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Cáncer cutáneo distinto de melanoma: tendencia de la incidencia poblacional en Girona, 1994-2007
Non-melanoma skin cancer: incidence time trends analysis in Girona, Spain, 1994-2007
Neus Vilar-Corominaa,b, Josefina Miró-Queraltc, Annabel Cano-Bautistad, Loreto Vilardell-Gild, Priscila Torres Babiée, Rafael Marcos-Gragerad,f,
Autor para correspondencia
rmarcos@iconcologia.net

Autor para correspondencia.
a Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, España
b Servei de Dermatologia, Hospital Sant Jaume, Olot, Girona, España
c Servei d’Anatomia Patològica, Clínica Girona, Girona, España
d Unitat d’Epidemiologia i Registre de Càncer de Girona, Pla Director d’Oncologia, Departament de Salut, Girona, España
e Registro Nacional de Cáncer, Instituto Nacional de Oncología y Radiobiología, UNCC, La Habana, Cuba
f Departament d’Infermeria, Universitat de Girona, Girona, España
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tendencia de la incidencia del c&#225;ncer de piel no melanoma seg&#250;n histolog&#237;a y sexo&#46; Girona 1994-2007&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="par0005" class="elsevierStylePara elsevierViewall">El t&#233;rmino c&#225;ncer cut&#225;neo no melanoma &#40;CCNM&#41; se utiliza fundamentalmente para definir el carcinoma escamoso cut&#225;neo &#40;CEC&#41; y el carcinoma basocelular &#40;CB&#41;&#44; aunque en sentido estricto incluya asimismo otros procesos como los linfomas cut&#225;neos<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a>&#44; el carcinoma de c&#233;lulas de Merkel<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a>&#44; los tumores anexiales y otros tumores cut&#225;neos primarios &#171;raros&#187;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>&#46; El CEC y el CB representan los subtipos de c&#225;ncer m&#225;s frecuentes en la poblaci&#243;n cauc&#225;sica<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a>&#46; Su inclusi&#243;n bajo un &#250;nico grupo de procesos &#40;CCNM&#41; explica que su an&#225;lisis epidemiol&#243;gico se realice conjunto&#44; aunque entre el CEC y el CB existan importantes diferencias en cuanto a su etiopatogenia&#44; evoluci&#243;n cl&#237;nica&#44; manejo terap&#233;utico y pron&#243;stico&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">El n&#250;mero de estudios epidemiol&#243;gicos de base poblacional sobre CCNM es limitado&#44; probablemente como consecuencia de que la mayor&#237;a de pacientes son tratados de forma ambulatoria y&#44; en un gran n&#250;mero de casos&#44; a partir del diagn&#243;stico cl&#237;nico&#44; sin confirmaci&#243;n histopatol&#243;gica&#46; La mayor&#237;a de registros poblacionales de c&#225;ncer no suelen recoger informaci&#243;n sobre este tipo de tumores y&#44; si lo hacen&#44; los datos registrados no siempre son exhaustivos&#46; No obstante&#44; el Registro de C&#225;ncer de Girona &#40;RCG&#41; recoge desde su inicio la incidencia de este tipo de c&#225;ncer<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a>&#46; El RCG es un registro de base poblacional que abarca la provincia de Girona&#46; La poblaci&#243;n incluida en el RCG seg&#250;n el padr&#243;n continuo del Instituto de Estad&#237;stica de Catalu&#241;a &#40;IDESCAT&#41; 2006 fue de 687&#46;331 habitantes<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46; Las fuentes de informaci&#243;n del registro son todos los hospitales y los laboratorios de anatom&#237;a patol&#243;gica de la provincia de Girona&#44; as&#237; como los centros de referencia situados fuera de &#233;sta&#46; La exhaustividad global del Registro fue del 96&#44;3&#37;<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;8</span></a>&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">El principal objetivo de este estudio fue describir la tendencia de la incidencia del CCNM en la provincia de Girona&#44; por grupo histol&#243;gico&#44; sexo y edad&#44; durante el per&#237;odo 1994-2007&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Material y m&#233;todo</span><p id="par0020" class="elsevierStylePara elsevierViewall">Se realiz&#243; un estudio