Objetivo: comparar el número de citologías oncóticas planificadas y las realizadas en la ciudad de Río de Janeiro entre los años 2013 y 2022 . Métodos: utilizando la población femenina de Río de Janeiro, se estimó cuántas pruebas se deberían realizar si se recomienda el tamizaje. realizado por el Ministerio de Salud se realizó de manera ideal y luego se comparó con la cantidad de pruebas disponibles en la base de datos pública. Resultados: En este periodo se realizaron 1.364.325 frente a una estimación de 7.886.720. Después del ajuste por el uso de asistencia sanitaria complementaria, la pandemia y los exámenes fuera de la edad recomendada, se observó el 36% del ideal. Conclusión: la cantidad realizada está muy por debajo de lo ideal, incluso después de ajustes, lo que aumenta los costos para el servicio público de salud, haciendo necesarias nuevas políticas públicas para mejorar el seguimiento.

Objetivo: comparar a quantidade de colpocitologias oncóticas ideias e a realmente realizadas no município do Rio de Janeiro entre os anos de 2013 e 2022. Métodos: através da população feminina do Rio de Janeiro, foi feita estimativa de quantos exames deveriam ser realizados caso o rastreio preconizado pelo Ministério da Saúde fosse feito de forma ideal e posteriormente foi comparado com a quantidade de exames disponíveis na base de dados pública. Resultados: foram realizados 1.364.325 nesse período comparado a 7.886.720 estimados. Após ajuste pelo uso de saúde suplementar, pandemia e exames fora da idade recomendada, observou-se 36% do ideal. Conclusão: a quantidade realizada está muito abaixo da ideal, mesmo após os ajustes, o que aumenta custos para o serviço de saúde pública, sendo necessárias novas políticas públicas para melhorar o rastreamento.

Objective: to compare the number of planned oncotic smear tests and those actually performed in the city of Rio de Janeiro between the years 2013 and 2022 . Methods: using the female population of Rio de Janeiro, an estimate was made of how many tests should be carried out if screening recommended by the Ministry of Health was done in an ideal way and was subsequently compared with the number of tests available in the public database. Results: 1,364,325 were carried out in this period compared to an estimated 7,886,720. After adjustment for the use of supplementary healthcare, the pandemic and exams outside the recommended age, 36% of the ideal was observed. Conclusion: the quantity carried out is far below ideal, even after adjustments, which increases costs for the public health service, making new public policies necessary to improve tracking.

RESUMEN Introducción: A nivel mundial, el cáncer de cuello uterino es el cuarto cáncer más frecuente en la mujer. Objetivo: Describir las coberturas anuales de vacunación contra VPH y ESAVI. Material y Métodos: Estudio observacional descriptivo transversal, realizado en Paraguay, periodo 2013-2023, variables analizadas: coberturas de vacunación contra VPH en niñas de 10 años, según esquema: 3 dosis (2013-2016), 2 dosis (2017-2023), coberturas de vacunación de seguimiento a los 15 años (1ª dosis y Dosis Final), ESAVI grave y no grave. Resultados: Los intervalos de coberturas de vacunación contra VPH 1ª dosis: 55-73% (periodo no pandémico), 33-53 % (periodo pandémico), mientras que para Dosis Final: 1-64% (periodo prepandémico) y 5-31 % (periodo pandémico). Al analizar las coberturas de vacunación contra VPH Dosis Final según esquema el promedio de deserción fue mayor en esquema de 3 dosis: 42 vs 25% (valor p= 0,001). El intervalo de coberturas de seguimiento a los 15 años Dosis Final: 66 a 77%. Hubo un recupero importante en los años 2019-2021: 71%, 65% y 59% respectivamente. La Tasa de ESAVI: 2,5 x 100.000 dosis administradas. Conclusión: Las coberturas de vacunación de seguimiento a los 15 años fueron < 90%. La tasa de ESAVI por 100.000 fue baja.

ABSTRACT Introduction: Worldwide, cervical cancer is the fourth-most frequent cancer in women. Objective : To describe HPV vaccination coverage and Adverse Events Following Immunizations (AEVF). Material and Methods: This was a cross-sectional, descriptive and observational study, carried out in Paraguay during 2013-2023; the variables analyzed were: HPV vaccination coverage in 10-year-old girls, according to the recommended vaccination schedule: 3 doses (2013-2016), 2 doses (2017-2023), follow-up vaccination coverage at 15 years (1st dose and Final Dose), AEVF classification during 2013-2023. Results: The coverage intervals for the 1st dose of the HPV vaccine were: 55-73% during the pre-pandemic period (2013-2019) and 33-55% during the pandemic years (2020-2023); Final HPV Vaccine dose coverage: 1-64% during the pre-pandemic period and 5-31% during the pandemic period. The average dropout was higher during the use of a 3-dose schedule: 42 vs. 25% (p value = 0.001). Follow-up vaccination coverage at 15 years for Final Dose: 66-77%. A significant catch-up was achieved from 2019-2021: 71%, 65% and 59% respectively. Regarding the safety of the vaccine the AEFV rate: 2.1 x 100,000. Conclusions: HPV Vaccination coverage at 15 years was below 90%; the AEFV rate per 100,000 dose was low.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita. cuts 20102019 2010 2019 (2010-2019 framework system loglinear log linear model positive however congenital syphilis screening. screening . screening) due insurance capita 2010201 201 (2010-201 201020 20 (2010-20 20102 2 (2010-2 (2010- (2010 (201 (20 (2 (

