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Objective. To evaluate the prognostic factors (clinicalpathological characteristics and treatments) in patients with breast cancer and metastasis to central nervous system (CNS) as the first site of the disease. Materials and methods. Kaplan-Meier method and life tables were used to estimate overall survival time over a retrospective cohort of 125 breast cancer patients treated at the Instituto Nacional de Cancerología (INCan) during 2007-2015, who presented metastasis to the CNS as the first site of extension of the disease. The cox proportional hazards model was used to determine the prognosis factors. Result. The median overall survival time was 14.2 months (IC95%: 11.83-26.93). Patients with triple negative (TN), according to inmunohistochemistry analysis classification, had lower survival times (p=0.0004) and had a risk of dying two times (p=0.037) higher than patients with a different immunophenotype (HR: 2.77. 95%CI: 1.10-6.99). The degree of intermediate SBR increases the risk of dying in patients with metastasis (HR 2.76, 95% CI: 1.17-6.51). Conclusion. CNS metastasis continues to be a poor prognostic factor that reduces survival and affects quality of life. It is recommended to monitor the early presence of clinical neurological manifestations during follow-up for prompt treatment. TN patients have worse prognosis and HER2+ a better control.

Chronic noncommunicable diseases (NCDs), including can- cer, 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 popula- tion, 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. DOI: http://dx.doi.org/10.21149/spm.v58i2.7804

Cancer is one of the major causes of morbidity and mortality in the world, with 14.1 million new cases and 8.2 million deaths annually. A marked disparity exists between developed countries and developing countries, with 57% of new cases and 65% of deaths in 2012 occurring in developing countries. This global picture can only be obtained because of data obtained from population-based cancer registries, which allow cancer estimations for different geographic areas. Our objective is to perform a review of different types of registries and their role in the control of cancer. These types of registries are lacking in developing countries. In Central and South America, only 6% of the population is included in cancer registries versus 83% in North America. It is necessary to increase the coverage of cancer registries to obtain more reliable data that will more appropriately guide control programs. DOI: http://dx.doi.org/10.21149/spm.v58i2.7802

Objective. To estimate the indirect costs generated by adults with cancer in Mexico from 2002-2020. Materials and methods. Using information from national sources and the national cancer incidence from GLOBOCAN, we estimated income lost due to premature death (ILPD), short-term benefits (STBs), disability pensions (DPs), and opportunity costs for the carer (OCCs) generated by patients with cancer. Amounts were reported in Mexican pesos. Results. We estimated 23 359 deaths and 216 679 new cases of cancer by 2020, which would be associated with a total indirect cost of 20.15 billion Mexican pesos. Men are expected to generate 54.9% of these costs. ILPD is expected to comprise the highest percentage of the cost (60%), followed by OCCs (22%), STBs (17%) and DPs (1%). Conclusions. From an economic perspective, the results emphasize the need to strengthen preventive interventions and early detection of cancer among adults to reduce its effect on the productivity of Mexico. DOI: http://dx.doi.org/10.21149/spm.v58i2.7792

Objective. To analyze the utilization of hospital services for cancer care by location, sex, age group and care institution in Mexico from 2004-2013. Materials and methods. Time series study from 2004-2013, based on administrative records of hospital discharges for cancer in the health sector, including the private sector. Results. The utilization rate increased significantly from 290 to 360 per 100 000 inhabitants. A total of 62% of hospital discharges related to malignant tumors were concentrated in eight types of cancer. Leukemia, breast and colorectal cancers almost doubled in the period. While lung cancer showed a decline among men, it increased among women. A total of 63.1% of cancer patients were women, and 81% of cases occurred in the public sector. From 2011, the Ministry of Health was the main provider of hospital services for cancer care. Conclusions. Increases in utilization were mainly found in the Ministry of Health, quite possibly as a result of the implementation of universal insurance.

