Epidemiology of Eye Cancer in Cali, Colombia: A 55-Year Study.

PURPOSE: To describe the epidemiology, incidence, mortality and survival of ocular cancer in Cali between 1962 and 2019. METHODS: Ecological population-based study analyzing data of incidence, mortality, and 5-years survival of malignant ocular tumors from the Populational Cancer Registry of Cali between 1962 and 2019. RESULTS: Between 1962 and 2019, 586 ocular tumors were found, 50.5% occurred in females, the mean age at diagnosis was 45 years (standard deviation = 25), 70.3% of ocular malignancies occurred in >14 years. The average annual incidence rate was 7.8 per million for male and 6.9 per million for females. Retinoblastoma (21%), squamous cell carcinoma (20%), melanoma (16%) and lymphoma (8%) were the most common neoplasm. In those <15 years, the most frequent malignant tumors were retinoblastomas (85.7%), followed by non-specified malignant neoplasm (NOS, 7.9%), and rhabdomyosarcoma (3.6%). In those >14 years, there were NOS (30%), followed by squamous cell carcinomas (28%), melanomas (23%), and lymphomas (9.7%). Conjunctiva (38.2%), retina (21%) and orbit (10%) constituted the majority of anatomical sites of ocular tumors. The survival rate was about 83.2% and mortality did not show a decreasing trend over time (p > .05). CONCLUSIONS: The incidence of ocular cancer in Cali has a slightly increasing trend, with stable behavior in the last decades. Squamous cell carcinoma, retinoblastoma, melanoma and lymphoma are the most frequent ocular cancers, with being retinoblastoma more frequent than melanoma. In general, ocular cancer had good survival rates in Cali.

Gastric adenocarcinoma burden, trends and survival in Cali, Colombia: A retrospective cohort study.

Background: Gastric adenocarcinoma (GA) has changed in recent decades. Cancer estimates are often calculated from population-based cancer registries, which lack valuable information to guide decision-making (clinical outcomes). We describe the trends in clinical practice for GA using a hospital-based cancer registry over a timespan of 15 years. Methods: A retrospective cohort study was conducted. Data were gathered from adults diagnosed and treated for GA at Fundación Valle del Lili (FVL), between 2000 and 2014, from the hospital's own cancer registry and crossed with Cali's Cancer Registry. Additional data were obtained directly from clinical records, pathology reports and the clinical laboratory. Patients younger than 18 years and those for whom limited information was available in the medical history were excluded. A survival analysis was conducted using Kaplan-Meier method. Results: A total of 500 patients met eligibility criteria. Median age was 64 years (IQR: 54-74 years), 39.8% were female, 22.2% were at an early stage, 32.2% had a locally advanced disease, and 29% a metastatic disease, 69% had intestinal subtype, 48.6% had a positive H. pylori test, 85.2% had a distal lesion, 62% underwent gastrectomy, 60.6% lymphadenectomy, and 40.6% received chemotherapy. Survival at 5 years for all cases was 39.9% (CI 95% 35.3-44.5). Survival decreased over time in all groups and was lower in age-groups <39 and 60-79 with either locally advanced or metastatic disease. Prognostic factors that were significant in the Cox proportional-hazards model were late stages of the tumor (locally advanced: HR=2.52; metastatic: HR=4.17), diffuse subtype (HR=1.40), gastrectomy (subtotal: HR=0.42; total: 0.44) and palliative chemotherapy (HR=0.61). Conclusions: The treatment of GA has changed in recent decades. GA survival was associated with clinical staging, diffuse subtype, gastrectomy and palliative chemotherapy. These findings must be interpreted in the context of a hospital-based study.

Primary central nervous system tumors survival in children in ten Colombian cities: a VIGICANCER report.