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita. década Utilizaramse Utilizaram se 2010 (201 2019, 2019 , 2019) adaptada VPA (VPA loglinear. loglinear log linear. linear log-linear apresentaram geral favorável entanto sífilis congênita uterino. uterino . uterino) Verificouse, Verificouse Verificou se, Verificou-se ainda envelhecimento suplementar capita 201 (20 20 (2 2 (

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology. Brazil crosssectional cross sectional 1 9 years 200 2015 HCR (HCR Integrator NRHI (NRHI) System used 484 48 4 48.4% PR 1.06 106 06 1.011.10, 101110 1.01 1.10 , 01 10 1.01-1.10) black brown raceskin race skin 1.04 104 04 1.011.07, 101107 1.07 07 1.01-1.07) 1.28 128 28 1.161.40, 116140 1.16 1.40 16 40 1.16-1.40) 110 1.071.13, 107113 1.13 13 1.07-1.13) 107 1.031.11, 103111 1.03 1.11 03 11 1.03-1.11) 1.08 108 08 1.011.14. 101114 1.14 . 14 1.01-1.14) cytology 20 201 (NRHI 48.4 1.0 0 011 1.011.10 10111 101 1.1 1.01-1.10 1.011.07 10110 1.01-1.07 1.2 12 2 161 1.161.40 11614 116 140 1.4 1.16-1.40 071 1.071.13 10711 113 1.07-1.13 031 1.031.11 10311 103 111 1.03-1.11 1.011.14 114 1.01-1.14 48. 1. 1.011.1 1011 1.01-1.1 1.011.0 1.01-1.0 1.161.4 1161 1.16-1.4 1.071.1 1071 1.07-1.1 1.031.1 1031 1.03-1.1 1.011. 1.01-1. 1.161. 1.16-1. 1.071. 1.07-1. 1.031. 1.03-1. 1.011 1.01-1 1.161 1.16-1 1.071 1.07-1 1.031 1.03-1 1.01- 1.16- 1.07- 1.03-

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica. Brasil transversal 1 9 anos 200 2015 Câncer Humano Ambulatoriais Usouse Usou se aleatório 484 48 4 48,4% RP 1,06 106 06 1,011,10, 101110 1,01 1,10 , 01 10 1,01-1,10) raçacor raça cor preta 1,04 104 04 1,011,07, 101107 1,07 07 1,01-1,07) 1,28 128 28 1,161,40, 116140 1,16 1,40 16 40 1,16-1,40) 110 1,071,13, 107113 1,13 13 1,07-1,13) 107 1,031,11 103111 1,03 1,11 03 11 1,03-1,11 1,08 108 08 1,011,14. 101114 1,14 . 14 1,01-1,14) oncótica 20 201 48,4 1,0 0 011 1,011,10 10111 101 1,1 1,01-1,10 1,011,07 10110 1,01-1,07 1,2 12 2 161 1,161,40 11614 116 140 1,4 1,16-1,40 071 1,071,13 10711 113 1,07-1,13 031 1,031,1 10311 103 111 1,03-1,1 1,011,14 114 1,01-1,14 48, 1, 1,011,1 1011 1,01-1,1 1,011,0 1,01-1,0 1,161,4 1161 1,16-1,4 1,071,1 1071 1,07-1,1 1,031, 1031 1,03-1, 1,011, 1,01-1, 1,161, 1,16-1, 1,071, 1,07-1, 1,031 1,03-1 1,011 1,01-1 1,161 1,16-1 1,071 1,07-1 1,03- 1,01- 1,16- 1,07-

Resumo O artigo apresenta uma análise do desempenho da APS no estado de São Paulo na última década, em contexto de crise econômica e retração dos investimentos em saúde. Utilizaram-se indicadores de desempenho, determinantes em saúde e sistema de saúde, em série temporal (2010 a 2019), a partir de matriz conceitual adaptada. Foram calculadas variações percentuais anuais (VPA) de cada indicador em modelo log-linear. Os indicadores de desempenho apresentaram, no geral, evolução favorável; no entanto, ocorreu piora em indicadores relacionados à qualidade do cuidado (sífilis congênita, partos cesáreos e rastreamento de câncer de colo uterino). Verificou-se, ainda, um potencial aumento das demandas ao SUS (envelhecimento da população e redução da cobertura da saúde suplementar) e aumento das despesas em saúde em contexto de redução do PIB per capita.

