In Colombia it is necessary to continue producing quality and continuously updated information on the magnitude of cancer, derived from population-based cancer registries to contribute to decision making, and implementation of strategies for health promotion, prevention and treatment of cancer in order to reduce the impact on the population. To describe the incidence, mortality and cancer trends in Pasto-Colombia from 1998 to 2012. Observational descriptive study of morbi - mortality due to malignant tumours in Pasto. The collection, processing and systematization of the data, was carried out according to international standards for population-based cancer registries. The incidence and mortality rates were calculated by period, sex, age and tumour site.p men= 0.7, p females= 0.3) and mortality  did not present significant changes over 15 years of observation and the tumours that cause greater morbi-mortality affect the stomach, cervix uteri, breast and prostate. During the period 1998-2012 there were 8,010 new cases of cancer, of them, 57.7% occurred in females. There were 4,214 deaths reported, 52.0% in females. The incidence ( Cancer in general, continues to be a serious health problem for the population of Pasto. The global behaviour of cancer incidence and mortality, identify the need to promote and strengthen promotion and prevention programs, especially focused on tumours of the stomach, prostate, breast and cervix uteri that produce greater morbidity and mortality in the population. According to the World Health Organization (WHO), this disease represents 21% of total deaths due to non-communicable diseases, and it is the second cause of death after cardiovascular diseases (48%) According to estimations published by GLOBOCAN, an epidemiological surveillance system derived from PBCR, cancer is not only a problem exclusively of high-income countries(HIC), low and middle-income countries (LMIC) allow more than half of the annual cancer burden with 7 million new cases (56%) and 4.8 millions of deaths (64%), although they are the least prepared to face this situation. Without planning and control interventions in these populations, the burden of disease due to cancer will increase by 70%. Therefore, cancer is considered a threat to human and economic development in these countries. In Latin America and the Caribbean it is estimated that each year there are around 900,000 new cases, 542,000 deaths, and more than 2 million people living with cancer ,In Colombia, the National Cancer Institute (NCI) estimated that for the period 2007-2011 the morbi- mortality from cancer at national and departmental level from the mortality information in combination with data produced by five PBCR that followed the methods of the IACR and that have produced information regarding the magnitude, distribution and tendency of the malignant tumours in certain populations that correspond to 8.9% of the national population  The Cancer Registry of Pasto, processes information on cancer cases that occur in the rural and urban area of Pasto, Colombia, which according to the 2005 census has a population of 382,422 inhabitants, 47.8% males, 52.2% females. The population is spread out 81.7% in the urban area, and 18.3% in the rural area. Previous studies conducted over 1998-2007 showed that the cancer which produces the highest morbi-mortality in males was the stomach, and in females the cervix uteri.,In order to observe the behaviour of the different types of tumours, the characterization of morbi-mortality due to cancer in Pasto was carried out over the period 1998-2012, and the analysis of the trend of the incidence and mortality of the main types of tumours over a period of fifteen years. This study was done to contribute to decision-making and the implementation of strategies to promote health, prevention and treatment of cancer that help to mitigate the impact of this disease in the region ,A descriptive observational study of all the malignant tumours and cancer deaths presented on residents of The Municipality of Pasto-Colombia during 1998-2012 was conducted. The city is located in south western Colombia and by the middle of the study period there were approximately 350,000 inhabitants (2005), of which 74.7% with health care and 57.0% living in low socioeconomic neighborhoods Ninety per cent of the tumours that were included were microscopically confirmed ; the rest, were identified using other methods valid for the IACR  in population-based studies. The percentage distribution of indices of data quality varies according to the primary site of the tumour and is shown in For mortality analysis all deaths recorded on the death certificate with basic cause of death C00-C99 according to ICD-10  were included. Deaths coded as "non-specific uterus" (C55), corresponding to 12% of deaths due to uterine cancer, were distributed between the category "cervix uteri" and "body of the uterus" taking into account the proportion of deaths observed by age, according to IACR guidelinesFor each person with an incident tumour and cancer death recorded in the period, information was collected on demographic  and clinical conditions . The date of incidence corresponds to the first chronological event of diagnostic confirmation of the disease or in case of lack of data the date of death was used.The information was collected in an active, continuous and systematic way in all the health institutions that generate information on cancer: hospitals, clinics, oncology units, pathology and haematology laboratories, medical centers, specialized offices and the Municipal Health Secretariat, responsible for processing the death certificates. In addition, to guarantee the completeness of the data, databases of hospital discharges, Beneficiaries Selection System for Social Programs (SISBEN in Spanish), National Attorney General's Office, National Registry of Civil Status, Registry of patients of third level hospitals , the Solidarity and Guarantee Fund - FOSYGA and the mortality database of the National Administrative Department of Statistics (DANE in Spanish).The cases were entered into the CanReg5 system for the elimination of duplicates, processing and complementation of data. The identification of primary multiple tumours follows the IACR standards,For the analysis of incidence and mortality, frequencies were calculated such as absolute, relative, crude, specific rates  and standardized by age (ASR) to the world population standard (SEGI) by the direct method The incidence and mortality results are presented in specific Tables or Charts and the analysis of the main sites was intensified because they are diseases of great relevance for the region. Crude and standardized incidence and mortality rates are expressed per 100,000 males-year or females-year.To assess the trend of incidence and mortality, a global analysis between five-year periods was made and the percentage change in rates between the last two periods was estimated. Additionally, a trend analysis of annual incidence and mortality rates was performed using a segmented linear regression or joinpoint, accepting a maximum of three change points (joinpoints) with four linear segments respectively. The annual percentage of change (APC) was estimated in each possible segment generated between each point and the average annual percentage change (AAPC) was calculated for the entire period. All possible models were adjusted with the weighted least squares method and the model selection was made with the Montecarlo permutations test. All analyses were carried out in the SEER stat and Joinpoint 4.0 program produced by the Surveillance Research Program of the National Cancer Institute of the United States This study is classified as without risk research according to resolution 8430 of 1993 of the Ministry of Health of Colombia, since the information comes from secondary sources and has no direct contact or intervention of the biological, physiological, psychological or social variables of the individuals studied. The handling of information follows the confidentiality rules established by the International Agency for Cancer Research (IACR) that regulate the use of data for scientific purposes without the disclosure of personal data, guaranteeing respect and non-maleficence towards patients. On the other hand, the Cancer Registry of Pasto and the investigations that derive from it have agreements with the sources of information to guarantee the adequate flow of the data.During the period 1998-2012 in the municipality of Pasto, 8,010 cases of cancer were identified. , 3,426 in males  and 4,584 cases in females (ASR: 150.3 cases) per 100,000 females-year)  and 3.By sex and period, in males there were in 1998-2002, 982 cases , for 2003-2007 1,174 cases  and in 2008-2012 1,270 cases . In females during 1998-2002 there were 1,359 cases , for 2003-2007: 1,541 cases  and in 2008-2012: 1,684 cases . The percentage of change in the global incidence rates between the last two periods was 0.2 in males and in females of 1.0%p-value males= 0.7, p-value females= 0.3), that means the incidence was stable. The average annual incidence rates standardized by age were 139.7 cases per 100,000 males-year and 150.7 cases per 100,000 females-year , prostate (18.3%), lymphomas (7.6%) colon and rectum (5.2%) and lung (4.9%). In females were: breast (17.3%), cervix uteri (16.0%), stomach (10.8%), thyroid (6.6%) and colon and rectum (5.3%). This behaviour was observed when analysing each of the three five-year periods that comprise the study period  and 3..5%, prosp-value = 0.0) annually from an ASR of 41.5 in 1998 to 19.1 cases per 100,000 males-year in 2012. In