OBJECTIVE : To describe clinical, histopathological and treatment characteristics of melanoma in a private institution of Bogotá, Colombia, and to identify differences regarding sex and age.
MATERIALS AND METHODS : Observational, retrospective study. 415 medical records between January 1999 and May 2014 were analyzed.
RESULTS : Out of 415 patients, 244 (58.8%) were females and 171 (41.2%) were males with a mean age of 56.1 ±16.2 SD. Superficial spreading melanoma (SSMM) was the main subtype (n=175, 42.7%). Breslow's thickness ≤1mm was predominant, while phototypes II and III were more frequent (n=87, 69.6%). Melanoma was predominantly localized on the head in men (n=83, 50.3%) and in the lower limbs in women (n=89, 36.8%), with a higher frequency of SSMM pattern among patients aged ≤65. Lentigo maligna (LM) was more frequent in patients aged >65 (p<0.001), with a higher number of ulcerated melanomas (p=0.046).
CONCLUSIONS : A predominance of thin SSMM and fair skin phototypes were found, unlike previous reports that showed acral lentiginous melanoma (ALM) as predominant, which may be caused by local variations related to mixed ethnicity.

BACKGROUND: Gastric Cancer is highly prevalent and deadly worldwide. In Colombia, it is the most lethal form of cancer. Some single-nucleotide polymorphisms in IL-10, IL-4, and IL-4Rα genes have been associated with an anti-inflammatory environment and a Th2 profile in detriment of the antitumor Th1 response. This research sought to detect single-nucleotide polymorphisms in promoter sequences, like - 1082 (G/A), - 592 (C/A), and - 819 (C/T), as well as - 590 (C/T) of the IL-10 and IL-4 genes, respectively; in addition to the IL-4Rα mutation variants, Ile50Val and Q576R, together with circulating levels of IL-4, TNF-α, IL-10, and IFN-γ in patients with gastric carcinoma in Cúcuta, Colombia.
METHODS: In a cross-sectional study, 17 patients and 30 healthy individuals were genotyped for the six polymorphisms mentioned through PCR-RFLP of DNA obtained from peripheral blood cells and serum samples were analyzed by sandwich ELISA to quantify cytokines. Statistical difference between groups was determined along with the association between the presence of polymorphisms and the risk of gastric cancer, as well as the mortality in patients, using Mann-Whitney U test and logistic regression analysis, respectively.
RESULTS: An association between the - 1082 (G/A) and the risk of gastric cancer was found (OR = 7.58, range 0.77-74.06, P = 0.08). Furthermore, patients had a significant increase in IL-4 serum levels (P < 0.01) compared to healthy individuals, both variables showed a higher estimated risk of mortality in patients, although without statistical association (P > 0.05).
CONCLUSION: We infer that two possible biomarkers (one immunological and one genetic) could be considered in association with gastric cancer in our population, which should be confirmed by subsequent studies involving a greater number of individuals.

Latino women show lower incidences of breast cancer (BC) than non-Hispanic whites. Large-scale genetic association studies have identified variants robustly associated with BC risk in European women. We examine here the relevance of these variants to Colombian BC and possible interactions with genetic ancestry. Native American, European and African proportions were estimated for 1022 Colombian BC cases and 1023 controls. Logistic regression was applied to assess the association between 78 variants and BC risk and interactions between the variants and ancestry proportions. We constructed a multifactorial risk score combining established BC risk factors, associated risk variants and individual ancestry proportions. Each 1% increase in the Native American proportion translated into a 2.2% lower BC risk (95% CI: 1.4-2.9). Thirteen variants were associated with BC in Colombian women, with allele frequencies and risk effects partially different from European women. Ancestry proportions moderated the risk effects of two variants. The ability of Native American proportions to separate Colombian cases and controls (area-under-the-curve (AUC) = 0.61) was similar to the discriminative ability of family history of BC in first-degree female relatives (AUC = 0.58) or the combined effect of all 13 associated risk variants (AUC = 0.57). Our findings demonstrate ample potential for individualized BC prevention in Hispanic women taking advantage of individual Native American proportions, information on established susceptibility factors and recently identified common risk variants.

