THE CUBA PARADOX: An Assessment of Primary and Maternal Healthcare in Cuba Today

Cuba’s healthcare system is lauded on the Global Health stage as renowned. Low mother/infant mortality rates paired with low infectious disease transmission rates have garnered Cuba’s maternal and primary healthcare systems significant fame. In addition to these healthcare feats, Cuban women experience challenges in finding access to basic forms of over-the-counter care. The Cuba Paradox emerges in which a Cuban woman’s healthcare experience in places such as Mayajigua, Cuba (407 km southeast of Havana) is characterized by access to acute care (expensive treatments such as IVF) and lacks of access to active care (over-the-counter products such as Acetaminophen/Ibuprofen and feminine hygiene). This study aims to investigate the primary and reproductive care paradoxes presented to Cuban women today, specifically in rural Mayajigua, Cuba. A Mixed Methods approach that synthesizes information from a 2015 independent research quantitative survey alongside a 2016 independent research ethnographic project were used to assess the Cuban Medical Paradox in a holistic manner. Analysis showed that the Cuba Paradox exists due to a series of recent international developments, notably the 2016 Cuban Special Period. These results have implications on the study of the Cuban healthcare system at large in addition to implications for healthcare policy assessment beyond Cuba

Dominantly inherited micro-satellite instable cancer – the four Lynch syndromes - an EHTG, PLSD position statement

The recognition of dominantly inherited micro-satellite instable (MSI) cancers caused by pathogenic variants in one of the four mismatch repair (MMR) genes MSH2, MLH1, MSH6 and PMS2 has modified our understanding of carcinogenesis. Inherited loss of function variants in each of these MMR genes cause four dominantly inherited cancer syndromes with different penetrance and expressivities: the four Lynch syndromes. No person has an “average sex “or a pathogenic variant in an “average Lynch syndrome gene” and results that are not stratified by gene and sex will be valid for no one. Carcinogenesis may be a linear process from increased cellular division to localized cancer to metastasis. In addition, in the Lynch syndromes (LS) we now recognize a dynamic balance between two stochastic processes: MSI producing abnormal cells, and the host’s adaptive immune system’s ability to remove them. The latter may explain why colonoscopy surveillance does not reduce the incidence of colorectal cancer in LS, while it may improve the prognosis. Most early onset colon, endometrial and ovarian cancers in LS are now cured and most cancer related deaths are after subsequent cancers in other organs. Aspirin reduces the incidence of colorectal and other cancers in LS. Immunotherapy increases the host immune system’s capability to destroy MSI cancers. Colonoscopy surveillance, aspirin prevention and immunotherapy represent major steps forward in personalized precision medicine to prevent and cure inherited MSI cancer