females, the incidence of cervix uteri decreased 8.6% (p= 0.0) annually from 2003 from an ASR of 34.2 to 13.4 cases per 100,000 females-year in 2012. The incidence of prostate tumours (p= 0.2) and breast (p= 0.3) was constant and the average of its annual incidence rates standardized by age was 26 cases per 100,000 males-year and 26.4 cases per 100,000 females-year, respectively , 1,949 in males  and 2,272 deaths in females , for 2003-2007, 648 deaths  and in 2008-2012, 748 deaths . Over 1998-2002 there were 601 deaths in females , for 2003-2007, 701 deaths  and in 2008-2012, 970 deaths .p-value males = 1.0, p-value females = 0.0), the average annual mortality rate standardized by age was 78.5 deaths per 100,000 males-year. While in females mortality rates reached 2.1% per year from an ASR: of 58.6 to 86.0 deaths per 100,000 females-year, in 1998 and 2012 respectively  and in females (55.2%) . The aveOver 1998-2012, the main causes of cancer mortality in males were tumours of: Stomach (28.8%), prostate (12.3%) lung (9.7%), lymphomas and myelomas (7%) and liver 5.5%). In females were tumours of: Stomach (16.7%), cervix uteri (12.5%), breast (11.3%), lung (6.2%), colon and rectum (6.2%). This behaviour was observed during the three five-year periods that comprise the period of study  and 5..5%. In fp-value = 0.0) 2.18% annually from an ASR of 24.5 in 1998 to 19.9 deaths per 100,000 males-year in 2012. In females, breast cancer mortality increased  3% annually from an ASR of 6.3 in 1998 to 10.8 deaths per 100,000 females-year in 2012. Mortality from prostate tumours , stomach tumours in females  and cervix uteri  was constant and the average of their annual mortality rates standardized by age was 9.3 deaths per 100,000 males-year, 12.3 deaths per 100,000 females-years and 9.2 deaths per 100,000 females-year, respectively , the specialized agency in cancer IARC and at the national level the Ministry of Health and Social Protection and the National Institute of Cancerology of Colombia the national program for cancer control that Colombia addressed in 2010 At the regional level, thanks to the advances of the Cali Cancer Registry for the systematic reporting of data on incidence, mortality and survival to cancer, the Union for International Cancer Control (UICC), selected the city of Cali as one of the first cities in the world to implement the C/Can 2025 initiative: Challenge of cities against cancer, that consists of involving all the stakeholders of each city in the design, planning and implementation of solutions for cancer care. The data on the characterization of cancer morbi- mortality provided by the Cali Cancer Registry for five decades will be the only source of evidence for evaluating the effects of the implementation of this strategy In general, it is considered that the global incidence rate for the Municipality of Pasto  and in other geographically close regions are low; Cali-Colombia , Manizales-Colombia , Bucaramanga-Colombia , Quito-Ecuador , Manabí-Ecuador  ,The behaviour of the global incidence rates of the populations can be associated to lifestyles, diagnostic capacity in the health system, but mainly to the demographic and epidemiological transition; in populations of North America, Oceania, Europe and Asia with a significant population aging, the risk of chronic diseases increases, especially those of late presentation such as cancer, in contrast to those populations with a younger population structure such as in Latin America and Africa, which have greater public health problems related to communicable diseases When contrasting incidence rates with mortality rates, to establish the mortality-incidence ratio (M: I) it can be observed that, although the majority of North American registries have higher rates of incidence in both males and females, the mortality and incidence ratio reaches the lowest values (M:I= 30-40), which means that for every 100 cases that are diagnosed there are between 30 and 40 cancer deaths in the same period. On the other hand, in Latin American countries the ratio M:I range between 60 and 80, its mean, for every 100 incident cases there are around 80 deaths. This is an indirect indicator of the quality of the health system in relation to diagnostic tests for the identification of new cancer cases and oncological treatment services to avoid deaths ,When comparing the incidence and mortality trends reported by other registries that have published at least 15 years consecutively in IC5, it is observed that the incidence of stomach tumours decreased significantly in most populations, primarily in those from European countries where the annual percentage of change (APC) reported ranges between -5.1% and -3.1%, with less decrease in North American, Oceanic and some European countries, the APC varies between -2.9% and -2.3% and with the lowest decrease in Latin American populations with an APC that ranges between -2.2% and -0.9%. Only the registry of kyadondo county-Uganda and Goiania-Brazil, have reported an increase in the incidence of stomach cancer where the APC is 2.1% and 0.1% respectively. In the Municipality of Pasto, the trend of incidence and mortality from stomach cancer has achieved a significant decrease, this behaviour is explained by the study on the trend of incidence and mortality from stomach cancer in Cali, which indicates that it is probably related to the decrease of the prevalent rates of infection by Helicobacter pylori, the improvement of life habits and early detection in the population, however, for the case of the Municipality of Pasto, it is suggested to study in depth the causes of this behaviour behaviour The trend of the incidence of prostate tumours in the world has increased significantly in most populations, in an accelerated way in Latin American populations, some European, Asian and oceanic with an APC that varies between 5.2% and 11.0%, has slightly increased in some European, Asian and Oceanic countries with an APC that fluctuates between 3.4% and 3.9%, and in Africa, North America and some European countries has increased very little, with an APC ranging between 3.3% and 1.5%. Only Indian populations (3 records) reported that the incidence trend of prostate cancer has decreased slightly with an APC of 0.2%. For the Municipality of Pasto, incidence and mortality rates over time have remained constant without showing a statistically significant change. The analysis of this behavior should be studied to establish the factors related to early diagnosis and treatment.In females, the trend in the incidence of breast cancer is increasing globally and is accentuated in populations of African and some European and Asian registries with an APC ranging between 5.3% and 2.2%, in Latin American, oceanic and some European populations increased moderately with an APC that varies between 2.1% and 1.3%, and very little in North American populations and some Asians with an APC that ranges between 0.3% and 1.2%. This behaviour is probably caused by the increase in obesity, physical inactivity, and changes in reproductive and other behavioural habits The decrease in the incidence rates of cervical cancer worldwide is very evident, with a greater decrease in Latin American, Oceanic and some European populations with an APC that ranges between -2.7% and -8.6%, an average decrease in populations in North America, some European and Asian with an APC that fluctuates between -1.4% and -2.6% and with a reduced decrease in some European and Asian populations with an APC that oscillates between -0.3% and -1.1%, behaviour contrary to that reported by African populations where the incidence trend increased with an APC of 3.9%. In Pasto the tendency of the incidence of cervical cancer has lowered nevertheless the tendency of the mortality stays constant, results that reflect difficulties in the early detection and opportune treatment.For the Municipality of Pasto the analysis of the incidence, mortality and behaviour of the tendency of the types of cancer of greater occurrence becomes a base for the evaluation of the impact of the measures of prevention, treatment, implementation of new technologies and investigations that promote actions to control the impact of the disease on the population. comparabilidad, exhaustividad, validez y oportunidad con la finalidad de fundamentar políticas públicas e intervenciones para la prevención y control del cáncer, así como también evaluar su efectividad ,En las últimas décadas el cáncer se ha convertido en una de las principales causas de mortalidad a nivel mundial. Según cifras de la Organización Mundial de la Salud (OMS), esta enfermedad representa el 21% del total de las muertes por enfermedades no trasmisibles y es la segunda causa de muerte después de las enfermedades cardiovasculares (48%) Según estimaciones publicadas por GLOBOCAN, un sistema de vigilancia epidemiológica derivada de los RPCs, el cáncer no es un problema propio de los países de ingresos altos (PIA), los países de ingresos medios y bajos (PIMB) soportan más de la mitad de la carga anual por cáncer con 7 millones de casos nuevos (56%) y 4.8 millones de muertes (64%), aunque son los menos preparados para afrontar esta situación. Sin intervenciones de planificación y control en estas poblaciones, la carga de la enfermedad debido al cáncer aumentará un 70%. Por ello, se considera que el cáncer supone una amenaza al desarrollo humano y económico en estos países. En América Latina y el Caribe se estima que cada año existen alrededor de 900,000 nuevos casos, 542,000 muertes, y más de 2 millones de personas que conviven con la enfermedad ,En Colombia, el Instituto Nacional de Cancerología