Cancer Mortality In A Rural Department Of Paraguay

Manuel CODAS, National Itapua University, Encarnacion, Paraguay, Paraguay
MADRAZO C. 1 , TAEGER D. 2 , BEHRENS T. 2 , CHAUX A. 3 , BRUENING T. 2 , PESCH B. 2

1 Regional Hospital, National Itapua University, Encarnacion, Paraguay
2 Institute for Prevention and Occupational Medicine of the German Social Accident Insurance, Institute of Ruhr University Bochum (IPA), 44789 Bochum, Germany,
3 Universidad del Norte, Asunción, Paraguay

Purpose: Itapúa is a rural department in Paraguay lacking cancer diagnostics and treatment in the public health sector. We analyzed the cancer mortality in this region as a first step towards epidemiological data for cancer prevention and capacity building.
Methods: We calculated the age-adjusted mortality rates according to world standard (AMRWs) for the major cancer sites in both men and women between 2003 and 2012, and compared the capital city of Itapúa and adjacent central districts (3,968 km2, population 232,800 in 2012) with remote districts (14,072 km2, population 313,043 in 2012).
Results: There were about 2,000 cancer deaths in the decade studied, with AMRWs for all malignancies of 90.9/100,000 in men from central vs. 49.1/100,000 in remote districts and 69.0/100,000 vs. 45.0/100,000 in women. Cancer was documented on 12% of all death certificates and outweighed mortality from certain infectious and parasitic diseases (3.6%). However, the cause of death was ill-defined in nearly 20% of all certificates, especially from remote regions. The part of cancer located in the uterus or cell type of neoplasm of the lymphatic or hematopoietic system were frequently not specified (47.8% and 73.1%, respectively). The uterus (mainly the cervix) was the leading cancer site in women with AMRWs of 17.2/100,000 in central and 14.0/100,000 in remote districts, followed by the breast. Lung and prostate were the leading cancer sites in men. AMRWs for lung cancer were 19.3/100,000 in central and 9.5/100,000 in remote districts. Children comprised 36% of the population, but only 24 death certificates listed childhood cancer in this decade.
Conclusions: The results have been presented to the Ministry of Health to support the development of a national cancer plan. The cancer burden is likely underestimated, especially in remote regions and children. Lung and uterus are common cancer sites with high potential for prevention.