Cancer incidence and mortality in Quito: information to monitor cancer control policies.

Introduction: Cancer represents a challenge for global public health, since it requires a comprehensive strategy for its control. In this context, the Population-Based Cancer Registries (PBCR) are key actors for the generation of public policies that guarantee their implementation. Objective: This study analyses the trend in cancer incidence and mortality rates in the city of Quito during the period 1985-2017 and discusses them within the framework of the National Strategy against cancer proposed in 2017 for Ecuador. Methods: Age-standardized incidence and mortality rates are established using data from the Quito PBCR. For trend analysis of selected locations, joinpoint regression and annual percentage change (APC) are used. Results: Throughout the study period, there was a sustained increase in both incidence rates (APC male= 2.0, 95% CI: 1.7-2.4; APC female= 2.0%, 95% CI: 1.4-2.6), as in mortality rates (APC male= 2.0%, 95% CI: 1.8-2.3; APC female= 1.3%, 95% CI: 1.1-1.6). Cancer incidence and mortality rates of the breast, prostate, colon-rectum, thyroid, and lymphoma increased, while the incidence rates of cervical and stomach cancer initially decreased, then stagnation was observed. Conclusion: The information presented by the PBCR of Quito serves as a reference for the prognosis of cancer in the country and as a baseline for its control. Actions are urgently required to strengthen cancer prevention and promotion strategies.

Introducción: El cáncer representa un desafío para la salud pública global, ya que requiere de una estrategia integral para su control. En este contexto los Registros de Cáncer de Base Poblacional (RCBP) son actores clave para la generación de políticas públicas que garanticen su implementación. Objetivo: Este estudio analiza las tasas de incidencia y mortalidad por cáncer en la ciudad de Quito durante el período 1985-2017 y las discute en el marco de la Estrategia Nacional contra el cáncer propuesta en 2017 para Ecuador. Métodos: Se establecieron las tasas de incidencia y mortalidad estandarizadas por edad utilizando datos del RCBP de Quito. Para el análisis de las tendencias, de ubicaciones seleccionadas, se utilizó la regresión de join point y el cambio porcentual anual (CPA). Resultados: Durante todo el período de estudio, hubo un incremento sostenido tanto en las tasas de incidencia (CPA hombres= 2.0, IC 95%: 1.7-2.4; CPA mujeres= 2.0%, IC 95%: 1.4-2.6), como en las tasas de mortalidad (CPA hombres= 2.0%, IC 95%: 1.8-2.3; CPA mujeres= 1.3%, IC 95%: 1.1-1.6). La incidencia y mortalidad de los cánceres de mama, próstata, colon-recto, tiroides y linfoma se incrementaron, mientras que las tasas de incidencia de cáncer de cuello uterino y estómago disminuyeron inicialmente, luego se observó un estancamiento. Conclusión: La información presentada por el PBCR de Quito sirve como referencia para el pronóstico del cáncer en el país y como línea de base para su control. Son urgentes acciones para fortalecer las estrategias de prevención y promoción del cáncer.

Cancer incidence and mortality in Quito: information to monitor cancer control policies / Incidencia y mortalidad por cáncer en Quito: información para monitorear las políticas de control del cáncer

Abstract Introduction: Cancer represents a challenge for global public health, since it requires a comprehensive strategy for its control. In this context, the Population-Based Cancer Registries (PBCR) are key actors for the generation of public policies that guarantee their implementation. Objective: This study analyses the trend in cancer incidence and mortality rates in the city of Quito during the period 1985-2017 and discusses them within the framework of the National Strategy against cancer proposed in 2017 for Ecuador. Methods: Age-standardized incidence and mortality rates are established using data from the Quito PBCR. For trend analysis of selected locations, joinpoint regression and annual percentage change (APC) are used. Results: Throughout the study period, there was a sustained increase in both incidence rates (APC male= 2.0, 95% CI: 1.7-2.4; APC female= 2.0%, 95% CI: 1.4-2.6), as in mortality rates (APC male= 2.0%, 95% CI: 1.8-2.3; APC female= 1.3%, 95% CI: 1.1-1.6). Cancer incidence and mortality rates of the breast, prostate, colon-rectum, thyroid, and lymphoma increased, while the incidence rates of cervical and stomach cancer initially decreased, then stagnation was observed. Conclusion: The information presented by the PBCR of Quito serves as a reference for the prognosis of cancer in the country and as a baseline for its control. Actions are urgently required to strengthen cancer prevention and promotion strategies.

