Relationship between universal health insurance benefits and prostate cancer mortality in Colombia.

PURPOSE: Prostate cancer is the most common cause for cancer mortality among men in Colombia. Law 100, in 1993, created a contributory regime (private insurance) and subsidized regime (public insurance) in which the subsidized regime had fewer benefits. However, Ruling T760 in July 2012 mandated that both systems must offer equal quality and access to healthcare. This study examines the impact of this change on prostate cancer mortality rates before and after 2012. METHODOLOGY: Prostate cancer mortality records from 2006 to 2020 were collected from Colombia's National Administrative Department of Statistics (DANE). Crude mortality was calculated by health insurance for different geographic areas and analyzed for changes between 2006 and 2012 and 2013-2020. Join-Point regressions were used to analyze trends by health insurance. RESULTS: Crude mortality rates in the contributory regime had a non-statistically significant decrease from 2006 to 2012 (AAPC= -1.32%, P = 0.14, 95% CI= -3.12, 0.52). In contrast, between 2013 and 2020 there was a non-statistically significant increase in crude mortality (AAPC 1.10%, P = 0.07, 95% CI= -0.09, 2.31). Comparatively, crude mortality in the subsidized regime, from 2006 to 2012, increased with a statistically significant AAPC of 2.51% (P < 0.001, 95% CI = 1.21, 3.83). From 2013 to 2020, mortality continued to increase with statistically significant AAPC of 5.52% (P < 0.001, 95% CI = 4.77, 6.27). Compared to their crude mortality differences from 2006 to 2020, from 2013 to 2020, the departments of Atlántico, Córdoba, Sucre, Arauca, Cesar, and Cauca had the highest rates in prostate cancer mortality in the subsidized regime compared to the contributory regime. CONCLUSION: Ruling T760 did not positively impact prostate cancer mortality, particularly of men in the subsidized regime.

Cancer mortality among Colombian and foreign populations over a 15-year period.

Purpose: We aimed to compare cancer mortality among foreign- and Colombian populations in Colombia during the period of 2006-2020. Methods: This retrospective study utilized vital statistics from the Colombian National Department of Statistics (DANE). The dataset included variables such as age group, sex, country of permanent residency, insurance, education level, marital status, ethnicity, and cause of death. The population data to calculate rates was obtained from the Colombian census and the United Nations. Crude and adjusted rates as well as proportional mortality rates were calculated. Results: A total of 561,932 cancer deaths occurred in Colombia from 2006 to 2020. The foreign population (country of permanent residency different to Colombia) had a lower crude cancer mortality rate (31.1 per 100,000 inhabitants) than the Colombian population (81.9 per 100,000 inhabitants). However, the age-adjusted cancer mortality rate among the foreign population was 253.6 per 100,000, compared to 86.1 per 100,000 among the Colombian population. The proportional cancer mortality was 10.4 % among foreign population compared to 17.4 % among Colombian population. Conclusions: The proportional cancer mortality shows that the proportion of cancer-related deaths is greater among the Colombian population compared to the immigrant population. However, immigrants in Colombia have a higher age-adjusted cancer mortality rate than Colombians, indicating that immigrants have worse cancer outcomes than the Colombians even though the immigrant population is younger. This is likely due to the frequent barriers that immigrants encounter in accessing health care in Colombia. Future research needs to focus on access to care for the immigrant population by investigating cancer-related risk factors among immigrants and addressing their barriers to cancer prevention and treatment.

Impact of the universal health insurance benefits on cervical cancer mortality in Colombia.

