Age-period-cohort effects on incidence trends of childhood leukemia from four population-based cancer registries in Colombia.

BACKGROUND: Childhood leukemia (CL) is the most prevalent form of pediatric cancer on a global scale. However, there is a limited understanding of the dynamics of CL incidence in South America, with a specific knowledge gap in Colombia. This study aimed to identify trends in CL incidence and to analyze the effects of age, period, and birth cohort on the risk of leukemia incidence in this population. METHODS: Information on all newly diagnosed leukemia cases (in general and by subtype) among residents aged 0-18 years and living in the serving areas of population-based cancer registries of Cali (2008-2017), Bucaramanga (2000-2017), Manizales (2003-2017), and Pasto (1998-2018). Estimated annual percent changes (EAPC) in incidence over time and potential changes in the slope of these EAPCs were calculated using joinpoint regression models. The effects of age, period, and cohort in CL incidence trends were evaluated using age-period-cohort models addressing the identifiability issue through the application of double differences. RESULTS: A total of 966 childhood leukemia cases were identified. The average standardized incidence rate (ASIR) of leukemia was calculated and expressed per 100,000 person-years - observing ASIR of 4.46 in Cali, 7.27 in Bucaramanga, 3.89 in Manizales and 4.06 in Pasto. Concerning CL trends there were no statistically significant changes in EAPC throughout the different periods, however, when analyzed by leukemia subtype, statistically significant changes were observed in the EAPC for both ALL and AML. Analysis of age-period-cohort models revealed that age-related factors significantly underpin the incidence trends of childhood leukemia in these four Colombian cities. CONCLUSIONS: This study offers valuable insights into the incidence trends of childhood leukemia in four major Colombian cities. The analysis revealed stable overall CL incidence rates across varying periods, predominantly influenced by age-related factors and the absence of cohort and period effects. This information is useful for surveillance and planning purposes for CL diagnosis and treatment in Colombia.

Use of the noninvasive entero-test in the detection of Helicobacter pylori in children in an endemic area in Colombia.

BACKGROUND AND OBJECTIVE: Gastric infection with Helicobacter pylori (H pylori), a strong risk factor for gastric cancer, is highly prevalent in children residing in the Colombian Andes. We aimed to validate the use of the Entero-test to culture and genotype H pylori strains from asymptomatic Colombian children. METHODS: Children (ages 10-15 years, n = 110, 80 of which were H pylori positive by the urea breath test [UBT]) were subjected to the Entero-test, and strings were cultured and/or used for DNA extraction for polymerase chain reaction (PCR). These children had been treated for H pylori in 2007. A second population of children (ages 10-15 years, n = 95),which had not been previously treated, was also subjected to the Entero-test. RESULTS: Of UBT-positive children in the treated group, 29 of 80 (36%) Entero-test samples were H pylori culture positive; 29 additional string extracts were tested by PCR for the H pylori virulence factors cagA and vacA. PCR from cultures and extracts yielded a sensitivity of 74% and specificity of 87%. In the untreated group, 16 of 94 UBT-positive children (17%) produced Entero-tests that were culture positive. Fifty-eight of 94 (62%) string extracts were PCR positive for cagA and/or vacA. In previously treated children, H pylori strains were more often the less virulent vacA s2 (P = 0.001), m2 (P = 0.006), and i2 genotypes (P = 0.039). CONCLUSIONS: The Entero-test may be used as a noninvasive test to detect H pylori in asymptomatic children residing in high-risk areas for gastric cancer. Treatment of H pylori in children was associated with less virulent genotypes.

Plasma selenium measurements in subjects from areas with contrasting gastric cancer risks in Colombia.

