Supervivencia y factores asociados en pacientes con cáncer cervicouterino atendidas por el Seguro Popular en México

Abstract

Objetivo. Estimar la supervivencia a cinco años por cáncer cervicouterino y sus factores asociados en pacientes mexica­nas, cuya atención fue financiada por el Fondo de Protección contra Gastos Catastróficos (FPGC) del Seguro Popular durante el periodo 2006-2014. Material y métodos. Se analizó la base de datos de las pacientes mencionadas y se vinculó con el Subsistema Epidemiológico y Estadístico de Defunciones. Se hizo un análisis de supervivencia a cinco años por etapa clínica y factores asociados, mediante el método de Kaplan-Meier y los modelos de riesgos proporcionales de Cox. Resultados. La supervivencia global por cáncer cervicouterino a los cinco años fue de 68.5%. Los factores asociados fueron la etapa clínica (locoregional [HR=2.8 IC95% HR: 2.6,3.0] y metastásica [HR=5.4 IC95% HR: 4.9,5.9]) com­parada con la etapa temprana y la edad (HR=1.003 IC95% HR:1.001,1.004). Conclusiones. Las mujeres que lograron el acceso a la atención del cáncer cervical financiadas por el FPGC tuvieron una supervivencia ligeramente superior a las reportadas en otros estudios.

The health system and access to treatment in patients with cervical cancer in Mexico

“…Overall survival (OS) at 5 years was 68.5%. The OS analysis by clinical stage was 88% in early stages, 63.9% in locally advanced disease, and 43.6% for advanced disease ( 8 ). The results of this study found 5-year survival rates comparable to the reported for other countries, which are 63%, 66%, 67%, and 58.8% for Spain, the USA, Chile, and Colombia, respectively.…”

“…Recently, in 2022, a retrospective analysis was published that included more than 20,000 patients diagnosed with CC, whose treatment was financed by the Popular Insurance Catastrophic Expenditure Protection Fund (FPCGC). The prevailing clinical stage at the time of diagnosis was locally advanced disease (FIGO) in 14,782 women (68.5%), followed by early disease in 5,286 patients (24.5%) and advanced disease in 1488 women, corresponding to 6.9% ( 8 ). Among 346 CC patients treated at an oncology hospital, more than half of the women did not have a formal job (57%), two-thirds of the women had social security through a family member or their retirement, and 32% had social security coverage through their employment.…”

“…It can be inferred from the shortage in oncological infrastructure that not all CC patients are treated effectively and on time. Despite those caveats, it can be suggested that the outcomes of patients in Mexico treated for invasive CC are within the expected, according to a recent study ( 8 ). To place this study in perspective, currently, the population with no Employment-based Social Security Services in Mexico is 37.7%, and the goals of the current Federal Administration are to cover this population with medical services via the IMSS-Bienestar subsystem.…”

“…The FPGC provided monetary resources through a trust to accredited service providers (public and private) at the country level to care for 66 high-cost diseases, including CC, from 2005 to 2018. The study reported the treatment outcome of 38,187 women with CC from 2006 to 2014 covered by FPGC ( 8 ). For this analysis, the survival analysis was done in 25,556 women only as 16,619 were excluded (12 with poor-prognosis histology, 8,544 preinvasive diseases, 1,130 recurrent or progression, 1,619 unconfirmed diagnoses, 2,284 and 3,043 had no 5-year follow-up because data on deaths were available until 2019).…”

RIPOR2 Expression Decreased by HPV-16 E6 and E7 Oncoproteins: An Opportunity in the Search for Prognostic Biomarkers in Cervical Cancer

“…In developing countries, such as Mexico, a high proportion of CC cases are diagnosed in advanced clinical stages, resulting in lower survival and a high mortality rate [ 8 ], which is largely due to the lack of effective cervical cancer screening programs. In Mexico, more than 70% of cervical cancer patients are detected in locally advanced or advanced stages [ 9 ], while the overall survival (OS) worsens as the clinical stage progresses [ 10 ]. Disease characteristics related to clinical stages, such as tumor size, lymph node infiltration, and distant metastasis, are related to patient survival; however, not all patients with the same clinical stage have the same outcome.…”