Cancer incidence estimates and mortality for the top five cancer in Colombia, 2007-2011.

OBJECTIVES: To describe the incidence and mortality for the five main types of cancer in Colombia, from 2007-2011. METHODS: We estimated cases and cancer incidence rates standardised by age, based on incidence/mortality ratios; and we calculated the observed deaths and mortality rates standardised by age in Colombia, both differentiated by province, type of cancer and sex. Incidence estimates were generated based on information from four cancer population registries (Cali, Pasto, Bucaramanga and Manizales), published in Cancer Incidence in Five Continents, volume X, and the official mortality and population information of the National Administrative Province of Statistics (DANE, for its initials in Spanish). RESULTS: The annual number of expected cases (all cancers) was 62,818 in men and women; and there were 32,653 recorded deaths. The main incidental cancers were prostate (46.5 per 100,000 person-years) in men, and breast (33.8 per 100,000 person-years) in women. The highest mortality figures were for stomach cancer in men (14.2); and breast cancer in women (9.9). CONCLUSIONS: The highest incidence and mortality estimates in Colombia were for breast and prostate cancers, as well as a proportion of infection-related cancers, such as stomach and cervical cancer. These four neoplasms were responsible for more than 50% of the burden of the disease. Only through good quality, long-duration cancer registries, can information be obtained about the changes in incidence trends.

OBJETIVOS: Describir la incidencia y mortalidad para los cinco principales tipos de cáncer en Colombia, de 2007-2011. MÉTODOS: Se estimaron casos y tasas de incidencia de cáncer ajustadas por edad a partir de razones incidencia/mortalidad y se calcularon las muertes observadas y tasas de mortalidad ajustadas por edad en Colombia, ambas diferenciadas por departamentos, tipo de cáncer y sexo. Las estimaciones de incidencia se generaron con base en la información de cuatro registros poblacionales de cáncer (Cali, Pasto, Bucaramanga y Manizales), publicada en Cancer Incidence in Five Continents, volumen X, y la información oficial de mortalidad y población del Departamento Administrativo Nacional de Estadística (DANE). RESULTADOS: El número anual de casos esperados (todos los cánceres) fue 62,818 en hombres y en mujeres y se registraron 32,653 muertes. Los principales cánceres incidentes fueron próstata (46.5 por 100,000 años-persona) en hombres y mama (33.8 por 100,000 años-persona) en mujeres. La mortalidad más alta en hombres se presentó en estómago (14.2) y mama en mujeres (9.9). CONCLUSIONES: Las estimaciones de incidencia y mortalidad más altas en Colombia fueron para los cánceres de mama y próstata, además de una proporción de cánceres relacionados con la infección como son el cáncer de estómago y de cuello uterino. Estas cuatro neoplasias fueron responsables de más del 50% de la carga de la enfermedad. Solamente a través de los registros de cáncer de buena calidad y de larga trayectoria podrá tenerse información sobre el cambio en las tendencias de incidencia.

Quality of death certification in Colombia.

OBJECTIVE: To evaluate the quality of the certification of general death and cancer in Colombia. METHODS: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships. RESULTS: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites. CONCLUSIONS: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

OBJETIVO: Evaluar la calidad de la certificación de la muerte general y por cáncer en Colombia. MÉTODOS: Se describieron indicadores de validez para cada departamento y las ciudades de Bogotá, Cali, Manizales, Pasto y Bucaramanga. Se realizó un análisis factorial de componentes principales con el fin de identificar relaciones no evidentes. RESULTADOS: Se analizaron 984,159 defunciones, dentro de las cuales había 164,542 muertes por cáncer. El 93.7% de la mortalidad general estaba bien certificada. Los errores predominantes fueron signos, síntomas y afecciones mal definidas. El 92.8% de la mortalidad por cáncer estaba bien certificada. Los errores predominantes fueron cánceres de sitio mal definido. CONCLUSIONES: Los indicadores de calidad de certificación en Colombia mejoraron. Ante el buen comportamiento de los indicadores de calidad de la certificación de la muerte general y por cáncer, se considera que ésta es un insumo válido para la estimación de incidencia de cáncer.

