Browsing by Author "Murillo, R"

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Breast cancer early detection: A phased approach to implementation
(John Wiley and Sons Inc., 2020) Ginsburg, O; Yip, CH; Brooks, A; Cabanes ACaleffi, M; Dunstan Yataco, JA; Gyawali, B; McCormack, V; McLaughlin de Anderson, M; Mehrotra, R; Mohar, A; Murillo, R; Pace, LE; Paskett, ED; Romanoff, A; Rositch, AF; Scheel, JR; Schneidman, M; Unger-Saldaña, K; Vanderpuye, V; Wu, TY; Yuma, S; Dvaladze, A; Duggan, C; Anderson, BO
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
Choosing Wisely in oncology in Latin America: what SLACOM does not recommend in the care of cancer patients in Latin America
(ecancer Global Foundation, 2024) Ismael, J; Esandi, E; Arroyo, G; Becerra, S; Bejarano, S; Castro, C; Enrique, C; Gauna, C; Gutiérrez-Delgado, F; Deza, EG; Kopitowsky, K; Lewi, D; Muller, B; Murillo, R; Pomata, A; Puyol, J; Quintanilla, G; Rompato, S; Santini, L; Vidaurre, T; Solano, A; Cazap, E
Choosing Wisely is an initiative by the American Board of Internal Medicine (ABIM) and ABIM Foundation to deter unnecessary medical treatments and procedures. Faced with the burden of modern technologies and treatments, it is crucial to identify practices lacking value in daily care. The Latin American and Caribbean Society (SLACOM), comprising cancer control experts, deems it vital to tailor this initiative for enhancing cancer care in the region. Through a modified DELPHI methodology involving two rounds of electronic questionnaires and a hybrid meeting to discuss key points of contention, ten essential recommendations were identified and prioritised to avoid harmful oncology procedures in our region. These consensus-based recommendations, contextualised for Latin America, have been compiled and shared to benefit patients. The Scientific Committee, consisting of prominent oncologists and health experts, collaborates remotely to drive this project forward.
Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated (CLARO PARTE) for Latin America and the Caribbean Countries
(Lippincott Williams and Wilkins, 2024) Riano, I; Alas-Pineda, C; Reyes, Garcia, S; Murillo, R; Gutiérrez-Delgado, F; Cazap, E; Pais, Viegas, CM; Torre, MDL; Barahona, KC; Sarria, GJ; Del, Castillo, Bahi, R; Luongo-Céspedes, Á; Ovalles, B; Umaña, Herrera, FV; Sánchez, R; Mcvorran, S; Williams, B; Kascmar, J; Kennedy, LS; Lyons, KD; Bejarano, S; Wong, SL
PURPOSE This study aimed to identify, evaluate, and rank suitable safety innovations developed during the COVID-19 pandemic in Latin American and Caribbean (LAC) radiation oncology centers.METHODSWe conducted a multimodal participatory engagement collaboration with the Latin-American and Caribbean Society of Medical Oncology. The study consisted of four phases. Innovations were collected from a panel of radiotherapy experts representing a diverse group of 11 countries from LAC (Phase I). Next, a medical scientific team compared the innovations against international standards regarding their potential impact on risk of infection, clinical operation, and continuity of quality cancer care (Phase II). Their findings were supplied to the country representatives who rated the innovations for acceptability in their cancer centers (Phase III), resulting in a final report of the panel's recommendations (Phase IV). RESULTS A total of 81 innovations were reported by the country representatives and merged by the medical scientific team into 24 innovations that combined similar innovations. The 24 innovations were grouped into six categories including practices aimed at (1) reducing clinic crowding (n = 3), (2) increasing screening and vaccinations for COVID-19 disease (n = 5), (3) implementing social distancing (n = 6), (4) strengthening personal infection equipment and disinfection (n = 6), (5) avoiding delaying or shortening treatment protocols (n = 2), and (6) mixed procedures (n = 2). The medical scientific team found nearly all innovations were supported by international recommendations and rated as safe, efficient, and acceptable. CONCLUSION By using the lessons learned from the Community-Led Action Research in Oncology: Pandemic-Appropriate Radiotherapy Innovations Evaluated study, a manual of scalable practices in radiation oncology clinics may be developed to guide actions during future large-scale public health crises in low- and middle-income countries of LAC.
Performance of visual inspection of the cervix with acetic acid (VIA) for triage of HPV screen-positive women: results from the ESTAMPA study
(John Wiley and Sons Inc, 2023) Baena, A; Mesher, D; Salgado, Y; Martínez, S; Villalba, GR; Amarilla, ML; Salgado, B; Flores, B; Bellido-Fuentes, Y; Álvarez-Larraondo, M; Valls, J; Lora, O; Virreira-Prout, G; Figueroa, J; Turcios, E; Soilán, AM; Ortega, M; Celis, M; González, M; Venegas, G; Terán, C; Ferrera, A; Mendoza, L; Kasamatsu, E; Murillo, R; Wiesner, C; Broutet, N; Luciani, S; Herrero, R; Almonte, M
VIA is recommended for triage of HPV-positive women attending cervical screening. In the multicentric ESTAMPA study, VIA performance for detection of cervical intraepithelial neoplasia grade 3 or worse (CIN3+) among HPV-positive women was evaluated. Women aged 30-64 years were screened with HPV testing and cytology and referred to colposcopy if either test was positive. At colposcopy visit, study-trained midwives/nurses/GPs performed VIA ahead of colposcopy. VIA was considered positive if acetowhite lesions were observed in or close to the transformation zone. Ablative treatment eligibility was assessed for VIA positives. Performance indicators were estimated. Three thousand one hundred and forty-two HPV-positive women were included. Sensitivity for CIN3+ was 85.9% (95% CI 81.2-89.5) among women <50 years and, although not significant, slightly lower in women 50+ (78.0%, 95% CI 65.9-86.6). Overall specificity was 58.6% (95% CI 56.7-60.5) and was significantly higher among women 50+ (70.3%, 95% CI 66.8-73.5) compared to women <50 (54.3%, 95% CI 52.1-56.5). VIA positivity was lower among women 50+ (35.2%, 95% CI 31.9-38.6) compared to women <50 (53.2, 95% CI 51.1-55.2). Overall eligibility for ablative treatment was 74.5% and did not differ by age. VIA sensitivity, specificity, and positivity, and ablative treatment eligibility varied highly by provider (ranges: 25%-95.4%, 44.9%-94.4%, 8.2%-65.3%, 0%-98.7%, respectively). VIA sensitivity for cervical precancer detection among HPV-positive women performed by trained providers was high with an important reduction in referral rates. However, scaling-up HPV screening triaged by VIA will be challenging due to the high variability of VIA performance and providers' need for training and supervision.