The screening strategy more cost-effective for Colombia is the FOBT biennial guaiac type, using as a threshold the gross domestic product (GDP) per capita in Colombia.

diseño de pauta de colección Kilka -Diseño Gráfico diagRamación y montaje de cubieRta Mauricio Salamanca ilustRación de cubieRta Manuel Gómez coRRección de estilo María José Díaz Granados impResión Imagen Editorial Hecho el depósito que exige la ley Queda prohibida la reproducción parcial o total de este libro, sin la autorización de los titulares del copyright, por cualquier medio, comprendidos la reprografía y el tratamiento informático. Esta edición y sus características gráficas son propiedad de la Universidad de La Sabana. Este libro es resultado de investigación del proyecto Availability and

e18810 Background: Breast, stomach and colorectal cancers have high incidence in Colombia. Official cancer incidence registries depend upon sentinel site reports as there is no nationwide surveillance system. We aimed to identify administrative database algorithms for breast, stomach and colorectal cancer case selection and to compare their cancer incidence estimates to official registries. Methods: We conducted a systematic review to identify algorithms with high positive predictive values (VPP) for breast, stomach and colorectal cancer case identification in administrative databases. For each cancer we selected two algorithms: a sensitive algorithm, based on cancer-specific ICD-10 codes, and a specific algorithm, combining cancer-specific ICD-10 codes with at least one code for oncological procedures. We varied the number of months a cancer-specific ICD-10 code was registered within each algorithm to test for algorithm stability. We conducted a cohort study to estimate incident cancer cases for 2013 in four cancer sentinel cities in Colombia and one cancer reference center using both algorithms. We defined incident cases as cases lacking a cancer-specific ICD-10 code in the preceding two years and adjusted incident cases for type of regimen affiliation. Algorithms with results closest to official sources were selected as best performing algorithms. We used the contributive regimen Capitation Payment Unit administrative database of Colombia for 2011-2014 as source of information. Results: Breast cancer case-identification algorithms have a higher VPP reported in literature (83-100%) compared to colorectal (41.7-94%) and stomach cancer (35-59.7%) algorithms. The closest breast cancer incidence estimates to the official registries Infocancer and National Cancer Institute were yielded by the specific algorithm with ICD-10 codes persisting for four months (n= 672 vs 649 and 397 vs 212, respectively). The closest colorectal cancer cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for three months (n= 219 vs 230 and 168 vs 139, respectively). The closest stomach cancer incidence estimates to official registries were yielded by the specific algorithm with ICD-10 codes persisting for one month (n= 122 vs 146 and 99 vs 153, respectively). Sensitive algorithms were less stable than specific algorithms across all three cancer types. Conclusions: Breast, stomach and colorectal incident cancer cases can be identified through administrative databases. VPP vary among types of algorithms and cancers. Specific algorithms provide better breast and colorectal incident cancer case-identification in Colombian administrative databases, compared to stomach cancer algorithms. This is a potential approach for estimating nationwide cancer incidence in Colombia.

PURPOSE Breast cancer care requires a multimodal approach and a multidisciplinary team who must work together to obtain good clinical results. The fragmentation of care can affect the breast cancer care; however, it has not been measured in a low-resource setting. The aim of this study was to identify fragmentation of care, the geographic variation of this and its association with 4-year overall survival (OS), and costs of care for patients with breast cancer enrolled in Colombia's contributory health care system. MATERIALS AND METHODS A retrospective cohort study was conducted using administrative databases. Women with breast cancer who were treated from January 1, 2013, to December 31, 2015, were included. Fragmentation of care was the exposure, which was measured by the number of different health care provider institutions (HCPIs) that treated a patient during the first year after diagnosis. Crude mortality rates were estimated, survival functions were calculated using the nonparametric Kaplan-Meier approach, and adjusted hazard ratios (HRs) were estimated using multivariate Cox regression model to identify the association of fragmentation with 4-year OS. The association between fragmentation and costs of care was assessed using a multivariate linear regression model. RESULTS A total of 10,999 patients with breast cancer were identified, and 1,332 deaths were observed. The 4-year crude mortality rate was 31.97 (95% CI, 30.25 to 33.69) per 1,000 person-years for the whole cohort, and the highest rate was in the cohort defined for the fourth quartile of the fragmentation measurement (eight or more HCPIs), 40.94 (95% CI, 36.49 to 45.39). The adjusted HR for 4-year OS was 1.04 (95% CI, 1.01 to 1.07) for each HCPI additional. The cost of care is increased for each additional HCPIs (cost ratio, 1.25; 95% CI, 1.23 to 1.26). CONCLUSION Fragmentation of care decreases overall 4-year OS and increases the costs of care in women with breast cancer for Colombia.