Burden of breast cancer in Cali, Colombia: 1962-2012.

OBJECTIVE: To describe the behavior of breast cancer (BC)during the 1962-2012 period from information provided by the Cali Cancer Registry and the Municipal Health Secretariat of Cali. MATERIALS AND METHODS: The incidence trend (1962-2007) and mortality trend (1984-2012) for breast cancer was studied and relative survival (RS)(1995-2004) was estimated. Age-standardized incidence and mortality rates to the world population (ASIR(w)/ASMR(w)) were expressed per 100000 persons-year. Their temporal trend was examined with the annual percent of change (APC), and the Cox model was used to analyze the variables that influenced the survival of women with breast cancer. RESULTS: The risk of breast cancer significantly increased in Cali through the 1962-2007 period, with an APC =1.7(95%CI:1.4-2.0). The ASIR(w) of BC increased from 27.1 in 1962 to 48.0 in 2007 and currently there are more than 500 cases reported annually. The mortality for BC has remained stable since 1984; in the 2009-2012 period, the ASMR(w) was 14.2. The 5-year RS was 69% (95%CI:66-71) from 2000-2004 and 62% (95%CI:59-65) from 1995-1999. The risk of death (HR) from BC was greater in persons from lower socioeconomic strata (SES) than from higher SES, HR=1.9(95%CI:1.3-2.9) and in those older than 70 years vs. <50, HR=1.6(95%CI:1.1-2.2). CONCLUSION: Mortality remained stable while incidence increased and survival improved, which may be associated with better detection and advances in treatment.

Cancer epidemiology in Cali, 60 years of experience.

Background: The population-based Cancer Registry of Cali Colombia operates continuously since 1962, disseminating incidence information in the XI volumes of Cancer Incidence in Five Continents. Aim: To describe the incidence and mortality rates for the period 2011-2020 and the changes in the trend of incidence rates (1962-2017) and mortality rates from cancer (1986-2020). Methods: The Joinpoint model and the annual percentage change (APC) were used as summary measures of the changes in the trends of incidence rates (ASR-I) and mortality (ASR-M) standardized by age with the direct method. Results: Trough 1988-2017 the ASR-I for all locations increased 0.4% annually (95% CI: 0.2, 0.6) in men and decreased annually 0.2% (95% CI: -0.3; -0.1) in women. The ASR-Is of cancers related to opportunity screening activities (prostate and breast) increased until the early 21st century and then decreased. The ASR-I of cancers related to infectious agents continue to decrease (cervix, vulva, and stomach). There is evidence of control of cancer related to tobacco consumption (lung, oral cavity, bladder). In both sexes, the ASR-I of thyroid, colorectal and lymphoma cancers increased and those of ovarian cancer decreased. Between 1984-2020 the ASR-M for all locations decreased annually 0.7% (95% CI: -0.9, -0.5) in men and 1.1% (95% CI: -1.3, -0.9) in women. For both sexes, ASR-M decreased for cancers of the esophagus, stomach, lung, bladder, lymphomas, and leukemias; and increased in colorectal cancer. The ASR-M for cervical and prostate cancer decreased annually by 3.5% (95% CI: -3.9, -3.2) and 0.1% (95% CI: -0.5, -0.3), respectively. Comment: This information allows the construction of some indicators to monitor the City Cancer Challenge initiative and the current 10-year plan for cancer control in Colombia, 2011-2021.

Antecedentes: El registro poblacional de Cáncer de Cali-Colombia, opera desde 1962 divulgando continuamente la información de incidencia en los XI volúmenes de Cancer Incidence in Five Continents. Objetivo: Describir las tasas de incidencia y mortalidad del periodo 2011-2020 y los cambios en la tendencia de las tasas de incidencia (1962-2017) y mortalidad por cáncer (1986-2020). Métodos: Se utilizó el modelo de Joinpoint y el cambio porcentual anual (APC) como medidas de resumen de los cambios en las tendencias de las tasas de incidencia (ASR-I) y mortalidad (ASR-M) estandarizadas por edad con el método directo. Resultados: Durante el periodo 1988-2017 las ASR-I para todas las localizaciones aumentaron anualmente 0.4% (IC 95%: 0.2; 0.6) en los hombres y disminuyeron anualmente 0.2% (IC 95%: -0.3; -0.1) en las mujeres. Las ASR-I de los cánceres relacionados con actividades de tamización de oportunidad (próstata y mama) aumentaron hasta principios del siglo XXI y luego descendieron. Las ASR-I de los canceres relacionados con agentes infecciosos continúan disminuyendo (cérvix, vulva y estómago). Hay evidencias de control de los cánceres relacionados al consumo de tabaco (pulmón, cavidad oral, vejiga). En ambos sexos aumentaron las ASR-I de los cánceres de tiroides, colorrectal y linfomas y disminuyeron las de cáncer de ovario. Entre 1984-2020 las ASR-M para todas las localizaciones disminuyeron anualmente 0.7% (IC 95%: -0.9; -0.5) en los hombres y 1.1% (IC 95%: -1.3; -0.9) en las mujeres. Para ambos sexos, disminuyeron las ASR-M para los cánceres de esófago, estómago, pulmón, vejiga, linfomas y leucemias; y aumentaron en cáncer colorrectal. Las ASR-M por cáncer de cérvix y próstata disminuyeron anualmente 3.5% (IC 95%: -3.9; -3.2) y 0.1% (IC 95%: -0.5; -0.3), respectivamente. Comentario: Esta información permite construir algunos indicadores para monitorear la iniciativa City Cancer Challenge y el actual Plan Decenal para el Control del Cáncer en Colombia, 2011-2021.

