By Dr. Blanca Norero, director of the Chilean Association of Hepatology (ACHHEP), a subsidiary of the Chilean Society of Gastroenterology
In Chile, more than 50% of the causes of mortality are attributed to cardiovascular events and cancer. Among the latter, the most frequent in our country (GLOBOCAN source) in 2021, is the prostate, followed by breast, colorectal, lung and stomach. Regarding mortality, lung cancer has the first place followed by colorectal, prostate, breast and stomach. An alarming reality, without a doubt, but never paralyzing.
These indicators, beyond putting us on alert, are a call to action: doctors to sharpen our health surveillance, society to improve their preventive habits and behaviors, and the State to improve public policies.
Within digestive cancers, there is concern about the increase in the incidence and mortality of colorectal cancer in our country in recent years. For a long time, Chile presented a high incidence and mortality rate of stomach cancer, however, in 2020 and 2021 it decreased, possibly thanks to greater access to endoscopic studies, greater access to GES therapies for the eradication of Helicobacter pylori and treatment already diagnosed patients.
On the other side, colorectal cancer is on the rise and its main risk factors are associated with greater economic development in our country, including a low-fiber diet, high prevalence of type 2 diabetes, high alcohol consumption and smoking, high obesity rates and family history of colorectal cancer.
Colorectal cancer is a GES pathology, but still has a high mortality. This is probably explained by the advanced stage in which many patients are diagnosed, which is why it is important to speed up their diagnosis through colonoscopy, a procedure with limited access in Chile.
If colorectal cancer is our priority, it is important to warn about the liver cancer in the country, given that hepatocarcinoma occurs in patients with some chronic liver pathology, the main ones being fatty liver associated with metabolic syndrome, chronic alcohol consumption and chronic viral hepatitis. Although figures for 2021 (GLOBOCAN) place it third among the most frequent digestive cancers, it represents the third in mortality.
Recent figures from the WHO predict an increase of over 55% by the year 2040, both in incidence and mortality, although what is worrisome is that the figures for cancer in Chile may be under-reported, since it is a cancer that is rarely diagnosed by biopsy. . So it would not be surprising if the real indicators of hepatocellular carcinoma are even higher.
An aggravating factor is that these patients usually have chronic liver damage and the cause of death may be registered as liver disease and not as cancer. Therefore, not only is there a need for better coverage for patients with hepatocarcinomaand We hope that in the future there will be GES guaranteesbut also public health policies are developed to try to contain this alarming prediction.