Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study.

Background: Essential indicators of health system performance for breast cancer are lacking in Mexico. We estimated survival and clinical stage distribution for women without social insurance who were treated under a health financing scheme that covered 60% of the Mexican population. Methods: We conducted a retrospective cohort study cross-linking reimbursement claims for 56,847 women treated for breast cancer between 2007 and 2016 to a mortality registry. We estimated overall- and clinical stage-specific survival and breast cancer survival according to patient age, state of residence, marginalization, type of treatment facility, and patient volume of the treatment facility. We also explored the distribution of clinical stage according to age, year of treatment initiation, and state where the woman was treated. We used log-rank tests and estimated 95% CIs to compare differences between patient groups. Findings: Median age was 52 years (interquartile range [IQR] 45, 61) (Sixty five percent patients (36,731/56,847) had advanced disease at treatment initiation. Five-year overall survival was 72.2% (95% CI 71.7, 72.6). For early disease (excluding stage 0), 5-year overall survival was 89.0% (95% CI 88.4, 89.5), for locally advanced disease 69.9% (95% CI 69.0, 70.2) and for metastatic 36.9% (95% CI 35.4, 38.4). Clinical stage at treatment initiation and breast cancer survival remained unchanged in the period analyzed. Clinical stage and survival differed across age groups, state of residence, and type of facility where women received treatment. Interpretation: In the absence of population-based cancer registries, medical claims data may be efficiently leveraged to estimate essential cancer-related performance indicators. Funding: The authors received no financial support for this research.

Menarche characteristics in association with total and cause-specific mortality: a prospective cohort study of Mexican teachers.

PURPOSE: We evaluated the relation between age at menarche and time to menstrual regularity with all-cause and cause specific mortality in a cohort of Mexican women. METHODS: We followed 113,540 women from the Mexican Teachers' Cohort. After a mean follow-up time of 9.2 years, 1,355 deaths were identified. We estimated hazard ratios from Cox regression models for total mortality and a competitive risk models for cause-specific mortality adjusting for year of birth and childhood factors. RESULTS: Women with extreme age of menarche were at increased risk of all-cause mortality (HR [95% CI]: <11 years 1.50 [1.20, 1.87]; 14 years 1.19 [0.97, 1.43]) relative to those with menarche at 13 years. Extreme ages at menarche had higher risk of mortality for diabetes (HR: <11 years 1.66 [0.90, 3.05]; 14 years 1.47 [0.90, 2.40]), breast cancer (HR: <11 years 1.34 [0.56, 3.20]), and other cancer (HR:<11 years 1.65 [1.10, 2.48]) compared to menarche at 13 years. Women who took three or more years to achieve menstrual regularity had a higher risk of all-cause mortality compared to those who took less (HR: 1.27 [1.01, 1.58]). CONCLUSIONS: Extreme ages at menarche and longer time to reach menstrual regularity were associated with an increased rate of all-cause and cause-specific mortality.

Carbon limitation, stem growth rate and the biomechanical cause of Corner's rules.

Background and aims: Corner's rules describe a global spectrum from large-leaved plants with thick, sparingly branched twigs with low-density stem tissues and thick piths to plants with thin, highly branched stems with high-density stem tissues and thin piths. The hypothesis was tested that, if similar crown areas fix similar amounts of carbon regardless of leaf size, then large-leaved species, with their distantly spaced leaves, require higher stem growth rates, lower stem tissue densities and stiffnesses, and therefore thicker twigs. Methods: Structural equation models were used to test the compatibility of this hypothesis with a dataset on leaf size, shoot tip spacing, stem growth rate and dimensions, and tissue density and mechanics, sampling 55 species drawn from across the angiosperm phylogeny from a morphologically diverse dry tropical community. Key results: Very good fit of structural equation models showed that the causal model is highly congruent with the data. Conclusions: Given similar amounts of carbon to allocate to stem growth, larger-leaved species require greater leaf spacing and therefore greater stem extension rates and longer stems, in turn requiring lower-density, more flexible, stem tissues than small-leaved species. A given stem can have high resistance to bending because it is thick (has high second moment of area I) or because its tissues are stiff (high Young's modulus E), the so-called E-I trade-off. Because of the E-I trade-off, large-leaved species have fast stem growth rates, low stem tissue density and tissue stiffness, and thick twigs with wide piths and thick bark. The agreement between hypothesis and data in structural equation analyses strongly suggests that Corner's rules emerge as the result of selection favouring the avoidance of self-shading in the context of broadly similar rates of carbon fixation per unit crown area across species.