Abstract This article presents the results of an analysis of the performance of primary health care in São Paulo state over the last decade against a backdrop of financial crisis and health funding cuts. We conducted a time series analysis (2010-2019) of performance indicators across the following dimensions based on an adapted conceptual framework: health service performance, health system, and determinants of health. Annual percentage change was calculated for each indicator using a log-linear model. Performance across the indicators was generally positive; however, there was a decline in performance across indicators of quality of care (congenital syphilis, cesarean section rate and cervical cancer screening). The findings also show a potential rise in demand for public services (due to population aging and a reduction in the percentage of the population with private health insurance) and increase in health expenditure against a backdrop of falling GDP per capita.

Resumo O estudo visa analisar a prevalência de estadiamento avançado ao diagnóstico do câncer do colo do útero e sua associação com indicadores individuais e contextuais socioeconômicos e de oferta de serviços de saúde no Brasil. Estudo transversal, realizado com casos de câncer do colo do útero em mulheres de 18 a 99 anos, no período de 2006 a 2015, extraídos do Integrador de Registros Hospitalares de Câncer. Variáveis contextuais foram coletadas no Atlas do Desenvolvimento Humano, no Cadastro Nacional de Estabelecimentos de Saúde e no Sistema de Informações Ambulatoriais. Usou-se o modelo de regressão de Poisson multinível com intercepto aleatório. A prevalência de diagnóstico em estádio avançado foi de 48,4%, apresentando associação com idades mais avançadas (RP 1,06; IC 1,01-1,10), raça/cor da pele preta, parda e indígena (RP 1,04; IC 1,01-1,07), menores níveis de escolaridade (RP 1,28; IC 1,16-1,40), ausência de parceiro conjugal (RP 1,10; IC 1,07-1,13), encaminhamento do tipo público ao serviço de saúde (RP 1,07; IC 1,03-1,11) e menor taxa de realização de exame citopatológico (RP 1,08; IC 1,01-1,14). Os resultados reforçam a necessidade de melhorias no programa nacional de prevenção do câncer do colo do útero em áreas com baixa cobertura da citologia oncótica.

Abstract The scope of this study is to analyze the prevalence of advanced stage diagnosis of cervical cancer and its association with individual and contextual socioeconomic and healthcare service indicators in Brazil. A cross-sectional study was conducted using cervical cancer cases in women aged 18 to 99 years, from 2006 to 2015, extracted from the Hospital Cancer Registry (HCR) Integrator. Contextual variables were collected from the Atlas of Human Development in Brazil; the National Registry of Health Institutions (NRHI); and the Outpatient Information System. Multilevel Poisson Regression with random intercept was used. The prevalence of advanced stage diagnosis was 48.4%, revealing an association with older age groups (PR 1.06; CI 1.01-1.10), black, brown, and indigenous race/skin color (PR 1.04; CI 1.01-1.07), lower levels of schooling (PR 1.28; CI 1.16-1.40), no marital partner (PR 1.10; CI 1.07-1.13), public referral to the health service (PR 1.07; CI 1.03-1.11), and lower rates of cytological examination (PR 1.08; CI 1.01-1.14). The results reinforce the need for improvements in the national cervical cancer prevention program in areas with low coverage of oncotic cytology.

Abstract Introduction : Little evidence exists on the impact of the COVID-19 pandemics on the compliance with cervi cal cancer treatment. Methods : We carried out a population-based, be fore-and-after retrospective cohort study of all cervical cancer patients diagnosed in the Jujuy province public health sector (n=140), Argentina, between 2017 and 2020. Patients diagnosed in 2020 were considered exposed to the COVID-19 pandemic (n=21). We used multivariable logistic regression to assess the relationship between the pandemics and compliance with treatment. We also measured treatment duration for women who were indicated brachytherapy and time to treatment initia tion by stage. Results : Compared with women diagnosed in 2017- 2019 the odds ratio of non-complying with treatment was 1.77 (95%CI 0.59-5.81; p = 0.32) for women diagnosed during 2020. An increased risk of non-compliance was found in patients with prescribed brachytherapy (OR 4.14. 95%CI 1.95-9.11; p < 0.001). Median treatment dura tion for women with prescribed brachytherapy was 12.8 and 15.7 weeks in 2017-2019 vs. 2020 (p = 0.33); median time to treatment initiation for women with early-stage disease was 9 and 5 weeks during 2017-2019 and 2020 respectively (p = 0.06), vs 7.2 and 9 weeks in 2017-2019 and 2020 respectively (p = 0.36) for patients with stages IIB+ disease. Conclusions : Low access to brachytherapy was a major determinant of non-compliance. irrespective of the effect of the pandemics.

