Factores socioeconómicos asociados por nivel de inseguridad alimentaria en adultos mexicanos con diabetes mellitus durante la pandemia de la COVID-19

OBJETIVOS

estimar la prevalencia de la inseguridad alimentaria e identificar los factores socioeconómicos asociados en adultos mexicanos con diabetes mellitus, durante la pandemia de la COVID-19.

MÉTODOS

estudio transversal, análisis secundario de los datos de la Encuesta Nacional de Salud y Nutrición 2020 sobre la COVID-19. Se estudió a 1 232 individuos que representan a 9 569 330 adultos con diabetes mellitus. La inseguridad alimentaria se midió utilizando la Escala Latinoamericana y Caribeña de Seguridad Alimentaria adaptada para México. Se realizó un modelo de regresión logístico binario para cada nivel de inseguridad alimentaria. Se calcularon razón de momios e intervalos de confianza al 95 %. Un valor de p < 0.05 fue estadísticamente significativo.

RESULTADOS

el 64.8 % presentó inseguridad alimentaria: 40.7 % leve, 14.2 % moderada y 9.9 % severa. Los factores asociados a inseguridad alimentaria leve fueron: nivel socioeconómico muy bajo (RM 2.6), pérdida del empleo de algún miembro del hogar (RM 2.0) y reducción de gastos en alimentación (RM 5.0); para inseguridad moderada la RM fue de 7.7, 3.4 y 18.6 y en severa la RM 7.1, 3.0 y 46.7, respectivamente.

CONCLUSIONES

la COVID-19 ha tenido efectos inmediatos en la inseguridad alimentaria de la población de adultos mexicanos con diabetes mellitus. Identificar los factores socioeconómicos asociados es prioritario para llevar a cabo políticas públicas que permitan redirigir los recursos y cubrir necesidades básicas como la alimentación.

Understanding Sociodemographic Factors among Hispanics Through a Population-Based Study on Testicular Cancer in Mexico

Testicular cancer (TCa) is a rare malignancy affecting young men worldwide. Sociodemographic factors, especially socioeconomic level (SEL) and healthcare access, seem to impact TCa incidence and outcomes, particularly among Hispanic populations. However, limited research has explored these variables in Hispanic groups. This study aimed to investigate sociodemographic and clinical factors in Mexico and their role in health disparities among Hispanic TCa patients. We retrospectively analyzed 244 Mexican TCa cases between 2007 and 2020 of a representative cohort with diverse social backgrounds from a national reference cancer center. Logistic regression identified risk factors for fatality: non-seminoma histology, advanced stage, and lower education levels. Age showed a significant trend as a risk factor. Patient delay and healthcare distance lacked significant associations. Inadequate treatment response and chemotherapy resistance were more likely in advanced stages, while higher education positively impacted treatment response. Cox regression highlighted non-seminoma histology, below-median SEL, higher education, and advanced-stage survival rates. Survival disparities emerged based on tumor histology and patient SEL. This research underscores the importance of comprehensive approaches that integrate sociodemographic, biological, and environmental factors to address health disparities improving outcomes through personalized interventions in Hispanic individuals with TCa.

A brain metastasis prediction model in women with breast cancer

BACKGROUND

Breast cancer (BC) is a leading cause of mortality and the most frequent malignancy in women, and most deaths are due to metastatic disease, particularly brain metastases (BM). Currently, no biomarker or prediction model is used to predict BM accurately. The objective was to generate a BM prediction model from variables obtained at BC diagnosis.

METHODS

A retrospective cohort of women with BC diagnosed from 2009 to 2020 at a single center was divided into a training dataset (TD) and a validation dataset (VD). The prediction model was generated in the TD, and its performance was measured in the VD using the area under the curve (AUC) and C-statistic.

RESULTS

The cohort (n = 5009) was divided into a TD (n = 3339) and a VD (n = 1670). In the TD, the model with the best performance (lowest AIC) was built with the following variables: age, estrogen receptor status, tumor size, axillary adenopathy, anatomic clinical stage, Ki-67 expression, and Scarff-Bloom-Richardson score. This model had an AUC of 0.79 (95%CI, 0.76-0.82; p < 0.0001) in the TD. The 10-fold cross-validation showed the good stability of the model. The model displayed an AUC of 0.81 (95%CI, 0.77-0.85; P < 0.0001) in the VD. Four groups, according to the risk of BM, were generated. In the low-risk group, 1.2% were diagnosed with BM (reference); in the medium-risk group, 5.0% [HR 4.01 (95%CI, 1.8 - 8.8); P < 0.0001); in the high-risk group, 8.5% [HR 8.33 (95%CI, 4.1-17.1); P < 0.0001]; and in the very high-risk group, 23.7% [HR 29.72 (95%CI, 14.9 - 59.1); P < 0.0001].

CONCLUSION

This prediction model built with clinical and pathological variables at BC diagnosis demonstrated robust performance in determining the individual risk of BM among patients with BC, but external validation in different cohorts is needed.

Mortality Prognosis Factors in Patients with Active Cancer Under Treatment, and Severe COVID-19

BACKGROUND

COVID-19 is associated with systemic inflammation. This inflammatory response is further deregulated by oncological treatments increasing mortality in this population. However, there is conflicting information regarding the clinical factors that increase mortality in patients with severe COVID-19.

OBJECTIVE

The aim of this study was to identify prognostic factors associated with mortality during severe COVID-19 in patients with active cancer. In addition, the correlation between oncologic codes and mortality related to severe COVID-19 was evaluated.

PATIENTS AND METHODS

We analyzed a cohort of Mexican patients with active cancer and severe COVID-19 between March 2020 and February 2021. We collected information on patient demographic characteristics, COVID-19 symptoms, clinical and laboratory data, and treatments. Patients were classified according to oncologic code. We defined the oncological code based on clinical stage, treatment intention, performance status before COVID-19, and median overall survival with palliative treatment. A log-rank test was performed to determine survival. A multivariate logistic regression model was used to adjust for potential confounders.

RESULTS

One hundred fifty-two patients with severe COVID-19 were analyzed. The red oncologic code was associated with an increased risk of mortality OR 22.8 (CI 95% 5.0-105.1, p <0.001), low oxygen saturation OR 5.4 (CI 95% 1.7-17.4, p = 0.005), chronic corticosteriod use OR 4.3 (CI 95% 1.0-18.1, p = 0.050) and high D-dimer level OR 3.2 (CI 95% 1.2-8.2, p = 0.019).

CONCLUSIONS

The survival of patients with active cancer and severe COVID-19 was possible to identify, at the time of admission, specific oncological characteristics. Based on this code, decreased oxygen saturation, increased D-dimer levels, and chronic corticosteroid use were the main predictive factors related to mortality.

Insurance status and access to cervical cancer treatment in a specialized cancer center in Mexico

To describe access to complete treatment in women with cervical cancer and state-sponsored insurance versus no insurance. We conducted a retrospective observational study. The source population consisted of women treated for cervical cancer from January 2000 to December 2015 in a tertiary care hospital. We included 411 women with state-sponsored insurance and 400 without insurance. We defined access to cervical cancer treatment as complete treatment (according NCCN/ESMO (National Comprehensive Cancer Network/European Society for Medical Oncology) standards) and timely initiation of treatment (less than 4 weeks). Clinical and sociodemographic characteristics were described and analyzed with logistic regression using complete treatment as the main outcome. A total of 811 subjects were included, the median age was 46 (IQR (Interquartile range) 42-50) years. Most of them were married (36.1%), unemployed (50.4%), and had completed primary school (44.0%). The most common clinical stages at diagnosis were II (38.2%) and III (24.7%). In the adjusted regression model, being married (OR (odds ratio): 4.3, 95% CI (confidence interval): 1.74-10.61) and having paid employment (OR: 2.79, 95% CI: 1.59-4.90) or state-sponsored insurance (OR: 1.54, 95% CI: 1.04-2.26) were positively associated with the possibility of having a complete treatment. Women with insurance were likely to be younger and receive timely treatment compared with uninsured women. Complete treatment was associated to insurance status and advanced stages of cervical cancer. State-sponsored insurance improves access to complete treatment. Government policies are needed to avoid social and economic inequity and provide better management of cervical cancer in our country.