Purpose: Primary central nervous system (CNS) tumors are the second most common cancer in children and adolescents, leading to premature death and disability. Population-based survival estimates aid decision-making in cancer control, however data on survival for primary CNS tumors in Latin America is lacking. We describe survival rates for children with primary CNS tumors treated in ten Colombian cities. Methods: We analyzed data from children and adolescents newly diagnosed with cancer between 2012 and 2021, participating in the Childhood Cancer Clinical Outcomes Surveillance System (VIGICANCER) in ten cities in Colombia. VIGICANCER collects information on clinical outcomes from twenty-seven pediatric oncology units and conducts active follow-up every three months. VIGICANCER does not register craniopharyngiomas; we excluded intracranial germ cell tumors for this report. We used the Kaplan-Meier method to estimate the overall survival probability, stratified by sociodemographic variables, topography, WHO grading, receipt of radiation therapy, and type of surgical resection. We analyzed the prognostic capacity of variables using multivariate proportional Cox's regression, stratified by city and year of diagnosis. Results: During the study period, VIGICANCER included 989 primary CNS tumors in 879 children and 110 adolescents. The cohort median age was 9 years; 53% of patients were males, and 8% were Afro-descendants. Most common tumors were supratentorial astrocytomas (47%), astrocytic tumors (35%), medulloblastomas (20%), ependymomas (11%), and mixed and unspecified gliomas (10%). Five-year overall survival of the entire cohort was 54% (95% CI, 51-58); for supratentorial gliomas, WHO grade I was 77%, II was 62%, III-IV was 27%, respectively, and for medulloblastoma was 61%. The adjusted hazard rate ratio for patients with WHO grade III and IV, for those with subtotal resection, for brainstem location, and for those not receiving radiation therapy was 7.4 (95% CI, 4.7-11.8), 6.4 (95% CI, 4.2-9.8), 2.8 (95% 2.1-3.8), 2.0 (95% CI, 1.3-2.8) and 2.3 (95% CI, 1.7-3.0), respectively. Conclusion: We found that half of Colombia's children and adolescents with primary CNS tumors survive five years, compared to 70% to 80% in high-income countries. In addition to tumor biology and location, gross total resection was crucial for improved survival in this cohort. Systematic monitoring of survival and its determinants provides empirical data for guiding cancer control policies.

Trends in long-term cancer survival in Cali, Colombia: 1998-2017.

Background: Population-based cancer survival is an indicator of the effectiveness of cancer services that reflects the survival of all cancer patients in the population, regardless of socioeconomic status and disease characteristics. Aim: Provision of an up-to-date survival estimate of patients recorded within Cali Population Cancer Registry (RPCC) in 1998-2017. As a second objective, results will be compared with those reported by the CONCORD study for cancers prioritized by the current Ten-Year Cancer Control Plan of Colombia, 2012-2021. Methods: Adult cancer cases (aged 15 to 99 years) for nine cancer types diagnosed between 1998 and 2017, with follow-up to 2018, were obtained from the RPCC. The 5-year age-standardized net survival estimates (NS) were estimated using the Pohar-Perme. The results for the period 1995- 2014 were compared with those reported by the CONCORD study for the following locations: stomach (C16), breast (C50), cervix (C53), prostate (C61), and lung (C33-34). Results: Five-year survival estimates for breast and prostate cancers improved ten percentage points through 2007 (70.8 to 81.1 for breast and 79.9 to 90.2 for prostate) and remained stable during 2008-2017. For cervical cancer, survival estimates has remained stable for the last two decades at 53%. For stomach cancer and lung cancer, five-year NS was lower than 25% over the study period. For colorectal cancer, survival estimates increased from 37.9% in 1998-2002 to 54.8% in 2013-2017. Compared to previous 5-year survival estimates of cases diagnosed in 2010-2014, the estimates in this study are significantly higher than those obtained by CONCORD. Survival estimates of patients diagnosed in 1995-2009 showed no difference to CONCORD study. Conclusions: Periodic update of vital status and date of last contact reduces bias in survival estimates in population-based cancer registries with passive follow-up.

