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Chanakira EZ, Thomas CV, Balen J, Mandrik O. A systematic review of public health interventions to address breast cancer inequalities in low- and middle-income countries. Syst Rev 2024; 13:195. [PMID: 39054497 PMCID: PMC11271015 DOI: 10.1186/s13643-024-02620-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 07/18/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Breast cancer is the most diagnosed cancer in the world, with a worse prognosis documented in low- and middle-income countries. Inequalities pertaining to breast cancer outcomes are observed at within-country level, with demographics and socioeconomic status as major drivers. AIM This review aims to aggregate all available evidence from low- and middle-income countries on public health interventions that can be utilized to reduce breast cancer inequalities within the breast cancer continuum. METHODS The study was a systematic review and narrative synthesis of available literature, with the literature search conducted between September and October 2021. The search was re-run in September 2022 to update the review. PubMed, Scopus, Embase, African Index Medicus and LILACS were searched, based on predetermined criteria. Randomized controlled trials, cohort studies and quasi-experimental studies were included for review, while studies without an intervention and comparator group were excluded. The Joanna Briggs Institute family of checklists was used for quality assessment of the included studies. Data pertaining to study design, quality control and intervention effectiveness was extracted. RESULTS A total of 915 studies were identified for screening and 21 studies met the selection criteria. Only one study specifically evaluated the impact of an intervention on breast cancer inequalities. Diverse, multi-level interventions that can be utilized to address breast cancer inequalities through targeted application to disadvantaged subpopulations were identified. Educational interventions were found to be effective in improving screening rates, downstaging through early presentation as well as improving time to diagnosis. Interventions aimed at subsidizing or eliminating screening payments resulted in improved screening rates. Patient navigation was highlighted to be effective in improving outcomes throughout the breast cancer continuum. CONCLUSION Findings from the systematic review underline the importance of early detection in breast cancer management for low- and middle-income countries. This can be achieved through a variety of interventions, including population education, and addressing access barriers to public health services such as screening, particularly among under-served populations. This study provides a comprehensive database of public health interventions relevant to low- and middle-income countries that can be utilized for planning and decision-making purposes. Findings from the review highlight an important research gap in primary studies on interventions aimed at reducing breast cancer inequalities in low- and middle-income countries. SYSTEMATIC REVIEW REGISTRATION PROSPERO registration number: CRD42021289643.
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Affiliation(s)
- Esther Z Chanakira
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK.
| | - Chloe V Thomas
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
| | - Julie Balen
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
- School of Allied and Public Health Professions, Canterbury Christ Church University, Canterbury, UK
- Medical Research Council Unit The Gambia at the London, School of Hygiene and Tropical Medicine, Fajara, The Gambia
- Manmohan Memorial Institute of Health Sciences, Kathmandu, Nepal
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, 30 Regent St, Sheffield, S1 4DA, UK
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Varghese S, Jisha M, Rajeshkumar K, Gajbhiye V, Alrefaei AF, Jeewon R. Endophytic fungi: A future prospect for breast cancer therapeutics and drug development. Heliyon 2024; 10:e33995. [PMID: 39091955 PMCID: PMC11292557 DOI: 10.1016/j.heliyon.2024.e33995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 08/04/2024] Open
Abstract
Globally, breast cancer is a primary contributor to cancer-related fatalities and illnesses among women. Consequently, there is a pressing need for safe and effective treatments for breast cancer. Bioactive compounds from endophytic fungi that live in symbiosis with medicinal plants have garnered significant interest in pharmaceutical research due to their extensive chemical composition and prospective medicinal attributes. This review underscores the potentiality of fungal endophytes as a promising resource for the development of innovative anticancer agents specifically tailored for breast cancer therapy. The diversity of endophytic fungi residing in medicinal plants, success stories of key endophytic bioactive metabolites tested against breast cancer and the current progress with regards to in vivo studies and clinical trials on endophytic fungal metabolites in breast cancer research forms the underlying theme of this article. A thorough compilation of putative anticancer compounds sourced from endophytic fungi that have demonstrated therapeutic potential against breast cancer, spanning the period from 1990 to 2022, has been presented. This review article also outlines the latest trends in endophyte-based drug discovery, including the use of artificial intelligence, machine learning, multi-omics approaches, and high-throughput strategies. The challenges and future prospects associated with fungal endophytes as substitutive sources for developing anticancer drugs targeting breast cancer are also being highlighted.