Cancer incidence estimates and mortality for the top five cancer in Colombia, 2007-2011 / Estimaciones de incidencia y mortalidad para los principales cinco tipos de cáncer en Colombia, 2007-2011

Abstract Objectives: To describe the incidence and mortality for the five main types of cancer in Colombia, from 2007-2011. Methods: We estimated cases and cancer incidence rates standardised by age, based on incidence/mortality ratios; and we calculated the observed deaths and mortality rates standardised by age in Colombia, both differentiated by province, type of cancer and sex. Incidence estimates were generated based on information from four cancer population registries (Cali, Pasto, Bucaramanga and Manizales), published in Cancer Incidence in Five Continents, volume X, and the official mortality and population information of the National Administrative Province of Statistics (DANE, for its initials in Spanish). Results: The annual number of expected cases (all cancers) was 62,818 in men and women; and there were 32,653 recorded deaths. The main incidental cancers were prostate (46.5 per 100,000 person-years) in men, and breast (33.8 per 100,000 person-years) in women. The highest mortality figures were for stomach cancer in men (14.2); and breast cancer in women (9.9). Conclusions: The highest incidence and mortality estimates in Colombia were for breast and prostate cancers, as well as a proportion of infection-related cancers, such as stomach and cervical cancer. These four neoplasms were responsible for more than 50% of the burden of the disease. Only through good quality, long-duration cancer registries, can information be obtained about the changes in incidence trends.

Resumen Objetivos: Describir la incidencia y mortalidad para los cinco principales tipos de cáncer en Colombia, de 2007-2011. Métodos: Se estimaron casos y tasas de incidencia de cáncer ajustadas por edad a partir de razones incidencia/mortalidad y se calcularon las muertes observadas y tasas de mortalidad ajustadas por edad en Colombia, ambas diferenciadas por departamentos, tipo de cáncer y sexo. Las estimaciones de incidencia se generaron con base en la información de cuatro registros poblacionales de cáncer (Cali, Pasto, Bucaramanga y Manizales), publicada en Cancer Incidence in Five Continents, volumen X, y la información oficial de mortalidad y población del Departamento Administrativo Nacional de Estadística (DANE). Resultados: El número anual de casos esperados (todos los cánceres) fue 62,818 en hombres y en mujeres y se registraron 32,653 muertes. Los principales cánceres incidentes fueron próstata (46.5 por 100,000 años-persona) en hombres y mama (33.8 por 100,000 años-persona) en mujeres. La mortalidad más alta en hombres se presentó en estómago (14.2) y mama en mujeres (9.9). Conclusiones: Las estimaciones de incidencia y mortalidad más altas en Colombia fueron para los cánceres de mama y próstata, además de una proporción de cánceres relacionados con la infección como son el cáncer de estómago y de cuello uterino. Estas cuatro neoplasias fueron responsables de más del 50% de la carga de la enfermedad. Solamente a través de los registros de cáncer de buena calidad y de larga trayectoria podrá tenerse información sobre el cambio en las tendencias de incidencia.

Quality of death certification in Colombia / Calidad de la certificación de la muerte en Colombia

Abstract Objective: To evaluate the quality of the certification of general death and cancer in Colombia. Methods: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships. Results: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites. Conclusions: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

Resumen Objetivo: Evaluar la calidad de la certificación de la muerte general y por cáncer en Colombia. Métodos: Se describieron indicadores de validez para cada departamento y las ciudades de Bogotá, Cali, Manizales, Pasto y Bucaramanga. Se realizó un análisis factorial de componentes principales con el fin de identificar relaciones no evidentes. Resultados: Se analizaron 984,159 defunciones, dentro de las cuales había 164,542 muertes por cáncer. El 93.7% de la mortalidad general estaba bien certificada. Los errores predominantes fueron signos, síntomas y afecciones mal definidas. El 92.8% de la mortalidad por cáncer estaba bien certificada. Los errores predominantes fueron cánceres de sitio mal definido. Conclusiones: Los indicadores de calidad de certificación en Colombia mejoraron. Ante el buen comportamiento de los indicadores de calidad de la certificación de la muerte general y por cáncer, se considera que ésta es un insumo válido para la estimación de incidencia de cáncer.

High-dose-rate brachytherapy delivered in two fractions as monotherapy for low-risk prostate cancer.