E.S.E, estimó para el periodo 2007-2011 la morbi-mortalidad por cáncer a nivel nacional y departamental a partir de la información de mortalidad en combinación con cifras producidas por cinco registros poblacionales de cáncer que siguen la metodología de la IACR y que han producido información respecto a la magnitud, distribución y tendencia de los tumores malignos en determinadas poblaciones que corresponden al 8.9% de la población nacional  epsEl registro Poblacional de cáncer del Municipio de Pasto procesa información de los casos de cáncer que ocurren en el área rural y urbana del municipio de Pasto-Colombia que según el censo de 2005 tiene una población de 382,422 habitantes, 47.8% hombres 52.2% mujeres. La población se distribuye el 81.7% en la zona urbana y 18.3% en la zona rural. Los estudios realizados en el período 1998-2007 mostraron que el cáncer que produce mayor morbi mortalidad en hombres fue el de estómago y en mujeres el de cuello uterino.,Con el propósito de observar el comportamiento de los diferentes tipos de tumores, se realizó la caracterización de la morbi mortalidad por cáncer en el municipio de Pasto durante el período 1998-2012 y el análisis de la tendencia de la incidencia y mortalidad de los principales tipos de tumores en un período de quince años, con el fin de contribuir a la toma de decisiones y a la implementación de estrategias de promoción de la salud, prevención y tratamiento del cáncer que contribuyan a mitigar el impacto de la enfermedad en la región ,Se realizó un estudio observacional descriptivo de todos los tumores malignos y las muertes por cáncer presentadas durante 1998-2012 en personas residentes en el Municipio de Pasto-Colombia. El municipio está localizado en el suroccidente de Colombia y para la mitad del periodo de estudio contaba con aproximadamente 350,000 habitantes (2005), de los cuales el 74.7% con aseguramiento en salud y 57% viviendo en estratos socioeconómicos bajos. El 90% de los tumores que se incluyeron fueron confirmados histopatológicamente ; el resto, mediante otros métodos de diagnóstico válidos según la IARC  para estudios de base poblacional. La distribución porcentual varía según la localización primaria del tumor y se presenta en la Para el análisis de mortalidad se incluyeron las muertes por cáncer registradas en el certificado de defunción con causa básica de defunción C00-C99 según la CIE-10 . Las muertes codificadas como “útero inespecífico” (C55), que corresponden a un 12% de las muertes por cáncer uterino, fueron distribuidas entre la categoría “cuello del útero” y “cuerpo del útero” teniendo en cuenta la proporción de muertes observadas por edad, según guías de la IARC De cada tumor incidente o muerte por cáncer registrada en el periodo se recolectó información sobre condiciones demográficas de la persona  y clínicas . La fecha de incidencia corresponde al primer evento cronológico de confirmación diagnóstica de la enfermedad o en caso de carencia de datos se utilizó la fecha de defunción. La información se recolectó de forma activa, continua y sistemática en todas las instituciones de salud que generan información sobre cáncer: hospitales, clínicas, unidades de oncología, laboratorios de patología y hematología, centros médicos, consultorios especializados y la Secretaría de Salud Municipal, organismo encargado de procesar los certificados de defunción del municipio. Adicionalmente para garantizar al máximo la exhaustividad de los datos, se consultaron bases de datos de egresos hospitalarios, Sistema de Selección de Beneficiarios para programas Sociales (SISBEN), Procuraduría General de la Nación, Registraduría Nacional del Estado Civil, Registro de pacientes de hospitales de tercer nivel, el Fondo de Solidaridad y Garantía - FOSYGA y la base de mortalidad del Departamento Administrativo Nacional de Estadística (DANE).Los casos se ingresaron al sistema CanReg5 para la eliminación de duplicados, procesamiento y complementación de datos. La identificación de tumores múltiples primarios sigue las normas de la IARC ,Para el análisis de la incidencia y mortalidad se calcularon frecuencias absolutas, relativas, tasas crudas, específicas, periodo, sexo, edad y localización del tumor o causa de muerte según la CIE-10 , agrupados en grandes categorías.) y ajustadas por edad a la población mundial estándar (Segi) mediante el método directo Los resultados de incidencia y mortalidad se presentan en Tablas o Figuras específicas y se profundizó el análisis de las principales localizaciones por tratarse de enfermedades de gran relevancia para la región. Las tasas de incidencia y mortalidad crudas y ajustadas se expresan por cada 100,000 hombres-año o mujeres-año.Para evaluar la tendencia de la incidencia y mortalidad se realizó un análisis entre periodos quinquenales y se estimó el porcentaje de cambio de las tasas entre los dos últimos periodos. Adicionalmente se realiza un análisis de tendencia de las tasas de incidencia y mortalidad anuales utilizando una regresión lineal segmentada o joinpoint, aceptando como máximo 3 puntos de cambio (joinpoints) con cuatro segmentos lineales respectivamente. El porcentaje anual de cambio (PAC) fue estimado en cada posible segmento generado entre cada punto y el promedio del porcentaje anual de cambio (AAPC en inglés) fue calculado para todo el periodo. Todos los posibles modelos se ajustaron con el método de mínimos cuadrados ponderados y la selección del modelo se realizó con la prueba de permutaciones de Montecarlo. Todos los análisis se llevaron a cabo en el programa SEER stat y Joinpoint 4.0 producidos por el Surveillance Research Program of the National Cancer Institute de los Estados Unidos Este estudio se clasificó como investigación sin riesgo según la resolución 8430 de 1993 del Ministerio de Salud de Colombia, puesto que la información proviene de fuentes secundarias y no se tuvo un contacto directo o realizó intervenciones de las variables biológicas, fisiológicas, sicológicas o sociales de los individuos de estudio. El manejo de la información siguió las normas de confidencialidad establecidas por la Agencia Internacional de Investigación en Cáncer (IARC) que regulan el uso de los datos con fines científicos sin la divulgación de datos personales, garantizando el respeto y la no maleficencia hacia los pacientes. Por otra parte, el Registro Poblacional de Cáncer del Municipio de Pasto y las investigaciones que de él se derivan tienen convenios con las fuentes de información para garantizar el flujo adecuado de los datos.Durante el periodo 1998-2012 en el municipio de Pasto se identificaron 8,010 casos de cáncer , 3,426 en hombres  y 4,584 casos en mujeres   y 3. Según el sexo y periodo, en hombres se presentaron entre 1998 y 2002, 982 casos , para 2003-2007 1,174 casos  y en 2008-2012 1,270 casos . En mujeres entre 1998 y 2002 se presentaron 1,359 casos , para 2003-2007: 1,541 casos  y en 2008-2012: 1,684 casos . El porcentaje de cambio de las tasas globales de incidencia entre los últimos dos periodos fue de 0.2 en hombres y en mujeres del 1.0%.p-valor hombres= 0.7; p-valor mujeres= 0.3), es decir que la incidencia fue estable. El promedio de las tasas anuales de incidencia ajustada por edad fue de 139.7 casos por 100,000 hombres-año y de 150.7 casos por 100,000 mujeres-año , próstata (18.3%), linfomas (7.6%) colon y recto (5.2%) y pulmón (4.9%). En mujeres fueron de: mama (17.3%), cuello del útero (16.0%), estómago (10.8%), tiroides (6.6%) y colon y recto (5.3%). Este comportamiento se observó cuando se analizó cada uno de los tres quinquenios que comprendió el periodo de estudio  y 3..5%, prósp-valor= 0.0) anualmente desde una TAE de 41.5 en 1998 a 19.1 casos por 100,000 hombres-año en 2012. En mujeres, la incidencia del cáncer de cuello uterino disminuyó 8.6%  anualmente a partir de 2003 desde una TAE de 34.2 hasta 13.4 casos por 100,000 mujeres-año en 2012. La incidencia de los tumores de próstata  y mama  fue constante y el promedio de sus tasas anuales de incidencia ajustada por edad fue de 26 casos por 100,000 hombres-año y 26.4 casos por 100,000 mujeres-año, respectivamente , 1,949 en hombres  y 2,272 muertes en mujeres , para 2003-2007, 648 muertes  y en 2008-2012, 748 muertes . En mujeres durante 1998 y 2002 se presentaron 601 muertes casos , para 2003-2007, 701 muertes  y en 2008-2012, 970 muertes .p-valor hombres= 1.0; p-valor mujeres= 0.0), el promedio de la tasa anual de mortalidad ajustada por edad fue de 78.5 muertes por 100,000 hombres-año. Mientras que en mujeres las tasas de mortalidad se incrementaron 2.1% anualmente de una TAE de 58.6 a 86.0 muertes por 100,000 mujeres-año entre 1998 y 2012  como en mujeres (55.2%).  