Mexico's Forward-Thinking Strategies For Cancer Prevention

Issue 24 Winter/Spring 2015

Innovative Programs May Have Lessons For U.S. Immigrant Population, Too

With more than 122 million people, Mexico is the second most populous country in Latin America and the Caribbean, and the most populous Spanish speaking country in the world. It is categorized as an upper middle income level country1, with a life expectancy of 77 years at birth, surpassing that of other Latin American and Caribbean countries (mean of 74.5 years)1.

The country has undergone a major demographic transition, with a shift over time in the burden of disease from communicable to chronic. Because of this, cancer now ranks as the third leading cause of death after cardiovascular disease and type 2 diabetes. Cancer related mortality is highest for lung cancer, followed by stomach cancer, with prostate, liver and breast cancers in third, fourth and fifth places.2

Lung cancer mortality is twice as high in Mexican men as in women. In men, cancer incidence — based on regional registry data, as there is no national cancer registry — is highest for prostate, liver, and lung cancer, while in women, incidence is highest for breast cancer, followed by thyroid and cervical cancer.

Picture of Mexican Cancer Brochures

After multiple health reform initiatives (one in 1983 and one in 2003), Mexico has gradually advanced towards universal health coverage and coverage now includes the "seguro popular" providing basic care for low-income citizens.

The Fund for Community Health Services includes funds for primary prevention and early detection. Among these innovations are the disease prevention national health cards ("Cartillas Nacionales de Salud") which outline age and gender-specific cancer screening guidelines, recognizing that screening criteria differ for each of the targeted population groups.4

In 2007, the Mexican Ministry of Health designated the "Cartillas Nacionales de Salud" as part of the National Strategy for Promotion and Prevention for better health. The health cards, which are physically similar to immunization records, have been available (free of charge) through all the government administered health care systems since 2009. The cards are designed for particular age or gender groups, with five categories: 1) children (both genders) ages 0 to 9, 2) children and adolescents ages 10 to 19, 3) women ages 20 to 59, 4) men ages 20 to 59, and 5) adults (both genders) older than 60 years. The cards include recommended schema for health promotion, nutrition, detection, prevention and control of diseases, vaccine requirements, as well as a section for documenting medical appointments, and are distributed via various government affiliated health care systems.

Picture of Cancer Information Cards

Specific recommendations for cervical and breast cancer screening are included on all the cards. Cervical cancer screening for women ages 25-64 years has increased from about 44% in 2006 to 48.5% in 2012. The human papillomavirus (HPV) vaccine has also been given to girls since 2008, and since 2012 all girls age 9 receive the vaccine. Three doses are given, with the second and third doses given 6 and 60 months after the initial dose.4 Concurrent work has also focused on self-collection sampling for HPV testing in women at high risk.5

Breast cancer mortality has surpassed that of cervical cancer since 2006.6 One challenge faced by Mexico in terms of cancer prevention is that screening for breast cancer via mammography remains low, and has remained at about 20% according to the National Surveys of Health and Nutrition.4

Other recent national cancer prevention efforts include an effective 2008 mass media campaign to reduce smoking in public places, which has served as an example for future health messaging campaigns.7 Simultaneously, the Ministry of Health has begun to regulate the tobacco industry, including the restriction of advertisements.8

Another measure has focused on Mexico's obesity epidemic, and in an effort to reduce caloric intake, the country has instituted a tax of $0.08 per liter on soft drinks and an 8% tax on the price of foods high in calories.9

Picture of a Mexican father holding his daughter with a mexican flag

The implementation of cancer prevention efforts may be particularly challenging in rural areas with a shortage of health care personnel,10 as well as in areas affected by increasing violence.12 Despite the wide dissemination of information on cancer screening and documented high rates of knowledge13 about the importance of early detection and screening, many cases of cancers such as breast cancer are too often diagnosed in their later stages, and care is compromised by diagnostic delays.14

Understanding Mexico's health care system and cancer prevention policies may have lessons for health care delivery in the US, which has absorbed high rates of immigration from Mexico.