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Affiliation(s)
- Sherin Varghese
- School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, 686560, India
| | - M.S. Jisha
- School of Biosciences, Mahatma Gandhi University, Kottayam, Kerala, 686560, India
| | - K.C. Rajeshkumar
- National Fungal Culture Collection of India (NFCCI), Biodiversity and Palaeobiology (Fungi) Gr., Agharkar Research Institute, G.G. Agharkar Road, Pune, 411 004, Maharashtra, India
| | - Virendra Gajbhiye
- Nanobioscience Group, Agharkar Research Institute, G.G. Agharkar Road, Pune, 411 004, Maharashtra, India
| | - Abdulwahed Fahad Alrefaei
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
| | - Rajesh Jeewon
- Department of Zoology, College of Science, King Saud University, P.O. Box 2455, Riyadh, 11451, Saudi Arabia
- Department of Health Sciences, Faculty of Medicine and Health Sciences, University of Mauritius, Reduit, Mauritius
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Yigci D, Bonventre J, Ozcan A, Tasoglu S. Repurposing Sewage and Toilet Systems: Environmental, Public Health, and Person-Centered Healthcare Applications. GLOBAL CHALLENGES (HOBOKEN, NJ) 2024; 8:2300358. [PMID: 39006062 PMCID: PMC11237177 DOI: 10.1002/gch2.202300358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/27/2024] [Indexed: 07/16/2024]
Abstract
Global terrestrial water supplies are rapidly depleting due to the consequences of climate change. Water scarcity results in an inevitable compromise of safe hygiene and sanitation practices, leading to the transmission of water-borne infectious diseases, and the preventable deaths of over 800.000 people each year. Moreover, almost 500 million people lack access to toilets and sanitation systems. Ecosystems are estimated to be contaminated by 6.2 million tons of nitrogenous products from human wastewater management practices. It is therefore imperative to transform toilet and sewage systems to promote equitable access to water and sanitation, improve public health, conserve water, and protect ecosystems. Here, the integration of emerging technologies in toilet and sewage networks to repurpose toilet and wastewater systems is reviewed. Potential applications of these systems to develop sustainable solutions to environmental challenges, promote public health, and advance person-centered healthcare are discussed.
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Affiliation(s)
- Defne Yigci
- School of MedicineKoç UniversityIstanbul34450Türkiye
| | - Joseph Bonventre
- Division of Renal MedicineDepartment of Medicine, Brigham and Women's HospitalHarvard Medical SchoolBostonMA02115USA
| | - Aydogan Ozcan
- Electrical and Computer Engineering DepartmentUniversity of CaliforniaLos AngelesCA90095USA
- Bioengineering DepartmentUniversity of CaliforniaLos AngelesCA90095USA
- California NanoSystems Institute (CNSI)University of CaliforniaLos AngelesCA90095USA
- Computer Science DepartmentUniversity of CaliforniaLos AngelesCA90095USA
- Department of SurgeryDavid Geffen School of MedicineUniversity of CaliforniaLos AngelesCA90095USA
| | - Savas Tasoglu
- Department of Mechanical EngineeringKoç UniversitySariyerIstanbul34450Türkiye
- Koç University Translational Medicine Research Center (KUTTAM)Koç UniversityIstanbul34450Türkiye
- Boğaziçi Institute of Biomedical EngineeringBoğaziçi UniversityIstanbul34684Turkey
- Koç University Arçelik Research Center for Creative Industries (KUAR)Koç UniversityIstanbul34450Turkey
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Gutiérrez Urzúa RA, Hernández-Girón CA, Ángeles-Llerenas A, Torres-Mejía G. The marginalization index and its association with selected services within the comprehensive care offered to breast cancer patients. Eur J Oncol Nurs 2024; 68:102508. [PMID: 38219474 DOI: 10.1016/j.ejon.2024.102508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 12/15/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024]
Abstract
PURPOSE There is little information on the supportive care offered to breast cancer patients. We investigated the association between the marginalization index and selected services offered by health professionals. METHODS We used data from a cross-sectional parent study performed in Mexico from 2007 to 2009. We analyzed data from 832 women between 35 and 69 years of age with a histopathological diagnosis of breast cancer. This study was performed in hospitals in 5 states. We used frequencies, measures of central tendency, and logistic regression. We used the svy package of STATA statistical software v17. RESULTS Overall, 15.6% of the study population reported that health professionals offered them selected services. The offer of two or more selected services was greater among women living in states with a very high marginalization index (21.8%) than among those living in states with a very low marginalization index (13.8%). Among women living in states with high marginalization, the odds of receiving a selected service offer were 2.03 times higher than those living in states with low marginalization (Odds ratio (OR) = 2.03, 95% CI 1.08-3.83). For women in the highest tertile of the asset index, the odds of receiving a selected service offer were 2.7 times greater than the odds for women in the lowest tertile (OR = 2.66, 95% CI 1.03-6.88). CONCLUSION The prevalence of comprehensive care offered to breast cancer patients is low in Mexico and varies according to the marginalization index and the asset index.