La edad Durante 1998-2012, las principales causas de mortalidad por cáncer en hombres fueron los tumores de: Estómago (28.8%), próstata (12.3%) pulmón (9.7%), linfomas y mielomas (7%) y hígado (5.5%). En mujeres fueron los tumores de: Estómago (16.7%), cuello del útero (12.5%), mama (11.3%), pulmón (6.2%), colon y recto (6.2%). Este comportamiento se observó durante los tres quinquenios que comprende el periodo de estudio  y5.p-valor= 0.0) 2.18% anualmente desde una TAE de 24.5 en 1998 a 19.9 muertes por 100,000 hombres-año en 2012. En mujeres, la mortalidad por cáncer de mama aumentó  3% anualmente a partir de una TAE de 6.3 en 1998 a 10.8 muertes por 100,000 mujeres-año en 2012. La mortalidad por tumores de próstata  estomago en mujeres  y cuello uterino  fue constante y el promedio de sus tasas anuales de mortalidad ajustada por edad fue de 9.3 muertes por 100,000 hombres-año, 12.3 muertes por 100,000 mujeres-año y 9.2 muertes por 100,000 mujeres-año, respectivamente  la agencia especializada en cáncer la IARC y a nivel nacional el Ministerio de Salud y Protección Social y el Instituto Nacional de Cancerología de Colombia Plan Nacional para el Control del Cáncer que se planteó en Colombia en el 2010 .A nivel regional, gracias a los avances del Registro de Cáncer de Cali para el reporte sistemático de datos sobre incidencia, mortalidad y supervivencia a cáncer, la Unión para el Control Internacional del Cáncer (UICC), seleccionó a la ciudad de Cali como una de las primeras ciudades del mundo para implementar la iniciativa C/Can 2025: Desafío de ciudades contra el cáncer que consiste en involucrar a todos los actores interesados de cada ciudad, en el diseño, planificación e implementación de soluciones para el cuidado del cáncer. Los datos de la caracterización de la morbi-mortalidad por cáncer que provee el Registro de cáncer de Cali desde hace cinco décadas serán la única fuente de evidencia para la evaluación de los efectos de la implementación de ésta estrategia ,El Registro Poblacional de Cáncer en el Municipio de Pasto inició la recolección de datos desde 1998 sobre la magnitud del cáncer con el fin de realizar el seguimiento y vigilancia de la evolución de la morbi-mortalidad, servir como insumo en la toma de decisiones a nivel institucional, regional y nacional y fomentar la producción de conocimiento con el fin de disminuir y controlar de la enfermedad s: 157.0 casos por 100,000 mujeres-año), Quito-Ecuador , Manabi-Ecuador  En general, se considera que la tasa de incidencia global para el Municipio de Pasto  y en otras regiones cercanas geográficamente son bajas; Cali-Colombia , Manizales-Colombia , Bucaramanga-Colombia  se puede observar que, si bien la mayoría de registros norteamericanos tienen tasas más altas de incidencia tanto en hombres como en mujeres, la razón mortalidad e incidencia alcanzó los valores más bajos (M:I =30-40), lo cual quiere decir que por cada 100 casos que se diagnosticaron se presentaron entre 30 y 40 muertes por cáncer. Por otra parte, en los países Latinoamericanos la razón M:I osciló entre 60 y 80, es decir que por cada 100 casos incidente se presentaron aproximadamente 80 muertes. Este un indicador indirecto de la calidad del sistema de salud en relación a las pruebas diagnósticas para la identificación de nuevos casos de cáncer y a los servicios de tratamiento oncológico para evitar las muertes Helicobacter pylori, la mejora de los hábitos vida y detección temprana en la población,Cuando se compara las tendencias de la incidencia y mortalidad reportada por otros registros que han publicado al menos 15 años de forma consecutiva en CI5, se observa que la incidencia de los tumores de estómago disminuyó de forma significativa en la mayoría de poblaciones, primordialmente en aquellas de países europeos donde el PCA reportado oscila entre -5.1% y -3.1%, con menor disminución en países norteamericanos, oceánicos y algunos europeos, el PCA varía entre -2.9% y -2.3% y con la más baja disminución las poblaciones Latinoamericanas con un PCA que oscila entre -2.2% y -0.9%. Únicamente el registro de kyadondo county-Uganda y Goiania- Brasil, han reportado aumento de la incidencia del cáncer de estómago donde el PCA 2.1% y 0.1% respectivamente. En el Municipio de Pasto la tendencia de la incidencia y mortalidad por cáncer de estómago ha logrado una disminución significativa, este comportamiento lo explica el estudio sobre tendencia de la incidencia y mortalidad por cáncer de estómago en Cali que refiere que probablemente esté relacionado con la disminución gradual de las tasas de prevalencia de la infección por La tendencia de la incidencia de los tumores de próstata en el mundo ha aumentado de forma significativa en la mayoría de poblaciones; de forma acelerada en poblaciones latinoamericanas, algunas europeas, asiáticas y oceánicas con un PCA que oscilan entre 5.2% y 11.0%, ha elevado levemente en algunos países europeos, asiáticos y oceánicos con un PCA que fluctúa entre 3.4% y 3.9%, y en países africanos, norteamericanos y algunos europeos ha aumentado muy poco, con un PCA que oscila entre 3.3% y 1.5%. Solo poblaciones de la India (3 registros) han reportado que la tendencia de la incidencia del cáncer de próstata ha disminuido levemente con un PCA de 0.2%. Para el Municipio de Pasto las tasas de incidencia y mortalidad a lo largo del tiempo se han manteni do constantes sin evidenciar un cambio estadísticamente significativo. El análisis de éste comportamiento debe ser objeto de estudio para establecer los factores relacionados con el diagnóstico temprano y tratamiento.En mujeres la tendencia de la incidencia de cáncer de mama esta aumentado de forma global y se acentúa en poblaciones de registros africanos y algunos europeos y asiáticos con un PCA que oscila entre 5.3% y 2.2%, en poblaciones latinoamericanas, oceánicas y algunas europeas ha aumentado medianamente con un PCA que varía entre 2.1% y 1.3%, y muy poco en poblaciones norteamericanas y algunos asiáticos con un PCA que oscila entre 0.3% y 1.2%. Este comportamiento probablemente causado por el aumento de la obesidad inactividad física, cambios en los hábitos reproductivos y otros comportamentales La disminución de la tasas de incidencia del cáncer de cuello uterino a nivel mundial es muy evidente, con un descenso mayor en poblaciones Latinoamericanas, oceánicas y algunas europeas con un PCA que oscila entre -2.7% y -8.6%, una disminución media en poblaciones norteamericanas, algunas europeas y asiáticas con un PCA que fluctúan entre -1.4% y -2.6% y con una disminución reducida en algunas poblaciones europeas y asiáticas con un PCA que oscila entre -0.3% y -1.1%, comportamiento contrario a la reportada por poblaciones africanas donde la tendencia de la incidencia aumenta con un PCA de 3,9%. En Pasto la tendencia de la incidencia de cáncer de cuello uterino ha bajado sin embargo la tendencia de la mortalidad se mantiene constante, resultados que reflejan dificultades en la detección temprana y tratamiento oportuno. Para el Municipio de Pasto el análisis de la incidencia, mortalidad y el comportamiento de la tendencia de los tipos de cáncer de mayor ocurrencia se convierte en una base para la evaluación del impacto de las medidas de prevención, tratamiento, implementación de nuevas tecnologías e investigaciones que promuevan acciones para controlar el impacto de la enfermedad en la población.


To estimate the years of life lost by the Brazilian population due to mouth and pharynx cancer from 1979 to 2013, and analyze the temporal trends in the studied period, according to the country’s region, sex and anatomical site. The death records were obtained from the Mortality Information System and the data referring to the population, from the censuses of the Brazilian Institute of Geography and Statistics of 1980, 1991, 2000, 2010, and from intercensal estimates for the other years. The rates of potential years of life lost were calculated by applying the method suggested by Romeder and McWhinnie, and their trends were calculated using the Prais-Winsten method with first-order autocorrelation. The historical series were smoothed with the centered moving average technique of third order for white noise reduction. In the period from 1979 to 2013 in Brazil, there were a total of 107,506 premature deaths due to mouth and pharynx cancer, which generated a total of 1,589,501 potential years of life lost, the equivalent to a rate of 3.6 per 10,000 inhabitants. Males, whose rate was six times higher than for females, contributed with 85% of the years lost. The trends in the rates of years of life lost showed an annual 0.72% increase for men, 1.13% for women and 1.05% for pharynx cancer. The rate of potential years of life lost due to mouth and pharynx cancer in the country showed an upward trend within the studied period for both sexes, as well as for pharynx cancer and for the North, Northeast and Midwest regions. It is estimated that in 2015, 571,386 new cases of the disease emerged, and 316,168 people died as a result of these tumors worldwide. According to the International Agency for Research on Cancer, these values are expected to rise in the quinquennium from 2016 to 2020, reaching 350,000 deaths and 639,171 new cases in 20201 . The mortality rate for mouth and pharynx cancer in Brazil is 5.91/100,000 inhabitants, while other countries in the region, such as Argentina, Chile, Colombia and Mexico, did not have more than three deaths per 100,000 inhabitants1 . From 1979 to 2002, the mortality rate was 2.7 per 100,000 inhabitants2 , but in 2013, according to data from the Informatics Department of the Unified Health System (Datasus), the rate reached 3.6 deaths for each 100,000 inhabitants, indicating a 33% increase compared to the previous year.In Latin America, the estimated number of deaths in 2015 was 33,925, with Brazil being the country with the largest number of cases in the region3 . It is estimated that in 2020, mouth and pharynx cancer will correspond to more than 21 thousand new cases and kill more than 10 thousand people in Brazil1 .The National Cancer Institute (Inca) estimates the incidence risk to be 7.8 per 100,000 inhabitants, with 11.27 new cases for every 100,000 men and 4.21 for every 100,000 women4 . The temporal trend analysis enhances the understanding of the dynamics, follow-up, and evolution of the deaths that occurred over the years, also allowing to make predictions, which contributes effectively to the planning of actions5 .Although mortality rates allow the analysis of the risk of deaths in different regions of the world, they do not include these deaths’ impact on the communities, since they do not