2023-12-14 13:00:37
Although people change their lifestyle to prevent it, cancer is a disease whose presence in Latin America will increase. This argument was reached by epidemiologist Joaquín Barnoya, a member of Guatemala Saludable and the Integra Cancer Institute, who was part of the team of 60 specialists and civil society that developed the first Latin American and Caribbean Code against Cancer, which took two years to prepare. and was launched last October.
A panorama based on the fact that the main risk factor is age, and in the region life expectancy is increasing, to the point that by 2040 the disease would increase by 64%.
Guatemala lacks statistical data about how much of the population has cancer to, with evidence, give recommendations on how to address the disease from the health system, both public and private, says Barnoya. The closest data are those presented by the World Cancer Observatory, with an estimate for 2020 of almost 15 thousand new cases.
Among women, breast cancer ranks first, followed by cervical and liver cancer. While among the male population, those that most affect are the prostate, liver and stomach.
How important is it for countries to have specific control of cancer cases?
This code emphasizes the need to collect mortality and new cancer cases at the population level, because the little data there is is at the hospital level. It should be a call to the Ministry of Health to launch a population-based cancer registry; there was already a bill to establish it, but unfortunately it was not followed up.
Care for cancer patients in countries like Guatemala is limited. How can we expand diagnosis and treatment coverage?
In the code there are 17 recommendations at the individual level – stop smoking, maintain a healthy weight, not expose yourself to excessive sunlight, among others – and 17 recommendations at the public policy level, since there are actions that are essential for the person. difficult to do, but by making them a public policy it becomes easier to change behavior.
For example, in the Congress of the Republic there is initiative 5504, a law to promote healthy eating, which includes placing a label on ultra-processed foods, high in fat, sugar and sodium. The policy has already been implemented in Mexico, Chile, Argentina and the consumption of these foods has decreased, but in the country it has been stuck since 2018. There is also 5461, the law on the control of tobacco and its derivatives, which includes putting warning labels on cigarettes, increase the tobacco tax. They are public policies for direct cancer control.
On the other hand, from the point of health services we ensure that there are screening tests. But it is not just about taking the exam, because it is useless if it is not followed up. That is one of the problems in Guatemala.
Clear guidelines must be established on who to do the exam and who not to, and this has to be regulated by the Ministry of Health and in private practice.
In Guatemala, is that part deficient?
The Health System is there to provide health services once the disease is diagnosed and provide treatment.
In Guatemala there is a gap in health coverage, where the majority have access to very few services, including early diagnostic tests, and once diagnosed, quality and continuous treatment.
Cancer is a marathon, it is not like tonsillitis or pharyngitis, these are treatments that last years and are traumatic, and the patient must be followed up. This must be multidisciplinary, with specialist doctors, surgeons, oncologists, nutritionists and psychologists.
A health system, then, has to be strengthened because, even if all the factors are controlled, cancer is going to increase, we are not going to get rid of that epidemic. If the problem was already complicated, the two years of the covid-19 pandemic only accelerated it.
Guatemalan epidemiologist Joaquín Barnoya, member of Guatemala Saludable and the Integra Cancer Institute. (Free Press Photo: Courtesy)
How should case detection be?
As we are living longer, there will be more cases of cancer and some cancers occur at an early age, and generally, these are more aggressive.
Screening, early detection, is not one for all, it will depend on the clinical history of each patient. It is important that it be explained to the population, that the health services be approached, but they must be trained to say whether or not there is a risk of cancer, and to proceed with the examinations.
Well, early detection exams are abused in people who do not have a high risk of cancer, either because they are very young or because they do not have a family history of the disease. Mammography has been particularly abused, especially in the private sector. Also screening for early detection of prostate and colon cancer.
It is very clear that some patients are going to benefit from these early detection tests, but there are others who will not, that has to be a discussion with the patient.
Does it then depend on the patient’s medical history to know whether or not they need these tests?
Yes, first you have to do an interview and a risk profile is created. Yes, you do not meet all the risk conditions for cancer, for example, breast cancer, you do not merit a mammogram right now. But if risk is detected, then it is justified, but first you have to tell the patient to stop smoking, do a little exercise, lose weight and alcohol (risk factors).
This is not a mechanics shop, where every 10 thousand km you have to change pads. No, this has to be a discussion with the patient and before doing an extensive interrogation to define what her profile is.
Is this code intended to provide recommendations to prevent cancer according to the specific context of each country?
That was one of the objectives, that we also recognized that this is a complex Guatemala, that cancer between indigenous and ladino populations is not the same. For example, how do I explain to a woman in Cakchiquel that her risk of cervical cancer is greater than her risk of breast cancer, or to the urban woman of a high socioeconomic level that she has a higher risk of breast cancer than cancer? of cervix.
The code is clear that each country has to recognize that it is multiethnic and be sensitive to that holistic or multicultural approach to the disease, and differentiate between urban and rural. Of course, the code makes it clear that governments have to first recognize that there is a cancer problem, and there are individual and collective measures to control it, and it can also be adapted depending on whether it is an urban or rural population.
We have seen that this is a patched health system, which does not respond to a multidisciplinary approach, we speak from prevention -avoiding risk factors-, early detection -performing examinations, such as mammography-, and then providing treatment and comprehensive treatment.
The 17 recommendations included in the code to prevent cancer
Do not smoke or use any type of tobacco. Make your home smoke-free. Maintain or achieve a healthy weight. Do physical activity daily. Limit the time you spend sitting. Eat a healthy diet, eat more fruits, vegetables and whole grains. Avoid sugary drinks, limit consumption of ultra-processed foods, avoid processed meat, and limit consumption of very hot beverages. Avoid the consumption of alcoholic beverages. Breastfeed, the more months the better. Protect yourself from direct sun exposure. If you cook with charcoal or wood, avoid the accumulation of smoke inside your home. If there is high air pollution in your environment, limit the time you spend outdoors. Find out if your work exposes you to substances that can cause cancer, demand and adopt recommended protective measures. Bacterial infection Helicobacter pylori can cause stomach cancer. Virus infections: hepatitis B and C, human papillomavirus (HPV), and acquired immunodeficiency virus (HIV) can also cause cancer. Do not use hormone replacement therapies during menopause unless medically indicated. If you are between 50 and 74 years old, get an early detection test for colon and rectal cancer. If you are 40 years old or older, have a clinical breast exam every two years. From age 50, a mammogram. If you are between 30 and 64 years old, get an HPV test at least every 5 to 10 years to screen for cervical cancer.
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