descriptivo de los 9&#46;247 pacientes con diagn&#243;stico de CCNM reportados en el RCG durante el per&#237;odo comprendido entre enero de 1994 y diciembre de 2007&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">Las variables utilizadas en el estudio fueron el m&#233;todo diagn&#243;stico del c&#225;ncer&#44; la fecha de diagn&#243;stico&#44; la edad&#44; el sexo&#44; la histolog&#237;a seg&#250;n la Clasificaci&#243;n Internacional de Enfermedades para Oncolog&#237;a &#40;CIE-O&#41; 3&#46;&#170; edici&#243;n<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> &#40;c&#243;digos morfol&#243;gicos para CEC&#58; 8050-8084 y c&#243;digos morfol&#243;gicos para CB&#58; 8090-8097&#41; y para la localizaci&#243;n piel &#40;C44&#41;&#46; Se excluyeron los casos de carcinoma <span class="elsevierStyleItalic">in situ&#46;</span></p><p id="par0030" class="elsevierStylePara elsevierViewall">Dado que el c&#225;ncer de piel es un problema especial en el an&#225;lisis de las tasas de incidencia porque el mismo individuo puede tener muchas de estas neoplasias en el curso de su vida&#44; la <span class="elsevierStyleItalic">International Agency for Research on Cancer</span> &#40;IARC&#41; public&#243; las reglas de definici&#243;n de los tumores primarios cut&#225;neos m&#250;ltiples para el c&#225;lculo de su incidencia&#46; &#201;stas establecen que s&#243;lo el primer tumor de un tipo histol&#243;gico definido&#44; en cualquier parte de la piel&#44; se cuenta como un incidente de c&#225;ncer&#44; a menos que fueran dos histolog&#237;as diferentes<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a>&#59; estas reglas son las que hemos tenido en cuenta en el an&#225;lisis de nuestros datos&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Se calcularon las tasas de incidencia global&#44; para cada grupo histol&#243;gico y para cada sexo&#46; Las tasas espec&#237;ficas por edad se calcularon para 18 grupos de edad&#44; expresados en nuevos casos por 10<span class="elsevierStyleSup">5</span> personas-a&#241;o&#46; El c&#225;lculo de las tasas estandarizadas por edad se realiz&#243; por el m&#233;todo directo utilizando la poblaci&#243;n mundial como est&#225;ndar para ambos sexos y a&#241;o<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a>&#46; El denominador de estas tasas fue la poblaci&#243;n de la provincia de Girona de finales del primer semestre de cada a&#241;o proporcionado por el IDESCAT<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a>&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Se utilizaron los modelos de regresi&#243;n <span class="elsevierStyleItalic">joinpoint</span> para estimar las tendencias temporales mediante el c&#225;lculo del porcentaje de cambio anual &#40;PCA&#41; seg&#250;n el grupo histol&#243;gico y edad&#44; teniendo en cuenta los siguientes grupos de edad&#58; 45-64 y &#62; 64 a&#241;os&#46; No se calcularon las tendencias para el grupo &#60; 45 a&#241;os por el escaso n&#250;mero de casos registrados&#46; El resultado de estos modelos es doble&#58; identifican el momento en que se producen los cambios significativos de la tendencia y estiman la magnitud del aumento o el descenso observado en cada intervalo&#46; Para la estimaci&#243;n de dichos modelos se utilizaron las tasas brutas de incidencia y espec&#237;ficas por edad para cada grupo histol&#243;gico y para cada grupo de edad&#46; El software utilizado fue el <span class="elsevierStyleItalic">Joinpoint</span> del <span class="elsevierStyleItalic">Surveillance Research Program of the US National Cancer of Institute</span><a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a><span class="elsevierStyleItalic">&#46;</span></p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Resultados</span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Carcinoma cut&#225;neo no melanoma &#40;carcinoma escamoso cut&#225;neo y carcinoma basocelular&#41;</span><p id="par0045" class="elsevierStylePara elsevierViewall">Durante los 14 a&#241;os de estudio&#44; 9&#46;247 pacientes residentes en la provincia de Girona diagnosticados de CCNM fueron reportados en el RCG&#46; La media de edad fue de 70 a&#241;os &#40;extremos&#58; m&#237;nimo 17&#44; m&#225;ximo&#58; 108&#41;&#44; siendo esta media estad&#237;sticamente superior para el CEC independientemente del sexo&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">En referencia a los indicadores de calidad de los datos&#44; la verificaci&#243;n morfol&#243;gica fue del 99&#44;6&#37; y los casos reportados s&#243;lo a trav&#233;s del certificado de defunci&#243;n &#40;SCD&#41; del 0&#44;05&#37;&#44; con un cociente de mortalidad-incidencia del 0&#44;01&#37;&#44; siendo todos indicadores de buena calidad&#46; La exhaustividad para el CCNM fue del 97&#44;2&#37; &#40;datos no mostrados&#41;&#46;</p><p id="par0055" class="elsevierStylePara elsevierViewall">La tasa bruta de incidencia &#40;TB&#41; para ambos sexos fue de 115&#44;3 por 10<span class="elsevierStyleSup">5</span> personas-a&#241;o y la tasa de incidencia ajustada por edad a la poblaci&#243;n mundial &#40;TA&#41; fue de 55&#44;74&#46; La incidencia del CCNM fue superior en el var&#243;n&#44; con una relaci&#243;n var&#243;n&#58;mujer de 1&#44;43&#44; ratio que se mantuvo constante durante todo el per&#237;odo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0060" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio&#44; la TA se increment&#243; para ambos sexos desde 48&#44;53 hasta 60&#44;54&#44; con un PCA del 2&#44;30&#37;&#44; siendo m&#225;s importante este incremento para la mujer &#40;PCA del 2&#44;65&#37; frente a 1&#44;99&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0065" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la edad&#44; este incremento fue solamente significativo en los mayores de 64 a&#241;os en ambos sexos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>A-C y <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0070" class="elsevierStylePara elsevierViewall">La sublocalizaci&#243;n m&#225;s frecuente en varones y mujeres fue la cara tanto para el CEC como para el CB &#40;43&#44;4 y 40&#44;6&#37; respectivamente&#41;&#44; aunque el porcentaje de casos con sublocalizaci&#243;n desconocida fue del 20&#44;5&#37; &#40;CEC&#41; y el 25&#44;7&#37; &#40;CB&#41; &#40;datos no mostrados&#41;&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Carcinoma escamoso cut&#225;neo</span><p id="par0075" class="elsevierStylePara elsevierViewall">En la provincia de Girona fueron registrados 2&#46;333 casos de CEC&#44; representando el 25&#37; del total de CCNM&#46; La media de edad de presentaci&#243;n fue de 77 a&#241;os &#40;extremos 29-101&#41;&#44; siendo esta media superior en las mujeres &#40;79 a&#241;os&#41; que en los varones &#40;75 a&#241;os&#41;&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">La TB en ambos sexos fue de 29&#44;15 por 10<span class="elsevierStyleSup">5</span> personas-a&#241;o y la TA fue de 11&#44;18&#46; La incidencia del CEC fue superior en el var&#243;n&#44; con una relaci&#243;n var&#243;n&#58;mujer de 2&#44;40&#44; ratio que se mantuvo constante durante todo el per&#237;odo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio&#44; la TA en varones y mujeres se increment&#243; desde 8&#44;24 hasta 13&#44;51&#44; con un PCA del 4&#44;03&#37;&#44; siendo m&#225;s importante este incremento para la mujer &#40;PCA del 4&#44;24 frente a 3&#44;78&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><p id="par0090" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la edad&#44; este incremento fue significativo en los dos grupos de edad y en ambos sexos &#40;excepto en el grupo de mujeres menores de 64 a&#241;os&#41; &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>D-F y <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Carcinoma basocelular</span><p id="par0095" class="elsevierStylePara elsevierViewall">En la provincia de Girona fueron diagnosticados 6&#46;914 casos de CB &#40;75&#37; del total de CCNM&#41;&#46; La media de edad de presentaci&#243;n fue de 68 a&#241;os &#40;extremos 17-108&#41; tanto en varones como en mujeres&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">La TB en varones y mujeres fue de 86&#44;15 por 10<span class="elsevierStyleSup">5</span> personas-a&#241;o y la TA fue de 44&#44;56&#46; La