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Cáncer de Mama en Jalisco: Problemas y Soluciones Dr. Adrián Daneri Navarro Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara Center-South Northwest Northeast Total 1111 510 455 3600 Center-North 1134 1155 Center-South 541 577 Northwest 508 452 Northeast 3855 3884 Total 326 1202 1111 616 510 503 455 4173 3600 355 1228 1134 650 541 520 508 4229 3855 342 1231 1155 666 577 537 452 4457 3884 421 1283 1202 699 616 598 503 4604 4173 389 1355 1228 770 650 579 520 4830 4229 433 1335 1231 736 666 614 537 4905 4457 468 1392 1283 751 699 640 598 5059 4604 489 1429 1355 773 770 643 579 5221 4830 492 1335 736 614 4905 491 1392 751 640 5059 Situación Actual del Cáncer de Mama en México y Jalisco E. Soto-Perez-de-Celis, Y. Chavarri-Guerra / Cancer Epidemiology 41 (2016) 24–33 cancer has been the leading cause of cancer-related mortality in Mexican women, surpassing cervical cancer [8]. A review of the regional geographic trends of breast and cervical cancer mortality between 1979 and 2006 showed a higher risk of dying from breast cancer in women from the northern states, while women from the southern states had higher mortality attributable to cervical cancer [9]. In order to tackle inequities in the access to healthcare, in 2003 the Mexican government instituted a national health insurance program directed at the poorest sectors of the population called Seguro Popular, which includes coverage of breast cancer screening, diagnosis and treatment [10]. One of the main barriers for designing strategies to tackle cancer in developing nations is the paucity of statistics regarding its incidence and mortality [11], and the Breast Health Global Initiative has included the assessment of the burden of breast cancer at the national level as one of its top priorities [2]. Due to the fact that Mexico lacks a national population-based cancer registry, information on these indicators usually comes from data extrapolated from neighboring countries, from hospital-based histopathological databases [8] or from the only regional cancer registry, which is located in the western state of Jalisco [12]. For example, data from GLOBOCAN 2012, (which reports an incidence of 35.4 cases of breast cancer per 100,000 person-years in Mexico) are not obtained from any registry, but rather extrapolated from the mortality data obtained from the death certificate database of the Instituto Nacional de Estadística y Geografía (National Institute of Statistics and Geography, INEGI) [13], which is considered of high quality. Furthermore, the previous edition of GLOBOCAN, published in 2008, obtained incidence data by using a regional model extrapolated from other territories in Central America and the Latin Caribbean with a high quality population-based cancer registry (Puerto Rico and Costa Rica) [14]. Thus, although the regional and national mortality figures attributable to breast cancer in Mexico come from reliable sources and have been published before [15], the true incidence of the disease is largely unknown and no direct data sources have been used to describe it. Starting in 2000, the Dirección General de Epidemiología (National Epidemiological Administration, DGE) of the Mexican Ministry of 535 1429 773 643 5221 25 Health instituted the weekly mandatory reporting of all new breast cancer cases as part of the Sistema Nacional de Vigilancia Epidemiológica (National System of Epidemiological Surveillance, SINAVE) [16]. SINAVE was created in the 1970’s and since 1995 it has national coverage, encompassing all the public institutions that constitute the Sistema Nacional de Salud (National Health System) and several private institutions. Data reported by SINAVE include confirmed and suspected cases of 142 different diseases, including not only breast cancer but also cervical cancer and cervical dysplasia [17]. These suspected cases are reported on a weekly basis by physicians at nurses at every medical unit or hospital belonging to the institutions included in SINAVE using an online computerized format called Sistema Único de Información para la Viligancia Epidemiologica (Unified Information System for Epidemiological Surveillance, SUIVE) [18]. The reported cases are reviewed by the Sanitary Jurisdiction to which each medical unit belongs and then reported on a state level weekly, monthly and yearly [17]. In this paper, we describe national and regional breast cancer incidence trends using population-based data from the SINAVE database and mortality trends using the INEGI records for the first decade of the 21st century, in order to understand the epidemiological variations generated by recent changes in the country, including growing access to healthcare, increasing coverage of screening methods and the quality of data reporting. Tendencia de la Incidencia / Mortalidad en México 2001-‐2011 2. Patients and methods 2.1. Study area Mexico is a federation comprising 31 states and a Federal District (DF), geographically limited by United States border on the north and by the Guatemala–Belize border on the south. We divided the country into three geographic regions and 8 sub regions: North (Northwest and Northeast); Central (North-Central, South Central, West and East) and South (Southeast and Southwest). The location of each region and subregion within the country can be seen in Fig. 1. Fig. 2. National incidence (a) and mortality (b) trends 2001–2011, joinpoint analysis. Fig. 2. National incidence (a) and mortality (b) trends 2001–2011, joinpoint analysis. 