Under the national plan for addressing cancer, prevention and detection play important roles. However, the cost of treatments and late diagnosis represent a significant burden on health services. At the National Cancer Institute, more than half of patients present with tumors in advanced stages, and approximately 10% of patients seen for the first time exhibit terminal-stage malignancies, where there are no feasible cancer treatment options, and the patients are instead admitted to the hospital exclusively for palliative symptomatic management. In 2010, the National Cancer Plan began implementing a model of integrative management of palliative care in oncology that has gradually come to include symptomatic palliative care, involving ambulatory, distant and hospitalized management of patients with cancer, in its final stages and, more recently, in earlier stages. DOI: http://dx.doi.org/10.21149/spm.v58i2.7803

Primary prevention of cancer was initiated with the introduction of Hepatitis B vaccine in the 80’s. However, in primary prevention of cancer at the worldwide level has been relatively recent. Intervention-action initiatives began at the global level in 2003 with the WHO Framework Convention on Tobacco Control, which was the first treaty negotiated under WHO guidance and as of today includes 168 countries. This negotiation, although innovative, was somewhat overdue, considering that the causal association between exposure to tobacco and elevated cancer incidence was established over 65 years ago. Vaccines against hepatitis and more recently human papilloma virus are other noteworthy developments in primary cancer prevention. As for secondary prevention, it has focused on early detection of cancer, especially among women, first with screening based on the Pap test and later other strategies for cervical cancer detection. For breast cancer, early detection strategies such as mammograms and clinical breast examination have been used for many years. However, today their impact on mortality for this cancer has come into question. In this context, in Mexico we face enormous challenges to provide an efficient organized social response to cancer prevention and control. This issue of Salud Pública de México on “Cancer burden in Mexico: urgent challenges to be met” is an effort to estimate in epidemiological terms the breadth and depth of the problem faced in Latin America and particularly in Mexico. The authors do this by describing the enormous population-level and clinical challenges which need to be faced in the short term. DOI: http://dx.doi.org/10.21149/spm.v58i2.7778

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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.

OBJETIVOS: Evaluar la asociación entre cáncer cervicouterino (CaCu) invasor y el virus del papiloma humano de alto riesgo (VPH-AR) (carga viral/tipo 16), así como con factores ginecológicos y socioeconómicos. MATERIAL Y MÉTODOS: Estudio de casos y controles pareado individualmente (215 casos con CaCu invasor y 420 controles). La población de estudio se reclutó entre los años 2000 y 2001. Se evaluaron variables tradicionalmente asociadas con CaCu (ginecológicas y socioeconómicas) y dos variables asociadas con la presencia de VPH (carga viral y el tipo 16). La presencia de VPH-AR se determinó mediante Captura de Híbridos II. La carga viral se midió a través de unidades relativas de luz y picogramos por ml (1 RLU=1 pg/ml), divididas en cuatro categorías: negativa (499 pg/ml). El análisis estimó razones de momios (RM) ajustadas a través de modelos de regresión logística condicionada. RESULTADOS: La presencia de VPH-AR incrementa en 78 veces la probabilidad de presentar CaCu invasor; cuando el VPH es tipo 16, el incremento es mayor (RM= 429.7) comparado con otros tipos (RM=64.1). Se observó una tendencia importante en la RM al elevarse la carga viral (RM=46.6 carga baja; RM=250.7 intermedia y RM=612.9 alta). Finalmente, los factores demográficos y obstétricos conocidos, incrementaron la probabilidad de CaCu invasor. No se observó asociación entre CaCu invasor y tabaquismo en la población de estudio. CONCLUSIONES: Este estudio contribuye a la identificación de las mujeres con alto riesgo de desarrollar CaCu invasor, entre las pacientes infectadas con VPH-AR. Por otra parte, confirma la importancia de la infección de VPH-AR y refleja la carga viral del VPH-AR como cofactor y posible promotor en el desarrollo de la enfermedad. Por último, este biomarcador puede contribuir a mejorar la prevención y la detección temprana de esta enfermedad.OBJECTIVE: To evaluate the association between invasive Cervical Cancer (CC) and high risk Human Papilloma Virus (HR-HPV) (viral load and type 16), along with other gynecological and socioeconomic factors. MATERIAL AND METHODS: Individually matched case-control study (215 women with invasive CC and 420 controls). The study population was recruited between 2000 and 2001. A set of variables traditionally linked with CC (gynecological and socioeconomic factors) and two variables related to HPV infection (viral load and type 16) were assessed. Hybrid Capture II was used to detect HR-HPV DNA. Viral load was measured by light measurements expressed as relative light units (RLU) and they were categorized for analysis into four groups: negative (499 RLU). The analysis included univariate, bivariate and multivariate techniques being the final step the estimation of Odds Ratios (OR) by means of conditional logistic regression models. RESULTS: The probability of having invasive CC was 78 times higher in patients with infection of HR-HPV. Risk increases with HPV type 16 (OR=429.7) as compared with other types of HR-HPV (OR=64.1). An important trend was observed with the increase of the viral load (from 46.6 with low viral load; to 250.7 with intermediate and 612.9 with high load). The findings also indicate significant diferences in the viral load between cases and controls according to age groups and HR-HPV types (16 versus others high risk types). Finally, the partner-demographic and obstetrical variables related to the disease increased the risk of invasive CC. No association between CC and smoking was observed in this population. CONCLUSIONS: This study helps in identifying women at higher risk of developing invasive CC as a subset of those patients infected with HR-HPV. The findings point strongly to the importance of the viral load in HR-HPV as a co-factor in the development of this disease. This biomarker contributes to improving the prevention and early detection of this disease and also to identify women at higher risk who carry a high viral load of HR-HPV.

