Marion Piñeros

Cancer Incidence in Five Continents: Inclusion criteria, highlights from Volume X and the global status of cancer registration

Cancer Incidence in Five Continents (CI5), a longstanding collaboration between the International Agency for Research on Cancer and the International Association of Cancer Registries, serves as a unique source of cancer incidence data from high‐quality population‐based cancer registries around the world. The recent publication of Volume X comprises cancer incidence data from 290 registries covering 424 populations in 68 countries for the registration period 2003–2007. In this article, we assess the status of population‐based cancer registries worldwide, describe the techniques used in CI5 to evaluate their quality and highlight the notable variation in the incidence rates of selected cancers contained within Volume X of CI5. We also discuss the Global Initiative for Cancer Registry Development as an international partnership that aims to reduce the disparities in availability of cancer incidence data for cancer control action, particularly in economically transitioning countries, already experiencing a rapid rise in the number of cancer patients annually.

Cancer incidence estimates at the national and district levels in Colombia

OBJECTIVES To estimate national and district cancer incidence for 18 major cancer sites in Colombia. MATERIALS AND METHODS National and district incidence was estimated by applying a set of age, sex and site-specific incidence/mortality ratios, obtained from a population-based cancer registry, to national and regional mortality. The work was done in Bogotá (Colombia) and Lyon (France) between May 2003 and August 2004. RESULT The annual total number of cases expected (all cancers but skin) was 17 819 in men and 18 772 in women. Among males the most frequent cancers were those of the prostate (45.8 per 100 000), stomach (36.0), and lung (20.0). In females the most frequent were those of the cervix uteri (36.8 per 100 000), breast (30.0), and stomach (20.7). Districts with the lowest death certification coverage yielded the highest incidence rates. CONCLUSIONS In the absence of national population-based cancer registry data, estimates of incidence provide valuable information at national and regional levels. As mortality data are an important source for the estimation,the quality of death certification should be considered as a possible cause of bias.

Patterns and trends in cancer mortality in Colombia 1984–2008

BACKGROUND Cancer has become increasingly acknowledged as a public health issue in Colombia. Rates of the most common malignancies have been generally increasing. We update an evaluation of mortality trends in the major cancers in Colombia one decade ago, discussing the trends in the context of cancer control. METHODS We calculated the annual age-standardized mortality rates for the major cancer sites by sex between 1984 and 2008; we also present the estimated annual percentage change (EAPC) for the entire period and for the last decade. RESULTS There was an average of 32,000 cancer deaths annually in Colombia in the period studied. Overall cancer mortality rates decreased slightly in both men and women. The four most common sites of cancer death among men were stomach (17.6%), prostate (15.0%), lung (14.8%) and colorectum (6.5%). In women, the most common cancer sites were breast (12.3%), cervix (12.1%), stomach (11.5%) and lung (9.2%). Colorectal and CNS cancers exhibited the greatest increases (EAPC of 2.0% and 3.4% respectively) while the largest declines were seen for cancers of the larynx, stomach and oesophagus (EAPC between -3% and -4%). In the last decade, the greatest declines were seen in cervical cancer mortality rates (EAPC = -3.2). CONCLUSIONS The slight decrease in mortality trends from all cancers combined is partially driven by the strong declines in mortality of stomach and cervical cancer. It may be still too early to properly evaluate trends in mortality due to other cancers and the relative impact of changing access to health care in Colombia.

Patient delay among Colombian women with breast cancer

OBJECTIVE Characterize diagnosis and treatment of breast cancer in Bogota, Colombia and examine the extent and determinants of patient delay. MATERIAL AND METHODS Using a census approach we identified 1 106 women with breast cancer. Information was gathered through personal interviews and the review of medical records. Patient delay was defined as the time elapsed from first symptoms to initial consultation. RESULTS More than 80% of the women (902) consulted due to symptoms; the majority had advanced-stage disease. Patient delay was established in 20.3% and the main related factors were older age, lack of social security and advanced clinical stage. Higher education in patients was associated with reduced delays. DISCUSSION Women do not recognize breast cancer symptoms. Patient delay and related factors are similar to those found in other studies. There is an urgent need to develop communication and education strategies regarding breast cancer symptoms and early detection.

Demoras en el diagnóstico y tratamiento de mujeres con cáncer de mama en Bogotá, Colombia

Objective. Establish provider delay for breast cancer and related factors. Material and Methods. 1 106 women with breast cancer were approached in health care institutions of Bogota, Colombia. According to the history of first consultation, we established diagnostic and treatment incidence rates, which were compared for different variables. A Cox hazard model was established. Results. Median time from first consultation to diagnosis and start of treatment were 91 days (CI95%:82-97 days) and 137 days (CI95%:127-147 days) respectively. Diagnosis and treatment were faster in women with higher educational level, affiliated to the “special” social security, with better socioeconomic conditions and in screening-detected breast cancers. Conclusion. Provider delay is excessive. There are clear inequities in access to services and a need of reducing the waiting times for women with a suspicion of breast cancer.

Pilot Implementation of Breast Cancer Early Detection Programs in Colombia.

Breast cancer is increasing in developing countries, and Colombia has a double burden from cervical and breast cancer. Suitable guidelines for breast cancer early detection are needed, and the Breast Health Global Initiative provides a favorable framework for breast cancer control in low resource nations. The Colombian National Cancer Institute developed evidence-based guidelines for breast cancer early detection in which coordinated early detection in symptomatic women and hospital-based screening in women aged 50–69 are recommended. A pilot project to evaluate programmatic approaches (opportunistic screening) was designed, and it is expected that organized hospital-based screening for breast cancer will represent a move towards population-based screening in the near future in accordance with country specific conditions.

