Cáncer  de  Mama  en  Jalisco:  Problemas  y  Soluciones  

 Dr.  Adrián  Daneri  Navarro  

Centro  Universitario  de  Ciencias  de  la  Salud,  Universidad  de  Guadalajara  

   

Situación  Actual  del  Cáncer  de  Mama  en  México  y  Jalisco  

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    

4. Discussion

Breast cancer in Mexico presented a continuous increase in thereported incidence and mortality rates between 2001 and 2011. Asignificant increase in both rates was seen in Central and Southernregions and subregions of the country. On the other hand, thereported incidence and mortality rates in the North remainedunchanged, with a downturn in more recent years. Women 60–69 years old showed the largest rise in reported incidence, whilewomen 60 years of age and older were the group with the highestincrease in mortality.

4.1. Population aging

The observed increase in the incidence of breast cancer couldreflect population growth, aging and lifestyle modifications seenin developing countries transitioning to a more “developed”epidemiological landscape. Life expectancy in Mexico doubledduring the second half of the 20th century, and by 2005 the lifeexpectancy of Mexican women was 77.9 years. Although in theyear 2000 older adults represented only 7% of the population, thisproportion is expected to increase to 12.5% by 2020 and to 28% by2050, owing to the aging of people born during the Mexicaneconomic expansion of 1960–1980 (the Mexican baby boomers)[19]. This will inevitably lead to an increase in the incidence ofdiseases associated with aging, including breast cancer. Addi-tionally, since women in the 50–59 and 60–64 age group arespecially targeted by breast cancer screening programs, this isexpected to rise even further. As a matter of fact, an increase in

the incidence and mortality of breast cancer in women 60 yearsof age and older seems to be the main factor driving theupward trends we observed. These changes might lead to anincrease in the median age at diagnosis for breast cancer patientsin Mexico, which has historically been reported to be of 50 yearsof age [8]. Another interesting observation is the fact that thenumber of new cases reported in women 65 years and older islower than that in the 50–59 and 60–64 subgroups, in contrast towhat is seen in other countries like the United States [22].Although there is no clear explanation for this, it may be due tothe fact that older women in Mexico have lower participation inscreening programs or that they fail to seek medical attention forbreast symptoms.

4.2. Changes in access and availability of healthcare facilities

An important landmark which could partially explain some ofthe changes seen in our study is the aforementioned establishmentof the Seguro Popular program in 2003. In the first 9 years after itsinception, 52.6 million Mexicans, previously uninsured, wereincorporated into the program [10]. Currently, the public sectoraccounts for 88% of the available medical facilities, while theprivate sector is responsible for the remaining 12% [23]. 44% of thepopulation is covered by Social Security (for salaried workers) and45% is covered by Seguro Popular, while 7% are covered by otherpublic schemes (directed at government employees) and less than3% have private insurance [24]. From 2003 to 2013, the number ofexisting medical facilities (including both ambulatory clinics andhospitals) in the public sector grew from 19,505 to 22,228,

Table 2Total number of Breast Cancer deaths reported by INEGI for each subregion of the country during the studied period.

Region Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Southwest 179 180 231 238 226 250 246 291 268 323 313Southeast 125 127 117 155 135 147 138 150 180 190 192East 436 467 486 495 491 531 592 569 620 590 626West 458 543 524 543 590 662 580 627 660 682 710Center-North 326 355 342 421 389 433 468 489 492 491 535Center-South 1111 1134 1155 1202 1228 1231 1283 1355 1335 1392 1429Northwest 510 541 577 616 650 666 699 770 736 751 773Northeast 455 508 452 503 520 537 598 579 614 640 643Total 3600 3855 3884 4173 4229 4457 4604 4830 4905 5059 5221

Fig. 2. National incidence (a) and mortality (b) trends 2001–2011, joinpoint analysis.

