Publications by authors named "Marion Piñeros"

63 Publications

Cervical cancer in the Newly Independent States of the former Soviet Union: Incidence will remain high without action.

Cancer Epidemiol 2021 May 8;73:101944. Epub 2021 May 8.

Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France.

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http://dx.doi.org/10.1016/j.canep.2021.101944DOI Listing
May 2021

Global estimates of expected and preventable cervical cancers among girls born between 2005 and 2014: a birth cohort analysis.

Lancet Public Health 2021 Apr 14. Epub 2021 Apr 14.

Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer (IARC/WHO), Lyon, France. Electronic address:

Background: WHO has launched an initiative aiming to eliminate cervical cancer as a public health problem. Elimination is a long-term target that needs long-lasting commitment. To support local authorities in implementing human papillomavirus (HPV) vaccination, we provide regional and country-specific estimates of cervical cancer burden and the projected impact of HPV vaccination among today's young girls who could develop cervical cancer if not vaccinated.

Methods: The expected number of cervical cancer cases in the absence of vaccination among girls born between 2005 and 2014 was quantified by combining age-specific incidence rates from GLOBOCAN 2018 and cohort-specific mortality rates by age from UN demographic projections. Preventable cancers were estimated on the basis of HPV prevalence reduction attributable to vaccination and the relative contribution of each HPV type to cervical cancer incidence. We assessed the number of cervical cancer cases preventable through vaccines targeting HPV types 16 and 18, with and without cross-protection, and through vaccines targeting HPV types 16, 18, 31, 33, 45, 52, and 58.

Findings: Globally, without vaccination, the burden of cervical cancer in these birth cohorts is expected to reach 11·6 million (95% uncertainty interval 11·4-12·0) cases by 2094. Approximately 75% of the burden will be concentrated in 25 countries mostly located in Africa and Asia, where the future number of cases is expected to increase manyfold, reaching 5·6 million (5·4-6·0) cases in Africa and 4·5 million (4·4-4·6) cases in Asia. Worldwide immunisation with an HPV vaccine targeted to HPV types 16 and 18, with cross-protection against HPV types 31, 33, and 45, could prevent about 8·7 million (8·5-9·0) cases.

Interpretation: Detailed estimates of the increasing burden of cervical cancer and projected impact of HPV vaccination is of immediate relevance to public health decision makers. Shifting the focus of projections towards recently born girls who could develop cervical cancer if not vaccinated is fundamental to overcome stakeholders' hesitancy towards HPV vaccination.

Funding: Bill & Melinda Gates Foundation, Canadian Institutes of Health Research.
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http://dx.doi.org/10.1016/S2468-2667(21)00046-3DOI Listing
April 2021

Cancer statistics for the year 2020: An overview.

Int J Cancer 2021 Apr 5. Epub 2021 Apr 5.

Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon Cedex, France.

Our study briefly reviews the data sources and methods used in compiling the International Agency for Research on Cancer (IARC) GLOBOCAN cancer statistics for the year 2020 and summarises the main results. National estimates were calculated based on the best available data on cancer incidence from population-based cancer registries (PBCR) and mortality from the World Health Organization mortality database. Cancer incidence and mortality rates for 2020 by sex and age groups were estimated for 38 cancer sites and 185 countries or territories worldwide. There were an estimated 19.3 million (95% uncertainty interval [UI]: 19.0-19.6 million) new cases of cancer (18.1 million excluding non-melanoma skin cancer) and almost 10.0 million (95% UI: 9.7-10.2 million) deaths from cancer (9.9 million excluding non-melanoma skin cancer) worldwide in 2020. The most commonly diagnosed cancers worldwide were female breast cancer (2.26 million cases), lung (2.21) and prostate cancers (1.41); the most common causes of cancer death were lung (1.79 million deaths), liver (830000) and stomach cancers (769000).
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http://dx.doi.org/10.1002/ijc.33588DOI Listing
April 2021

The role and utility of population-based cancer registries in cervical cancer surveillance and control.

Prev Med 2021 Mar 4;144:106237. Epub 2021 Mar 4.

Cancer Surveillance Section, International Agency for Research on Cancer, Lyon, France.

Population-based cancer registries (PBCR) are vital to the assessment of the cancer burden and in monitoring and evaluating national progress in cervical cancer surveillance and control. Yet the level of their development in countries exhibiting the highest cervical cancer incidence rates is suboptimal, and requires considerable investment if they are to document the impact of WHO global initiative to eliminate cervical cancer as a public health problem. As a starting point we propose a comprehensive cancer surveillance framework, positioning PBCR in relation to other health information systems that are required across the cancer control continuum. The key concepts of PBCR are revisited and their role in providing a situation analysis of the scale and profile of the cancer-specific incidence and survival, and their evolution over time is illustrated with specific examples. Linking cervical cancer data to screening and immunization information systems enables the development of a comprehensive set of measures capable of assessing the short- and long-term achievements and impact of the initiative. Such data form the basis of national and global estimates of the cancer burden and permit comparisons across countries, facilitating decision-making or triggering cancer control action. The initiation and sustainable development of PBCR must be an early step in the scale-up of cervical cancer control activities as a means to ensure progress is successfully monitored and appraised.
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http://dx.doi.org/10.1016/j.ypmed.2020.106237DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7957339PMC
March 2021

Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study.

Lancet Oncol 2021 03 5;22(3):361-369. Epub 2021 Feb 5.

Cancer Surveillance Branch, International Agency for Research on Cancer, Lyon, France. Electronic address:

Background: Screening for breast cancer and cervical cancer in the newly independent states of the former Soviet Union is largely opportunistic, and countries in the region have among the highest cervical cancer incidence in the WHO European Region. We aimed to compare the stage-specific distributions and changes over time in breast cancer and cervical cancer incidence in the newly independent states of the former Soviet Union.

