The Impact of Health Inequities on Population-Based Breast Cancer Survival in a Colombian Population, 2008-2015.

OBJECTIVE: To obtain breast cancer survival estimates in Manizales, Colombia, considering socioeconomic level, health insurance regime and residential area, while adjusting for age, histology and stage at diagnosis. METHODS: Analytical cohort study based on breast cancer incident cases recorded by the Population-based Manizales Cancer Registry between 2008-2015. Patients were followed-up for 60 months. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the Wilcoxon-Breslow-Gehan test for differences. Cox multivariate regression models were fitted. RESULTS: 856 breast cancer cases were included. The 5-year cause-specific survival for the entire cohort was 78.2%. It was higher in women with special/exception health insurance, high socioeconomic level, <50 years old, ductal carcinoma, and stages I and II. Residential area did not impact survival. In Cox models, the subsidized health insurance regime (HR: 4.87 vs contributory) and low socioeconomic level (HR: 2.45 vs high) were predictors of the hazard of death in women with breast cancer, adjusted for age, histology, stage and interactions age-stage and insurance-stage. A positive interaction (synergistic effect modification) between health insurance regime and stage regarding to survival was observed. CONCLUSION: Socioeconomic factors significantly contribute to the inequities in breast cancer survival, independent of the stage at diagnosis. This suggests the need for comprehensive interventions to remove barriers to accessing the health system. This research provides evidence of survival gaps mediated by certain social determinants of health and generates data on the overall performance of the Colombian health system.

Colorectal cancer survival in Manizales, Colombia, 2008-2017: a population-based study.

OBJECTIVE: To determine 5-year survival in patients with colorectal cancer (CRC) according to patient and tumor characteristics. METHODS: Longitudinal study based on incident cases of invasive CRC between 2008 and 2017 captured by the Manizales Population-based Cancer Registry (n=850). Patients were followed up to August 24th, 2021. Cause-specific survival and net survival were calculated for sociodemographic and tumor characteristics, and Cox multivariate was fitted. RESULTS: Fifty-five percent of cases occurred in women. The most frequent histological type was adenocarcinoma (78.2%). The most frequent locations were rectum (32.0%), ascending colon (16.6%), and sigmoid (16.2%). Twenty-five percent of cases were diagnosed in stage IV. There were 567 deaths due to CRC. The 5-year specific survival was 45.8% (95%CI 42.4-49.3), with independent effects for age (HR=1.83; 95%CI 1.26-2.65 age >75 years vs. <50 years) and advanced clinical stage (HR=2.5 and HR 5.7 for stages III and IV vs. stage I, respectively). Lower survival was observed in patients of medium socioeconomic status compared with higher socioeconomic status (HR=1.52; 95%CI 1.08-2.14), but not in patients of low socioeconomic status. No independent effects were observed for the health insurance regime. CONCLUSIONS: In Manizales, approximately 5 out of 10 patients with invasive CRC die in the first five years after diagnosis, with a lower survival in patients older than 75 years, from medium socioeconomic level and diagnosed in advanced clinical stages.

Colorectal cancer survival in Manizales, Colombia, 2008-2017: a population-based study / Supervivencia al cáncer colorrectal en Manizales, Colombia, 2008-2017: un estudio de base poblacional

ABSTRACT Objective: To determine 5-year survival in patients with colorectal cancer (CRC) according to patient and tumor characteristics. Methods: Longitudinal study based on incident cases of invasive CRC between 2008 and 2017 captured by the Manizales Population-based Cancer Registry (n=850). Patients were followed up to August 24th, 2021. Cause-specific survival and net survival were calculated for sociodemographic and tumor characteristics, and Cox multivariate was fitted. Results: Fifty-five percent of cases occurred in women. The most frequent histological type was adenocarcinoma (78.2%). The most frequent locations were rectum (32.0%), ascending colon (16.6%), and sigmoid (16.2%). Twenty-five percent of cases were diagnosed in stage IV. There were 567 deaths due to CRC. The 5-year specific survival was 45.8% (95%CI 42.4-49.3), with independent effects for age (HR=1.83; 95%CI 1.26-2.65 age >75 years vs. <50 years) and advanced clinical stage (HR=2.5 and HR 5.7 for stages III and IV vs. stage I, respectively). Lower survival was observed in patients of medium socioeconomic status compared with higher socioeconomic status (HR=1.52; 95%CI 1.08-2.14), but not in patients of low socioeconomic status. No independent effects were observed for the health insurance regime. Conclusions: In Manizales, approximately 5 out of 10 patients with invasive CRC die in the first five years after diagnosis, with a lower survival in patients older than 75 years, from medium socioeconomic level and diagnosed in advanced clinical stages.

