Programa De Acción Específico De Prevención Y Control Del Cáncer: 2021-2024

Objectives

Mexico’s Specific Action Programme for Cancer Prevention and Control 2021-2024 seeks to reduce mortality from the principal cancers through an integrated, life-course and gender-responsive response spanning primary prevention, organised population screening, early detection, diagnostic confirmation, coordinated referral and multidisciplinary treatment in specialised units.[1][2]It frames cancer as a multifactorial chronic non-communicable disease and aims to replace fragmented disease-specific arrangements with coordinated action across the National Health System.[3][4]

• Reduce exposure to modifiable cancer risks through healthier lifestyles, action on tobacco, alcohol and other harmful substances, vaccination, infection control and environmental-risk reduction.[5][6]
• Increase early detection through population screening and recognition of cancer signs and symptoms by communities and health personnel, with screening linked to confirmation, referral and treatment.[7][8]
• Apply validated population screening for breast, cervical and colorectal cancers, while expanding equitable access to cervical and breast screening and reviewing new methods through evidence, validation and piloting.[5][7]
• Promote timely, appropriate and personalised treatment for confirmed cases, including psychosocial support, rehabilitation and palliative care to protect quality of life.[9][10]
• Strengthen infrastructure, equipment, supplies, information systems and technical workforce capacity for prevention, detection, diagnosis and care.[11][12]
• Reduce inequities affecting historically discriminated and vulnerable populations through affirmative measures, gender-responsive and intercultural approaches, and attention to intersecting disadvantages.[3][9]
• Support cervical-cancer elimination benchmarks of 70% screening coverage by 2030, 90% human papillomavirus vaccination coverage among children under 15, and treatment for 90% of detected cases.[13]

Implementation

The programme uses national stewardship and inter-institutional coordination to connect prevention, screening, diagnosis, referral, treatment, quality assurance and evaluation. Healthcare-providing institutions are responsible for acquiring and securing clinical resources, while the cancer prevention and control programme monitors their existence, availability, quality and capacity.[14][11]Actions and associated coordination, monitoring and reporting are financed from the authorised budgets of participating spending executors; no total budget or funding allocation is specified.[15]

• Align implementation with Mexico’s National Development Plan 2019-2024, Health Sector Programme 2020-2024, constitutional planning requirements, health legislation, official standards and international commitments on cancer, non-communicable diseases, gender equality and sustainable development.[16][17][15]
• Coordinate the Ministry of Health, National Centre for Preventive Programmes and Disease Control, National Centre for Child and Adolescent Health, National Centre for Gender Equality and Reproductive Health, National Centre for Chronic Diseases and public institutions of the National Health System.[18][16][19]
• Integrate prevention with public-health communication, addiction prevention, vaccination against high-risk human papillomavirus and hepatitis B, services for sexually transmitted infections and human immunodeficiency virus, and environmental-health action.[20][6]
• Deliver early diagnosis through public awareness, access to first-contact care, clinical assessment, diagnostic confirmation and treatment access; deliver screening with valid, reproducible tests and adequately resourced, person-centred care units.[5]
• Continue active case-finding among children and adolescents, develop mechanisms for other common identifiable cancers, and ensure specialised assessment and rapid histopathological confirmation of suspicious cases.[9]
• Refer confirmed cases promptly to accredited oncology centres or hospitals, verify treatment delivery, and record treatment follow-up disaggregated by gender, age and other social determinants for at least five years after treatment begins.[10]
• Develop workforce capability through continuing standardised training, certification or recertification, and content on cancer-risk identification, referral pathways, human rights, gender, non-discrimination and intercultural practice.[11][12]
• Produce an annual national inventory of specialised cancer infrastructure, human resources and equipment; maintain equipment and infrastructure; and address regional gaps in functional equipment, supplies and specialised staff.[12][2]
• Apply standardised internal, external and inter-institutional quality control to screening and diagnostic processes, including cervical cytology, human papillomavirus testing, colposcopy, mammography, ultrasonography and pathology laboratories.[2][21]
• Maintain cancer records and strengthen population-based nominal cancer registration, screening records, notification of positive results, referral tracking and treatment follow-up to support epidemiological planning and corrective action.[13][9]
• Evaluate performance systematically, publish annual evaluation results through National Health System institutional websites, and publish programme results to promote transparency regarding allocated-resource use.[11][21]
• Track national annual indicators for diagnostic confirmation after probable-case identification, treatment initiation within 30 calendar days of confirmation, functional specialised equipment and implementation of quality-control programmes.[22][23][24][25]

Monitoring & Evaluation

The programme establishes a national monitoring and quality-assurance approach for cancer prevention, screening, diagnosis, referral, treatment and resource availability. It combines information systems, epidemiological surveillance, administrative records, systematic performance assessment, public reporting and institutional accountability, although several extracts do not provide a complete common evaluation methodology or reporting timetable.[11][6][21][19]

