of different risk factors, estimating the population risk of developing the illness, -in a designated area and time-, as well as measuring the impact of interventions by analyzing survival and mortality2. Since modifying the incidence or mortality by cancer requires interventions which imply a minimum of five years, generating information in cancer is generally done every five years.

Oncology services supply in Colombia

Abstract Objective: To characterize the current status of oncological services supply in Colombia. Methods: A descriptive analysis of oncological services for cancer care in the adult and infant population that meet the requirements for operation according to the Special Register of Health Service Providers was carried out. The case - by - provider ratio was calculated based on the cancer incidence estimated for Colombia by the National Cancer Institute. Results: Were identified 1,780 qualified oncology health services in the country related to specialties for providing care to cancer patients. Twenty five providers nationwide had all three qualified services: chemotherapy, radiotherapy and surgery. Nearly 50% of the offer was concentrated in Bogotá, Antioquia and Valle del Cauca. Putumayo and the Amazonas group departments, with the exception of Vaupés, did not show any oncological services. Healthcare Providers were responsible for 87.8%, and independent professionals provided 12.2%. Outpatient services were 66.7% of oncology services, 17.4% was diagnostic support services and therapeutic complementation, and 15.9% was surgical services. 87.9% of the oncological service offer in Colombia takes place in the private sector. Conclusions: The ratio between the service groups is asymmetric, with few providers jointly offering the basic services for oncology treatment, which reflects how provision is fragmented. It is necessary to redefine the concept of oncology service under a comprehensive care approach and the importance of enabling functional units, comprehensive treatment centers and other forms of care.