Incidence, Mortality, and Survival Trends of Primary CNS Tumors in Cali, Colombia, From 1962 to 2019.

PURPOSE: Global studies have shown varying trends of CNS tumors within geographic regions. In Colombia, the epidemiologic characteristics of CNS neoplasms are not well elucidated. We aimed to provide a summary of the descriptive epidemiology of primary CNS tumors among the urban population of Cali, Colombia. METHODS: We conducted a time-trend study from 1962 to 2019 using the Population-Based Cali Cancer Registry. The age-standardized rates per 100,000 person-years were obtained by direct method using the world standard population. Results were stratified by sex, age group at diagnosis, and histologic subtype. We used Joinpoint regression analysis to detect trends and obtain annual percentage change (APC) with 95% CIs. We estimated 5-year net survival using the Pohar-Perme method. RESULTS: During 1962 to 2016, 4,732 new cases of CNS tumors were reported. From 1985 to 2019, a total of 2,475 deaths from malignant CNS tumors were registered. A statistically significant increase in the trends of incidence (APC, 2.8; 95% CI, 2.1 to 3.5) and mortality (APC, 1.5; 95% CI, 1.1 to 2.0) rates was observed during the study. The most common malignant CNS tumor was glioblastoma (17.8% of all tumors), and the most frequent benign tumor was meningioma (17.2%). Malignancy was more common in males than in females. Unspecified malignant neoplasms represented 32% of all cases. The highest 5-year net survival was 31.4% during 2012 to 2016. CONCLUSION: Our findings demonstrate an increasing burden of primary CNS tumors for the last 60 years, with a steady rate from the early 2010s. There was an improvement of 5-year net survival for the last decade. Males had higher mortality than did females. Additional efforts are needed to fully explore the geographic, environmental, and genetic contributors of CNS malignancies within the region.

Cali cancer registry methods.

BACKGROUND: The Population Cancer Registry of Cali (RPCC) has operated since 1962, disseminating high quality information to provide a framework to assess and control the burden of cancer in Cali. METHODS: The collection of new cancer cases in permanent residents of Cali is done through active search in and notification from hospitals, and public and private laboratories. The Secretary of Municipal Public Health provides individual information on general mortality and death from cancer. Tumors are coded with ICDO-3 and mortality with ICD-10. Presented rates are standardized by age and trends are assessed by estimating the percentage annual change using the regression analysis in JoinPoint. The 5-year net survival was analyzed with the Pohar-Perme estimator. RESULTS: The 88.5% of the registered cancers had morphological verification (MV). The proportion of unknown primary site represented 5% and the death certificate only cases (DCO) varied between 0 to3% depending on the cancer site. All deaths were certified by a physician, 94.2% of cancer deaths were correctly certified. The ill-defined site proportion was 5.3% and that of uterine cancer not specified (C55) was 0.5%. For survival analysis, existing data collection procedure and infrastructure ensures assessment of the patient's vital status and follow-up, with an average lost to follow-up of 13.2%. COMMENT: The information has been published in the eleven volumes of "Cancer Incidence in Five Continents" confirming high quality of the collected data. The RPCC PCRC has also participated in the Concord Study and is participating in SURVCAN-3.

ANTECEDENTES: El Registro Poblacional de Cáncer de Cali (RPCC) opera de manera continua desde 1962 divulgando información de calidad para proporcionar un marco para valorar y controlar el impacto del cáncer en Cali. MÉTODOS: La recolección de los casos nuevos de cáncer en residentes permanentes de Cali se hace mediante búsqueda activa y por notificación en los hospitales y laboratorios públicos y privados. La Secretaria de Salud Pública Municipal proporciona la información individual de mortalidad general y por cáncer. Los tumores se codifican con la CIO-3 y la mortalidad con la CIE-10. Las tasas se estandarizan por edad y la tendencia se estudia con el porcentaje de cambio anual y con la regresión de JoinPoint. La supervivencia neta a 5 años se analizó con el estimador de Pohar-Perme. RESULTADOS: El 88.5% de los canceres tuvieron verificación morfológica (VM). La proporción de los casos codificada como de sitio mal definido representó el 5% y el certificado de defunción como única evidencia del diagnóstico de cáncer (DCO) varió entre 0-3% dependiendo de la localización. Todas las defunciones fueron certificadas por un médico, el 94.2% de las muertes por cáncer fueron bien certificadas. La proporción de sitio mal definido fue 5.3% y la de cáncer de útero no especificado (C55) fue 0.5%. En todos los casos de supervivencia fue posible el seguimiento y la proporción de censuras fue 13.2. COMENTARIO: La información ha sido publicada en los once volúmenes de "Cancer Incidence in Five Continents". El RPCC participó en el Estudio Concord y está participando en SURVCAN-3.