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Affiliation(s)
- R Aleja Gutiérrez Urzúa
- School of Public Health, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Carlos Alfonso Hernández-Girón
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Angélica Ángeles-Llerenas
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico
| | - Gabriela Torres-Mejía
- Population Health Research Center, National Institute of Public Health, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, Morelos, 62100, Mexico.
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S K P. Cancer reduction in mice with Prakasine nanomedicine immunotherapy. ARTIFICIAL CELLS, NANOMEDICINE, AND BIOTECHNOLOGY 2023; 51:572-589. [PMID: 37882207 DOI: 10.1080/21691401.2023.2270023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/03/2023] [Indexed: 10/27/2023]
Abstract
In this study, non-toxic mercury nanoparticle Prakasine (PRK-NP) was synthesized as per 'Prakash theory of metal drugs' and nanoparticle's non toxicity has been demonstrated by employing in vitro MTT (dose = 320ug/ml), SBR (dose = 80ug/ml) and apoptosis assays (dose = 320ug/ml), and in vivo acute and chronic toxicity studies in mice (n = 12, dose = 900 mg/kg body weight oral), rat (n = 14, dose = 500 mg/kg body weight oral for 18 months), rabbit (n = 14, dose = 500 mg/kg body weight oral for 18 months) and dogs (n = 14, dose = 500 mg/kg body weight oral for 18 months). The MTT, SBR and apoptosis assays established no cytotoxicity, no genotoxicity and no cytolytic anticancer effects. The mice, rat, rabbit and dog studies also indicated nontoxicity. The PRK-NPs significantly reduced the breast cancer tumour in murine mammary tumour - C3H/HeJ model 35% and 43.7% in mice at doses of 200 mg/kg and 500 mg/kg respectively. Also, in xenograft mammary tumour mice model the tumour regressions are 25.7% and 83% in the doses of 500 mg/kg and 1000 mg/kg respectively, compared to standard positive control drugs without any adverse effects and toxicity. Thus, the current study beholds anticipation PRK-NPs may play a vital role in therapeutic.
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Affiliation(s)
- Prakash S K
- Naval AIDS Research Centre, Namakkal, Tamil Nadu, India
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Achan J, Kasujja FX, Opito R, Wabinga H, Orach CG, Mwaka AD. Factors associated with diagnostic and pre-treatment intervals among breast cancer patients attending care at the Uganda Cancer Institute: A cross-sectional study. Cancer Med 2023; 12:19701-19713. [PMID: 37787090 PMCID: PMC10587984 DOI: 10.1002/cam4.6618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 08/09/2023] [Accepted: 09/23/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Most breast cancer (BC) patients in Uganda are diagnosed with advanced-stage disease and experience poor outcomes. This study examined the diagnostic and pre-treatment intervals and factors associated with these intervals among BC patients attending care at the Uganda Cancer Institute (UCI). METHODS This was a cross-sectional, facility-based study. Data were collected using structured questionnaire administered by trained research assistants and analyzed using STATA version 14.0. Modified Poisson regressions models were used to determine the strength of associations between independent variables and diagnostic and pre-treatment intervals. RESULTS The mean age (±SD) of the 401 participants was 47.1 ± 11.7 years. Four in 10 participants had stage III (41.9%; n = 168) and over a third (34.7%; n = 140) stage IV cancers. The median interval from first consultation to diagnosis, i.e. diagnostic interval (DI) was 5.6 months (IQR: 1.5-17.0), while the median interval from histological diagnosis to start of chemotherapy, i.e. pre-treatment interval (PTI) was 1.7 months (IQR: 0.7-4.5). Majority (85%, n = 341) of participants were diagnosed at ≥3 months from first consultation with clinicians. Participants with tertiary education and those who lived within 100-199 km from the UCI were about four times and twice more likely to be diagnosed early (DI <3 months from first consultation) ([aPR = 3.88; 95% CI: 1.15-13.0] and [aPR = 2.19; 95% CI: 1.06-4.55]), respectively. About half (48.3%; n = 176) of participants started chemotherapy within 1 month of cancer diagnosis. Patients who lived more than 300 km from the UCI were less likely to start chemotherapy within 1 month of histology diagnosis of cancer. [Correction added on October 17, 2023 after first online publication. The term ', i.e.' has been included in the results section in this version.] CONCLUSION: Majority of breast cancer patients are diagnosed late and in advanced stages. There is need to promote all efforts toward timely diagnosis when cancers are still in early stages by identifying factors responsible for prolonged diagnostic intervals among breast cancer patients.