E. Soto-Perez-de-Celis, Y. Chavarri-Guerra / Cancer Epidemiology 41 (2016) 24–33 27

4. Discussion

Breast cancer in Mexico presented a continuous increase in thereported incidence and mortality rates between 2001 and 2011. Asignificant increase in both rates was seen in Central and Southernregions and subregions of the country. On the other hand, thereported incidence and mortality rates in the North remainedunchanged, with a downturn in more recent years. Women 60–69 years old showed the largest rise in reported incidence, whilewomen 60 years of age and older were the group with the highestincrease in mortality.

4.1. Population aging

The observed increase in the incidence of breast cancer couldreflect population growth, aging and lifestyle modifications seenin developing countries transitioning to a more “developed”epidemiological landscape. Life expectancy in Mexico doubledduring the second half of the 20th century, and by 2005 the lifeexpectancy of Mexican women was 77.9 years. Although in theyear 2000 older adults represented only 7% of the population, thisproportion is expected to increase to 12.5% by 2020 and to 28% by2050, owing to the aging of people born during the Mexicaneconomic expansion of 1960–1980 (the Mexican baby boomers)[19]. This will inevitably lead to an increase in the incidence ofdiseases associated with aging, including breast cancer. Addi-tionally, since women in the 50–59 and 60–64 age group arespecially targeted by breast cancer screening programs, this isexpected to rise even further. As a matter of fact, an increase in

the incidence and mortality of breast cancer in women 60 yearsof age and older seems to be the main factor driving theupward trends we observed. These changes might lead to anincrease in the median age at diagnosis for breast cancer patientsin Mexico, which has historically been reported to be of 50 yearsof age [8]. Another interesting observation is the fact that thenumber of new cases reported in women 65 years and older islower than that in the 50–59 and 60–64 subgroups, in contrast towhat is seen in other countries like the United States [22].Although there is no clear explanation for this, it may be due tothe fact that older women in Mexico have lower participation inscreening programs or that they fail to seek medical attention forbreast symptoms.

4.2. Changes in access and availability of healthcare facilities

An important landmark which could partially explain some ofthe changes seen in our study is the aforementioned establishmentof the Seguro Popular program in 2003. In the first 9 years after itsinception, 52.6 million Mexicans, previously uninsured, wereincorporated into the program [10]. Currently, the public sectoraccounts for 88% of the available medical facilities, while theprivate sector is responsible for the remaining 12% [23]. 44% of thepopulation is covered by Social Security (for salaried workers) and45% is covered by Seguro Popular, while 7% are covered by otherpublic schemes (directed at government employees) and less than3% have private insurance [24]. From 2003 to 2013, the number ofexisting medical facilities (including both ambulatory clinics andhospitals) in the public sector grew from 19,505 to 22,228,

Table 2Total number of Breast Cancer deaths reported by INEGI for each subregion of the country during the studied period.

Region Year

2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011

Southwest 179 180 231 238 226 250 246 291 268 323 313Southeast 125 127 117 155 135 147 138 150 180 190 192East 436 467 486 495 491 531 592 569 620 590 626West 458 543 524 543 590 662 580 627 660 682 710Center-North 326 355 342 421 389 433 468 489 492 491 535Center-South 1111 1134 1155 1202 1228 1231 1283 1355 1335 1392 1429Northwest 510 541 577 616 650 666 699 770 736 751 773Northeast 455 508 452 503 520 537 598 579 614 640 643Total 3600 3855 3884 4173 4229 4457 4604 4830 4905 5059 5221

Fig. 2. National incidence (a) and mortality (b) trends 2001–2011, joinpoint analysis.

E. Soto-Perez-de-Celis, Y. Chavarri-Guerra / Cancer Epidemiology 41 (2016) 24–33 27

Tendencia  de  la  

Incidencia  /  Mortalidad  en  México  2001-­‐2011  

cancer has been the leading cause of cancer-related mortality inMexican women, surpassing cervical cancer [8]. A review of theregional geographic trends of breast and cervical cancer mortalitybetween 1979 and 2006 showed a higher risk of dying from breastcancer in women from the northern states, while women from thesouthern states had higher mortality attributable to cervical cancer[9]. In order to tackle inequities in the access to healthcare, in2003 the Mexican government instituted a national healthinsurance program directed at the poorest sectors of thepopulation called Seguro Popular, which includes coverage ofbreast cancer screening, diagnosis and treatment [10].