Antecedentes: La supervivencia del cáncer es un indicador de la eficacia de los servicios oncológicos que refleja la supervivencia de todos los pacientes con cáncer de la población, independientemente del nivel socioeconómico y las características de la enfermedad. Objetivo: Realizar una estimación actualizada de la supervivencia de los pacientes registrados en el Registro Poblacional de Cáncer de Cali durante 1998-2017. Como segundo objetivo, los resultados se compararán con los reportados por el estudio CONCORD para los cánceres priorizados por el actual Plan Decenal de Control del Cáncer de Colombia, 2012-2021. Métodos: Los casos de cáncer en adultos (15 a 99 años) para nueve tipos de cáncer diagnosticados entre 1998 y 2017, con seguimiento hasta 2018, se obtuvieron del RPCC. Las estimaciones de supervivencia neta (NS) estandarizada por edad a 5 años se estimaron utilizando el método de Pohar-Perme. Los resultados del periodo 1995-2014 se compararon con los obtenidas por el estudio CONCORD para las siguientes localizaciones: estómago (C16), mama (C50), cuello uterino (C53), próstata (C61) y pulmón (C33-34). Resultados: La SN-5a para los cánceres de mama y próstata mejoró diez puntos porcentuales hasta 2007 (SN=70.8 a 81.1 para mama y NS=79.9 a 90.2 para próstata) y se mantuvo estable durante 2008-2017. Para el cáncer de cuello uterino fue 53% y permaneció estable durante dos décadas. Para el cáncer de estómago y el cáncer de pulmón, la SN-5años fue inferior al 25%. Para cáncer colorrectal las estimaciones de supervivencia aumentaron de 37.9% en 1998-2002 a 54.8% en 2013-2017. En comparación con estimaciones anteriores de supervivencia a 5 años de casos diagnosticados en 2010-2014, las estimaciones de este estudio son significativamente más altas que las obtenidas por CONCORD-3. Para la década 1995-2009 no hubo diferencia. Conclusión: La actualización periódica del estado vital y la fecha de último contacto reduce el sesgo en las estimaciones de supervivencia en los registros de cáncer de base poblacional que hacen seguimiento pasivo.

Survival in stomach cancer: analysis of a national cancer information system and a population-based cancer registry in Colombia

Background: Stomach cancer is among the most frequent, is a leading cause of mortality in low- and middle-income countries. Assessing its survival is important to guide evidence-based health policies. Aims: To estimate stomach cancer survival in Colombia (2014-2019) with data from the National Cancer Information System (NCIS) and in Cali with data from the Cali Population Cancer Registry (RPCC) (1998-2017). Methods: NCIS estimated the overall 3-year net survival for 8,549 people, while RPCC estimated 5-year net survival for 6,776 people. Results: The 3-year net survival was 36.8% (95% CI: 35.5-38.1). Net survival was higher in people with special insurance (61.7%; 95% CI: 44.8-74.8) or third payer (40.5%; 95% CI: 38.7-42.3) than state insurance (30.7%; 95% CI: 28.7-32.8). It was also higher in women and people diagnosed at early stages. Multivariable analysis showed consistency with survival estimations with a higher risk of death in men, people with state insurance, and diagnosed at advanced stages. In Cali, the 5-year net survival remained stable in men during the last 20 years. In women the 5-year net survival in women increased 8.60 percentage points, equivalent to a 50% increase compared to the 1998-2002 period. For 2013-17, it was 19.1% (95%CI: 16.2-22.2) in men, and 24.8% (95% CI: 20.4-29.3) in women. Conclusions: Population survival estimates from the RPCC were lower than those observed in the NCIS. The differences in their methods and scope can explain variability. Nevertheless, our findings could be complementary to improve cancer control planning in the country.

Antecedentes: El cáncer de estómago se encuentra entre los más frecuentes y es una de las principales causas de mortalidad en los países de ingresos bajos y medianos. Evaluar su supervivencia es importante para orientar las políticas de salud basadas en la evidencia. Objetivos: Estimar la supervivencia del cáncer de estómago en Colombia (2014-2019) con datos del Sistema Nacional de Información del Cáncer (NCIS) y en Cali con datos del Registro Poblacional de Cáncer de Cali (RPCC) (1998-2017). Métodos: El NCIS estimó la supervivencia neta a tres años para 8,549 personas y el RPCC la calculó a 5 años para 6,776 personas registradas en sus bases de datos. Resultados: La supervivencia neta a tres años en Colombia fue del 36.8% (IC 95%: 35.5-38.1). La supervivencia neta fue mayor en personas con seguro especial (61.7%; IC 95%: 44.8-74.8) o tercer pagador (40.5%; IC 95%: 38.7-42.3) que el seguro estatal (30.7%; IC 95%: 28.7-32.8). También fue mayor en mujeres y personas diagnosticadas en etapas tempranas. El análisis multivariable mostró consistencia con la estimación de supervivencia con mayor riesgo de muerte en hombres, personas con seguro estatal y diagnosticados en estadios avanzados. En Cali, la supervivencia neta a 5 años se mantuvo estable en los hombres durante los últimos 20 años. En las mujeres aumentó 8.60 puntos porcentuales, equivalente a un aumento del 50% en comparación con el período 1998-2002. Para el período 2013-17 fue 19.1% (IC 95%: 16.2-22.2) en los hombres y 24.8% (IC 95%: 20.4-29.3) en las mujeres. Conclusiones: Las estimaciones de supervivencia del RPCC fueron más bajas que las obtenidas por el NCIS. Las diferencias en sus métodos y alcance pueden explicar la variabilidad. Sin embargo, nuestros hallazgos pueden ser complementarios para mejorar la planificación del control del cáncer en el país..

