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. 2025 Jul;36(7):733-742.
doi: 10.1007/s10552-025-01973-w. Epub 2025 Feb 20.

Integrating healthcare utilization databases for cancer ascertainment in a prospective cohort in a limited resource setting: the Mexican Teachers' Cohort

Liliana Gómez-Flores-Ramos  1 , Marion Brochier  2   3 , Dalia Stern  1 , Antonio García-Anaya  3 , Adrian Cortés-Valencia  3 , Jocelyn Jaen  3 , Hugo R Sánchez-Blas  3 , Susana Lozano-Esparza  4 , Andrés Catzin-Kuhlmann  5   6 , Juan Eugenio Hernández-Ávila  7 , Angélica Pon  8 , Olga Rivera-Ontiveros  9 , Pabel Miranda-Aguirre  10 , Patricia Pérez-Escobedo  11 , Alberto Castellanos  12 , Mildred Chávez-Cárdenas  11 , Oscar Arrieta  13 , Alejandro Mohar  14 , Ruy López-Ridaura  15 , Isabelle Romieu  3 , Mauricio Hernández-Avila  16 , Martín Lajous  17   18
Affiliations

Integrating healthcare utilization databases for cancer ascertainment in a prospective cohort in a limited resource setting: the Mexican Teachers' Cohort

Liliana Gómez-Flores-Ramos et al. Cancer Causes Control. 2025 Jul.

Abstract

Purpose: Prospective cohort development in low-resource settings may be limited by cancer registry population coverage; however, information routinely collected in health systems may offer opportunities to advance cancer research. We aim to illustrate in a cohort study in Mexico, a cancer ascertainment strategy that integrates multiple sources of information including healthcare utilization databases.

Methods: The Mexican Teachers' Cohort (MTC) includes 114,545 female teachers aged 25 years and older who completed a baseline questionnaire between 2006 and 2010 and were breast cancer free. We used healthcare utilization databases (including electronic health records), self-reported breast cancer, mortality, and cancer registries to identify women with incident breast cancer. We estimated the positive predictive value for self-reported breast cancer and age-specific and age-standardized incidence rates for breast cancer and corresponding 95% confidence intervals (95%CI) calculating person-time from the date of baseline questionnaire response to diagnosis, death, or December 31, 2019.

Results: Between baseline and 2019, we identified 1,313 women with incident breast cancer. We established the diagnosis in 88% using healthcare utilization databases, 6% using cancer and mortality registries, and 6% directly by contacting participants. The positive predictive value of self-reported diagnosed and treated breast cancer was 94% (95%CI 91, 97). The age-standardized incidence was 77.0 per 100,000 person-years (95%CI 75.9, 84.3). The highest incidence was observed in women aged 65-69 years (185.3 per 100,000 person-years).

Conclusion: Leveraging healthcare utilization databases to establish cancer diagnoses within prospective cohorts may offer an opportunity to advance global cancer research.

Keywords: Breast cancer; Cohort; Healthcare utilization databases; LMIC; Prospective.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Research, research Ethics and Biosecurity Committees at the National Institute of Public Health of Mexico (#CI-1645). Consent to participate: Participants received the baseline questionnaire with a letter of invitation detailing study objectives. Response to the questionnaire was considered consent.

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