BACKGROUND: An inverse association between selenium status and incidence of different neoplasias including gastric cancer has been reported. This pilot study aimed to determine and compare selenium status in two Colombian populations with different gastric cancer risks: a high-risk area in the volcanic region of the Andes Mountains and a low-risk area on the Pacific coast. METHODS: Eighty nine adult males were recruited in the outpatient clinics of two public hospitals (44 and 45 from high- and low-risk areas, respectively) and provided a blood sample. Seventy one (79.8%) participants underwent upper gastrointestinal endoscopy. Plasma selenium was assayed using a fluorometric method, selenoprotein-P by ELISA, and glutathione peroxidase activity by a spectrophometric method. Histological diagnosis and Helicobacter pylori infection were evaluated in gastric biopsy samples. Unpaired samples t-test and linear regression analyses were used for statistical analyses. RESULTS: Although none of the subjects in either of the two geographic areas was selenium deficient, the level of plasma selenium was significantly lower in men from the high-risk area compared with those from the low-risk area. Levels of selenoprotein-P and glutathione peroxidase activity were similar between groups after adjustment for confounders. Selenium measurements were not associated with histopathological diagnosis. CONCLUSIONS: The high incidence of gastric cancer in the Andean region of Colombia is unlikely to be explained by selenium deficiency. We cannot exclude, however, that suboptimal selenium levels may exist in the gastric mucosa of subjects in the high-risk area. Therefore, the benefit of selenium supplementation in gastric cancer prevention cannot be dismissed.

Trends on cancer incidence and mortality in Pasto, Colombia. 15 years experience.

INTRODUCTION: In Colombia it is necessary to continue producing quality and continuously updated information on the magnitude of cancer, derived from population-based cancer registries to contribute to decision making, and implementation of strategies for health promotion, prevention and treatment of cancer in order to reduce the impact on the population. OBJECTIVE: To describe the incidence, mortality and cancer trends in Pasto-Colombia from 1998 to 2012. METHODS: Observational descriptive study of morbi - mortality due to malignant tumours in Pasto. The collection, processing and systematization of the data, was carried out according to international standards for population-based cancer registries. The incidence and mortality rates were calculated by period, sex, age and tumour site. RESULTS: During the period 1998-2012 there were 8,010 new cases of cancer, of them, 57.7% occurred in females. There were 4,214 deaths reported, 52.0% in females. The incidence (p men= 0.7, p females= 0.3) and mortality (p males= 1.0, p females= 0.0) did not present significant changes over 15 years of observation and the tumours that cause greater morbi-mortality affect the stomach, cervix uteri, breast and prostate. CONCLUSIONS: Cancer in general, continues to be a serious health problem for the population of Pasto. The global behaviour of cancer incidence and mortality, identify the need to promote and strengthen promotion and prevention programs, especially focused on tumours of the stomach, prostate, breast and cervix uteri that produce greater morbidity and mortality in the population.

INTRODUCCIÓN: En Colombia es necesario que se continúe produciendo información de calidad y actualizada sobre la magnitud del cáncer a partir de datos de los registros poblacionales de cáncer para contribuir a la toma de decisiones e implementación de estrategias de promoción de la salud, prevención y tratamiento del cáncer con el objetivo de disminuir el impacto en la población. OBJETIVO: Describir la incidencia, mortalidad y tendencia del cáncer en Pasto-Colombia durante 1998-2012. MÉTODOS: Estudio observacional descriptivo de la morbi-mortalidad por tumores malignos en Pasto. La recolección, procesamiento y sistematización de los datos se realizó de acuerdo a parámetros estandarizados internacionalmente para registros poblacionales de cáncer. Las tasas de incidencia y mortalidad se calcularon por periodo, sexo, edad y localización del tumor. RESULTADOS: En el período 1998-2012 se registraron 8,010 casos nuevos de cáncer, de ellos, 57.7% se presentaron en mujeres. Se reportaron 4,214 muertes, 52.0% en mujeres. La incidencia (p hombres= 0.7; p mujeres= 0.3) y mortalidad (p hombres= 1.0; p mujeres= 0.0) no presentó cambios significativos durante 15 años de observación y los tumores que causan mayor morbi-mortalidad afectan al estómago, cuello uterino, mama y próstata. CONCLUSIONES: El cáncer en general continúa siendo un importante problema de salud para la población de Pasto. El comportamiento global de la incidencia y la mortalidad por cáncer, evidencian la necesidad de fomentar y fortalecer programas de promoción y prevención, enfocados especialmente hacia los tumores de estómago, próstata, mama y cuello uterino que producen mayor morbi-mortalidad en la población.

Different gastric microbiota compositions in two human populations with high and low gastric cancer risk in Colombia.