Resumen Introducción: El cáncer representa un desafío para la salud pública global, ya que requiere de una estrategia integral para su control. En este contexto los Registros de Cáncer de Base Poblacional (RCBP) son actores clave para la generación de políticas públicas que garanticen su implementación. Objetivo: Este estudio analiza las tasas de incidencia y mortalidad por cáncer en la ciudad de Quito durante el período 1985-2017 y las discute en el marco de la Estrategia Nacional contra el cáncer propuesta en 2017 para Ecuador. Métodos: Se establecieron las tasas de incidencia y mortalidad estandarizadas por edad utilizando datos del RCBP de Quito. Para el análisis de las tendencias, de ubicaciones seleccionadas, se utilizó la regresión de join point y el cambio porcentual anual (CPA). Resultados: Durante todo el período de estudio, hubo un incremento sostenido tanto en las tasas de incidencia (CPA hombres= 2.0, IC 95%: 1.7-2.4; CPA mujeres= 2.0%, IC 95%: 1.4-2.6), como en las tasas de mortalidad (CPA hombres= 2.0%, IC 95%: 1.8-2.3; CPA mujeres= 1.3%, IC 95%: 1.1-1.6). La incidencia y mortalidad de los cánceres de mama, próstata, colon-recto, tiroides y linfoma se incrementaron, mientras que las tasas de incidencia de cáncer de cuello uterino y estómago disminuyeron inicialmente, luego se observó un estancamiento. Conclusión: La información presentada por el PBCR de Quito sirve como referencia para el pronóstico del cáncer en el país y como línea de base para su control. Son urgentes acciones para fortalecer las estrategias de prevención y promoción del cáncer.

Epidemiología del cáncer pancreático en Quito: 1986-2016 / Epidemiology of pancreatic cancer in Quito, 1986 - 2016

Resumen Introducción: El cáncer de páncreas se encuentra entre los tipos de cáncer más mortales en el mundo, con una tasa de supervivencia neta del 9% a los 5 años. Si bien ha mejorado la comprensión de la fisiopatología, las opciones de detección temprana y tratamiento siguen siendo un desafío importante para la Salud Pública mundial. Este artículo busca describir la tendencia temporal de incidencia y mortalidad en la ciudad de Quito, de 1986 a 2016, así como la evolución de su base diagnóstica. Metodología: Utilizando datos del Registro de Cáncer de Base Poblacional de Quito, se calcularon las tasas anuales de incidencia y mortalidad estandarizadas por edad según sexo. El análisis incluyó la distribución de los casos de acuerdo con la base diagnóstica. El análisis de regresión joinpoint se realizó para estimar el cambio porcentual anual promedio (CPAP). Resultados: Durante el período de análisis, la tasa de incidencia disminuyó de 3.8 a 3.1 casos en hombres (CPAP: -1.0* Intervalos de confianza al 95% (IC95%): -1,9; -0.1) y se mantuvo estable en mujeres. La tasa de mortalidad se incrementó en mujeres (CPAP: 1.3* IC95%:0.2; 2.4) y se mantuvo estable en hombres. Con el tiempo, la proporción de verificación histológica de los casos se incrementó en un 109% en hombres y en un 76% en mujeres. Conclusiones: Se evidencia una mejora en la calidad de registro de la información; sin embargo, la proporción de verificación histológica es aún baja en Quito comparado con las estimaciones a nivel regional. Se subraya la necesidad de intensificar los esfuerzos del diagnóstico oportuno y adecuado.