Response to neoadjuvant chemotherapy in breast cancer patients is of prognostic value in determining short- and mid-term outcomes. Inflammatory biomarkers, such as platelet-to-lymphocyte ratio (PLR) and neutrophil to lymphocyte ratio (NLR), have been proposed as predictive factors of response to neoadjuvant chemotherapy. Currently, there are no studies in Colombian patients reporting the role of inflammatory biomarkers as response predictors in patients receiving neoadjuvant chemotherapy. Therefore, in this study we performed a cross-sectional study and analyzed the association between inflammatory biomarkers and pCR (pathological complete response) in patients diagnosed with breast cancer-of different molecular subtypes- and treated with neoadjuvant chemotherapy. A total of 288 patients were included in the study, with a median age of 51 years old. Disease was locally advanced in 83% of the participants, and 77.7% had compromised lymph nodes. In our cohort, the most frequent tumor molecular subtype was luminal B/Her2- (27.8%) followed by triple negative [TN] (21.5%), luminal B/Her2+ (19.8%), Her2-enriched (16%) and luminal A (13.5%). PLR was not associated with age, menopausal status, baseline tumor size, histologic grade, axillary lymph node involvement, disease stage, estrogen receptor status, or Ki67; however, complete pathological response was significantly higher in the low PLR group (PLR<150) compared with the high PLR group (35.1% Vs. 22.2%, p = 0.03). In addition, Her2-enriched tumors achieved the highest pCR rates (65%), followed by TN (34%) tumors. Our results suggest that breast cancer patients with low platelet-to-lymphocyte ratio (PLR <150), treated with neoadjuvant chemotherapy achieve higher complete pathological response, independently of primary tumor molecular subtype.

Introduction. Breast reconstruction, either immediate or delayed, is part of the treatment of breast cancer. Each country and health system pays for and evaluates these procedures in different ways. Thus, it is important to determine which strategy is most cost-effective in Colombia. Objective: To evaluate the cost-utility of breast cancer treatment with immediate reconstruction compared with delayed reconstruction. Materials and methods: We used a decision tree model and a one-year time horizon from the perspective of the third-party payer; the cost data were taken from the Colombian Instituto de Seguros Sociales 2001 rate manual plus a 30% adjustment according to the methodology of the Instituto de Evaluación Tecnológica en Salud, IETS, and the billing model of the Centro Javeriano de Oncología at the Hospital Universitario San Ignacio. The transition probabilities and profits were obtained from medical specialists, patients, and the medical literature. We also conducted univariate and probabilistic sensitivity analyses. Results: The expected costs per capita were COP$ 26,710,605 (USD$ 11,165) for the immediate reconstruction and COP$ 26,459,557 (USD$ 11,060) for the deferred reconstruction. Immediate reconstruction generated an incremental cost of COP$ 251,049 (USD$ 105) and 0.75 quality-adjusted life years (QALY), while deferred reconstruction generated 0.63 QALYs, with an incremental cost-utility ratio of COP$ 2,154,675 per QALY (USD$ 901). Conclusions: The cost per QALY did not exceed the acceptability threshold of the Gross Domestic Product (GDP) per capita. The costs for the first year were similar. Both techniques are favorable for the Colombian health system, but the utility reported by patients and the literature is greater with the immediate reconstruction.

BACKGROUND: The incidence of basal cell carcinoma (BCC) in younger individuals has increased in recent decades. However, the characteristics of BCCs in this population, especially in Ibero-Latin American countries, have not been completely defined.
OBJECTIVE: To describe the demographic, clinical, and histopathological characteristics of BCCs in patients younger than 40 treated with Mohs Micrographic Surgery (MMS).
MATERIALS AND METHODS: A multicenter, retrospective study conducted between January 2009 and December 2014, in five Ibero-American countries, included biopsy-proven BCCs in patients younger than 40 that were treated with MMS. Demographic, clinical, histopathological, and surgical characteristics were described.
RESULTS: The study included 301 tumors in 241 patients, of whom 61% were female. The most common Fitzpatrick phototype was III. The most common histological subtypes were nodular (37.5%) and infiltrative (18.9%). Perineural invasion was encountered in 1.7%, and tumor clearance was achieved in 87.4% within two stages of MMS.
CONCLUSIONS: This is the first Ibero-Latin American transnational study describing the characteristics of BCCs in young patients treated with MMS. Despite darker skin phototypes in this population, BCCs can occur in early ages and may present with aggressive features. Therefore, MMS may be considered an appropriate first-line treatment option in this population.

