Cancer mortality in Latin America: implications for prevention.

address the problem of detection and screening strategiesfor cancer prevention. One paper is on the diffusion of Pap smear tests for cervi-cal cancer prevention in a high-risk area of South America (1), and the other is onprostate-specific antigen (PSA) and digital rectal examinations in the diagnosis ofprostate cancer (2). A third study in this issue analyzes the incidence of canceramong Hispanic children in the United States of America, including mainly neo-plasms of the lymphoid and hematopoietic system, many of which are amenableto treatment (3). These screening and diagnostic tests, as well as modern treat-ments for leukemias and Hodgkin's lymphomas, are largely available in devel-oped countries, such as those of North America (Canada and the United States)and Western Europe. As illustrated by the paper by Dzuba et al. (1), there havebeen some delays in the adoption of organized programs and strategies for can-cer prevention and treatment in some countries of Central America and SouthAmerica. Even in the United States there are racial and ethnic disparities in can-cer incidence and mortality (3, 4), which suggests that not all segments of thepopulation in the country benefit equally from progress in the prevention, earlydetection, and treatment of cancer. A recent paper provided an overview summary of cancer mortality inthe Americas over the 1970-2000 period, with relevant implications for furtherinvestigation and public health intervention (5). Age-standardized (world pop-ulation) mortality rates, derived from the World Health Organization (WHO)database (6), were presented for several cancers in 10 countries of Latin Americawith available and updated mortality and population data—Argentina, Brazil,Chile, Colombia, Costa Rica, Cuba, Ecuador, Mexico, Puerto Rico (United States),and Venezuela—plus in Canada and the United States, for comparative purposes. This comprehensive analysis showed widely diverging patterns in totalcancer mortality in the countries of Latin America, which reflect the variable mor-tality and trends for site-specific cancers. In 2000 the highest total male cancermortality was seen in Argentina and Chile, with rates comparable to those ofNorth America, i.e., about 155/100 000. For women, Chile and Cuba had the high-est rates in Latin America (both over 100/100 000), again comparable to those ofNorth America. These rates reflect the high mortality from cancer of the stomach(for Chile), lung and prostate (for Cuba) in men, stomach and cervix uteri (for Chi-le), and intestines and lung (for Cuba) in women. Colombia, Ecuador, and Mexicohad the lowest male cancer mortality rates, due to low mortality from stomach,colorectal, and lung cancer. For women, the lowest rates were in Brazil and PuertoRico, reflecting their low stomach and cervical cancer rates. In Argentina, Chile,Colombia, Costa Rica, and Venezuela, cancer mortality rates tended to decreasebetween 1970 and 2000, particularly among men. Rates were stable in Ecuadorand Puerto Rico, and they increased in Cuba and Mexico. With reference to head and neck cancers, in the year 2000 the highestrates for oral/pharyngeal cancer mortality in men were in Brazil, Cuba, andPuerto Rico, with values around 5-6/100 000, i.e., 1.5-2.0-fold higher than the val-ues from North America. Colombia, Ecuador, and Mexico showed the lowestrates, with values around 1-2/100 000. As in North America and several countriesof Europe (7), a leveling out, or even a fall, in mortality from oral/pharyngealcancer occurred in various countries of Latin America between 1990 and 2000.Mortality rates for cancer of the mouth/pharynx in women were very low (0.5-1.5/100 000) in most countries, and showed no appreciable change between 197