Deep DNA sequencing of MGMT, TP53 and AGT in Mexican astrocytoma patients identifies an excess of genetic variants in women and a predictive biomarker

PURPOSE

Astrocytomas are a type of malignant brain tumor with an unfavorable clinical course. The impact of AGT and MGMT somatic variants in the prognosis of astrocytoma is unknown, and it is controversial for TP53. Moreover, there is a lack of knowledge regarding the molecular characteristics of astrocytomas in Mexican patients.

METHODS

We studied 48 Mexican patients, men and women, with astrocytoma (discovery cohort). We performed DNA deep sequencing in tumor samples, targeting AGT, MGMT and TP53, and we studied MGMT gene promoter methylation status. Then we compared our findings to a cohort which included data from patients with astrocytoma from The Cancer Genome Atlas (validation cohort).

RESULTS

In the discovery cohort, we found a higher number of somatic variants in AGT and MGMT than in the validation cohort (10.4% vs < 1%, p < 0.001), and, in both cohorts, we observed only women carried variants AGT variants. We also found that the presence of either MGMT variant or promoter methylation was associated to better survival and response to chemotherapy, and, in conjunction with TP53 variants, to progression-free survival.

CONCLUSIONS

The occurrence of AGT variants only in women expands our knowledge about the molecular differences in astrocytoma between men and women. The increased prevalence of AGT and MGMT variants in the discovery cohort also points towards possible distinctions in the molecular landscape of astrocytoma among populations. Our findings warrant further study.

Analysis of cancer mortality in Mexico using the results of the Global Burden of Disease 2021 study

BACKGROUND

In Mexico, cancer mortality rates have undergone changes over the past decades.

OBJECTIVE

To analyze the evolution of cancer mortality rates in Mexico between 1990 and 2021.

MATERIALS AND METHODS

Based on the Global Burden of Disease study, the mortality rates for the 10 most prevalent types of cancer in Mexico were obtained, at the national and regional level and by states, considering different age groups and gender. Global Burden of Disease reassigns misclassified causes and distributes them among different types of cancer; subsequently, it models and adjusts the causes to the total number of deaths with a model of a set of causes of death and a cause corrector, which corrects INEGI's mortality records.

RESULTS

The cancer mortality rate went from 117.87 in 1990 to 84.18 in 2021. In women, breast, cervical, stomach and lung cancers were the most frequent. In men, the most common were prostate, stomach, lung, and colon and rectum cancer. The decrease in cancer mortality for men and women stood out, particularly from lung and cervical cancer.

CONCLUSIONS

The results provide information for the development of health policies and specific prevention and control strategies to address the impact of cancer in Mexico.

Role of Neck Dissection in Organ-Preservation for Glottic Squamous Cell Carcinoma

The surgical approach to the neck in laryngeal cancer depends on the tumor site and stage. Clinical practice guidelines recommend elective neck dissection in ≥ T2 N0 and all supraglottic cancers; however, there is no evidence supporting these recommendations. The objective is to evaluate the results of bilateral elective neck dissection in patients with glottic cancer who underwent supracricoid partial laryngectomy (SCPL) with cricohyoidoepiglottopexy (CHEP). Thirty-five patients diagnosed with ≥ T2 N0 laryngeal squamous cell carcinoma (LSCC) in a single-center retrospective study. Right-sided neck dissections yielded 900 lymph nodes, none of which were positive for metastatic disease. Left-sided neck dissections yielded 949 lymph nodes, one of which was positive for malignancy. Prelaryngeal (Delphian) neck dissection was performed in all patients. Out of 50 lymph nodes removed; one was positive for malignancy. Median overall survival was 172 months, and the 60-month overall survival was 87.3%. The 60-month disease-specific survival was 97.1%. Bilateral neck dissection and Delphian node dissection showed a low rate of metastasis (2.8%). Radical neck dissection may thus represent overtreatment; however, this surgical procedure could be justified to prevent regional recurrences.

Cancer Prevention Behaviors in Workers of a Referral Cancer Center in Mexico City: A Pilot Study on Early Detection Awareness for Cancer

Background

Prevention strategies for cancer are necessary. Health workers who often serve as role models bear responsibility for prevention counseling and programs. However, whether their habits and behaviors reflect prevention goals are unknown. We describe the prevalence of cancer risk factors and prevention behaviors in health workers of a referral cancer center in Mexico City.

Methods

Cross-sectional study in which workers of the National Cancer Institute were invited to participate in a prevention program, risk factor survey, and nutrition, psychological, and genetic counseling were included. The likelihood of cancer was calculated based on the presence of risk factors. Factors associated with prevention behaviors were identified by logistic regression.

Results

We recruited 301 workers; 77% were women. The median self-reported BMI was 26.4 kg/m², 9.97% smoked, 78% drank alcohol, and 89% did not get at least 150 min/week of physical activity. In women, age (OR = 1.3 95%CI 1.01-1.06) and physical activity of 150 min/week (OR = 2.52 95% CI 1.28-4.96) were associated with cancer prevention behaviors. No risk factors were associated with healthy behaviors among men.

Conclusion

Health workers may have unhealthy lifestyles and behaviors, is essential to create supportive environments to promote cancer prevention counseling and programs effectively.

Prognostic importance of DNA from human papillomavirus in patients with oral squamous cell carcinoma

Background

Survival of patients with oral squamous cell carcinoma (OSCC) is generally low, with the likelihood of locoregional recurrence or disease progression (LR/DP). Knowledge of prognostic factors for survival is key to achieving an understanding and increased survival. The present study aimed to identify prognostic factors for patients with OSCC, especially the presence of DNA from human papillomavirus (HPV).

Material and Methods

Retrospective cohort study including 119 patients with OSCC treated at the National Cancer Institute in Mexico City (2009-2013). Clinical information was obtained from patient records including LR/DP. Formalin-fixed, paraffin-embedded tissues were obtained and used for detecting DNA from different types of HPV. Potential prognostic factors for Overall Survival (OS) were analyzed using the Cox proportional hazards model.

Results

After model adjustment, factors associated with longer OS were a pre-treatment platelet count above 400,000/mm3 (HR=0.09, p=0.026) and response to primary treatment (HR=0.26, p=0.001). HPV DNA was present in 23 (19.3%) of the patients and importantly, type 16 found in 19 of them. Although survival of HPV-positive patients was longer, difference was not significant. However, among patients with LR/DP, HPV positivity was significantly associated with increased survival (HR=0.23, p=0.034). Importantly, survival was significantly different for HPV-positive patients with LR/DP > 6 months (HR=0.20, p=0.002), had higher absolute lymphocyte count at start of treatment (HR=0.50, p=0.028) or had local rescue treatment (HR=0.24, p=0.019).

Conclusions

Although HPV positivity was not associated with a longer OS of OSCC patients, a better prognosis was significantly associated with HPV positivity and recurring or progressing disease, particularly with HPV type 16.

