title: The challenge of cancer in middle-income countries with an ageing population: Mexico as a case study.
abstract: Mexico is undergoing rapid population ageing as a result of its epidemiological transition. This study explores the interface between this rapid population ageing and the burden of cancer. The number of new cancer cases is expected to increase by nearly 75% by 2030 (107,000 additional cases per annum), with 60% of cases in the elderly (aged ≥ 65). A review of the literature was supplemented by a bibliometric analysis of Mexico's cancer research output. Cancer incidence projections for selected sites were estimated with Globocan software. Data were obtained from recent national census, surveys, and cancer death registrations. The elderly, especially women and those living in rural areas, face high levels of poverty, have low rates of educational attainment, and many are not covered by health insurance schemes. Out of pocket payments and private health care usage remain high, despite the implementation of Seguro Popular that was designed to achieve financial protection for the lowest income groups. A number of cancers that predominate in elderly persons are not covered by the scheme and individuals face catastrophic expenditure in seeking treatment. There is limited research output in those cancer sites that have a high burden in the elderly Mexican population, especially research that focuses on outcomes. The elderly population in Mexico is vulnerable to the effects of the rising cancer burden and faces challenges in accessing high quality cancer care. Based on our evidence, we recommend that geriatric oncology should be an urgent public policy priority for Mexico.
authors.affiliation: Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK ; Department of Clinical Oncology, Guys and St Thomas' NHS Trust, London SE1 9RT, UK.
authors.forename: Ajay
authors.initials: A
authors.lastname: Aggarwal
authors.affiliation: Mexican National Cancer Institute (INCan), 14080 México, D.F.
authors.forename: Karla
authors.initials: K
authors.lastname: Unger-Saldaña
authors.affiliation: Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK.
authors.forename: Grant
authors.initials: G
authors.lastname: Lewison
authors.affiliation: Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK ; International Prevention Research Institute (iPRI), Lyon 69006, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Sullivan
keywords: ageing; cancer burden; demographic transition; geriatric oncology; low middle-income country