consider the age of death (early or otherwise). The potential years of life lost (PYLL) indicator covers premature mortality, the magnitude of causes and the social impact of diseases, since prematurity affects the individual’s economic and social potential in society. Moreover, this indicator is an alternative for the development of cancer prevention actions, enabling interventions in specific risk groups and assisting the improvement in the use of existing resources“oral cancer” and “ potential years of life lost ” did not identify recent studies analyzing the rates of years of life lost due to mouth and pharynx cancer in Brazil. Given this knowledge gap and the relevance of the theme, the present study was carried out to analyze the trend of premature mortality due to mouth and pharynx cancer in Brazil from 1979 to 2013.A search conducted in the PubMed database (Medline) in March 2018 on Data on the deaths by mouth and pharynx cancer in Brazil of individuals aged between zero and 69 years old that occurred in the country from 1979, year of the beginning of data collection on the national level by the Ministry of Health’s Mortality Information System (SIM), until 2013, were analyzed. The observations ignoring sex, 26 in total (0.02% of the cases), were not included in the analysis of the rates according to sex.6 . It consists in the sum of the number of deaths in each age group multiplied by the number of years missing until the reference age, which was 69 years old in the present study. There are different cutoff points to define this reference age in the literature. The authors argue that, by including the deaths of people with higher ages, the weight given to it in the calculation of natural causes of death would be too great, and premature mortality would not be properly identified.The method for calculating PYLL is an adaptation of the proposal of Romeder and McWhinnieThe deaths that occurred between 1979 and 1995 were classified according to the ninth revision of the International Classification of Diseases (ICD), and those that occurred between 1996 and 2013, according to the tenth revision. To allow the comparability of data throughout the period according to the main cause of death, codes 140.0 to 145.9 of ICD-9 and C00.0 to C8.9 of ICD-10 were classified as deaths by mouth cancer, and codes 146.0 to 149.9 of ICD-9 and C09 to C14.8 of ICD-10 as deaths by pharynx cancer, to neutralize the influence that the change in the coding could have on the results. The deaths were categorized according to the macro-region of residence, sex and age group (every five years).The values of the resident population required for the calculation of the rates were obtained from the censuses performed by the Brazilian Institute of Geography and Statistics (IBGE) in 1980, 1991, 2000, 2010, and from intercensal estimates for the other years, available on the Datasus website.4 . Considering that the analysis of the present study includes only mouth and pharynx cancer and that the mortality due to this disease of children under one year is also of interest to the authors, the 50 deaths in this age group were not excluded (0.04% of the cases).The criteria for establishing the reference age used in the calculation of the potential years of life lost varies from author to author. A broad discussion regarding the inclusion or exclusion of deaths of children under one year old and the age to be considered as the upper limit can be found in the literaturedi represents the number of deaths between ages i and i + 1, and ai represents the number of missing years until the reference age when death occurs between ages i and i + 1.The original method for calculating PYLL uses Equation 1, where 6 .The calculation of PYLL may be simplified by using five-year groups, as shown in Equation 2, with less than 2% divergence in the resultsDq represents the number of deaths in each quinquennium q , and Aq represents the difference between the quinquennium’s mean age q and the established reference age.In this case, 7 per 10,000 inhabitants were calculated, and subsequently standardized using the direct method of Equation 3. The Brazilian population of 2012 was used as the standard population.To compare PYLL between sexes, anatomical site and regions, the PYLL ratesPq = number of people whose ages are included in quinquennium q in the current population; Pqr = number of people whose ages are included in quinquennium q in the reference population; and Nr = number of people aged between zero and 69 years old in the reference population.In this equation, Finally, the temporal trend of PYLL rates was calculated according to the Prais-Winsten method with correction for first-order autocorrelation, according to equations 4 and 5:b ” corresponds to the annual growth rate, “ se ” is the default error’s value, and the value of “ t ” is provided by Student’s t distribution. For further details on this methodology, the reader may consult the work developed by Antunes and Waldman8 .where “ Stata Corp ., College Station , USA).The upward, downward or stagnation trend was expressed as annual percentage variation (APV) and was considered stationary when the regression coefficient did not differ from zero (p > 0.05). All analyses were carried out using version 13 of the Stata program .There was a significant disparity in the distribution of premature deaths between men and women. Of the total years of life lost, 1,342,939 were attributed to males, with approximately eight out of 10 deaths having been premature. The ratio of the PYLL rate per 10,000 inhabitants between men and women was 6:1. The number of deaths and years of life lost with their rates, according to sex, may be seen in In the analysis according to anatomical site, 46.3% of the premature deaths corresponded to mouth cancer, with an average PYLL rate of 1.7 per 10,000 inhabitants, thus contributing with 719,238 potential years of life lost. Pharynx cancer caused 53.7% of the premature deaths, contributing with 846,136 PYLL. The ratio between the PYLL rate per 10,000 inhabitants between pharynx and mouth cancer was 1.2:1, i.e., the PYLL rate for pharynx cancer was 20% higher than the one for mouth cancer. The number of deaths and years of life lost with their rates, according to anatomical site, may be seen in The region of the country with the highest number of years of life lost was the Southeast (56.6%). The Southern region corresponded to 19.7% of the total PYLL, the Northeast region to 15.6%, the Midwest region to 5.6% and the North region showed the lowest rates, 2.5%. The Southeast and South regions had the highest PYLL rates, with values of 4.53 per 10,000 inhabitants and 4.48 per 10,000 inhabitants, respectively. The lowest rate was observed in the North region, with 1.50 per 10,000 inhabitants.The historical series of PYLL rates for mouth and pharynx cancer (together) showed an upward trend for both sexes. For men, APV was 0.72%, while for women, whose APV was 1.13%, the upward trend was more accentuated, as may be seen in The historical series of APV rates for pharynx cancer also showed an upward trend, with 1.05% APV, and may be seen in In the analysis by regions, the upward trend was observed for the Northern (APV: 1.63%), Midwest (APV: 2.63%) and Northeast regions (APV: 3.23%), which may be seen in Premature mortality due to mouth and pharynx cancer showed an upward trend in the period between 1979 and 2013 in Brazil. Differences in intensity were identified according to sex and region of residence, with higher increase in females and in the Northeast region. The disease’s load analysis aims to describe as accurately as possible its impact on the lives of those who have it, and can be measured by several indicators, one of them being the potential years of life lost.10 .By incorporating trend analysis into the historical series of rates to study the behavior of premature mortality in the long term, the present study observed a positive annual percentage variation for both sexes in the rate of years of life lost due to mouth and pharynx cancer. According to the results observed by Alves and Neto, this reality is not very different from those of other neoplasms, which showed an increase in the premature mortality trend analysis for the period from 2000 to 201111 . It may be noted that the prevalence of the regular use of dental services was directly proportional to age, that is, the younger the patient, the lower the number of dentist appointments.12 In this study, the high number of years of life lost by the male population during the study period , as well as the PYLL rates’ ratio, according to which the value observed in men is 6 times higher than that observed in women, show a great loss in the young and productive male population. Even still, the trend analysis showed an increase in both sexes, with the annual percentage variation for women being twice that of men. The adequate use of health services, among other factors, such as early diagnosis, strongly influences premature mortality.The behavior of premature mortality rates for mouth and pharynx cancer in the long term is mainly affected by exposure in the past to the main risk factors, alcoholism and smoking. Studies show that adolescents start smoking increasingly early, especially males13 . Cigarette consumption is one of the main risk factors of mouth and pharynx cancer. It is expected that the changes in the prevalence of consumption are related to the behavior of the mortality rates of these types of cancer.The worldwide prevalence of cigarette consumption almost tripled in the period between 1950 and 2009, but began to decline in the 1980s. In