incidencia del CB fue superior en el var&#243;n&#44; con una relaci&#243;n var&#243;n&#58;mujer de 1&#44;26&#44; ratio que se mantuvo constante durante todo el per&#237;odo &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a>&#41;&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall">Durante el per&#237;odo de estudio&#44; la TA se increment&#243; desde 40&#44;3 hasta 47&#44;03&#44; con un PCA del 1&#44;72&#37;&#44; siendo m&#225;s importante este incremento para la mujer &#40;PCA del 2&#44;17 frente a 1&#44;30&#37;&#41; &#40;<a class="elsevierStyleCrossRef" href="#tbl0005">tabla 1</a> y <a class="elsevierStyleCrossRef" href="#fig0005">fig&#46; 1</a>&#41;&#46;</p><p id="par0110" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la edad&#44; este incremento fue significativo en el grupo de edad superior a 64 a&#241;os para ambos sexos &#40;<a class="elsevierStyleCrossRef" href="#fig0010">fig&#46; 2</a>G-I y <a class="elsevierStyleCrossRef" href="#tbl0010">tabla 2</a>&#41;&#46;</p></span></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discusi&#243;n</span><p id="par0115" class="elsevierStylePara elsevierViewall">Este trabajo ilustra la incidencia del CCNM y su tendencia en la poblaci&#243;n residente en la provincia de Girona durante un per&#237;odo de catorce a&#241;os&#46; A nuestro conocimiento&#44; se trata del primer estudio y la serie m&#225;s amplia de &#225;mbito nacional que describe los indicadores de incidencia del CCNM y su tendencia a nivel poblacional&#46;</p><p id="par0120" class="elsevierStylePara elsevierViewall">Nuestros resultados muestran un importante y continuo incremento en la incidencia tanto para el CB como para el CEC en ambos sexos entre 1994 y 2007&#46; Adem&#225;s&#44; es interesante resaltar dos importantes observaciones&#58; la primera es que&#44; tanto para el CEC como para el CB&#44; las mujeres han experimentado un mayor incremento anual de la incidencia respecto a los varones&#59; y la segunda&#44; que las tasas de incidencia espec&#237;ficas por edad tanto del CEC como del CB se ven incrementadas en el grupo de personas mayores de 64 a&#241;os&#46;</p><p id="par0125" class="elsevierStylePara elsevierViewall">Estudios recientes se&#241;alan un incremento de la incidencia del CB mayor en personas j&#243;venes &#40;menores de 40 a&#241;os&#41; que en mayores para ambos sexos &#40;especialmente en mujeres&#41;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#59; sin embargo en nuestra serie no se observa un incremento significativo de CB en j&#243;venes&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Respecto al CEC&#44; estudios de tendencia recientes observan que el mayor aumento de incidencia se produce en el grupo de edad avanzada para ambos sexos<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; En cambio&#44; en nuestro estudio&#44; la incidencia del CEC se produce en todos los grupos de edad analizados&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">La incidencia del CEC observada en nuestra &#225;rea fue similar a la observada en la poblaci&#243;n alemana<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a>&#44; danesa<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#44; escocesa<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> y de Gales<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#46; Para el CB&#44; la incidencia fue similar a la observada en la poblaci&#243;n alemana<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a> e inferior a la poblaci&#243;n de Gales<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">16</span></a>&#44; Escocia<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> y danesa<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a>&#46; Sin embargo&#44; Australia tiene unas cifras de incidencia de CCNM muy superiores a las observadas en Europa<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> con datos tan elevados para el CEC &#40;499 y 291 casos por 100&#46;000 habitantes-a&#241;o para varones y mujeres&#44; respectivamente&#41; y para el CB &#40;1&#46;041 y 745 casos por 100&#46;000 habitantes-a&#241;o para varones y mujeres respectivamente&#41;&#46;</p><p