In summary, the RPCC was established in , it is a population-based cancer registry which provides continuous information on new cases of all types of cancer in permanent residents of Cali through active search and notification. Vital status, relapse, treatment abandonment, and second neoplasms are the primary outcomes. The incidence rates standardized by age for all cancer sites per , person-years were In the absence of other causes of death, the cumulative risk of developing cancer before reaching the age of 75 was Cancer incidence rates per , person-year by sex and cancer location are shown in Table 1.
In men, the five primary sites of primary cancer were prostate ASR: Together they constituted Prostate cancer accounted for APC is calculated for period In females, the most frequent locations for cancer according to their ASR were in descending order: breast These locations together accounted for Breast cancer alone accounted for Table 2 shows cancer deaths that occurred in Cali in two quinquennial periods; and During this decade there were , deaths, Overall mortality from cancer corresponded to For the analysis of cancer mortality, emphasis was placed on the results of the quinquennium APC is calculated for the period Cancer was the third cause of death in Cali after mortality due to cardiovascular diseases In contrast to the number of deaths, standardized cancer mortality rates for all combined locations per , person-years were higher among males Cancer of stomach, lung, colorectal, breast and prostate were the main causes of cancer-related death, together they represent approximately half of all cancer deaths Based on mortality rates standardized by age, prostate cancer ASR: Breast cancer was the leading cause of death in females ASR: The incidence rates for all cancer body sites increased in male an annual average of 0.
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In contrast, mortality for all cancer body sites has been significantly decreasing at an annual average of 0. The incidence of cancer decreased in both males and females in the following sites: oral cavity and pharynx, esophagus, stomach, larynx, urinary bladder and leukemia of unspecified type. The decrease was only observed in male with pancreatic cancer and with Hodgkin's disease; and in females with cervical cancer.
In contrast, increased incidence rates of colorectal cancer, melanoma, non-Hodgkin's lymphoma and lymphoid leukemia were found in both males and females; breast and thyroid cancer increased in females only; and liver, prostate and testicular cancer in males only.
In females, there was no change in the risk of morbidity due to cancer of the liver, pancreas, lung, uterine body, ovary and Hodgkin's lymphoma and in males the incidence of thyroid cancer and myeloid leukemia remained stable. Mortality from cancer shows a favorable trend.
There was only an increase in mortality rate from melanoma and colorectal cancer in men. In the rest of the neoplasms, there was evidence of a decrease in mortality rates for ten of the 17 main body locations. The decrease was observed in both males and females with cancer of the esophagus, stomach, lung, urinary bladder, lymphomas and multiple myeloma; only in males with cancer of the oral cavity and pharynx; and only in females with cancer of liver, pancreas, cervix and uterine body. There were no changes in leukemia mortality in the entire population of Cali. Mortality rates for liver, pancreas, and prostate cancer remained stable in males; and females, there were no changes in mortality rates for breast, colorectal, ovarian and melanoma cancer.
For the analysis, a total of 38, patients diagnosed with cancer were included through The distribution of the most frequent malignancies corresponded to breast The median age at diagnosis for the period considered was 64 years. There has been an increase in the number of patients diagnosed for the last study period The trend of net survival for certain types of cancer by sex and diagnosis period is shown in Figure 1.
Figure 2 shows the 5-year net survival standardized by age for three quinquennial periods: , and When compared with previous periods, patients diagnosed with cancer in the most recent period marked improvements in net survival of 5 years were observed for most cancer sites. The proportions of increased cancer survival in females could be explained in part by common types of cancer in females e.
When examined by year of diagnosis and localization of cancer, in general terms it was evident that in the last period which includes the years there was an increase in survival for most of the cancer locations except for stomach cancer and colorectal cancer. On the other hand, the highest estimates of net survival for the period were seen for thyroid cancer In the case of hematolymphoid neoplasms, survival was better in patients with Hodgkin lymphoma In leukemia and multiple myeloma survival was lower, with estimates for the period of Ninety-six percent n: 1, contributed to the follow-up hemato-lymphoid tumors y solid tumors.
