Prostate Cancer Screening in Colombia: ¿Is It Possible to Overcome the Controversy?

La detección temprana sigue siendo pilar fundamental en el control del cáncer ya que no mas de 30% de las neoplasias malignas se pueden prevenir mediante la intervención de sus factores de riesgo,1 y adicionalmente, la enfermedad localizada sigue teniendo mayor supervivencia que los estados metastásicos, aún con la sustancial mejora del tratamiento sistémico. A pesar de ello, existe una controversia creciente acerca de la tamización, en donde juega papel central el sobrediagnóstico. La reducción de la mortalidad es el objetivo primordial de la tamización en cáncer y dada la frecuente manifestación tardía de síntomas, la búsqueda de la enfermedad en población asintomática reviste toda lógica; no obstante, esta lógica se basa en la definición de neoplasia maligna como el crecimiento anómalo de células con capacidad de invasión progresiva, capacidad que se determina por cambios morfológicos y no por la dinámica de la enfermedad. Hoy se sabe que los cambios morfológicos tienen espectro amplio con cursos naturales variables, incluyendo neoplasias que no progresan o que progresan muy lentamente sin que lleguen a manifestarse durante la vida del paciente.2Q4https://orcid.org/0000-0001-7187-9946Revista Nacional - IndexadaCN

Propuesta de opción organizativa de gestión ambiental para la Alcaldía municipal de Pereira

La magnitud y complejidad de las dinámicas y procesos ambientales, observados sus efectos más negativos y a veces irreversibles sobre la calidad de vida de la población y sobre la posibilidad de lograr un desarrollo económico sostenible, relacionados con la pérdida o disminución de la oferta natural, las transformaciones del entorno rural y la urbanización, obligan a revisar las prácticas y formas más corrientes de adelantar la Gestión Ambiental Municipal -GAM- en una perspectiva más coordinada, estratégica y permanente de lo que ha sido hasta el presente, en particular en aquellas áreas donde, siendo mayores y más complejos los problemas, se presentan serias debilidades conceptuales, técnicas y operativas que inhiben y a menudo obstaculizan una práctica exitosa, coordinada y eficaz, acorde con la problemática que enfrentan. En el plano institucional, las perspectivas abiertas por la Constitución Nacional, el desarrollo de la legislación ambiental a nivel nacional, la mejor comprensión y puesta en común con las comunidades de estos temas y problemas, asociados a la formulación de los POT , las evidentes demostraciones de interés de los diversos gobiernos regionales y municipales en el manejo de esta problemática y los evidentes logros alcanzado en diversas prácticas exitosas a lo largo y ancho del país, abren un espacio esperanzador y optimista para introducir cambios y ajustes que permitan lograr una Gestión Ambiental Municipal más coordinada, eficaz y permanente

Trends in inequalities in premature cancer mortality by educational level in Colombia, 1998-2007

Background There is a paucity of studies on socioeconomic inequalities in cancer mortality in developing countries. We examined trends in inequalities in cancer mortality by educational attainment in Colombia during a period of epidemiological transition and rapid expansion of health insurance coverage. Methods Population mortality data (1998–2007) were linked to census data to obtain age-standardised cancer mortality rates by educational attainment at ages 25–64 years for stomach, cervical, prostate, lung, colorectal, breast and other cancers. We used Poisson regression to model mortality by educational attainment and estimated the contribution of specific cancers to the slope index of inequality in cancer mortality. Results We observed large educational inequalities in cancer mortality, particularly for cancer of the cervix (rate ratio (RR) primary vs tertiary groups=5.75, contributing 51% of cancer inequalities), stomach (RR=2.56 for males, contributing 49% of total cancer inequalities and RR=1.98 for females, contributing 14% to total cancer inequalities) and lung (RR=1.64 for males contributing 17% of total cancer inequalities and 1.32 for females contributing 5% to total cancer inequalities). Total cancer mortality rates declined faster among those with higher education, with the exception of mortality from cervical cancer, which declined more rapidly in the lower educational groups. Conclusions There are large socioeconomic inequalities in preventable cancer mortality in Colombia, which underscore the need for intensifying prevention efforts. Reduction of cervical cancer can be achieved through reducing human papilloma virus infection, early detection and improved access to treatment of preneoplastic lesions. Reinforcing antitobacco measures may be particularly important to curb inequalities in cancer mortality

