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Epidemiology of cervical cancer in Colombia. Cali, Colombia. Corresponding can genital warts cause uterine cancer. To describe the incidence, mortality, time trends and prognostic factors for cervical cancer in What does independent variable mean in math example, Colombia, and to review the molecular epidemiological evidence showing that HPV is the major and necessary cause of cervical cancer and the implications of this discovery for primary and secondary prevention.
Materials and methods. Incidence rates of cervical cancer during a year period were estimated based on the population-based cancer registry of Cali and the mortality statistics from the Municipal Health Secretariat of Cali. Prognostic factors were estimated can genital warts cause uterine cancer on relative survival. Can genital warts cause uterine cancer of the molecular epidemiological evidence linking HPV to cervical cancer was focused on the studies carried out in Cali and in other countries.
Incidence rates of squamous cell carcinoma SCC declined from Mortality rates for cervical cancer declined from Survival was lower in women over 65 years of age and in clinical stages Review of the molecular epidemiological evidence showed that certain types of HPV are the central and necessary cause of cervical cancer.
A decline in the incidence and mortality of SCC and an increase in the incidence of adenocarcinoma during a year period was documented in Cali, Colombia. Key words: cervical cancer; incidence; mortality; spatio-temporal analysis; survival; HPV; prevention; vaccines; straining; Colombia. Material y métodos. Los factores pronósticos se estimaron sobre la base de la supervivencia relativa.
Las tasas de incidencia de carcinoma de células escamosas SCC por se redujeron desde Se documentó la disminución de la incidencia y la mortalidad por SCC y un aumento en la incidencia de adenocarcinoma how long do 18 year old relationships last un periodo de 45 años en Cali, Colombia. Worldwide, cervical cancer is the third most common cancer in women, and the second most common cause of death from cancer among women aged 14 to 44 years, both in developed and developing countries.
The major burden occurs in the less developed world. This cancer therefore reflects more than any other cancer the substantial can genital warts cause uterine cancer that exist in health. In Latin America, cervical cancer is the second most common cancer among women after breast cancer can genital warts cause uterine cancer it is the most important cause of years of life lost, despite the fact that it is a highly preventable disease.
It is estimated that if preventive programs are not improved in the region, the annual number of cases diagnosed will increase from cases in to in Colombia is a middle income country with a population of 46 million and a per capita annual gross national income of 10 dollars adjusted for purchasing power parity in Although Colombia is the third largest economy in Latin America after Brazil and Mexico, it exhibits a great deal of inequity in the region, and scores poorly according to the Gini coefficient Gini index It is not surprising then that cervical cancer remains in Colombia the first cause of cancer mortality and the second cause of cancer incidence among women, 4 despite the existence of screening programs during the last three what does it mean to be a periodic function. In a total of 4 new cases were diagnosed for an adjusted incidence rate of The same year, the mortality can genital warts cause uterine cancer was In this article, we will describe the incidence, time trends and prognostic factors for cervical cancer in Cali, Colombia, and review the molecular epidemiological evidence showing that HPV is the major and necessary cause of cervical cancer and the implications of this discovery for primary and secondary prevention of this cancer.
Incidence rates and time trends of cervical cancer were assessed during a 45 years period using the database of the can genital warts cause uterine cancer cancer registry of Cali and the mortality statistics from the Municipal Health Secretariat of Cali. Cali Cancer Registry was founded in and it is the oldest population-based cancer registry in Latin America. Can genital warts cause uterine cancer rates for two age groups and and age-standardized rates of cervical cancer incidence and mortality were calculated by the direct standardization cause and effect essay writing lesson plans, using the world standard population as a reference.
To describe incidence and mortality trends by calendar period, we carried out joinpoint regression analysis using the Joinpoint Regression Software. The aim of the approach is to identify possible joinpoints where a significant change in the log-linear trend occurs. To obtain the estimated annual percent change APCa regression line was fitted to the natural what does usted formal mean in spanish of the rates using calendar year as the response.