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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.

Objective: To evaluate the association between invasive Cervical Cancer (CC) and high risk Human PapillomaVirus (HR-HPV) (viral load and type 16), along with other gynecological and socioeconomic factors., Material and Methods: Individually matched case-control study (215 women with invasive CC and 420 controls). The study population was recruited between 2000 and 2001. A set of variables traditionally linked with CC (gynecological and socioeconomic factors) and two variables related to HPV infection (viral load and type 16) were assessed. Hybrid Capture II was used to detect HR-HPV DNA. Viral load was measured by light measurements expressed as relative light units (RLU) and they were categorized for analysis into four groups: negative (< 1 RLU), low viral load (1-49 RLU), middle load (50-499 RLU) and high load (>499 RLU). The analysis included univariate, bivariate and multivariate techniques being the final step the estimation of Odds Ratios (OR) by means of conditional logistic regression models. Results. The probability of having invasive CC was 78 times higher in patients with infection of HR-HPV. Risk increases with HPV type 16 (OR = 429.7) as compared with other types of HR-HPV (OR = 64.1). An important trend was observed with the increase of the viral load (from 46.6 with low viral load; to 250.7 with intermediate and 612.9 with high load). The findings also indicate significant diferences in the viral load between cases and controls according to age groups and HR-HPV types (16 versus others high risk types). Finally, the partner-demographic and obstetrical variables related to the disease increased the risk of invasive CC. No association between CC and smoking was observed in this population., Conclusions: This study helps in identifying women at higher risk of developing invasive CC as a subset of those patients infected with HR-HPV. The findings point strongly to the importance of the viral load in HR-HPV as a co-factor in the development of this disease. This biomarker contributes to improving the prevention and early detection of this disease and also to identify women at higher risk who carry a high viral load of HR-HPV.

Autopsies have long been viewed as a biased source of information with regard to the mortality statistics that prevail in the hospital and community. This bias could be of either a demographic or clinical nature. Our objective was to define the autopsy characteristics from the National Cancer Institute of Mexico and determine how representative they were of hospital mortality. Age, sex, place of residence, socioeconomic status, and tumor location were obtained from the Hospital Mortality Registry (1985 and 1987). During these two years, 451 deaths were registered; in 290 of these cases (64.3%), an autopsy was performed. Discrepancies of 9.8 percent were found between autopsy diagnosis and mortality registry data. Our results indicate that autopsy examinations effectively reflect total hospital mortality, and represent a useful tool for epidemiological cancer studies in Mexico. Furthermore, we believe that mortality statistics should be based on autopsy results.