id="par0140" class="elsevierStylePara elsevierViewall">Recientemente se ha publicado un estudio de un &#225;rea mediterr&#225;nea espa&#241;ola que presenta unas cifras de incidencia del CB muy altas &#40;128 casos por 100&#46;000 habitantes-a&#241;o&#41; en comparaci&#243;n con nuestro estudio&#44; que es de un &#225;rea similar&#46; Sin embargo&#44; estas tasas tan altas est&#225;n justificadas porque pacientes con m&#225;s de un CB se consideran como un nuevo caso de incidencia para el c&#225;lculo de las tasas<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a>&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">El PCA determinado en nuestro estudio para el CEC &#40;PCA<span class="elsevierStyleInf">CEC</span><span class="elsevierStyleInf">varones</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>3&#44;8&#37; frente a PCA<span class="elsevierStyleInf">CEC</span><span class="elsevierStyleInf">mujeres</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>4&#44;7&#37;&#41; fue el m&#225;s alto en comparaci&#243;n con otros estudios europeos &#40;Irlanda del Norte&#44; Escocia y Dinamarca&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15&#44;19</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; A pesar del mayor incremento de la incidencia del CEC para las mujeres en nuestra &#225;rea&#44; se ha mantenido una incidencia superior en el var&#243;n durante todo el per&#237;odo&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia><p id="par0150" class="elsevierStylePara elsevierViewall">El incremento anual estimado para el CB en nuestra &#225;rea &#40;PCA<span class="elsevierStyleInf">CB</span><span class="elsevierStyleInf">varones</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#44;3&#37; frente a PCA<span class="elsevierStyleInf">CB</span><span class="elsevierStyleInf">mujeres</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2&#44;2&#37;&#41; se situ&#243; en un nivel intermedio en el contexto europeo &#40;similar al de Escocia&#44; superior al de Irlanda del Norte e inferior al de Dinamarca&#41;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15&#44;19</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46; Estudios de predicci&#243;n de la incidencia publicados recientemente<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> predicen que las tasas de incidencia del CB en la mujer superar&#225;n las de los varones&#46; Probablemente ocurra lo mismo en nuestra &#225;rea&#44; teniendo en cuenta el mayor incremento observado en las mujeres respecto a los varones&#46;</p><p id="par0155" class="elsevierStylePara elsevierViewall">El CB se diagnostica a una media de edad m&#225;s temprana que el CEC en ambos sexos&#44; concretamente con unos 10 a&#241;os de diferencia&#46; Una posible explicaci&#243;n puede responder al distinto modelo etiol&#243;gico de exposici&#243;n solar para estos tumores&#58; mientras se considera la exposici&#243;n solar acumulada como el principal factor de riesgo para el CEC&#44; ser&#237;a m&#225;s bien la fotoexposici&#243;n intensa e intermitente el factor de riesgo para el CB<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a>&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">En nuestro estudio detectamos un aumento importante de la incidencia del CCNM&#44; siendo &#233;ste m&#225;s importante para el CEC que para el CB&#44; para los mayores de 64 a&#241;os y mayor para las mujeres&#46; Dicho incremento tambi&#233;n ha sido observado en otros estudios poblacionales&#44; como los realizados en 2007 en el este de Escocia y Dinamarca<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;15</span></a> &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">tabla 3</a>&#41;&#46;</p><p id="par0165" class="elsevierStylePara elsevierViewall">Una limitaci&#243;n de nuestro estudio es la infraestimaci&#243;n de la incidencia del CCNM&#44; posiblemente como consecuencia de un registro incompleto de los casos&#44; ya que&#44; en un n&#250;mero significativo de ellos&#44; no se realiza el estudio histopatol&#243;gico de forma sistem&#225;tica&#46; Las caracter&#237;sticas cl&#237;nicas&#44; junto con la localizaci&#243;n de la lesi&#243;n&#44; son