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Objetivo. Proporcionar recomendaciones para la detección temprana de pacientes con alto riesgo de desarrollar cáncer de pulmón (CP) en el primer nivel de atención y su referencia oportuna. Material y métodos. Se realizó una búsqueda detallada de la evidencia científica disponible para responder las preguntas de investigación clínica y se utilizó el Panel Delphi modificado para lograr un consenso entre expertos. Resultados. Se generaron 14 recomendaciones siguiendo los estándares de una GPC. Conclusión. El CP representa un problema de salud pública en México; por ello, esta guía establece recomendaciones que apoyan la toma de decisiones sobre la detección precoz y la referencia de pacientes con sospecha de CP en el primer nivel de atención.

Objective. To provide recommendations for the early lung cancer diagnosis in patients with risk factors at primary care and their timely referral. Materials and methods. This clinical practice guideline (CPG) was developed to establish recommendations based on the best available evidence and agreed upon by a group of experts representing different health sectors. A multidisciplinary group of experts that conformed to the Guideline Development Group (GDG) and conducted detailed scientific evidence research that answered the clinical research questions. The modified Delphi Panel was used to achieve an adequate consensus on the recommendations contained in this CPG. Results. Fourteen recommendations were generated following the standards of a CPG. Conclusion. LC represents a public health concern in México. Therefore, this guideline establishes recommendations to support decision-making regarding early detection and referral of LC in primary care health services. [ABSTRACT FROM AUTHOR]

Resumen. El cáncer de pulmón es una de las principales causas de mortalidad alrededor del mundo. Su historia natural, con la manifestación de síntomas en etapas avanzadas y el retraso en su diagnóstico hacen que una gran proporción de pacientes se diagnostiquen en estadios tardíos de la enfermedad, lo que hace muy complicado el tratamiento exitoso de la misma. De esto deriva la importancia de dar origen a recomendaciones basadas en evidencia para soportar la toma de decisiones clínicas por parte de los grupos interdisicplinarios que se encargan del manejo de este padecimiento. Objetivos. Esta Guía de Práctica Clínica (GPC) contiene recomendaciones clínicas desarrolladas de forma sistematizada para asistir la toma de decisiones de médicos especialistas, pacientes, cuidadores de pacientes y elaboradores de políticas pú­blicas involucrados en el manejo de pacientes con cáncer de pulmón en estadios tempranos, localmente avanzados y metastásicos. Material y métodos. Este documento se desarrolló por parte de la Sociedad Mexicana de Oncología en colaboración con el Centro Nacional de Excelencia Tec­nológica de México (Cenetec) a través de la dirección de integración de Guías de Práctica Clínica en cumplimiento a estándares internacionales como los descritos por el Ins­tituto de Medicina de EUA (IOM, por sus siglas en inglés), el Instituto de Excelencia Clínica de Gran Bretaña (NICE, por sus siglas en inglés), la Red Colegiada para el Desarrollo de Guías de Escocia (SIGN, por sus siglas en inglés), la Red Internacional de Guías (G-I-N, por sus siglas en inglés); entre otros. Se integró en representación de la Sociedad Mexicana de Oncología un Grupo de Desarrollo de la Guía (GDG) de manera interdisciplinaria, considerando oncólogos médicos, cirujanos oncólogos, cirujanos de tórax, radio-oncólogos, y metodólogos con experiencia en revisiones sistemáticas de la literatura y guías de práctica clínica. Resultados. Se consensuaron 62 preguntas cllínicas que abarcaron lo establecido previamente por el GDG en el documento de alcances de la Guía. Se identificó la evidencia científica que responde a cada una de estas preguntas clínicas y se evaluó críticamente la misma, antes de ser incorporada en el cuerpo de evidencia de la Guía. El GDG acordó mediante la técnica de consenso formal de expertos Panel Delphi la redacción final de las recomendaciones clínicas. Conclusión. Esta Guía de Práctica Clínica pretende proveer recomendaciones clínicas para el manejo de los distintos estadios de la enfermedad y que asistan en el proceso de toma de decisiones compartida. El GDG espera que esta guía contribuya a mejorar la calidad de la atención clínica en las pacientes con cáncer de pulmón de células no pequeñas.

