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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
EPIDEMIOLOGICAL NOTE
BREAST CANCER SCREENING
CHALLENGES / PROPOSALS
EPIDEMIOLOGICAL NOTE
BREAST CANCER SCREENING
CHALLENGES / PROPOSALS
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
MORTALITY OF BREAST CANCER IN SELECTED COUNTRIES
Source: WHO, Globocan 2008
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
MAMMOGRAPHY EQUIPMENT IN MEXICO PUBLIC SECTOR, 2008
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
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
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
MEDICAL CARE IN MEXICO SOCIAL SECURITY (90%-95%)
MEDICAL CARE IN MEXICO SOCIAL SECURITY (90%-95%)
40%
7%
45%
3%
1943-
2003-
1959-
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
CONFORMAL RT / PET-CT CONFORMAL RT / PET-CT
DIAGNOSIS AND TREATMENTDIAGNOSIS AND TREATMENT(NCCN / ST. GALLEN)(NCCN / ST. GALLEN)
SBRHR / HER-2
SURGERY
RADIOTHERAPYHORMONE-THTX / AI
NEO / ADY CHTTARGET / MAB?
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
What is not happeningWhat is not happening……
Early DxTXFollow-up
UNEMES (MEDICAL UNITS) ALGORITHM
MAMMOGRAM & SEND FOR READING
• “FRIENDLY” MAMMOGRAM• READ ON TIME • US / DIAGNOSIS• BIOPSY
• FINAL DIAGNOSIS• TREATMENT AND
CONTROL
PATHOLOGISTRADIOLOGIST
SURGEONONCOLOGIST
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
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
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
PROJECT / LAEDIPROJECT / LAEDI--BRACABRACA
T h a n k y o uwww.incan.edu.mx
T h a n k y o uwww.incan.edu.mx
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