Cancer in indigenous people in Latin America and the Caribbean: a review

Cancer is a leading cause of death in Latin America but there have been few assessments of the cancer burden for the 10% of the population who are indigenous. Evidence from other world regions suggests cancer survival is poorer for indigenous people than for others due to a greater incidence of case‐fatal cancers, later stage at diagnosis, and less cancer treatment. A status report on the cancer profile of indigenous people in Latin America and the Caribbean (LAC) is therefore clearly warranted. We undertook a systematic review of the peer‐reviewed literature in academic databases, and considered evidence from cancer registries from 1980, to assess cancer epidemiology among indigenous people in LAC. We identified 35 peer‐reviewed articles pertaining to cancer in indigenous people. Rates of cervical cancer in parts of Brazil, Ecuador, and Guyana, stomach cancer rates in regions of Chile and gallbladder rates in Chile and Bolivia, were higher for indigenous compared to others. Breast cancer rates were lower in Ecuador, Brazil, and Chile. Six cancer registries in Brazil provided incidence data but no other reports of incidence, mortality, or survival were identified. There was a paucity of data surrounding the cancer burden of indigenous people in LAC. In view of predicted increases in cancer rates in ensuing decades, and the disparities in burden already experienced by indigenous people in the region, it is imperative that cancer profiles are obtained and cancer control measures identified and prioritized.

HPV knowledge and impact of genital warts on self esteem and sexual life in Colombian patients

BackgroundInformation on HPV knowledge in patients with genital warts is scarse as is the information on factors related to the impact on self-esteem and sex life among them.MethodsWe conducted a cross-sectional study in adult patients with a clinical diagnosis of genital warts (GW) attending a major private out-patient clinic in Bogotá, Colombia. Patients underwent biopsy for pathological diagnosis, HPV-DNA testing and completed a questionnaire assessing HPV knowledge, and the consequences of GW on self-esteem and sexual life. Differences in proportions were assessed with a chi2 test.Results106 men and 155 women had pathologic confirmation of GW. 51% of subjects had heard of HPV before consultation coming mainly from the media (82%). Less than half of the participants knew that HPV could be transmitted through non-penetrant sexual intercourse and only two thirds acknowledged HPV vaccine as a preventive measure against HPV infection. Impact on self-esteem was higher among women than men (90.3% vs 60.4%, [p < 0.01]). In men, factors related to a higher impact on sexual life were HPV awareness and age; in women they were higher education and anatomic location; external GW had a higher impact on sexual life in women (83% vs. 66%; [p = 0.05]).ConclusionsWe found a low awareness of HPV and low knowledge on the vaccine as a preventive measure for associated diseases even in patients suffering from genital warts, highlighting the need for communication and education on HPV. Greater impact on self-esteem in women might reflect higher health consciousness among Latin American women.

Cobertura de examen clínico y mamografía de tamización para cáncer de mama en mujeres bogotanas

Resumen Objetivo Determinar la cobertura de examen clinico y mamografia de tamizacion para cancer de mama en un grupo de mujeres bogotanas afiliadas a seguros de salud. Metodos Se realizo una encuesta telefonica a 4.526 mujeres entre 50 y 69 anos, residentes en Bogota y en municipios vecinos, afiliadas a tres companias de seguros de salud. Se excluyeron las mujeres con antecedente personal de cancer de mama. La cobertura de tamizacion se valoro como la proporcion de mujeres con antecedente de mamografia y examen clinico de la mama. Se estimo la frecuencia en la vida, en los ultimos dos anos y en el ultimo ano. Se analizaron factores asociados a la practica de tamizacion, mediante el calculo de OR ajustados. Resultados La frecuencia de vida de uso del examen clinico y mamografia fue de 59,3% y 79,8% respectivamente; el 49,7% y el 65,6% de las mujeres se realizo los examenes con fines de tamizacion; el resto, con fines diagnosticos (sintomaticas). El 34,2% tenia examen clinico en el ultimo ano, y el 54%, mamografia en los ultimos dos anos. La educacion y el antecedente familiar de cancer de mama estuvieron asociados a la practica de tamizacion. Conclusiones La cobertura de examen clinico de la mama como metodo de tamizacion es baja. Las coberturas de mamografia son superiores a lo exigido por el sistema colombiano, pero inferiores a las coberturas utiles reportadas en paises desarrollados.

A Global Cancer Surveillance Framework Within Noncommunicable Disease Surveillance: Making the Case for Population-Based Cancer Registries

The growing burden of cancer among several major noncommunicable diseases (NCDs) requires national implementation of tailored public health surveillance. For many emerging economies where emphasis has traditionally been placed on the surveillance of communicable diseases, it is critical to understand the specificities of NCD surveillance and, within it, of cancer surveillance. We propose a general framework for cancer surveillance that permits monitoring the core components of cancer control. We examine communalities in approaches to the surveillance of other major NCDs as well as communicable diseases, illustrating key differences in the function, coverage, and reporting in each system. Although risk factor surveys and vital statistics registration are the foundation of surveillance of NCDs, population-based cancer registries play a unique fundamental role specific to cancer surveillance, providing indicators of population-based incidence and survival. With an onus now placed on governments to collect these data as part of the monitoring of NCD targets, the integration of cancer registries into existing and future NCD surveillance strategies is a vital requirement in all countries worldwide. The Global Initiative for Cancer Registry Development, endorsed by the World Health Organization, provides a means to enhance cancer surveillance capacity in low- and middle-income countries.