Three

Most evidence on breast cancer screening accuracy derives from high income countries. We evaluated screening accuracy and factors related to program implementation in Bogota, Colombia. Between 2008 and 2012 participants underwent clinical breast examination (CBE) and mammography. Positive results underwent histological verification. Adherence to screening protocols was analyzed. Sensitivity, specificity, and predictive values were estimated and adjusted by overdiagnosis. Impact of alternative screening algorithms on follow-up was explored, including combined screening tests and modified coding systems for mammography. In total, 7436 women aged 50-69 were enrolled; 400 discontinued and 1003 non-compliant with screening protocols. 23 cancer cases were diagnosed. Mammography sensitivity and specificity were 78.3% (95%CI 77.3-99.3) and 99.4% (95%CI 99.2-99.6). CBE sensitivity was 39.1% (95%CI 37.9-40.3) and specificity 83.4% (95%CI 82.6-84.3). Parallel mammography and CBE showed the highest sensitivity (95.6%) and combined as serial tests the lowest (positive CBE followed by mammography 13.0%). A simplified coding system for mammography (recall/no-recall) had 6.3% of positive results and a minor reduction in specificity compared with standard mammography, but reported the best balance between recall rates and screening protocol compliance. Call-backs had high rates of loss-to-follow-up; thus, alternative screening algorithms might help increase screening compliance and follow-up in low and middle income countries, particularly in populations with poor screening history and low access to health services.

BACKGROUND: Poor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs.
METHODS: We adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30-49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50-69 years in a middle-income setting (Colombia).
FINDINGS: In the East African setting, relative mortality reductions were 8-41%, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100 000 women over 10 years. In Colombia, mortality reductions were 7-25%, corresponding to 32 (-29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years.
INTERPRETATION: The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common.
FUNDING: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.

Objective: To describe the outcomes of risk management indicators for five types of cancer in population that is affiliated to the General System of Social Security in Health, in six cities of Colombia.
Methods: Based on the data from the administrative cancer registry for the period 2016, the High Cost Disease Fund (CAC in Spanish) as a technical organization of the Colombian health system, processed and analyzed the data for the calculation of risk management indicators established in consensus based on the evidence found in six cities.
Results: There is a diversity in the indicators results found among the different cities, evidencing strengths and weaknesses in each of them for the different types of cancer. From the set of indicators, those with the best results presented are related to the greater detection of cancer in early stages or in situ, as well as a decrease in mortality, especially in colorectal and in gastric cancer. Most indicators in gastric cancer showed optimal results. Important measurements such as the opportunity for diagnosis and treatment are below the proposed standard for most types in all the six cities.
Conclusions: The descriptive analysis of cancer risk management indicators shows certain weaknesses in the quality and timeliness of the care of cancer patients, the standards agreed upon in the consensus with the different actors of the system are not being reached, situation which may be due to a reality of problems of the Colombian health system, as well as deficiencies in the quality of the report to the CAC.

Objective: To evaluate the quality of the certification of general death and cancer in Colombia.
Methods: Validity indicators were described for each province and the cities of Bogotá, Cali, Manizales, Pasto and Bucaramanga. A factorial analysis of principal components was carried out in order to identify non-obvious relationships.
Results: Were analyzed 984,159 deaths, among them there were 164,542 deaths due to cancer. 93.7% of the general mortality was well certified. The predominant errors were signs, symptoms and ill-defined conditions. 92.8% of cancer mortality was well certified. The predominant errors were due to poorly defined cancer sites.
Conclusions: Certification of quality indicators in Colombia has improved. Given the good performance of the quality indicators for certificating general death and cancer, it is considered that this is a valid input for the estimation of cancer incidences.

Background: The Population Cancer Registry of Cali (RPCC) has operated since 1962, disseminating high quality information to provide a framework to assess and control the burden of cancer in Cali.
Methods: The collection of new cancer cases in permanent residents of Cali is done through active search in and notification from hospitals, and public and private laboratories. The Secretary of Municipal Public Health provides individual information on general mortality and death from cancer. Tumors are coded with ICDO-3 and mortality with ICD-10. Presented rates are standardized by age and trends are assessed by estimating the percentage annual change using the regression analysis in JoinPoint. The 5-year net survival was analyzed with the Pohar-Perme estimator.
Results: The 88.5% of the registered cancers had morphological verification (MV). The proportion of unknown primary site represented 5% and the death certificate only cases (DCO) varied between 0 to3% depending on the cancer site. All deaths were certified by a physician, 94.2% of cancer deaths were correctly certified. The ill-defined site proportion was 5.3% and that of uterine cancer not specified (C55) was 0.5%. For survival analysis, existing data collection procedure and infrastructure ensures assessment of the patient's vital status and follow-up, with an average lost to follow-up of 13.2%.
Comment: The information has been published in the eleven volumes of "Cancer Incidence in Five Continents" confirming high quality of the collected data. The RPCC PCRC has also participated in the Concord Study and is participating in SURVCAN-3.

