Statistics indicate that in the last decade colorectal cancer has presented a progressive rise in terms of incidence, prevalence and mortality in Chile. Likewise, and as an aggravating circumstance, there is a geographic and socioeconomic gradient that determines a worse survival in more vulnerable sectors and with less access to health.
A study of Dr. Camila Estay, Gastroenterologist at the Hospital Clínico Universidad de Chilesoon to be published in international scientific journals PLOS ONE and Lancet Oncologyawarded as the best research paper in the Chilean Congress of Gastroenterology 2021 of the Chilean Society of Gastroenterology (SChGE)reveals worrying differences in colorectal cancer survival in our country, of 65% at 5 years in Isapre, versus 39% in Fonasa patients.
For its author, «the objective of the work was to obtain updated statistics on the incidence, prevalence and mortality of colon cancer in Chile, using an innovative methodology crossing databases of hospital discharges and deaths. As secondary objectives, it was established to search for sociodemographic factors that could influence the incidence, prevalence and survival of colorectal cancer.
The study concluded that in In the last decade, colorectal cancer has presented a progressive rise in terms of incidence, prevalence and mortality in Chile. Likewise, and as an aggravating circumstance, there is a geographic and socioeconomic gradient that determines a worse survival in more vulnerable sectors and with less access to health.
“To date, the GES program has not been shown to improve 5-year colon cancer survival, and this may be explained by the lack of resource targeting and the absence of a prevention program for this cancer,” explains Dr. Estay.
The crude incidence rate of colon cancer in women in 2018 was 27.8 per 100,000 inhabitants and in men it was 29.2/100,000, with a 38% increase between 2009 and 2018.
According to the Cancer Observatory of the World Health Organization, Globocan, there is no ranking by country in terms of incidence of colorectal cancer, but with respect to the different regions, Chile is below Europe, Australia, New Zealand , East Asia and North America. It has the highest adjusted incidence in the region in Latin America, Polynesia, Africa, and Asia excluding East Asia.
In Chile there are a total of 3.7 million people affiliated with isapres, while 14.8 million inhabitants belong to Fonasa (December 2021). For Dr. Camila Estay, this study has the main strength that is made up of a multidisciplinary team between mathematicians and doctors, which established a new type of methodology to identify patients and individualized follow-up for hospital discharges, which which is innovative in this type of study.
“It also constitutes a diagnostic study that makes it possible to make visible the Chilean reality regarding colon and rectal cancer. By showing that 5-year survival in ISAPRE is comparable to developed countries, it should make us think about the reasons that cause this inequity, which is part of a second study currently underway.
The gaps that exist with respect to differences in access to health depending on geography, infrastructure, human capital and individual socioeconomic conditions determine changes in survival and emphasis should be placed on improving it. The latter also include a higher frequency of comorbidities, poorer baseline health status and an unhealthy lifestyle”, the specialist pointed out.
Dr. Estay adds that improvements to the health system should focus efforts on what determines mortality, which is the stage of cancer at the time of diagnosis. For this, it is essential and necessary to establish prevention and screening policies, currently non-existent at the country level, that allow cancer to be diagnosed at an earlier stage. She specifies that: “although in industrialized countries the incidence of colorectal cancer is high, since the implementation of screening programs it has been possible to stabilize and even reduce mortality.
In this sense, the current GES program is useful, but it does not include prevention. In Chile, the Program for the Prevention of Colorectal Neoplasms (PRENEC) implemented for a few years starting in 2011 in certain public hospitals, managed to demonstrate that focused screening manages to diagnose early cancer, even allowing its resolution via endoscopy”.
The specialist also highlighted the need to improve and strengthen the training of gastroenterologists, endoscopists and coloproctologists, which will improve coverage at the national level, ensure that the centers have the technical and human capacity to meet the demands of the population. And finally, the public health system requires the implementation of educational programs focused on healthy lifestyles, including diet, exercise and warning signs for which it should be consulted early.
The study was developed jointly with professionals Zoltan Berger, Felipe Subiabre, Natalia Yankovic, Susana Mondschein and Christian von Mühlenbrock.