One of the main barriers for designing strategies to tacklecancer in developing nations is the paucity of statistics regardingits incidence and mortality [11], and the Breast Health GlobalInitiative has included the assessment of the burden of breastcancer at the national level as one of its top priorities [2]. Due to thefact that Mexico lacks a national population-based cancer registry,information on these indicators usually comes from dataextrapolated from neighboring countries, from hospital-basedhistopathological databases [8] or from the only regional cancerregistry, which is located in the western state of Jalisco [12]. Forexample, data from GLOBOCAN 2012, (which reports an incidenceof 35.4 cases of breast cancer per 100,000 person-years in Mexico)are not obtained from any registry, but rather extrapolated fromthe mortality data obtained from the death certificate database ofthe Instituto Nacional de Estadística y Geografía (National Instituteof Statistics and Geography, INEGI) [13], which is considered ofhigh quality. Furthermore, the previous edition of GLOBOCAN,published in 2008, obtained incidence data by using a regionalmodel extrapolated from other territories in Central America andthe Latin Caribbean with a high quality population-based cancerregistry (Puerto Rico and Costa Rica) [14]. Thus, although theregional and national mortality figures attributable to breastcancer in Mexico come from reliable sources and have beenpublished before [15], the true incidence of the disease is largelyunknown and no direct data sources have been used to describe it.Starting in 2000, the Dirección General de Epidemiología (NationalEpidemiological Administration, DGE) of the Mexican Ministry of

Health instituted the weekly mandatory reporting of all new breastcancer cases as part of the Sistema Nacional de VigilanciaEpidemiológica (National System of Epidemiological Surveillance,SINAVE) [16]. SINAVE was created in the 1970’s and since 1995 ithas national coverage, encompassing all the public institutionsthat constitute the Sistema Nacional de Salud (National HealthSystem) and several private institutions. Data reported by SINAVEinclude confirmed and suspected cases of 142 different diseases,including not only breast cancer but also cervical cancer andcervical dysplasia [17]. These suspected cases are reported on aweekly basis by physicians at nurses at every medical unit orhospital belonging to the institutions included in SINAVE using anonline computerized format called Sistema Único de Informaciónpara la Viligancia Epidemiologica (Unified Information System forEpidemiological Surveillance, SUIVE) [18]. The reported cases arereviewed by the Sanitary Jurisdiction to which each medical unitbelongs and then reported on a state level weekly, monthly andyearly [17].

In this paper, we describe national and regional breast cancerincidence trends using population-based data from the SINAVEdatabase and mortality trends using the INEGI records for the firstdecade of the 21st century, in order to understand the epidemio-logical variations generated by recent changes in the country,including growing access to healthcare, increasing coverage ofscreening methods and the quality of data reporting.

2. Patients and methods

2.1. Study area

Mexico is a federation comprising 31 states and a FederalDistrict (DF), geographically limited by United States border on thenorth and by the Guatemala–Belize border on the south. Wedivided the country into three geographic regions and 8 subregions: North (Northwest and Northeast); Central (North-Central,South Central, West and East) and South (Southeast andSouthwest). The location of each region and subregion withinthe country can be seen in Fig. 1.

Fig. 1. Geographic regions of Mexico.

E. Soto-Perez-de-Celis, Y. Chavarri-Guerra / Cancer Epidemiology 41 (2016) 24–33 25

   

DiagnósWco  en  Jalisco  por  Etapa  Clínica:  Estudio  Binacional  ELLA  

Daneri-­‐Navarro  y  Cols.  2015    

Etapa  Clínica   HE/HGO-CMNO-IMSS  

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%  

   

MarBnez  ME,  Cancer  Epidemiol  Biomarkers  Prev.  2013  Aug  15  

       

Análisis  de  las  PolíWcas  Publicas  en  Cáncer  de  Mama  en  México  /  Jalisco.  

v Según  Estudio  publicado:  México y Brasil son los países con 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.