Key words:HPV, human papillomavirus, HPV-16, oral squamous cell carcinoma, oral cancer, survival, locoregional recurrence, disease progression.

Genotoxicity of Marijuana in Mono-Users

Marijuana (Cannabis sp.) is among the most recurred controlled substances in the world, and there is a growing tendency to legalize its possession and use; however, the genotoxic effects of marijuana remain under debate. A clear definition of marijuana's genotoxic effects remains obscure by the simultaneous consumption of tobacco and other recreational substances. In order to assess the genotoxic effects of marijuana and to prevent the bias caused by the use of substances other than cannabis, we recruited marijuana users that were sub-divided into three categories: (1) users of marijuana-only (M), (2) users of marijuana and tobacco (M+T), and (3) users of marijuana plus other recreative substances or illicit drugs (M+O), all the groups were compared against a non-user control group. We quantified DNA damage by detection of γH2AX levels and quantification of micronuclei (MN), one of the best-established methods for measuring chromosomal DNA damage. We found increased levels of γH2AX in peripheral blood lymphocytes from the M and M+T groups, and increased levels of MNs in cultures from M+T group. Our results suggest a DNA damage increment for M and M+T groups but the extent of chromosomal damage (revealed here by the presence of MNs and NBuds) might be related to the compounds found in tobacco. We also observed an elevated nuclear division index in all marijuana users in comparison to the control group suggesting a cytostatic dysregulation caused by cannabis use. Our study is the first in Mexico to assess the genotoxicity of marijuana in mono-users and in combination with other illicit drugs.

Association of the neutrophil-to-lymphocyte ratio with brain metastases in Hispanic breast cancer patients

BACKGROUND

Breast cancer (BC) is one of the most common cancers and leading cause of cancer-related deaths in women. Metastatic disease, particularly brain metastases (BM), is associated with death in BC patients. The neutrophil-to-lymphocyte ratio (NLR) has been associated with BC prognosis, but it is not usually used in clinical practice and has not been associated with BM. We aimed to determine if there is an association between NLR and BM and if NLR is associated with survival in a Hispanic population.

METHODS

A retrospective cohort with a total of 2,104 patients with a confirmed diagnosis of BC at a single referral center were randomly divided into training and validation datasets. Univariable and multivariable analyses were performed to study the association of NLR with BM and/or survival.

RESULTS

No significant differences between datasets were identified. A high NLR (> 2.2) was associated with a higher frequency of BM after multivariable adjustment in both datasets. Overall survival was shorter in patients with a high NLR; however, the most important factor associated with outcome was the presence of BM. The interaction NLR/BM was not statistically significant.

CONCLUSION

A high NLR at BC diagnosis was associated with a higher frequency of BM, and the presence of BM was associated with worse overall survival in Hispanic BC patients.

Prostate Cancer Risk Calculators for Healthy Populations: Systematic Review

Background

Screening for prostate cancer has long been a debated, complex topic. The use of risk calculators for prostate cancer is recommended for determining patients’ individual risk of cancer and the subsequent need for a prostate biopsy. These tools could lead to better discrimination of patients in need of invasive diagnostic procedures and optimized allocation of health care resources

Objective

The goal of the research was to systematically review available literature on the performance of current prostate cancer risk calculators in healthy populations by comparing the relative impact of individual items on different cohorts and on the models’ overall performance.

Methods

We performed a systematic review of available prostate cancer risk calculators targeted at healthy populations. We included studies published from January 2000 to March 2021 in English, Spanish, French, Portuguese, or German. Two reviewers independently decided for or against inclusion based on abstracts. A third reviewer intervened in case of disagreements. From the selected titles, we extracted information regarding the purpose of the manuscript, analyzed calculators, population for which it was calibrated, included risk factors, and the model’s overall accuracy.

Results

We included a total of 18 calculators from 53 different manuscripts. The most commonly analyzed ones were the Prostate Cancer Prevention Trial (PCPT) and European Randomized Study on Prostate Cancer (ERSPC) risk calculators developed from North American and European cohorts, respectively. Both calculators provided high diagnostic ability of aggressive prostate cancer (AUC as high as 0.798 for PCPT and 0.91 for ERSPC). We found 9 calculators developed from scratch for specific populations that reached a diagnostic ability as high as 0.938. The most commonly included risk factors in the calculators were age, prostate specific antigen levels, and digital rectal examination findings. Additional calculators included race and detailed personal and family history.

Conclusions

Both the PCPR and ERSPC risk calculators have been successfully adapted for cohorts other than the ones they were originally created for with no loss of diagnostic ability. Furthermore, designing calculators from scratch considering each population’s sociocultural differences has resulted in risk tools that can be well adapted to be valid in more patients. The best risk calculator for prostate cancer will be that which has been calibrated for its intended population and can be easily reproduced and implemented.

Trial Registration

PROSPERO CRD42021242110; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=242110

Landscape of Germline Genetic Variants in AGT, MGMT, and TP53 in Mexican Adult Patients with Astrocytoma

Astrocytoma is the most common type of primary brain tumor. The risk factors for astrocytoma are poorly understood; however, germline genetic variants account for 25% of the risk of developing gliomas. In this study, we assessed the risk of astrocytoma associated with variants in AGT, known by its role in angiogenesis, TP53, a well-known tumor suppressor and the DNA repair gene MGMT in a Mexican population. A case-control study was performed in 49 adult Mexican patients with grade II-IV astrocytoma. Sequencing of exons and untranslated regions of AGT, MGMT, and TP53 from was carried in an Ion Torrent platform. Individuals with Mexican Ancestry from the 1000 Genomes Project were used as controls. Variants found in our cohort were then assessed in a The Cancer Genome Atlas astrocytoma pan-ethnic validation cohort. Variants rs1926723 located in AGT (OR 2.74, 1.40-5.36 95% CI), rs7896488 in MGMT (OR 3.43, 1.17-10.10 95% CI), and rs4968187 in TP53 (OR 2.48, 1.26-4.88 95% CI) were significantly associated with the risk of astrocytoma after multiple-testing correction. This is the first study where the AGT rs1926723 variant, TP53 rs4968187, and MGMT rs7896488 were found to be associated with the risk of developing an astrocytoma.

Saliva is a reliable and accessible source for the detection of SARS-CoV-2

OBJECTIVES

The aim of this study was to investigate the feasibility of saliva sampling as a non-invasive and safer tool to detect severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and to compare its reproducibility and sensitivity with nasopharyngeal swab samples (NPS). The use of sample pools was also investigated.

METHODS

A total of 2107 paired samples were collected from asymptomatic healthcare and office workers in Mexico City. Sixty of these samples were also analyzed in two other independent laboratories for concordance analysis. Sample processing and analysis of virus genetic material were performed according to standard protocols described elsewhere. A pooling analysis was performed by analyzing the saliva pool and the individual pool components.

RESULTS

The concordance between NPS and saliva results was 95.2% (kappa 0.727, p = 0.0001) and 97.9% without considering inconclusive results (kappa 0.852, p = 0.0001). Saliva had a lower number of inconclusive results than NPS (0.9% vs 1.9%). Furthermore, saliva showed a significantly higher concentration of both total RNA and viral copies than NPS. Comparison of our results with those of the other two laboratories showed 100% and 97% concordance. Saliva samples are stable without the use of any preservative, and a positive SARS-CoV-2 sample can be detected 5, 10, and 15 days after collection when the sample is stored at 4 °C.