Children 5-year overall survival OS was Group I was the most frequent both in children Within this group Among group II, From all groups, Infancy and early childhood malignant solid tumors frequency was 2. Malignant bone tumors group VIII were more frequent in adolescents Group IX soft tissue sarcomas was similar in children and adolescents 5. Germ cell tumors group X showed an overall frequency of 5. Epithelial malignant tumors group XI had higher frequency in adolescents In this group, thyroid tumor was the most frequent Non-specified cancers group XII were 1.
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This information is necessary for health authorities to make estimates of cancer risk for other regions of Colombia that are lacking cancer registries. These statistics complement previous reports 5 , 22 and provides uninterrupted continuous monitoring for the last 55 years, which allows detailed analyses of the 50 year-incidence , 30 year-mortality and year-survival of cancer in the region. Cali has experienced profound epidemiological and demographic changes in the last half of the century.
The population has quadrupled and has aged, and the life expectancy at birth increased from Eighty five percent of the oncology services in Cali are private 16 , the care is not comprehensive and there are several barriers to accessing quality oncological care services. Government measures aimed at stabilizing the health system have been unsuccessful and there has been evidence of discriminatory behavior and risk selection of the oncological patients by the health care provider entities responsible for managing the risks related to the disease Therefore, the clinical outcomes remain unfavorable primarily because patients present late with in advanced stages of the disease and, thus, survival is low for most types of cancer compared to that observed in Europe and the United States 24 , Coinciding with demographic changes there are significant variations in trends, patterns and differences in incidence rates and cancer mortality.
The increase or decrease in the risk of morbidity and mortality due to this group of diseases is determined by different factors. So far, some are recognized and most are still to be identified.
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These changes may be the result of variations in the exposure of the population to different risk factors, better access to health services and improvement in diagnostic and treatment techniques 26 , Although several threats persist, the available information shows evidence of advances in the control of some types of cancer in Cali. The magnitude of the decrease was greater in patients with cancer related to tobacco consumption, infectious agents and hematolymphoid neoplasms where important therapeutic advances have been made Fig.
Figure 3. Cali, Colombia. Trend in cancer rates in the last 55 years. The incidence and mortality rates for stomach and cervix uteri cancer have decreased significantly over the last 55 years Fig. The descent is monotonic, continuous and began before knowing the prominent role in the processes of carcinogenesis of Helicobacter pylori 28 and the Human Papilloma Virus HPV These changes are not related to specific interventions against these infectious agents, they are the result of progress in the development and improvement of sanitary conditions.
Economic development determined changes in lifestyles and modifications of the known risk factors for gastric cancer. Refrigeration facilitates the consumption of fresh foods and limits the use of chemical-based food preservation methods salting, desiccation, smoking, and acidification. In the 21st century, gastric cancer still represents a great social burden in Cali and Colombia because it causes the highest number of deaths from cancer 3 , 5 , The disease is fatal when discovered clinically because the diagnosis is usually made in the advanced stages.
It is also possible that estimates of gastric cancer survival in Ecuador and Cuba may be overestimated 24 , Despite the continuous decline in the incidence and mortality of infection-related cancers, rates remain high and the number of cases continues to increase due to aging and population growth It is a priority to implement additional measures to accelerate the decline, improve survival and achieve control The perspectives for the control of gastric cancer are uncertain because therapeutic advances are insufficient, the pre-clinical results of efforts to develop vaccines against H.
During the first stages of tumor growth, cancer is clinically silent. Therefore, an alternative to control, is the implementation of primary prevention programs which would help eradicate H. Due to the above, it is necessary to develop 1 monotherapies to facilitate adherence to antibiotic treatment and 2 accurate non-invasive tests to identify premalignant gastric lesions and thus serve as a risk stratification tool of patients.