Inhabitants of Túquerres in the Colombian Andes have a 25-fold higher risk of gastric cancer than inhabitants of the coastal town Tumaco, despite similar H. pylori prevalences. The gastric microbiota was recently shown in animal models to accelerate the development of H. pylori-induced precancerous lesions. 20 individuals from each town, matched for age and sex, were selected, and gastric microbiota analyses were performed by deep sequencing of amplified 16S rDNA. In parallel, analyses of H. pylori status, carriage of the cag pathogenicity island and assignment of H. pylori to phylogeographic groups were performed to test for correlations between H. pylori strain properties and microbiota composition. The gastric microbiota composition was highly variable between individuals, but showed a significant correlation with the town of origin. Multiple OTUs were detected exclusively in either Tumaco or Túquerres. Two operational taxonomic units (OTUs), Leptotrichia wadei and a Veillonella sp., were significantly more abundant in Túquerres, and 16 OTUs, including a Staphylococcus sp. were significantly more abundant in Tumaco. There was no significant correlation of H. pylori phylogeographic population or carriage of the cagPAI with microbiota composition. From these data, testable hypotheses can be generated and examined in suitable animal models and prospective clinical trials.

Estimating the cost of operating cancer registries: Experience in Colombia.

BACKGROUND: Maintaining population-based registries requires adequate and sustained resources; however, to date there has been no systematic evaluation to identify the resource needs for cancer registration in most countries, including Colombia. A systematic assessment of the costs can quantify the funding required and identify processes to improve efficiency of cancer registries. METHODS: The Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) was tailored specifically for the Colombian registries and was used to collect resource use data from five regional population-based cancer registries: Barranquilla, Bucaramanga, Cali, Manizales, and Pasto. The registries provided cost data for the year 2013 and cancer cases corresponding to the year 2010. RESULTS: We identified an almost threefold variation in the average cost per case (77,932 to 214,082 Colombian pesos or US $41 to US $113 in 2013) across the registries, but there were also substantial differences in data collection approaches, types of data collected, and activities performed. Cost per inhabitant varied between 95 and 415 Colombian pesos (US $0.05 to US $0.22). Between 20% and 45% of the total cost was due to fixed cost activities. CONCLUSIONS: The detailed economic information presented in this study constitutes a valuable source of activity-based cost data that registries can use to compare operations, assess key factors that lead to differences in cost per case, and identify potential approaches to improve efficiencies. Furthermore, the knowledge gained from studying the Colombian registries can help inform the planning and operations of other registries in the region.

Comprehensive assessment of population-based cancer registries: an experience in Colombia.

BACKGROUND: In the global context, the establishment of population-based cancer registries, particularly in less developed regions, has become of strategic importance. The factors influencing the operation and sustainability of registries can be determinants for their success, despite the existence of uniform quality indicators in the cancer incidence information. Our objective was to determine the current state of the structure, organization and operation of populationbased cancer registries in Colombia, obtain information on their degree of development and identify specific problems that affect their operation and sustainability. METHODS: We developed a descriptive study in 5 population-based cancer registries (Barranquilla, Bucaramanga, Cali, Manizales, and Pasto). The analysis included 7 broad categories: general characteristics, operational procedures, scientific production, completeness, validity, comparability and continuing education. To establish the validity of the information we used the available incidence databases. RESULTS: All registries were based in a university (3 public, 2 private). The 5 registries covered 11.8 percent of the Colombian population. Four registries published their results on cancer incidence. Financing came from different sources and costs varied significantly. Cancer incidence rates ranged from 94.1 to 189.2 per 100,000. The coverage of information sources ranged from 60 to 90 percent. Validity indicators were within acceptable limits while comparability parameters showed variations between registries. All registries participated in regular workshops and congresses. CONCLUSIONS: Operation of cancer registries in a model with universities and with several financial sources seems to provide sustainability; follow-up, training and assistance are critical to motivation and quality, costs vary significantly and determinants of costs of registry activities need to be further assessed.