According to the 2010 census, the Mexican population in the United States grew by 54% in the last decade — rising from 20.6 million in 2000 to 31.8 million in 2010.3 In 2011, 88% of the Mexicans living in the United States were between the ages 16 and 64 years old.11

More recent Mexican immigrants will have been exposed to "card" policies both prior to their migration as well as through their family members who remain in Mexico. As a result of being exposed to cancer prevention — through the basic schema built into their health care system — this group may be particularly receptive to the concept of cancer screening and prevention. In this way, knowledge of the recommendations disseminated in Mexico may be informative for U.S. practitioners, enabling them to build on this preexisting knowledge in order to be more effective in reaching the immigrant population.

Manuela Orjuela-Grimm, MD, ScM

Manuela Orjuela-Grimm, MD, ScM
Director, Community and Ambulatory Research
Enrollment (CARE), shared resource
Herbert Irving Comprehensive Cancer Center
Assistant Professor of Pediatrics (Oncology) and
Epidemiology
Columbia University Medical Center and
Columbia University Mailman School of Public Health

Fabiola Mejia-Rodriguez
Instituto Nacional de Salud Publica de Mexico
Centro de Investigación en Nutrición y Salud

Silvia Bhatt-Carreño
Department of Environmental Health Sciences
Columbia University Mailman School of Public Health

References

  1. WorldBank. World Development Indicators. 2014 [cited 2014 September].
  2. Globocan, The Global Cancer Atlas, 2012, World Health Organization: International Agency for Research on Cancer.
  3. Organization, W.H., Table 2. Estimated deaths per 100,000 population by cause, sex and Member State, 2008 G.B.D.D.E.S. 2008, Editor 2011: Department of Measurement and Health Information
  4. Knaul, F.M., et al., The quest for universal health coverage: achieving social protection for all in Mexico. The Lancet, 2012. 380(9849): p. 1259-1279.
  5. Cartillas Nacionales de Salud. 2013 [cited 2014 19 August 2014]; Available from: http://www.promocion.salud.gob.mx/dgps/interior1/programas/cartillas.html.
  6. Lazcano-Ponce, E., et al., Specimen self-collection and HPV DNA screening in a pilot study of 100,242 women. International Journal of Cancer, 2014. 135(1): p. 109-116.
  7. Palacio-Mejía, L.S., et al., Diferencias regionales en la mortalidad por cáncer de mama y cérvix en México entre 1979 y 2006. Salud Pública de México, 2009. 51: p. s208-s219.
  8. Villalobos, V., et al., Mercadotecnia social y políticas públicas de salud: campaña para promover espacios libres de humo de tabaco en México. Salud Pública de México, 2010. 52: p. S129-S137.
  9. Diaz, G. Campaña Contra el Tabaquismo " El Paraiso de Los Fumadores... Fumar Mata". 2006 13 October 2010; Available from: http://www.conadic.salud.gob.mx/prensa/boletines2006/fumarmata_301.html.
  10. Villegas, P., Mexico: Junk Food Tax is Approved in New York Times 2013: New York
  11. Rebuilding a Primary Health Care System in Rural Mexico, 2013: Partners in Health
  12. Stoney, S. and J. Batalova. Mexican Immigrants in the United States 2013 4 October 2014]; Available from: http://migrationpolicy.org/article/mexican-immigrants-united-states.
  13. National survey on victimization and perceptions about public security > ENVIPE (Encuesta Nacional de Victimizacion y percepcion sobre Seguridad Publica http://www.inegi.org.mx/est/contenidos/proyectos/encuestas/hogares/regulares/envipe/
  14. Banegas MP, Bird Y, Moraros J, King S, Prapsiri S, Thompson B. Breast cancer knowledge, attitudes, and early detection practices in United States-Mexico border Latinas. J Womens Health (Larchmt). 2012 Jan;21(1):101-7. doi: 10.1089/jwh.2010.2638. Epub 2011 Oct 4. PubMed PMID: 21970564; PubMed Central PMCID: PMC3304252.