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Affiliation(s)
- Jennifer Achan
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Francis Xavier Kasujja
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Ronald Opito
- Department of Public Health, School of Health SciencesSoroti UniversitySorotiUganda
| | - Henry Wabinga
- Department of Pathology, School of Biomedical SciencesCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Christopher Garimoi Orach
- Department of Community Health & Behavioral Sciences, School of Public HealthCollege of Health Sciences, Makerere UniversityKampalaUganda
| | - Amos Deogratius Mwaka
- Department of Medicine, School of MedicineCollege of Health Sciences, Makerere UniversityKampalaUganda
- Department of Medicine, Faculty of MedicineGulu UniversityGuluUganda
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Sauvaget C, Boutayeb S, Bendahhou K, Selmouni F, Belbaraka R, Muwonge R, Hassouni K, Lucas E, Alaoui L, Ibrahim Khalil A, Bennani M, Chami Y, Bekkali R. The journey of cancer patients and the quest to equity: findings from Morocco. Public Health 2023; 223:33-41. [PMID: 37597462 PMCID: PMC10547108 DOI: 10.1016/j.puhe.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVES Rapid diagnostic and assessment pathways for cancer patients provide timely and effective care. This study took place in Morocco, where the majority of patients treated in the public sector are diagnosed at an advanced stage. The aim of this study was to determine the duration of different time intervals along the cancer patient pathway and to highlight problem areas so that strategies can be implemented to make the process more equitable and effective. STUDY DESIGN Cross-sectional study. METHODS Recently diagnosed cancer patients were recruited from four major oncology centres in Morocco; namely, Marrakech, Casablanca, Rabat, and Fez. A questionnaire survey was administered, including sociodemographic and medical information and questions on access to the oncology centre, beliefs, and opinions on the medical staff. The dates of symptom recognition, assessment, diagnosis referral, biopsy, and treatment initiation were collected. Different time intervals (patient, diagnosis, biopsy, and treatment) were estimated and their determinants were investigated. RESULTS A total of 812 patients were interviewed. The majority of participants were breast cancer patients. In total, 60% of participants were at stage III-IV. The main facilitators of cancer diagnosis confirmation and treatment initiation were easy access to diagnosis and treatment facilities, financial resources, personal history of cancer, time availability, late stage at diagnosis, advanced age, and private health insurance. The patient interval (i.e., time from symptom recognition to initial healthcare assessment) had a median duration of 30 days. The biopsy and treatment intervals were within the current international recommendations (7 and 28 days, respectively). However, the diagnosis interval (52 days) was twice as long as the recommended timeframes from the UK, Australia, and the World Health Organization (<28 days). CONCLUSIONS Interval targets should be defined to encourage health systems to be more equitable and effective and to ensure that cancer patients are treated within a defined timeframe.
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Affiliation(s)
- C Sauvaget
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France.
