Trends in cancer incidence in Uruguay: 2002 -2015

Spatio-Temporal Distribution of Colorectal Cancer Incidence in Córdoba, Argentina

OBJECTIVE

To study the trend of colorectal cancer (CRC) incidence, considering its spatiotemporal distribution and its association with the level of urbanisation in Córdoba, Argentina (2004-2014).

METHODS

An ecological and longitudinal study was conducted in the province of Córdoba (the second most populated of the country) using annual data for the period 2004-2014. Age-standardised incidence rates (ASIR) (standard national and world population) by sex were calculated for Córdoba and its 26 departments for CRC using the provincial tumour registry database. Joinpoint regression models were adjusted to provincial ASIRs. Departments ASIRs were mapped in quintiles. The departments were grouped into three strata according to urbanisation: High (n1=6, >107,000 people); Intermediate (n2=13, 33,000-107,000 people); and Low (n3=7, <33,000 people). The spatio-temporal correlation analysis of the departments' rates was fulfilled using the multilevel modelling strategy.

RESULTS

ASIRs of CRC in Córdoba province were 30.9 ±1.5 and 24.3 ±1.5 cases/100,000 for men and women, respectively. During 2004-2014, ASIRs tended to decrease (annual per cent change: -0.6; CI95% -1.8, 0.6). Maps reflected different geospatial patterns by sex. CRC incidence in males was higher than in females in all strata (high urbanisation, incidence rate ratios (IRR): 1.66; intermediate, IRR: 1.59; and low, IRR: 1.40). There was a significant downward temporary variation in the most populous departments (3% per year).

CONCLUSIONS

CRC presents a non-random spatial pattern across the territory with a decreasing temporal variation in the most populous departments. Differential incidence and temporospatial tendency burden in Córdoba involve sex and urbanisation. Men continue to be the population at the greatest risk; this pattern is more noticeable in most urban settings.

Colorectal Cancer in Young and Older Adults in Uruguay: Changes in Recent Incidence and Mortality Trends

Uruguay has the highest colorectal cancer incidence rates in Latin America. Previous studies reported a stable incidence and a slight increase in mortality among males. We aimed to assess colorectal cancer incidence (2002-2017) and mortality trends (1990-2017) by age groups and sex, using data from the National Cancer Registry. Annual percent changes (APCs) were estimated using joinpoint regression models. We included 27,561 colorectal cancer cases and 25,403 deaths. We found an increasing incidence among both males and females aged 40-49, with annual increases of 3.1% (95%CI: 1.21-5.03) and 2.1% (95%CI: 0.49-3.66), respectively, and an increasein the rate in older males (70+) of 0.60% (95%CI: 0.02-1.20) per year between 2002 and 2017. Mortality remained stable among those younger than 50, whereas it decreased for older females aged 50-69 and 70+ (APC: -0.61% (-1.07-0.14) and -0.68% (-1.02-0.34), respectively), and increased for the oldest males (70+; APC: 0.74 (0.47-1.01)). In conclusion, we found rising colorectal cancer incidence accompanied by stable mortality in young adults. Sex disparities were also found among the older adults, with a more favorable pattern for females. Exposures to dietary and lifestyle risk factors, and inequalities in access to and awareness of screening programs, are probably among the main underlying causes and deserve further investigation.

Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.