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.

[Immunotyping of lymphocytes in the gastric mucosa of patients infected by H. pylori in two regions with contrast in the risk of developing gastric cancer]. / Inmunotipificación de linfocitos en mucosa gástrica de pacientes infectados por H. pylori en dos regiones geográficas con contraste en el riesgo de desarrollar cáncer gástrico.

Helicobacter pylori (H. pylori) infection involves multiple factors internal and external to the host. Among the internal factors, the immune response plays a fundamental role in the process of antigen presentation, lymphocytic response and cytokine-mediated regulatory response that are directly as sociated with disease progression and prognosis. OBJECTIVE: To compare the immune response in gas tric mucosa of H. pylori infected patients in two regions comparing the risk of developing gastric can cer. PATIENTS AND METHOD: 71 participants with symptoms of dyspepsia were included. The samples for biopsies were collected from different regions of the gastric mucosa; the identification of H. pylori was carried out by culture and polymerase chain reaction (PCR) of the ureA gene. For the characteri zation of the histopathological alterations and the immunophenotyping of lymphocytes, anti-human mouse monoclonal antibodies specific for each antigen were used: T lymphocytes: CD3 and CD8; B lymphocytes: CD20; Natural Killer Cells: CD56; Macrophages: CD68. RESULTS: The prevalence of H. pylori was 83.1%, the predominant types of gastritis were chronic gastritis and multifocal atrophic gastritis with intestinal metaplasia (63.4% and 22.5%, respectively). The cellular response was charac terized mainly by polymorphonuclear lymphocytes and positive anti-CD8 reactivity both in stroma and epithelium. CONCLUSIONS: Multifocal atrophic gastritis was more prevalent in the high-risk region for gastric cancer (GC) while non-atrophic gastritis and the expression of CD3 and CD8 antigens in the foveolar epithelium was higher in the low-risk region.

Trends in long-term cancer survival in Cali, Colombia: 1998-2017 / Tendencias en la supervivencia al cáncer a largo plazo en Cali, Colombia: 1998-2017

Abstract Background: Population-based cancer survival is an indicator of the effectiveness of cancer services that reflects the survival of all cancer patients in the population, regardless of socioeconomic status and disease characteristics. Aim: Provision of an up-to-date survival estimate of patients recorded within Cali Population Cancer Registry (RPCC) in 1998-2017. As a second objective, results will be compared with those reported by the CONCORD study for cancers prioritized by the current Ten-Year Cancer Control Plan of Colombia, 2012-2021. Methods: Adult cancer cases (aged 15 to 99 years) for nine cancer types diagnosed between 1998 and 2017, with follow-up to 2018, were obtained from the RPCC. The 5-year age-standardized net survival estimates (NS) were estimated using the Pohar-Perme. The results for the period 1995- 2014 were compared with those reported by the CONCORD study for the following locations: stomach (C16), breast (C50), cervix (C53), prostate (C61), and lung (C33-34). Results: Five-year survival estimates for breast and prostate cancers improved ten percentage points through 2007 (70.8 to 81.1 for breast and 79.9 to 90.2 for prostate) and remained stable during 2008-2017. For cervical cancer, survival estimates has remained stable for the last two decades at 53%. For stomach cancer and lung cancer, five-year NS was lower than 25% over the study period. For colorectal cancer, survival estimates increased from 37.9% in 1998-2002 to 54.8% in 2013-2017. Compared to previous 5-year survival estimates of cases diagnosed in 2010-2014, the estimates in this study are significantly higher than those obtained by CONCORD. Survival estimates of patients diagnosed in 1995-2009 showed no difference to CONCORD study. Conclusions: Periodic update of vital status and date of last contact reduces bias in survival estimates in population-based cancer registries with passive follow-up.