| | - S Boutayeb
- National Institute of Oncology, Rabat, Morocco
| | | | - F Selmouni
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - R Belbaraka
- Oncology and Hematology Centre, CHU Mohammed VI, Marrakech, Morocco
| | - R Muwonge
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - K Hassouni
- Oncology Centre, CHU Hassan II, Fez, Morocco
| | - E Lucas
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - L Alaoui
- IQVIA Maroc, Casablanca, Morocco
| | - A Ibrahim Khalil
- Early Detection, Prevention and Infections Branch, International Agency for Research on Cancer, Lyon, France
| | - M Bennani
- Lalla Salma Foundation, Cancer Prevention and Treatment, Rabat, Morocco
| | - Y Chami
- Lalla Salma Foundation, Cancer Prevention and Treatment, Rabat, Morocco
| | - R Bekkali
- Lalla Salma Foundation, Cancer Prevention and Treatment, Rabat, Morocco
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Belkacemi Y, Biston MC, Benchekroun N, Benider A, Chargari C, Debbi K, Doré M, El Kacimi H, Flandin I, Lalya I, Samlali H, Sellal N, Supiot S. Limited applicability and implementation of the international oncology treatments guidelines in low- and middle-income countries, an example from the Mediterranean area borders. Cancer Radiother 2023; 27:666-675. [PMID: 37550156 DOI: 10.1016/j.canrad.2023.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/09/2023] [Accepted: 07/10/2023] [Indexed: 08/09/2023]
Abstract
The quality of cancer care in the modern era is based on a precise diagnosis and personalized therapy according to patients and their disease based on validated guidelines with a high level of evidence. During cancer patients' management, the objective is first to make an accurate diagnosis and then offer the best treatment, validated beforehand in a multidisciplinary board meeting, with the best benefit/risk ratio. In the context of many low- and middle-income countries, the limited available means do not allow an adequate offer, resulting in non-optimal patients' care. In addition, in many low- and middle-income countries, priority can be given to other types of disease than cancer, which may considerably reduce allocation of specific resources to cancer care. Thus, the limited availability of systemic therapy, radiotherapy machines, brachytherapy and technological development may come up against another difficulty, that of geographical distribution of the means in the countries or a lack of expertise due to insufficient training programs. For all these reasons, the implementation of the guidelines established in Western countries could be impossible for many low- and middle-income countries which, moreover, have to face a completely different epidemiology of cancers compared to developed countries. In this work, we will discuss through a few examples of common cancers on both borders of the Mediterranean area, the applicability of the guidelines and the limits of their implementation for optimal cancer care.
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Affiliation(s)
- Y Belkacemi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France.
| | - M-C Biston
- Centre Léon-Bérard and Creatis, CNRS UMR 5225, Inserm U1044, Insa-Lyon, université Lyon 1, Villeurbanne, France
| | - N Benchekroun
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - A Benider
- Department of Radiation Oncology, centre Mohamed-VI, université de Casablanca, Casablanca, Morocco
| | - C Chargari
- Department of Radiation Oncology, groupe hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université Paris VI, Paris, France
| | - K Debbi
- Department of Radiation Oncology and Henri-Mondor Breast Center, centre hospitalier universitaire Henri-Mondor, AP-HP, université Paris-Est Créteil, Créteil, France; Inserm U955, i-Biot Team, IMRB, university of Paris-Est Crétil, Créteil, France
| | - M Doré
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France
| | - H El Kacimi
- Department of Radiation Oncology, Institut d'oncologie de Rabat, Rabat, Morocco
| | - I Flandin
- Department of Radiation Oncology, centre hospitalier universitaire de Grenoble, Grenoble, France
| | - I Lalya
- Department of Radiation Oncology, hôpital militaire Mohamed-V, Rabat, Morocco
| | - H Samlali
- Department of Radiation Oncology, clinique d'oncologie le Littoral, Casablanca, Morocco
| | - N Sellal
- Department of Radiation Oncology, hôpital universitaire Mohmed-VI, université Abdelmalek-Essadi, Tanger, Morocco
| | - S Supiot
- Department of Radiation Oncology, Institute de cancérologie de l'Ouest (ICO) centre René-Gauducheau, Saint-Herblain, France; Université de Nantes, Nantes, France
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Blavin FE, Smith LB, Dubay L, Basurto L. Assessing patterns in cancer screening use by race and ethnicity during the coronavirus pandemic using electronic health record data. Cancer Med 2023; 12:16548-16557. [PMID: 37347148 PMCID: PMC10469733 DOI: 10.1002/cam4.6246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/16/2023] [Accepted: 06/02/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Efforts to prevent the spread of the coronavirus led to dramatic reductions in nonemergency medical care services during the first several months of the COVID-19 pandemic. Delayed or missed screenings can lead to more advanced stage cancer diagnoses with potentially worse health outcomes and exacerbate preexisting racial and ethnic disparities. The objective of this analysis was to examine how the pandemic affected rates of breast and colorectal cancer screenings by race and ethnicity. METHODS We analyzed panels of providers that placed orders in 2019-2020 for mammogram and colonoscopy cancer screenings using electronic health record (EHR) data. We used a difference-in-differences design to examine the extent to which changes in provider-level mammogram and colonoscopy orders declined over the first year of the pandemic and whether these changes differed across race and ethnicity groups. RESULTS We found considerable declines in both types of screenings from March through May 2020, relative to the same months in 2019, for all racial and ethnic groups. Some rebound in screenings occurred in June through December 2020, particularly among White and Black patients; however, use among other groups was still lower than expected. CONCLUSIONS This research suggests that many patients experienced missed or delayed screenings during the first few months of the pandemic, which could lead to detrimental health outcomes. Our findings also underscore the importance of having high-quality data on race and ethnicity to document and understand racial and ethnic disparities in access to care.