4. Discussion the incidence and mortality the of breast cancer inmortality women 60 incidence and of years breast cancer in women 60 years of age and older seems toof be main factor driving agethe and older seems to bethe the main factor driving the Breast cancer in Mexico presented upward trends continuous increase in the a continuous weinobserved. These trends changeswemight lead to an changes might lead to an Breasta cancer upward in Mexico presented increase the observed. These reported incidence and mortality increase2001 ratesincidence between 2001 and 2011.rates A between in the median diagnosis cancer reported and mortality and 2011. Aage atincrease in for thebreast median age atpatients diagnosis for breast cancer patients significant increase in both rates was seen in Central and rates Southern which has historically been reported to historically be of 50 years significant in Mexico, increase in both was seenininMexico, Central and Southern which has been reported to be of 50 years regions and subregions of the of country. the otherofhand, the Another observation is the fact that observation the regions of age andOn subregions the country. Onage the[8]. other hand, interesting the [8]. Another interesting is the fact that the reported incidence and mortality rates in the North remainedrates number of new cases reported in women 65cases yearsreported and older reported number incidence and mortality in the North remained of new in is women 65 years and older is unchanged, with a downturnunchanged, loweryears. in more recent Women than that in the 50–59 lower and 60–64 subgroups, in contrast to with years. a downturn in 60– more recent Women 60– than that in the 50–59 and 60–64 subgroups, in contrast to 69 years old showed the largest what rise in reported incidence, while is seen in other countries like the United States [22]. 69 years old showed the largest rise in reported incidence, while what is seen in other countries like the United States [22]. women 60 years of age and older Although were60the group with theolder highest there no clear explanation for this, it clear may be due to women Although there years of age and were the group with theishighest is no explanation for this, it may be due to increase in mortality. the fact that older women in Mexico have lower participation in have lower participation in increase in mortality. the fact that older women in Mexico screening programs or that they fail to seek medical attention forto seek medical attention for screening programs or that they fail 4.1. Population aging breast symptoms. 4.1. Population aging breast symptoms. 4. Discussion Fig. 1. Geographic regions of Mexico. Tasa de Incidencia (2011): México / Occidente 25.17 / 32.96 (100 000 Mujeres < 15 años). Tasa Mortalidad (2011) México / Occidente: 14.59 / 16.55 (100 000 Mujeres < 15 años). Cancer Epidemiology 41 (2016) 24–33 The observed increase in the The 4.2. incidence of breast cancer could in access and availability of healthcare 4.2. Changes observed increase in the incidence ofChanges breast cancer could in access facilities and availability of healthcare facilities reflect population growth, aging andpopulation lifestyle modifications reflect growth, agingseen and lifestyle modifications seen Anmore in developing countries transitioning to acountries more “developed” important landmark which partially explainwhich some could of Ancould in developing transitioning to a “developed” important landmark partially explain some of DiagnósWco en Jalisco por Etapa Clínica: Estudio Binacional ELLA HE/HGO-CMNOIMSS IJC Total I 24.9% 2.0% 16.6% IIA 31.2% 18.4% 26.6% IIB 22.5% 15.3% 19.9% IIIA 9.2% 10.2% 9.6% IIIB 5.8% 33.7% 15.9% IIIC 3.5% 6.1% 4.4% IV 2.9% 14.3% 7.0% Etapa Clínica Daneri-‐Navarro y Cols. 2015 Análisis de las PolíWcas Publicas en Cáncer de Mama en México / Jalisco. Estudio publicado: México y Brasil son los países con v Según mayor avance en la formulación de políticas públicas en América Latina (Rev Panam Salud Publica 33(3), 2013). v NORMA Oficial Mexicana NOM-041-SSA2-2011, Para la prevención, diagnóstico, tratamiento, control y vigilancia epidemiológica del cáncer de mama. v Importancia del Seguro Popular. v No se cuenta con un Registro Nacional de Cáncer en Base Poblacional. v Cobertura limitada de los programas de diagnóstico temprano del cáncer de mama. v Retardo en el inicio del tratamiento. Retos PolíWcas Publicas en Cáncer de Mama en México / Jalisco. v Programa Integral de Prevención y Control Cáncer en México. v Programas para Cáncer Hereditario y Familiar. v Programas para soporte emocional de las pacientes con cáncer y sus familias. v Se requiere más investigación traslacional en el campo de la genética, biología molecular, epidemiología, diagnóstico, tratamiento del cáncer de mama. Aportaciones de la Universidad de Guadalajara y propuesta para enfrentar el Cáncer de Mama en México y en Jalisco v Conocimiento sobre factores de riesgo, genética y biología molecular del cáncer de mama en Jalisco. v Diagnóstico molecular del cáncer de mama. v Unidad de Asesoramiento Genético. v Programa de Navegadores para Pacientes Oncológicos y sus Familias: Más de 6000 actividades en 4 hospitales. v Manual de Acompañamiento Emocional a Nivel Nacional para el Instituto Nacional de las Mujeres.
