International cooperation and the challenge of internet accessibility in Caribbean territories: example of a collaborative platform between the University Hospital of Martinique and Ramón González Coro Hospital in Cuba, through the French PRPH-3 program.

BACKGROUND: Martinique shares with the other Caribbean countries specific public health issues, particularly in the diagnostic and therapeutic management of cancer patients. Mutualization of human and material resources by promoting cooperation is the most appropriate response to the challenges of the health systems of the Caribbean territories. Through the French PRPH-3 program, we propose to set up a collaborative digital platform adapted to the specificities of the Caribbean to strengthen professional links and skills in oncofertility and oncosexology and reduce inequalities in access to reproductive and sexual health care for cancer patients. METHODS: Within the context of this program, we have developed of an open-source platform based on a Learning Content Management System (LCMS), with an operating system developed by UNFM for low speed internet. LO libraries have been created and interaction between trainers and learners were done in asynchronous mode. This training management platform is based on: a TCC learning system (Training, Coaching, Communities); a web-hosting with pedagogical engineering appropriate to low bandwidth; a reporting system and a responsibility for processing. RESULTS: We have carried out a flexible, multilingual and accessible digital learning strategy functionality called e-MCPPO according to low-speed internet ecosystem. In close connection with the e-learning strategy we conceived (i) a multidisciplinary team; (ii) an appropriate training program for expert health professionals and (iii) a responsive design. DISCUSSION AND CONCLUSION: This low-speed web-based infrastructure allows communities of experts to cooperate in creating, validating, publishing and managing academic learning content. The self-learning modules provide the digital layer for each learner to extend their skills. Learners, as well as trainers, would gradually take ownership of this platform and encourage its promotion. Innovation in this context is both technological (low-speed Internet broadcasting, free interactive software) and organizational (moderating educational resources). This collaborative digital platform is unique in its form and content. This challenge could contribute to the digital transformation of the Caribbean ecosystem for capacity building in this specifics topics.

Collaborative digital platform France - Cuba: oncorehabilitation in reproductive and sexual health.

BACKGROUND: In the French West-Indies, few studies have been performed on fertility and sexual problems in cancer survivors, which are frequent and recurring issues reported by surveys on unmet needs. Additionally, mutualizing human and material resources and promoting cooperation through a collaborative platform are the most appropriate response to complex health pathways in the Caribbean territories. Implementation of such a collaborative platform will help to launch a strategic Caribbean partnership to transfer theoretical and technical skills and care standards in oncofertility and oncosexuality. METHODS: We propose to set up a collaborative digital platform to strengthen, from the French expertise, Cuban health professionals' knowledge, know-how, and skills in oncofertility and oncosexuality. The project will be coordinated by a coordinating, scientific, and supervisory committee, and the main activities will include: 1. Theoretical training in e-learning adapted to low-speed Internet. 2. Practical training in fertility preservation and sexual rehabilitation. 3. Digital multidisciplinary consultation meetings for medical decisions to be taken for complex clinical cases. The platform will benefit from a recurrent evaluation, by the two cancer registries of Martinique and Cuba, with the following performance indicators: number of Cuban professionals trained, number of professionals sensitized, hourly volumes (or number of training courses provided), satisfaction of trained professionals, number of e-RCPs carried out online and number of missionaries supported. These indicators will be set up and analyzed by the registers. This project meets the Cuban and French health policies (cancer plans and national sexual health strategies) and will be implemented in liaison with the Health Agencies of both countries and the Embassy of France in Cuba. DISCUSSION: This project aims to provide support through bilateral exchanges to improve reproductive and sexual health in Cuba's cancer patients. This collaboration will be based on a long-lasting French expertise and a solid Cuban health system. Consequently, this collaborative digital platform will contribute to data collection for cancer surveillance, and the two participating countries will ultimately be identified in the Caribbean as having centers of competence and excellence in oncofertility and oncosexuality with care standards.