Objective: to provide and compare estimations of two-year overall survival for cervical and female breast cancer in three cohorts (first treated in 2007, 2010, 2012) at the Instituto Nacional de Cancerología of Colombia.
Methods: All patients first treated at the Instituto Nacional de Cancerología for breast or cervical cancer in the years 2007, 2010, 2012, without a prior cancer diagnosis, were included for the study. The hospital-based cancer registry was cross linked with governmental databases to obtain follow-up information on all patients. Probability of surviving 24 months since the date of entry at the hospital was estimated using Kaplan-Meier methods, using the log-rank test to evaluate differences between groups.
Results: We analyzed 1,928 breast cancer cases and 1,189 cervical cancer cases, resulting in an overall survival probability at 24 months of 79.6% (95% CI: 77.8-81.4) for BC and of 63.3% (95% CI: 60.6- 66.0) for cervical cancer, there were no differences in survival for year of entry. Advanced clinical stage substantially affected overall survival, being 32.2% (95% CI: 28.4-44.0) for stage IV breast cancer and 22.6% (95% CI: 11.4-33.8) for stage IV cervical cancer.
Conclusions: Breast cancer was the cancer with the best survival rates at Instituto Nacional de Cancerología; cervical cancer was the one with the lowest survival rates. Overall survival did not change over the years for any of the cancers.

In low-income countries, a child diagnosed with cancer has an 80% chance of dying, while in high-income countries more than 80% survive the disease. In Colombia, a middle-income country, the government issued new legislation that promotes the generation of comprehensive care units; nevertheless, seven years after its expedition, no institution has been recognized as such by the Ministry of Health. The objective of this study was to characterize the current offer of oncological services for cancer care in children and to identify the institutions that can be constituted in Units of Comprehensive Care of Childhood Cancer in Colombia.
Methods: descriptive study of secondary source, the Special Register of Health Providers of the Ministry of Health and Social Protection was consulted, in order to identify the institutions that had enabled hospitalization services of medium or high complexity, chemotherapy, specialized consultation, emergencies, oncological surgery, and radiotherapy or nuclear medicine. The information is reported in absolute frequencies.
Results: Seventy one institutions have hematology-oncology consultation, 39 institutions have chemotherapy and hospitalization services of medium or high complexity, and 18 have radiotherapy enabled. Only nine of the institutions include all the services that are necessary for comprehensive care.
Conclusion: Colombia has a sufficient supply of services for the care of children with cancer. Only a minority are in institutions that have the capacity to guarantee the integrality of the attention.

Objective: To characterize the current status of oncological services supply in Colombia.
Methods: A descriptive analysis of oncological services for cancer care in the adult and infant population that meet the requirements for operation according to the Special Register of Health Service Providers was carried out. The case - by - provider ratio was calculated based on the cancer incidence estimated for Colombia by the National Cancer Institute.
Results: Were identified 1,780 qualified oncology health services in the country related to specialties for providing care to cancer patients. Twenty five providers nationwide had all three qualified services: chemotherapy, radiotherapy and surgery. Nearly 50% of the offer was concentrated in Bogotá, Antioquia and Valle del Cauca. Putumayo and the Amazonas group departments, with the exception of Vaupés, did not show any oncological services. Healthcare Providers were responsible for 87.8%, and independent professionals provided 12.2%. Outpatient services were 66.7% of oncology services, 17.4% was diagnostic support services and therapeutic complementation, and 15.9% was surgical services. 87.9% of the oncological service offer in Colombia takes place in the private sector.
Conclusions: The ratio between the service groups is asymmetric, with few providers jointly offering the basic services for oncology treatment, which reflects how provision is fragmented. It is necessary to redefine the concept of oncology service under a comprehensive care approach and the importance of enabling functional units, comprehensive treatment centers and other forms of care.

Background: This study provides information on cancer incidence and mortality in a Colombian population during 2010-2014, based on the data and methodology of the Population-based Cancer Registry of Antioquia to facilitate the implementation of cancer control strategies.
Methods: This is a descriptive study of cancer incidence and mortality in a population, residing in the urban area of the municipality of Medellin. The cancers included in the study are those prioritized in the cancer control plan for Colombia (PDCC-cancers). The collection, processing and systematization of the data were performed in accordance with internationally standardized parameters for population cancer registries. Incidence and mortality rates were calculated by gender, age and tumor location.
Results: During 2010-2014 there were 22,379 new cancer cases recorded in the urban area of the municipality of Medellin, of which 43.5% corresponded to the PDCC-cancers. During the same period, 14,922 cancer deaths were reported, 23.5% related to the PDCC-cancers, 53.5% in women. Prostate cancer and breast cancer were the principal cause of morbidity in men and women, respectively, and lung cancer was the principal cause of death for both sexes.
Conclusion: Cancer is a health problem for the population of Medellin. It is necessary to emphasize research and monitor risk factors, the health response and the capacity of the health provider network when facing the growing demand caused by this epidemic.