RESUMEN Objetivo: Estimar la supervivencia a 5 años en pacientes con cáncer colorrectal (CCR) según características del paciente y del tumor. Métodos: Estudio longitudinal a partir de los casos de CCR invasivo diagnosticados entre 2008 y 2017 captados por el Registro Poblacional de Cáncer de Manizales (n=850). Se realizó seguimiento hasta el 24 de agosto de 2021. Se calculó la supervivencia causa-específica y la supervivencia neta para las características sociodemográficas y del tumor, y análisis multivariado de Cox. Resultados: El 55,5% de los casos se presentaron en mujeres. El tipo histológico más frecuente (78,2%) fue el adenocarcinoma. Las localizaciones más frecuentes fueron recto (32,0%), colon ascendente (16,6%) y sigmoides (16,2%). El 25,5% de los casos fue diagnosticado en estadio IV. Ocurrieron 567 muertes por CCR. La supervivencia específica a 5 años fue del 45,8% (IC95% 42,4-49,3), con efectos independientes para la edad (HR=1,83; IC95% 1,26-2,65 edad >75 años vs. edad <50 años) y el estadio clínico avanzado (HR=2,5 y HR 5,7 para estadios III y IV vs. estadio I). Se observó una menor supervivencia en pacientes de nivel socioeconómico medio en comparación con el grupo de mayor posición socioeconómica (HR=1,52; IC95% 1,08-2,14), pero no en los pacientes de posición socioeconómica baja. No se observaron efectos independientes para el régimen de aseguramiento en salud. Conclusiones: En Manizales, aproximadamente 5 de cada 10 pacientes con CCR invasivo fallecen en los primeros cinco años del diagnóstico, con sobrevida menor en pacientes mayores de 75 años, de nivel socioeconómico medio y diagnosticados en estadio clínico avanzado.

Trends in cancer incidence and mortality in Manizales, Colombia, 2008-2017.

Objective: To describe cancer incidence and mortality trends in Manizales, Colombia, between 2008-2017. Methods: All incident cancer cases in Manizales collected by the Population-based Manizales Cancer Registry between January 1, 2008, and December 31, 2017, and all deaths caused by cancer in the same period, were included. The population at risk was obtained from the National Administrative Department of Statistics databases. Age-standardized incidence and mortality rates were calculated by sex and cancer site. Changes in trends were assessed using Joinpoint regression. Results: There were 11,188 incident cases, 56.7% in women. There were 4,996 cancer deaths, 52.6% in women. Breast, prostate, stomach, thyroid, lung, and colon cancers accounted for 50% of all incident cases. During this period, the incidence in women decreased and equaled that of men due to a significant decrease in cervical, stomach, and lung cancers, among others; likewise, mortality in women decreased slightly due to the reduction in deaths from cervical, stomach, esophagus, and connective tissue cancers. In contrast, in men, overall incidence and mortality remained unchanged. Conclusions: In Manizales, population aging has contributed to an increased burden of cancer. In terms of incidence and mortality, progress in the fight against this disease is still discrete. It is a priority to reinforce cancer control strategies with a differential approach by sex.

Objetivo: Describir las tendencias en incidencia y mortalidad por cáncer en Manizales, Colombia, entre 2008-2017. Métodos: Se incluyeron todos los casos incidentes de cáncer en Manizales captados por el Registro Poblacional de Cáncer de Manizales entre el 1º de enero de 2008 y el 31 de diciembre de 2017, así como todas las muertes causadas por cáncer en el mismo periodo. La población en riesgo se obtuvo de las estadísticas del DANE. Se calcularon tasas de incidencia y mortalidad ajustadas por edad según sexo y localización del cáncer. Se evaluaron cambios en las tendencias mediante una regresión Joinpoint. Resultados: Se registraron 11,188 casos incidentes, 56.7% en mujeres. Ocurrieron 4,996 muertes por cáncer, 52.6% en mujeres. Los cánceres de mama, próstata, estómago, tiroides, pulmón y colon, representaron el 50% de todos los casos incidentes. Durante este periodo, la incidencia en mujeres descendió y equiparó a la de los hombres, a partir de una disminución significativa en los cánceres de cérvix, estómago, y pulmón, entre otros; asimismo, la mortalidad en mujeres disminuyó levemente, debido a la reducción en muertes por cáncer de cérvix, estómago, esófago y tejidos blandos. En contraste, en hombres la incidencia y la mortalidad general no variaron. Conclusiones: El envejecimiento poblacional ha contribuido a una mayor carga de cáncer. En términos de incidencia y mortalidad, los avances en la lucha contra esta enfermedad aún son discretos. Es prioritario reforzar las estrategias para el control del cáncer con enfoque diferencial por sexo.