Overall Survival of Patients with Locally Advanced or Metastatic Esophageal Squamous Cell Carcinoma Treated with Nimotuzumab in the Real World.

INTRODUCTION: Despite improvements in surgical techniques and treatments introduced into clinical practice, the overall survival of patients with esophageal squamous cell carcinoma remains low. Several epidermal growth factor receptor inhibitors are being evaluated in the context of clinical trials, but there is little evidence of effectiveness in real-world conditions. This study aimed at assessing the effectiveness of nimotuzumab combined with onco-specific treatment in Cuban real-life patients with locally advanced or metastatic esophageal squamous cell carcinoma. METHODS: A comparative and retrospective effectiveness study was performed. The 93 patients treated with nimotuzumab were matched, with use of propensity score matching, with patients who received a diagnosis of locally advanced or metastatic squamous cell carcinoma of the esophagus in three Cuban provinces reported between 2011 and 2015 to the National Cancer Registry. The Kaplan-Meier method was used to estimate event-time distributions. Log-rank statistics were used for comparisons of overall survival between groups. A two-component mixture model assuming a Weibull distribution was fitted to assess the effect of nimotuzumab on short-term and long-term survival populations. RESULTS: There was an increase in median overall survival in patients treated with nimotuzumab (11.9 months versus 6.5 months without treatment) and an increase in the 1-year survival rate (54.0% versus 21.9% without treatment). The 2-year survival rates were 21.1% for patients treated with nimotuzumab and 0% in the untreated cohort. There were statistically significant differences in survival between groups treated and not treated with nimotuzumab, both in the short-term survival population (6.0 months vs 4.0 months, p = 0.009) and in the long-term survival population (18.0 months vs 11.0 months, p = 0.001). CONCLUSIONS: Our study shows that nimotuzumab treatment concurrent with chemoradiotherapy increases the survival of real-world patients with locally advanced or metastatic esophageal squamous cell carcinoma. Further prospective studies are required to confirm the therapeutic effectiveness of nimotuzumab in esophageal cancer.

Is there a subgroup of long-term evolution among patients with advanced lung cancer?: hints from the analysis of survival curves from cancer registry data.

BACKGROUND: Recently, with the access of low toxicity biological and targeted therapies, evidence of the existence of a long-term survival subpopulation of cancer patients is appearing. We have studied an unselected population with advanced lung cancer to look for evidence of multimodality in survival distribution, and estimate the proportion of long-term survivors. METHODS: We used survival data of 4944 patients with non-small-cell lung cancer (NSCLC) stages IIIb-IV at diagnostic, registered in the National Cancer Registry of Cuba (NCRC) between January 1998 and December 2006. We fitted one-component survival model and two-component mixture models to identify short- and long- term survivors. Bayesian information criterion was used for model selection. RESULTS: For all of the selected parametric distributions the two components model presented the best fit. The population with short-term survival (almost 4 months median survival) represented 64% of patients. The population of long-term survival included 35% of patients, and showed a median survival around 12 months. None of the patients of short-term survival was still alive at month 24, while 10% of the patients of long-term survival died afterwards. CONCLUSIONS: There is a subgroup showing long-term evolution among patients with advanced lung cancer. As survival rates continue to improve with the new generation of therapies, prognostic models considering short- and long-term survival subpopulations should be considered in clinical research.

Años de vida saludable perdidos por cáncer de pulmón en Cuba en años seleccionados / Healthy years of life lost due to lung cancer in Cuba in selected years