Reliable information for cancer control in Cali, Colombia.

BACKGROUND: The Cali Population Cancer Registry (RPCC) has been in continuous operation since 1962 with the objective of producing valid statistics on the incidence of cancer, its patterns, trends and survival rates. METHODS: During the period 2008-2012, 23,046 new cases were registered and during 2011-2015 there were 12,761 cancer deaths. The trend of the rates was described with the APC average annual change rate and with the Joinpoint analysis. We analyzed the individual data of 38,671 adults (15-99 years) diagnosed with cancer between 1995-2009, and we calculated the standardized net survival by age for the 14 most common cancer body sites, using the Pohar-Perme method. RESULTS: Prostate and breast cancer were the first cause of cancer morbidity. The incidence rates in these were susceptible to early detection, tumors stabilized after decades of growth, while an increase in the incidence of colon cancer and papillary thyroid carcinoma was observed. The incidence rates of cervical and stomach cancer and conditions related to infectious agents decreased, although the number of absolute cases increased, due to the growth and aging of the population. Gastric cancer was responsible for the highest number of cancer related deaths. The types of cancer related to tobacco consumption (lung, oral cavity, esophagus, pancreas, urinary bladder) showed low numbers and a tendency to decrease. During the period 2000-2004, the 5-year net survival improved for cancers of the breast, cervix, prostate, melanoma and thyroid, although in the period 2005-2009 a stagnation was observed. In stomach, liver and lung cancer, the 5-year net survival was less than 15%. The 5-year overall survival in children was 51.0% (95% CI: 47.5, 54.3) and in adolescents 44.6% (95% CI: 36.0, 52.8). COMMENT: RPCC has been an advisor to the Colombian government in the evaluation of CPRs in the country and its data has contributed significantly to different aspects of cancer control in Colombia.

ANTECEDENTES: El Registro Poblacional de Cáncer de Cali (RPCC) está en operación continua desde 1962 con el objetivo de producir estadísticas válidas sobre la incidencia de cáncer, sus patrones, tendencias y supervivencia. MÉTODOS: Durante el periodo 2008-2012, se registraron 23,046 casos nuevos y durante 2011-2015 se registraron 12,761 defunciones por cáncer. La tendencia de las tasas se describió con el porcentaje de cambio medio anual APC y con el análisis de Joinpoint. Se analizaron los datos individuales de 38,671 adultos (15-99 años) con diagnóstico de cáncer entre 1995-2009, y se calculó la supervivencia neta estandarizada por edad para las 14 localizaciones más comunes de cáncer, con el método de Pohar-Perme. RESULTADOS: Próstata y mama fueron la primera causa de morbilidad por cáncer. Las tasas de incidencia en estos tumores susceptibles de detección temprana se estabilizaron tras décadas de crecimiento, mientras que se observó un incremento de la incidencia de cáncer de colon y carcinoma papilar de tiroides. Las tasas de incidencia de cáncer de cuello uterino y estómago, afecciones relacionados con agentes infecciosos, disminuyeron, aunque el número de los casos absolutos aumentó, debido al crecimiento y envejecimiento de la población. El cáncer gástrico fue responsable del mayor número de muertes por cáncer. Los tipos de cáncer relacionados con el consumo de tabaco (pulmón, cavidad oral, esófago, páncreas, vejiga urinaria) mostraron cifras bajas y con tendencia al descenso. Durante el periodo 2000-2004, la supervivencia neta a 5 años mejoró para los cánceres de mama, cuello uterino, próstata, melanoma y tiroides, aunque en el periodo 2005-2009 se observó un estancamiento. En cáncer de estómago, hígado y pulmón, la supervivencia neta a 5 años fue inferior al 15%. La supervivencia global a 5 años en niños fue de 51.0% (IC 95%: 47.5, 54.3) y en adolescentes de 44.6% (IC 95%: 36.0, 52.8). COMENTARIO: El RPCC ha sido asesor del gobierno colombiano en la evaluación de RPCs en el país y sus datos han contribuido significativamente a diferentes aspectos del control del cáncer en Colombia.

Human papillomavirus in lung carcinomas among three Latin American countries.

