RESUMO
INTRODUCTION AND AIM: Helicobacter pylori (H. pylori) is known to be capable of causing chronic inflammation of the gastric mucosa that slowly progresses through the premalignant stages, reaching localized gastric adenocarcinoma (GAC). Its outcome is closely related to the stage at which diagnosis is made. The aim of the present study was to determine cost-benefit by comparing esophagogastroduodenoscopy, serum pepsinogen detection, and no screening at all. MATERIAL AND METHODS: Utilizing Markov chains and Monte Carlo simulation, the costs and effects of various detection modalities were simulated to analyze the cost-benefit of each strategy. For our population, we used the published data of patients with gastric cancer, applicable to the Mexican population. RESULTS: The results were reported as incremental cost-effectiveness ratios. The best strategy was serum pepsinogen determination, followed by the strategy of endoscopic examination with continued monitoring every 3 years. CONCLUSIONS: The performance of serum pepsinogen serology and directed endoscopic examination (and continued monitoring, if necessary) for GAC screening could be a cost-effective intervention in Mexico, despite the low-to-moderate general prevalence of the disease.
Assuntos
Adenocarcinoma , Infecções por Helicobacter , Neoplasias Gástricas , Adenocarcinoma/diagnóstico , Adenocarcinoma/epidemiologia , Análise Custo-Benefício , Infecções por Helicobacter/diagnóstico , Infecções por Helicobacter/epidemiologia , Humanos , México , Pepsinogênio A , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/epidemiologiaRESUMO
INTRODUCTION AND AIM: Helicobacter pylori (H. pylori) is known to be capable of causing chronic inflammation of the gastric mucosa that slowly progresses through the premalignant stages, reaching localized gastric adenocarcinoma (GAC). Its outcome is closely related to the stage at which diagnosis is made. The aim of the present study was to determine cost-benefit by comparing esophagogastroduodenoscopy, serum pepsinogen detection, and no screening at all. MATERIAL AND METHODS: Utilizing Markov chains and Monte Carlo simulation, the costs and effects of various detection modalities were simulated to analyze the cost-benefit of each strategy. For our population, we used the published data of patients with gastric cancer, applicable to the Mexican population. RESULTS: The results were reported as incremental cost-effectiveness ratios. The best strategy was serum pepsinogen determination, followed by the strategy of endoscopic examination with continued monitoring every 3 years. CONCLUSIONS: The performance of serum pepsinogen serology and directed endoscopic examination (and continued monitoring, if necessary) for GAC screening could be a cost-effective intervention in Mexico, despite the low-to-moderate general prevalence of the disease.
RESUMO
Objetivo: Estudiar los polimorfismos IL1B-511 y TNF-A-308 asociaciados a lesiones precursoras de cáncer gástrico (CG) en una población infectada con Helicobacter pylori (H. pylori) de bajo riesgo de CG de Nariño. Material y método: De 105 pacientes con síntomas de dispepsia se incluyeron 81 infectados por H. pylori, (n=63) con gastritis no atrófica y (n=18) con lesiones precursoras de CG de Tumaco: población de bajo riesgo de CG. Las lesiones gástricas se clasificaron por el sistema de Sydney y H. pylori por tinción de Giemsa. Los polimorfismos de IL1B-511 y TNF-A-308 se genotipificaron por PCR-RFLP's. Los polimorfismos y su asociación con lesiones gastricas se evaluaron por análisis bivariado y regresión logística binomial. Resultados: Los pacientes portadores del alelo mutante T (IL-1B-511) no se encontraron a riesgo de lesiones precursoras de malignidad (OR=0,7). No se calculó el OR para TNF-A-308, por fijación del alelo normal G. Ser hombre y estar infectado por H. pylori incrementa 4,3 veces el riesgo de presentar lesiones precursoras de CG y no estar vinculado al régimen de salud aumenta 6,7 veces el riesgo de atrofia gástrica, (OR=4,27 y OR=6,72), respectivamente. Conclusión: El alelo mutante T (IL-1B-511) es un biomarcador de resistencia de los pobladores de Tumaco, de bajo riesgo de CG e infectados con H. pylori a padecer lesiones precursoras de CG.
