Enrique Soto-Perez-de-Celis

Trends in Cervical Cytology Test Reports and Cervical Dysplasia Severity according to Social Deprivation in Mexico (2013–2019): An Analysis of a National Database

Abstract Background: Cervical cancer is a leading cause of cancer-related mortality in women living in low- and middle-income countries such as Mexico. Preventive and screening programs are often inaccessible to socially deprived populations, whose limited access to timely diagnosis and treatment reduces the chance of detecting premalignant lesions early. Methods: Cervical malignant and premalignant lesion positivity rates were analyzed from 2013 to 2016 using the Bethesda system, whereas human papillomavirus (HPV) positivity rates were analyzed from 2017 to 2019. Both were stratified according to state-level Social Deprivation Indices in Mexico, published by the National Council for the Evaluation of Social Development Policy. The data originated from the four main healthcare providers in Mexico. Data processing and statistical analyses were performed using Joinpoint Regression Software and SPSS version 25. Results: Positivity rates for dysplasia and atypia varied across social deprivation levels. A downward trend in premalignant lesion positivity rates was observed. This varied across social deprivation groups, with differing annual percentage changes (APC). The greatest decrease occurred in high-grade cervical intraepithelial dysplasia (CIN 2–3) in states with very high social deprivation, with an estimated APC of −22.1% (−30% to −14.7%; P = 0.001). HPV positivity by PCR ranged from 11% to 24% between 2017 and 2019. The estimated APC for invasive cervical carcinoma was −22.3% [95% confidence interval (CI); −54.4% to 19.8%], which was not statistically significant (P = 0.223). Conclusions: Our study highlights a decline in cervical dysplasia positivity rates. These declines were uneven across social deprivation levels. Impact: Reducing health inequities is essential to prevent, detect, and treat cervical cancer and its precursors.

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.