Alejandro Mohar-Betancourt

Uptake of Risk-Reducing Surgeries in an International Real-World Cohort of Hispanic Women

PURPOSE Women with pathogenic variants (PVs) in breast cancer (BC) and ovarian cancer (OC) associated genes are candidates for cancer risk-reducing strategies. Limited information is available regarding risk-reducing surgeries (RRS) among Hispanics. The aim of this study was to describe the uptake of RRS in an international real-world experience of Hispanic women referred for genetic cancer risk assessment (GCRA) and to identify factors affecting uptake. METHODS Between July 1997 and December 2019, Hispanic women, living in the United States or in Latin America, enrolled in the Clinical Cancer Genomics Community Research Network registry were prospectively included. Demographic characteristics and data regarding RRS were obtained from chart reviews and patient-reported follow-up questionnaires. Median follow-up was 41 months. RESULTS Among 1,736 Hispanic women referred for GCRA, 27.2% women underwent risk-reducing mastectomy (RRM), 25.5% risk-reducing salpingo-oophorectomy (RRSO) and, 10.7% both surgeries. Among BRCA carriers, rates of RRM and RRSO were 47.6% and 56.7%, respectively. In the multivariate analyses, being a carrier of a BC susceptibility gene (odds ratio [OR], 3.44), personal history of BC (OR, 6.22), living in the US (OR, 3.90), age ≤50 years (OR, 1.68) and, family history of BC (OR, 1.56) were associated with a higher likelihood of undergoing RRM. Carrying an OC susceptibility gene (OR, 6.72) was associated with a higher likelihood of undergoing RRSO. CONCLUSION The rate of RRS among Hispanic women is suboptimal. PV carriers, women with personal history of cancer, and those with a family history of cancer were more likely to have RRS, with less uptake outside the US. Understanding personal and systemic factors influencing uptake may enable interventions to increase risk appropriate uptake of RRS.

Assessing disparities in cancer resources distribution in Mexico

Abstract Background Given the rising cancer burden, the capacity of Mexico’s healthcare system to effectively address cancer care through its current available infrastructure becomes increasingly critical. Limited availability of diagnostic and therapeutic infrastructure leads to delays in diagnosis and treatment. Countries like Mexico, should undertake comprehensive assessments of infrastructure and human resources available for cancer, including its quantification and geolocation, to understand the service gaps. This study seeks to map oncological infrastructure in Mexico in five types of cancer: breast, lung, prostate, colon, and cervix. Methods Through a realist evaluation of publicly available databases from the High Specialty Medical Equipment National Inventory and the General Direction of Health Information, a comprehensive identification and classification of cancer resources was conducted with the intended outcome to map cancer care infrastructure in Mexico. Guided by the literature, resources necessary for diagnosis and treatment were selected by an expert consensus. Thereafter, facilities were classified by service scope into either diagnostic or diagnostic and therapeutic, and by infrastructure level into core or enhanced and then mapped geographically. Results From N = 14,133 unique healthcare facilities that deliver any type of healthcare, only 5% provided cancer care. Cancer-specific infrastructure that can provide diagnosis and treatment at the national level included N = 10 brachytherapy, N = 11 cobalt-60, N = 21 linear particle accelerators and N = 188 operating rooms. Five issues were found: (1) low availability of core therapeutic infrastructure across all cancer types; (2) regional and national centralization of available therapeutic infrastructure for all cancer types, whilst no centralization found in diagnostic resources; (3) inconsistent allocation of resources in densely populated areas; (4) infrastructure disparities per cancer type i.e., Lung, prostate, and breast cancer require significant investments in diagnostic infrastructure compared to cervical and colon cancer, and (5) lack of precise and updated infrastructure data from the public health system that requires either new codes or subcodes. Conclusions Addressing disparities in cancer resources distribution in Mexico is a dual imperative—ensuring equity while seizing an opportunity to fortify the overall health system for people without social security coverage.