Resumen Introducción : Hay escasa evidencia sobre el impacto de la pandemia de COVID-19 en el cumplimiento del tratamiento de cáncer cervicouterino. Métodos : Se llevó a cabo un estudio poblacional de cohorte retrospectivo. -antes/después- de las pacientes con cáncer cervicouterino diagnosticadas en estable cimientos públicos de la provincia de Jujuy (n = 140), entre 2017 y 2020. Las pacientes diagnosticadas en 2020 se consideraron expuestas a la pandemia (n = 21). Utili zamos la regresión logística multivariada para analizar la asociación entre pandemia y cumplimiento del tra tamiento de cáncer. Además, se midió la duración del tratamiento en aquellas con indicación de braquiterapia y el tiempo hasta el inicio al tratamiento según estadio. Resultados : Comparadas con las mujeres diagnosti cadas en 2017-2019 el odds ratio de incumplimiento del tratamiento fue de 1.77 (IC95% 0.59-5.81; p = 0.32) para las diagnosticadas durante 2020. Se encontró un mayor riesgo de incumplimiento en pacientes con indicación de braquiterapia (OR 4.14; IC 95%:1.95-9.11; p < 0.001). La mediana de duración del tratamiento para aquellas con indicación de braquiterapia fue de 12.8 y 15.7 sema nas en 2017-2019 y 2020 respectivamente (p = 0.33). La mediana de tiempo hasta el inicio del tratamiento para pacientes con enfermedad en estadio temprano fue de 9 y 5 semanas durante 2017-2019 y 2020 respectivamente (p = 0.06), versus una mediana de 7.2 y 9 semanas en 2017-2019 y 2020 respectivamente (p=0.36) para las pa cientes con enfermedad en estadio IIB+. Conclusiones : El bajo acceso a la braquiterapia fue un factor determinante de incumplimiento de tratamiento de cáncer cervicouterino, independientemente del efecto de la pandemia.

ABSTRACT Introduction: Cervical cancer is the third leading cause of death from malignancies worldwide, affecting mainly low- and middle-income countries. By 2020 an incidence of 604,000 new cases was estimated. Objective: To characterize the main hospital indicators of the Cervical Cancer Early Diagnosis Program. Methods: An observational, descriptive and cross-sectional study was carried out to characterize the main hospital indicators of the Program in the Neck Pathology Service of the General Hospital Dr. Bruno Zayas Alfonso of Santiago de Cuba, from January 2020 to December 2022. The study population consisted of 443 women. The data collected were analyzed using descriptive statistic techniques, expressed in frequency and percentages. Results: Of the women studied, 60.9 %had cervical intraepithelial lesion of high degree of malignancy, with 32.6 % positive for cervical cancer. The overall percentage of useless cytological tests was 2.07 and no cells from the processing zone was 4.01, both quality indicators. There was a high significance in terms of the overall coverage rate of women at risk (K=0.615), showing that the results of the cytology largely reflect the diagnosis of histology, with a good agreement. Conclusions: Cervical-vaginal cytology remains the most valuable diagnostic method for detecting cervical intraepithelial neoplasm and early-stage carcinoma in large populations

RESUMEN Introducción: El cáncer cervicouterino ocupa el tercer lugar como causa de defunción por neoplasias malignas a nivel mundial, afectando principalmente a los países de ingresos bajos y medianos. Hacia el 2020 se estimó una incidencia de 604 000 nuevos casos. Objetivo: Caracterizar los principales indicadores hospitalarios del Programa de Diagnóstico Precoz del Cáncer Cervicouterino. Métodos: Se realizó un estudio observacional, descriptivo y transversal, que permitió caracterizar los principales indicadores hospitalarios del Programa en el Servicio de Patología de Cuello del Hospital General Dr. Juan Bruno Zayas Alfonso de Santiago de Cuba, de enero del 2020 a diciembre del 2022. La población de estudio estuvo constituida por 443 mujeres. Los datos recopilados fueron analizados mediante técnicas de estadística descriptiva, expresándose en frecuencia y porcentajes. Resultados: De las mujeres estudiadas, 60,9 % presentaron lesión intraepitelial cervical de alto grado de malignidad, con 32,6 % positivo a cáncer cervicouterino. El porcentaje global de pruebas citológicas no útiles fue de 2,07 y sin células de la zona de transformación, de 4,01; ambos indicadores de calidad. Existió una alta significación en cuanto a la tasa de cobertura global de las mujeres en riesgo (K=0,615), demostrando que los resultados de la citología reflejan en gran medida los diagnósticos de la histología, con una buena concordancia. Conclusiones: La prueba citológica cérvico-vaginal sigue siendo el método diagnóstico de mayor valor para detectar neoplasia intraepitelial cervical y carcinoma en estadio precoz en grandes masas de población.