The presence of human papillomavirus (HPV) genome in lung carcinomas has been reported worldwide but its frequency varies from country to country. We examined HPV genome in 36 lung carcinomas, consisting of 14 squamous cell carcinomas, 13 adenocarcinomas, and 9 small cell carcinomas, collected from Colombia, Mexico and Peru. PCR analysis using GP5+/GP6+ primers, combined with Southern blot hybridization, found the presence of HPV genome in 10 (28%) of 36 cases. This percentage is similar to the value of 22% reported by Syrjänen, who conducted a meta-analysis of nearly 2500 lung carcinomas examined to date. Genotype analysis revealed that the most predominant genotype was HPV-16 (7 cases), followed by HPV-18 (2 cases) and HPV-33 (1 case). HPV-16 was more frequently found among female than male cases (P=0.008) but was not detected in any adenocarcinoma cases. On the other hand, HPV-18 and HPV-33 were detected only among male cases. These HPV genotypes were detected only in adenocarcinomas, and all the HPV genotypes detected in this histological type were HPV-18 or HPV-33. The frequency of HPV-16 positive cases among all the HPV positive cases differed in the sexes (P=0.033) and differed in the three histological types (P=0.017). The presence of HPV tended to be more frequent in well-differentiated tumors when squamous cell carcinomas and adenocarcinomas were combined. However, it was not statistically significant (P=0.093). Neither p16 nor p53 expression in carcinoma cells was related to the proportion of HPV-positive cases. In conclusion, high-risk HPV DNA was detected in 28% of lung carcinomas. The predisposition of HPV-16 to female cases and to non-adenomatous carcinomas warrants further investigation.

Risk factors of gastric cancer specific for tumor location and histology in Cali, Colombia.

AIM: To examine histology- and tumor-location specific risk factors of gastric cancer (GC). METHODS: This was a case-control study. The study subjects were 216 GC patients newly diagnosed during the period 2000-2002 and 431 controls selected from non-cancer patients matching in age, gender, and hospital. We obtained information on lifestyles, dietary habits, and others by a questionnaire. RESULTS: The subjects who were not eldest among his/her siblings were at a slightly elevated GC risk (OR 1.3; 95% CI 0.8-2.0). Salting meals before tasting was related to an increased GC risk (OR 3.5; 95% CI 1.6- 7.3). Frequent consumptions of fruits (OR 0.3; 95% CI 0.1-1.0) and vegetables (OR 0.3; 95% CI 0.1-1.0) were related to decreased GC risks. On the other hand, frying foods (OR 1.9; 95% CI 1.0-3.6) and cooking with coal (OR 1.8; 95% CI 1.3-2.6) were related to increased GC risks. Neither Laurenos histological classification (intestinal and diffuse types) nor tumor location significantly affected those associations except birth order. The subjects who were not eldest among his/her siblings had an increased risk of GCs in the distal and middle thirds, and their ORs were 1.7 (95% CI 1.0-2.8) and 1.9 (95% CI 0.8-4.3), respectively. The corresponding OR in the upper third stomach was 0.3 (95% CI 0.1-0.9). The differences of those three ORs were statistically significant (P = 0.010). CONCLUSION: The present study shows that birth order, salt intake, consumption of fruits and vegetables, the type of cooking, and cigarette smoking are related to GC risk. In histology and tumor-location specific analyses, non-eldest person among their siblings is related to an increased GC risk in the distal and middle thirds of the stomach, and is related to a decreased GC risk in the cardia.

Human papillomavirus in esophageal squamous cell carcinoma in Colombia and Chile.

AIM: To examine the presence of human papillomavirus (HPV) in esophageal squamous cell carcinoma (ESCC) specimens collected from Colombia and Chile located in the northern and southern ends of the continent, respectively. METHODS: We examined 47 and 26 formalin-fixed and paraffin-embedded ESCC specimens from Colombia and Chile, respectively. HPV was detected using GP5+/GP6+ primer pair for PCR, and confirmed by Southern blot analysis. Sequencing analysis of L1 region fragment was used to identify HPV genotype. In addition, P16(INK4A) protein immunostaining of all the specimens was conducted. RESULTS: HPV was detected in 21 ESCC specimens (29%). Sequencing analysis of L1 region fragment identified HPV-16 genome in 6 Colombian cases (13%) and in 5 Chilean cases (19%). HPV-18 was detected in 10 cases (21%) in Colombia but not in any Chilean case. Since Chilean ESCC cases had a higher prevalence of HPV-16 (without statistical significance), but a significantly lower prevalence of HPV-18 than in Colombian cases (P = 0.011) even though the two countries have similar ESCC incidence rates, the frequency of HPV-related ESCC may not be strongly affected by risk factors affecting the incidence of ESCC. HPV-16 genome was more frequently detected in p16 positive carcinomas, although the difference was not statistically significant. HPV-18 detection rate did not show any association with p16 expression. Well-differentiated tumors tended to have either HPV-16 or HPV-18 but the association was not statistically significant. HPV genotypes other than HPV-16 or 18 were not detected in either country. CONCLUSION: HPV-16 and HPV-18 genotypes can be found in ESCC specimens collected from two South American countries. Further studies on the relationship between HPV-16 presence and p16 expression in ESCC would aid understanding of the mechanism underlying the presence of HPV in ESCC.

