experience-exchange for developing country …
TRANSCRIPT
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EXPERIENCE-EXCHANGE FOR DEVELOPING COUNTRY INITIATIVESLatin America & Caribbean, the Case of Mexico
Dr. Alejandro Mohar
EXPERIENCEEXPERIENCE--EXCHANGE FOR DEVELOPING COUNTRY INITIATIVESEXCHANGE FOR DEVELOPING COUNTRY INITIATIVESLatin America & Caribbean, the Case of MexicoLatin America & Caribbean, the Case of Mexico
Dr. Alejandro MoharDr. Alejandro Mohar
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EPIDEMIOLOGICAL NOTE
BREAST CANCER SCREENING
CHALLENGES / PROPOSALS
EPIDEMIOLOGICAL NOTE
BREAST CANCER SCREENING
CHALLENGES / PROPOSALS
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EPIDEMIOLOGICAL TRANSITION IN MEXICO, MORTALITY 1EPIDEMIOLOGICAL TRANSITION IN MEXICO, MORTALITY 1
*
1922 1930 1940 1950 1960 1970 1980 1990
YEAR
0.1
1
10
100
1000
RATE
PER 105
**
*
*
****
DIARRHEA
ACCIDENTS
CARDIOVASC.
CANCER
DIABETES
PERINATAL
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MORTALITY OF BREAST CANCER IN SELECTED COUNTRIES
Source: WHO, Globocan 2008
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Tendencia de la Mortalidad por Cáncer de Mama en Mujeres, Según Grupo de Edad. México 1980-2006
0
10
20
30
40
50
60
80 81 82 83 84 85 86 87 88 90 91 92 93 94 96 97 98 99 '01 '02 '03 '04 '05 '06
40-49 50 - 59 60 - 69 70+
R A T E
AGE GROUP* por 100 mil mujeres
INCREASE
+65.1%
+43.3%
+59.6%
+45.7%
MORTALITY TREND OF BREAST CANCER IN MEXICO, MORTALITY TREND OF BREAST CANCER IN MEXICO, BY AGE GROUP MEXICO 1980BY AGE GROUP MEXICO 1980--20062006
20,000 NEW CASES5,000 DEATHS
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MAMMOGRAPHY EQUIPMENT IN MEXICO PUBLIC SECTOR, 2008
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Source: Health at a Glance 2007: OECD Indicators. Health Care Resources and Utilisation. 4-7. Medical technologies ( http://bit.ly/ioQzL )
NUMBER OF MAMMOGRAPHY MACHINESNUMBER OF MAMMOGRAPHY MACHINES
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Estimaciones de la Cobertura de Detección por Mastografía en la Secretaría de Salud 2007
YEAR
MAMMOGRAMS, NUMBER, COVERAGE (%) SUMMARY
≥40 45 – 64 50 – 69 45 – 64 (%)
50 – 69 (%)Núm (%) Núm (%) Núm (%)
2003 99,978 1.7% 72,514 2.2% 57,917 2.3% 3.1% 3.9%
2004 136,709 2.2% 94,042 2.8% 71,102 2.7% 4.1% 5.1%
2005 172,397 2.6% 112,558 3.2% 78,165 2.8% 4.9% 6.2%
2006 206,602 3.1% 122,970 3.4% 84,147 2.9% 5.7% 7.1%
2007 223,573 3.2% 133,473 3.5% 91,330 3.0% 5.9% 7.4%
SOURCE: SICAM e Informe de Entidades Federativas
ESTIMATES OF COVERAGE FOR BREASTCANCER ESTIMATES OF COVERAGE FOR BREASTCANCER WITH MAMMOGRAPHY, MINISTRY OF HEALTH, 2007WITH MAMMOGRAPHY, MINISTRY OF HEALTH, 2007
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78
158
402 418
489
574
291
0
100
200
300
400
500
600
0 I IIa IIb IIIa IIIb IV
CLINICAL STAGE DISTRIBUTION, 2008CLINICAL STAGE DISTRIBUTION, 2008
SOURCE: CNEGySR
FULL TREATMENT BY SEGURO POPULAR N=2,410
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MEDICAL CARE IN MEXICO SOCIAL SECURITY (90%-95%)