Abstract Introduction: Pancreatic cancer is one of the deadliest forms of cancer in the world, with a 9% net survival rate in 5 years. Although the understanding of its pathophysiology has improved, early detection options continue to be a challenge for global public health. This article describes the temporal trend of incidence and mortality in Quito, Ecuador, from 1986 to 2016, as well as the evolution of its diagnostic criteria. Methodology: Using data of the population-based Quito Cancer Registry, standardized annual incidence and mortality rates were calculated by age according to sex. The analysis included case distribution according to diagnostic basis. To estimate the average annual percentage change (AAPC), Joinpoint Regression Analysis was performed. Results: During the analysis period, incidence rate decreased from 3.8 to 3.5 cases in men (AAPC: -1.0; CI 95%: -1.9; -0.1) and remained stable in women. The mortality rate increased in women (AAPC: 1.3*; CI 95%: 0.2; 2.4) and remained stable in men. Over time, the proportion of histological verification has increased 109% in men and 76% in women. Conclusions: An improvement in the quality of information recording is evident; however, the proportion of histological verification is still low in Quito compared to the regional level. The study underscores the need to intensify efforts for adequate and timely diagnosis.

The histology of brain tumors for 67 331 children and 671 085 adults diagnosed in 60 countries during 2000-2014: a global, population-based study (CONCORD-3).

BACKGROUND: Global variations in survival for brain tumors are very wide when all histological types are considered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America. METHODS: The source for the analysis was the CONCORD database, a program of global surveillance of cancer survival trends, which includes the tumor records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumor during 2000-2014, whether malignant or nonmalignant. We presented the histology distribution of these tumors, for patients diagnosed during 2000-2004, 2005-2009, and 2010-2014. RESULTS: Records were submitted from 60 countries on 5 continents, 67 331 for children and 671 085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60 783 children and 602 112 adults. Only 59 of 60 countries covered in CONCORD-3 were included because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common subtype in countries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glioblastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in the proportion of tumors with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults. CONCLUSIONS: To our knowledge, this is the first account of the global histology distribution of brain tumors, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide.

Progress, challenges and ways forward supporting cancer surveillance in Latin America.

Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control.

Stagnation in Decreasing Gastric Cancer Incidence and Mortality in Quito: Time Trend Analysis, 1985-2013.

BACKGROUND: Despite the significant global decline in mortality and incidence, gastric cancer (GC) remains a very common cause of illness and death in the Latin American region. This article seeks to describe, in depth, the time trend of incidence and mortality of GC in the city of Quito, from 1985 to 2013. METHODS: Using data from the Quito Cancer Registry, annual sex-specific age-standardized incidence and mortality rates were calculated. The analysis included all types of GC together, as well as by histological subtype. Joinpoint regression analysis was performed to estimate the annual percentage change (EAPC). To evaluate cohort and period effects, Age-Period-Cohort (APC) modeling was performed. RESULTS: Over time, incidence rate decreased from 30.4 to 18.8 cases in men and from 20.1 to 12.9 cases in women. The mortality rate decreased from 17.5 to 14.4 deaths in men and from 14.2 to 10.9 deaths in women. The incidence trend was composed of a first period (1986-1999) of strong decline (EAPC Men= -2.6, 95% Confidence Interval [CI]: -4.2, -0.9; EAPC Women= -3.2, 95% CI: -4.6, -1.9), followed by a less important decrease in men (EAPC= -0.8, 95% CI:-2.5, 0.9) and a slight increase in women (EAPC= 0.7, 95% CI: -1.4; 2.8). Mortality rates were constantly decreasing in both men (EAPC= -0.5, 95% CI: -0.9, -0.1) and women (EAPC= -0.9, 95% CI: -1.7, -0.1) throughout the period of analysis. CONCLUSIONS: The declines in incidence and mortality rates are stagnating. It is important to take measures to further reduce the high burden of GC.

Stomach cancer burden in Central and South America.