Cutaneous melanoma incidence, mortality, and survival in Manizales, Colombia: a population-based study.

OBJECTIVE: We estimated the cutaneous melanoma (CM) incidence, mortality, and survival in Manizales, Colombia to establish predictors for survival. METHODS: This analytical cohort study used CM incident cases during 2006 to 2015 in the Manizales Cancer Registry (n = 132). Incidence and mortality rates were standardized using the direct method. Patients were followed up until 30 November 2020. Cause-specific survival was calculated using the Kaplan-Meier method for variables of interest, with the log-rank test for differences. Cox multivariate regression models were fitted. RESULTS: Incidence (per 100,000) increased from 1.6 to 3.0 in men and 2.6 to 2.8 in women during 2006-2010 to 2011-2015, respectively. Mortality was low and stable. Five-year survival was 68.7%, with significant differences according to age (hazard ratio [HR] >70 vs. ≤70 years: 3.37); histological subtype (HR for melanoma not otherwise specified and HR for nodular melanoma vs lentigo malignant melanoma and superficial spreading melanoma: 17.39 and 10.16, respectively); and clinical stage (HR stages III-IV vs. stages I-II: 5.94). CONCLUSION: CM is characterized by increasing incidence and unfavorable prognosis, particularly in patients aged >70 years, with melanoma not otherwise specified and nodular melanoma, and advanced stages. Promoting photoprotection and early detection and management of suspicious skin lesions is crucial.

Trends in cancer incidence and mortality in Manizales, Colombia, 2008-2017 / Tendencias en la incidencia y en la mortalidad por cáncer en Manizales, Colombia, 2008-2017

Abstract Objective: To describe cancer incidence and mortality trends in Manizales, Colombia, between 2008-2017. Methods: All incident cancer cases in Manizales collected by the Population-based Manizales Cancer Registry between January 1, 2008, and December 31, 2017, and all deaths caused by cancer in the same period, were included. The population at risk was obtained from the National Administrative Department of Statistics databases. Age-standardized incidence and mortality rates were calculated by sex and cancer site. Changes in trends were assessed using Joinpoint regression. Results: There were 11,188 incident cases, 56.7% in women. There were 4,996 cancer deaths, 52.6% in women. Breast, prostate, stomach, thyroid, lung, and colon cancers accounted for 50% of all incident cases. During this period, the incidence in women decreased and equaled that of men due to a significant decrease in cervical, stomach, and lung cancers, among others; likewise, mortality in women decreased slightly due to the reduction in deaths from cervical, stomach, esophagus, and connective tissue cancers. In contrast, in men, overall incidence and mortality remained unchanged. Conclusions: In Manizales, population aging has contributed to an increased burden of cancer. In terms of incidence and mortality, progress in the fight against this disease is still discrete. It is a priority to reinforce cancer control strategies with a differential approach by sex.

Resumen Objetivo: Describir las tendencias en incidencia y mortalidad por cáncer en Manizales, Colombia, entre 2008-2017. Métodos: Se incluyeron todos los casos incidentes de cáncer en Manizales captados por el Registro Poblacional de Cáncer de Manizales entre el 1º de enero de 2008 y el 31 de diciembre de 2017, así como todas las muertes causadas por cáncer en el mismo periodo. La población en riesgo se obtuvo de las estadísticas del DANE. Se calcularon tasas de incidencia y mortalidad ajustadas por edad según sexo y localización del cáncer. Se evaluaron cambios en las tendencias mediante una regresión Joinpoint. Resultados: Se registraron 11,188 casos incidentes, 56.7% en mujeres. Ocurrieron 4,996 muertes por cáncer, 52.6% en mujeres. Los cánceres de mama, próstata, estómago, tiroides, pulmón y colon, representaron el 50% de todos los casos incidentes. Durante este periodo, la incidencia en mujeres descendió y equiparó a la de los hombres, a partir de una disminución significativa en los cánceres de cérvix, estómago, y pulmón, entre otros; asimismo, la mortalidad en mujeres disminuyó levemente, debido a la reducción en muertes por cáncer de cérvix, estómago, esófago y tejidos blandos. En contraste, en hombres la incidencia y la mortalidad general no variaron. Conclusiones: El envejecimiento poblacional ha contribuido a una mayor carga de cáncer. En términos de incidencia y mortalidad, los avances en la lucha contra esta enfermedad aún son discretos. Es prioritario reforzar las estrategias para el control del cáncer con enfoque diferencial por sexo.