Introduction: Cancer is a burden in the world, especially for the least developed countries. The Population Registries of Cancer are fundamental in order to know the territorial profiles of cancer, and to evaluate the impact of their control programs.
Objective: To estimate the incidence and mortality from cancer in the Metropolitan Area of ​​Bucaramanga in the period 2008-2012.
Methods: A descriptive population study of cancer incidence and mortality in the Metropolitan Area of ​​Bucaramanga was conducted. Primary invasive cancer cases from the 2008-2012 period was obtained from the RPC-AMB base. Population and death data were provided by the National Administrative Department of Statistics (DANE, for its initials in Spanish). Crude rates of global and specific incidence and mortality were estimated by sex, and standardized incidence and mortality rates.
Results: During the five-year period, 8,775 incidents of cancer were recorded (excluding non-melanoma skin cancer). The global standardized incidence rates per 100,000 person-years were 151.7 in men and 157.2 in women. The main locations were prostate, stomach and colorectal, in men; breast, thyroid and colorectal in women. The standardized mortality rate per 100,000 person-years was 94.8 in men and 78.0 in women.
Conclusion: The incidence and mortality rates in most locations are lower than the national ones and those in the previous quinquennium in the Metropolitan Area of ​​Bucaramanga. Thyroid cancer, colorectal cancer, and leukemia show a tendency to increase, which demands further investigation.

Objective: To analyze differences in survival of breast, cervical, lung, prostate and stomach cancer by health insurance regime (HIR) and socioeconomic position (SEP) in an intermediate city in a middle-income country.
Methods: All patients with breast, cervix uteri, lung, prostate and stomach cancer diagnosed between 2003 and 2007 and characterized by the Manizales population-based Cancer Registry (MCR) were included and followed up to a maximum of 5 years for identifying deaths. Survival probabilities estimated by HIR were defined according to the type of affiliation at the date of diagnosis, and by socioeconomic stratification of residence (SS) as indicator of SEP, stratifying for other prognostic factors using Kaplan-Meier methods. Cox proportional hazard models were fitted for multivariate analysis.
Results: A total of 1,384 cases and 700 deaths were analyzed
Conclusions: Important inequities in cancer survival exist related to HIR and SEP. Possible explanations include underlying comorbidities, late stage at diagnosis, or barriers to timely and effective treatment.

Objective: To describe cancer incidence and mortality during the 2008-2012 period in the District of Barranquilla.
Methods: Cancer incident cases were collected, analyzed and processed by the Barranquilla Population Cancer Registry during the study period. Population structure was obtained from the
Results: 8,182 cases of cancer were identified, excluding non-melanoma skin cancer (62.8% in women). 83.0% of the tumors had histological verification and only 5.2% were DCO. The adjusted incidence rate for all tumors was 116.5 per 100,000 in men and 155.4 per 100,000 in women. The most frequent locations were prostate and trachea-bronchi-lung in men, while in women, breast and cervix occupied the first places. Breast and prostate had the highest mortality rates in women and men, respectively.
Conclusion: Specific behavior of cancer incidence and mortality in Barranquilla has important increases for the main types of tumors (breast and prostate) when compared to the country and other population registries. To provide data is key to showing a representative behavior of the Colombian Caribbean.

Introduction: In Colombia it is necessary to continue producing quality and continuously updated information on the magnitude of cancer, derived from population-based cancer registries to contribute to decision making, and implementation of strategies for health promotion, prevention and treatment of cancer in order to reduce the impact on the population.
Objective: To describe the incidence, mortality and cancer trends in Pasto-Colombia from 1998 to 2012.
Methods: Observational descriptive study of morbi - mortality due to malignant tumours in Pasto. The collection, processing and systematization of the data, was carried out according to international standards for population-based cancer registries. The incidence and mortality rates were calculated by period, sex, age and tumour site.
Results: During the period 1998-2012 there were 8,010 new cases of cancer, of them, 57.7% occurred in females. There were 4,214 deaths reported, 52.0% in females. The incidence (
Conclusions: Cancer in general, continues to be a serious health problem for the population of Pasto. The global behaviour of cancer incidence and mortality, identify the need to promote and strengthen promotion and prevention programs, especially focused on tumours of the stomach, prostate, breast and cervix uteri that produce greater morbidity and mortality in the population.