CONCLUSIONS

The study results indicate that saliva is as effective as NPS for the identification of SARS-CoV-2-infected asymptomatic patients. Sample pooling facilitates the analysis of a larger number of samples, with the benefit of cost reduction.

Trends in breast-conserving surgery in Mexico after the implementation of a public health insurance system

Although breast conserving surgery is the standard of care for patients with localized breast cancer in high-income countries, little is known about its use in developing countries, where disparities in access to treatment may lead to an increased use of mastectomy. We examined the use of breast conserving surgery at a Mexican cancer center after the implementation of a public insurance program aimed at providing coverage for previously uninsured patients. Between 2006 and 2016, 4519 women received surgical treatment for breast cancer, of which 39% had early-stage disease. The proportion of patients treated with breast conserving surgery increased from 10% in the 2006-2009 period to 33% in the 2013-2016 period, with most of this increase occurring among women with early-stage disease (17-52%). Improving access to care and reducing the financial burden of breast cancer in developing countries may lead to an increased use of breast conserving surgery.

Implementation of the population-based cancer registry in the city of Mérida, Mexico: process and early results

OBJECTIVE

To briefly describe the process of establishment and preliminary results of the Mérida Population-based Cancer Registry (Mérida-PBCR).

MATERIALS AND METHODS

Mérida-PBCR started in 2016 as a research project in the IMSS, with a gradual increase in its information sources. It covers a population of 908 536 inhabitants. Data collection is active and passive, international standards are used; CanReg5 software enables data entry, storage and analysis.

RESULTS

Current data include 71.5% of sources. For the period 2015- 2016, a total of 2 623 new cancer cases were registered, the majority of these (60.1%) among females. 81.5% of the cases had morphological verification. Prostate (17.4%), colorectal (8.5%) and stomach (8.1%) cancers were the most common among males, and breast (31.6%), cervix (12%) and corpus uteri (7.6%) cancers, the most common among females. Ageadjusted cancer incidence rates (per 100 000) for all sites combined were 114.9 among males and 145.1 among females.

CONCLUSIONS

The implementation of the Mérida-PBCR has followed particular parameters, with important efforts to include new information sources. Although the data are still preliminary and must be interpreted with great caution, the main cancers follow a similar pattern to that of the national and regional estimates.

Cervical Cancer in Young Women: Do They Have a Worse Prognosis? A Retrospective Cohort Analysis in a Population of Mexico

BACKGROUND

Cervical cancer (CC) is a global problem; it is among the five leading causes of cancer death in women. Several studies have examined the association between age and disease prognosis; however, controversy still exists. The objective of the present study is to determine if age at diagnosis has an impact on overall survival (OS) and disease-free survival (DFS).

MATERIALS AND METHODS

Retrospective cohort of 2,982 patients with CC treated at the National Cancer Institute of Mexico from 2005 to 2015. We collected demographic, clinical, and treatment data, as well as current status, of 2 groups: women under and over 40 years of age. We calculated OS and DFS rates with Kaplan-Meier estimates. Cox proportional hazards modeling was used to determine risks.

RESULTS

The median follow-up time was 26.5 months (percentile [P]₂₅ -P₇₅ , 11-60.23). When comparing DFS, OS, stage, and histologic subtype between young patients <40 and adult patients >40, we did not observe any difference. We found that in both groups, locally advanced and advanced stage, neuroendocrine subtype, hydronephrosis, and positive inguinal lymph nodes increased the risks of death and recurrence. Having been pregnant was identified as protective factor in DFS (hazard ratio, 0.54; 95% confidence interval, 0.04-0.71).

CONCLUSION

We corroborated that age at diagnosis is not a prognostic factor for decreased or increased OS or DFS, and in both groups, the stage, histologic subtype, hydronephrosis, and node involvement were identified as factors adverse to OS and DFS, and pregnancy history was a protective factor in DFS.

IMPLICATIONS FOR PRACTICE

The present study directly affects everyday clinical practice because it allows us to focus on the most relevant prognostic factors in patients with cervical cancer. When planning treatment and follow-up, clinicians should focus on stage at diagnosis, histologic subtype, hydronephrosis, and distant metastasis instead of patients' age. They should also be aware of any previous pregnancies and poor response, or nonresponse, to treatment, which results in disease progression and persistence. Paying attention to these factors affecting overall survival and disease-free survival will help treat patients better and increase their chances of survival and improve their quality of life.

Identification of risk factors for central nervous system metastasis in patients with breast cancer with neurologic symptoms

BACKGROUND

The current study was performed to identify factors that are present at the time of breast cancer (BC) diagnosis that are associated with a higher rate of central nervous system metastasis (CNSm).

METHODS

The authors analyzed a database of patients with a confirmed diagnosis of BC who were referred for a neuro-oncology consultation at the National Cancer Institute in Mexico City, Mexico, from June 2009 to June 2017. Information was collected prospectively and included demographic, pathologic, and clinical data at the time of diagnosis of BC. Bivariate and multivariate logistic regression models were built to estimate the associations between the development of CNSm and the time after BC diagnosis.

RESULTS

Among 970 patients with BC, 263 (27%) were diagnosed with CNSm. The median time from BC diagnosis to the development of CNSm was 33 months (interquartile range, 15-76 months). After multivariate analysis, age <50 years at the time of BC diagnosis (odds ratio [OR], 2.5; 95% confidence interval [95% CI], 1.8-3.5 [P < .0001]), human epidermal growth factor receptor 2 (HER2)-positive status (HER2+) (OR, 3.6; 95% CI, 2.1-6.1 [P < .0001]), luminal B/HER2+ subtype (OR, 3.1; 95% CI, 1.9-5.3 [P < .001]), triple-negative subtype(OR, 2.4; 95% CI, 1.5-4 [P = .001]), and Karnofsky performance status ≤70 (OR, 6.6; 95% CI, 4.5-9.6 [P < .0001]) were associated with a higher frequency of CNSm. Brain parenchyma was the most common site of CNSm. The median overall survival after a diagnosis of CNSm was 12.2 months (95% CI, 9.3-15.1 months).

CONCLUSIONS

CNSm is not uncommon among patients with BC, particularly in those with neurologic symptoms who require neuro-oncology evaluation and are aged <50 years at the time of diagnosis, have HER2+ or triple-negative subtypes, have a poor Karnofsky performance status, and/or have ≥2 non-CNS metastases.

Abstract P2-07-13: OncoproMex®: An intelligent decision support system for Mexican breast cancer patients

Background: Breast cancer in Mexico is the first cause of mortality due to malignant tumors among women. The five-year overall survival among Mexican breast cancer patients (MexBCP)treated at governmental facilities is about 75-80% as a result of an increased access to oncology treatments (WHO 20thmodel list essential medicines) in the Public Health Insurance called "Seguro Popular". Expert systems are computer programs that are derived from a branch of computer Science research called Artificial Intelligence (AI). We do not have a system based on artificial intelligence for MexBCP prognostic and predictive evaluation. The aim was develop an expert system that generates a model based on data mining techniques, which allowed predict the MexBCP survival

Patients and Methods:

This study was carried out by the methodology currently used in the processes of Knowledge Discovery from Databases (KDD), supported by the WEKA free distribution tool for the modeling of data mining techniques. The breast cancer data of 4,773 were provided by INCAN cohort of 4300 patients diagnosed from 2006 to 2013 with a median follow-up of 40.5 months and by INCMNSZ cohort of 473 patients from 2011 to may 2018 with a median follow-up of 39 months. The clinical and pathologic variables were: age, TNMc stage, hormonal status (pre or perimenopause or postmenopause), ER, PR, HER2, Ki67, nuclear grade. Date of histological diagnosis, date of recurrence or last medical consultation, date of death, date of death, specific cancer were used for Survival analysis.

