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