ResumenObjetivo. Caracterizar el diagnóstico y tratamiento de mujeres con cáncer de mama en Bogotá, Colombia; establecer la demora de pacientes en la asistencia a consulta y los factores relacionados. Material y Métodos. A través de una aproximación censal se identificaron 1 106 mujeres con cáncer de mama. La recolección de información se hizo mediante entrevistas y revisión de historias clínicas. Se consideró demora de la paciente el tiempo entre la percepción del síntoma y la primera consulta. Resultados. Más de 80% de las mujeres consultaron por síntomas; la mayoría eran estados avanzados. Los factores que se relacionaron con la demora fueron una mayor edad, no tener afiliación al sistema de salud y la enfermedad avanzada. Una mayor educación se relacionó con menor demora. Discusión. Las mujeres no reconocen los síntomas del cáncer de mama; es necesario diseñar estrategias de comunicación y educación para estimular el reconocimiento de los síntomas y la oportunidad de consulta.

A rising trend in suicide rates in Colombia was confirmed, especially among the productive segment of the population, which has resulted in a marked increase in YPLL.

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 Cancer Incidence in Five Continents, volume X, and the official mortality and population information of the National Administrative Province of Statistics (DANE, for its initials in Spanish).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 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.

Results indicated the need for efforts at increasing coverage amongst the poorer population as well as amongst women from the subsidiary regimen and those having no affiliation. Persistence of high mortality in spite of acceptable coverage suggested the need for more efforts regarding definitive diagnosis and opportune treatment.

Attempts to make the Pap smear as objective as possible were found to be satisfactory, even though no logical relationship was found between knowledge of the Pap smear and its practice. Older women have the social representation of risk implicit in an acute infection model. Lack of opportunity for a having a Pap smear appointment and delays in presenting the corresponding report have a negative impact on cancer control.

Follow-up care after abnormal cytology was very poor and could explain the lack of cervical cancer screening impact in Colombia and in most Latin-American countries.

In Colombia the cancer of uterine cervix is diagnosed in advanced stages and its treatment is based on the application of the radiotherapy or radiotherapy more chemotherapy. Most of studies show that the IGF-IR expression leads to the cellular increase of resistance to radiation, that the tumor like hypoxia induces the IGF-IR expression and selects cells that overexpressing IGF-IR. The aim of this study was to evaluate the effect of expression of IGF-IR, IGF-I, IGF-II, GAPDH, and hemoglobin concentration on tumoral response to ionizing radiation in patients with locally advanced cervical cancer. A series of 37 consecutive patients were recruited from 2002 to 2004. For each patient, a representative tumoral sample in fresh was taken at the time of diagnosis before the beginning of the treatment. In order to have a group control for the analysis of gene expression, 30 samples of normal tissue of uterine cervix from patients treated by exclusive hysterectomy were also analyzed. The mean age of the remaining 37 patients was 46 years (ranging from 33 to 70 years). All patients received exclusive pelvic external beam radiotherapy (EBRT). Treatment consisted of teletherapy using 6 to 18 MV photons with standard four field technique delivering a total dose of 45— 50,4 Gy in 28 fractions (1.8 Gy per fraction, 5 consecutive days per week, overall EBRT treatment time 5 weeks). Follow-up was scheduled at 6 weeks after completion of intracavitary brachytherapy, then every three months during the next 2 years. Complete remission was defined as no evidence of residual disease on clinical examination and radiological imaging, six weeks to three months after completion of the therapeutic sequence. Gene expression of IGF-IR, IGF-I, IGF-II and GAPDH was determined by Real Time PCR and IGF-IR protein was detected using Western Blot. Hemoglobin levels were also evaluated as a parameter of oxygenation before the beginning of ionizing radiation (Hgb≤11g/dl). Gene expression levels were compared between complete responders and non responders using Anova or Kruskal-allis Anova. A major increase was observed in gene expression IGF-IR (34%), followed by the expression of IGF-II (24%) in the cases of cancer in comparison with the control group (expression not detected). Gene expression of IGF-IR (p=0.04) and incomplete treatment (p=0.019) were associated with the lack of treatment response. Patients expressing IGF-IR had 4.6 times more risk of non treatment response; GAPDH expression was directly correlated with the IGF-IR expression, IGF-IR and IGF-II co-expression under anemic hypoxia conditions (Hgb≤11g/dl), demonstrated a possible activation of a glicolytic pathway as an answer to the high metabolic rate of tumoral cells. This is the first report in the clinical setting that relates the expression of IGF-IR as a strong marker of responsiveness. Therefore, the IGF-IR can be considered as a molecular target for optimizing the treatment of cervical cancer with radiotherapy.