Objetivos Identificar diferencias en la carga integral (combinando mortalidad y morbilidad) asociada al cáncer de pulmón entre sexos y provincias y describir su evolución en los años 1990,1995, 2000 y 2002. Métodos Los Años de Vida Potencial Perdidos por mortalidad se calcularon a partir de la Esperanza de Vida estimada para grupos quinquenales de edad. Los Años de Vida Potencial Perdidos se calcularon como promedio por cada defunción. Los Años de Vida Potencial Perdidos por morbilidad se obtuvieron a partir de las severidades, la incidencia y duración promedio. Resultados La tasa de Años de Vida Potencial Perdidos por mortalidad prematura se incrementó del 1990 al 2002 para ambos sexos, de 6,07 a 7,45 por 1 000 y de 2,52 a 4,21 por 1 000 en hombres y mujeres, respectivamente. Las provincias con mayores valores para esta tasa, en hombres en 1990 y 2002 fueron Ciudad de La Habana, Matanzas, La Habana e Isla de la Juventud, mientras que en el sexo femenino estas fueron Pinar del Río, Villa Clara, Ciudad de La Habana, Isla de la Juventud y Ciego de Ávila; se encontró un incremento de la tasa de Años de Vida Potencial Perdidos por morbilidad para ambos sexos del año 1990 al 2002 de 0,42 a 0,52 por 1 000 y de 0,19 a 0,28 por 1 000 en hombres y mujeres, respectivamente. La tasa de Años de Vida Ajustados por Discapacidad, también mostró una evolución desfavorable en ambos sexos. Los valores mayores de esta tasa se encontraron en La Habana, Ciudad de La Habana y Villa Clara para ambos sexos. El sexo masculino resultó más afectado tanto por mortalidad como por mortalidad. Conclusiones El impacto del cáncer de pulmón en términos de años de vida saludables perdidos tuvo una evolución desfavorable en Cuba en los años seleccionados del período 1990-2002.

Objectives To identify differences in the integral burden (combined mortality and morbidity) associated to lung cancer between sexes and among provinces, and to describe the evolution in 1990, 1995, 2000 and 2002. Methods The Potential Years of Life Lost due to mortality were calculated on the basis of estimated Life Expectancy for quinquennial groups of age. The Potential Years of Life Lost were calculated per death as an average. The Potential Years of Life Lost due to morbidity were estimated on the basis of severity, incidence and average duration. Results The rate of potential years of life lost due to premature mortality increased for both sexes in the 1990-2002 period; it was 6.07 to 7.45 per 1 000 inhabitants in males and 2.52 to 4.21 per 1 000 inhabitants in females. The provinces with the highest rates for males in 1990 and 2002 were Ciudad de La Habana, Matanzas, La Habana and Isla de la Juventus whereas the highest rates for females were found in Pinar del Río, Villa Clara, Ciudad de La Habana, Isla de la Juventud and Ciego de Avila provinces in the same years. There was found an increase in the rate of Potential Years of Life Lost due to morbidity for both sexes from 1990 to 2002; it was 0.42 to 0.52 and 0.19 to 0.28 per 1 000 inhabitants in males and females respectively. The rate of Disability Adjusted Years of Life also showed unfavourable evolution in both sexes. The highest figures were seen in La Habana, Ciudad de La Habana and Villa Clara for both sexes. The males were more affected in terms of mortality and morbidity. Conclusions The impact of lung cancer in healthy years of life lost had unfavourable evolution in Cuba in the selected years of the 1990-2002 period.

Childhood cancer incidence in Cuba, 2001 to 2003.