Methods: We collected breast cancer and cervical cancer incidence data from official statistics from Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Republic of Moldova, Russian Federation, Ukraine, and Uzbekistan for the years 2008-17 by tumour, node, metastasis (TNM) stage, and by age where population-based cancer registry data were available. We used log-linear regression to quantify the changes over time in age-standardised rates.

Findings: During the period 2013-17, more than 50% of breast cancer cases across the analysed countries, and more than 75% of breast cancer cases in Belarus, Kazakhstan, and Ukraine, were registered at stages I-II. The proportion of stage I breast cancer cases was highest in the screening age group (50-69 years) compared with other ages in Moldova and the Russian registries, but was highest in those aged 15-49 years in Georgia and Ukraine. Breast cancer stage-specific incidence rates increased over time, most prominently for stage I cancers. For cervical cancer, the proportions of cancers diagnosed at a late stage (stages III and IV) were high, particularly in Moldova and Armenia (>50%). The proportion of stage I cervical cancer cases decreased with age in all countries, whereas the proportions of late stage cancers increased with age. Stage-specific incidence rates of cervical cancer generally increased over the period 2008-17.

Interpretation: Our results suggest modest progress in early detection of breast cancer in the newly independent states of the former Soviet Union. The high proportions of early-stage disease in the absence of mammography screening (eg, in Belarus) provide a benchmark for what is achievable with rapid diagnosis. For cervical cancer, there is a need to tackle the high burden and unfavourable stage-specific changes over time in the region. A radical shift in national policies away from opportunistic screening toward organised, population-based, quality-assured human papillomavirus vaccination and screening programmes is urgently needed.

Funding: Union for International Cancer Control, WHO Regional Office for Europe, and Ministry of Health of Ukraine.
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http://dx.doi.org/10.1016/S1470-2045(20)30674-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8014987PMC
March 2021

Progress, challenges and ways forward supporting cancer surveillance in Latin America.

Int J Cancer 2021 Jul 14;149(1):12-20. Epub 2020 Dec 14.

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Population-based cancer registries (PBCRs) are the only means to provide reliable incidence and survival data as a basis for policy-making and resource allocations within cancer care. Yet, less than 3% and 10% of the respective populations of Central America and South America are covered by high-quality cancer registries. The Global Initiative for Cancer Registry Development provides support to improve this situation via the International Agency for Research on Cancer Regional Hub for Latin America. In this paper, we summarize activities (advocacy, technical assistance, training and research) over the last 5 years, their impact and current challenges, including the implementation of new PBCR in four countries in the region. Despite the favorable political support to cancer registration in many countries, the sustainability of cancer registration remains vulnerable. Renewed efforts are needed to improve data quality in Latin America while ensuring maximum visibility of the data collected by disseminating and promoting their use in cancer control.
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http://dx.doi.org/10.1002/ijc.33407DOI Listing
July 2021

Scaling Up the Surveillance of Childhood Cancer: A Global Roadmap.

J Natl Cancer Inst 2021 Jan;113(1):9-15

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

The World Health Organization recently launched the Global Initiative for Childhood Cancer aiming to substantially increase survival among children with cancer by 2030. The ultimate goal concerns particularly less developed countries where survival estimates are considerably lower than in high-income countries where children with cancer attain approximately 80% survival. Given the vast gap in high-quality data availability between more and less developed countries, measuring the success of the Global Initiative for Childhood Cancer will also require substantial support to childhood cancer registries to enable them to provide survival data at the population level. Based on our experience acquired at the International Agency for Research on Cancer in global cancer surveillance, we hereby review crucial aspects to consider in the development of childhood cancer registration and present our vision on how the Global Initiative for Cancer Registry Development can accelerate the measurement of the outcome of children with cancer.
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http://dx.doi.org/10.1093/jnci/djaa069DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7781445PMC
January 2021

Cervical cancer burden in Latin America and the Caribbean: Where are we?

Int J Cancer 2020 09 9;147(6):1638-1648. Epub 2020 Apr 9.

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

In May 2018, the World Health Organization (WHO) called for the elimination of cervical cancer. To monitor this initiative, we examined cervical cancer incidence and mortality in the Latin America and Caribbean (LAC) region using GLOBOCAN 2018, Cancer Incidence in Five Continents Series, and the WHO Mortality Database. We estimated the number of cases and age-standardized rates (ASRs) for cervical cancer incidence and mortality for 2018. We also presented the ASRs for recorded cervical cancer incidence from the period 2008 to 2012. We calculated annual rates and analyzed trends in cervical cancer incidence and mortality for all ages combined and for the following age groups: 0-29, 30-49, 50-64 and 65+. Finally, we calculated the estimated average annual percentage change in incidence and mortality rates for the past 10 years. In 2018, an estimated 56,000 new cervical cancer cases and 28,000 cervical cancer deaths occurred among women in LAC with great variations between subregions and countries/territories. Overall, trends in cervical cancer incidence and mortality have decreased over the past decade; however, the rates are still above the elimination threshold of 4 per 100,000 in most LAC countries/territories. Despite the encouraging trends observed, achieving the elimination of cervical cancer in the region still requests substantial political commitment and economic effort. Population-based cancer registries are critical in monitoring the elimination initiative.
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http://dx.doi.org/10.1002/ijc.32956DOI Listing
September 2020

Gallbladder and extrahepatic bile duct cancers in the Americas: Incidence and mortality patterns and trends.

Int J Cancer 2020 08 21;147(4):978-989. Epub 2020 Jan 21.

Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD.