Environmental factors related to gastric cancer associated with Epstein-Barr virus in Colombia.

Epstein-Barr virus (EBV)-encoded small RNA can be detected in about 1-17 % of gastric carcinomas. To elucidate lifestyles and other factors related to such an EBV-associated gastric carcinoma (EBV-GC), we conducted a case-control study in Cali, Colombia. The study subjects were 368 patients with gastric carcinoma newly diagnosed during the period between September 2000 and June 2003, including 42 EBV-GC cases. We obtained information on lifestyles, dietary habits, and occupational exposure by a questionnaire. The frequency of EBV-GC was related to birth order of patients (P for trend =0.025). More precisely, EBV-GC was much less frequent among the patients who were the eldest child in a family (P=0.007). Those findings were contrary to what was reported by the study conducted in Japan, where EBV-GC was more frequently observed among eldest brothers/sisters. A possible explanation for the apparently conflicting results is that EBV-GC risk is related to the age at first EBV infection but its relationship is not monotonic. In addition to the relationship with birth order, the present study showed that high salt intake and metal dust exposure may be related to EBV-GC as reported by the Japanese study although these associations observed in the present study were not statistically significant. No significant association was observed in other factors, including dietary habits. Further studies seem warranted to elucidate the difference between Japan and Colombia with respect to the environmental factors related to EBV-GC cases.

Hepatoid Adenocarcinoma of the Urachus.

Hepatoid adenocarcinoma of the urachus is a rare condition. We present the case of a 51-year-old female who developed abdominal pain and hematuria. Pelvic magnetic resonance imaging (MRI) reported an urachal mass with invasion to the bladder that was resected by partial cystectomy. On light microscopy the tumor resembled liver architecture, with polygonal atypical cells in nest formation and trabecular structures. Immunochemistry was positive for alfa-fetoprotein (AFP) and serum AFP was elevated. Hepatoid adenocarcinomas have been reported in multiple organs, being most commonly found in the stomach and the ovaries. Bladder compromise has been rarely described in the literature, and it has been associated with poor prognosis, low remission rates, and early metastasis.

Histology-specific gender, age and tumor-location distributions of Epstein-Barr virus-associated gastric carcinoma in Japan.

We examined 1,918 Japanese gastric cancer cases diagnosed during the period 1976-1995 to clarify histology-specific gender, age and tumor-location distributions of Epstein-Barr virus-associated gastric carcinoma (EBV-GC). EBV-GCs accounted for 4.5% and 6.1% of 1,088 intestinal-type and 830 diffuse-type gastric carcinomas, respectively. Both intestinal- and diffuse-type EBV-GCs showed male predominance, but the observed gender difference was statistically significant only in diffuse-type carcinomas (P<0.001). An age-dependent decrease of the EBV-GC proportion was observed in intestinal-type carcinomas (P=0.002), but not in diffuse-type carcinomas. In intestinal-type tumors, the estimated incidence of EBV-GCs reached its peak around age 70. Diffuse-type EBV-GCs appeared to have a much older peak incidence, if any. Both intestinal- and diffuse-type EBV-GCs were least prevalent in the stomach antrum. This study, examining the largest number of EBV-GCs in current literature, showed different patterns of age-dependence in intestinal- and diffuse-type EBV-GCs, suggesting that pathogenic pathways of EBV-GCs may be different in these 2 histological types.

Epstein-Barr virus-associated gastric carcinoma in Cali, Colombia.

To estimate the incidence of Epstein-Barr virus-associated gastric carcinoma (EBV-GC) in Colombia and to clarify its clinicopathological features, we examined 178 consecutive gastric carcinoma cases, diagnosed during the period from 1996 to 1998, at Hospital Universitario del Valle in Cali, Colombia. The mean age of the cases was 60 years in males and 58 years in females. Using in situ hybridization assay of EBV-encoded small RNA-1 in paraffin-embedded tissue samples, we identified 23 cases of EBV-GC (13%). After excluding remnant carcinoma, which was found to be EBV-negative in this series, there were 19 (18%) male and 4 (6%) female EBV-GC cases, and the male predominance was statistically significant (P=0.004). The proportion of EBV-GCs decreased with age (P for trend = 0.022). Using sex- and age-specific proportions of EBV-GCs estimated by logistic models and gastric cancer incidence in Cali, which was obtained from tumor registry during the period 1987-1991, we estimated sex- and age-specific incidence of EBV-GCs. The incidence of EBV-GCs (per 100,000 person-years) was 4.1 and 1.4 among men and women, respectively, after age adjustment using the standard world population. Pathological features of EBV-GCs were also examined. EBV-GCs accounted for 33% (8/24) of carcinomas located in the stomach cardia, 14% (6/43) of carcinomas in the middle-part of the stomach, and 7% (6/81) of carcinomas in the antrum. The difference by tumor location was statistically significant (P=0.009). Histology-specific analysis using Lauren classification revealed that the proportion of EBV-GCs was not different in intestinal- and diffuse-type carcinomas (13% in both types). When the classification scheme of the Japanese Research Society for Gastric Cancer was used, EBV-GCs were identified more frequently in moderately differentiated tubular adenocarcinoma, and solid poorly differentiated adenocarcinoma when compared to other histological types. No lymphoepitelioma-like histology was found in the present series. The frequency of EBV-GC was slightly higher in advanced tumors, which involved serosa. Further analysis of clinico-pathological features of EBV-GC using a larger number of cases would give invaluable insights into its etiology.