Objective. To update information on the mortality trend due to lung cancer in Mexico from 1990 to 2016. Materials and methods. Age-adjusted rates were obtained using the direct method. The percentage of annual change in the mortality of lung cancer was obtained through joinpoint analysis at the national level, by region, sex and rural-urban stratum, and in the last two the age-cohort-period effect. Results. There was an annual decrease in mortality rates due to this neoplasm in the last 10 years, significantly higher in men (-3.5% CI95% -4.0,-2.9) than in women (-1.9% CI95% -2.1,-1.7), and a generational gap between men and women and urban-rural stratum with a decreasing trend in the risk of death. Conclusion. Mortality trends due to lung cancer from 1993 to 2016 show a decrease in different magnitudes and specific periods.

Smoking is the main cause of lung cancer. It plays a role in the etiology, and depending on the intensity and duration, it also has an influence on histology, stage and therapeutic outcome. Therefore, it is never too late to stop smoking. Tobacco smoke is so toxic, that there is no safe smoking modality. Filters, light cigarettes, pipes, water pipes, etc. are prohibitively harmful. In addition, the electronic nicotine delivery systems, besides promoting addiction, cause acute respiratory and cardiovas¬cular effects. In addition, even though long-term consequences are yet to be known, cell proliferation and tumor progression have been identified. Tobacco control efforts should look at all these new products as its main threat.

Objective. To describe temporal trends in lung cancer incidence, mortality and associated health care costs in the Mexican Institute of Social Security. Materials and methods. Incident cases were estimated from hospital discharges in 276 IMSS hospitals between 2006 and 2016. Crude and adjusted mortality rates were calculated. The costs of outpatient and inpatient treatment were calculated based on the medical-technical costs of reference o standard cost. Results. Both incidence and mortality had a decreased time trend. The cost of medical care for the 2 539 patients in 2017 was 42 million US dollars, with an average cost per patient of 16 537 US dollars. The cost per annum of disability pensions is 97.2 million pesos. Conclusions. It is likely that the reduction of the risk of getting sick and dying from lung cancer in IMSS affiliates is due to the control measures of tobacco smoke. It is still necessary to establish strategies to diagnose and treat patients in early stages.

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. Conclusion. 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. [ABSTRACT FROM AUTHOR]

Lung cancer is one the leading causes of mortality worldwide. Symptomatic manifestations of the disease generally occur in the advanced-stage setting, and therefore an important number of patients have advanced or metastatic disease by the time they are diagnosed. This situation contributes to a poor prognosis in the treatment of lung cancer. Evidence-based clinical recommendations are of great value to support decision-making for daily practice, and thus improving health care quality and patient outcomes. Objectives. This Clinical Practice Guideline (CPG) contains systematically-developed recommendations to support clinicians, patients and patientcarers, policy makers and other stakeholders in the diagnosis and management of patients with early, advanced and metastatic stages of non-small cell lung cancer. Materials and methods. This document was an initiative of the Mexican Society of Oncology (SMEO) in collaboration with Mexican Center of Clinical Excellence (Cenetec) according to International Standards. Such standards included those described by the IOM, NICE, SIGN and GI-N. An interdisciplinary Guideline Development Group (GDG) was put together which included medical oncologists, surgical oncologistsc, radiation therapists, and methodologists with expertise in critical appraisal, systematic reviews and clinical practice guidelines development. Results. 62 clinical questions were agreed among members of the GDG. With the evidence identified from systematic reviews, the GDG developed clinical recommendations using a Modified Delphi Panel technique. Patients’ representatives validated them. Conclusions. These Clinical Practice Guideline aims to support the shared decision-making process for patients with different stages of non-small cell lung cancer. Our goal is to improve health-care quality on these patients. [ABSTRACT FROM AUTHOR]

Lung cancer is a major public health problem, yet the disease is highly stigmatized, which impairs the optimal treatment of these patients. Globally, as well as locally in Mexico, lung cancer is the main cause of cancer-related deaths. Despite this, it is the only one among the five deadliest cancers which is not covered by Popular Health Insurance. Lung cancer treatment is a complex algorithm which requires fully trained personnel to assess each patient in order to determine standard-of-care therapy based on several factors associated with the molecular profile of the tumor, patient characteristics and financial possibilities. In the recent decade, several breakthrough therapies have been launched, shifting the outlook for certain patient subgroups. None of these novel therapies are currently available to patients who have public-based health insurance. In this paper, we review the inequities present in the Mexican health system and highlight the importance of addressing these opportunities. [ABSTRACT FROM AUTHOR]