Trends in gallbladder cancer incidence and mortality in populations across the Americas can provide insight into shifting epidemiologic patterns and the current and potential impact of preventative and curative programs. Estimates of gallbladder and extrahepatic bile duct cancer incidence and mortality for the year 2018 were extracted from International Agency for Research on Cancer (IARC) GLOBOCAN database for 185 countries. Recorded registry-based incidence from 13 countries was extracted from IARCs Cancer Incidence in Five Continents series and corresponding national deaths from the WHO mortality database. Among females, the highest estimated incidence for gallbladder and extrahepatic bile duct cancer in the Americas were found in Bolivia (21.0 per 100,000), Chile (11.7) and Peru (6.0). In the US, the highest incidence rates were observed among Hispanics (1.8). In the Chilean population, gallbladder cancer rates declined in both females and males between 1998 and 2012. Rates dropped slightly in Canada, Costa Rica, US Whites and Hispanics in Los Angeles. Gallbladder cancer mortality rates also decreased across the studied countries, although rising trends were observed in Colombia and Canada after 2010. Countries within Southern and Central America tended to have a higher proportion of unspecified biliary tract cancers. In public health terms, the decline in gallbladder cancer incidence and mortality rates is encouraging. However, the slight increase in mortality rates during recent years in Colombia and Canada warrant further attention. Higher proportions of unspecified biliary tract cancers (with correspondingly higher mortality rates) suggest more rigorous pathology procedures may be needed after surgery.
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http://dx.doi.org/10.1002/ijc.32863DOI Listing
August 2020

Implementation of the population-based cancer registry in the city of Mérida, Mexico: process and early results.

Salud Publica Mex 2020 Jan-Feb;62(1):96-104

Sección de Vigilancia del Cáncer, Agencia Internacional para la Investigación en Cáncer. Lyon, France.

Objective: To briefly describe the process of establishment and preliminary results of the Mérida Population-based Cancer Registry (Mérida-PBCR).

Materials And Methods: Mérida-PBCR started in 2016 as a research project in the IMSS, with a gradual increase in its information sources. It covers a population of 908 536 inhabitants. Data collection is active and passive, international standards are used; CanReg5 software enables data entry, storage and analysis.

Results: Current data include 71.5% of sources. For the period 2015- 2016, a total of 2 623 new cancer cases were registered, the majority of these (60.1%) among females. 81.5% of the cases had morphological verification. Prostate (17.4%), colorectal (8.5%) and stomach (8.1%) cancers were the most common among males, and breast (31.6%), cervix (12%) and corpus uteri (7.6%) cancers, the most common among females. Ageadjusted cancer incidence rates (per 100 000) for all sites combined were 114.9 among males and 145.1 among females.

Conclusions: The implementation of the Mérida-PBCR has followed particular parameters, with important efforts to include new information sources. Although the data are still preliminary and must be interpreted with great caution, the main cancers follow a similar pattern to that of the national and regional estimates.
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http://dx.doi.org/10.21149/10501DOI Listing
July 2020

Essential TNM: Evaluation of a Training Exercise in Sub-Saharan Africa.

J Registry Manag 2019 ;46(1):15-18

Information on cancer stage at diagnosis is largely missing or poorly documented among population-based cancer registries in sub-Saharan Africa (SSA). In an early field trial of Essential TNM staging, it was observed that some training was needed to enable cancer registrars to abstract the correct TNM from case records. In November 2018, the Addis Ababa City Cancer Registry hosted a training course attended by 17 participants from 16 cancer registries in SSA. The participants were asked to stage 16 cancer cases (from anonymized photocopies of case records obtained from the Global Initiative for Cancer Registry Development) before and after the training. The discrepancy of the stages from before and after were scored and compared. Results showed that there was a substantial improvement in the participants' performance after the training. The application of the Essential TNM staging system, with training in its use, would allow cancer registrars in SSA to abstract cancer stage at diagnosis in a clinically recognized format, which is crucial for cancer control and public health care policy making.
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September 2019

Global Consultation on Cancer Staging: promoting consistent understanding and use.

Nat Rev Clin Oncol 2019 12 6;16(12):763-771. Epub 2019 Aug 6.

Department of Radiation Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Disease burden is the most important determinant of survival in patients with cancer. This domain, reflected by the cancer stage and codified using the tumour-node-metastasis (TNM) classification, is a fundamental determinant of prognosis. Accurate and consistent tumour classification is required for the development and use of treatment guidelines and to enable clinical research (including clinical trials), cancer surveillance and control. Furthermore, knowledge of the extent and stage of disease is frequently important in the context of translational studies. Attempts to include additional prognostic factors in staging classifications, in order to facilitate a more accurate determination of prognosis, are often made with a lack of knowledge and understanding and are one of the main causes of the inconsistent use of terms and definitions. This effect has resulted in uncertainty and confusion, thus limiting the utility of the TNM classification. In this Position paper, we provide a consensus on the optimal use and terminology for cancer staging that emerged from a consultation process involving representatives of several major international organizations involved in cancer classification. The consultation involved several steps: a focused literature review; a stakeholder survey; and a consultation meeting. This aim of this Position paper is to provide a consensus that should guide the use of staging terminology and secure the classification of anatomical disease extent as a distinct aspect of cancer classification.
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http://dx.doi.org/10.1038/s41571-019-0253-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136160PMC
December 2019

The descriptive epidemiology of lung cancer and tobacco control: a global overview 2018.

Salud Publica Mex 2019 May-Jun;61(3):219-229

Section of Cancer Surveillance, International Agency for Research on Cancer. Lyon, France.

Objective: To present the most recent national estimates of lung cancer burden globally in 185 countries and tobacco smoking prevalence (%) by sex.

Materials And Methods: Estimates of lung cancer incidence and mortality for 2018 were extracted from the Globocan database; observed incidence, from the last volume of Cancer Incidence in Five Continents, and tobacco prevalence, from the World Health Observatory/WHO database.

Results: In 2018, over two million new lung cancer cases and 1.7 million deaths were estimated to occur worldwide, representing 14% of the new cancer cases and 20% of the cancer deaths. Incidence rates showed marked variation between countries. Stable or decreasing incidence rates were predominant among males, while among females increasing rates were common.