INTRODUCTION: Estimating childhood cancer incidence globally is hampered by lack of reliable data and uniform age limits for classifying and analyzing data reported. In Cuba, cancer data has been systematically gathered and processed by the National Cancer Registry (NCR) since 1964. The International Classification of Childhood Cancer (ICCC) is currently recommended for registering neoplasms in the population aged < or =19 years. Cancer incidence data published by the Cuban Ministry of Public Health, however, uses ICCC diagnostic groups for the population aged <15 years, and topographic sites for the population aged > or =15 years. OBJECTIVE: The objectives of this study are to describe cancer incidence in the Cuban population aged < or =19 years in 2001-2003 using the ICCC, as well as geographic distribution of incidence by sex and by principal diagnostic groups. METHODS: A descriptive study of cancer incidence in the population aged < or =19 years was conducted using NCR data for 2001-2003. ICCC diagnostic groups and subgroups were used, and 5 age groups (<1, 1-4, 5-9, 10-14 and 15-19 years) were analyzed. Total incidence and percentages for each diagnostic group were calculated. Number of cases in each diagnostic group and subgroup was also recorded by age group, and age-specific rates per 100,000 population aged < or =19 years (ASR) and age-adjusted rates to the standard world population aged < or =19 years (AAR) were calculated. AARs for leukemias, lymphomas and central nervous system (CNS) tumors were used to analyze childhood cancer risk by sex and geographical distribution in the country's 14 provinces and Isle of Youth Special Municipality. RESULTS: In 2001-2003, the NCR reported 1285 new cancer cases in the population aged < or =19 years for an overall incidence of 13.9 per 100,000 population aged < or =19 years (AAR). Highest risk was found in children aged <1 year with an ASR of 21.9 per 100,000 population aged < or =19 years. Leukemias, lymphomas and central nervous system tumors comprised 61.1% of new cases, and geographic distribution of these diagnostic groups varied by sex. Childhood cancer risk was highest for males in Ciego de Avila, Villa Clara and the Isle of Youth Special Municipality and highest for females in Sancti Spiritus, Villa Clara and Cienfuegos. CONCLUSIONS: Incidence of childhood cancer in Cuba conforms to rates reported internationally and to the incidence pattern most common in Latin America. Further research is recommended to examine risk factors influencing geographical variations in incidence within Cuba.

La carga de enfermedad por cáncer en Cuba en el período 1990-2002 / The burden of disease from cancer in Cuba, 1990-2002

OBJETIVO: Caracterizar la carga de enfermedad por morbilidad y mortalidad en Cuba entre 1990 y 2002, según el tipo y la localización de cáncer. MÉTODOS: Estudio descriptivo de la carga de enfermedad en los años 1990, 1995, 2000 y 2002, asociada con los tipos y las localizaciones de cáncer más frecuentes en Cuba. Se utilizaron fuentes oficiales cubanas para calcular los años de vida potencial perdidos (AVPP) por mortalidad (a partir de la esperanza de vida) y morbilidad (a partir de la incidencia, la duración promedio y la gravedad de la enfermedad), así como los años de vida potencial perdidos promedio por cada defunción (AVPP/D) y los años de vida ajustados por discapacidad (AVAD), para cada tipo y localización de cáncer por sexo y grupo de edad. RESULTADOS: Las localizaciones con más AVPP coincidieron con las de mayor carga total: pulmón, mama, próstata, colon y recto, y cuello del útero, y mostraron una tendencia ascendente en todos los tipos y localizaciones de cáncer, excepto la leucemia. Los AVPP por morbilidad se concentraron en: mama, pulmón, próstata, colon y recto, y cuello del útero. En hombres, los mayores valores de AVPP por mortalidad fueron en boca y orofaringe, esófago, estómago, pulmón, vejiga, melanoma, linfoma y leucemia; el cáncer de colon y recto afectó más a las mujeres. Los mayores valores de AVPP/D se observaron en cuello del útero, mama, ovario, leucemia y linfoma. Los tipos y las localizaciones de cáncer con más AVAD fueron: pulmón, mama, próstata, colon y recto, cuello del útero y endometrio. CONCLUSIONES: La carga de enfermedad por cáncer aumentó en Cuba entre 1990 y 2002, especialmente por un aumento en la carga por mortalidad.