PURPOSE: High-dose-rate (HDR) brachytherapy has been accepted as an effective and safe method to treat prostate cancer. The aim of this study was to describe acute toxicity following HDR brachytherapy to the prostate, and to examine the association between dosimetric parameters and urinary toxicity in low-risk prostate cancer patients. MATERIAL AND METHODS: Patients with low-risk prostate cancer were given HDR brachytherapy as monotherapy in two 12.5 Gy fractions. Planning objectives for the planning target volume (PTV) were V100% ≥ 90% and V150% ≤ 35%. Planning objectives for organs at risk were V75% ≤ 1 cc for the bladder, rectum and perineum, and V125% ≤ 1 cc for the urethra. Toxicity was assessed three months after treatment using the Common Terminology Criteria for Adverse Events. RESULTS: Seventy-three patients were included in the analysis. Thirty-three patients (45%) reported having any type of toxicity in the three months following HDR brachytherapy. Most toxicity cases (26%) were grade 1 urinary toxicity. Mean coverage index was 0.89 and mean V100 was 88.85. Doses administered to the urethra were associated with urinary toxicity. Patients who received more than 111.3% of the prescribed dose in 1 cc of the urethra were four times more likely to have urinary toxicity compared to patients receiving less than 111.3% (OR = 4.71, 95% CI: 1.43-15.6; p = 0.011). CONCLUSIONS: High-dose-rate brachytherapy administered as monotherapy for prostate cancer proved to be a safe alternative treatment for patients with low-risk prostate cancer. Urinary toxicity was associated with the dose administered to 1 cc and 0.1 cc of the urethra and was remarkably inferior to the reported toxicity in similar studies.

Displacements of fiducial markers in patients with prostate cancer treated with image guided radiotherapy: A single-institution descriptive study.

AIM: To describe daily displacements when using fiducial markers as surrogates for the target volume in patients with prostate cancer treated with IGRT. BACKGROUND: The higher grade of conformity achieved with the use of modern radiation technologies in prostate cancer can increase the risk of geographical miss; therefore, an associated protocol of IGRT is recommended. MATERIALS AND METHODS: A single-institution, retrospective, consecutive study was designed. 128 prostate cancer patients treated with daily on-line IGRT based on 2D kV orthogonal images were included. Daily displacement of the fiducial markers was considered as the difference between the position of the patient when using skin tattoos and the position after being relocated using fiducial markers. Measures of central tendency and dispersion were used to describe fiducial displacements. RESULTS: The implant itself took a mean time of 15 min. We did not detect any complications derived from the implant. 4296 sets of orthogonal images were identified, 128 sets of images corresponding to treatment initiation were excluded; 91 (2.1%) sets of images were excluded from the analysis after having identified that these images contained extreme outlier values. If IGRT had not been performed 25%, 10% or 5% of the treatments would have had displacements superior to 4, 7 or 9 mm respectively in any axis. CONCLUSIONS: Image guidance is required when using highly conformal techniques; otherwise, at least 10% of daily treatments could have significant displacements. IGRT based on fiducial markers, with 2D kV orthogonal images is a convenient and fast method for performing image guidance.

IMRT, RapidArc® and conformal radiotherapy in the treatment of tumours of the anal canal.

PURPOSE: To compare dosimetric results of the use of RapidArc® with simultaneous integrated boost, sliding window intensity-modulated radiotherapy (IMRT) with simultaneous integrated boost, and conformal radiotherapy with sequential boost in the management of anal canal cancer. METHODS: Two patients with squamous cell cancer of the anal canal with compromised inguinal nodes were included. The simulation was performed in the supine position with a customized Vac-Lok™ immobilizer. Treatment volumes and organs at risk were defined in accordance with international recommendations. Dosimetric comparisons were made in the target volume by means of tumour conformity, coverage, and homogeneity indexes; in healthy organs, integral doses were compared. RESULTS: A similar planning target volume coverage was achieved with the three techniques. The two IMRT techniques demonstrated benefits in doses received by healthy organs compared to the conformal radiotherapy. RapidArc® showed reduction in the execution time and monitor units required for treatment compared with sliding window IMRT. CONCLUSIONS: The IMRT showed coverage and tumour conformity indexes similar to those of conformal radiotherapy with better dosimetric results in the organs at risk, which should translate into a better toxicity profile. RapidArc® demonstrated benefits over the sliding window IMRT, which makes treatment more comfortable for the patient with less uncertainty about intrafraction motion and a reduced potential for radiation-induced tumours.

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.

IGF1R gene expression as a predictive marker of response to ionizing radiation for patients with locally advanced HPV16-positive cervical cancer.