Results: The knowledge base for the expert system was based on the rules generated by the different data mining techniques. The rules used were generated by the Prism classification algorithm, which classify with a 97% percentage of instances correctly and a Kappa statistic of 0.9208. These rules obtained characteristics in each of the attributes, as well as the percentage of certainty of each of those rules. In addition to determining the average life of the group of patients that was classified in each of the generated rules. Finally, the basic elements that formed part of the architecture of the expert system carried out were the knowledge base, the inference engine, the database and the interface with the user. An on-line expert system was created, which allows users to interact and thus allow decision-making based on the results presented.

Conclusion:

As far as we know this is the first expert system that allows calculate prognosis according to clinical-pathological variables. It is of great relevance know the survival of a Mexican patient with breast cancer in the public health system with access to essential treatment. The applications of the system can be multiple in the usual clinical practice, education and in the taking of public policies for breast cancer in Mexico. We are currently working on a predictive model of oncological treatment benefit based also on an expert system.

Citation Format: Armengol-Alonso A, Villalobos-Castaldi FM, Cabrera-Galeana P, Bargallo-Rocha E, Reynoso-Noverón N, Mohar A, Melo-Morin JP. OncoproMex®: An intelligent decision support system for Mexican breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-13.

Abstract P1-11-14: Efficacy and quality of life analysis of palonosetron vs ondansetron for high and moderate emetogenic chemotherapy for breast cancer

Background: Nausea and vomiting are common complications on the chemotherapy (CINV) and can affect the quality of life of the patients. There are various antiemetic regiments that varies in both cost and effectiveness. The aim of this trial is to evaluate the efficacy in acute and delayed CINV of ondansetron vs palonosetron.

Patients and methods: In his was a randomized, open label trial, we included breast cancer patients' candidate to (AC, TC, TCH regimens); arm A received palonosetron, dexamethasone and fosaprepitant and arm B ondansetron, dexamethasone, fosaprepitant; patients who had received previously any chemotherapy or radiotherapy were excluded.Presence of CINV were investigated, as well the ER visits due for CINV and QoL (EORTC QLQ 30 and EORTC B-23) were analyzed during the first cycle of treatment. Local ethics committee approved the trial.

Results: 262 patients were included, 87% received AC and 13% TC; acute control was achieved in 87% and 94% respectively, p=ns and delayed control was achieved in 76% and 86% p=ns, toxicity was similar in both arms. QoL analysis showed no differences in family interaction, social life and financial troubles. ER visits due to severe symptoms were similar p=ns

Conclusions: Palonosetron or ondansetron are equally effective in prevention acute and delayed CINV and they also maintain similar quality of life.

Citation Format: Arce-Salinas C, Deneken-Hernandez Z, Flores-Diaz D, Gonzalez-Serrano JP, Matus-Santos JA, Ruiz-Garcia E, Calderillo-Ruiz G, Macedo O, Santamaría-Galicia J, Aguilar-Ponce JL, Reynoso-Noverón N. Efficacy and quality of life analysis of palonosetron vs ondansetron for high and moderate emetogenic chemotherapy for breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-11-14.

Abstract P2-13-05: Prevalence of trastuzumab-induced cardiotoxicity in a real-world setting

Background: Trastuzumab treatment plus adjuvant or neoadjuvant chemotherapy is the standard of care for women with HER2 positive breast cancer. Despite relative low rates of cardiotoxicity observed in randomized clinical trials, trastuzumab interruption driven by LVEF reduction is a major concern in current clinical practice.

Patients and methods: We retrospectively identified women with stage I-III HER2 positive breast cancer who received 12 months of trastuzumab treatment after adjuvant or neoadjuvant chemotherapy at Instituto Nacional de Cancerología (INCan, Mexico City), between 2006 and 2018. Patients were eligible if a pre-therapy MUGA scan and ≥2 subsequent follow-up scans were available. Cardiotoxicity was defined as a ≥10% LVEF reduction to a value &lt; 50%, associated with trastuzumab interruption.

Results: 910 patients were included, with a median age at diagnosis of 50 (24-85) years and a median follow up of 7 (2-11 ) years. Among the whole cohort, 10.3% of patients had diabetes, 15.4% had hypertension, 78% were obese/overweight, and 40% had positive estrogen and/or progesterone receptor status. Anthracycline-based therapy was used in 819 (90%) patients, with a median (doxorubicin equivalent) cumulative dose of 200 mg/m2 (IQR 180-240). The median baseline LVEF was 61.8% (50-88.9). In total, 94 (10.3%) patients developed cardiotoxicity, but symptomatic heart failure was observed in only 31 (3.4%) individuals. In univariable analyses, the development of cardiotoxicity was not associated significantly with cardiovascular risk factors.

Conclusions: In this large single-center cohort, cardiotoxicity rates remain high, thus, interventions to minimize the risk of cardiotoxicity and trastuzumab treatment interruption should be considered.

Citation Format: Calvillo-Argüelles O, Flores-Diaz D, Gonzalez-Serrano J-P, López-Rojas A, Mendoza-Galindo L, Matus-Santos J-A, Reynoso-Noverón N, Cabrera-Galeana P, Bargalló-Rocha E, Arce-Salinas C. Prevalence of trastuzumab-induced cardiotoxicity in a real-world setting [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-13-05.

Angiotensinogen rs5050 germline genetic variant as potential biomarker of poor prognosis in astrocytoma

Introduction

Renin-angiotensin system (RAS) in brain cancer represents a scarcely explored field in neuro-oncology. Recently, some pre- and clinical studies have reported that RAS components play a relevant role in the development and behavior of gliomas. The angiotensinogen (AGT) rs5050 genetic variant has been identified as a crucial regulator of the transcription of AGT mRNA, which makes it a logical and promising target of research. The aim of this study was to determine the relationship between the AGT rs5050 genetic variant in blood with prognosis in astrocytoma.

Methods

A prospective pilot study was performed on forty-eight astrocytoma patients, who received the standard-of-care treatment. Blood samples were taken prior to surgery and DNA was sequenced using Ion Torrent next-generation sequencing and analyzed by Ion Reporter software. Descriptive, bivariate, multivariate, and survival analyses were performed using SPSS v21, STATA 12 and GraphPad Prism 7.

Results

Median follow-up was 41 months (range 1–48). Survival analysis showed a significant difference between the rs5050 genotypes (p = .05). We found lower survival rates in individuals with the GG-genotype of rs5050 AGT compared to patients with the TT- and TG-genotype (2 months vs. 11.5 months, respectively [p = .01]). In bivariate and multivariate analyses, GG-genotype was negatively associated with survival.

Conclusions

In patients with astrocytoma, AGT rs5050 GG-genotype was associated with poor prognosis. We propose this germline genetic variant as a complementary biomarker, which can be detected practically and safely in blood samples or saliva.

Factors associated with ever use of mammography in a limited resource setting. A mixed methods study

Objective

To evaluate facilitators and barriers influencing mammography screening participation among women.

Design

Mixed methods study.

Setting

Three hospital catchment areas in Hidalgo, Mexico.

Participants

Four hundred and fifty-five women aged 40-69 years.

Intervention

Three hundred and eighty women completed a survey about knowledge, beliefs and perceptions about breast cancer screening, and 75 women participated in semi-structured, in-person interviews. Survey data were analyzed using logistic regression; semi-structured interviews were transcribed and analyzed using elements of the grounded theory method.