OBJECTIVE: To describe the burden of disease, using morbidity and mortality in Cuba from 1990-2002, by cancer type and location. METHODS: A descriptive study of the disease burden in the years 1990, 1995, 2000, and 2002, by Cuba's most frequently associated cancer types and locations. Official Cuban sources were used to calculate years of potential life lost (YPLL) due to mortality (based on life expectancy) and morbidity (based on the incidence, average duration, and severity of the disease), as well as years of potential life lost per death (YPLL/D) and the disability-adjusted life years (DALY), for each cancer type and location, by sex and age group. RESULTS: The locations with higher YPLL were also those with the greatest total burden: lung, breast, prostate, colon and rectum, and cervix, and showed an upward trend for all cancer types and locations, except leukemia. The morbidity-related YPLL were concentrated in: breast, lung, prostate, colon and rectum, and cervix. In men, the highest mortality-related YPLL values were in the oral cavity and oropharynx, esophagus, stomach, lung, bladder, melanoma, lymphoma, and leukemia; women were more affected by cancer of the colon and rectum. The highest YPLL/D values were observed for cervix, breast, ovaries, leukemia, and lymphoma. The cancer types and locations with more DALYs were: lung, breast, prostate, colon and rectum, cervix, and endometrium. CONCLUSIONS: The burden of disease from cancer increased in Cuba from 1990-2002, mostly due to a rise in the mortality burden.

[The burden of disease from cancer in Cuba, 1990-2002]. / La carga de enfermedad por cáncer en Cuba en el período 1990-2002.

OBJECTIVE: To describe the burden of disease, using morbidity and mortality in Cuba from 1990-2002, by cancer type and location. METHODS: A descriptive study of the disease burden in the years 1990, 1995, 2000, and 2002, by Cuba's most frequently associated cancer types and locations. Official Cuban sources were used to calculate years of potential life lost (YPLL) due to mortality (based on life expectancy) and morbidity (based on the incidence, average duration, and severity of the disease), as well as years of potential life lost per death (YPLL/D) and the disability-adjusted life years (DALY), for each cancer type and location, by sex and age group. RESULTS: The locations with higher YPLL were also those with the greatest total burden: lung, breast, prostate, colon and rectum, and cervix, and showed an upward trend for all cancer types and locations, except leukemia. The morbidity-related YPLL were concentrated in: breast, lung, prostate, colon and rectum, and cervix. In men, the highest mortality-related YPLL values were in the oral cavity and oropharynx, esophagus, stomach, lung, bladder, melanoma, lymphoma, and leukemia; women were more affected by cancer of the colon and rectum. The highest YPLL/D values were observed for cervix, breast, ovaries, leukemia, and lymphoma. The cancer types and locations with more DALYs were: lung, breast, prostate, colon and rectum, cervix, and endometrium. CONCLUSIONS: The burden of disease from cancer increased in Cuba from 1990-2002, mostly due to a rise in the mortality burden.

Trends in Cuba's Cancer Incidence (1990 to 2003) and Mortality (1990 to 2007).

Introduction Cancer has been the second cause of death in Cuba since 1958. The National Cancer Registry (NCR) and the National Statistics Division of the Ministry of Public Health provide incidence, mortality and other relevant epidemiological data on the disease, as a basis for analysis and decision-making in public health planning for cancer control. Objectives Describe trends in incidence and mortality of cancer in Cuba overall and by sex since 1990, and analyze the most current 3-year data for frequent types and risk of developing and dying from cancer, by age group, sex, site, and province. Methods Cancer incidence and mortality were described using age-adjusted rates based on standard world population for 1990-2003 and 1990-2007, respectively. Crude and age-adjusted rates were calculated for the most common sites (excluding nonmelanoma skin cancer) by sex using the latest 3-year incidence data available (2001-2003) from the National Cancer Registry and mortality data (2005-2007) from the National Statistics Division of the Ministry of Public Health. To compare risk of developing and dying from cancer among Cuban provinces, age-adjusted rates were distributed in quartiles. Results Cancer incidence and mortality have increased in both sexes since 1990. In 2001-2003, an average of 23,710 new cancer cases were diagnosed annually (excluding nonmelanoma skin cancer), and the average annual risk of developing cancer was 216.5 per 100,000 population for men and 204.0 per 100,000 population for women. Between 2005 and 2007, there were 19,671 average annual deaths from cancer in Cuba. The risk of developing and dying from cancer varies by age group and by geographic location but was highest in Havana City province. The sites with highest incidence and mortality were lung, female breast, prostate, colon, and uterine cervix. Conclusions Cancer incidence and mortality are increasing in Cuba, and the differences by site, age, sex and geographical distribution analyzed in this article, as well as recommended further research, should serve to inform adoption and implementation of more effective strategies for the Ministry of Public Health's national Comprehensive Cancer Control Program.