Trends on cancer incidence and mortality in Pasto, Colombia. 15 years experience / Tendencia de la incidencia y mortalidad por cáncer en Pasto, Colombia; 15 años de experiencia

Abstract Introduction: In Colombia it is necessary to continue producing quality and continuously updated information on the magnitude of cancer, derived from population-based cancer registries to contribute to decision making, and implementation of strategies for health promotion, prevention and treatment of cancer in order to reduce the impact on the population. Objective: To describe the incidence, mortality and cancer trends in Pasto-Colombia from 1998 to 2012. Methods: Observational descriptive study of morbi - mortality due to malignant tumours in Pasto. The collection, processing and systematization of the data, was carried out according to international standards for population-based cancer registries. The incidence and mortality rates were calculated by period, sex, age and tumour site. Results: During the period 1998-2012 there were 8,010 new cases of cancer, of them, 57.7% occurred in females. There were 4,214 deaths reported, 52.0% in females. The incidence (p men= 0.7, p females= 0.3) and mortality (p males= 1.0, p females= 0.0) did not present significant changes over 15 years of observation and the tumours that cause greater morbi-mortality affect the stomach, cervix uteri, breast and prostate. Conclusions: Cancer in general, continues to be a serious health problem for the population of Pasto. The global behaviour of cancer incidence and mortality, identify the need to promote and strengthen promotion and prevention programs, especially focused on tumours of the stomach, prostate, breast and cervix uteri that produce greater morbidity and mortality in the population.

Resumen Introducción: En Colombia es necesario que se continúe produciendo información de calidad y actualizada sobre la magnitud del cáncer a partir de datos de los registros poblacionales de cáncer para contribuir a la toma de decisiones e implementación de estrategias de promoción de la salud, prevención y tratamiento del cáncer con el objetivo de disminuir el impacto en la población. Objetivo: Describir la incidencia, mortalidad y tendencia del cáncer en Pasto-Colombia durante 1998-2012. Métodos: Estudio observacional descriptivo de la morbi-mortalidad por tumores malignos en Pasto. La recolección, procesamiento y sistematización de los datos se realizó de acuerdo a parámetros estandarizados internacionalmente para registros poblacionales de cáncer. Las tasas de incidencia y mortalidad se calcularon por periodo, sexo, edad y localización del tumor. Resultados: En el período 1998-2012 se registraron 8,010 casos nuevos de cáncer, de ellos, 57.7% se presentaron en mujeres. Se reportaron 4,214 muertes, 52.0% en mujeres. La incidencia (p hombres= 0.7; p mujeres= 0.3) y mortalidad (p hombres= 1.0; p mujeres= 0.0) no presentó cambios significativos durante 15 años de observación y los tumores que causan mayor morbi-mortalidad afectan al estómago, cuello uterino, mama y próstata. Conclusiones: El cáncer en general continúa siendo un importante problema de salud para la población de Pasto. El comportamiento global de la incidencia y la mortalidad por cáncer, evidencian la necesidad de fomentar y fortalecer programas de promoción y prevención, enfocados especialmente hacia los tumores de estómago, próstata, mama y cuello uterino que producen mayor morbi-mortalidad en la población.

Cancer incidence and mortality in the municipality of Pasto, 1998 - 2007.

INTRODUCTION: In Colombia, information on cancer morbidity at the population level is limited. Incidence estimates for most regions are based on mortality data. To improve the validity of these estimates, it is necessary that other population-based cancer registries, as well as Cali, provide cancer risk information. OBJECTIVE: To describe the incidence and cancer mortality in the municipality of Pasto within the 1998-2007 period. METHODS: The study population belongs to rural and urban areas of the municipality of Pasto. Collection, processing, and systematization of the data were performed according to internationally standardized parameters for population-based cancer registries. The cancer incidence and mortality rates were calculated by gender, age, and tumor. RESULTS: During the 1998-2007 period 4,986 new cases of cancer were recorded of which 57.7% were in female. 2,503 deaths were presented, 52% in female. Neoplasm-associated infections are the leading cause of cancer morbidity in Pasto: stomach cancer in males and cervical cancer in females. DISCUSSION: Cancer in general is a major health problem for the population of the municipality of Pasto. The overall behavior of the increasing incidence and cancer mortality in relation to other causes of death show the need to implement and strengthen prevention and promotion programs, focusing especially on tumors that produce greater morbidity and mortality in the population.