AIM: The aim of this study was to evaluate the predictive utility of Insulin-like growth factor-1 receptor (IGF1R), IGF1, IGF2, Glyceraldehyde 3-phosphate dehydrogenase (GAPDH) and of hemoglobin levels for tumor response to exclusive radiotherapy, in patients with locally advanced Human papillomavirus (HPV) 16-positive cervical cancer. PATIENTS AND METHODS: From 102 patients treated at our institutes, 38 patients with histologically-proven HPV16-positive cervical cancer were included in this prospective case-controlled study. All patients underwent exclusive radiotherapy-only. Complete response was defined as an absence of residual disease at clinical examination and radiological imaging, three months after the completion of treatment. Gene expression levels, assessed before radiotherapy, were compared between responders and non-responders. Controls consisted of normal cervical tissue samples from 30 patients with non-oncological indications. RESULTS: Twenty patients (52.6%) showed a complete response. Gene expressions of IGF1R (34%), IGF2 (24%), and GAPDH (median=3.26 versus 2.12) were increased in cancer patients, in comparison with the control group. Higher levels of expression of GAPDH were observed in patients co-expressing IGF2 and IGF1R, who had a hemoglobin level ≤ 11 g/dl (p=0.05). Clinical characteristics in the responder and in the non-responder groups were similar. In bi-variate and multi-variate analyses, IGF1R expression was the only factor predictive of response to radiotherapy (p=0.018). Accordingly, patients with IGF1R expression had a 28.6-fold greater risk of treatment failure. CONCLUSION: In our study, IGF1R was a strong predictive marker of lack of response to radiotherapy. Larger prospective trials are needed to validate IGF1R as a biomarker of radiation response for patients with HPV16-positive cervical cancer.

Intensity modulated radiotherapy (IMRT) with simultaneous integrated boost (SIB) in a patient with left breast cancer and pectus excavatum.

INTRODUCTION: Pectus excavatum is a frequent anomaly. It represents a challenge for adjuvant radiotherapy in the conservative treatment of breast cancer. Primary objective of this study is to compare dosimetric outcomes, normal tissue complication probability (NTCP), and integral dose using four radiation techniques. Secondary objective is to describe acute toxicity and setup errors. METHODS AND MATERIALS: A 57-year-old female patient with an inner quadrant, left breast, ductal carcinoma in situ, was identified. Whole breast was prescribed with 50 Gy in 25 fractions. Boost planning target volume (PTV) was prescribed with 60 Gy in 30 fractions for sequential boost (SB) plans or 57.5 Gy in 25 fractions in the simultaneous integrated boost (SIB) plan. All plans were normalized to deliver 47.5 Gy to 95 % of the breast PTV. Daily image-guided radiotherapy (IGRT) was performed. Setup deviations were described. RESULTS: Constraints were not accomplished for heart when using intensity modulated radiotherapy (IMRT) + SB or conformal radiotherapy with three photon fields and SB. Left lung constraint was not achieved by any of the techniques in comparison. IMRT + SIB and conformal photons and electrons + SB plan were closer to the objective. Integral doses were lower with IMRT for heart and ipsilateral lung; however, it were higher for contralateral breast and lung. Coverage and tumoral conformity indexes were similar for all techniques in comparison. Greater inhomogeneity was observed with the photons and electrons + SB. IMRT + SIB treatment was administered daily with grade I skin toxicity. The highest setup error was observed in Y direction. CONCLUSION: Planning target volume coverage was similar with the four techniques. Homogeneity was superior with both IMRT plans. A good balance between dose constraints for organs at risk, PTV coverage, homogeneity, and NTCP was observed with IMRT + SIB. The documented daily setup error justifies the use of online IGRT.

Modelo para la estimación de incidencia de cáncer en el orden departamental en Colombia, 2002-2006 / Model for estimating cancer incidence at the regional state level in Colombia, 2002-2006

Objetivo: Describir los resultados de la aplicación de una metodología para la estimación de casos incidentes de cáncer en Colombia, en el orden departamental, durante el periodo 2002-2006, considerando el impacto que tienen las fuentes de información en los resultados del proceso de estimación. Métodos: La incidencia nacional de cáncer se estimó a partir de la suma de casos de cáncer, según la localización obtenida para cada departamento, utilizando un modelo de regresión lineal generalizado, el cual asume que el número de casos incidentes sigue una distribución de Poisson y emplea la razón incidencia mortalidad, el sexo y el grupo de edad como variables predictoras. Se ajustaron siete modelos diferentes y se validó la información de casos estimados respecto a casos observados, por medio de la suma de errores al cuadrado, el error absoluto promedio y el máximo error absoluto. Resultados: El modelo que mostró mejores resultados es el que incluye la información de los registros de Cali, Pasto y Bucaramanga; sin embargo, este modelo subestima los casos de cáncer en el orden nacional. Conclusiones: Se recomienda aplicar el modelo que se basa exclusivamente en información de Cali, debido a que puede haber una subestimación de casos como consecuencia de incluir en la modelación la información de registros que aún tienen por resolver aspectos relacionados con la exhaustividad.