Main Outcome Measure

Women were categorized as never having had mammography or having had at least one mammogram in the past.

Results

From survey data, having had a Pap in the past year was associated with ever having had breast screening (odds ratio = 2.15; 95% confidence interval 1.30-3.54). Compared with never-screened women, ever-screened women had better knowledge of Mexican recommendations for the frequency of mammography screening (49.5% vs 31.7% P < 0.001). A higher percentage of never-screened women perceived that a mammography was a painful procedure (44.5% vs 33.8%; P < 0.001) and feared receiving bad news (38.4% vs 22.2%; P < 0.001) compared with ever-screened women. Women who participated in semi-structured, in-person interviews expressed a lack of knowledge about Mexican standard mammographic screening recommendations for age for starting mammography and its recommended frequency. Women insured under the 'Opportunities' health insurance program said that they are referred to receive Pap tests and mammography.

Conclusions

Local strategies to reduce mammogram-related pain and fear of bad news should work in tandem with national programs to increase access to screening.

[Resultados quirúrgicos de histerectomía radical laparoscópica en pacientes con cáncer de cérvix en etapa temprana: experiencia inicial en Instituto de Cáncer]

Antecedentes

La histerectomía radical abierta con linfadenectomía pélvica bilateral es el tratamiento estándar para el cáncer de cérvix uterino (CACU) en etapas temprana (1A2-1B1); la histerectomía radical por laparoscopia (HRL) es una opción segura y viable.

Objetivo

Evaluar la seguridad y la factibilidad de la HRL en un centro hospitalario de atención de cáncer.

Método

Estudio retrospectivo que incluyó 17 pacientes con CACU en etapa temprana intervenidas con HRL entre abril de 2013 y noviembre de 2016 en el Instituto Nacional de Cancerología de México.

Resultados

Las 17 pacientes se encontraban en etapa clínica IB1, en 10 (58.8%) fue subtipo epidermoide, en 4 (23.5%) adenocarcinoma y en 3 (17.6%) adenoescamoso. La media de edad fue de 42 ± 8 años. El tamaño del tumor fue de 2.3 ± 0.9 cm, y en el 94.1% los márgenes quirúrgicos estaban libres de enfermedad. El promedio de tiempo operatorio fue de 341 ± 65 minutos, con una pérdida sanguínea de 107 ± 64 ml, no requirieron trasfusión sanguínea y no hubo conversión a cirugía abierta. La media de estancia hospitalaria fue de 2.7 días (rango: 2-7 días). No se presentaron complicaciones intraoperatorias ni posoperatorias.

Conclusiones

La HRL es una alternativa segura y confiable para el tratamiento del CACU en etapa temprana.

Background

Open radical hysterectomy with bilateral pelvic lymphadenectomy is the standard treatment in early stages (1A2-1B1) of uterine cervical cancer (UCC); laparoscopic radical hysterectomy (LRH) is a safe and viable option.

Objective

To evaluate the safety and feasibility of LRH in a hospital cancer care center.

Method

Retrospective study that included the first 17 patients with UCC in an early stage operated with LRH in the period from April 2013 to November 2016 at the National Cancer Institute of Mexico.

Results

The 17 patients were stage IB1 clinical, of which 10 (58.8%) was epidermoid subtype, 4 (23.5%) adenocarcinoma and 3 (17.6%) adenoescamoso. The mean age was 42 ± 8 years. The tumor size was 2.3 ± 0.9 cm, and in 94.1% the surgical margins were free of disease. The average operative time was 341 ± 65 minutes and blood loss of 107 ± 64 ml, no patient required blood transfusion and there was no case of conversion to open surgery. The average length of hospital stay was 2.7 days (range: 2-7 days). There were no intraoperative or postoperative complications.

Conclusions

LRH is a safe and reliable alternative for the treatment of early stage UCC.

Factores pronósticos en pacientes con cáncer de mama y metástasis cerebral como primer sitio de recurrencia

Objetivo. Evaluar los factores pronósticos (características clínico-patológicas y tratamientos) en las pacientes con cáncer de mama y metástasis al sistema nervioso central (SNC) como primer sitio de afección. Material y métodos. Cohorte retrospectiva, formada por 125 pacientes con cáncer de mama atendidas en el Instituto Nacional de Cancerología durante 2007-2015, quienes presentaron afección en el SNC como primer sitio de metástasis. A través del método Kaplan-Meier y tablas de vida se estimó la supervivencia global. El modelo de riesgos proporcionales de Cox fue utilizado para determinar los factores pronósticos. Resultados. La mediana de super­vivencia global fue de 14.2 meses (IC95% 11.8-26.9). Pacientes clasificadas por inmunohistoquímica como triple negativo (TN) presentaron tiempos de supervivencia más cortos (p<0.004) y con dos veces más riesgo de fallecer, en com­paración con los otros inmunofenotipos (HR= 2.77; IC95% 1.10-6.99); asimismo, se identificó que un grado intermedio en la escala Scarff-Bloom-Richardson incrementa el riesgo de morir en pacientes con metástasis (HR=2.76; IC95% 1.17- 6.51). Conclusiones. La metástasis al SNC continúa siendo un factor de mal pronóstico que reduce la supervivencia y afecta la calidad de vida. Se recomienda vigilar puntualmente la presencia de manifestaciones clínicas neurológicas durante el seguimiento, para una rápida intervención. Las pacientes TN tienen peor pronóstico, y las HER2+ (es decir, con resultado positivo para el receptor 2 del factor de crecimiento humano epidérmico), mejor control a mediano plazo.

A prognostic score for survival in patients older than 65 years with Diffuse Large B-Cell Lymphoma

Background

Available prognosis scores for patients with diffuse large B-cell lymphoma (DLBCL) included a limited number of patients ≥ 65 years of age, and most of them did not include comorbidities. Here, we propose a prognostic score for overall survival (OS) for this group of patients.

Materials and Methods

Patients ≥ 65 years with DLBCL treated at a single national reference center were included. Clinical features including comorbidities and biochemical parameters were analyzed.

Results

We included 141 patients. Response rate in the whole group was 77%. Based on multivariate analysis, the presence of the European Cooperative Oncology Group (ECOG) > 2, elevated levels of beta-2 microglobulin, bulky disease, and anemia (hemoglobin < 10 g/dL) had a significant effect on OS. These parameters were considered when computing the prognostic score, which identified three groups with differential survival: Low, intermediate, and high risk of death, with a probability of survival at 60 months of 80.05%, 55.5%, and 29.84%, respectively.

Discussion

This score may select patients to optimize treatment. The presence of high levels of beta-2 microglobulin, bulky disease, and hemoglobin < 10 g/dL, and ECOG > 2 was associated with poor OS in elderly patients with DLBCL.

Challenges in the development and implementation of the National Comprehensive Cancer Control Program in Mexico

Chronic noncommunicable diseases (NCDs), including cancer, have become the leading cause of human morbidity and mortality. In Mexico, cancer is the third leading cause of death, with a high incidence among the economically active population, a high proportion of advanced stages at diagnosis and limited care coverage for patients. However, no public policy aimed at managing this important public health problem has been developed and implemented to date. This manuscript describes the first interinstitutional proposal of a National Program for Cancer Control, considering the known risk factors, early detection, treatment, palliative care and patient rehabilitation. This manuscript also outlines a series of thoughts on the difficulties and needs that the Mexican health system faces in achieving the main objectives of the program: to decrease the incidence of cancer, to increase survival and to improve the quality of life for this group of patients.