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Affiliation(s)
- Fredric E. Blavin
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | | | - Lisa Dubay
- Health Policy CenterUrban InstituteWashingtonDistrict of ColumbiaUSA
| | - Luis Basurto
- Duke University, Sanford School of Public PolicyDurhamNorth CarolinaUSA
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Sevilla AR, Castañeda MEG, Herrera IMR, Molina CD, Sánchez GB, Hernandez RA, Sánchez CQ, Morales AF. A Geospatial Model to Identify Areas Associated with Late- Stage Breast Cancer: A Spatial Epidemiology Approach. Asian Pac J Cancer Prev 2023; 24:2621-2628. [PMID: 37642047 PMCID: PMC10685234 DOI: 10.31557/apjcp.2023.24.8.2621] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 08/19/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE The aim of this study was to show how a geospatial model can be used to identify areas with a higher probability for late-stage breast cancer (BC) diagnoses. METHODS Our study considered an ecological design. Clinical records at a tertiary care hospital were reviewed in order to obtain the place of residence and stage of the disease, which was classified as early (0-IIA) and late (IIB-IV) and whose diagnoses were made during the 2013-2017 period. Then, they were geolocated to identify the distribution and spatial trend. Subsequently, the pattern of location, i.e. scattered, random and concentrated, was statistically assessed and a geospatial model was elaborated to determine the probability of late diagnoses in the state of Jalisco, Mexico. RESULT There were 1 954 (N) geolocated BC diagnoses: 58.3% were late. During the five-year period, a southwest-northeast trend was identified, nearly 9.5% of the surface of Jalisco, where 6 out of 10 (n= 751) late- stage diagnoses were concentrated. A concentrated and statistically significant pattern was identified in the southern, central and northern Pacific area of Jalisco, where the geospatial model delimited the places with the highest probability of late clinical stages (p <0.05). CONCLUSION The geographical differences associated with the late diagnoses of BC suggest it is necessary to adapt and focus the strategies for early detection as an alternative to create a major impact on the population. Reproducible analysis tools were used in other contexts where geolocation data are available to complement public policies and strategies aimed to control BC.
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Affiliation(s)
- Antonio Reyna Sevilla
- Health Planning and Innovation Unit, Directorate of Medical Benefits, Mexican Social Security Institute, Cuauhtémoc, CDMX, Mexico.
| | | | - Igor Martin Ramos Herrera
- Department of Public Health, University Center for Health Sciences, University of Guadalajara, Guadalajara, Jalisco, Mexico.
| | - Célida Duque Molina
- Directorate of Medical Benefits, Mexican Social Security Institute, Cuauhtémoc, CDMX, Mexico.
| | - Gabriela Borrayo Sánchez
- Health Innovation Coordination, Health Planning and Innovation Unit, Medical Benefits Directorate, Mexican Social Security Institute, Cuauhtémoc, CDMX, Mexico.
| | - Ricardo Aviles Hernandez
- Health Planning and Innovation Unit, Directorate of Medical Benefits, Mexican Institute of Social Security, Cuauhtémoc, CDMX, Mexico.
| | - Carlos Quezada Sánchez
- Directorate of Medical Benefits, Mexican Social Security Institute, Cuauhtémoc, CDMX, Mexico.
| | - Abelardo Flores Morales
- Health Innovation Coordination, Health Planning and Innovation Unit, Medical Benefits Directorate, Mexican Social Security Institute, Cuauhtémoc, CDMX, Mexico.