Toxoplasmosis of the spinal cord in an immunocompromised patient: case report and review of the literature.

We, herein, describe an HIV-positive patient with toxoplasmosis of the spinal cord. We also carried out a comprehensive literature review of this topic, with emphasis on the diagnostic tools and therapeutic approach.

Se presenta el caso de un paciente seropositivo para VIH con diagnóstico de toxoplasmosis medular en conjunto con la revisión de la literatura de los pocos casos descritos hasta la fecha, con énfasis en las claves diagnósticas y la aproximación terapéutica.

Reliable information for cancer control in Cali, Colombia / Información fiable para el control del cáncer en Cali, Colombia

Abstract Background: The Cali Population Cancer Registry (RPCC) has been in continuous operation since 1962 with the objective of producing valid statistics on the incidence of cancer, its patterns, trends and survival rates. Methods: During the period 2008-2012, 23,046 new cases were registered and during 2011-2015 there were 12,761 cancer deaths. The trend of the rates was described with the APC average annual change rate and with the Joinpoint analysis. We analyzed the individual data of 38,671 adults (15-99 years) diagnosed with cancer between 1995-2009, and we calculated the standardized net survival by age for the 14 most common cancer body sites, using the Pohar-Perme method. Results: Prostate and breast cancer were the first cause of cancer morbidity. The incidence rates in these were susceptible to early detection, tumors stabilized after decades of growth, while an increase in the incidence of colon cancer and papillary thyroid carcinoma was observed. The incidence rates of cervical and stomach cancer and conditions related to infectious agents decreased, although the number of absolute cases increased, due to the growth and aging of the population. Gastric cancer was responsible for the highest number of cancer related deaths. The types of cancer related to tobacco consumption (lung, oral cavity, esophagus, pancreas, urinary bladder) showed low numbers and a tendency to decrease. During the period 2000-2004, the 5-year net survival improved for cancers of the breast, cervix, prostate, melanoma and thyroid, although in the period 2005-2009 a stagnation was observed. In stomach, liver and lung cancer, the 5-year net survival was less than 15%. The 5-year overall survival in children was 51.0% (95% CI: 47.5, 54.3) and in adolescents 44.6% (95% CI: 36.0, 52.8). Comment: RPCC has been an advisor to the Colombian government in the evaluation of CPRs in the country and its data has contributed significantly to different aspects of cancer control in Colombia.

Resumen Antecedentes: El Registro Poblacional de Cáncer de Cali (RPCC) está en operación continua desde 1962 con el objetivo de producir estadísticas válidas sobre la incidencia de cáncer, sus patrones, tendencias y supervivencia. Métodos: Durante el periodo 2008-2012, se registraron 23,046 casos nuevos y durante 2011-2015 se registraron 12,761 defunciones por cáncer. La tendencia de las tasas se describió con el porcentaje de cambio medio anual APC y con el análisis de Joinpoint. Se analizaron los datos individuales de 38,671 adultos (15-99 años) con diagnóstico de cáncer entre 1995-2009, y se calculó la supervivencia neta estandarizada por edad para las 14 localizaciones más comunes de cáncer, con el método de Pohar-Perme. Resultados: Próstata y mama fueron la primera causa de morbilidad por cáncer. Las tasas de incidencia en estos tumores susceptibles de detección temprana se estabilizaron tras décadas de crecimiento, mientras que se observó un incremento de la incidencia de cáncer de colon y carcinoma papilar de tiroides. Las tasas de incidencia de cáncer de cuello uterino y estómago, afecciones relacionados con agentes infecciosos, disminuyeron, aunque el número de los casos absolutos aumentó, debido al crecimiento y envejecimiento de la población. El cáncer gástrico fue responsable del mayor número de muertes por cáncer. Los tipos de cáncer relacionados con el consumo de tabaco (pulmón, cavidad oral, esófago, páncreas, vejiga urinaria) mostraron cifras bajas y con tendencia al descenso. Durante el periodo 2000-2004, la supervivencia neta a 5 años mejoró para los cánceres de mama, cuello uterino, próstata, melanoma y tiroides, aunque en el periodo 2005-2009 se observó un estancamiento. En cáncer de estómago, hígado y pulmón, la supervivencia neta a 5 años fue inferior al 15%. La supervivencia global a 5 años en niños fue de 51.0% (IC 95%: 47.5, 54.3) y en adolescentes de 44.6% (IC 95%: 36.0, 52.8). Comentario: El RPCC ha sido asesor del gobierno colombiano en la evaluación de RPCs en el país y sus datos han contribuido significativamente a diferentes aspectos del control del cáncer en Colombia.