• Maintain accurate records of diagnosed people and treatment follow-up to generate epidemiological information, guide control measures and support planning and management of cancer-care resources.[9][11]
• Strengthen population-based nominal cancer registration, recording of screened people, notification of positive results, referral, follow-up and process evaluation, addressing weaknesses in data quality, monitoring and information tools.[13][2]
• Apply quality control across prevention and control processes to reduce overdiagnosis, overtreatment, false-negative and false-positive results, associated sequelae and inefficient resource use.[14][3][6]
• Publish annual programme-performance evaluation results on official websites of National Health System institutions and publish results on the use of allocated resources to support transparency and public access to information.[11][21]
• Conduct annual national inventories of specialised infrastructure, equipment and human resources, and monitor equipment distribution, functionality and maintenance across regions, requesting corrective action where required.[11][12]
• Standardise quality control for cervical cytology, high-risk human papillomavirus testing, colposcopy, mammography acquisition and interpretation, diagnostic ultrasonography, pathology laboratories and other screening-suitable cancer detection processes.[21]

Key performance measures cover early detection, diagnostic confirmation, timely treatment, specialised-resource functionality, fulfilment of agreements and implementation of quality-control programmes.[26][22][23][24][25]

• Measure the proportion of probable cancer cases identified through effective screening or early detection that receive diagnostic confirmation, using cancer information systems operated by the relevant institution.[22][27][28]
• Target diagnostic-confirmation performance of 65 in 2021, 70 in 2022, 75 in 2023 and 80 in 2024; a separate extract records a 2024 target of 90 for the average across public National Health System institutions.[29][30]
• Measure timely treatment as the proportion of people with confirmed cancer who start care in a hospital unit or oncology centre within 30 calendar days of confirmation; targets rise from 65 in 2021 to 80 in 2024, with a separate 2024 average target of 90 recorded across public institutions.[23][30]
• Measure specialised-resource functionality as installed and functioning specialised equipment divided by existing specialised equipment, multiplied by 100; the 2024 target is 80.[24][31]
• Measure implementation of quality-control programmes as implemented programmes divided by programmes developed for cancer screening and diagnostic confirmation; this is a national, annual, cumulative management indicator with an increasing expected trend and a 2024 target of 90.[25][32][33]
• Monitor the proportion of agreements adequately fulfilled annually, calculated as adequately fulfilled agreements divided by generated agreements, multiplied by 100; the National Centre for Chronic Diseases is identified as reporter.[26]

Screening and service indicators show material performance gaps. Combined cervical cytology and high-risk human papillomavirus screening coverage was 46.4% in 2018, while mammography coverage was 24.4% and clinical breast-examination coverage among women aged 25 to 69 was 26.7%; coverage subsequently declined during the Covid-19 pandemic.[34][13]The programme uses the World Health Organization reference of 70% screening coverage, alongside cervical-cancer elimination benchmarks of 70% screening coverage by 2030, 90% human papillomavirus vaccination among children under 15 and treatment for 90% of detected cases.[34][13]

Reporting is generally national and annual, with data collected from January to December and, for several indicators, reported or made available in January or March.[26][22][23][24][32]Baselines are intended to be definitive 2018 values or earlier, but multiple indicator extracts record no available baseline despite tables showing a value of zero, and some tables contain formatting artefacts.[35][27][30][31][33]

Costing & Financing

Financing is primarily assigned to participating spending executors and healthcare-providing institutions. Programme actions, inter-institutional coordination, implementation, monitoring and reporting are to be funded from executors’ authorised budgets during the programme period, while service-providing institutions are responsible for acquiring and securing the resources required for delivery.[15][14][3]

• Assign programme stewardship to monitoring the existence, availability, quality and capacity of resources, rather than purchasing medicines, equipment or specialised personnel directly.[9][11]
• Provide infrastructure, specialised equipment, supplies, medicines, trained personnel, maintenance arrangements, screening capacity, diagnostic confirmation, treatment, palliative care, rehabilitation and cancer information systems.[7][9][11][12]
• Address unequal regional distribution and shortages of human, financial and material resources, infrastructure and equipment that impede prevention, early diagnosis and care.[2]
• Maintain equipment and infrastructure, including applicable maintenance insurance, and apply controls to procurement and distribution of medicines, supplies and infrastructure.[12]
• Optimise resources through an integrated primary-health-care approach, which is associated with more efficient resource use and lower operating costs, without quantified savings.[19]

No total programme budget, individual allocation, unit cost, financing gap value, additional resource-mobilisation target, costing methodology or quantified economic assumption is specified in the supplied material.[15][2][6][12]Historical treatment access through social-security coverage and the former Seguro Popular model is described, but no monetary amounts or current financing arrangements are provided.[4]