RESUMEN Introducción: En América Latina y el Caribe, el cáncer de mama constituye la primera causa de muerte por neoplasias malignas femeninas, desplazando en diversos países al cáncer cervicouterino. En México es la segunda causa de muerte por procesos tumorales en mujeres mayores de 25 años y cada año se diagnostican 14 000 casos nuevos. Objetivo: Determinar los factores de riesgo a los que pueden estar expuestas las mujeres con antecedentes familiares de cáncer de mama. Metodología: Se realizó una revisión integradora en la que se buscaron artículos relacionados con los temas de cáncer de mama y factores de riesgo en mujeres con antecedentes familiares de cáncer de mama. Para la búsqueda se utilizaron las bases de datos de Google Scholar, PubMed y Scielo. Se seleccionaron los términos de búsqueda basándose en la pregunta de investigación con la estrategia de Concepto, Población y Contexto (CPC). Resultados: De las bases de datos Google Scholar, PubMed y Scielo se seleccionaron 42 artículos, y se encontró que aún existe desconocimiento en lo que respecta a las prácticas del propio cuidado, enfrentando esta problemática de salud pública los países en desarrollo. Conclusiones: Investigaciones sobre el tema han concluido que las mujeres con un bajo nivel de escolaridad, que habitan en zonas rurales y pertenecen a estratos socioeconómicos bajos tienen mayor probabilidad de padecer esta patología.

ABSTRACT Introduction: In Latin America and the Caribbean breast cancer, it is the leading cause of death from malignant neoplasms in women, displacing cervical cancer in several countries. In Mexico, it is the second cause of death due to tumor processes in women over 25 years of age and 14,000 new cases are diagnosed each year. Objective: To determine the risk factors to which women with a family history of breast cancer may be exposed. Methodology: An integrative review was carried out where articles related to the topics of breast cancer, risk factors and care in women with a family history of breast cancer were searched. For the search, the Google Scholar, PubMed and Scielo databases were used. Search terms were selected based on the research question using the Concept, Population and Context (CPC) strategy. Results: From the Google Scholar, PubMed and Scielo databases, 42 articles were selected, finding that there is still a lack of knowledge regarding self-care practices, facing this public health problem in developing countries. Conclusions: Research on the subject has concluded that women with a low level of schooling, who live in rural areas and belong to low socioeconomic strata are more likely to suffer from this pathology.

ABSTRACT Introduction: cancer entails a mortality of up to 12 % in transplanted patients and is considered the third leading cause of morbidity and mortality in recipients who are susceptible to develop oncoproliferative diseases in the long term. Objective: to describe the incidence of neoplasms in renal transplant recipients. Methods: we carried out a descriptive and longitudinal study including 15 functioning renal transplant recipients who were diagnosed with malignant neoplasms in different locations in the Nephrology service at “Arnaldo Milián Castro” Clinical and Surgical University Hospital in Santa Clara, Villa Clara between January 2017 and June 2023. Results: males and white skin color predominated: 53.3 % and 73.3% respectively, with post-transplant time greater than three years in 12 patients (80 %). The history of cytomegalovirus exposure represented 80 %; bacterial infection of the respiratory and digestive tracts was the most frequent. Conclusions: cervicouterine intraepithelial neoplasia, colon cancer with liver and brain metastases were the most frequent and treated with surgery chemotherapies or both according to the surgical criteria in each case; however, mortality was elevated. Cervical intraepithelial neoplasia predominated in a 26.6 %. Mortality was high and survival was lower in males, without exceeding two years after the diagnosis.

RESUMEN Introducción: El cáncer conlleva a una mortalidad de hasta 12 % en los pacientes trasplantados, y se considera la tercera causa de morbilidad y mortalidad en los receptores, al ser estos susceptibles a desarrollar enfermedades oncoproliferativas, a largo plazo. Objetivo: Describir la incidencia de neoplasias en receptores de trasplante renal. Métodos: Estudio descriptivo y longitudinal que incluyó 15 receptores de trasplante renal funcionante, con diagnóstico de neoplasias malignas en diferentes localizaciones en el período comprendido entre enero de 2017 y junio de 2023 en el servicio de Nefrología del Hospital Universitario Clínico-Quirúrgico «Arnaldo Milián Castro» de Santa Clara, Villa Clara. Resultados: Predominaron los hombres y el color de piel blanca: 53,3 % y 73,3% respectivamente, con tiempo postrasplante superior a tres años en 12 pacientes (80 %). El antecedente de exposición al citomegalovirus representó el 80 %; la infección bacteriana de la vía respiratoria y digestiva fue la más frecuente. Conclusiones: La neoplasia intraepitelial cervicouterina, la de colon con metástasis hepática y las cerebrales resultaron las más frecuentes, y fueron tratadas con cirugía, quimioterapias o ambas, según los criterios quirúrgicos en cada caso; no obstante, la mortalidad fue elevada. La estirpe neoplásica preponderante fue la neoplasia intraepitelial cervical en un 26,6 %. La mortalidad fue alta y la supervivencia fue menor en el sexo masculino, sin rebasar los dos años posteriores al diagnóstico.