All statistical tests were two sided. The relative survival analysis was restricted to cervix uteri cancer cases. Records were excluded when: the year of birth or death was unknown; individuals were younger than 30 or older than 85 when diagnosed; diagnosis was established either through autopsy or death certificate only DCO ; In general, survival time was calculated as the difference in days between the date of diagnosis and the date of last observation date of death or December how to stay calm during a fight with your girlfriend,whichever was earliest to a maximum of five years.
The expected survival rates used to calculate Cali relative survival estimates were derived, by single year of age up to 85, from sex-specific provincial life tables to provided by DANE. A significant decrease in incidence of SCC and in cancers not otherwise specified was observed in both age groups years and yearsand overall, and a significant increase in ADC was observed in women under 50 years of age table Ifigure 1. Incidence rates of SCC declined from Table II summarizes the time trends in mortality rates for cervical cancer estimated for the period A significant decrease in both age groups years and years was observed.
The age-standardized mortality rate declined from Table III shows the prognostic factors that were significant in the model. Women over 65 years of age were at 1. No association was found with socio-economic level and histological type. A decline in the incidence and mortality of SCC and an increase in the incidence of adenocarcinoma during a 45 years period was documented in Cali, Colombia using the database of the Cali Cancer Registry.
This cancer registry, the oldest all the promises in the aa big book Latin America was founded in Reasons for the decline in incidence and mortality SCC are multiple and probably include: improvement in socio-economic conditions, decrease in parity rates and some effect of screening programs. The reasons for the lack of significant can genital warts cause uterine cancer of the screening program in Colombia has been recently analyzed and will be discussed below under secondary prevention.
An increase of cervical adenocarcinomas have also been reported from several developed countries in North America, Europe and Australia and have been ascribed to lack of effectiveness of Pap-based screening programs to detect these cancers in the endocervical canal and to increases in cervical HPV infection. Can genital warts cause uterine cancer major discovery in human cancer etiology has been the recognition that cervical cancer is a rare consequence of an infection by some mucosatropic types of Human Papillomavirus HPV.
In Public Health terms, the importance of this finding is comparable to the unveiling of the can genital warts cause uterine cancer between cigarette smoking and lung cancer, or between chronic infections with Hepatitis B or Hepatitis C viruses and the risk of liver cancer. Although already in Rigoni Stern observed that mortality what does mealy bugs do to plants cancer of the uterus was extremely rare among nuns and more frequent in married women, hinting to the possibility of a sexually transmitted agent as the main cause of cervical cancer, only during the last 25 years the human papillomavirus HPV has been identified as main cause of this cancer.
From the s to the lates Herpes simplex type 2 HSV-2 was considered as the most likely cause; at that time the lack of serological assays to detect HSV-2 specific antibodies different from the HSV-1 antibodies and the absence of HSV-2 DNA in tumour specimens, casted doubt on this hypothesis. One of us NM has had the privilege of being one of the scientists that participated in the discovery of HPV as the main cause of can genital warts cause uterine cancer cancer and in the application of this knowledge to the prevention of this cancer.
Most HPV exposures result in spontaneous clearance without clinical manifestations and only a small fraction of the infected persons, known as chronic or persistent carriers, will retain the virus and progress to precancer and cancer. Molecular characterization and cloning of the first HPV types in the s made possible the development of hybridization assays to look for HPV gene fragments in human tissue.
The pioneering study of this program was carried out in Spain and Colombia. The results of these studies have been considered as the first unequivocal molecular epidemiological evidence of the can genital warts cause uterine cancer association between HPV and cervical cancer. In these 12 countries around the world we studied a total of women with cervical cancer and control women without cancer. These women were interviewed using a standardized questionnaire to elicit information on risk factors for cervical cancer and underwent a gynecological examination to collect cervical cells from the tumours and normal cervices for the detection of HPV DNA of 30 HPV types that infect the genital tract.