Objective: To describe the results of a methodology used to estimate the incidence of cancer cases in Colombia at the regional state level from 2002-2006, which takes into account the impact of information sources on final estimate results. Methods: National cancer incidence was estimated upon the total number of cases reported at locations within each regional state under the application of a generalized linear regression model, which assumes that the number of cases conforms to Poisson distribution and utilizes incidence mortality and causes, gender, and age group as predictive variables. Seven different models were adjusted, and information was validated on estimated cases in comparison with observed cases through sum of squared errors, average absolute error, and absolute maximum error. Results: The most precise model included the data from the cities of Cali, Pasto and Bucaramanga; however, this model underestimates cancer incidence at the national level. Conclusions: Application of the model based exclusively on information from Cali is recommended; due to the fact that the number of cases could be underestimated as a consequence of including information in model construct from other registries which have, as yet, unsolved thoroughness issues.

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.

Comprehensive evaluation of cervical cancer screening programs: the case of Colombia

OBJECTIVE: To identify critical screening program factors for reducing cervical cancer mortality in Colombia. MATERIAL AND METHODS: Coverage, quality, and screening follow-up were evaluated in four Colombian states with different mortality rates. A case-control study (invasive cancer and healthy controls) evaluating screening history was performed. RESULTS: 3-year cytology coverage was 72.7 percent, false negative rate 49 percent, positive cytology follow-up 64.2 percent. There was no association between screening history and invasive cancer in two states having high cytology coverage but high false negative rates. Two states revealed association between deficient screening history and invasive cancer as well as lower positive-cytology follow-up. CONCLUSIONS: Reduced number of visits between screening and treatment is more relevant when low access to health care is present. Improved quality is a priority if access to screening is available. Suitable interventions for specific scenarios and proper appraisal of new technologies are compulsory to improve cervical cancer screening. Comprehensive process-failure audits among invasive cancer cases could improve program evaluation since mortality is a late outcome.

OBJETIVO: Identificar factores críticos para reducir la mortalidad por cáncer cervical en Colombia. MATERIAL Y MÉTODOS: Se evaluó cobertura, calidad y seguimiento del tamizaje en cuatro departamentos con tasas de mortalidad diferenciales. Un estudio de casos (cáncer invasor) y controles (sanos) evaluó historia de tamizaje. RESULTADOS: Cobertura 72,7 por ciento; falsos negativos 49 por ciento; acceso a diagnóstico-tratamiento de HSIL 64,2 por ciento. La historia de tamizaje no se asoció con cáncer invasor en dos departamentos con elevada cobertura pero elevada proporción de falsos negativos. Dos departamentos con asociación entre historia de tamizaje deficiente y cáncer invasor tuvieron cobertura aceptable pero bajo acceso a diagnóstico-tratamiento. No hubo relación entre mortalidad y desempeño del programa. CONCLUSIONES: Reducir visitas entre tamizaje y tratamiento es prioritario ante bajo acceso a los servicios. Incrementar calidad es prioritario si hay adecuado acceso al tamizaje. Intervenciones y tecnologías apropiadas a cada contexto son indispensables para obtener mejores resultados. Vigilar integralmente el cáncer invasor contribuye a la evaluación de los programas por ser un desenlace más temprano que la mortalidad.

Demoras en el diagnóstico y tratamiento de mujeres con cáncer de mama en Bogotá, Colombia / Delay for diagnosis and treatment of breast cancer in Bogotá, Colombia

OBJETIVO: Establecer la demora en la atención de cáncer de mama. MATERIAL Y MÉTODOS: En 1 106 mujeres que recibían tratamiento por cáncer de mama en Bogotá, se establecieron tasas de incidencia de diagnóstico y de tratamiento a partir de la primera consulta. Se compararon con las variables de interés y se elaboró un modelo de peligro de Cox. RESULTADOS: Las medianas de tiempo desde la primera consulta hasta el diagnóstico y hasta el tratamiento fueron de 91 días (IC95 por ciento:82-97 días) y de 137 días (IC95 por ciento:127-147 días) respectivamente. El diagnóstico y el tratamiento fueron más rápidos en mujeres con mayor nivel educativo, afiliadas al régimen especial de salud, en el estrato socioeconómico más alto y cuando consultaron por tamización. CONCLUSION: Las demoras en la atención son excesivas. Hay una clara inequidad y se requieren intervenciones para brindar mayor oportunidad, particularmente para el diagnóstico.

OBJECTIVE: Establish provider delay for breast cancer and related factors. MATERIAL AND METHODS: 1 106 women with breast cancer were approached in health care institutions of Bogota, Colombia. According to the history of first consultation, we established diagnostic and treatment incidence rates, which were compared for different variables. A Cox hazard model was established. RESULTS: Median time from first consultation to diagnosis and start of treatment were 91 days (CI95 percent:82-97 days) and 137 days (CI95 percent:127-147 days) respectively. Diagnosis and treatment were faster in women with higher educational level, affiliated to the "special" social security, with better socioeconomic conditions and in screening-detected breast cancers. CONCLUSION: Provider delay is excessive. There are clear inequities in access to services and a need of reducing the waiting times for women with a suspicion of breast cancer.