Cali cancer registry methods / Métodos del Registro de Cáncer en Cali, Colombia

Abstract Background: The Population Cancer Registry of Cali (RPCC) has operated since 1962, disseminating high quality information to provide a framework to assess and control the burden of cancer in Cali. Methods: The collection of new cancer cases in permanent residents of Cali is done through active search in and notification from hospitals, and public and private laboratories. The Secretary of Municipal Public Health provides individual information on general mortality and death from cancer. Tumors are coded with ICDO-3 and mortality with ICD-10. Presented rates are standardized by age and trends are assessed by estimating the percentage annual change using the regression analysis in JoinPoint. The 5-year net survival was analyzed with the Pohar-Perme estimator. Results: The 88.5% of the registered cancers had morphological verification (MV). The proportion of unknown primary site represented 5% and the death certificate only cases (DCO) varied between 0 to3% depending on the cancer site. All deaths were certified by a physician, 94.2% of cancer deaths were correctly certified. The ill-defined site proportion was 5.3% and that of uterine cancer not specified (C55) was 0.5%. For survival analysis, existing data collection procedure and infrastructure ensures assessment of the patient's vital status and follow-up, with an average lost to follow-up of 13.2%. Comment: The information has been published in the eleven volumes of "Cancer Incidence in Five Continents" confirming high quality of the collected data. The RPCC PCRC has also participated in the Concord Study and is participating in SURVCAN-3.

Resumen Antecedentes: El Registro Poblacional de Cáncer de Cali (RPCC) opera de manera continua desde 1962 divulgando información de calidad para proporcionar un marco para valorar y controlar el impacto del cáncer en Cali. Métodos: La recolección de los casos nuevos de cáncer en residentes permanentes de Cali se hace mediante búsqueda activa y por notificación en los hospitales y laboratorios públicos y privados. La Secretaria de Salud Pública Municipal proporciona la información individual de mortalidad general y por cáncer. Los tumores se codifican con la CIO-3 y la mortalidad con la CIE-10. Las tasas se estandarizan por edad y la tendencia se estudia con el porcentaje de cambio anual y con la regresión de JoinPoint. La supervivencia neta a 5 años se analizó con el estimador de Pohar-Perme. Resultados: El 88.5% de los canceres tuvieron verificación morfológica (VM). La proporción de los casos codificada como de sitio mal definido representó el 5% y el certificado de defunción como única evidencia del diagnóstico de cáncer (DCO) varió entre 0-3% dependiendo de la localización. Todas las defunciones fueron certificadas por un médico, el 94.2% de las muertes por cáncer fueron bien certificadas. La proporción de sitio mal definido fue 5.3% y la de cáncer de útero no especificado (C55) fue 0.5%. En todos los casos de supervivencia fue posible el seguimiento y la proporción de censuras fue 13.2% Comentario: La información ha sido publicada en los once volúmenes de "Cancer Incidence in Five Continents". El RPCC participó en el Estudio Concord y está participando en SURVCAN-3.

A rare association of localized scleroderma type morphea, vitiligo, autoimmune hypothyroidism, pneumonitis, autoimmune thrombocytopenic purpura and central nervous system vasculitis. Case report.

BACKGROUND: The localized scleroderma (LS) known as morphea, presents a variety of clinical manifestations that can include systemic involvement. Current classification schemes divide morphea into categories based solely on cutaneous morphology, without reference to systemic disease or autoimmune phenomena. This classification is likely incomplete. Autoimmune phenomena such as vitiligo and Hashimoto thyroiditis associated with LS have been reported in some cases suggesting an autoimmune basis. To our knowledge this is the first case of a morphea forming part of a multiple autoimmune syndrome (MAS) and presenting simultaneously with autoimmune thrombocytopenic purpura and central nervous system vasculitis. CASE PRESENTATION: We report an uncommon case of a white 53 year old female patient with LS as part of a multiple autoimmune syndrome associated with pneumonitis, autoimmune thrombocytopenic purpura and central nervous system vasculitis presenting a favorable response with thrombopoietin receptor agonists, pulses of methylprednisolone and cyclophosphamide. CONCLUSION: Is likely that LS have an autoimmune origin and in this case becomes part of MAS, which consist on the presence of three or more well-defined autoimmune diseases in a single patient.

Human papillomavirus in upper digestive tract tumors from three countries.