BACKGROUND: Cervical cancer patients in Colombia have a lower likelihood of survival compared to breast cancer patients. In 1993, Colombia enrolled citizens in one of two health insurance regimes (contributory-private insurance and subsidized- public insurance) with fewer benefits in the subsidized regime. In 2008, the Constitutional Court required the Colombian government to unify services of both regimes by 2012. This study evaluated the impact of this insurance change on cervical cancer mortality before and after 2012. METHODS: We accessed 24,491 cervical cancer mortality records for 2006-2020 from the vital statistics of Colombia's National Administrative Department of Statistics (DANE). We calculated crude mortality rates by health insurance type and departments (geopolitical division). Changes by department were analyzed by rate differences between 2006 and 2012 and 2013-2020, for each health insurance type. We analyzed trends using join-point regressions by health insurance and the two time-periods. RESULTS: The contributory regime (private insurance) exhibited a significant decline in cervical cancer mortality from 2006 to 2012, characterized by a noteworthy average annual percentage change (AAPC) of -3.27% (P = 0.02; 95% CI [-5.81, -0.65]), followed by a marginal non-significant increase from 2013 to 2020 (AAPC 0.08%; P = 0.92; 95% CI [-1.63, 1.82]). In the subsidized regime (public insurance), there is a non-significant decrease in mortality between 2006 and 2012 (AAPC - 0.29%; P = 0.76; 95% CI [-2.17, 1.62]), followed by a significant increase from 2013 to 2020 (AAPC of 2.28%; P < 0.001; 95% CI [1.21, 3.36]). Examining departments from 2013 to 2020 versus 2006 to 2012, the subsidized regime showed fewer cervical cancer-related deaths in 5 out of 32 departments, while 6 departments had higher mortality. In 21 departments, mortality rates remained similar between both regimes. CONCLUSION: Improvement of health benefits of the subsidized regime did not show a positive impact on cervical cancer mortality in women enrolled in this health insurance scheme, possibly due to unresolved administrative and socioeconomic barriers that hinder access to quality cancer screening and treatment.

Argentina's National Program for Control of Breast Cancer: Time 1, Patient Navigation, and Patient Cancer Education Experience.

Argentina has the second highest mortality rate for breast cancer (BC) in South America. The age-standardized incidence of BC in Argentina is 73 per 100,000. Despite the availability of early detection services, 30% of BCs are diagnosed at advanced disease stages. The National Cancer Institute (NCI) of Argentina and the National Program for Control of Breast Cancer (NPCBC) focus on two main objectives: guaranteeing adequate and timely BC treatment and reducing BC mortality in Argentina. These objectives are addressed by maintaining three core concepts: quality control, disease monitoring, and wide coverage of available early detection and treatment services. The NPCBC is currently implementing the "Time 1 Survey Study." Time 1 is defined as the time from the first appearance of BC signs or symptoms to the first consult within the public healthcare system. This timeframe is important in Argentina because it is outside of the health timeframes and data parameters monitored by the national cancer data registry system. The Time 1 Survey study has the potential to serve as an informational tool for BC patient navigation efforts in Argentina because it can be used to identify and characterize the barriers and delays that women face during Time 1. Lessons and experiences included in this study could be translated to other Latin American and middle-income countries for developing cancer control programs that can lead to improving treatment and reducing mortality through patient navigation and cancer education efforts for the public, health professionals, and patients.

The influence of medical providers on HPV vaccination among children of Mexican mothers: a comparison between Mexico and the Midwest region of the United States.

BACKGROUND: Among cervical cancer patients in the U.S., a disproportionate number are Hispanics/Latinos. Also, about a third of patients diagnosed with cervical cancer annually in Mexico die of the disease. Vaccines are available to protect against HPV, the cause of cervical cancer. METHODS: A cross-sectional study was conducted with 200 mothers of Mexican origin in the U.S. Midwest and Xalapa, Veracruz, Mexico. Based on a validated bilingual questionnaire, this study elicited information about knowledge and attitudes regarding HPV vaccination and cervical cancer. RESULTS: Mothers living in Mexico showed better knowledge about HPV and HPV vaccine (77.8%) than participants living in the U.S. (48%) p < .0001. Logistic regression revealed that receiving information about the HPV vaccine from medical providers was a significant predictor of mothers' willingness to vaccinate their children. CONCLUSIONS: A need for increasing public health education of Mexican mothers in the Midwest on HPV/HPV vaccination, may lead to improving utilization of the vaccination and eventually a reduction of cervical cancer. HPV vaccination for boys is critical for reducing the risk of transmission to sexual partners and decreasing the risk of HPV- related diseases in the population. Therefore, we recommend increasing efforts to vaccine boys and increasing knowledge that boys must also be vaccinated, especially in Mexico.