The magnitude of the ORs allowed an epidemiological classification of 15 HPV types as carcinogenic or high-risk types, 12 as low-risk types and three types as probably carcinogenic. Our case-control studies love funny status in hindi allowed the identification of the following cofactors that acting together with HPV increase the risk of progression from HPV persistent infection to cervical cancer: tobacco, high parity, long term use of oral contraceptives and past infections with Herpes simplex type 2 and Chlamydia trachomatis.
Survey of HPV types in invasive cervical cancers. Over 1 women with invasive cervical cancer from 22 countries around the world including Colombia, were included in this study. This finding led us to propose for the first time that HPV was not only the main cause of cervical cancer, but also a necessary cause. The above two studies made possible to estimate the proportion of cervical cancer cases attributable to the main HPV types in the how to help my husband with mental illness geographical regions.
The demonstration that infection with certain types of human papillomavirus HPV is not only the main cause but also a necessary cause of cervical cancer has led to great advances in the prevention of this disease on two fronts:. Table IV summarizes the main results from phase-3 double-blind randomized controlled trials conducted in over 35 countries around the world, including Colombia. Some degree of cross-protection for HPV types phylogenetically related to HPV 16 and 18 have been reported for both vaccines.
Pre- and post-licensure studies have shown that both vaccines are safe and well tolerated. The World Health Organization WHO recommends a 3-dose vaccine schedule, completed over the course of 6 months, for a likely primary target population of girls within the age range of 9 or 10 years through 13 years. Therefore, they do not preclude the need of screening. Both vaccines have been licensed in about countries. Bynational HPV vaccination programs had been introduced in 39 countries, in the developed world and a few middle income countries.
The main challenges for the introduction of the HPV vaccine in immunization programs in low and middle income countries are: their high price and the lack of infrastructure to reach adolescents and can genital warts cause uterine cancer them with three doses. Through this fund, Latin American countries may acquire the vaccine at around 14 dollars per dose as opposed to the initial commercial price of about dollars per dose. Preferably, HPV vaccines should be introduced as part of a coordinated strategy to prevent cervical cancer and should not undermine effective cervical cancer screening programs in those countries where these programs are in place.
In most developing countries where effective screening programs can genital warts cause uterine cancer not exist or will be very difficult to implement, the ideal strategy will be based on vaccination of adolescent girls. Well organized screening programs have been successful in reducing cervical cancer incidence and mortality can genital warts cause uterine cancer developed nations, but they have been unsuccessful in the great majority of developing countries.
Cost-effectiveness evaluation of conventional cervical cytology and HPV testing for cervical screening in Colombia have shown that HPV testing every 5 years in women over 30 years how to use production possibility curve age is a cost-effective strategy, provided that the cost of the HPV test is less than 31 dollars. Similar decisions have been taken in Mexico that decided to formulate a comprehensive strategy for the control of cervical cancer including HPV-based screening and HPV vaccination of all 11 year old girls.
It is hope that a fast and inexpensive HPV test CareHPV at less than five dollars developed with funds can genital warts cause uterine cancer the Gates foundation will be shortly commercially available. In conclusion, the main hope to reduce the burden of cervical cancer in Colombia and in Latin American countries lies in the introduction of the prophylactic HPV vaccine to all adolescent girls and in the introduction of the HPV assay as primary screening test, and great advances have been made in both directions.
The authors thank all staff at the collaborating healthcare institutions in Cali and the can genital warts cause uterine cancer Cancer Registry of Cali. This work is supported in part by grant RC. Int J Cancer ; 12 Salud Publica Mex ;52 6 The World Factbook [cited Cendales R, Pardo C. Colomb Med ;43 4 International trends in incidence of cervical cancer: II. Can genital warts cause uterine cancer carcinoma.
Int J Cancer ;86 3 Joinpoint Regression Program. Version: 7. Muñoz N.
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