RATIONALE AND OBJECTIVE: Stomach cancer mortality rates in Central and South America (CSA) are among the highest in the world. We describe the current burden of stomach cancer in CSA. METHODS: We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer deaths from WHO's mortality database (18 countries). We estimated world population age-standardized incidence (ASR) and mortality (ASMR) rates per 100,000 and estimated annual percent change to describe time trends. RESULTS: Stomach cancer was among the 5 most frequently diagnosed cancers and a leading cause of cancer mortality. Between CSA countries, incidence varied by 6-fold and mortality by 5-6-fold. Males had up to 3-times higher rates than females. From 2003 to 2007, the highest ASRs were in Chile, Costa Rica, Colombia, Ecuador, Brazil and Peru (males: 19.2-29.1, females: 9.7-15.1). The highest ASMRs were in Chilean, Costa Rican, Colombian and Guatemalan males (17.4-24.6) and in Guatemalan, Ecuadorian and Peruvian females (10.5-17.1). From 1997 to 2008, incidence declined by 4% per year in Brazil, Chile and Costa Rica; mortality declined by 3-4% in Costa Rica and Chile. 60-96% of all the cancer cases were unspecified in relation to gastric sub-site but, among those specified, non-cardia cancers occurred 2-13-times more frequently than cardia cancers. CONCLUSION: The variation in rates may reflect differences in the prevalence of Helicobacter pylori infection and other risk factors. High mortality may additionally reflect deficiencies in healthcare access. The high proportion of unspecified cases calls for improving cancer registration processes.

Evaluación externa de registros de cáncer de base poblacional: la Guía REDEPICAN para América Latina / External evaluation of population-based cancer registries: the REDEPICAN Guide for Latin America

OBJETIVO: Evaluar la factibilidad y la adecuación de la Guía REDEPICAN (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) a la situación actual de los Registros de Cáncer de Base Poblacional (RCBP) en América Latina y el Caribe como herramienta útil para mejorar dichos registros. MÉTODOS: La Guía fue diseñada por expertos en registros de cáncer y auditorías sanitarias, y se establecieron siete dominios para evaluarla. Para cada dominio se eligieron varios criterios con sus correspondientes estándares. Se determinaron tres niveles de cumplimiento del estándar. Se organizaron dos cursos de formación de evaluadores externos y tres paneles de discusión con expertos. La Guía se probó en seis RCBP de América Latina y España. RESULTADOS: La Guía contiene 68 criterios, 10 de ellos considerados esenciales para un RCBP. De acuerdo con la puntuación alcanzada, el registro se considera como aceptable (41-199), bueno (200-299) o excelente (300-350). El dominio sobre Métodos de registro representa el 25% de la puntuación, seguido por la Exhaustividad y validez (19%), la Difusión de resultados (19%), la Estructura (13%), la Confidencialidad y aspectos éticos (11%), la Comparabilidad (9%) y el Manual de procedimiento (3%). El proyecto piloto permitió: 1) perfeccionar criterios y estándares, 2) ampliar el concepto de calidad para incorporar las necesidades de los clientes y 3) potenciar la sección de Difusión de resultados. Dos registros latinoamericanos evaluados mejoraron su calidad hasta alcanzar el estándar de la Agencia Internacional de Investigación sobre el Cáncer. CONCLUSIONES: La guía REDEPICAN se ha elaborado teniendo en cuenta el contexto de los registros en América Latina y constituye una herramienta útil y novedosa para la mejora de la calidad de los RCBP. Además está preparada para ser utilizada en otros países y registros.

OBJECTIVE: Evaluate the feasibility of the REDEPICAN Guide (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) and its adaptation to the current situation of population-based cancer registries (PBCRs) in Latin America and the Caribbean as a useful tool to improve these registries. METHODS: Experts in cancer registries and health audits designed the guide and developed seven domains to evaluate in PBCRs. Several criteria were selected for each domain, with corresponding standards, scored according to three levels of compliance. Two training courses for external evaluators and three discussion panels for experts were organized. The guide was tested in six PBCRs in Latin America and Spain. RESULTS: The guide contains 68 criteria, 10 of which are considered essential for a PBCR. Based on its score, a registry is regarded as acceptable (41-199), good (200-299), or excellent (300-350). The registry methods domain accounts for 25% of the score, followed by completeness and validity (19%), dissemination of outcomes (19%), structure (13%), confidentiality and ethical aspects (11%), comparability (9%), and the procedures manual (3%). The pilot project enabled (1) enhancement of criteria and standards, (2) expansion of the quality concept to include client needs, and (3) strengthening the dissemination of outcomes section. Two of the Latin American registries that were evaluated improved their quality, meeting the standards of the International Agency for Research on Cancer. CONCLUSIONS: Development of the REDEPICAN Guide has taken into account the context of the registries in Latin America and is a useful and innovative tool for improving the quality of PBCRs. Furthermore, it is ready for use in other countries and registries.