ABSTRACT Background: Pancreatic metastases are rare but are likely to be diagnosed more frequently in the future due to the increase in oncology surveillance programs. Objective: The aim of this study was to describe the surgical and oncologic outcomes of a series of patients undergoing surgery for pancreatic metastases. Materials and methods: We conducted a retrospective, descriptive, and multicenter cohort study on patients who underwent pancreatic resections for metastases in the pancreas by the same surgical group between January 2016 and December 2022 in three healthcare providers. Results: A total of 19 patients were operated on, mean age was 59 years (45-79), and 11 were women with good performance status and no other evidence of oncologic disease. Clear cell renal cell carcinoma was the primary tumor in 14 cases (7 diagnosed during surveillance), and the remaining primary tumors were one case of breast ductal carcinoma, one testicular cancer, one colorectal cancer, one melanoma and one cervical cancer. The surgical techniques used were pancreatectomies and splenectomies in 7 patients (5 via laparoscopy and 2 conventional procedures), 4 enucleations (3 conventional procedures and 1 laparoscopic surgery), 3 conventional cephalic pancreaticoduodenectomies, 2 conventional central pancreatectomies and one spleen-preserving distal pancreatectomy. No deaths were reported within 90 days of surgery, and overall survival and disease-free survival were 58 and 53 months, respectively. Conclusion: Resection of pancreatic metastases is safe and provides good oncologic outcomes and overall survival when performed with a multidisciplinary approach in centers with a high volume of hepatobiliary and pancreatic surgeries and in selected cases.

RESUMEN Antecedentes: las metástasis pancreáticas, si bien son poco frecuentes, representan una entidad clínica cuyo diagnóstico probablemente se incrementará en el futuro por el aumento de los programas de seguimiento oncológico. Objetivo: describir los resultados quirúrgicos y oncológicos de una serie de pacientes operados por metástasis pancreáticas. Materiales y métodos: se realizó un estudio de cohorte retrospectivo, descriptivo, multicéntrico, de los pacientes sometidos a resecciones pancreáticas por metástasis entre enero de 2016 y diciembre de 2022, en tres efectores de salud por el mismo grupo quirúrgico. Resultados: fueron operados 19 pacientes, con una media de edad de 59 años (45-79), 11 de sexo femenino, en buen estado general y sin otra evidencia de enfermedad oncológica. El origen de los tumores primarios fue 14 en riñón (7 diagnosticados durante el seguimiento), uno carcinoma mamario, uno melanoma, uno testicular, uno colorrectal y uno de cuello de útero. Las técnicas quirúrgicas empleada fueron: 7 esplenopancreatectomías (5 videolaparoscópicas y 2 convencionales), 4 enucleaciones (3 convencionales y 1 videolaparoscópica), 3 duodenopancreatectomías cefálicas convencionales, 2 duodenopancreatectomías totales convencionales, 2 pancreatectomías centrales convencionales, y una pancreatectomía corporocaudal con preservación del bazo. No se registró mortalidad operatoria (dentro de los 90 días posoperatorios), y presentaron una supervivencia global y libre de enfermedad de 58 y 53 meses, respectivamente. Conclusión: la resección de metástasis pancreáticas, en casos seleccionados, con un abordaje multidisciplinario, y en centros de alto volumen de patología hepatobiliopancreática, es segura y permite buenos resultados oncológicos y de supervivencia global.

