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      Estadio clínico tardío de cáncer de mama en el estado de Jalisco: magnitud y variaciones espaciotemporales Translated title: Clinical late-stage of breast cancer in the state of Jalisco: magnitude and spatial-temporal variations

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          Abstract

          Resumen Los registros oficiales indican que, en Jalisco, México, el diagnóstico de cáncer de mama (Cama) en mujeres generalmente se realiza en fases avanzadas. Mediante datos georreferenciados de pacientes atendidas en un hospital de tercer nivel, se identificó la magnitud y variación espaciotemporal asociada a estadio clínico tardío (IIb, IIIa, IIIb, IIIc, IV) por municipio de residencia en el trienio 2013-2015. Los municipios Acatic, Atoyac y Zapotlanejo mostraron un incremento en la tasa estimada para este periodo, cuyo valor fue 44.6, 17.7 y 19.2 por cada cien mil mujeres mayores de 20 años, respectivamente. Además, el riesgo de estadio tardío se incrementó hasta cuatro veces según el municipio de residencia. Los resultados sugieren cuáles son los municipios donde se requiere mejorar la detección y diagnóstico de Cama, pero sobre todo garantizar un tratamiento oportuno para las mujeres que residen en los lugares de mayor riesgo, en apego a lineamientos establecidos en la NOM 041-SSA2-2011.

          Translated abstract

          Abstract Official records indicate that in Jalisco, Mexico, the diagnosis of breast cancer (BC) in women is usually performed at advanced stages. Using geo-referenced data of patients treated at a third-level hospital, the magnitude and spatialtemporal variation associated with late clinical stage (IIb, IIIa, IIIb, IIIc, IV) by municipality of residence was identified during 2013-2015. The municipalities of Acatic, Atoyac and Zapotlanejo showed an increase in the estimated rate for this period, whose value was 44.6, 17.7 and 19.2 per hundred thousand women older than 20 years of age, respectively. In addition, the risk of late-stage breast cancer increased up to four times and in accordance to the patient’s municipality of residence. The results show the municipalities where it is required to improve the detection and diagnosis of BC and, especially, to guarantee an early treatment for women who reside in the places of higher risk, in compliance with the guidelines established in the NOM 041-SSA2-2011.

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          Stage at breast cancer diagnosis and distance from diagnostic hospital in a periurban setting: a South African public hospital case series of over 1,000 women.

          Advanced stage at diagnosis contributes to low breast cancer survival rates in sub-Saharan Africa. Living far from health services is known to delay presentation, but the effect of residential distance to hospital, the radius at which this effect sets in and the women most affected have not been quantified. In a periurban South African setting, we examined the effect of a geographic information system (GIS)-measured straight-line distance, from a patient's residence to diagnostic hospital, on stage at diagnosis in 1,071 public-sector breast cancer patients diagnosed during 2006-2012. Generalized linear models were used to estimate risk ratios for late stage (stage III/IV vs. stage I/II) associated with distance, adjusting for year of diagnosis, age, race and socioeconomic indicators. Mean age of patients was 55 years, 90% were black African and diagnoses were at stages I (5%), II (41%), III (46%) and IV (8%). Sixty-two percent of patients with distances >20 km (n = 338) had a late stage at diagnosis compared to 50% with distances <20 km (n = 713, p = 0.02). Risk of late stage at diagnosis was 1.25-fold higher (95% CI: 1.09, 1.42) per 30 km. Effects were pronounced in an underrepresented group of patients over age 70. This positive stage-distance association held to 40 km, and plateaued or slightly reversed in patients (9%) living beyond this distance. Studies of woman and the societal and healthcare-level influences on these delays and on the late stage at diagnosis distribution are needed to inform interventions to improve diagnostic stage and breast cancer survival in this and similar settings.
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            Breast cancer in Mexico: a growing challenge to health and the health system.

            Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care. Copyright © 2012 Elsevier Ltd. All rights reserved.
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              Investigación Científica en Ciencias de la Salud

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                Author and article information

                Journal
                au
                Acta universitaria
                Acta univ
                Universidad de Guanajuato, Dirección de Investigación y Posgrado (México, Guanajuato, Mexico )
                0188-6266
                2007-9621
                2020
                : 30
                : e2487
                Affiliations
                [1] Guadalajara orgnameUniversidad de Guadalajara orgdiv1Centro Universitario de Ciencias de la Salud orgdiv2División de Disciplinas para el Desarrollo, Promoción y Preservación de la Salud Mexico
                [2] orgnameUniversidad de Guadalajara orgdiv1Centro Universitario de Ciencias Sociales y Humanidades orgdiv2División de Estudios Históricos y Humanos Mexico
                [3] orgnameSecretaría de Salud Jalisco orgdiv1Instituto Jalisciense de Cancerología orgdiv2Coordinación de investigación
                Article
                S0188-62662020000100128 S0188-6266(20)03000000128
                10.15174/au.2020.2487
                bd6aa2b6-641f-4aac-a67e-a063e68f9c5d

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 01 June 2020
                : 22 January 2019
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 28, Pages: 0
                Product

                SciELO Mexico

                Categories
                Artículos

                sistemas de información geográfica,estadio tardío,etapa en el diagnóstico,Neoplasias de mama,geographic information systems,late-stage,stage at diagnosis,Breast neoplasm

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