Conclusions: The continuing rise in lung cancer among women reinforces the need for strengthening implementation of the preventive actions committed to by governments in the WHO Framework Convention for Tobacco Control.
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http://dx.doi.org/10.21149/10140DOI Listing
January 2020

Global patterns and trends in the incidence of non-Hodgkin lymphoma.

Cancer Causes Control 2019 May 20;30(5):489-499. Epub 2019 Mar 20.

Section of Cancer Surveillance, International Agency for Research on Cancer, 150 Cours Albert Thomas, 69372, Lyon CEDEX 08, France.

Purpose: Despite an increasing understanding of the pathology and genetics of non-Hodgkin lymphoma (NHL), global reports on variations in the incidence of NHL remain limited in their number and scope.

Methods: To provide a situation analysis, national incidence estimates for NHL in 185 countries for the year 2018 were obtained from the GLOBOCAN database. We also used recorded incidence data from Cancer Incidence in Five Continents (CI5) plus for years of diagnosis 1980-2012 to examine temporal trends.

Results: NHL ranked as the 5th to 9th most common cancer in most countries worldwide, with almost 510,000 new cases estimated in 2018. Observed incidence rates of NHL 2008-2012 varied markedly by world region: among males, rates were highest among Israel Jews [age-standardized (world) rate of 17.6 per 100,000), Australia (15.3), US whites (14.5), Canada (13.7), and Portugal (13.3)]. Where data were available, most populations exhibited stable or slightly increasing incidence rates; in North America, parts of Europe, and Oceania the rising incidence rates were generally observed until the 1990s, with a stabilization seen thereafter.

Conclusion: Marked variations in NHL incidence rates remain in populations in each world region. Special attention should be given to further etiological research on the role of endemic infections and environmental exposures, particularly in Africa, Asia, and Latin America. To permit internationally comparable statistics, an equal focus on addressing the quality of hematological information in population-based registries is also warranted.
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http://dx.doi.org/10.1007/s10552-019-01155-5DOI Listing
May 2019

Aging and the cancer burden in Latin America and the Caribbean: Time to act.

J Geriatr Oncol 2019 09 7;10(5):799-804. Epub 2019 Mar 7.

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Objective: To describe the cancer burden in adults aged 65 years and older in Latin America and the Caribbean to serve as rational for improving cancer control planning among region's older population.

Materials And Methods: Using the up-to-date GLOBOCAN estimates for 2018, we describe the cancer burden including key patterns for the major cancer sites among adults aged 65 years and older in Latin America and the Caribbean. We also predict the future burden in 2040 by applying population projections, assuming no changes in incidence rates over time.

Results: In 2018, an estimated 679,000 new cancer cases occurred among older adults in LAC, representing almost half (48%) of the total incidence burden (43% in Central America, 49% in South America, and 52% in the Caribbean). Prostate, colorectum, and lung were the most common cancers among older males in South America and the Caribbean, with non-melanoma skin cancer ranking third in Central America. Among older females, the most common sites were breast, colorectum, and non-melanoma skin cancer, except in the Caribbean, where lung cancer ranked third. Overall, the number of new cancer cases among older adults in the region is expected to double by 2040, reaching 1.6 million new cases.

Conclusion: Our findings highlight the need for an urgent adaptation of healthcare systems across LAC by improving training in geriatrics for the oncology workforce, and by including older adults in clinical guidelines, insurance schemes, and cancer prevention policies.
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http://dx.doi.org/10.1016/j.jgo.2019.02.014DOI Listing
September 2019

Essential TNM: a registry tool to reduce gaps in cancer staging information.

Lancet Oncol 2019 02;20(2):e103-e111

Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Union for International Cancer Control, Geneva, Switzerland.

Accurate information on the extent of disease around the time of diagnosis is an important component of cancer care, in defining disease prognosis, and evaluating national and international cancer control policies. However, the collection of stage data by population-based cancer registries remains a challenge in both high-income and low and middle-income countries. We emphasise the lack of availability and comparability of staging information in many population-based cancer registries and propose Essential TNM, a simplified staging system for cancer registries when information on full Tumour, Node, Metastasis (TNM) is absent. Essential TNM aims at staging cancer in its most advanced disease form by summarising the extent of disease in the order of distant metastasis (M), regional lymph node involvement (N), and tumour size or extension, or both (T). Flowcharts and rules have been developed for coding these elements in breast, cervix, prostate, and colon cancers, and combining them into stage groups (I-IV) that correspond to those obtained by full TNM staging. Essential TNM is comparable to the Union for International Cancer Control TNM stage groups and is an alternative to providing staging information by the population-based cancer registries that complies with the objectives of the Global Initiative for Cancer Registry Development.
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http://dx.doi.org/10.1016/S1470-2045(18)30897-0DOI Listing
February 2019

Perspectives on Strengthening Cancer Research and Control in Latin America Through Partnerships and Diplomacy: Experience of the National Cancer Institute's Center for Global Health.

J Glob Oncol 2018 09;4:1-11

Silvina Frech, Catherine A. Muha, Lisa M. Stevens, Edward L. Trimble, Roxanne Brew, Doug Puricelli Perin, Paul C. Pearlman, and Brenda Kostelecky, National Cancer Institute, Rockville, MD; Silvana Luciani, Pan American Health Organization; Cristina Rabadan-Diehl, US Department of Health and Human Services; Denise Duran, Centers for Disease Control and Prevention, Washington, DC; Alejandro Mohar, Instituto Nacional de Cancerología, Mexico City, Mexico; Marion Piñeros, International Agency for Research on Cancer, Lyon, France; Tatiana Vidaurre, Instituto Nacional de Enfermedades Neoplásicas, Surquillo, Peru; Douglas R. Morgan, Vanderbilt-Ingram Cancer Center, Nashville, TN; Ernest T. Hawk, Kathleen M. Schmeler, Lewis E. Foxhall, and Melissa S. Lopez, The University of Texas MD Anderson Cancer Center, Houston, TX; Melissa Rendler-Garcia, Union for International Cancer Control, Geneva, Switzerland; Eduardo L. Cazap, Sociedad Latinoamericana y del Caribe del Oncología Médica, Buenos Aires, Argentina; Luiz Santini and Walter Zoss, Red de Institutos e Instituciones Nacionales de Cáncer, Sao Paolo, Brazil; Lucia B. Delgado, Universidad de la República, Montevideo, Uruguay; and Leslie Given and Karin Hohman, Strategic Health Concepts, Arvada, CO.