MEDICAL CARE IN MEXICO SOCIAL SECURITY (90%-95%)
40%
7%
45%
3%
1943-
2003-
1959-
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Instituto Instituto NacionalNacional
dedePsiquiatrPsiquiatrííaaRamRamóón de n de la Fuentela Fuente
Instituto Instituto NacionalNacional
dedeCancerologCancerologííaa
Instituto Instituto NacionalNacional
dedeCardiologCardiologííaa
Instituto Instituto NacionalNacional
dedeEnfermedadesEnfermedadesRespiratoriasRespiratorias
Instituto Instituto NacionalNacional
dedeNeurologNeurologííaa
yyNeurocirugNeurocirugííaa
Instituto Instituto NacionalNacional
dedePediatrPediatrííaa
Instituto Instituto NacionalNacional
dedePerinatologPerinatologííaa
Instituto Instituto NacionalNacional
dedeSalud Salud PPúúblicablica
Instituto Instituto NacionalNacional
dedeNutriciNutricióónn
HospitalHospitalInfantilInfantil
dedeMMééxicoxico
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CONFORMAL RT / PET-CT CONFORMAL RT / PET-CT
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DIAGNOSIS AND TREATMENTDIAGNOSIS AND TREATMENT(NCCN / ST. GALLEN)(NCCN / ST. GALLEN)
SBRHR / HER-2
SURGERY
RADIOTHERAPYHORMONE-THTX / AI
NEO / ADY CHTTARGET / MAB?
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OUTPATIENT CLINICOUTPATIENT CLINICOUTPATIENT CLINIC
DAILY
• ~800 Consults in 60 offices
• ~300 patients to RT
• 100 sessions of CHT
• 12-15 surgeries
DAILY
• ~800 Consults in 60 offices
• ~300 patients to RT
• 100 sessions of CHT
• 12-15 surgeries
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What is not happeningWhat is not happening……
Early DxTXFollow-up
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UNEMES (MEDICAL UNITS) ALGORITHM
MAMMOGRAM & SEND FOR READING
• “FRIENDLY” MAMMOGRAM• READ ON TIME • US / DIAGNOSIS• BIOPSY
• FINAL DIAGNOSIS• TREATMENT AND
CONTROL
PATHOLOGISTRADIOLOGIST
SURGEONONCOLOGIST
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UNEMES FOR EARLY DETECTION AND DIAGNOSIS OF BREAST CANCER
UNEMES DACMA
Ags 1Baja California 1Baja California
Sur 1Campeche 1Coahuila 1Colima 1Chiapas 2
Chihuahua 1Distrito Federal 2
Durango 1Guanajuato 2
Guerrero 2Hidalgo 1Jalisco 2México 4
Michoacán 2Morelos 1Nayarit 1
Nuevo León 1Oaxaca 2Puebla 2
Querétaro 1Quintana Roo 1
San Luis Potosí 1Sinaloa 1Sonora 1
Tabasco 1Tamaulipas 1
Tlaxcala 1Veracruz 3Yucatán 1
Zacatecas 1TOTAL 45
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Hospital 2 Hospital 4
DATA BASE
NCI-MEXHospital 1 Hospital 3
INTERNET- 2
INTERNET- 2
HIGH RESOLUTION STATIONS MAMMOGRAPY READING
INTERNET-2
CD
MASTOGRAFÍA RED2. MAMMOGRAPHY NETWORK
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CHALLENGES / PROPOSALSCHALLENGES / PROPOSALS
HUMAN RESOURCES BREAST RADIOLOGISTS (104) & OTHERS
QUALITY CONTROL
REFERRAL ON TIME EARLY & LATE (COSTS $5,000 - $50,000) FIRSTSECOND
FOLLOW-UP
AWARENESS & EDUCATION
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PROJECT / LAEDIPROJECT / LAEDI--BRACABRACA
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T h a n k y o uwww.incan.edu.mx
T h a n k y o uwww.incan.edu.mx