Brazil, a reduction in the prevalence of cigarette consumption among adults may be observed, with the proportion of men who use cigarettes being more than twice higher than that of womenThe anatomical site analysis shows that although the rates of mouth and pharynx cancer do not differ significantly, the PYLL rate was 20% higher for pharynx cancer than for mouth cancer. In addition, a 1% increase in the PYLL trend was observed for pharynx cancer during the study period. These findings suggest either greater difficulty in the timely diagnosis of pharynx cancer or an increase in the number of cases in this region, strongly associated with HPV infection.10 . This could be related to the fact that the Southeast and South regions are associated with greater exposure to risk factors such as alcoholism and smoking14 . According to data from Datasus, the PYLL rate in the South region was 4.7 per 100,000 inhabitants in 2013, three times higher than the rate of the North region and two times higher than that of the Northeast region.The mortality rates of mouth and pharynx cancer have always been higher in the Southeast and South regions when compared to other regionsConsidering that the PYLL rate is affected by both the age and the number of deaths, a high PYLL value was expected in the Southeast and South regions. These regions, despite having stable trends, showed an average PYLL rate that was three times higher than that of the North region, which had the lowest rate of all.15 . Due to its relationship with socioeconomic inequalities, mouth and pharynx cancer have a high mortality burden, especially in the most socio-economically vulnerable population groups.An increase in the trend of the PYLL rates was observed in the regions with the lowest mortality rates . The highest increase was observed in the Northeast region. The difference in the rate trends between regions obeys several conditions that influence inequality. The North and Northeast regions have the lowest rates of health professionals in activityThe upward global trend of mouth and pharynx cancer found in this study would seem very close to stability if it was not masking the differences between the sexes. It is important to consider that this variation covers each year of a fairly long period, which means we cannot expect a linear behavior of these outcomes.16 in Japan showed that, in 2005, men corresponded to 73% of the PYLL rate for mouth and pharynx cancer. These results are similar to those observed in the present study, which shows the impact of premature mortality among males. Ibayashi et al.16 observed that the PYLL rate in men  was four times higher than in women , having concluded that the specific sites responsible for the higher PYLL rate were oropharynx and tongue cancer, although they regretted not having used this indicator to analyze the rate for mouth and pharynx cancer more broadly, on both a national and international scale.Due to the unavailability of similar studies in Brazil, it was not possible to compare the findings with previous studies. However, a study developed by Ibayashi et al.A limitation of this article refers to the interpretation of the rate trends, especially on the regional level, which requires caution, since regional inequalities in the collection of mortality data and the quality of the information systems should be considered. Analyses that are based on secondary records depend on the quality of the system of notification of deaths. The underreporting of deaths and the lack of accuracy in the definition of the cause of death may influence the results of the study by generating reduced rates that do not reflect reality. Similarly, the decrease in underreporting in regions characterized by poor quality of medical care may be influencing the increase in trends more than the increase in premature mortality itself.18 . These studies have observed a gradual increase in the system’s scope since its decentralization in 1992, and corroborate the adequate filling of the data in a percentage around 90%.As a positive aspect, it worth noting that the quality of the mortality data provided by SIM has been verified in several studies19 .Health information systems in Brazil have shown great advances in the coverage of records. In the case of SIM, 96.1% coverage had already been reached in 2011. In the Southeast, South and Midwest regions, this coverage is close to 100%, while in the North and Northeast regions, only four federative units have coverage between 80% and 90%, and the others have coverage above 90%. With regard to the percentage of deaths with ill-defined underlying cause, a decline has been observed over the years, from 7.2% to 6.7% in the period from 2009 to 2011. The South and Midwest regions are those with lowest underreporting rates, with percentages of deaths due to ill-defined basic causes corresponding to 4.5% and 4.4%, respectively20 . The ratio of deaths due to ill-defined causes decreased from 45.7% to 23.7% in the period from 1979 to 2004, reaching 17.0% in 2005 and 8.0% in 200921 .The reduction in deaths due to ill-defined causes, especially in the North and Northeast regions, as a result of the program of Reduction in the Percentage of Deaths due to Ill-defined Causes developed by the Ministry of Health’s Health Surveillance Secretariat, should be emphasized7 , which considers premature the deaths of those under 70 years old. The use of the life expectancy according to gender is more appropriate when one wants to know the years of life lost during the productive period of each sex (WYPLL)5 . This method favors the analysis of premature deaths focusing on differentiated life expectancy and the retirement age of each sex to analyze the loss of productivity due to these deaths.Another limitation of the study could be the use of 69 years of age as the reference age, which may seem like an arbitrary choice in a study analyzing a population with discretionary life expectancy between genders. However, the reference age in this work is the age used in the methodology for calculation of the PYLL rate proposed by Romeder and McWhinnie10 .The results of this work emphasize the importance of studies analyzing the behavior of chronic diseases for subsequent development of prevention strategies. The high rates of years of life lost due to cancer, as well as to other chronic diseases, translate into a large volume of labor disabilities, burden on health systems and economic impact for families and society. All this may lead to social impairment and impoverishment23 .The definition and calculation of the PYLL rate imply that higher rates correspond to a greater number of premature deaths. This ends up negatively impacting the economy, since premature deaths would affect the production of the young and productive population – not to mention the attempts of treatment before death, which generate high costs for the health systemIt is suggested that further studies on the trends of the PYLL rates are carried out to monitor the situation. This is the only way to learn more about the behavior of this disease and subsidize early detection strategies, timely diagnosis and treatment. 1 .O câncer de boca e de faringe é considerado um problema de saúde pública em todo o mundo. Estima-se que em 2015 tenham surgido 571.386 casos novos da doença e 316.168 pessoas tenham morrido em decorrência desses tumores em todo o mundo. Segundo a Agência Internacional de Pesquisa em Câncer, espera-se que tais valores apresentem ascensão no quinquênio de 2016 a 2020, chegando a 350.000 óbitos e 639.171 casos novos em 20201 . A taxa de mortalidade por câncer de boca e faringe no Brasil é de 5,91/100.000 habitantes, enquanto outros países da região, tais como Argentina, Chile, Colômbia e México, não superaram três óbitos por 100.000 habitantes1 . De 1979 a 2002, a taxa de mortalidade foi de 2,7 por 100.000 habitantes2 , mas em 2013, segundo dados do Departamento de Informática do Sistema Único de Saúde (Datasus), a taxa chegou a 3,6 óbitos para cada 100.000 habitantes, indicando um aumento de 33% em relação ao ano anterior.Na América Latina, o número estimado de mortes em 2015 foi de 33.925, sendo o Brasil o país com o maior número de casos na região3 . Estima-se que no ano 2020 o câncer de boca e faringe apresente mais de 21 mil casos novos e mate mais de 10 mil pessoas no Brasil1 .O Instituto Nacional de Câncer (Inca) estima um risco de incidência de 7,8 por 100 mil habitantes, sendo 11,27 casos novos a cada 100 mil homens e 4,21 a cada 100 mil mulheres4 . A análise de tendência temporal potencializa a o entendimento da dinâmica, do monitoramento, da evolução das mortes que ocorreram ao longo dos anos, inclusive possibilitando fazer previsões, o que contribui de maneira efetiva para o planejamento de ações5 .Ainda que as taxas de mortalidade permitam a análise do risco de óbitos nas diferentes regiões do mundo, elas não incluem o impacto das mortes nas comunidades, uma vez que não consideram a idade do óbito (precoce ou não). O indicador anos potenciais de vida perdidos (APVP) apresenta a mortalidade prematura, a magnitude das causas e o impacto social das doenças, uma vez que a prematuridade afeta o potencial econômico e social do indivíduo na sociedade. Além disso, esse indicador é uma alternativa para o desenvolvimento das ações preventivas para o câncer, possibilitando intervenções em grupos específicos de risco e auxiliando no aprimoramento do uso dos recursos já existentesoral cancer ” e “ potential years of life lost ” não identificou estudos recentes analisando as taxas de anos de vida perdidos por câncer de boca e faringe no Brasil. Diante dessa lacuna de conhecimento