According to the Pan American Health Organization, noncommunicable diseases, including cancer, are the leading causes of preventable and premature death in the Americas. Governments and health care systems in Latin America face numerous challenges as a result of increasing morbidity and mortality from cancer. Multiple international organizations have recognized the need for collaborative action on and technical support for cancer research and control in Latin America. The Center for Global Health at the US National Cancer Institute (NCI-CGH) is one entity among many that are working in the region and has sought to develop a strategy for working in Latin America that draws on and expands the collaborative potential of engaged, skilled, and diverse partners. NCI-CGH has worked toward developing and implementing initiatives in collaboration with global partners that share the common objectives of building a global cancer research community and translating research results into evidence-informed policy and practice. Both objectives are complementary and synergistic and are additionally supported by an overarching strategic framework that is focused on partnerships and science diplomacy. This work highlights the overall strategy for NCI-CGH engagement in Latin America through partnerships and diplomacy, and highlights selected collaborative efforts that are aimed at improving cancer outcomes in the region.
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http://dx.doi.org/10.1200/JGO.17.00149DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6223440PMC
September 2018

Advancing Reliable Data for Cancer Control in the Central America Four Region.

J Glob Oncol 2018 09 8;4:1-11. Epub 2017 Mar 8.

Marion Piñeros and Mathieu Laversanne, International Agency for Research on Cancer, Lyon, France; Silvina Frech, US National Cancer Institute, Bethesda, MD; Lindsay Frazier, Dana-Farber/Children's Cancer Center, Boston MA; Joaquin Barnoya and Eduardo Gharzouzi, Instituto de Cancerologia; Claudia Garrido, Unidad Nacional Oncología Pediátrica, Guatemala City, Guatemala; Joaquin Barnoya, Washington University in St. Louis, St. Louis, MO; Andrea Chacón, Unidad Nacional para la Prevención y control del Cáncer, Ministerio de Salud; Soad Fuentes Alabi, Hospital Benjamín Bloom, Ministerio de Salud; Lisseth Ruiz de Campos, Asociación Salvadoreña para la Prevención del Cáncer, San Salvador, El Salvador; Jacqueline Figueroa, Unidad de Registro de Cáncer, Secretaria de Salud, Tegucigalpa; Ricardo Dominguez, Hospital de Occidente, Secretaria de Salud, Copán, Honduras; Ofelia Rojas, Rosario Pereira, and Carla Rivera, Universidad Nacional Autónoma de Nicaragua, León, Nicaragua; and Douglas R. Morgan, Vanderbilt University, Nashville, TN.

The Central America Four (CA-4) region, comprising Guatemala, Honduras, El Salvador, and Nicaragua, is the largest low- and middle-income country region in the Western Hemisphere, with over 36 million inhabitants. The CA-4 nations share a common geography, history, language, and development indices, and unified with open borders in 2006. The growing CA-4 cancer burden among the noncommunicable diseases is expected to increase 73% by 2030, which argues for a regional approach to cancer control. This has driven efforts to establish population-based cancer registries as a central component of the cancer control plans. The involvement of international and academic partners in an array of initiatives to improve cancer information and control in the CA-4 has accelerated over the past several years. Existing data underscore that the infectious cancers (cervical, stomach, and liver) are a particular burden. All four countries have committed to establishing regional population-based cancer registries and have advanced significantly in pediatric cancer registration. The challenges common to each nation include the lack of national cancer control plans and departments, competing health priorities, lack of trained personnel, and sustainability strategies. General recommendations to address these challenges are outlined. The ongoing regional, international, and academic cooperation has proven helpful and is expected to continue to be a powerful instrument to contribute to the design and implementation of long-term national cancer control plans.
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http://dx.doi.org/10.1200/JGO.2016.008227DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6180802PMC
September 2018

Changing geographical patterns and trends in cancer incidence in children and adolescents in Europe, 1991-2010 (Automated Childhood Cancer Information System): a population-based study.

Lancet Oncol 2018 09 8;19(9):1159-1169. Epub 2018 Aug 8.

National Cancer Registration and Analysis Service, Public Health England, London, UK.

Background: A deceleration in the increase in cancer incidence in children and adolescents has been reported in several national and regional studies in Europe. Based on a large database representing 1·3 billion person-years over the period 1991-2010, we provide a consolidated report on cancer incidence trends at ages 0-19 years.

Methods: We invited all population-based cancer registries operating in European countries to participate in this population-based registry study. We requested a listing of individual records of cancer cases, including sex, age, date of birth, date of cancer diagnosis, tumour sequence number, primary site, morphology, behaviour, and the most valid basis of diagnosis. We also requested population counts in each calendar year by sex and age for the registration area, from official national sources, and specific information about the covered area and registration practices. An eligible registry could become a contributor if it provided quality data for all complete calendar years in the period 1991-2010. Incidence rates and the average annual percentage change with 95% CIs were reported for all cancers and major diagnostic groups, by region and overall, separately for children (age 0-14 years) and adolescents (age 15-19 years). We examined and quantified the stability of the trends with joinpoint analyses.