[Mortality and years of potential life lost due to homicide in Colombia, 1985-2006]. / Mortalidad y años potenciales de vida perdidos por homicidios en Colombia, 1985-2006.

OBJECTIVE: Describe the mortality patterns, burden of disease, and mechanisms of injury by homicide in Colombia between 1985 and 2006. METHODS: The official population and mortality databases in Colombia were used. Equivalencies of the underlying cause of death were identified and grouped according to the shortlists of the Ninth and Tenth Revision of the International Classification of Diseases. The years of potential life lost (YPLL), indices of YPLL, and crude, adjusted, and specific mortality rates associated with major causes and external causes for each sex were calculated. The homicide mechanisms were described. RESULTS: During the study period, a total of 523 870 homicides were recorded (484 475 in men and 39 395 in women). Homicides accounted for 13.8% of total mortality (21.4% of mortality in men and 2.6% in women) and generated 24.2% of YPLL (35.2% in men and 5.8% in women). The highest rates in men were found in the 20-44-year age range, with specific rates of up to 366.9 per 100 000 population, and in women in the 15-40 years age range with specific rates of up to 24.9 per 100 000 population. The most frequent homicide mechanism in both sexes was firearms. CONCLUSION: Homicides represent a significant burden of disease in Colombia, particularly affecting the young male population. Mortality from homicide has trended downward in recent years.

[Colombian death certificate quality, 2002-2006]. / La calidad de certificación de la mortalidad en Colombia, 2002-2006.

OBJECTIVE: Mortality study is useful for the estimation of cancer incident cases; but a quality assessment of the mortality information is required previous to the process of cancer incidence estimation. The aim of this study is to evaluate the quality of death-certification in Colombia. MATERIALS AND METHODS: Overall quality of death certification and quality of cancer mortality certification was analyzed for the period 2002-2006. Classic validity indexes were described through simple percentages for each district and four cities, where operating population-based cancer registries: Bucaramanga, Cali, Manizales, and Pasto. A principal component analysis was performed in order to identify relationships that might not be evident in the descriptive analysis. RESULTS: 952 104 registries were analyzed, 150 163 corresponding to cancer deaths. A high quality index was observed for overall death certification, with 92.8 % of the overall mortality properly certified. Most errors were due to ill defined causes of death. A high quality index was also observed for cancer death registration with 91.5 % of the cancer deaths properly certified. Ill-defined, secondary and unspecified cancer sites certification prevailed as the most frequent causes of error. CONCLUSION: Colombia has high quality standards for overall death and cancer death certification. Mortality data can be used confidently in the cancer incidence estimation process, without requirements for any specific corrections.

Mortalidad y años potenciales de vida perdidos por homicidios en Colombia, 1985-2006 / Mortality and years of potential life lost due to homicide in Colombia, 1985-2006

OBJETIVO: Describir el comportamiento de la mortalidad, la carga de enfermedad y los mecanismos de lesión por homicidios en Colombia entre 1985 y 2006. MÉTODOS: Se emplearon las bases de datos oficiales de población y mortalidad en Colombia. Se hicieron equivalencias de la causa básica de defunción agrupándolas de acuerdo con las listas cortas de la Clasificación Internacional de Enfermedades en su novena y décima revisión. Para cada sexo se calcularon los años potenciales de vida perdidos (APVP), los índices de APVP, las tasas crudas, las tasas ajustadas y las tasas específicas de mortalidad por grandes grupos de causas y causas externas. Se describieron los mecanismos de homicidio. RESULTADOS: Durante el período de estudio se registraron 523 870 homicidios (484 475 en hombres y 39 395 en mujeres). Los homicidios representaron 13,8 por ciento de la mortalidad general (21,4 por ciento de la mortalidad en hombres y 2,6 por ciento en mujeres) y generaron 24,2 por ciento de APVP (35,2 por ciento en hombres y 5,8 por ciento en mujeres). Las tasas más altas en hombres se encontraron en el rango de 20 a 44 años con tasas específicas de hasta 366,9 por 100 000 habitantes, y en las mujeres en el rango de 15 a 40 años con tasas específicas de hasta 24,9 por 100 000 habitantes. El mecanismo de homicidio más frecuente fueron las armas de fuego en ambos sexos. CONCLUSIONES: Los homicidios representan una gran carga de enfermedad en Colombia, que afecta particularmente a la población de hombres jóvenes. La mortalidad por homicidios ha mostrado una tendencia descendente en años recientes.