suficientes para el diagn&#243;stico&#44; a pesar de que los indicadores de calidad evaluados avalan la calidad de los datos utilizados en el estudio&#46;</p><p id="par0170" class="elsevierStylePara elsevierViewall">Por otro lado&#44; la incorporaci&#243;n en la pr&#225;ctica cl&#237;nica de nuevas estrategias terap&#233;uticas como el uso de inmunomoduladores&#44; la aplicaci&#243;n de f&#225;rmacos t&#243;picos o la terapia fotodin&#225;mica&#44; que consiguen la curaci&#243;n de la lesi&#243;n sin necesidad de extirpaci&#243;n quir&#250;rgica&#44; puede asimismo conllevar su no inclusi&#243;n en el registro&#46; Otra limitaci&#243;n en nuestro estudio es la de no poder analizar las tendencias seg&#250;n la sublocalizaci&#243;n del tumor en la piel&#44; ya que en un elevado porcentaje de casos no se recogi&#243; la informaci&#243;n del subsitio anat&#243;mico del tumor&#46; Esto ser&#237;a interesante conocerlo para constatar la mayor frecuencia de localizaci&#243;n del CCNM en &#225;reas corporales fotoexpuestas&#44; ya que el principal factor de riesgo para su desarrollo es la exposici&#243;n solar&#46;</p><p id="par0175" class="elsevierStylePara elsevierViewall">Analizando los casos de CCNM a lo largo del per&#237;odo de estudio &#40;TB&#41;&#44; se observa un incremento del n&#250;mero de casos&#44; que probablemente se deba al envejecimiento de la poblaci&#243;n&#46; Para evitar el sesgo de la edad y poder realizar comparaciones temporales&#44; se ajusta a la poblaci&#243;n est&#225;ndar mundial &#40;TA&#41;&#46; Constatamos que se mantiene dicho incremento a lo largo del per&#237;odo de estudio &#40;pero de forma menos acusada&#41;&#46; Probablemente este incremento se deba a un cambio en la prevalencia de los factores de riesgo &#40;mayor exposici&#243;n a la radiaci&#243;n ultravioleta ya sea por el mayor uso de camas solares&#44; cambios en el estilo de vestir&#44; mayor tiempo de permanencia al aire libre&#44; etc&#46;&#41; y&#47;o a la mejora en la detecci&#243;n del tumor&#46; Asimismo&#44; no se puede descartar que parte de este incremento sea debido a una mejora de la exhaustividad del Registro a lo largo de los 14 a&#241;os del per&#237;odo de estudio&#46;</p><p id="par0180" class="elsevierStylePara elsevierViewall">El incremento detectado para el CCNM tambi&#233;n se ha observado para el melanoma <span class="elsevierStyleItalic">in situ</span> e invasivo &#40;aunque para &#233;stos en una proporci&#243;n mayor&#41; en la misma regi&#243;n y para per&#237;odos similares <a class="elsevierStyleCrossRefs" href="#bib0110"><span class="elsevierStyleSup">22&#44;23</span></a>&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">La medida preventiva m&#225;s eficaz es la protecci&#243;n de la exposici&#243;n solar&#46; Es probable que una protecci&#243;n solar suficiente que comience en la primera infancia pueda prevenir la mayor&#237;a de los CCNM&#46; Esto requiere establecer patrones de conducta a una edad temprana&#44; como la aplicaci&#243;n de filtros solares&#44; uso de sombreros y vestidos protectores y evitar el sol durante las horas de m&#225;xima intensidad&#46; Asimismo&#44; con el mejor acceso a los servicios sanitarios y la incorporaci&#243;n de nuevas estrategias para el tratamiento de las lesiones precursoras del CEC&#44; se espera una reducci&#243;n de la incidencia de &#233;ste y&#44; por tanto&#44; del CCNM&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Teniendo en cuenta la incidencia en nuestra &#225;rea&#44; estimamos que para el a&#241;o 2010 se habr&#225;n diagnosticado aproximadamente unos 53&#46;200 nuevos casos de CCNM en Espa&#241;a&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">En conclusi&#243;n&#44; en nuestro estudio se observ&#243; un aumento importante de la incidencia del CCNM&#44; siendo &#233;ste m&#225;s significativo para el CEC que para el CB&#44; en los mayores de 64 a&#241;os y en las mujeres&#46;</p><p id="par0200" class="elsevierStylePara elsevierViewall">Un mejor conocimiento de la incidencia del CCNM y la monitorizaci&#243;n de su tendencia permitir&#225; evaluar de forma precisa el impacto cl&#237;nico&#44; asistencial y econ&#243;mico del c&#225;ncer cut&#225;neo&#44; el m&#225;s frecuente en nuestra poblaci&#243;n&#44; lo que contribuir&#225; en un futuro&#44; a partir de los datos obtenidos&#44; a mejorar las estrategias de planificaci&#243;n sanitaria&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicto de intereses</span><p id="par0205" class="elsevierStylePara elsevierViewall">Los autores declaran no tener ning&#250;n conflicto de intereses&#46;</p></span></span>"