RESUMEN Introducción: el sarcoma del estroma endometrial de bajo grado es un tumor que representa menos del uno por ciento de todas las neoplasias malignas uterinas. Se diagnostica mayoritariamente entre los 40 y los 55 años de edad, tiene un crecimiento lento, con diseminación extrauterina en el 40 y hasta el 50% de los casos al momento del diagnóstico. Información del paciente: mujer de 72 años de edad, con antecedentes de hipertensión arterial, de diabetes mellitus tipo 2 y de intervención quirúrgica por fibroma, junto con necrobiosis, a la que hubo que realizarle histerectomía total abdominal con doble anexectomía. Como resultado de la biopsia se detectaron leiomiomas intramurales submucosos y subserosos con áreas de necrosis y hemorragias. Posteriormente, en agosto de 2022, presentó sangrado escaso, por lo que se envió a la Consulta de patología de cuello. Se le realizó una videocolposcopia con lesión exofítica en la cúpula vaginal. La paciente regresó al centro por una tumoración de ±6 a 8 cm, violácea, que protruía a través del introito vulvar, procedente de la cúpula vaginal y acompañada de sangrado, y friable. El resultado de la biopsia determinó un tumor mesenquimal maligno tipo sarcoma de bajo grado con dos focos de necrosis. Conclusiones: el cáncer uterino es la neoplasia maligna ginecológica más común. Por otro lado, el sarcoma del estroma endometrial de bajo grado, es un tumor muy inusual que ocupa el segundo lugar entre los tumores mesenquimales uterinos.

ABSTRACT Introduction: low-grade endometrial stromal sarcoma is a tumor that represents less than one percent of all uterine malignancies. It is mostly diagnosed between 40 and 55 years of age, it has slow growth, with extrauterine dissemination in 40 and up to 50% of cases at the time of diagnosis. Patient information: 72-year-old woman, with a history of high blood pressure, type 2 diabetes mellitus and surgery for fibroid, along with necrobiosis, who had to undergo total abdominal hysterectomy with double adnexectomy. As a result of the biopsy, submucosal and subserosal intramural leiomyomas with areas of necrosis and hemorrhages were detected. Subsequently, in August 2022, she presented scant bleeding, so she was sent to the Neck Pathology Consultation. She underwent video colposcopy with an exophytic lesion in the vaginal vault. The patient returned to the center due to a tumor measuring ±6 to 8 cm, violaceous, protruding through the vulvar introitus, coming from the vaginal vault and accompanied by bleeding, and friable. The biopsy result determined a low-grade sarcoma-type malignant mesenchymal tumor with two foci of necrosis. Conclusions: uterine cancer is the most common gynecological malignancy. On the other hand, low-grade endometrial stromal sarcoma is a very unusual tumor that ranks second among uterine mesenchymal tumors.

Introduction: The thyroid gland has its embryological origin from the base of the tongue, where it descends to the neck. This migratory process can stop early or continue beyond, giving rise to differents cases of ectopic thyroid. The thyroglossal cyst is the most frequent embryological alteration in the neck, and it can develop cancer as a rare complication. Clinical case: A 21 year old patient with a cervical volume increase is diagnosed a thyroglossal cyst. Biopsy identifies papilary cancer in the cyst. It is decided to complete de thyroidectomy, and agenesis of the gland is observed. Due to incomplete biochemical response, a scintigram is performed, wich identifies a retrolingual nodule that is resected. Discussion: The resection of the thyroglossus cyst should be performed according to the description of Sistrunk to avoid recurrence. The natural history of cancer in the thyroglossal cyst is much less known and could have a worst prognosis than usual thyroid cancer. Some groups advocate for the need to complete a thyroidectomy and eventually perform cervical dissections as part of its management. Conclusion: The cancer on a thyroglossal cyst is a rare pathology. There are diferents management approaches that are discussed in the literature. However, an individualized analysis of patients in multidisciplinary expert committees it still the suggested aproach.

Resumen Introducción: La glándula tiroides tiene su origen embriológico en la base de la lengua, desde donde desciende al cuello. Este proceso migratorio puede detenerse o continuar más allá, dando diferentes cuadros de tiroides ectópica. El quiste tirogloso es la alteración embriológica más frecuente en el cuello, pudiendo desarrollar cáncer como una complicación rara. Caso clínico: Paciente de 21 años con aumento de volumen cervical, se diagnostica quiste tirogloso, la biopsia identifica cáncer papilar en el quiste. Se decide completar tiroidectomía, se objetiva agenesia de glándula. Ante respuesta bioquímica incompleta se realiza cintigrama que identifica nódulo retrolingual, el cual es resecado. Discusión: La resección del quiste tirogloso se debe realizar según la descripción de Sistrunk para evitar recidivas. La historia natural del cáncer en quiste tirogloso es bastante menos conocida y podría tener un peor pronóstico que el cáncer tiroideo habitual. Existen grupos que defienden la necesidad de completar tiroidectomía y, eventualmente, realizar disecciones cervicales como parte de su manejo. Conclusión: El cáncer de quiste tirogloso es una patología infrecuente, Existen diferentes lineas de manejo que se discuten en la literatura. Aún el análisis individualizado de los pacientes en comités multidisciplinario de expertos es la conducta sugerida.

Abstract Background: Persistent infection by high-risk human papillomavirus (HR-HPV) genotypes is the main cause of cervical cancer worldwide. Genotypes 16 and 18 are associated with progression to cervical cancer, however other genotypes also present high oncogenic risk. There is little evidence regarding the distribution of HR-HPV genotypes in the national population, being an issue that should be addressed in the context of a growing increase in immigration and implementation of the immunization program in Chile since 2015. Aim: To show the distribution of HR-HPV genotypes detected in women and men, attended at the private care network of Clinica Davila, Santiago City, between 2014 and 2021. Methods: Genital and anal samples from 3,642 patients were studied, including both sexes. Genotyping was performed by real-time polymerase chain reaction (PCR) (HPV AnyplexTM II HPV28 detection, Seegene, Korea). Results: The global distribution of genotypes in women (percentage) was: 16 (14.34%) - 31 (6.20%) - 39 (5.94%) - 58 (5.94%) - 51 (5.68%) - 53 (5.64%) - 52 (5.30%) - 56 (5.27%) - 68 (5.19%) - 66 (4.97%) - 18 (3.36%) - 59 (3.29%) - 73 (2.80%) - 35 (2.54%) - 45 (2.13%) - 33 (1.53%) - 82 (1.38%) - 26 (0.49%) and 69 (0.41%). In men was: 16 (8.52%) - 58 (4.39%) - 51 (8.44%) - 26 (0.42%) - 18 (3.21%) - 52 (4.47%) - 39 (5.40%) - 53 (4.56%), 33 (1.69%) - 35 (2.03%) - 73 (2.19%) - 69 (0.59%) - 45 (2.11%) - 59 (4.22%) - 68 (3.04%) - 66 (5.06%) - 31 (4.64%) - 56 (4.81%) and 82 (1.10%). Conclusions: The distribution of HPV genotypes was consistent with previous national studies. A tendency to reduce genotype 16 over the years was observed, which could be related to the vaccination, implemented in recent years in Chile. It is remarkable that other HR-HPV genotypes had a high frequency in the population studied, so it would be advisable to evaluate an expanded screening for HR-HPV genotypes to assess the oncogenic risk, for diagnostic and therapeutic purposes.

Resumen Introducción: La infección persistente por genotipos de virus papiloma humano de alto riesgo (VPH-AR) es la principal causa del cáncer cérvico-uterino en todo el mundo. Los genotipos 16 y 18 están asociados a la progresión hacia el cáncer de cuello uterino; sin embargo, otros genotipos también presentan alto riesgo oncogénico. Existe escasa evidencia respecto a la distribución de genotipos VPH-AR en la población nacional, siendo un tema que debiese ser abordado en el contexto de un creciente aumento de la inmigración e implementación del programa de inmunización en Chile desde 2015. Objetivo: Dar a conocer la distribución de genotipos de VPH-AR detectados en pacientes de ambos sexos, atendidos en la red de atención privada de Clínica Dávila de Santiago, entre los años 2014 y 2021. Metodología: Se estudiaron muestras genitales y anales provenientes de 3.642 pacientes, incluyendo ambos sexos. La genotipificación fue realizada mediante reacción de la polimerasa en cadena (RPC) en tiempo real (HPV AnyplexTM II HPV28 detection, Seegene, Korea. Resultados: La distribución global de genotipos en mujeres (porcentaje) fue: 16 (14,34%) - 31 (6,20%) - 39 (5,94%) - 58 (5,94%) - 51 (5,68%) - 53 (5,64%) - 52 (5,30%) - 56 (5,27%) - 68 (5,19%) - 66 (4,97% - 18 (3,36%) - 59 (3,29%) - 73 (2,80%) - 35 (2,54%) - 45 (2,13%) - 33 (1,53%) - 82 (1,38%) - 26 (0,49%) y 69 (0,41%). En hombres fue: 16 (8,52%) - 58 (4,39%) - 51 (8,44%) - 26 (0,42%) - 18 (3,21%) - 52 (4,47%) - 39 (5,40%) - 53 (4,56%) - 33 (1,69%) - 35 (2,03%), 73 (2,19%) - 69 (0,59%) - 45 (2,11%) - 59 (4,22%) - 68 (3,04%) - 66 (5,06%) - 31 (4,64%) - 56 (4,81%) y 82 (1,10%). Conclusiones: La distribución de los genotipos de VPH fue concordante con estudios previos nacionales. Se observó una tendencia a la reducción del genotipo 16 en el tiempo, lo cual podría relacionarse a la vacunación, implementada en los últimos años en Chile. Destaca que otros genotipos de VPH-AR tuvieron una alta frecuencia en la población estudiada por lo que sería recomendable evaluar la pesquisa ampliada de genotipos de VPH-AR para valorar el riesgo oncogénico, con fines diagnósticos y terapéuticos.