AIM: To clarify human papillomavirus (HPV) involvement in carcinogenesis of the upper digestive tract of virological and pathological analyses. METHODS: The present study examined the presence of HPV in squamous cell carcinomas of the oral cavity (n = 71), and esophagus (n = 166) collected from Japan, Pakistan and Colombia, with different HPV exposure risk and genetic backgrounds. The viral load and physical status of HPV16 and HPV16-E6 variants were examined. Comparison of p53 and p16(INK4a) expression in HPV-positive and HPV-negative cases was also made. RESULTS: HPV16 was found in 39 (55%) oral carcinomas (OCs) and 24 (14%) esophageal carcinomas (ECs). This site-specific difference in HPV detection between OCs and ECs was statistically significant (P < 0.001). There was a significant difference in the geographical distribution of HPV16-E6 variants. Multiple infections of different HPV types were found in 13 ECs, but multiple infections were not found in OCs. This difference was statistically significant (P = 0.001). The geometric means (95% confidence interval) of HPV16 viral load in OCs and ECs were 0.06 (0.02-0.18) and 0.12 (0.05-0.27) copies per cell, respectively. The expression of p16(INK4a) proteins was increased by the presence of HPV in ECs (53% and 33% in HPV-positive and -negative ECs, respectively; P = 0.036), and the high-risk type of the HPV genome was not detected in surrounding normal esophageal mucosa of HPV-positive ECs. CONCLUSION: Based on our results, we cannot deny the possibility of HPV16 involvement in the carcinogenesis of the esophagus.

Burden of breast cancer in Cali, Colombia: 1962-2012 / La carga del cáncer de mama en Cali, Colombia: 1962-2012

Objective. To describe the behavior of breast cancer (BC)during the 1962-2012 period from information provided by the Cali Cancer Registry and the Municipal Health Secretariat of Cali. Materials and methods. The incidence trend (1962-2007) and mortality trend (1984-2012) for breast cancer was studied and relative survival (RS)(1995-2004) was estimated. Age-standardized incidence and mortality rates to the world population (ASIR(w)/ASMR(w)) were expressed per 100000 persons-year. Their temporal trend was examined with the annual percent of change (APC), and the Cox model was used to analyze the variables that influenced the survival of women with breast cancer. Results. The risk of breast cancer significantly increased in Cali through the 1962-2007 period, with an APC =1.7(95%CI:1.4-2.0). The ASIR(w) of BC increased from 27.1 in 1962 to 48.0 in 2007 and currently there are more than 500 cases reported annually. The mortality for BC has remained stable since 1984; in the 2009-2012 period, the ASMR(w) was 14.2. The 5-year RS was 69% (95%CI:66-71) from 2000-2004 and 62% (95%CI:59-65) from 1995-1999. The risk of death (HR) from BC was greater in persons from lower socioeconomic strata (SES) than from higher SES, HR=1.9(95%CI:1.3-2.9) and in those older than 70 years vs. <50, HR=1.6(95%CI:1.1-2.2). Conclusion. Mortality remained stable while incidence increased and survival improved, which may be associated with better detection and advances in treatment.

Objetivo. Describir el comportamiento del cáncer de mama (CaMa) entre 1962 y 2012 con la información del Registro Poblacional de Cáncer de Cali y de la Secretaría de Salud Municipal de Cali, Colombia. Material y métodos. Se estudió la tendencia de la incidencia (1962-2007) y mortalidad (1984-2012) por CaMa y se estimó la supervivencia relativa (SR) (1995-2004). Las tasas de incidencia y mortalidad estandarizadas por edad con población estándar mundial (TIEE(m)/TMEE(m)) se expresan por 100000 personas/año. Su tendencia temporal fue estudiada con el porcentaje de cambio anual (APC, por su sigla en inglés) y el modelo de Cox fue utilizado para analizar las variables que influyen en la supervivencia. Resultados. La TIEE(m) de CaMa aumentó de 27.1 en 1962 a 48.0 en 2007 y actualmente más de 500 casos son registrados anualmente, con un APC de 1.7(IC95%:1.4-2.0). La mortalidad por CaMa ha permanecido estable desde 1984; en el periodo 2009-2012 la TMEE(m) fue 14.2. La SR a cinco años fue 69% (IC95%:66-71) durante el periodo 2000-2004 y 62% (IC95%: 59-65) entre 1995 y 1999. El riesgo de morir (HR, por su sigla en inglés) por CaMa fue mayor en las personas de estratos socioeconómicos (ESE) bajos vs ESE altos, HR=1.9(IC95%:1.3-2.9) y en los mayores de 70 años vs los menores de 50, HR=1.6(95%CI:1.1-2.2). Conclusión. La mortalidad estable, con aumento de la incidencia y mejor supervivencia, puede estar asociada con una mejor detección y avances en el tratamiento.

Toxoplasmosis of the spinal cord in an immunocompromised patient: case report and review of the literature / Toxoplasmosis medular en un paciente inmunosuprimido: Informe de un caso y revisión de la literatura

We, herein, describe an HIV-positive patient with toxoplasmosis of the spinal cord. We also carried out a comprehensive literature review of this topic, with emphasis on the diagnostic tools and therapeutic approach.

Se presenta el caso de un paciente seropositivo para VIH con diagnóstico de toxoplasmosis medular en conjunto con la revisión de la literatura de los pocos casos descritos hasta la fecha, con énfasis en las claves diagnósticas y la aproximación terapéutica.