Findings: For the years 1991-2010, 53 registries in 19 countries contributed a total of 180 335 unique cases. We excluded 15 162 (8·4%) of 180 335 cases due to differing practices of registration, and considered the quality indicators for the 165 173 cases included to be satisfactory. The average annual age-standardised incidence was 137·5 (95% CI 136·7-138·3) per million person-years and incidence increased significantly by 0·54% (0·44-0·65) per year in children (age 0-14 years) with no change in trend. In adolescents, the combined European incidence was 176·2 (174·4-178·0) per million person-years based on all 35 138 eligible cases and increased significantly by 0·96% (0·73-1·19) per year, although recent changes in rates among adolescents suggest a deceleration in this increasing trend. We observed temporal variations in trends by age group, geographical region, and diagnostic group. The combined age-standardised incidence of leukaemia based on 48 458 cases in children was 46·9 (46·5-47·3) per million person-years and increased significantly by 0·66% (0·48-0·84) per year. The average overall incidence of leukaemia in adolescents was 23·6 (22·9-24·3) per million person-years, based on 4702 cases, and the average annual change was 0·93% (0·49-1·37). We also observed increasing incidence of lymphoma in adolescents (average annual change 1·04% [0·65-1·44], malignant CNS tumours in children (average annual change 0·49% [0·20-0·77]), and other tumours in both children (average annual change 0·56 [0·40-0·72]) and adolescents (average annual change 1·17 [0·82-1·53]).

Interpretation: Improvements in the diagnosis and registration of cancers over time could partly explain the observed increase in incidence, although some changes in underlying putative risk factors cannot be excluded. Cancer incidence trends in this young population require continued monitoring at an international level.

Funding: Federal Ministry of Health of the Federal German Government, the European Union's Seventh Framework Programme, and International Agency for Research on Cancer.
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http://dx.doi.org/10.1016/S1470-2045(18)30423-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6120055PMC
September 2018

Lung cancer incidence trends in Uruguay 1990-2014: An age-period-cohort analysis.

Cancer Epidemiol 2018 08 25;55:17-22. Epub 2018 May 25.

International Agency for Research on Cancer, Section of Cancer Surveillance, France.

Background: Uruguay, a country with one of the highest lung cancer rates worldwide, initiated a series of comprehensive anti-smoking measures in 2005. We assess the tobacco control policies in the context of cohort-driven lung cancer incidence trends over a 25-year period, providing baseline predictions to 2035.

Methods: Using data from the National Cancer Registry of Uruguay, an age-period-cohort analysis of trends 1990-2014 was performed. The NORDPRED package was used to predict the annual number of new cases of lung cancer and incidence rates up to 2035.

Results: In men, age-standardised (world) rates declined from a peak of 165.6 in 1995 to 103.1 by 2014, translating to a 70% reduction in the risk of lung cancer in men born in 1970 relative to the early-1940s. In females, rates increased steadily from 18.3 in 1991 to 30.0 by 2014, with successive increases in risk among generations of women born 1940-1960. There is however evidence of a decline in observed rates in women born recently. Extrapolations of the trends indicate an 8% reduction in the mean number of new lung cancer cases in men by 2035, but a 69% increase in women.

Conclusion: Despite observed and predicted reductions in lung cancer incidence in Uruguayan men, rates among women are set to continue to increase, with a large rise in the annual number of female lung cancer diagnoses expected before 2035. There are signals of a diminishing risk among recent generations of women born after 1960. The current analysis provides important baseline information in assessing the future impact of the recent tobacco control initiatives in Uruguay.
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http://dx.doi.org/10.1016/j.canep.2018.04.012DOI Listing
August 2018

Epidemiological patterns of leukaemia in 184 countries: a population-based study.

Lancet Haematol 2018 Jan;5(1):e14-e24

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Background: Leukaemia is a heterogeneous group of haemopoietic cancers that comprises a number of diverse and biologically distinct subgroups. We examine the leukaemia burden worldwide and highlight the distinct incidence patterns in order to elucidate explanatory factors that may support preventive measures and health resource planning. We aimed to estimate the global burden of leukaemia incidence according to the four major subtypes stratified by age and sex.

Methods: In this population-based study, we assessed leukaemia incidence for the major subtypes using the Cancer Incidence in Five Continents Volume X (CI5-X), which includes data from 290 cancer registries in 68 countries covering the diagnostic period 2003-07, for all ages and both sexes. We then extracted counts and incidence rates in 184 countries for the year 2012 from IARC's GLOBOCAN database of national estimates. We calculated age-specific incidence rates per 100 000 person-years and age-standardised rates (ASRs) using the world standard population by country, sex, age group, and where applicable, by major subtypes. We excluded from all analyses registries for which the total number of leukaemia cases was less than 100 or the proportion of microscopically verified (MV%) cases was less than 80% (2572 cases).

Findings: 717 863 cases between 2003-07 were included in this analysis. More than 350 000 new leukaemia cases were estimated in 2012. We observed substantial variation in incidence between and within world regions. The highest leukaemia incidence rates for both sexes were estimated in Australia and New Zealand (ASR per 100 000 11·3 in males and 7·2 in females), Northern America (10·5 in males and 7·2 in females), and western Europe (9·6 in males and 6·0 in females), and the lowest was in in western Africa (1·4 in males and 1·2 in females). Rates were generally higher in males than females with an overall male to female ratio of 1·4. In children, acute lymphoblastic leukaemia was the main subtype in all studied countries in both sexes, and characterised by a bimodal age-specific pattern. The subtype distribution was more diverse in adults, with a relatively higher proportion of chronic lymphocytic leukaemia in most European and North American countries, whereas rates of acute lymphoblastic leukaemia remained relatively high among adults in selected South American, Caribbean, Asian, and African populations.

Interpretation: Geographical disparities in leukaemia might partly be explained by quality of, and access to, health systems linked to resource levels, although there is probably a role for aetiological factors, including gene-environment interactions. The observed bimodal pattern could be due to different risk factors affecting different ages, and might include a genetic component.