Incidencia y mortalidad por cáncer en la mujer cubana. Trienio 2000-2002 / Incidence of and mortality from cancer in the Cuban woman in the 2000-2002 period

Se conoce que, entre los 25 y 50 años de edad, el cáncer es más frecuente en mujeres, fundamentalmente por los cánceres ginecológicos. Se decidió describir la situación actual del cáncer en la mujer cubana. Se calcularon las tasas promedio de incidencia y mortalidad (trienio 2000-2002) por 100 000 hab, estandarizadas a la población mundial para las 10 primeras localizaciones según sexo, y las específicas por edad y provincia de residencia. Se observó que las primeras localizaciones en mujeres, excluyendo piel, son: mama (mayor riesgo en occidente), cuello de útero (mayores riesgos en el oriente), pulmón y colon. Entre 20 y 39 años de edad el cáncer más frecuente es el de cuello de útero y en los grupos restantes es el de mama. Se insistió en el papel de la prevención para reducir la magnitud del problema cáncer en la mujer. Las acciones deben concentrarse en disminuir el hábito de fumar, modificar estilos de vida e incrementar la participación en los programas de diagnóstico precoz.

It is known that cancer, mainly the gynecological type, is more frequent in women aged 25-50 years, so it was decided to describe the current situation of cancer affecting the Cuban woman. Average incidence and mortality rates per 100 000 pop (2000-2002),standardized for the ten first locations by sex worldwide and specific by age and province of residence, were estimated. It was observed that the first locations in women, except for skin, were breast (highest incidence in the West), uterine neck (higher risks in the East), lung and colon. Uterine cancer is more common in 20-39 years age group whereas breast cancer predominates in the remaining groups. The role of prevention to reduce the extension of cancer in the female was stressed. Actions to be taken should be focused on reducing smoking, changing lifestyles and increasing the involvement of females in early diagnosis programs.

La carga por morbilidad del cáncer: Cuba, año 2000 / Burden of cancer morbidity in Cuba in the year 2000

Se han desarrollado diversos trabajos que cuantifican la carga asociada a la mortalidad (por distintas causas), expresada generalmente en términos de años de vida potencial perdidos (AVPP). Sin embargo, la carga por morbilidad, tan importante como la carga por mortalidad, no ha sido tan estudiada ya que, en buena medida, hay mucha menor disponibilidad de registros de morbilidad. Con este trabajo sobre la carga por morbilidad del cáncer en el 2000 se inicia una serie de estudios que ayuden a superar la relativa falta de información en Cuba sobre este tema. Se utilizaron indicadores epidemiológicos que caracterizan el comportamiento del cáncer en Cuba (mortalidad, incidencia y prevalencia) a partir de información brindada por la Dirección Nacional de Estadísticas y el Registro Nacional de Cáncer. Estos indicadores se validaron internamente con el programa DISMOD y fueron empleados para el cálculo de los AVPP por morbilidad (asociada al cáncer) según los procedimientos utilizados por la OMS en sus estudios sobre este aspecto. Se compararon los AVPP por mortalidad y por morbilidad para el 2000 en Cuba. Los AVPP por mortalidad son siete veces los AVPP por morbilidad del cáncer en el 2000. Esta relación entre los AVPP por morbilidad y por mortalidad varía con la edad. En el grupo de 0-4 años, los AVPP por morbilidad representan 3 por ciento de los AVPP por mortalidad, mientras que en el de 80 o más, el correspondiente porcentaje es de 19

Estudio de casos y controles sobre factores de riesgo de cáncer de próstata / A case-control study on prostate cancer risks