Objective. To review the state-of-the-art in relation to the current information on squamous cell lung cancer (SCLC). We describe the genetic anomalies reported, their effect, and fi- nally the most promising therapeutic agents. Materials and methods. We reviewed published articles in peer-reviewed journals as well as current treatment guidelines from local and international resources. Results. SCLC represents a smaller proportion of the global burden of disease for lung cancer compared to its more frequent presentation, the adenocarcinoma. However, more than 400 000 cases are reported annually, a substantial population for whom therapeutic options are scarce and with limited efficacy. Several groups have been given the task of elucidating the mechanisms that lead to the development of SCLC, including molecular anomalies that can be used as targets for drug design. Conclusion. There are potential therapeutic targets for SCLC, which must be studied in clinical trials for validation. [ABSTRACT FROM AUTHOR]

Objective. To describe the epidemiological studies about the relationship between lung cancer (LC) and pulmonary tuberculosis (Tb) and its possible molecular mechanisms. Material and methods. We reviewed research databases in search of publications that included keywords LC and Tb. Results. It has been proposed that chronic inflammation in the lungs due to Tb could cause clastogenic activity in the DNA of bronchial epithelium. Another possibility is lateral gene transfer; since Mycobacterium tuberculosis (MTb) is an intracellular organism, bacterial DNA could integrate to bronchial epithelial cells inducing neoplastic transformation. Conclusions. There are epidemiological reports, particularly from Asian countries, which confirm a relationship between LC and Tb. MTb could play an active role in cellular transformation and it is important to elucidate the mechanism involved. [ABSTRACT FROM AUTHOR]

Objective. To update information on the mortality trend due to lung cancer in Mexico from 1990 to 2016. Materials and methods. Age-adjusted rates were obtained using the direct method. The percentage of annual change in the mortality of lung cancer was obtained through joinpoint analysis at the national level, by region, sex and rural-urban stratum, and in the last two the age-cohort-period effect. Results. There was an annual decrease in mortality rates due to this neoplasm in the last 10 years, significantly higher in men (-3.5% CI95% -4.0,-2.9) than in women (-1.9% CI95% -2.1,-1.7), and a generational gap between men and women and urban-rural stratum with a decreasing trend in the risk of death. Conclusion. Mortality trends due to lung cancer from 1993 to 2016 show a decrease in different magnitudes and specific periods. [ABSTRACT FROM AUTHOR]

Smoking is the main cause of lung cancer. It plays a role in the etiology, and depending on the intensity and duration, it also has an influence on histology, stage and therapeutic outcome. Therefore, it is never too late to stop smoking. Tobacco smoke is so toxic, that there is no safe smoking modality. Filters, light cigarettes, pipes, water pipes, etc. are prohibitively harmful. In addition, the electronic nicotine delivery systems, besides promoting addiction, cause acute respiratory and cardiovascular effects. In addition, even though long-term consequences are yet to be known, cell proliferation and tumor progression have been identified. Tobacco control efforts should look at all these new products as its main threat. [ABSTRACT FROM AUTHOR]

Objective. To show lung cancer (LC) mortality and disability-adjusted life years (DALYs) in Mexico. Materials and methods. With the visualization tools at the Global Burden of Disease Study website, we analyzed LC mortality and disability-adjusted life years (DALYs) by state, sex, sociodemographic index (SDI), age, and risk factors between 1990 and 2016. Results. Mortality rate decreased from 13.9 to 9.1 per 100 000 between 1990 and 2016. This reduction is greater among men. However, deaths by LC rose from 5 478 to 8 470. DALYs rate also decreased. Northern states with higher SDI face a larger burden from LC but exhibited greater reductions compared with southern, less developed states. The burden of LC is concentrated among older population. Smoking is the main risk factor for LC. Conclusions. The burden by LC has decreased but is differential between states. LC threatens financially both the health system and individuals, since an important fraction of the population is not protected. [ABSTRACT FROM AUTHOR]