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11
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Chen KW, Chung KP, Hsu CH. The intention of utilization and experience toward traditional Chinese medicine among breast cancer patients in the early and late stages: a qualitative study. BMC Complement Med Ther 2023; 23:226. [PMID: 37420247 DOI: 10.1186/s12906-023-04054-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/24/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND In Taiwan, breast cancer patients usually take conventional medicine and traditional Chinese medicine simultaneously. The utilization of traditional Chinese medicine among breast cancer patients at various stages has not been examined. This study aims to compare the intention of utilization and experience toward traditional Chinese medicine among early- and late-stage breast cancer patients. METHOD This qualitative research collected data from breast cancer patients through focus groups interview by convenience sampling. Conducted in 2 branches of Taipei City Hospital, a public hospital managed by the Taipei City government. Breast cancer patients > 20 years old and had used TCM for breast cancer therapy for at least 3 months were included in the interview. A semi-structured interview guide was adopted in each focus group interview. In the following data analysis, stages I and II were considered early-stage, and stages III and IV were late-stage. For analyzing the data and reporting the results, we used qualitative content analysis as the approach for data analysis, assisted by NVivo 12. Categories and subcategories were identified through content analysis. RESULTS Twelve and seven early- and late-stage breast cancer patients were included in this study, respectively. The side effects were the main intention of utilizing traditional Chinese medicine. Improving side effects and constitution was the main benefit for patients in both stages. Additionally, early-stage breast cancer patients used traditional Chinese medicine to prevent recurrence or metastasis. Late-stage breast cancer patients responded more frequently to the use of traditional Chinese medicine due to the side effects of western medicine. However, some of their symptoms were not fully relieved. CONCLUSIONS Breast cancer staging may influence the intention and utilization of traditional Chinese medicine. Health policymakers should consider the results of this research and the evidence-based illustrations to establish guidelines for integrating traditional Chinese medicine among various stages of breast cancer to improve the outcome and quality of care for cancer patients.
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Affiliation(s)
- Kai-Wei Chen
- Institute of Health Policy and Management, National Taiwan University, 17 Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan
- Linsen, Chinese Medicine and Kunming Branch, Taipei City Hospital, 100 Kunming Street, Wanhua District, Taipei City, 108, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, National Taiwan University, 17 Xuzhou Road, Zhongzheng District, Taipei City, 100, Taiwan.
| | - Chung-Hua Hsu
- Linsen, Chinese Medicine and Kunming Branch, Taipei City Hospital, 100 Kunming Street, Wanhua District, Taipei City, 108, Taiwan
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12
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Unger-Saldaña K, Bandala-Jacques A, Huerta-Gutierrez R, Zamora-Muñoz S, Hernández-Ávila JE, Cabrera-Galeana P, Mohar A, Lajous M. Breast cancer survival in Mexico between 2007 and 2016 in women without social security: a retrospective cohort study. LANCET REGIONAL HEALTH. AMERICAS 2023; 23:100541. [PMID: 37408951 PMCID: PMC10319338 DOI: 10.1016/j.lana.2023.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 06/08/2023] [Accepted: 06/08/2023] [Indexed: 07/07/2023]
Abstract
Background Essential indicators of health system performance for breast cancer are lacking in Mexico. We estimated survival and clinical stage distribution for women without social insurance who were treated under a health financing scheme that covered 60% of the Mexican population. Methods We conducted a retrospective cohort study cross-linking reimbursement claims for 56,847 women treated for breast cancer between 2007 and 2016 to a mortality registry. We estimated overall- and clinical stage-specific survival and breast cancer survival according to patient age, state of residence, marginalization, type of treatment facility, and patient volume of the treatment facility. We also explored the distribution of clinical stage according to age, year of treatment initiation, and state where the woman was treated. We used log-rank tests and estimated 95% CIs to compare differences between patient groups. Findings Median age was 52 years (interquartile range [IQR] 45, 61) (Sixty five percent patients (36,731/56,847) had advanced disease at treatment initiation. Five-year overall survival was 72.2% (95% CI 71.7, 72.6). For early disease (excluding stage 0), 5-year overall survival was 89.0% (95% CI 88.4, 89.5), for locally advanced disease 69.9% (95% CI 69.0, 70.2) and for metastatic 36.9% (95% CI 35.4, 38.4). Clinical stage at treatment initiation and breast cancer survival remained unchanged in the period analyzed. Clinical stage and survival differed across age groups, state of residence, and type of facility where women received treatment. Interpretation In the absence of population-based cancer registries, medical claims data may be efficiently leveraged to estimate essential cancer-related performance indicators. Funding The authors received no financial support for this research.