Resumen Antecedentes: La supervivencia del cáncer es un indicador de la eficacia de los servicios oncológicos que refleja la supervivencia de todos los pacientes con cáncer de la población, independientemente del nivel socioeconómico y las características de la enfermedad. Objetivo: Realizar una estimación actualizada de la supervivencia de los pacientes registrados en el Registro Poblacional de Cáncer de Cali durante 1998-2017. Como segundo objetivo, los resultados se compararán con los reportados por el estudio CONCORD para los cánceres priorizados por el actual Plan Decenal de Control del Cáncer de Colombia, 2012-2021. Métodos: Los casos de cáncer en adultos (15 a 99 años) para nueve tipos de cáncer diagnosticados entre 1998 y 2017, con seguimiento hasta 2018, se obtuvieron del RPCC. Las estimaciones de supervivencia neta (NS) estandarizada por edad a 5 años se estimaron utilizando el método de Pohar-Perme. Los resultados del periodo 1995-2014 se compararon con los obtenidas por el estudio CONCORD para las siguientes localizaciones: estómago (C16), mama (C50), cuello uterino (C53), próstata (C61) y pulmón (C33-34). Resultados: La SN-5a para los cánceres de mama y próstata mejoró diez puntos porcentuales hasta 2007 (SN=70.8 a 81.1 para mama y NS=79.9 a 90.2 para próstata) y se mantuvo estable durante 2008-2017. Para el cáncer de cuello uterino fue 53% y permaneció estable durante dos décadas. Para el cáncer de estómago y el cáncer de pulmón, la SN-5años fue inferior al 25%. Para cáncer colorrectal las estimaciones de supervivencia aumentaron de 37.9% en 1998-2002 a 54.8% en 2013-2017. En comparación con estimaciones anteriores de supervivencia a 5 años de casos diagnosticados en 2010-2014, las estimaciones de este estudio son significativamente más altas que las obtenidas por CONCORD-3. Para la década 1995-2009 no hubo diferencia. Conclusión: La actualización periódica del estado vital y la fecha de último contacto reduce el sesgo en las estimaciones de supervivencia en los registros de cáncer de base poblacional que hacen seguimiento pasivo.

Factors associated with the presence of the Epstein-Barr virus in the oral cavity of high school students from the city of Cali (Colombia).

INTRODUCTION: The Epstein-Barr virus (EBV) is classified as a group 1 carcinogen. The main route of EBV transmission is oral, through saliva. The present study aimed to determine the frequency of EBV detection in the oral cavity in high school students in the city of Cali (Colombia). MATERIALS AND METHODS: Analytical cross-sectional study in order to determine the frequency of EBV detection in the oral cavity, the reasons for its prevalence and its association with several factors, in 1565 individuals. The variables analyzed were sociodemographic factors, oral hygiene, oral health, sexual behavior, cigarrete smoking and alcohol intake. The association between the EBV detection and the variables evaluated was done through a generalized linear regression model with logarithmic linkage and Poisson distribution with robust variance. RESULTS: The percentage of exposure to EBV in the oral cavity was 38.40% (CI 95%: 36.02-40.84). The frequency of presenting EBV exposure was 22% higher in men and the risk increased according to sexual behaviour. An inverse association with the school grade was found: the eleventh-grade participants had 27% less frequency of exposure to EBV than the lower grades (sixth to eighth). When analyzing the logistic model to study the association between EBV detection and independent variables, the association was overestimated. The overestimation ranged from 27% to 47% depending on the type of variable. CONCLUSIONS: The frequency of EBV detection in the oral cavity of healthy students was similar to that previously described. Factors associated to sexual behavior increased the risk of opportunity to be exposed to EBV.

Survival in stomach cancer: analysis of a national cancer information system and a population-based cancer registry in Colombia.

