Radiation oncology in Mexico: Current status according to Mexico's Radiation Oncology Certification Board

Aim: Describe the results of the first national census of radiotherapy in Mexico in order to make a situational diagnosis of radiotherapy availability, offer more accurate information to radiation oncologists, and promote an adequate scientific based investment for the country. Background: According to the Organisation for Economic Co-operation and Development (OECD), the density of radiotherapy (RT) machines per million habitants in Mexico is approximately 1.7-1.8. Other international organizations such as DIRAC-IAEA report 1.15 per million habitants. National organizations collect data indirectly and previous surveys had a low accrual rate (32.5%). Therefore, a precise census is required. Material and methods: The Mexican Radiation Oncology Certification Board (CMRO for its acronym in Spanish) conducted a nationwide census from January through November 2019. Gathered information was combined with CMRO database for sociodemographic information and human resources. Results: The study included 103 RT centers [95.1% answered the survey], with a median of 2 centers by state (ranging from 0 in Tlaxcala to 20 in Mexico City) and with a report of only 1 center in 11 states (34.4%). Fifty-six (54.3%) of the centers are public. Fourteen centers (13.6%) have residency-training programs. The total number of RT machines is 162 [141 clinical and linear accelerators (87%) and 21 radionuclide units (13%)] with a median of 3 machines by state (0 in Tlaxcala to 46 in Mexico City) and with <= 3 machines in 18 states (56.25%). The overall calculated density of RT machines per million habitants is 1.32, varying from 0 in Tlaxcala to 5.16 in Mexico City. The density of linear and clinical accelerators per million population is 1.19. The total number of brachytherapy units is 66, with a median of 1 center with brachytherapy unit per state and 29 states with <= 3 centers with a brachytherapy unit (90.6%). Thirty-seven brachytherapy units (56.1%) have automated afterload high-dose rate. The overall rate of brachytherapy units per million inhabitants is 0.55, varying from 0 in 5 states (15.6%), 0.1-0.49 in 8 states (25%), 0.5-0.99 in 13 states (40.6%), 1-1.49 in 5 states (15.6%) and 1.5-1.99 in Mexico City (3.1%). The Mexican CMRO has 368 radiation oncologists certified (99 women and 269 men), of whom only 346 remain as an active part of Mexico's workforce. Conclusions: This is the first time the CMRO conducts a national census for a radiotherapy diagnostic situation in Mexico. The country currently holds a density of clinical and linear accelerators of 1.19 per million habitants. Brachytherapy density is 0.55 devices per million habitants, and 57% of radiotherapy centers have brachytherapy units. (C) 2020 Greater Poland Cancer Centre. Published by Elsevier B.V. All rights reserved.