Funding: European Commission's FP-7 Marie Curie Actions-People-COFUND.
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http://dx.doi.org/10.1016/S2352-3026(17)30232-6DOI Listing
January 2018

Cancer patterns, trends, and transitions in Peru: a regional perspective.

Lancet Oncol 2017 10;18(10):e573-e586

Section of Cancer Surveillance, International Agency for Research on Cancer, Lyon, France.

Peru, like several other South American countries, is experiencing remarkable population growth, ageing, and urbanisation, which has given rise to profound changes in its epidemiological profile. Prostate and breast cancer are the most frequent cancers in men and women, respectively, in Lima and Arequipa, the two areas with population-based cancer registries. However, infection-associated cancers (cervix and stomach) are also common, and rank highest in the national cancer mortality profile. Although a foundation of surveillance informs cancer-control initiatives in Peru, improvements in the vital statistics system, and the quality and use of incidence data for the planning and assessment of cancer prevention and control actions, are needed. Existing population-based cancer registries in Lima and Arequipa, and linkages to the established national mandatory cancer reporting system, are crucial for the collection of high-quality data on national cancer incidence. The delivery of effective cancer prevention and control measures requires sustained investment in the collection of high-quality data capable of informing policies and driving research programmes.
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http://dx.doi.org/10.1016/S1470-2045(17)30377-7DOI Listing
October 2017

The TNM classification of malignant tumours-towards common understanding and reasonable expectations.

Lancet Oncol 2017 07;18(7):849-851

Princess Margaret Cancer Centre, Department of Radiation Oncology, University of Toronto, Toronto, ON, M5G 2M9, Canada. Electronic address:

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http://dx.doi.org/10.1016/S1470-2045(17)30438-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5851445PMC
July 2017

A Global Cancer Surveillance Framework Within Noncommunicable Disease Surveillance: Making the Case for Population-Based Cancer Registries.

Epidemiol Rev 2017 01;39(1):161-169

The growing burden of cancer among several major noncommunicable diseases (NCDs) requires national implementation of tailored public health surveillance. For many emerging economies where emphasis has traditionally been placed on the surveillance of communicable diseases, it is critical to understand the specificities of NCD surveillance and, within it, of cancer surveillance. We propose a general framework for cancer surveillance that permits monitoring the core components of cancer control. We examine communalities in approaches to the surveillance of other major NCDs as well as communicable diseases, illustrating key differences in the function, coverage, and reporting in each system. Although risk factor surveys and vital statistics registration are the foundation of surveillance of NCDs, population-based cancer registries play a unique fundamental role specific to cancer surveillance, providing indicators of population-based incidence and survival. With an onus now placed on governments to collect these data as part of the monitoring of NCD targets, the integration of cancer registries into existing and future NCD surveillance strategies is a vital requirement in all countries worldwide. The Global Initiative for Cancer Registry Development, endorsed by the World Health Organization, provides a means to enhance cancer surveillance capacity in low- and middle-income countries.
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http://dx.doi.org/10.1093/epirev/mxx003DOI Listing
January 2017

Worldwide comparison of survival from childhood leukaemia for 1995-2009, by subtype, age, and sex (CONCORD-2): a population-based study of individual data for 89 828 children from 198 registries in 53 countries.

Lancet Haematol 2017 05 11;4(5):e202-e217. Epub 2017 Apr 11.

Cancer Survival Group, Department of Non-Communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, UK.

Background: Global inequalities in access to health care are reflected in differences in cancer survival. The CONCORD programme was designed to assess worldwide differences and trends in population-based cancer survival. In this population-based study, we aimed to estimate survival inequalities globally for several subtypes of childhood leukaemia.

Methods: Cancer registries participating in CONCORD were asked to submit tumour registrations for all children aged 0-14 years who were diagnosed with leukaemia between Jan 1, 1995, and Dec 31, 2009, and followed up until Dec 31, 2009. Haematological malignancies were defined by morphology codes in the International Classification of Diseases for Oncology, third revision. We excluded data from registries from which the data were judged to be less reliable, or included only lymphomas, and data from countries in which data for fewer than ten children were available for analysis. We also excluded records because of a missing date of birth, diagnosis, or last known vital status. We estimated 5-year net survival (ie, the probability of surviving at least 5 years after diagnosis, after controlling for deaths from other causes [background mortality]) for children by calendar period of diagnosis (1995-99, 2000-04, and 2005-09), sex, and age at diagnosis (<1, 1-4, 5-9, and 10-14 years, inclusive) using appropriate life tables. We estimated age-standardised net survival for international comparison of survival trends for precursor-cell acute lymphoblastic leukaemia (ALL) and acute myeloid leukaemia (AML).

Findings: We analysed data from 89 828 children from 198 registries in 53 countries. During 1995-99, 5-year age-standardised net survival for all lymphoid leukaemias combined ranged from 10·6% (95% CI 3·1-18·2) in the Chinese registries to 86·8% (81·6-92·0) in Austria. International differences in 5-year survival for childhood leukaemia were still large as recently as 2005-09, when age-standardised survival for lymphoid leukaemias ranged from 52·4% (95% CI 42·8-61·9) in Cali, Colombia, to 91·6% (89·5-93·6) in the German registries, and for AML ranged from 33·3% (18·9-47·7) in Bulgaria to 78·2% (72·0-84·3) in German registries. Survival from precursor-cell ALL was very close to that of all lymphoid leukaemias combined, with similar variation. In most countries, survival from AML improved more than survival from ALL between 2000-04 and 2005-09. Survival for each type of leukaemia varied markedly with age: survival was highest for children aged 1-4 and 5-9 years, and lowest for infants (younger than 1 year). There was no systematic difference in survival between boys and girls.

Interpretation: Global inequalities in survival from childhood leukaemia have narrowed with time but remain very wide for both ALL and AML. These results provide useful information for health policy makers on the effectiveness of health-care systems and for cancer policy makers to reduce inequalities in childhood cancer survival.