Background: Stomach cancer is among the most frequent, is a leading cause of mortality in low- and middle-income countries. Assessing its survival is important to guide evidence-based health policies. Aims: To estimate stomach cancer survival in Colombia (2014-2019) with data from the National Cancer Information System (NCIS) and in Cali with data from the Cali Population Cancer Registry (RPCC) (1998-2017). Methods: NCIS estimated the overall 3-year net survival for 8,549 people, while RPCC estimated 5-year net survival for 6,776 people. Results: The 3-year net survival was 36.8% (95% CI: 35.5-38.1). Net survival was higher in people with special insurance (61.7%; 95% CI: 44.8-74.8) or third payer (40.5%; 95% CI: 38.7-42.3) than state insurance (30.7%; 95% CI: 28.7-32.8). It was also higher in women and people diagnosed at early stages. Multivariable analysis showed consistency with survival estimations with a higher risk of death in men, people with state insurance, and diagnosed at advanced stages. In Cali, the 5-year net survival remained stable in men during the last 20 years. In women the 5-year net survival in women increased 8.60 percentage points, equivalent to a 50% increase compared to the 1998-2002 period. For 2013-17, it was 19.1% (95%CI: 16.2-22.2) in men, and 24.8% (95% CI: 20.4-29.3) in women. Conclusions: Population survival estimates from the RPCC were lower than those observed in the NCIS. The differences in their methods and scope can explain variability. Nevertheless, our findings could be complementary to improve cancer control planning in the country.

Antecedentes: El cáncer de estómago se encuentra entre los más frecuentes y es una de las principales causas de mortalidad en los países de ingresos bajos y medianos. Evaluar su supervivencia es importante para orientar las políticas de salud basadas en la evidencia. Objetivos: Estimar la supervivencia del cáncer de estómago en Colombia (2014-2019) con datos del Sistema Nacional de Información del Cáncer (NCIS) y en Cali con datos del Registro Poblacional de Cáncer de Cali (RPCC) (1998-2017). Métodos: El NCIS estimó la supervivencia neta a tres años para 8,549 personas y el RPCC la calculó a 5 años para 6,776 personas registradas en sus bases de datos. Resultados: La supervivencia neta a tres años en Colombia fue del 36.8% (IC 95%: 35.5-38.1). La supervivencia neta fue mayor en personas con seguro especial (61.7%; IC 95%: 44.8-74.8) o tercer pagador (40.5%; IC 95%: 38.7-42.3) que el seguro estatal (30.7%; IC 95%: 28.7-32.8). También fue mayor en mujeres y personas diagnosticadas en etapas tempranas. El análisis multivariable mostró consistencia con la estimación de supervivencia con mayor riesgo de muerte en hombres, personas con seguro estatal y diagnosticados en estadios avanzados. En Cali, la supervivencia neta a 5 años se mantuvo estable en los hombres durante los últimos 20 años. En las mujeres aumentó 8.60 puntos porcentuales, equivalente a un aumento del 50% en comparación con el período 1998-2002. Para el período 2013-17 fue 19.1% (IC 95%: 16.2-22.2) en los hombres y 24.8% (IC 95%: 20.4-29.3) en las mujeres. Conclusiones: Las estimaciones de supervivencia del RPCC fueron más bajas que las obtenidas por el NCIS. Las diferencias en sus métodos y alcance pueden explicar la variabilidad. Sin embargo, nuestros hallazgos pueden ser complementarios para mejorar la planificación del control del cáncer en el país..

Head and neck cancer in Cali, Colombia: Population-based study.

INTRODUCTION: Head and neck cancer (HNC) is the seventh most common type of cancer in the world. In Latin America, data on HCN are limited by the scarcity of population-based cancer registries. OBJECTIVE: To describe survival and changes in the time trends of incidence and mortality rates of HCN with data from the Cali Cancer Population Registry (Colombia) during 1962-2018. METHOD: Males and females of any age residing in Cali were included. The trends in incidence rates (1962-2016) and mortality (1984-2018) were analysed by calculating the mean annual percentage change (APC). Five-year net survival was estimated for the four 5-year periods of 1996-2015 using the Pohar-Perme method. RESULTS: During 1962-2015, 5,110 new cases of HNC were recorded: 1,506 in the larynx, 1,377 in the oral cavity, 487 in the nose and paranasal sinuses, 643 in the oropharynx, 603 in the salivary glands and 360 in Naso-Hypopharynx region. The incidence rates of HNC decreased significantly at all subsites, except in those associated with the human papillomavirus. Between 1984 and 2018, there were 1,941 deaths attributed to HNC, and the mortality rate decreased significantly. The 5-year age-standardized net survival was 43.2% in 1996-2000, remained stable during the following decade, and for 2011-2015 it was 50.9%. CONCLUSION: The incidence and mortality of HNC in Cali decreased significantly during the study period in both sexes.

Strengthening Pathology Capacity to Deliver Quality Cancer Care in Cities in LMICs.