Background: The Cali Population Cancer Registry (RPCC) has been in continuous operation since 1962 with the objective of producing valid statistics on the incidence of cancer, its patterns, trends and survival rates.
Methods: During the period 2008-2012, 23,046 new cases were registered and during 2011-2015 there were 12,761 cancer deaths. The trend of the rates was described with the APC average annual change rate and with the Joinpoint analysis. We analyzed the individual data of 38,671 adults (15-99 years) diagnosed with cancer between 1995-2009, and we calculated the standardized net survival by age for the 14 most common cancer body sites, using the Pohar-Perme method.
Results: Prostate and breast cancer were the first cause of cancer morbidity. The incidence rates in these were susceptible to early detection, tumors stabilized after decades of growth, while an increase in the incidence of colon cancer and papillary thyroid carcinoma was observed. The incidence rates of cervical and stomach cancer and conditions related to infectious agents decreased, although the number of absolute cases increased, due to the growth and aging of the population. Gastric cancer was responsible for the highest number of cancer related deaths. The types of cancer related to tobacco consumption (lung, oral cavity, esophagus, pancreas, urinary bladder) showed low numbers and a tendency to decrease. During the period 2000-2004, the 5-year net survival improved for cancers of the breast, cervix, prostate, melanoma and thyroid, although in the period 2005-2009 a stagnation was observed. In stomach, liver and lung cancer, the 5-year net survival was less than 15%. The 5-year overall survival in children was 51.0% (95% CI: 47.5, 54.3) and in adolescents 44.6% (95% CI: 36.0, 52.8).
Comment: RPCC has been an advisor to the Colombian government in the evaluation of CPRs in the country and its data has contributed significantly to different aspects of cancer control in Colombia.

Objectives: To describe the incidence and mortality for the five main types of cancer in Colombia, from 2007-2011.
Methods: We estimated cases and cancer incidence rates standardised by age, based on incidence/mortality ratios; and we calculated the observed deaths and mortality rates standardised by age in Colombia, both differentiated by province, type of cancer and sex. Incidence estimates were generated based on information from four cancer population registries (Cali, Pasto, Bucaramanga and Manizales), published in
Results: The annual number of expected cases (all cancers) was 62,818 in men and women; and there were 32,653 recorded deaths. The main incidental cancers were prostate (46.5 per 100,000 person-years) in men, and breast (33.8 per 100,000 person-years) in women. The highest mortality figures were for stomach cancer in men (14.2); and breast cancer in women (9.9).
Conclusions: The highest incidence and mortality estimates in Colombia were for breast and prostate cancers, as well as a proportion of infection-related cancers, such as stomach and cervical cancer. These four neoplasms were responsible for more than 50% of the burden of the disease. Only through good quality, long-duration cancer registries, can information be obtained about the changes in incidence trends.

OBJECTIVE: To assess the effect of operational factors on the positivity rates of three HPV assays.
METHODS: Within the cross-sectional ESTAMPA study, women aged 30-64 years were recruited at healthcare centers from Soacha, Colombia, during 2012-2015. Cervical samples were collected for cotesting with Hybrid Capture 2 (HC2; Qiagen, Gaithersburg, MD, USA), and either Aptima (Hologic, Marlborough, MA, USA) or Cobas 4800 (Roche Diagnostics, Indianapolis, IN, USA). The effect of operational factors on assay performance was assessed using adjusted positivity rates obtained from logistic regression models.
RESULTS: There were 4168 women included. For samples collected in assay-specific medium, positivity rate differences were associated with the expertise of the nurse collecting the sample (P=0.014 HC2; P=0.091 Aptima) and if sample collection occurred after an initial cytology (P=0.025 HC2; P=0.033 Aptima). If PreservCyt medium (Hologic) was used, HC2 positivity differences were observed depending on the time between sample collection and processing (P=0.026) and on the laboratory technician processing the samples (P=0.003). No differences were observed for PreservCyt samples processed with Aptima or Cobas.
CONCLUSION: Nurse expertise, collection of previous cytology, processing time, and laboratory technician could influence HPV assay performance. Suitable quality assurance protocols for HPV-based screening programs are required. ClinicalTrials.gov: NCT01881659.

OBJECTIVES: This work sought to determine the family economic burden associated with caring for the child with cancer.
METHODS: Descriptive study with quantitative approach. The sample comprised 50 families of children with cancer attending a foundation in Bogotá (Colombia), which accompanies integrally children with lupus and cancer from a vulnerable population (providing food, psychological and spiritual advice, lodging, transportation and education). An identification file was employed to characterize the subjects and the Survey "Financial cost of caring for Chronic illness" by Montoya et al. The analysis was performed through the methodology "Economic burden attributable to caring for a person with chronic illness in Colombia" (CARACOL, for the term in Spanish), which quantifies the level of burden in sexagesimal degrees and the financial cost of the burden; a higher number of sexagesimal degrees indicate a higher level of economic burden.
RESULTS: Families of children with cancer have a high economic burden, in particular in transportation (28.5°), communications (26.3°), health (20.8°), housing (19.7°), and food (17.4°).
CONCLUSIONS: The families have a high economic burden associated with caring for the child with cancer. It is necessary to implement social support strategies to these families to keep the economic burden from interfering with adherence to treatment and, hence, with the child's survival.

Introduction: Gliomas are the most common primary tumors of the central nervous system and, according to their malignancy, they are graded from I to IV. Recent studies have found that there is an association between gliomas and mutations in exon 4 of genes that codify for isocitrate dehydrogenases 1 and 2 (IDH1: codon 132; IDH2: codon 172). Objective: To establish the frequency of mutations in IDH1 and IDH2 in a sample of gliomas from Colombian population. Materials and methods: DNA was extracted from tumor tissue. The exon 4 of IDH1 and IDH2 was amplified by PCR using specific primers and subsequently sequenced. Mutations were determined using the 4Peaks MAFFT programs. Results: We found mutations in the IDH1 gene in 34% of the glioma samples, with a predominance of the nonsynonymous mutation R132H. Mutations in the IDH2 gene were found in 7.5% of cases, with a predominance of the nonsynonymous R172K and R172W mutations. Conclusions: The frequency of mutations in the IDH1 and IDH2 genes in the sample was similar to that reported in other studies. The analysis of these mutations may be important to establish prognostic factors and for the development of future therapeutic targets in gliomas.

BACKGROUND: Hepatocellular carcinoma (HCC) is the most frequent primary malignant liver tumor, with the Milan criteria considered to be the gold standard for patient selection for liver transplantation (LT).
MATERIALS AND METHODS: We performed a descriptive observational study, reviewing 20 years of experience of LT in patients with HCC in the Fundacion Valle del Lilí in Cali, Colombia. Subgroup analysis was undertaken for periods 1999 to 2007 and 2008 to 2015.
RESULTS: Fifty-seven cases with a pretransplant HCC diagnosis were reviewed. In the first period patients within the Milan criteria had a recurrence-free survival at 5 years of 66.6%, and in those who exceeded the Milan criteria, recurrence-free survival was 75%. In the second period, patients within the Milan criteria, recurrence-free survival at 5 years was 93.5%, and in those who exceeded the Milan criteria, recurrence-free survival was 75.7%. No statistically significant difference was found in either period. For patients with mild and moderate tumor differentiation, the relapse survival rate at 5 years was 69.4% (95% confidence interval [CI] 35.8-87.8) and 74.7% (95% CI 44.5-90), respectively. All patients with poor tumor differentiation relapsed and died within 3 years.
CONCLUSION: Global and recurrence-free survival among patients who met and patients who exceeded the Milan criteria was not significantly different, suggesting an expansion of the Milan criteria to include potential recipients who were previously excluded. Obtaining histologic differentiation and identifying vascular invasion will provide a more worthwhile contribution to LT decision making.

Breast cancer (BC) is a highly heterogeneous disease associated with metabolic reprogramming. The shifts in the metabolome caused by BC still lack data from Latin populations of Hispanic origin. In this pilot study, metabolomic and lipidomic approaches were performed to establish a plasma metabolic fingerprint of Colombian Hispanic women with BC. Data from 1H-NMR, GC-MS and LC-MS were combined and compared. Statistics showed discrimination between breast cancer and healthy subjects on all analytical platforms. The differentiating metabolites were involved in glycerolipid, glycerophospholipid, amino acid and fatty acid metabolism. This study demonstrates the usefulness of multiplatform approaches in metabolic/lipid fingerprinting studies to broaden the outlook of possible shifts in metabolism. Our findings propose relevant plasma metabolites that could contribute to a better understanding of underlying metabolic shifts driven by BC in women of Colombian Hispanic origin. Particularly, the understanding of the up-regulation of long chain fatty acyl carnitines and the down-regulation of cyclic phosphatidic acid (cPA). In addition, the mapped metabolic signatures in breast cancer were similar but not identical to those reported for non-Hispanic women, despite racial differences.

Metabolic biomarkers for breast cancer (BC) prognosis and diagnosis are required, given the increment of BC incidence rates in developing countries and its prevalence in women worldwide. Human urine represents a useful resource of metabolites for biomarker discovery, because it could reflect metabolic alterations caused by a particular pathological state. Furthermore, urine analysis is readily available, it is non-invasive and allows in-time monitoring. Therefore, in present study, a metabolic- and lipid fingerprinting of urine was performed using an analytical multiplatform approach. The study was conducted in order to identify alterated metabolites which can be helpful in the understanding of metabolic alterations driven by BC as well as their potential usage as biomarkers. Urine samples collected from healthy controls and BC subjects were analyzed using LC-MS and GC-MS. Subsequently, significantly altered metabolites were determined by employing univariate and multivariate statistical analyses. An overall decrease of intermediates of the tricarboxylic acid cycle and metabolites belonging to amino acids and nucleotides were observed, along with an increment of lipid-related compounds. Receiver operating characteristic analysis evaluated the combination of dimethylheptanoylcarnitine and succinic acid as potential urinary markers, achieving a sensitivity of 93% and a specificity of 86%. The present analytical multiplatform approach enabled a wide coverage of urine metabolites that revealed significant alterations in BC samples, demonstrating its usefulness for biomarker discovery in selected populations.

INTRODUCTION: Cases of toxoplasmosis present in South America tend to be more severe than that found in other continents. Here, we present our clinical experience of ocular and ganglionar toxoplasmosis in the use of PCR, and of the treatment to prevent ocular involvement.
METHODOLOGY: Retrospective analysis of clinical charts of patients with ocular and lymphadenitic toxoplasmosis at the parasitology and tropical medicine consultation in the "Universidad del Quindio" in Colombia. In total, 91 records of cases with ocular toxoplasmosis and 17 with lymphadenitis that underwent PCR analysis for B1 repeated sequence in blood, were compared to the results of 104 people with chronic asymptomatic toxoplasmosis. In addition, 41 clinical records were included from patients with confirmed toxoplasmic lymphadenitis: 10 untreated, 6 that begun treatment after four months of symptoms, and 25 that were treated during the first four months of symptoms and had a follow-up during at least one year.
RESULTS: Patients with ocular toxoplasmosis or lymphadenitis had a higher probability of PCR positivity in peripheral blood than chronic asymptomatic people. There were no cases of retinochoroiditis in 25 patients with toxoplasmic lymphadenitis treated before 4 months of symptoms and followed during at least 12 months. In four out of ten untreated cases, new lesions of retinochoroiditis presented after the symptoms of lymphadenitis.
CONCLUSIONS: Toxoplasmosisin South America exhibits different clinical behavior and this influences the laboratory results as well as the need for treatment in the case of lymphadenitis. Clinicians should be aware of the geographical origin of the infection in order to adopt different therapeutic and diagnostic approaches.

BACKGROUND: Demographic, clinical, and morphological characteristics of cutaneous melanoma are unknown for the Colombian population. We aim to provide these characteristics as well as population-based incidence and survival data.
METHODS: All patients with an invasive cutaneous melanoma diagnosed in the period 2000-2009 registered in the population-based cancer registry of the metropolitan area of Bucaramanga were included for analysis (n = 169). Age-standardized incidence rates were calculated and melanoma-specific and overall survival estimated with follow-up until June 9, 2016, using Kaplan-Meier methodology, stratifying for gender, anatomical localization, and type of affiliation to the social security system.
RESULTS: The age-standardized melanoma incidence rate was 1.7 per 100,000, with lower limbs being the most affected body sites (42.6% of all melanomas). A high proportion of melanomas presented on the plants or palms (16%) and under the nails (7.1%); at least 24.3% of melanomas were ulcerated, and 21.1% had a Breslow thickness more than 2 mm. Melanoma-specific 5-year survival was 79.3%, with worst survival for melanomas localized on the plants (64.6%) and subungual areas (55.6%). Affiliation to the subsidized type of affiliation to the social security system was statistically significantly (P = 0.003) associated with poorer survival (68.8%) compared to the special regimes (95.8%).
CONCLUSIONS: Melanoma is a relatively rare cancer in Colombia with mainly the acral sites, high proportion of thick and ulcerated melanomas, and relatively poor survival being distinct features, indicating the need for tailor-made primary and secondary prevention strategies. Better training of pathologists in the difficult field of melanoma would improve precision of available data.