e da relevância do tema, realizou-se o presente estudo para analisar a tendência da mortalidade prematura de câncer de boca e faringe no Brasil, no período de 1979 a 2013.Uma busca realizada na base de dados da PubMed (Medline) em março de 2018 sobre “ Foram analisados os óbitos por câncer de boca e faringe no Brasil de indivíduos entre zero e 69 anos que ocorreram no país desde 1979, ano do início da coleta de dados em nível nacional pelo Sistema de Informações sobre Mortalidade (SIM) do Ministério da Saúde, até o ano 2013. As observações com sexo ignorado, 26 no total , não foram incluídas na análise das taxas segundo sexo.6 . Ele consiste na soma do número de mortes em cada faixa etária multiplicado pelo número de anos faltantes para a idade-limite, que foi de 69 anos no presente estudo. Existem diferentes pontos de corte para definir essa idade-limite na literatura. Os autores argumentam que, ao se incluir as mortes de pessoas com idades maiores, seria dado um grande peso no cálculo às causas naturais de morte, e a mortalidade prematura não seria devidamente identificada.O método de cálculo dos APVP é uma adaptação da proposta de Romeder e McWhinnieOs óbitos ocorridos entre 1979 e 1995 foram classificados segundo a nona revisão da Classificação Internacional de Doenças (CID), e os ocorridos entre 1996 e 2013, segundo a décima revisão. Para permitir a comparabilidade dos dados de todo o período segundo a causa principal de morte, os códigos 140.0 a 145.9 da CID-9 e C00.0 a C8.9 da CID-10 foram classificados como óbitos por câncer de boca, e os códigos 146.0 a 149.9 da CID-9 e C09 a C14.8 da CID-10 como óbitos por câncer de faringe, no intuito de neutralizar a influência que a mudança da codificação poderia ter nos resultados. Os óbitos foram categorizados segundo macrorregião de residência, sexo e faixa etária (a cada cinco anos).Os valores da população residente necessários para o cálculo das taxas foram obtidos por meio dos censos realizados pelo Instituto Brasileiro de Geografia e Estatística (IBGE) de 1980, 1991, 2000, 2010 e de estimativas intercensitárias para os demais anos, disponíveis no site do Datasus.4 . Considerando que a análise do presente estudo inclui apenas o câncer de boca e faringe e que a mortalidade devido a essa doença em menores de um ano também é de interesse dos autores, não foram excluídas as 50 mortes nessa faixa etária .Os critérios para estabelecer a idade-limite usada no cálculo dos anos potencias de vida perdidos varia de autor para autor. Uma ampla discussão com respeito à inclusão ou exclusão das mortes em menores de um ano e sobre a idade a ser considerada como limite superior pode ser encontrada na literaturadi representa o número de mortes entre as idades i e i + 1, e ai representa o número de anos faltantes para a idade limite quando a morte ocorre entre as idades i e i + 1.O método original para o cálculo dos APVP utiliza a equação 1, onde 6 .Usando grupos de cinco anos, o cálculo do APVP pode ser simplificado, conforme mostrado na equação 2, com divergência de menos de 2% nos resultadosDq representa o número de mortes em cada quinquênio q , e Aq representa a diferença entre a idade média do quinquênio q e a idade limite estabelecida.Nesse caso, 7 por 10.000 habitantes, posteriormente padronizadas pelo método direto da equação 3. A população brasileira de 2012 foi utilizada como população-padrão.A fim de comparar os APVP entre sexos, sítio anatômico e regiões, foram calculadas a taxas de APVPPq = número de pessoas cujas idades estão compreendidas no quinquênio q na população atual; Pqr = número de pessoas cujas idades estão compreendidas no quinquênio q na população de referência; e Nr = número de pessoas com idade entre zero e 69 na população de referência.Nessa equação, Por fim, foi calculada a tendência temporal das taxas de APVP pelo método de Prais-Winsten com correção para autocorrelação de primeira ordem, conforme as equações 4 e 5:b ” corresponde à taxa de crescimento anual, “ se ” é o valor do erro padrão, e o valor de “ t ” é fornecido pela tabela da distribuição t de Student. Para maiores detalhes sobre essa metodologia, o leitor pode consultar o trabalho desenvolvido por Antunes e Waldman8 .onde “ Stata Corp ., College Station , EUA).A tendência de aumento, declínio ou estagnação foi expressa como variação percentual anual (VPA) e foi considerada estacionária quando o coeficiente de regressão não diferiu de zero . As análises foram realizadas no programa Stata, versão 13 .Observou-se expressiva disparidade na distribuição das mortes prematuras entre homens e mulheres. Do total de anos de vida perdidos, 1.342.939 foram atribuídos ao sexo masculino, com aproximadamente oito de cada 10 óbitos prematuros. A razão entre a taxa de APVP por 10.000 habitantes entre homens e mulheres foi de 6:1. O número de mortes e de anos de vida perdidos com as suas taxas, segundo sexo, pode ser observado na Quando analisado o sítio anatômico, 46,3% das mortes prematuras corresponderam ao câncer de boca, apresentando uma taxa média de APVP de 1,7 por 10.000 habitantes e contribuindo, assim, com 719.238 anos potenciais de vida perdidos. Já o câncer de faringe ocasionou 53,7% das mortes prematuras, contribuindo com 846.136 APVP. A razão entre a taxa de APVP por 10.000 habitantes entre faringe e boca foi de 1,2:1, ou seja, a taxa de APVP por câncer de faringe foi 20% maior do que a taxa de APVP por câncer de boca. O número de mortes e de anos de vida perdidos com as suas taxas, segundo sítio anatômico, pode ser observado na A região do país que apresentou o maior número de anos de vida perdidos foi a Sudeste . A região Sul apresentou 19,7% dos APVP, a região Nordeste 15,6%, a região Centro-Oeste 5,6% e a região Norte apresentou o menor APVP, 2,5%. As regiões Sudeste e Sul tiveram as maiores taxas de APVP, com valores de 4,53 por 10.000 habitantes e 4,48 por 10.000 habitantes, respectivamente. A menor taxa foi observada na região Norte, com 1,50 por 10.000 habitantes.A série histórica das taxas de APVP devido ao câncer de boca e faringe (conjuntamente) mostrou tendência ascendente em ambos os sexos. Nos homens a VPA foi de 0,72%, enquanto nas mulheres, cuja VPA foi de 1,13%, a tendência de aumento foi maior, como observado na A série histórica das taxas de APVP devido ao câncer de faringe também mostrou tendência de aumento, com VPA de 1,05%, e pode ser observada na Segundo a análise por regiões, a tendência de aumento nas taxas foi observada para as regiões Norte , Centro-Oeste  e Nordeste , o que pode ser observado na A mortalidade prematura por câncer de boca e de faringe apresentou tendência de aumento no período entre 1979 e 2013 no Brasil. Foram identificadas diferenças de intensidade segundo sexo e região de residência, com maior ascensão no sexo feminino e na região Nordeste. A análise de carga da doença tem como objetivo descrever do modo mais preciso possível o impacto que determinada doença ou transtorno provoca na vida das pessoas quando as acomete e pode ser mensurada por vários indicadores, um deles sendo os anos potenciais de vida perdidos.10 .Ao incorporar a análise de tendências à série histórica das taxas para estudar o comportamento da mortalidade prematura em longo prazo, o presente trabalho observou variação percentual anual positiva para ambos os sexos na taxa de anos de vida perdidos devido ao câncer de boca e faringe. Segundo os resultados observados por Alves e Neto, essa realidade não é muito diferente do resto das neoplasias, que mostraram aumento na análise de tendência da mortalidade prematura abrangendo o período de 2000 a 201111 . Observa-se que a prevalência de uso regular de serviços odontológicos foi diretamente proporcional à idade, ou seja, quanto mais jovem, menor o número de consultas ao profissional da saúde12 . No presente trabalho, a grande quantidade de anos de vida perdidos pela população masculina durante o período de estudo , assim como a razão das taxas de AVPV, na qual o valor observado nos homens é 6 vezes maior do que o observado nas mulheres, evidencia uma grande perda na população masculina jovem e produtiva. Ainda assim, a análise de tendência mostrou aumento em ambos os sexos, com a variação percentual anual nas mulheres sendo o dobro da dos homens. O uso adequado dos serviços de saúde, entre outros fatores, como o diagnóstico precoce, influencia fortemente a mortalidade prematura.O comportamento das taxas de mortalidade prematura por câncer de boca e faringe em longo prazo é afetado, principalmente, pela exposição no passado aos principais fatores de risco do câncer de boca e faringe, o etilismo e o tabagismo. Estudos mostram que adolescentes começam a fumar cada vez mais cedo, especialmente os do sexo masculino13 . O consumo de cigarro é um dos principais fatores de risco para o câncer de boca e faringe. Espera-se que as modificações na prevalência de consumo estejam relacionadas com o comportamento das taxas de mortalidade por esses tipos de câncer.A prevalência mundial de consumo de cigarro quase triplicou no período entre 1950 e 2009, mas começou a declinar a partir de 1980. No Brasil, observa-se uma redução da prevalência do consumo de cigarros entre adultos, com uma proporção de homens que usam cigarros mais de duas vezes maior do que a de mulheresA análise segundo sítio anatômico mostra que, embora a razão de taxas entre boca e faringe não difira significativamente, a taxa de APVP por câncer de faringe foi 20% maior do que a taxa de APVP por câncer de boca. Além disso, foi observado aumento de 1% na tendência de APVP devido ao câncer de faringe durante o período estudado. Esses achados sugerem ou maior dificuldade no diagnóstico oportuno