Cancer Trends in Mexico: Essential Data for the Creation and Follow-Up of Public Policies

Purpose

Cancer in a country like Mexico is a challenge for the current health system and for public health. However, the statistics about cancer in Mexico are scarce, so epidemiologic surveillance needs to be improved. The objectives of this article were to describe the extent of cancer and to estimate the national burden of cancer through 2020.

Materials and Methods

To meet this objective, an analysis of secondary official sources was performed. The cancer cases through 2020 were estimated on the basis of trends in mortality and the projection of incident cases reported by GLOBOCAN.

Results

In 2013, cancer was the cause of 12.84% of all deaths in Mexico. It is projected that the prevalence of cancer will be 904,581 by 2017 and will reach 1,262,861 by early in the next decade (ie, 2020).

Conclusion

Available data for cancer are incomplete. The development and implementation of population-based cancer registries in Mexico are essential. Assessment of the future outlook of cancer in Mexico will provide awareness of future challenges and can help health systems prepare to face them.

Clinical and Epidemiological Profile of Breast Cancer in Mexico: Results of the Seguro Popular

Purpose

One half of the Mexican population lacks comprehensive health care coverage. In 2003, a reform to the General Health Law was approved that led to the creation of the System of Social Protection in Health and made universal health coverage mandatory. The main innovation of this reform was Seguro Popular, which provided coverage for breast cancer. Here we report the outcomes of women with breast cancer treated at a cancer center in Mexico under Seguro Popular.

Materials and Methods

This was a retrospective cohort study that included all patients with breast cancer treated in the Instituto Nacional de Cancerología in Mexico City between January 2007 and December 2013 with Seguro Popular coverage. Demographic and clinical information were collected and survival outcomes were analyzed.

Results

A total of 4,300 women with breast cancer were included in this analysis. Most patients had locally advanced disease at diagnosis (53%, n = 2,293), and 13% (n = 558) presented with stage IV disease. Neoadjuvant chemotherapy was administered to 1,834 patients (52%), with a pathologic complete response in 25.1% (n = 460). Median follow-up was 40.5 months. Five-year survival for the entire cohort was 82% (95% CI, 81% to 84%). Five-year survival was 97% for early-stage disease (95% CI, 95% to 98%), 82% for locally advanced disease (95% CI, 80% to 84%), and 36% for metastatic disease (95% CI, 30% to 42%).

Conclusion

This represents the first description of a cohort of patients with breast cancer treated in Mexico under Seguro Popular. Seguro Popular has allowed our institution, and other Mexican centers, to establish efficient standardized mechanisms to treat patients with breast cancer.

Molecular Subtypes and Prognosis in Young Mexican Women With Breast Cancer

INTRODUCTION

Young age represents an adverse prognostic factor in breast cancer (BC), and young women present with more advanced and aggressive disease. In Latin America, BC is increasing in young women, and there is a lack of information regarding the characteristics and outcomes of this patient population.

PATIENTS AND METHODS

We retrospectively analyzed a database of 4315 women treated for BC at a single institution. We compared clinical characteristics, treatment, and survival between women ≤ 40 and > 40 years of age. Survival analyses were performed for each molecular subtype.

RESULTS

A total of 662 women (15.3%) were ≤ 40 years old. Younger women had more advanced disease, higher grade, and a larger proportion of luminal B and triple-negative tumors (P < .001). At 5 years, both disease-free and overall survival (OS) were lower in younger women, although there were no differences after adjusting for stage. Five-year OS was worse for young women with hormone receptor-positive, human epidermal growth factor receptor 2-negative subtype (82% vs. 87.1%; P = .03), but not for those with human epidermal growth factor receptor 2-positive or triple-negative disease. This difference can be attributed to luminal B tumors, which showed a worse 5-year OS in younger women (79.1% vs. 85.2%; P = .03).

CONCLUSION

Although young Mexican patients with BC have more aggressive disease at presentation than older women, only those with luminal B tumors have a worse survival after adjusting for stage. Strategies aimed at downstaging the disease and at improving the treatment of luminal B tumors in this population are needed.

Estimation of the Cost-Effectiveness of Breast Cancer Screening Using Mammography in Mexico Through a Simulation

BACKGROUND

Currently, breast cancer is the most prevalent tumor among Mexican women. Screening methods such as mammography could potentially reduce the health and economic burden of breast cancer; however, its risk-benefit balance is still unclear.

OBJECTIVE

To estimate the cost-effectiveness of different breast cancer screening programs using mammography in Mexico and to contribute to the decision-making process on this preventive measure.

METHODS

A simulation study was performed using population data and incidence rates. Several screening programs were assessed using the cost-effectiveness methodology recommended by the World Health Organization.

RESULTS

The feasible recommended screening program has an examination schedule periodicity of every three years, with a population coverage of 0, 15, 18, 20, 25, 20, 18, and 0% for the age groups of 25-40, 40-45, 45-50, 50-55, 55-60, 60-65, 65-70, and 70-75 years, respectively.

CONCLUSIONS

Given the present coverage in Mexico, it is necessary to optimize our resource allocation to improve the country's breast cancer prevention policy.

Clinical prognostic factors in adults with astrocytoma: Historic cohort

OBJECTIVE

To explore the clinical prognostic factors for adults affected with astrocytoma.

PATIENTS AND METHODS

Using a historic cohort, we selected 155 clinical files from patients with astrocytoma using simple randomization. The main outcome variable was overall survival time. To identify clinical prognostic factors, we used bivariate analysis, Kaplan Meier, the log rank test and the Cox regression models. The number of lost years lived with disability (DALY) based on prevalence, was calculated.

RESULTS

The mean age at diagnosis was 45.7 years. Analysis according to tumour stage, including grades II, III and IV, also showed a younger age of presentation. Kaplan-Meier survival estimates showed that tumour grade, Karnofsky status (KPS) ≥70, resection type, chemotherapy, radiotherapy, alcohol consumption, familial history of cancer and clinical presentation were significantly associated with survival time. Using a proportional hazard model, age, grade IV, resection, chemotherapy+radiotherapy and KPS were identified as prognostic factors.The amount of life lost due to premature death in this population was 28 years.

CONCLUSION

In our study, astrocytoma was diagnosed in young adults. The overall survival was 15 months, 9% (n=14) of patients presented a survival of 2 years, and 3% of patients survived 3 years. On average the number of years lost due to premature death and disability was 28.53 years.

Burden of type 2 diabetes in Mexico: past, current and future prevalence and incidence rates

INTRODUCTION

Mexico diabetes prevalence has increased dramatically in recent years. However, no national incidence estimates exist, hampering the assessment of diabetes trends and precluding the development of burden of disease analyses to inform public health policy decision-making. Here we provide evidence regarding current magnitude of diabetes in Mexico and its future trends.

METHODS

We used data from the Mexico National Health and Nutrition Survey, and age-period-cohort models to estimate prevalence and incidence of self-reported diagnosed diabetes by age, sex, calendar-year (1960-2012), and birth-cohort (1920-1980). We project future rates under three alternative incidence scenarios using demographic projections of the Mexican population from 2010-2050 and a Multi-cohort Diabetes Markov Model.

RESULTS

Adult (ages 20+) diagnosed diabetes prevalence in Mexico increased from 7% to 8.9% from 2006 to 2012. Diabetes prevalence increases with age, peaking around ages 65-68 to then decrease. Age-specific incidence follows similar patterns, but peaks around ages 57-59. We estimate that diagnosed diabetes incidence increased exponentially during 1960-2012, roughly doubling every 10 years. Projected rates under three age-specific incidence scenarios suggest diabetes prevalence among adults (ages 20+) may reach 13.7-22.5% by 2050, affecting 15-25 million individuals, with a lifetime risk of 1 in 3 to 1 in 2.