INTRODUCCIÓN: En Colombia es limitada la información de morbilidad por cáncer dentro de la población. Las estimaciones de incidencia para la mayoría de las regiones se basan en los datos de mortalidad. Para mejorar la validez de estas estimaciones, es necesario que otros Registros poblacionales de cáncer, además de Cali, proporcionen información del riesgo de cáncer. OBJETIVO: Describir la incidencia y mortalidad por cáncer en el municipio de Pasto durante el período 1998-2007. METODOLOGÍA: La población objeto de estudio pertenece al área rural y urbana del municipio de Pasto. La recolección, procesamiento y sistematización de los datos se realizó de acuerdo con parámetros estandarizados internacionalmente para Registros poblacionales de cáncer. Las tasas de incidencia y mortalidad se calcularon por género, edad y localización del tumor. RESULTADOS: En el período 1998-2007 se registraron 4.986 casos nuevos de cáncer, de ellos, 57,7% se presentó en mujeres. Se reportaron 2.503 muertes, 52% en mujeres. Las neoplasias asociadas con infecciones son la primera causa de morbilidad por cáncer en Pasto: cáncer de estómago en hombres y cáncer de cuello uterino en mujeres. DISCUSIÓN: El cáncer, en general, constituye un importante problema de salud para la población del municipio de Pasto. El comportamiento global de la incidencia y el aumento de la mortalidad por cáncer en relación con otras causas de muerte, evidencian la necesidad de fomentar y fortalecer programas de promoción y prevención, enfocados especialmente hacia los tumores que producen mayor morbi-mortalidad en la población.

Data quality at population-based cancer registries in Colombia.

INTRODUCTION: Population-based cancer registries provide vital information for planning, prevention and cancer management. Information generated by the registries must be comprehensive, valid and comparable. Because of their importance, regular quality assessments are recommended. OBJECTIVE: The quality of cancer incidence data were assessed at four population-based cancer registries in Colombia for cancer incidence estimations. MATERIAL AND METHODS: Data collected at population-based cancer registries of Bucaramanga, Cali, Pasto, and Manizales were included. Completeness was assessed by the use of graphs in illustrating the mortality incidence ratios and their relation to the survival. Validity was evaluated by the description of morphologically verified cases, cases identified from death certificates only, and the internal consistency of the data. RESULTS: There was a global under-coverage of cancer registration at Bucaramanga and Manizales, whereas a more specific under-coverage for certain localizations was observed in Cali and Pasto. Validity analyses established that death certificates were little used as a source of information, and some inconsistencies appeared among the data associated with the most valid basis of diagnosis and morphology. CONCLUSIONS: In Colombia, the data quality at population-based cancer registries can be further improved by considering the use of additional sources of information, such as death certificates, the use of specialized software for data capture, and automatic validation of internal consistency. Mortality certification must be improved in areas where a population-based cancer registry is operating.

Data quality at population-based cancer registries in Colombia / Calidad de los datos en los registros de cáncer de base de población en Colombia

Introduction. Population-based cancer registries provide vital information for planning, prevention and cancer management. Information generated by the registries must be comprehensive, valid and comparable. Because of their importance, regular quality assessments are recommended. Objective. The quality of cancer incidence data were assessed at four population-based cancer registries in Colombia for cancer incidence estimations. Material and methods. Data collected at population-based cancer registries of Bucaramanga, Cali, Pasto, and Manizales were included. Completeness was assessed by the use of graphs in illustrating the mortality incidence ratios and their relation to the survival. Validity was evaluated by the description of morphologically verified cases, cases identified from death certificates only, and the internal consistency of the data. Results. There was a global under-coverage of cancer registration at Bucaramanga and Manizales, whereas a more specific under-coverage for certain localizations was observed in Cali and Pasto. Validity analyses established that death certificates were little used as a source of information, and some inconsistencies appeared among the data associated with the most valid basis of diagnosis and morphology. Conclusions. In Colombia, the data quality at population-based cancer registries can be further improved by considering the use of additional sources of information, such as death certificates, the use of specialized software for data capture, and automatic validation of internal consistency. Mortality certification must be improved in areas where a population-based cancer registry is operating.