Diagnostic pathology services for oncology health systems are essential; yet, surveys, observations, and hard data from across low- and middle-income countries have revealed that these services are almost always lacking adequate quality and often missing completely. The City Cancer Challenge Foundation (C/Can), the American Society for Clinical Pathology, and C/Can partner cities undertook intense analysis of their existing pathology services as part of a year-long assessment process including the specific formation of a pathology-focused team. Internal and external expert assessments identified sustainable solutions adapted to the local context and level of resources and created specific local implementation projects. Through local leadership, capacity development, and collaboration, services were improved city-wide in three cities: Cali, Colombia; Asunción, Paraguay; and Yangon, Myanmar. Common problems identified across cities included deficiencies in personnel training, equipment, reagents, processes, quality, and coordination. Specific solutions included quality training, standard process development and regulation, implementation of new services, and public-private collaboration. As the first cities joining the C/Can initiative, Cali, Asunción, and Yangon demonstrate the success of the approach and the value of local expertise in identifying problems and solutions. The additional value of international partners' expertise created opportunities for growth through mentorship and technical support. Importantly, the power of healthcare programs with strong political support is emphasized.

Progress, challenges and ways forward supporting cancer surveillance in Latin America.

Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control.

Análisis de mortalidad por COVID-19 en Colombia: Medidas de ocurrencia / Analysis of COVID-19 mortality in Colombia: Measures of disease occurrence

Resumen Introducción: El riesgo de morir por COVID-19 varía considerablemente entre regiones y países, se describe mediante índices de letalidad y tasas de mortalidad. Objetivo: Describir las medidas de ocurrencia de mortalidad por COVID-19 en Colombia. Materiales y métodos: Se incluyeron los casos de infección por coronavirus notificados al Instituto Nacional de Salud de Colombia durante marzo-octubre 2020. Los índices de letalidad se presentan como proporciones y las tasas de mortalidad se expresan por millón/personas. Resultados: El índice de letalidad en casos confirmados COVID-19 varió entre regiones y cambió con el transcurso de la pandemia, inicialmente fue alto porque las pruebas diagnósticas se realizaron a casos sintomáticos graves. Este índice estuvo subestimado por el retardo en la notificación. En Bogotá, Cali, Medellín y Cartagena el impacto de la pandemia fue menor con una velocidad gradual de ascenso y descenso de las tasas de mortalidad. En Barranquilla, Bucaramanga y Pasto, las curvas se caracterizaron por ascensos y descensos rápidos, relacionándose con más muertes durante el pico de la pandemia. Conclusiones: Los índices de letalidad y tasas de mortalidad por COVID-19 permiten monitorear la pandemia, pero están distorsionados por el diagnóstico póstumo de la infección por SAR-CoV2 y el retardo en la notificación.

Abstract Introduction: The risk of dying from COVID-19 varies considerably between regions and countries and it is assessed through fatality indices and mortality rates. Objective: To describe the measures of mortality occurrence due to COVID-19 in Colombia. Materials and methods: Cases of coronavirus infections reported to the National Institute of Health of Colombia during the months of March and October 2020 were included. The fatality indices and mortality rates are presented as proportions and million/people ratios, respectively. Results: The fatality index for confirmed COVID-19 cases varied between regions, changed as the pandemic progressed and was initially high because diagnostic tests were conducted on severe symptomatic cases. Also, this index was underestimated due to delays in notification. In Bogota, Cali, Medellin and Cartagena, the impact of the pandemic was minor, with gradual increases and decreases in the mortality rates. On the contrary, in Barranquilla, Bucaramanga and Pasto, the curves showed sudden increments and declines, which were related to more deaths registered during the peak of the pandemic. Conclusions: The fatality indices and mortality rates of COVID-19 facilitate the monitoring of the pandemic, but they can be distorted by posthumous diagnosis of SARS-CoV-2 infection and delays in notification.