[External evaluation of population-based cancer registries: the REDEPICAN Guide for Latin America]. / Evaluación externa de registros de cáncer de base poblacional: la Guía REDEPICAN para América Latina.

OBJECTIVE: Evaluate the feasibility of the REDEPICAN Guide (Red Iberoamericana de Epidemiología y Sistemas de Información en Cáncer) and its adaptation to the current situation of population-based cancer registries (PBCRs) in Latin America and the Caribbean as a useful tool to improve these registries. METHODS: Experts in cancer registries and health audits designed the guide and developed seven domains to evaluate in PBCRs. Several criteria were selected for each domain, with corresponding standards, scored according to three levels of compliance. Two training courses for external evaluators and three discussion panels for experts were organized. The guide was tested in six PBCRs in Latin America and Spain. RESULTS: The guide contains 68 criteria, 10 of which are considered essential for a PBCR. Based on its score, a registry is regarded as acceptable (41-199), good (200-299), or excellent (300-350). The registry methods domain accounts for 25% of the score, followed by completeness and validity (19%), dissemination of outcomes (19%), structure (13%), confidentiality and ethical aspects (11%), comparability (9%), and the procedures manual (3%). The pilot project enabled (1) enhancement of criteria and standards, (2) expansion of the quality concept to include client needs, and (3) strengthening the dissemination of outcomes section. Two of the Latin American registries that were evaluated improved their quality, meeting the standards of the International Agency for Research on Cancer. CONCLUSIONS: Development of the REDEPICAN Guide has taken into account the context of the registries in Latin America and is a useful and innovative tool for improving the quality of PBCRs. Furthermore, it is ready for use in other countries and registries.

Cáncer en regiones del Ecuador / Cancer in Ecuadorian Regions

Ofrece el registro de cáncer poblacionales en la ciudad de Quito desde 1985-1999, en Manabí desde 1997-1998. Cáncer gástrico en Tungurahua 1996-1998, cáncer en Cuenca 1997-1998 y cáncer en Loja 1997-1998

Carcinoma de colon y de recto / Carcinoma of colon and rectum

Se analizan 633 casos de cáncer colorrecta, registrados en la población de Quito, en 10 años y se encuentra una tendencia creciente de la tasa de incidencia, estadísticamente significativa, en el cáncer de colon en las mujeres y algunas diferencias entre los tumores que afectan al colon y al recto. Se establecen comparaciones con lo que sucede en otros países. El trabajo pretende aportar al conocimiento del comportamiento de estas neoplasias en nuestra población...

Cáncer del cuello uterino y de glándula mamaria como problemas de salud pública en el Ecuador / Cancer of uterine neck and mammary gland like problem of public health in Ecuador

Analiza las causas de mortalidad principalmente en las mujeres, y dentro de éstas la mortalidad por neoplasias. Se hace un análisis de las tendencias de la incidencia de los cánceres de cuello uterino y de la glándula mamaria durante los 10 últimos años, así como la incidencia por grupos de edad e instrucción. Se analizan las posibles causas que contribuyen para que esta situación no se haya modificado. Se concluye que es necesario considerarlos como problemas de salud pública, la necesidad de poner atención sobre la problemática que presentan las mujeres de edad madura y la necesidad de organizar programas de tamizaje para la prevención secundaria de éstos dos tumores...

Epidemiología del cancer

Se analiza el comportamiento epidemiológico del cáncer de mama femenina en la ciudad de Quito y en el país, basado en datos de incidencia que aporta el registro nacional de tumores (RNT) de SOLCA, núcleo de Quito, en un lapso de 9 años (1985-1993), y en los datos de mortalidad piublicados por el Instituto de Estadisticas y Censos del Ecuador, de 1967 a 1993. La incidencia entre los habitantes de Quito no ha variado significativamente en el período analizado. La tasa sitúa al Ecuador entre los países con valores intermedios. La mortalidad por esta neoplasia está aumentando en el país, y especialmente en algunas provincias de manera estadisticamente significativa.