OBJECTIVE: Describe the mortality patterns, burden of disease, and mechanisms of injury by homicide in Colombia between 1985 and 2006. METHODS: The official population and mortality databases in Colombia were used. Equivalencies of the underlying cause of death were identified and grouped according to the shortlists of the Ninth and Tenth Revision of the International Classification of Diseases. The years of potential life lost (YPLL), indices of YPLL, and crude, adjusted, and specific mortality rates associated with major causes and external causes for each sex were calculated. The homicide mechanisms were described. RESULTS: During the study period, a total of 523 870 homicides were recorded (484 475 in men and 39 395 in women). Homicides accounted for 13.8 percent of total mortality (21.4 percent of mortality in men and 2.6 percent in women) and generated 24.2 percent of YPLL (35.2 percent in men and 5.8 percent in women). The highest rates in men were found in the 20-44-year age range, with specific rates of up to 366.9 per 100 000 population, and in women in the 15-40 years age range with specific rates of up to 24.9 per 100 000 population. The most frequent homicide mechanism in both sexes was firearms. CONCLUSION: Homicides represent a significant burden of disease in Colombia, particularly affecting the young male population. Mortality from homicide has trended downward in recent years.

Supervivencia en pacientes con cáncer de mama temprano tratadas con cirugía conservadora asociada a radioterapia en el Instituto Nacional de Cancerología / Survival in patients with early breast cancer treated with conservative surgery and radiotherapy at the National Cancer Institute of Colombia

Objetivo: Evaluar los resultados de pacientes con cáncer temprano de mama tratadas con cirugía conservadora y teleterapia en el servicio de radioterapia entre 2003 y 2004. Métodos: Serie de casos secuencial retrospectiva. Se realizó un análisis descriptivo aplicando medidas resumen y métodos de supervivencia. Resultados: Se incluyó a 75 pacientes con cáncer de mama temprano tratadas con cirugía conservadora asociada a teleterapia. La supervivencia global a 5 años fue del 92,9%; la supervivencia libre de recaída locorregional, del 88,4%; y la supervivencia libre de enfermedad, del 79,8%. La mayoría de las pacientes eran mayores de 50 años, posmenopáusicas, con tumores moderadamente diferenciados, de tipo ductal infiltrante y expresión de receptores hormonales. La mayoría de ellas no recibieron neoadyuvancia, y fueron tratadas con un vaciamiento axilar de más de 10 ganglios, márgenes de resección mayores a 1 cm y adyuvancia con quimioterapia y hormonoterapia. Pocas pacientes recibieron manejo radioterápico supraclavicular; la mayoría recibieron sobreimpresión. Dentro de los factores pronósticos se encontraron los receptores hormonales y la razón ganglionar. Conclusión: El cáncer de mama es la primera causa de incidencia y la segunda causa de mortalidad por cáncer entre las mujeres colombianas. La cirugía conservadora de mama asociada a radioterapia es el estándar actual de tratamiento en pacientes con cáncer temprano. Aunque las cifras de supervivencia global y libre de enfermedad son similares a las reportadas, la supervivencia libre de recaída locorregional resulta inferior. Se recomienda considerar los receptores como factor pronóstico para recaída locorregional y garantizar márgenes de sección libres de compromiso tumoral.

Objective: To evaluate the results of patients with early breast cancer treated with conservative surgery and teletherapy in the Department of Radiotherapy at the National Cancer Institute (NCI) between 2003 and 2004. Methods: Research was based upon a retrospective sequential case study. Descriptive analysis included the application of summarized measurement and survival methods. Results: Seventy-five patients with early breast cancer treated with conservative surgery in combination with teletherapy were included in the study. Overall survival at five years was 92.9%, loco-regional relapse free survival was 88.4%, and disease free survival was 79.8%. Most patients were over 50, postmenopausal, with moderately differentiated tumors of infiltrating ductal carcinoma and hormone receptor expression. The majority did not receive neoadjuvant therapy, had axilliary dissection on more than 10 lymph nodes with resection margins greater than one centimeter and adjuvant chemo and radiotherapy. A few patients underwent the majority received overpressing. Hormone receptors and the nodal region were included among prognostic factors. Conclusion: Although the overall survival and disease free rates were similar to those reported elsewhere; loco-regional relapse free survival turned out to be lower. We recommend considering receptors as loco-regional prognosisfactors and that tumor-free margin sections be assured in surgery.