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              "titulo" => "Carcinoma cut&#225;neo no melanoma &#40;carcinoma escamoso cut&#225;neo y carcinoma basocelular&#41;"
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            1 => array:2 [
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              "titulo" => "Carcinoma escamoso cut&#225;neo"
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            0 => "C&#225;ncer cut&#225;neo no melanoma"
            1 => "Carcinoma escamoso cut&#225;neo"
            2 => "Carcinoma basocelular"
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            0 => "Non-melanoma skin cancer"
            1 => "Cutaneous squamous cell carcinoma"
            2 => "Basal cell carcinoma"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento y objetivo</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Describir la tendencia de la incidencia del c&#225;ncer cut&#225;neo no melanoma &#40;CCNM&#41;&#58; carcinoma escamoso cut&#225;neo &#40;CEC&#41; y carcinoma basocelular &#40;CB&#41; en Girona&#46;</p> <span class="elsevierStyleSectionTitle">Pacientes y m&#233;todo</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Los casos incluidos en el estudio fueron los 9&#46;247 pacientes con diagn&#243;stico de CCNM reportados en el Registro de C&#225;ncer Poblacional de Girona durante el per&#237;odo comprendido entre enero de 1994 y diciembre de 2007&#46; Para el an&#225;lisis de la tendencia de la incidencia poblacional se utiliz&#243; la tasa ajustada a la poblaci&#243;n mundial y se estandariz&#243; por el m&#233;todo directo&#59; para la tendencia por grupo de edad se utiliz&#243; la tasa espec&#237;fica por estos grupos &#40;45-64&#44; &#62; 64 a&#241;os&#41;&#46; Se excluy&#243; el grupo de menores de 45 a&#241;os&#46; Se utilizaron los m&#233;todos de regresi&#243;n <span class="elsevierStyleItalic">joinpoint</span> para estimar las tendencias temporales mediante el c&#225;lculo del porcentaje del cambio anual seg&#250;n el grupo histol&#243;gico y los grupos de edad seleccionados&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">La tasa ajustada a la poblaci&#243;n mundial fue de 55&#44;74 casos por 10<span class="elsevierStyleSup">5</span> personas-a&#241;o&#44; siendo superior en varones &#40;67&#44;13&#41; que en mujeres &#40;46&#44;9&#41;&#59; la del CB fue superior a la del CEC &#40;44&#44;56 y 11&#44;18 respectivamente&#41;&#46; La tasa del CCNM en ambos sexos se increment&#243; desde 48&#44;53 &#40;1994-95&#41; hasta 60&#44;54 &#40;2006-07&#41; con un porcentaje de cambio anual del 2&#44;30&#37;&#44; siendo m&#225;s importante este incremento para la mujer &#40;2&#44;65&#37;&#41; que para el var&#243;n &#40;1&#44;99&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">En nuestra poblaci&#243;n se detecta un importante incremento en la incidencia del CCNM&#44; siendo m&#225;s importante para el CEC que para el CB&#44; en los mayores de 64 a&#241;os y en las mujeres&#46;</p>"
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      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Background and objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">We aimed to assess the population-based incidence trends of non-melanoma skin cancer &#40;NMSC&#41;&#58; squamous cell carcinoma &#40;SCC&#41; and basal cell carcinoma &#40;BCC&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Patients and method</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">From January 1994 to December 2007&#44; 9&#44;247 patients diagnosed with NMSC were recruited in the population-based Cancer Registry of Girona&#46; Incidence rates were calculated with age-adjusted