Contingency planning for cancer care in low- and middle-income countries during the COVID-19 pandemic : a rapid assessment for future disaster resilience

Q3Q3Background: Many countries appear to be ill-prepared in their emergency responses towards the Corona Virus Disease 2019 (COVID-19) pandemic, particularly in managing chronic diseases such as cancer. We aimed to gain insight on the preparedness of health systems within low- and middle-income countries (LMICs) in maintaining delivery of cancer care amid the pandemic. Methods: We performed a rapid review of publications focusing on emergency contingency plans for cancer care during the pandemic in LMICs. An online desk research was conducted to identify relevant policy documents, guidelines or scientific publications. Results: Very few LMICs had readily accessible documents to ensure continuity in delivery of cancer care during the pandemic. A majority of publications were focused on delivery of cancer treatment whereas early detection, diagnosis and delivery of supportive and survivorship care received very little attention. Far fewer of the published guidelines appear to have been formulated at the national level by governmental agencies. A vast majority of publications constituted consensus guidelines from professional societies, followed by sharing of best practices from local institutions. Overall, three main strategies have been recommended to maintain delivery of cancer care amid the pandemic in LMICs: 1) Modification of cancer treatment regimens, 2) Changes in methods of administration of curative and supportive cancer care and 3) Implementation of generic measures to reduce the risk of COVID-19 infection in healthcare settings. Conclusion: All LMICs should consider collating best practices from the current pandemic and translating them into an explicit cancer preparedness plan, which can be escalated during future disasters.https://orcid.org/0000-0001-7187-9946https://orcid.org/0000-0002-4656-6064Revista Internacional - IndexadaBN

What determines the effects and costs of breast cancer screening?

__Background:__ Multiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and cost-effectiveness of the most used BCS approaches or tried to explain differences in conclusions of systematic reviews on this topic. Based on published reviews, this systematic review aims to assess the degree of variability of determinants for (a) effectiveness and (b) cost-effectiveness of BCS programmes using mammography, clinical breast examination, breast self-examination, ultrasonography, or their combinations among the general population. __Methods:__ We will perform a comprehensive systematic literature search in Cochrane, Scopus, Embase, and Medline (via Pubmed). The search will be supplemented with hand searching of references of the included reviews, with hand searching in the specialized journals, and by contacting prominent experts in the field. Additional search for grey literature will be conducted on the websites of international cancer associations and networks. Two trained research assistants will screen titles and abstracts of publications independently, with at least random 10% of all abstracts being also screened by the principal researcher. The full texts of the systematic reviews will then be screened independently by two authors, and disagreements will be solved by consensus. The included reviews will be grouped by publication year, outcomes, designs of original studies, and quality. Additionally, for reviews published since 2011, transparency in reporting will be assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the review on determinants of effectiveness and a modified PRISMA checklist for the review on determinants for cost-effectiveness. The study will apply the Assessing the Methodological Quality of Systematic Reviews checklist to assess the methodological quality of systematic reviews. We will report the data extracted from the systematic reviews in a systematic format. Meta-meta-analysis of extracted data will be conducted when feasible. __Discussion:__ This systematic review of reviews will examine the degree of variability in the effectiveness and cost-effectiveness of BCS programmes. _Systematic review registration:_ PROSPERO CRD42016050764and CRD42016050765

What determines the effects and costs of breast cancer screening?

__Background:__ Multiple reviews demonstrated high variability in effectiveness and cost-effectiveness outcomes among studies on breast cancer screening (BCS) programmes. No study to our knowledge has summarized the current evidence on determinants of effectiveness and cost-effectiveness of the most used BCS approaches or tried to explain differences in conclusions of systematic reviews on this topic. Based on published reviews, this systematic review aims to assess the degree of variability of determinants for (a) effectiveness and (b) cost-effectiveness of BCS programmes using mammography, clinical breast examination, breast self-examination, ultrasonography, or their combinations among the general population. __Methods:__ We will perform a comprehensive systematic literature search in Cochrane, Scopus, Embase, and Medline (via Pubmed). The search will be supplemented with hand searching of references of the included reviews, with hand searching in the specialized journals, and by contacting prominent experts in the field. Additional search for grey literature will be conducted on the websites of international cancer associations and networks. Two trained research assistants will screen titles and abstracts of publications independently, with at least random 10% of all abstracts being also screened by the principal researcher. The full texts of the systematic reviews will then be screened independently by two authors, and disagreements will be solved by consensus. The included reviews will be grouped by publication year, outcomes, designs of original studies, and quality. Additionally, for reviews published since 2011, transparency in reporting will be assessed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for the review on determinants of effectiveness and a modified PRISMA checklist for the review on determinants for cost-effectiveness. The study will apply the Assessing the Methodological Quality of Systematic Reviews checklist to assess the methodological quality of systematic reviews. We will report the data extracted from the systematic reviews in a systematic format. Meta-meta-analysis of extracted data will be conducted when feasible. __Discussion:__ This systematic review of reviews will examine the degree of variability in the effectiveness and cost-effectiveness of BCS programmes. _Systematic review registration:_ PROSPERO CRD42016050764and CRD42016050765

Quantification of impact of COVID-19 pandemic on cancer screening programmes – a case study from Argentina, Bangladesh, Colombia, Morocco, Sri Lanka, and Thailand

Q1Q1Pacientes con Cáncer de cuello uterinoPacientes con Cáncer de mamaIt is quite well documented that the COVID-19 pandemic disrupted cancer screening services in all countries, irrespective of their resources and healthcare settings. While quantitative estimates on reduction in volume of screening tests or diagnostic evaluation are readily available from the high-income countries, very little data are available from the low- and middle-income coun tries (LMICs). From the CanScreen5 global cancer screening data repository we identified six LMICs through purposive sampling based on the availability of cancer screening data at least for the years 2019 and 2020. These countries represented those in high human development index (HDI) cate gories (Argentina, Colombia, Sri Lanka, and Thailand) and medium HDI categories (Bangladesh and Morocco). No data were available from low HDI countries to perform similar analysis. The reduction in the volume of tests in 2020 compared to the previous year ranged from 14.1% in Bangladesh to 72.9% in Argentina (regional programme) for cervical screening, from 14.2% in Bangladesh to 49.4% in Morocco for breast cancer screening and 30.7% in Thailand for colorectal cancer screening. Number of colposcopies was reduced in 2020 compared to previous year by 88.9% in Argentina, 38.2% in Colombia, 27.4% in Bangladesh, and 52.2% in Morocco. The reduction in detection rates of CIN 2 or worse lesions ranged from 20.7% in Morocco to 45.4% in Argentina. Reduction of breast cancer detection by 19.1% was reported from Morocco. No association of the impact of pandemic could be seen with HDI categories. Quantifying the impact of service disruptions in screening and diagnostic tests will allow the programmes to strategize how to ramp up services to clear the back logs in screening and more crucially in further evaluation of screen positives. The data can be used to estimate the impact on stage distribution and avoidable mortality from these common cancers.https://orcid.org/0000-0001-7187-9946Revista Internacional - IndexadaA1N

Altered machinery of protein synthesis is region- and stage-dependent and is associated with α-synuclein oligomers in Parkinson’s disease

Introduction: Parkinson's disease (PD) is characterized by the accumulation of abnormal a-synuclein in selected regions of the brain following a gradient of severity with disease progression. Whether this is accompanied by globally altered protein synthesis is poorly documented. The present study was carried out in PD stages 1-6 of Braak and middle-aged (MA) individuals without alterations in brain in the substantia nigra, frontal cortex area 8, angular gyrus, precuneus and putamen. Results: Reduced mRNA expression of nucleolar proteins nucleolin (NCL), nucleophosmin (NPM1), nucleoplasmin 3 (NPM3) and upstream binding transcription factor (UBF), decreased NPM1 but not NPM3 nucleolar protein immunostaining in remaining neurons; diminished 18S rRNA, 28S rRNA; reduced expression of several mRNAs encoding ribosomal protein (RP) subunits; and altered protein levels of initiation factor eIF3 and elongation factor eEF2 of protein synthesis was found in the substantia nigra in PD along with disease progression. Although many of these changes can be related to neuron loss in the substantia nigra, selective alteration of certain factors indicates variable degree of vulnerability of mRNAs, rRNAs and proteins in degenerating sustantia nigra. NPM1 mRNA and 18S rRNA was increased in the frontal cortex area 8 at stage 5-6; modifications were less marked and region-dependent in the angular gyrus and precuneus. Several RPs were abnormally regulated in the frontal cortex area 8 and precuneus, but only one RP in the angular gyrus, in PD. Altered levels of eIF3 and eIF1, and decrease eEF1A and eEF2 protein levels were observed in the frontal cortex in PD. No modifications were found in the putamen at any time of the study except transient modifications in 28S rRNA and only one RP mRNA at stages 5-6. These observations further indicate marked region-dependent and stage-dependent alterations in the cerebral cortex in PD. Altered solubility and a-synuclein oligomer formation, assessed in total homogenate fractions blotted with anti-a-synuclein oligomer-specific antibody, was demonstrated in the substantia nigra and frontal cortex, but not in the putamen, in PD. Dramatic increase in a-synuclein oligomers was also seen in fluorescent-activated cell sorter (FACS)-isolated nuclei in the frontal cortex in PD. Conclusions: Altered machinery of protein synthesis is altered in the substantia nigra and cerebral cortex in PD being the frontal cortex area 8 more affected than the angular gyrus and precuneus; in contrast, pathways of protein synthesis are apparently preserved in the putamen. This is associated with the presence of alpha-synuclein oligomeric species in total homogenates; substantia nigra and frontal cortex are enriched, albeit with different band patterns, in alpha-synuclein oligomeric species, whereas alpha-synuclein oligomers are not detected in the putamen

Cervical cancer screening programmes and age-specific coverage estimates for 202 countries and territories worldwide: a review and synthetic analysis

Q1Q1Background: Cervical cancer screening coverage is a key monitoring indicator of the WHO cervical cancer elimination plan. We present global, regional, and national cervical screening coverage estimates against the backdrop of the 70% coverage target set by WHO. Methods: In this review and synthetic analysis, we searched scientific literature, government websites, and official documentation to identify official national recommendations and coverage data for cervical cancer screening for the 194 WHO member states and eight associated countries and territories published from database inception until Oct 30, 2020, supplemented with a formal WHO country consultation from Nov 27, 2020, to Feb 12, 2021. We extracted data on the year of introduction of recommendations, the existence of individual invitation to participate, financing of screening tests, primary screening and triage tests used, recommended ages and screening intervals, use of selfsampling, and use of screen-and-treat approaches. We also collected coverage data, either administrative or surveybased, as disaggregated as possible by age and for any available screening interval. According to data completeness and representativeness, different statistical models were developed to produce national age-specific coverages by screening interval, which were transformed into single-age datapoints. Missing data were imputed. Estimates were applied to the 2019 population and aggregated by region and income level. Findings: We identified recommendations for cervical screening in 139 (69%) of 202 countries and territories. Cytology was the primary screening test in 109 (78%) of 139 countries. 48 (35%) of 139 countries recommended primary HPV-based screening. Visual inspection with acetic acid was the most recommended test in resource-limited settings. Estimated worldwide coverage in women aged 30–49 years in 2019 was 15% in the previous year, 28% in the previous 3 years, and 32% in the previous 5 years, and 36% ever in lifetime. An estimated 1·6 billion (67%) of 2·3 billion women aged 20–70 years, including 662 million (64%) of 1·0 billion women aged 30–49 years, had never been screened for cervical cancer. 133 million (84%) of 158 million women aged 30–49 years living in high-income countries had been screened ever in lifetime, compared with 194 million (48%) of 404 million women in upper-middle-income countries, 34 million (9%) of 397 million women in lower-middle-income countries, and 8 million (11%) of 74 million in low-income countries. Interpretation: Two in three women aged 30–49 years have never been screened for cervical cancer. Roll-out of screening is very low in low-income and middle-income countries, where the burden of disease is highest. The priority of the WHO elimination campaign should be to increase both screening coverage and treatment of detected lesions; however, expanding the efforts of surveillance systems in both coverage and quality control are major challenges to achieving the WHO elimination target. Funding: Instituto de Salud Carlos III, European Regional Development Fund, Secretariat for Universities and Research of the Department of Business and Knowledge of the Government of Catalonia, and Horizon 2020.https://orcid.org/0000-0001-7187-9946Revista Internacional - IndexadaA1N