The simultaneous detection of serum pepsinogens and antibodies against H. This strategy has not been adequately validated in Latin America and continues to be an option that requires exploration with a well-founded project of implementation. The picture is different and more favorable for females with cervix uteri cancer CUC. Mortality rates in Cali are close to the PDPCC goal 4 , but they are still three times higher compared to the United States and Europe; where the risk of cervix uteri cancer is half of that observed in Cali. The incidence and mortality rates have declined for many reasons, including declining fertility rates, improved socio-economic conditions and the establishment of a citywide program to prevent cervix uteri cancer via a widespread use of pap smear 29 , The knowledge that certain genotypes of VPH infection are necessary to cause cervix uteri cancer has created new strategies for its prevention in the current PDPCC.
This reaction was supposedly associated with the VPH vaccine To increase the accuracy of cervix uteri screening, the Ministry of Health of Colombia incorporated HPV testing in cervical cancer screening programs. Prostate and breast cancer are the leading cause of cancer-related morbidity in males and females in Cali, respectively 5. In Colombia there are no organized screening programs for either cancer and cancer control is based on specific opportunistic screening activities. Mammography, digital rectal examination and PSA allowed us to detect cases of disease that were previously unknown and contributed to increasing the incidence rates before the first quinquennium of the 21st century and since then, it has begun to decline.
Most, but not all, of the increase may be due to earlier detection of the disease. Once the use of screening tests had been established the rates tended to stabilize as long as other factors causing the disease had not changed. These changes were more evident in the population subject to screening, the group of years of age, where there was also a turning point in the trend of incidence.
Similar changes were documented in Costa Rica and Ecuador at the end of the first decade of the 21st century and were observed in Europe and the United States 20 years earlier.
This could not be attributed exclusively to the screening activities Fig. An influential and perhaps determining factor is the evolution of treatments with curative intent; it is likely that the use of PSA and digital rectal examination have contributed to maintaining and consolidating this trend However, mortality from breast cancer remained stable during the study period Fig.
The United States and Europe have made great advances in the control of prostate and breast cancer. Despite the high incidence rates ASR: In Cali, 5-year net survival for the same neoplasms was This will remain an area of future investigation. The incidence and mortality due to colorectal cancer continues to rise in males and females in Cali. The reasons are that the screening activities are incipient, and the risk factors are difficult to control or are not clearly identified 41 ; it is a priority to promote an organized screening program to reverse the current trend.
Until this intervention occurs, oncological care services must be oriented to the early diagnosis of suspected cases. The trend in the incidence of lung cancer correlates with the historical patterns of prevalence of cigarette smoking and there is sufficient evidence of a causal relationship between cigarette smoking and various types of cancer. The reduction in the number of cancer cases related to tobacco use in Cali, has been interpreted as a successful example of cancer control. This was due to the implementation of a very strong anti-smoking government campaign implemented in the seventies and that has been consolidated in.
The incidence rates of lung cancer for both sexes in Cali reflect the end of a tobacco-related epidemic that began in the s and was interrupted around the s 5 , 42 , Since then, there has been a significant decrease in tobacco-related cancer incidence and mortality: oral cavity and pharynx, esophagus, pancreas, lung and urinary bladder. The decrease was more consistent in the oral cavity and lung cancer in both males and females.
Surveillance of cancer survival is important for health organizations, civil society and research agencies because it serves to formulate strategies and prioritize cancer control measures, and to evaluate effectiveness, as well as the cost effectiveness of these strategies 1. At the beginning of the 21st century, we began to monitor trends in cancer survival in Cali. The relative survival without age-adjustment was estimated for 16, patients diagnosed with prostate, breast, colorectal, cervical, stomach and lung cancer through The present study, covers 38, patients diagnosed with invasive primary cancer in 14 body locations representing around Furthermore, the accuracy of the previous estimates was improved through the implementation of the new unbiased Pohar-Perme estimator 44 - Coinciding with the implementation of the new health system in the s, survival improved for most of the neoplasms in the first five-year period of the 21st century compared to the period.
This trend stagnated in the five-year period The 5-year net survival was like that found in Argentina, Chile, Ecuador and Costa Rica and very low compared to that observed in developed countries Information on cancer mortality in liver, lung, brain and bones should be interpreted with caution, because in these sites, the occurrence of metastasis is frequent. In the Cali cancer registry, we found evidence that the primary site of some of these cancers came from locations different than these organs.
There were 2, new cases and deaths from cancer. The coding of the body locations made by the vital statistics office and the cancer registry were compared. Taken into account that cancer in children is not amenable to primary or secondary prevention, survival is the most relevant metric to evaluate efforts aimed to control cancer burden in this population group.
This implies that if in Colombia 1, to 1, children are treated for cancer per year then after 5 years to had died, and to would be preventable deaths. Effectiveness decrease in cancer treatment is mainly related to intensity lost. Chemotherapy intensity is related both to dose and time interval among doses. Therefore, effectiveness of treatment is very dependent on the delays in treatment administration adherence to treatment , being treatment abandonment the extreme example of this principle.
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Intensity lost has multifactorial causes involving the patient, their families, health providers, and the health system. Other path to reduce survival is due to treatment mortality and not because disease. This adverse outcome is both related to access to supportive care and advance disease at diagnosis. Access to timely and correct diagnosis and treatment is particularly related to poor outcomes in tumors that are dependent of the stage at diagnosis to achieve cure; retinoblastoma is the best example of this. Nevertheless, in the Latin-American context, the Argentinian hospital registries system reports a 3-year OS of RPCC does not actively monitor adults, and Cali lacks reliable statistics on population migration The RPCC has information about the cause of death through death certificates, but in some cases it can be difficult to determine if cancer is the basic cause of death.
The RPCC has participated in many other collaborative studies and has been an advisor to the Colombian government in the evaluation of PBCR in the country and its data have contributed significantly to different aspects of cancer control in Colombia. The collaborative work with the SSPM of Cali facilitates access to information on general mortality and cancer; and allows an independent source of verification of new cases of cancer.
Access to the information system of the Ministry of Health SISPRO and to the assurance databases provides a permanent update of the vital status and date of last contact. To all patients and to all oncology care services in Cali. This research was funded and carried out by Universidad del Valle. C, National Institute of Cancerology No.
Cali es la tercera ciudad de Colombia, capital del Departamento del Valle del Cauca. La expectativa de vida al nacimiento es El sistema incluye tanto residentes de la ciudad como pacientes remitidos de otros municipios y departamentos. En conjunto constituyeron el APC es calculado para periodo Estas localizaciones representaron en conjunto el La muerte por lesiones intencionales y no intencionales representa En el caso de neoplasias hematolinfoides la supervivencia fue mejor en pacientes con linfoma de Hodgkin De estos, el El El retinoblastoma grupo V, 4.
El osteosarcoma El grupo IX de sarcomas de tejidos blandos 5. Es prioritario implementar medidas adicionales para acelerar el descenso, mejorar la supervivencia y lograr su control Gran parte, pero no todo el aumento, puede ser en los estadios tempranos de la enfermedad. A pesar de las altas tasas de incidencia ASR: En el contexto Latinoamericano, Argentina reporta National Center for Biotechnology Information , U.
Journal List Colomb Med Cali v. Colomb Med Cali. A new strategy for mannose-binding lectin gene haplotyping.
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Prospective analysis of mannose-binding lectin genotypes and coronary artery disease in american indians: the strong heart study. Circulation ; Association of Chlamydia pneumoniae with coronary artery disease and its progression is dependent on the modifying effect of mannose-binding lectin. Mannose binding lectin polymorphisms as a disease-modulating factor in women with systemic lupus erythematosus from canary islands, spain. J Rheumatol ; Variant mannose-binding lectin genotypes and outcome in early versus late rheumatoid arthritis: comment on the article by ip et al.
Arthritis Rheum ; Low serum level of mannan-binding lectin is a determinant for pregnancy outcome in women with recurrent spontaneous abortion.