Objective. To describe temporal trends in lung cancer incidence, mortality and associated health care costs in the Mexican Institute of Social Security. Materials and methods. Incident cases were estimated from hospital discharges in 276 IMSS hospitals between 2006 and 2016. Crude and adjusted mortality rates were calculated. The costs of outpatient and inpatient treatment were calculated based on the medical-technical costs of reference o standard cost. Results. Both incidence and mortality had a decreased time trend. The cost of medical care for the 2 539 patients in 2017 was 42 million US dollars, with an average cost per patient of 16 537 US dollars. The cost per annum of disability pensions is 97.2 million pesos. Conclusions. It is likely that the reduction of the risk of getting sick and dying from lung cancer in IMSS affiliates is due to the control measures of tobacco smoke. It is still necessary to establish strategies to diagnose and treat patients in early stages. [ABSTRACT FROM AUTHOR]

Objective. To analyze the mortality trend of lung cancer (LC) in Mexico, according to the municipality marginalization index (MMI) by age group and sex, during the period 1998-2016. Materials and methods. The information on mortality, population and MMI was obtained from the National Institute of Statistics and Geography (INEGI) and the National Council of Population (Conapo). The adjusted LC mortality rate trends were analyzed using the joinpoint regression analysis. A total of 126 132 deaths were included. Results. The adjusted LC mortality rate decreased from 7.83 to 4.97 100 000 inhabitants during the period from 1998-2016, but the decrease was found to be less in women and in areas with very high marginalization. Conclusions. Unequal reduction in LC mortality according to the degree of marginalization are related to early diagnosis, timely treatment and inequity in medical services. This inequity affects mainly the populations of women, highly marginalized groups and older populations. [ABSTRACT FROM AUTHOR]

OBJETIVO: Cuantificar el efecto de las enfermedades atribuibles al consumo de tabaco, en términos epidemiológicos (morbilidad) y económicos (costos de atención médica), en el Instituto Mexicano del Seguro Social (IMSS) a escala nacional. MATERIAL Y MÉTODOS: Los costos de la atención médica se estimaron desde la perspectiva del proveedor y se empleó la metodología del costeo de enfermedad. A partir de una muestra de pacientes (n= 1 596) atendidos en las unidades médicas se estableció la frecuencia de utilización de servicios en los tres niveles de atención. Para cada enfermedad se consideraron costos promedio por paciente y costos totales de enfermedad, los cuales se mensuraron en pesos mexicanos de 2004. Se calculó la fracción atribuible al consumo de tabaco para cada enfermedad, misma que se usó para atribuir los costos al tabaco. RESULTADOS: Los costos totales anuales de atención médica nacional corresponden a 7 114 millones para el infarto agudo del miocardio, 3 424 millones para la enfermedad vascular cerebral, 1 469 millones para la enfermedad pulmonar obstructiva crónica y 102 millones para el cáncer pulmonar. El costo total anual para el IMSS por estas cuatro enfermedades asciende a 12 100 millones de pesos. Los costos atribuibles al consumo de tabaco corresponden a 7 100 millones de pesos, lo cual equivale a 4.3% del gasto de operación de la institución en el año 2004. CONCLUSIONES: Estos resultados confirman el elevado costo de la atención médica de las enfermedades atribuibles al consumo de tabaco en el IMSS y generan información de primera mano necesaria para impulsar las medidas de prevención en esa institución y reforzar las políticas de control del tabaquismo ya aplicadas en México.OBJECTIVE: To estimate the cost of medical care for the major diseases attributable to tobacco consumption at the IMSS. MATERIAL AND METODS: A cost of illness (COI) analysis was carried out from the perspective of the health provider. A random sample of clinical files (n= 1,596) was reviewed to estimate the human resources and medical supplies's utilization according to the health care facilities. The smoking attributable fraction (SAF) by disease was used to derive costs attributable to tobacco consumption. The unitary cost was valuated in 2004 Mexican pesos (MP). RESULTS: The estimated annual total cost of medical care was 7114 million MP for acute myocardial infarction (AMI); 3424 million MP for Cerebrovascular Disease, 1469 million MP for chronic obstructive pulmonary disease (COPD) and 102 million MP for lung cancer (LC). The annual total cost of medical care for IMSS was 12100 million MP. The total annual cost of medical care attributable to tobacco consumption corresponds to 7100 million MP, which is equivalent to 4.3% of the annual expenditures of the IMSS during 2004. CONCLUSIONS: These results confirm the high medical costs associated with smoking. This information would be used to reinforce the tobacco control preventive actions at IMSS and support decision-makers in strengthening public policies to control tobacco use in Mexico.