Aim: To study the IL1B-511 and TNF-A-308 polymorphisms and their possible association with gastric cancer (GC) precursor lesions in a population infected with Helicobacter pylori (H. pylori) of low risk area of GC of Nariño. Material/method: 105 patients with symptoms of dyspepsia were included, 81 infected with H. pylori, (n=63) with non-atrophic gastritis and (n=18) with precursor lesions of GC of Tumaco: population of low risk of GC. Gastric lesions were classified by the Sydney System an H. pylori by Giemsa staining. The IL1B-511 and TNFA-308 polymorphisms were genotyped by PCR-RFLPs. Polymorphisms and their association with gastric lesions were evaluated by bivariate analysis and binomial logistic regression. Results: Patients carryng the mutant T allele (IL-1B-511) were not at risk of precursor lesions of malignancy (OR=0,7). The OR was not calculated for TNF-A-308, by fixing the normal allele G. Being a man and being infected with H. pylori increases 4,3 times the risk of presenting precursor lesions of GC and not being linked to the health regimen increases 6,7 times the risk of gastric atrophy, (OR=4,27 and OR=6,72), respectively. Conclusion: The mutant T allele (IL-1B-511) is a resistance biomarker of Tumaco residents, low risk of GC and infected with H. pylori to suffer precursor lesions of GC.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Helicobacter pylori , Neoplasias Gástricas , Fatores de Risco , Colômbia , Alelos , MutaçãoRESUMO
Abstract Background: Uruguay is the south American country which has the highest cancer incidence and mortality rates. The National Cancer Registry collects data on cancer cases nationwide since 1989 and has reached high quality standards in the last decades. This is the first report on incidence trends. Methods: Data from the National Cancer Registry of all new cases of invasive cancer from twelve sites diagnosed in 2002-2015 was analyzed. Age-standardized rates were calculated. Trends of incidence rates were analyzed using joinpoint regression models. Results: For both, men and women, incidence rates trends for all cancer sites, colo-rectal and bladder cancer remained stable. Esophageal and gastric cancers descended while thyroid and kidney cancer incidence increased. In men lung cancer decreased; testicular cancer increased, and prostate cancer increased at the beginning of the period and decreased in the final years. In women, lung cancer increased, breast cancer remained stable and cervical cancer presented a significant decline from 2005 to 2010 and reached a plateau since then. Conclusion: Cancer incidence dynamics are complex and affected not only by Public Health policies such as tobacco control, vaccination and screening programs, but also by environmental and life style changes and the attitude of the medical community towards the application of diagnostic and therapeutic tools. The aim of this paper is to analyze cancer incidence time trends in the country and provide possible explanations to them.
Resumen Introducción: Uruguay es el país de Sudamerica que tiene las mayores tasas de incidencia y mortalidad por cáncer. El Registro Nacional de Cáncer recoge los datos de cáncer de todo el país desde 1989 y en las últimas décadas ha alcanzado los más altos estándares de calidad. Este es el primer reporte de tendencias de incidencia de cáncer de Uruguay. Métodos: Se analizaron los datos de todos los casos de cáncer invasivo diagnosticados entre 2002 y 2015 incluidos en el Registro Nacional de Cáncer y los de once topografías en particular. Se calcularon las tasas de incidencia estandarizada y se analizaron las tendencias utilizando los modelos de regresión de Joinpoint. Resultados: Las tasas de incidencia de cáncer colorrectal, vejiga y todos los sitios reunidos se mantuvieron estables tanto en hombres como en mujeres. La tasa de incidencia de cáncer de estómago y esófago disminuyeron mientras que las de tiroides y riñón aumentaron. En los hombres, el cáncer de pulmón disminuyó, el cáncer de testículo aumentó y el de próstata aumentó en un lapso inicial y decreció en los últimos años. En las mujeres el cáncer de pulmón aumentó y el de mama se mantuvo estable mientras que el cáncer de cérvix presentó un descenso significativo entre 2005 y 2010 alcanzando una meseta desde entonces. Conclusión: La dinámica de la incidencia de cáncer es compleja y está afectada no sólo por las políticas de Salud Pública como las campañas de control de tabaco, vacunación y programas de tamizaje sino por los cambios ambientales y de los estilos de vida y la actitud de los médicos respecto a la aplicación de técnicas diagnósticas y terapéuticas. En este trabajo se analizan las tendencias de incidencia en el país y se plantean posibles explicaciones para los cambios.