CONCLUSIONS

Diabetes prevalence in Mexico will continue to increase even if current incidence rates remain unchanged. Continued implementation of policies to reduce obesity rates, increase physical activity, and improve population diet, in tandem with diabetes surveillance and other risk control measures is paramount to substantially reduce the burden of diabetes in Mexico.

El cáncer en México:propuestas para su control

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Carcinoma in situ e infiltrante identificado por tamizaje mamográfico oportunista en mujeres asintomáticas de la Ciudad de México

Objetivo. Describir las características mamográficas y proporción de detección de carcinoma en mujeres asintomáticas de la Ciudad de México que participaron en un programa de tamizaje oportunista. Material y métodos. Se incluyeron 39 491 participantes con mamografías realizadas e interpretadas en el Instituto Nacional de Cancerología de 2008 a 2011. Los hallazgos radiológicos, tipo de lesión y verdaderos positivos (VP) se describen por grupos etarios. Se calculó el efecto crudo de la edad en la presencia de BIRADS (Breast Imaging Reporting and Data System) 0 y tipo de lesión. Resultados. La mediana de edad fue de 50 (45-57) años. El 80.5% fueron BIRADS 2, 11.4%(0), 4.1%(1), 3.5%(3), 0.5%(4) y 0.1%(5). Las lesiones malignas se detectaron en 1.3 y 3.3 por 1 000 y la proporción de VP fue 8.2 y 20.6%, en mujeres de 41-50 y 51-70 años, respectivamente. Conclusiones. Aunque en mujeres de 40-50 años se detectan casos, en mayores de 50 años el tamizaje mediante mastografía es más eficiente, con mayor proporción de casos detectados y menos falsos positivos.

[In situ and invasive carcinoma identified through an opportunistic screening mammography in asymptomatic women in Mexico City]

OBJECTIVE

To describe the mammographic findings and carcinoma detection rate in asymptomatic women of Mexico City, that participated in an opportunistic screening program.

MATERIALS AND METHODS

39 491 participants were included, with mammograms performed and interpreted in the National Cancer Institute, from 2008 to 2011. The mammographic findings, type of lesion and true positives (TP), are described by age groups. We calculated the crude effect of age on the classification BIRADS (Breast Imaging Reporting and Data System) 0 and the type of lesion.

RESULTS

The median age was 50 (45-57) years. 80.5% were classified as BIRADS 2, 11.4%(0), 4.1%(1), 3.5%(3), 0.5%(4) y 0.1%(5). Malignant lesions were detected in 1.3 and 3.3 per 1000 and the proportion of true positives (TP) was 8.2% and 20.6%, in women of 41-50 and 51-70 years, respectively.

CONCLUSIONS

Although some cases are detected in women 40 to 50 years, in women over 50 years the screening by mammography is more efficient, with a higher proportion of cases detected and fewer false positives.

Diabetes mellitus en México. El estado de la epidemia

Objetivo. Estimar la magnitud del reto de la diabetes en México y presentar propuestas de políticas públicas para su atención. Material y métodos. Análisis descriptivo de la información sobre diagnóstico previo de diabetes en adultos y adolescentes, de la Encuesta Nacional de Salud y Nutrición 2012 (ENSANUT 2012). Resultados. De los adultos en México, 9.17% ha recibido un diagnóstico de diabetes, con resultados heterogéneos entre estados: de 5.6% en Chiapas a 12.3% en el Distrito Federal. Del total de diabéticos, 46.95% reportó también diagnóstico de hipertensión, 4.47% antecedente de infarto del corazón y 54.46%, antecedentes familiares de diabetes. De los adolescentes, 0.68% ha sido ya diagnosticado con diabetes. Conclusiones. La gravedad de la epidemia de diabetes, así como el hecho de que se trata de una enfermedad prevenible, llama a fortalecer las estrategias para hacerle frente. El impacto que tiene sobre la calidad de vida de las personas que la padecen la convierte en un área prioritaria para el sector salud.

[Diabetes mellitus in Mexico. Status of the epidemic]

OBJECTIVE

To estimate the magnitude of diabetes in Mexico, as well as discuss alternative policies to face it appropriately.

MATERIALS AND METHODS

Descriptive analysis of the National Health and Nutrition Survey 2012, using reported information on previous diagnosis of diabetes from adults and adolescents.

RESULTS

From all adults 20 years and older in Mexico, 9.17% has been diagnosed with diabetes, presenting an important geographical heterogeneity, ranging from 5.6% in the southern state of Chiapas, to 12.3% in Mexico City. Of all people with diabetes, 46.95% also have been diagnosed with hypertension, 4.47% has had a stroke, and 54.46%, reported family background of diabetes. Regarding adolescents, 0.68% has been already diagnosed with diabetes.

CONCLUSIONS

The burden of diabetes in Mexico and the fact that is a preventable condition, calls to strengthen the health sector strategies to face it. The negative effect it has on the quality of life makes diabetes a priority for the health sector.

[Analysis of population survey for determining the factors associated with the control diabetes mellitus in Mexico]

OBJECTIVE

Determine the influence of nutritional counseling, exercise, access to social healthcare and drugs, and the quality of medical care on the control of diabetics.

MATERIAL AND METHODS

The information and blood samples were obtained in 2005. Glycemic control was defined as good if HbA1c was ≤7.0%, poor from 7.01%-9.50% and very poor if HbA1c >9.5%. Binary logistic regression models were used to determine the association of these factors with HbA1c>9.5%.

RESULTS

Thirty percent of the patients with a medical diagnosis of diabetes had adequate metabolic control.

CONCLUSIONS

Nutritional guidance was associated with an increase in the degree of control. A majority of diabetics have poor or very poor glycemic control. Strengthening the quality of and access to medical care for these patients is urgently needed.

Estimated incidence of cardiovascular complications related to type 2 diabetes in Mexico using the UKPDS outcome model and a population-based survey

BACKGROUND

To estimate the incidence of complications, life expectancy and diabetes related mortality in the Mexican diabetic population over the next two decades using data from a nation-wide, population based survey and the United Kingdom Prospective Diabetes Study (UKPDS) outcome model.

METHODS

The cohort included all patients with type 2 diabetes evaluated during the National Health and Nutrition Survey (ENSANut) 2006. ENSANut is a probabilistic multistage stratified survey whose aim was to measure the prevalence of chronic diseases. A total of 47,152 households were visited. Results are shown stratified by gender, time since diagnosis (> or ≤ to 10 years) and age at the time of diagnosis (> or ≤ 40 years).

RESULTS

The prevalence of diabetes in our cohort was 14.4%. The predicted 20 year-incidence for chronic complications per 1000 individuals are: ischemic heart disease 112, myocardial infarction 260, heart failure 113, stroke 101, and amputation 62. Furthermore, 539 per 1000 patients will have a diabetes-related premature death. The average life expectancy for the diabetic population is 10.9 years (95%CI 10.7-11.2); this decreases to 8.3 years after adjusting for quality of life (CI95% 8.1-8.5). Male sex and cases diagnosed after age 40 have the highest risk for developing at least one major complication during the next 20 years.

CONCLUSIONS

Based on the current clinical profile of Mexican patients with diabetes, the burden of disease related complications will be tremendous over the next two decades.