dos casos de câncer de faringe ou aumento dos casos de câncer nessa região, fortemente associado à infecção por HPV.10 . Isso poderia estar associado ao fato de as regiões Sudeste e Sul estarem associadas à maior exposição a fatores de risco como o etilismo e o tabagismo14 . Segundo os dados do Datasus, a taxa de APVP na região Sul para 2013 foi de 4,7 por 100.000 habitantes, três vezes maior que a taxa da região Norte e duas vezes maior do que a da região Nordeste.As taxas de mortalidade devido ao câncer de boca e faringe têm sido sempre maiores nas regiões Sudeste e Sul quando comparadas com as outras regiõesConsiderando que o AVPV é um indicador afetado tanto pela idade da morte quanto pelo número de mortes, era de se esperar um alto número de APVP nas regiões Sudeste e Sul. Essas regiões, embora tenham tendências estáveis, apresentaram uma taxa de APVP em média três vezes maior do que a região Norte, cuja taxa foi a menor de todas.15 . Devido a sua relação com as desigualdades socioeconômicas, o câncer de boca e faringe tem uma alta carga de mortalidade, especialmente nos grupos populacionais socioeconomicamente mais vulneráveis.Foi observado aumento na tendência das taxas de APVP nas regiões com as menores taxas de mortalidade . O maior aumento foi observado na região Nordeste. A diferença nas tendências das taxas entre regiões obedece a diversas condições que influenciam na desigualdade. As regiões Norte e Nordeste têm as menores taxas de profissionais de saúde em atividadeA tendência global ascendente de câncer de boca e faringe encontrada neste estudo poderia parecer uma variação bastante próxima da estabilidade se não estivesse mascarando as diferenças entre os sexos. É importante considerar que essa é uma variação para cada ano de um período bastante longo, no qual não podemos esperar comportamento linear de desfechos desse tipo.16 no Japão mostrou que, no ano de 2005, os homens apresentaram 73% dos APVP devido ao câncer de boca e faringe. Esses resultados são similares aos observados no presente estudo, no qual se evidencia o impacto da mortalidade prematura no sexo masculino. Ibayashi et al.16 observaram que a taxa de APVP nos homens  foi quatro vezes maior do que nas mulheres , concluíram que os sítios específicos responsáveis pela maior quantidade de APVP eram orofaringe e língua e lamentaram que o câncer de boca e faringe não tenha sido mais amplamente analisado através deste indicador tanto em nível nacional como internacional.Devido à indisponibilidade de estudos semelhantes no Brasil, não foi possível comparar os achados com estudos anteriores. Entretanto, estudo desenvolvido por Ibayashi et al.Como limitação deste artigo, pode ser citada a interpretação das tendências das taxas, especialmente no nível regional, que requer cautela, uma vez que devem ser consideradas as desigualdades regionais no registro dos dados sobre mortalidade e a qualidade dos sistemas de informação. Análises realizadas com base nos registros secundários dependem da qualidade do sistema de notificação dos óbitos. O sub-registro de mortes e a falta de acurácia na definição da causa de morte podem influenciar os resultados do estudo ao gerar taxas reduzidas que não refletem a realidade. Da mesma forma, a diminuição da subnotificação em regiões caracterizadas por baixa qualidade da assistência médica pode estar influenciando no aumento das tendências mais do que um aumento na mortalidade prematura em si.18 . Esses trabalhos têm observado o aumento gradativo da abrangência do sistema desde a sua descentralização em 1992 e corroboram o adequado preenchimento dos dados em uma porcentagem ao redor de 90%.Como aspecto positivo, ressalta-se que a qualidade dos dados de mortalidade fornecidos pelo SIM tem sido verificada em vários estudos19 .Os sistemas de informação em saúde no Brasil têm mostrado grande avanço na cobertura dos registros. No caso do SIM, já foi atingida uma cobertura de 96,1% em 2011. Nas regiões Sudeste, Sul e Centro-Oeste, essa cobertura é próxima de 100%, enquanto nas regiões Norte e Nordeste só quatro unidades federativas têm cobertura entre 80% e 90% e as demais têm cobertura acima de 90%. No que tange ao percentual de óbitos com causa básica mal definida, tem se observado uma queda através dos anos, passando de 7,2% para 6,7% no período de 2009 a 2011. As regiões Sul e Centro-Oeste são as que apresentam menor sub-registro, com percentuais de óbitos por causa básica mal definida de 4,5% e 4,4%, respectivamente20 . A proporção de mortes por causa mal definida passou de 45,7% a 23,7% no período de 1979 a 2004, chegando a 17,0% em 2005 e a 8,0% em 200921 .Salienta-se a diminuição de óbitos por causas mal definidas, especialmente nas regiões Norte e Nordeste, como resultado do programa Redução do Percentual de Óbitos por Causas Mal Definidas desenvolvido pela Secretaria de Vigilância em Saúde do Ministério da Saúde7 , que considera prematuras as mortes em menores de 70 anos. O uso da expectativa de vida de cada sexo é mais apropriado quando se quer conhecer os anos de vida perdidos durante o período produtivo de cada sexo (WYPLL)5 . Esse método favorece a análise das mortes prematuras com foco na expectativa de vida diferenciada e nas idades de aposentadoria de cada sexo para analisar a perda de produtividade devido a essas mortes.Poderia ser considerado também como limitação do estudo o uso de 69 anos como idade-limite, que pode parecer uma escolha arbitrária em um estudo analisando uma população com expectativas de vida discrepantes entre sexos. Entretanto, a idade considerada limite neste trabalho é a idade utilizada na metodologia de cálculo dos APVP proposta por Romeder e McWhinnie10 .Os resultados deste trabalho ressaltam a importância de estudos analisando o comportamento das doenças crônicas para posterior desenvolvimento de estratégias de prevenção. As altas taxas de anos de vida perdidos por câncer, assim como por outras doenças crônicas, se traduzem em um grande volume de incapacidades laborais, sobrecarga nos sistemas de saúde e impacto econômico para as famílias e para a sociedade. Tudo isso pode levar ao prejuízo social e empobrecimento23 .A definição e o cálculo dos APVP implicam que maiores taxas correspondem a uma maior quantidade de mortes prematuras. Isso acaba impactando negativamente a economia, uma vez que as mortes prematuras afetariam a produção da população jovem e produtiva – sem contar as tentativas de tratamento antes da morte, que gera custos altos ao sistema de saúdeSugere-se que novos estudos sobre tendências das taxas de APVP sejam realizados, a fim de monitorar a situação. Só assim se poderá conhecer melhor o comportamento dessa doença e direcionar os recursos para estratégias de detecção precoce, assim como de diagnóstico e tratamento oportunos.


In the published article, there was an error in affiliation “3.” The affiliation “Departamento do Curso de Farmácia, Faculdade Pitágoras, São Luis, Brazil,” should be removed. All remaining affilations have thus been renumbered accordingly.The authors apologize for this error and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.


The affiliation for the seventh author is incorrect. The correct affiliation for Rafael Malagoli Rocha is: Federal University of São Paulo–Gynaecology Department, Botucatu, São Paulo, Brazil.


Studies carried out in western societies have revealed that whereas systolic blood pressure rises continually with age starting at 30 years; diastolic blood pressure rises continually until 50 years and then remains stable or slightly decreases High Blood Pressure and related cardiovascular diseases are preventable and interventions at both population and individual level have effectively reduced the burden of HBP In spite of having ample evidence on the effectiveness of prevention and treatment for HBP, only 50% of hypertensive people have BP controlled (BP<140/90 mm Hg) worldwide ,Tackling the burden of HBP is a complex public health issue. A comprehensive and life course approach is needed to impact the multifactorial factors that accounting for the prevalence, access to treatment and the control of HBP We celebrate the “Know your numbers” 2018 PAHO initiative to improve the control and prevention of HBP  La Organización Panamericana de la Salud (OPS) y la Liga Mundial de Hipertensión han establecido el 17 de mayo como el día internacional para promover la prevención y el control de la Presión Arterial Elevada (PAE) ,,La PAE ha sido claramente asociada con factores de riesgo biológicos y condiciones del medio ambiente. Estudios llevados en sociedades occidentales han mostrado que mientras la presión arterial aumenta en forma constante con la edad a partir de los 30 años, la presión arterial diastólica aumenta continuamente hasta la edad de 50 años y luego permanece estable o desciende en forma moderada La PAE y las enfermedades cardiovasculares relacionadas son prevenibles y tanto las intervenciones a nivel individual como poblacional han efectivamente reducido la carga de enfermedad asociada a PAE A pesar de la amplia evidencia disponible acerca de la efectividad de prevenir y tratar la PAE, solo el 50% de la personas con PAE tienen la presión arterial controlada  a nivel mundial ,Reducir la carga de enfermedad atribuida a la PAE es una situación compleja en salud pública. Es necesario desarrollar una estrategia exhaustiva e integral basada en un enfoque de curso de vida que permita impactar los múltiples factores que determinan la prevalencia, el acceso al tratamiento y el control de la PAE Nosotros celebramos la campaña “Conoce tus números” que este año 2018 la OPS está promoviendo para mejorar la prevención y el control de la PAE