according to the Word standard population &#40;WASR&#41; by a direct method and reported as number of new cases per 100&#44;000 person-year&#46; To evaluate incidence trends by age group we used specific rates for these groups &#40;45-64&#44; &#62; 64 years&#41;&#46; We excluded patients younger than 45 years&#46; Joinpoint method was used to estimate the average annual percentage change &#40;AAPC&#41; for the whole study period according to histologic and age groups&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Age-adjusted incidence was 55&#46;74 per 10<span class="elsevierStyleSup">5</span> person-year&#59; it was higher in males &#40;67&#46;13&#41; than in females &#40;46&#46;9&#41;&#46; Age-adjusted incidence for BCC was higher compared with the incidence for SCC &#40;44&#46;56 and 11&#46;18 respectively&#41;&#46; Age-adjusted incidence rate for NMSC for both sexes increased from 48&#46;53 &#40;1994-95&#41; to 60&#46;54 &#40;2004-05&#41; with an AAPC of 2&#46;30&#37;&#44; which was higher in females &#40;2&#46;65&#37;&#41; than in males &#40;1&#46;99&#37;&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">There has been a significant increase in the incidence of NMSC in our area&#44; particularly evident for SCC&#44; and it is more important in patients older than 64 years and in females&#46;</p>"
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          "es" => "<p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Tendencia de la incidencia del c&#225;ncer de piel no melanoma seg&#250;n histolog&#237;a y sexo&#46; Girona 1994-2007&#46;</p>"
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          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">IC 95&#37;&#58; intervalo de confianza del 95&#37;&#59; N&#58; n&#250;mero de casos&#59; TA&#58; tasa ajustada&#59; TB&#58; tasa bruta&#46;</p>"
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " colspan="4" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Varones</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Mujeres</td><td class="td" title="\n
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                  \t\t\t\t  " colspan="4" align="center" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">Total</td><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
                  \t\t\t\t\ttop\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TA&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">N&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TB&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t\ttop\n
                  \t\t\t\t" style="border-bottom: 2px solid black">TA&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">IC 95&#37;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Ratio V&#47;M&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1994-95&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t"><span class="elsevierStyleHsp" style=""></span>1996-97&nbsp;\t\t\t\t\t\t\n
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Información del artículo
ISSN: 00257753
Idioma original: Español
Datos actualizados diariamente
año/Mes Html Pdf Total
2023 Marzo 2 1 3
2017 Octubre 7 1 8
2017 Septiembre 7 1 8
2017 Agosto 15 0 15
2017 Julio 14 1 15
2017 Junio 12 3 15
2017 Mayo 17 2 19
2017 Abril 20 2 22
2017 Marzo 25 19 44
2017 Febrero 16 3 19
2017 Enero 12 0 12
2016 Diciembre 37 4 41
2016 Noviembre 48 5 53
2016 Octubre 70 5 75
2016 Septiembre 37 4 41
2016 Agosto 34 2 36
2016 Julio 57 2 59
2016 Junio 30 7 37
2016 Mayo 47 7 54
2016 Abril 20 8 28
2016 Marzo 19 2 21
2016 Febrero 25 5 30
2016 Enero 26 8 34
2015 Diciembre 33 4 37
2015 Noviembre 35 6 41
2015 Octubre 37 6 43
2015 Septiembre 68 2 70
2015 Agosto 38 4 42
2015 Julio 46 4 50
2015 Junio 23 3 26
2015 Mayo 38 4 42
2015 Abril 22 7 29
2015 Marzo 30 6 36
2015 Febrero 47 3 50
2015 Enero 47 3 50
2014 Diciembre 73 6 79
2014 Noviembre 43 3 46
2014 Octubre 52 1 53
2014 Septiembre 40 2 42
2014 Agosto 51 3 54
2014 Julio 56 5 61
2014 Junio 1 0 1
2014 Mayo 4 0 4
2014 Abril 1 0 1
2014 Febrero 1 0 1
2013 Mayo 1 0 1
2011 Julio 1298 0 1298
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es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos