The prevalence of cancer in Colombia has been affecting women, especially with breast cancer, and men with prostate cancer. However, Despite the effects, the country has been advancing in prevention strategies and in the innovation of treatments.
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Carolina Wiesner, director of the National Cancer Institutespoke with Portafolio about the behavior of this disease in the country, but also about the measures that the entity is taking to treat it better.
In Colombia, how is cancer behaving?
In terms of incidence, that is, the number of new cases that occur each year, it occupies an intermediate place in relation to the world stage. Countries that have a high human development index have a higher incidence of cancer than those with lower human development, which have cancers associated with infection.
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Cancer is a set of 120 diseases, but those with the highest incidence are prostate, breast, colon-rectum, cervix, thyroid, and lung cancer, and this pattern has changed. When we were a country with less human development, those associated with infection predominated, such as cervical cancer and stomach cancer, which are associated with the Human Papillomavirus (HPV) and Helicobacter pylori, respectively.
In terms of mortality, for example, countries that have a very high incidence have lower mortality than Colombia and that happens because we, in terms of the social response we give to cancer, is not enough. Despite not having as many cases, we die proportionally more.
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Carolina Wiesner, director of the National Cancer Institute in Colombia
Courtesy
How are those figures being handled?
To reduce the incidence, prevention must be done. The only way to reduce the incidence, whose impact will be seen in 20 years, are the classic recommendations that we always make. For example, for lung cancer, because Colombians stopped smoking, the incidence has been reduced and cancers associated with tobacco consumption, which are the oral cavity, pharynx, larynx and even kidney.
Other cancers that can be prevented are cervical when women have cytology or HPV tests and a precancerous lesion is identified and treatment is given. But for other types of cancer where these techniques do not exist, the treatment is done and in Colombia treatment technologies have been incorporated that have transformed reality and cancer is no longer necessarily considered a lethal disease.
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Is there innovation regarding treatments?
Not only in terms of systemic treatment does chemotherapy exist, which causes undifferentiated destruction of cells, including tumor cells. Now there is immunotherapy and all the drugs that target therapeutic targets.
There, a genetic mutation or a hormone receptor is identified and the treatment is directed to those targets. This is a more personalized medicine and the survival of patients who have this treatment option changes radically.
Cancer
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Which affects men and women more?
Obviously, of the cancers in women, the one that occupies first place in incidence and mortality is breast cancer, which is associated with female hormones, and prostate cancer is the one most associated with men.
In men and women there is also stomach and colon-rectal cancer, which was one that was not so present, now the incidence and mortality has increased. Curiously, there is a higher mortality in women. She has also had more thyroid cancer, but fortunately it is not as fatal.
Lung cancer also depends on the prevalence of smoking, but there is lung cancer that occurs in women who do not necessarily smoke. There are differences in the patterns because there are hormonal factors that include.
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What are the costs of cancer?
In cancers that are diagnosed in early stages, surgical treatment or radiotherapy is generally performed and it is known that these have a lower cost to the system. However, medications and systemic treatments that are usually given on an outpatient basis add costs, particularly everything that is the great chapter of immunotherapy.
The use of monoclonal antibodies increases the costs of treatment and as the patient has to go through several lines, the costs of the medications increase. The average value of a patient’s treatment depends on the stage at which they are diagnosed and the type of medication they are administered.
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Is the country making more investments in treatments or equipment?
In surgery we have the possibility of offering minimally invasive surgery, that is, with robotic surgery. This makes the patient’s recovery much faster, the bleeding is less, the intensive care time is less, but the costs are higher. There are so many benefits that the system assumes it today and covers it.
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Everything that has to do with diagnostic technologies. The health system in Colombia is one of the most interesting because it has achieved universal access; patients, regardless of their ability to pay, can have access to the best technologies and the best treatments.
To the extent that cancers are not diagnosed early, it is a greater burden on the system and the resources are already insufficient, which is a bit of the structural crisis today. One of the strategies to reduce costs and that is proposed in the reform, is to promote early detection, so that general practitioners have more capabilities to quickly identify cancer.
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There is a study where it was found that women with breast cancer received their care in 5 or more sites. Fragmented care cost the system more and resulted in lower treatment survival. This shows us that the system lacks more comprehensiveness, more opportunity to improve clinical outcomes and to reduce the costs of care.
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What is the Institute working on?
We are in an institutional transformation because President Gustavo Petro sanctioned Law 2291 of 2023 that transforms the labor regime and the legal nature of the Institute, because the remuneration of doctors was not competitive and we had many legal and administrative difficulties to fulfill our functions.
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Unfortunately, the National Civil Service Commission filed a complaint with the Constitutional Court and declared it unconstitutional. Right now we are focused on trying to get out of that, but with the Ministry of Health we are implementing a shock plan particularly among other pathologies.
We are strengthening innovation at the Institute, we have a coordination center and we are strengthening the cancer research network. Like in the United States, we want to work more in a multidisciplinary way, so that the ideas that are going to be financed are by consensus and not competing with each other, but rather working collaboratively, because cancer implies that we all work together and help each other to understand it more and treat it better.