Para determinar el papel de algunos factores genéticos, hormonales, de estilo de vida y ambientales en el riesgo de desarrollar cáncer de próstata clínicamente manifiesto en La Habana, se estudiaron los casos (n = 273) diagnosticados durante 1998-2000, con verificación histológica o citológica de cáncer de próstata, residentes en Ciudad de La Habana y menores de 85 años. Los controles (n = 254) fueron seleccionados pareados por edad, del mismo hospital del caso. La información se obtuvo mediante una entrevista. La estimación del riesgo se obtuvo a través de una regresión logística condicional. No se observó asociación estadísticamente significativa entre el color de la piel y el riesgo de cáncer de próstata (OR = 1,30, IC 95(por ciento): 0,92-1,84) ni con el hábito de fumar (OR = 0,82, IC 95(por ciento): 0,58-1,16). Se observó una asociación positiva del riesgo de cáncer de próstata con las enfermedades venéreas (p = 0,01), así como con la edad de aparición de estas enfermedades (p = 0,06). No se encontraron diferencias en cuanto a la edad de inicio de las relaciones sexuales (p = 0,111) ni en el número de compañeras sexuales (p = 0,48). Se observó una asociación significativa entre el riesgo de padecer cáncer de próstata y el haber padecido de alguna enfermedad venérea, el no realizar ejercicio físico entre los 45 y los 50 años y la frecuencia de relaciones sexuales por encima de 10 veces a la semana

Sexual behaviour, history of sexually transmitted diseases, and the risk of prostate cancer: a case-control study in Cuba.

BACKGROUND: The relationship between the risk of prostate cancer and sexual activity and history of sexually transmitted diseases was investigated in a case-control study conducted in Cuba aimed at assessing the effect of lifestyle and environmental factors, as well as hormonal and genetic factors, on the occurrence of this disease. METHODS: During the period 1998-2000, all men up to 84 yr old with newly diagnosed, cytologically and/or histologically confirmed prostatic cancer who were resident in Havana City were identified in nine major hospitals in the area. Controls were resident in the same city, frequency-matched by age (+/-5 years) and hospital. The study included 273 cases and 254 controls. Information was obtained through an interview. RESULTS: The risk of prostate cancer was increased among men with a history of venereal disease (odds ratio = 1.7, 95% CI = 1.1-2.5). A higher frequency of cases reported having had sex with prostitutes, although the estimate of relative risk did not reach statistical significance. Similarly, a nonsignificant positive association was found with the number of female sexual partners. A significant increased risk was observed in subjects who reported having sexual intercourse more than 7 times per week compared with those who reported a weekly frequency of 3 times or fewer (odds ratio = 2.1, 95% CI = 1.2-3.7). Moreover, a significant trend was demonstrated. CONCLUSIONS: The study supports the hypothesis that an infectious factor related to sexual behaviour could be involved in the occurrence of prostate cancer. A role for hormonal factors related to sexual activity cannot be ruled out.

Incidencia del cáncer de piel en Cuba, 1988-1997 / Incidence of skin cancer in Cuba, 1988-1997

En Cuba, el cáncer de piel (excluyendo el melanoma)ocupa el segundo lugar en frecuencia, tanto en hombres como en mujeres. En 1997 constituían el 14,59 por ciento del total de tumores malignos diagnosticados con una tasa cruda de 29,19 por 100 000 habitantes, y una tasa estandarizada de 23,70, para ambos sexos. La mayoría de los pacientes son de raza blanca, constituyendo los carcinomas basales el principal tumor maligno de la piel (78,70 por ciento), por encima de los carcinomas epidermoides, que constituyen el 21,29 por ciento. Las tasas se incrementan rápidamente a partir de los 45 años de edad, alcanzándose la cifra máxima de 423 40 en hombres y 311 10 en mujeres en el grupo etáreo 80 a 84 años. La provincia de Villa Clara presenta la mayor tasa promedio en el período 1994 a 1997: 54, 46, con un riesgo de 2,55