Funding: Canadian Partnership Against Cancer, Cancer Focus Northern Ireland, Cancer Institute New South Wales, Cancer Research UK, US Centers for Disease Control and Prevention, Swiss Re, Swiss Cancer Research foundation, Swiss Cancer League, and the University of Kentucky.
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http://dx.doi.org/10.1016/S2352-3026(17)30052-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418564PMC
May 2017

The global burden of childhood cancer: Knowing what we do not know.

Pediatr Blood Cancer 2017 08 14;64(8). Epub 2017 Apr 14.

Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, Tennessee.

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http://dx.doi.org/10.1002/pbc.26532DOI Listing
August 2017

Cancer registration for cancer control in Latin America: a status and progress report.

Rev Panam Salud Publica 2017 8;41:e2. Epub 2017 Feb 8.

Cancer Surveillance Section International Agency for Research on Cancer Lyon France.

Cancer incidence by type has been included as a core indicator in the World Health Organization (WHO) Global Monitoring Framework for the Prevention and Control of Noncommunicable Diseases. The Global Initiative for Cancer Registry Development (GICR), coordinated by the International Agency for Research on Cancer (IARC), supports low- and middle-income countries to reduce disparities in cancer information for cancer control by increasing the coverage and quality of cancer registration. A baseline assessment has been performed at the IARC Regional Hub for Latin America using secondary and public information sources. Countries have been categorized according to the following criteria for population-based cancer registries (PBCRs): 1) "has no established PBCR (but some registration activity)," 2) "has established PBCR(s) but none of high-quality," and 3) "has established, high-quality PBCR(s) (regional or national)." Currently, in LatinAmerica, most countries have cancer control plans in place; PBCRs cover approximately20% of the region's population, though only 7% are deemed as having high-quality information. No information is available on the extent of use of the information generated by PBCRs for cancer control purposes. Though there are important advances in cancer registration in the region, there is still much to be done. This report also outlines key elementsfor improving cancer surveillance in the region, including 1) involvement of local stakeholders and experts, 2) integration of cancer registries into existing surveillance systems(accounting for the complexities and particularities of cancer surveillance), 3) improvementin data availability and quality, 4) enhanced communication and dissemination, and 5) better linkages between cancer registries and cancer planning and cancer research.
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http://dx.doi.org/10.26633/RPSP.2017.2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6660887PMC
February 2017

[Years of life lost as a measure of cancer burden in Colombia, 1997-2012].

Biomedica 2016 Dec 1;36(4):547-555. Epub 2016 Dec 1.

Subdirección de Investigaciones, Vigilancia Epidemiológica, Promoción y Prevención, Instituto Nacional de Cancerología, Bogotá, D.C., Colombia Departamento de Epidemiología Clínica y Bioestadística, Pontificia Universidad Javeriana, Bogotá, D.C., Colombia.

Introduction: There is hardly any information regarding years of life lost due to cancer in Colombia.

Objective: To quantify total and average years of life lost due to cancer in Colombia, and to investigate changes in this burden between 1997 and 2012.

Materials And Methods: We obtained sex-specific data on age distribution, remaining life expectancy, deaths due to specific cancers and total number of deaths from the Colombian Departamento Administrativo Nacional de Estadísticas. We calculated years of life lost based on each individual´s age at death and the remaining life expectancy at that age; as for average years of life, we divided these by the number of deaths due to specific cancers.

Results: The total number of cancer deaths increased by 33% between 1997 and 2012, comprising 15% of male and 20% of female deaths in the period 2010-2012. Total years of life lost due to cancer increased by 25.1% for males and 31.1% for females over the study period. The highest increases (>40%) were observed for colorectal, pancreas and kidney cancers in both sexes, for melanomas and bladder cancer in men, and for breast and ovarian cancer in women. Trends in average years of life lost were stable. Almost half (48-50%) of the years of life lost due to childhood cancers were due to leukemia.

Conclusion: Cancer is an increasing health burden in Colombia. The high average years of life lost illustrate the poor prognosis of the disease compared to other countries. Primary prevention, early detection, and adequate and timely treatments are needed to change this situation.
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http://dx.doi.org/10.7705/biomedica.v36i4.3207DOI Listing
December 2016

Estimating the cost of operating cancer registries: Experience in Colombia.

Cancer Epidemiol 2016 Dec 17;45 Suppl 1:S13-S19. Epub 2016 Oct 17.

RTI International, Research Triangle Park, NC, USA.

Background: Maintaining population-based registries requires adequate and sustained resources; however, to date there has been no systematic evaluation to identify the resource needs for cancer registration in most countries, including Colombia. A systematic assessment of the costs can quantify the funding required and identify processes to improve efficiency of cancer registries.

Methods: The Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool) was tailored specifically for the Colombian registries and was used to collect resource use data from five regional population-based cancer registries: Barranquilla, Bucaramanga, Cali, Manizales, and Pasto. The registries provided cost data for the year 2013 and cancer cases corresponding to the year 2010.

Results: We identified an almost threefold variation in the average cost per case (77,932 to 214,082 Colombian pesos or US $41 to US $113 in 2013) across the registries, but there were also substantial differences in data collection approaches, types of data collected, and activities performed. Cost per inhabitant varied between 95 and 415 Colombian pesos (US $0.05 to US $0.22). Between 20% and 45% of the total cost was due to fixed cost activities.

Conclusions: The detailed economic information presented in this study constitutes a valuable source of activity-based cost data that registries can use to compare operations, assess key factors that lead to differences in cost per case, and identify potential approaches to improve efficiencies. Furthermore, the knowledge gained from studying the Colombian registries can help inform the planning and operations of other registries in the region.
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http://dx.doi.org/10.1016/j.canep.2016.09.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913656PMC
December 2016