COVID-19: The Ivermectin African Enigma / COVID-19: El enigma de la Ivermectina en Africa

Abstract Introduction: The low frequency of cases and deaths from the SARS-CoV-2 COVID-19 virus in some countries of Africa has called our attention about the unusual behavior of this disease. The ivermectin is considered a drug of choice for various parasitic and viral diseases and shown to have in vitro effects against SARS-CoV-2. Aims: Our study aimed to describe SARS-CoV2 infection and death rates in African countries that participated in an intensive Ivermectin mass campaign carried out to control onchocerciasis and compare them with those of countries that did not participate. Methods: Data from 19 countries that participated in the World Health Organization (WHO) sponsored African Programme for Onchocerciasis Control (APOC), from 1995 until 2015, were compared with thirty-five (Non-APOC), countries that were not included. Information was obtained from https://www.worldometers.info/coronavirus/ database. Generalized Poisson regression models were used to obtain estimates of the effect of APOC status on cumulative SARS-CoV-2 infection and mortality rates. Results: After controlling for different factors, including the Human Development Index (HDI), APOC countries (vs. non-APOC), show 28% lower mortality (0.72; 95% CI: 0.67-0.78) and 8% lower rate of infection (0.92; 95% CI: 0.91-0.93) due to COVID-19. Conclusions: The incidence in mortality rates and number of cases is significantly lower among the APOC countries compared to non-APOC countries. That a mass public health preventive campaign against COVID-19 may have taken place, inadvertently, in some African countries with massive community ivermectin use is an attractive hypothesis. Additional studies are needed to confirm it.

Resumen Introducción: La baja frecuencia de casos y muertes por el virus SARS-CoV-2 COVID-19 en algunos países de África llamó nuestra atención sobre el comportamiento inusual de esta enfermedad. La ivermectina se considera un fármaco de elección para diversas enfermedades parasitarias y virales, y se ha demostrado que tiene efectos in vitro contra el SARS-CoV-2. Objetivos: Nuestro estudio tiene el objetivo describir las tasas de infección y mortalidad del SARS-CoV-2 en los países africanos que participaron en una campaña intensiva masiva de ivermectina para el control de la oncocercosis y compararlas con las de los países que no participaron. Métodos: Los datos de 19 países que participaron en el Programa Africano para el Control de la Oncocercosis (APOC) patrocinado por la Organización Mundial de la Salud (OMS), desde 1995 hasta 2015, se compararon con 35 países que no fueron incluidos (NO APOC). La información sobre casos y muertes por COVID-19 se obtuvo de la base de datos https://www.worldometers.info/coronavirus/. Se utilizaron modelos de regresión de Poisson para obtener estimaciones del efecto del estado APOC sobre las tasas acumuladas de infección y mortalidad por SARS-CoV-2. Resultados: Después de controlar diferentes factores, incluido el Índice de Desarrollo Humano (IDH), los países APOC (frente a los no APOC) mostraron una mortalidad 28% menor (razón de tasas ajustada: RR= 0.72, IC 95%: 0.67-0.78) y una tasa de infección 8% menor (RR= 0.92, IC 95%: 0.91-0.93) por COVID-19. Conclusiones: Las tasas de mortalidad e infección son significativamente más bajas en países APOC en comparación con los países no APOC. Una campaña preventiva masiva de salud pública contra el COVID-19 pudo haber tenido lugar inadvertidamente en algunos países africanos con un uso masivo de ivermectina en la comunidad es una hipótesis atractiva. Se necesitan estudios adicionales para confirmarlo.

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.

Childhood Leukemia in Small Geographical Areas and Proximity to Industrial Sources of Air Pollutants in Three Colombian Cities.

Acute leukemia is the most common childhood cancer and has been associated with exposure to environmental carcinogens. This study aimed to identify clusters of acute childhood leukemia (ACL) cases and analyze their relationship with proximity to industrial sources of air pollution in three capital cities in Colombia during 2000-2015. Incident ACL cases were obtained from the population cancer registries for the cities of Bucaramanga, Cali, and Medellín. The inventory of industrial sources of emissions to the air was obtained from the regional environmental authorities and industrial conglomerates were identified. The Kulldorf's circular scan test was used to detect city clusters and to identify clusters around industrial conglomerates. Multivariable spatial modeling assessed the effect of distance and direction from the industrial conglomerates controlling for socioeconomic status. We identified industrials sectors within a buffer of 1 km around industrial conglomerates related to the ACL clusters. Incidence rates showed geographical heterogeneity with low spatial autocorrelation within cities. The spatio-temporal tests identified one cluster in each city. The industries located within 1 km around the ACL clusters identified in the three cities represent different sectors. Exposure to air pollution from industrial sources might be contributing to the incidence of ACL cases in urban settings in Colombia.