Introducción. La información de los registros de población de cáncer resulta de vital importancia en la planeación, prevención y manejo del cáncer. La información generada por los registros debe ser exhaustiva, válida y comparable, por lo que se recomienda hacer evaluaciones periódicas de calidad. Objetivo. Evaluar algunos aspectos relacionados con la exhaustividad y la validez de la información recolectada por los registros de población de cáncer en Colombia para estimar las cifras de cáncer en el país. Materiales y métodos. Se evaluó la información de los registros de población de Bucaramanga, Cali, Pasto y Manizales. La exhaustividad se analizó mediante las razones de mortalidad, incidencia y su relación con la supervivencia. La validez se estableció con la descripción de los casos verificados morfológicamente y los registrados en certificados de defunción. Finalmente, se describieron las inconsistencias generadas. Resultados. El análisis de exhaustividad mostró un subregistro general en los registros de Bucaramanga y Manizales, y un subregistro para algunas localizaciones en todos los registros. El análisis de validez indicó un bajo uso de los certificados de defunción como fuente de información y porcentajes importantes de inconsistencias entre la base de diagnóstico y la histología. Conclusiones. La calidad de la información de los registros de población de cáncer en Colombia puede ser mejorada al considerar fuentes adicionales de información, el uso de software especializado en captura y validación, y fortalecimiento en el registro de la mortalidad en las áreas de cobertura.

Cancer incidence and mortality in the municipality of Pasto, 1998 - 2007 / Incidencia y mortalidad por cáncer en el municipio de Pasto 1998 - 2007

ABSTRACT Introduction: In Colombia, information on cancer morbidity at the population level is limited. Incidence estimates for most regions are based on mortality data. To improve the validity of these estimates, it is necessary that other population-based cancer registries, as well as Cali, provide cancer risk information. Objective: To describe the incidence and cancer mortality in the municipality of Pasto within the 1998-2007 period. Methodology: The study population belongs to rural and urban areas of the municipality of Pasto. Collection, processing, and systematization of the data were performed according to internationally standardized parameters for population-based cancer registries. The cancer incidence and mortality rates were calculated by gender, age, and tumor Results: During the 1998-2007 period 4,986 new cases of cancer were recorded of which 57.7% were in female. 2,503 deaths were presented, 52% in female. Neoplasm-associated infections are the leading cause of cancer morbidity in Pasto: stomach cancer in males and cervical cancer in females. Discussion: Cancer in general is a major health problem for the population of the municipality of Pasto. The overall behavior of the increasing incidence and cancer mortality in relation to other causes of death show the need to implement and strengthen prevention and promotion programs, focusing especially on tumors that produce greater morbidity and mortality in the population.

RESUMEN Introducción. En Colombia es limitada la información de morbilidad por cáncer dentro de la población. Las estimaciones de incidencia para la mayoría de las regiones se basan en los datos de mortalidad. Para mejorar la validez de estas estimaciones, es necesario que otros Registros poblacionales de cáncer, además de Cali, proporcionen información del riesgo de cáncer. Objetivo. Describir la incidencia y mortalidad por cáncer en el municipio de Pasto durante el período 1998-2007. Metodología. La población objeto de estudio pertenece al área rural y urbana del municipio de Pasto. La recolección, procesamiento y sistematización de los datos se realizó de acuerdo con parámetros estandarizados internacionalmente para Registros poblacionales de cáncer. Las tasas de incidencia y mortalidad se calcularon por género, edad y localización del tumor. Resultados. En el período 1998-2007 se registraron 4.986 casos nuevos de cáncer, de ellos, 57,7% se presentó en mujeres. Se reportaron 2.503 muertes, 52% en mujeres. Las neoplasias asociadas con infecciones son la primera causa de morbilidad por cáncer en Pasto: cáncer de estómago en hombres y cáncer de cuello uterino en mujeres. Discusión. El cáncer, en general, constituye un importante problema de salud para la población del municipio de Pasto. El comportamiento global de la incidencia y el aumento de la mortalidad por cáncer en relación con otras causas de muerte, evidencian la necesidad de fomentar y fortalecer programas de promoción y prevención, enfocados especialmente hacia los tumores que producen mayor morbi-mortalidad en la población.