Variation of cervical cancer incidence in Latin America and the Caribbean / Variación de la incidencia del cáncer cervicouterino en América Latina y el Caribe

OBJECTIVE: To provide a comprehensive analysis of the descriptive epidemiology of invasive cervical cancer in Latin America and the Caribbean by analyzing quality data from the area's cancer registries, including data that were excluded from the International Agency for Research on Cancer (IARC) publication, Cancer Incidence in Five Continents, Vol. IX (CI5-IX). METHODS: This was a descriptive epidemiologic study that involved 20 cancer registries, 9 of which were included by IARC in CI5-IX, and 11 of which were not. Data on invasive cervical cancers diagnosed from 1998-2002 were obtained from IARC. A cervical cancerspecific quality assessment was performed on all registries whether or not they were included in CI5-IX. Data from 14 registries met quality criteria and were analyzed. Incidence rates were calculated and compared across registries. RESULTS: A substantial variation in incidence rates existed among the registries; agestandardized rates ranged from 14.6-44.0 per 100 000 women per year. Mean cervical cancer incidence rates were 10.4% higher for registries included in CI5-IX than for those excluded; however, this difference was not significant (P = 0.541). CONCLUSIONS: This study compared cervical cancer rates from a more diverse group of Latin American and Caribbean countries than that of the CI5-IX. The heterogeneity found among registries highlights the importance of examining data from as many registries as possible when characterizing risk across a geographic area. Data from developing countries can be used to better understand cancer distribution and enable Region-specific recommendations on cancer control and prevention once data quality has been established.

OBJETIVO: Efectuar un análisis integral de las características epidemiológicas descriptivas del cáncer de cervicouterino invasor en América Latina y el Caribe mediante el análisis de datos de calidad de los registros de cáncer de la región, incluso datos que fueron excluidos de la publicación del Centro Internacional de Investigaciones sobre el Cáncer (CIIC), Incidencia del cáncer en cinco continentes, Vol. IX (CI5-IX). MÉTODOS: En este estudio epidemiológico descriptivo se incluyeron 20 registros sobre el cáncer, de los cuales solo nueve fueron incluidos por el CIIC en el informe CI5-IX. Los datos sobre cáncer cervicouterino invasor diagnosticado entre 1998 y 2002 se obtuvieron a partir del CIIC. Se llevó a cabo una evaluación de la calidad de todos los registros específica para el cáncer cervicouterino, con independencia de que estuvieran incluidos en el informe CI5-IX o no. Los datos de 14 registros satisficieron los criterios de calidad y se analizaron. Se calcularon las tasas de incidencia y se compararon estas entre los registros. RESULTADOS: Entre los registros se comprobó una variación sustancial en las tasas de incidencia; las tasas normalizadas según la edad variaron entre 14,6 y 44,0 por 100 000 mujeres por año. Las tasas de incidencia medias de cáncer cervicouterino fueron 10,4% mayores en los registros incluidos en el CI5-IX que en aquellos excluidos; sin embargo, esta diferencia no fue significativa (P = 0,541). CONCLUSIONES: En este estudio se compararon las tasas de cáncer cervicouterino de un grupo más diverso de países de América Latina y el Caribe que el comprendido en el informe CI5-IX. La heterogeneidad encontrada entre los registros destaca la importancia de examinar los datos de tantos registros como sea posible cuando se caracteriza el riesgo en una zona geográfica. Los datos de los países en desarrollo pueden usarse para conocer más a fondo la distribución del cáncer y permiten formular recomendaciones específicas para la región sobre el control y la prevención del cáncer, una vez que se ha comprobado la calidad de los datos.

Regional variation in histopathology-specific incidence of invasive cervical cancer among Peruvian women.

OBJECTIVE: To evaluate patterns of cervical cancer incidence in Peru by examining variation in 2 common histopathologic types, squamous cell carcinoma (SCC) and adenocarcinoma (ADC), and analyzing trends over time. METHODS: Data on the incidence of invasive cervical cancer between 1984 and 2006 were obtained from 3 population-based cancer registries in Peru: Lima, Trujillo, and Arequipa. For each registry, data quality assessment was performed, crude and age-specific incidence was calculated, and time trends were analyzed. RESULTS: Overall and SCC incidence varied across registries but incidence of ADC did not. Overall and SCC incidence showed significant declines in Trujillo (P<0.05) and modest declines in Lima (P>0.05) over time. ADC incidence showed marginally significant increases among women aged 15-29 years in Trujillo (P=0.10) and modest increases among young women in Lima (P>0.05). CONCLUSION: Population-based cancer registries were an efficient source of data for evaluating the incidence of cervical cancer once data quality had been established. Geographic and temporal variations in cervical cancer burden were documented in Peru. The trends suggest that cervical ADC is increasing among young women in urban Peru, particularly in Trujillo. We recommend supplementing current Papanicolaou test screening with complementary methods of cervical cancer control, including human papillomavirus (HPV) vaccination and HPV DNA testing.