Helical tomotherapy in patients with breast cancer and complex treatment volumes.

PURPOSE: To describe early clinical results of tomotherapy treatment in patients with breast cancer and complex treatment volumes. METHODS AND MATERIALS: Ten patients were treated with tomotherapy between January 2009 and March 2010. Treatment planning objectives were to cover at least 95% of the planning target volume with the 95% isodose; to have a minimum dose of 90% and a maximum dose of 105%. All treatments included daily CT/megavoltage image guidance. Acute toxicity was recorded weekly. RESULTS: Six patients were treated because constraints were not accomplished for heart, lung or contralateral breast in a previous three-dimensional conformal plan; two for preexisting cardiac or pulmonary disease, and two more for bilateral breast irradiation. Treatment volumes included the whole breast in the majority of patients, as well as the supraclavicular and the internal mammary chain nodes when indicated. Most patients were older than 50 years, and had an early breast cancer, with positive oestrogen receptors, negative HER2 expression and a poorly differentiated, infiltrating ductal carcinoma. The majority of patients had received neoadjuvant chemotherapy associated to breast-conserving surgery and adjuvant hormonotherapy. Median homogeneity index was 1.09; median coverage index was 0.81. Median V20Gy and V10Gy for ipsilateral lung was 20% and 37.1% respectively. Median V25 and V35 for heart was 15% and 4% respectively. Median dose for contralateral breast was 7 Gy. Skin acute toxicity was grade 1 in 41.7% and grade 2 in 58.3%. CONCLUSION: Tomotherapy is a technique capable of delivering a well tolerated treatment with high homogeneity and coverage indexes and high capabilities for sparing the organs at risk in patients with anatomically complex breast cancer, bilateral breast cancer, indication for internal mammary chain node irradiation, cardiac toxicity derived from chemotherapy, or preexisting cardiac or pulmonary disease. Further studies are required to evaluate local control and late toxicity.

La calidad de certificación de la mortalidad en Colombia, 2002-2006 / Colombian death certificate quality, 2002-2006

Objetivo El estudio de la mortalidad resulta útil en la estimación de casos incidentes de cáncer; sin embargo se requiere evaluar la calidad de la certificación de la mortalidad antes de proceder a hacer las estimaciones de incidencia. El objetivo de este estudio es evaluar la calidad de la certificación de la mortalidad en Colombia. Materiales y métodos Se analizó la calidad de la certificación de la mortalidad general y por cáncer en Colombia en el quinquenio 2002-2006. Se describieron indicadores clásicos de validez por medio de porcentajes simples para cada Departamento y además para cuatro áreas en donde operan registros poblacionales de cáncer (el área metropolitana de Bucaramanga y las ciudades de Cali, Manizales y Pasto). Se realizó un análisis de componentes principales con el fin de identificar relaciones no evidentes en el análisis descriptivo. Resultados Se analizaron 952 104 registros de defunción dentro de los cuales había 150 163 muertes por cáncer. El 92,8 por ciento de la mortalidad general estaba bien certificada. Predominaron los errores debidos al mal diligenciamiento. El 91,5 por ciento de la mortalidad por cáncer estaba bien certificada. Predominaron los errores debidos a la mala definición de la localización del tumor primario como causa de defunción. Conclusión La calidad de la certificación de la mortalidad general y por cáncer en Colombia es buena y ante la baja magnitud de problemas en la certificación, se puede emplear los datos de mortalidad en las estimaciones de incidencia de cáncer, sin aplicar más correcciones que las que se hacen de manera estándar.

Objective Mortality study is useful for the estimation of cancer incident cases; but a quality assessment of the mortality information is required previous to the process of cancer incidence estimation. The aim of this study is to evaluate the quality of deathcertification in Colombia. Materials and methods Overall quality of death certification and quality of cancer mortality certification was analyzed for the period 2002-2006. Classic validity indexes were described through simple percentages for each district and four cities, where operating population-based cancer registries: Bucaramanga, Cali, Manizales, and Pasto. A principal component analysis was performed in order to identify relationships that might not be evident in the descriptive analysis. Results 952 104 registries were analyzed, 150 163 corresponding to cancer deaths. A high quality index was observed for overall death certification, with 92.8 percent of the overall mortality properly certified. Most errors were due to ill defined causes of death. A high quality index was also observed for cancer death registration with 91.5 percent of the cancer deaths properly certified. Ill-defined, secondary and unspecified cancer sites certification prevailed as the most frequent causes of error. Conclusion Colombia has high quality standards for overall death and cancer death certification. Mortality data can be used confidently in the cancer incidence estimation process, without requirements for any specific corrections.