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Affiliation(s)
| | - Antonio Bandala-Jacques
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
| | - Rodrigo Huerta-Gutierrez
- Institute of Public Health and Center for Stroke Research, Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Salvador Zamora-Muñoz
- Facultad de Ciencias, Universidad Nacional Autónoma de México (UNAM), Mexico City, Mexico
| | | | | | - Alejandro Mohar
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México (UNAM) and National Cancer Institute, Mexico City, Mexico
| | - Martin Lajous
- Center for Research on Population Health, National Institute of Public Health, Mexico City, Mexico
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, USA
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13
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Akhtar K, Akhtar K, Nahar S, Hossain S, Rahman MM. Current Treatment Status and Treatment Seeking Time of Breast Cancer Patients during COVID-19 Pandemic in Bangladesh. Asian Pac J Cancer Prev 2023; 24:1835-1840. [PMID: 37378910 PMCID: PMC10505889 DOI: 10.31557/apjcp.2023.24.6.1835] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Rising incidence of cancer is a challenging form of seeking help to start treatment, especially in a pandemic situation. Treatment in due time may reduce the time interval of treatment-seeking, which influences the survival of breast cancer patients. The objective of this study was to determine the effect of the pandemic on treatment delays among breast cancer patients in Bangladesh. METHOD A cross-sectional study was conducted from July 2020 to June 2021. A total of 200 samples were collected randomly from the out clinic department of the National Institute of Cancer Research and Hospital. A face-to-face interview was taken with a pretested semi-structured questionnaire. Patients were selected by histopathologically confirmed breast cancer and excluded by their metastasis history, treatment history, physical condition, and informed consent. RESULTS Mean illness period was 16 months with patient delay was 4 months, provider delay was 7 months and total (treatment delay) was 11 months. Stage of cancer had 6 times chance to develop patient delay where OR of 6.234 at 95% CI (2.0, 19.23) and p-value 0.001, Stage of cancer had 4 times chance to develop provider delay where OR of 4.513 at 95% CI (1.35, 12.15) and p-value 0.012, to whom first seek help had 5 times chance to develop provider delay OR of 5.287 at 95% CI (2.58, 10.84) and p-value <0.0001. Provider delay was 2 times associated with a number of FNAC at 95% CI (1.13, 5.13) and a p-value of 0.023. Stage of cancer had 8 times chance to develop total delay where OR of 7.960, at 95% CI (3.20, 19.75) and p-value <0.0001, to whom first seek help had 4 times chance to develop total delay OR 3.860 at 95% CI (1.88, 7.95) and p-value <0.0001. CONCLUSION Stage of cancer and first health care provider play a role in treatment-seeking, so, to improve treatment-seeking time, health education is needed to whom they go first, to where they go first.
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Affiliation(s)
- Khursheda Akhtar
- Department of Community Medicine, National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, Dhaka, Bangladesh.
| | - Khodeza Akhtar
- Conservative Dentistry and Endodontics, Dental Unit, Chittagong Medical College, Mohakhali, Dhaka, Bangladesh.
| | - Shamsun Nahar
- Mymensingh Medical College Hospital, Mohakhali, Dhaka, Bangladesh.
| | - Sharmin Hossain
- Department of Community Medicine, Dhaka National Medical College & Hospital, Mohakhali, Dhaka, Bangladesh.
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Ferreira ADSS, Cintra JRD, Fayer VA, Nogueira MC, Júnior CB, Bustamante-Teixeira MT, Chaoubah A, Cintra AD, Simão CM, Guerra MR. Breast cancer survival and the health system in Brazil: an analysis of public and private healthcare. Front Oncol 2023; 13:927748. [PMID: 37305573 PMCID: PMC10248159 DOI: 10.3389/fonc.2023.927748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/01/2023] [Indexed: 06/13/2023] Open
Abstract
Background The incidence of breast cancer is increasing globally; however, survival outcomes vary and are lower in developing countries. Methods We analyzed the 5- and 10-year survival rates for breast cancer according to the type of healthcare insurance (public vs. private) in a referral center for cancer care in the Brazilian southeast region. This hospital-based cohort study included 517 women diagnosed with invasive breast cancer between 2003 and 2005. The Kaplan-Meier method was used to estimate the probability of survival, and the Cox proportional hazards regression model was used to assess prognostic factors. Results The 5- and 10-year breast cancer survival rates were as follows: private healthcare service survival rate of 80.6% (95% CI 75.0-85.0) and 71.5% (95% CI 65.4-77.1), respectively, and public healthcare service survival rate of 68.5% (95% CI 62.5-73.8) and 58.5% (95% CI 52.1-64.4), respectively. The main factors associated with the worst prognosis were lymph node involvement in both healthcare services and tumor size >2 cm only in public health services. The use of hormone therapy (private) and radiotherapy (public) was associated with the best survival rates. Conclusions The survival discrepancies found between health services can be explained mainly by the difference in the stage of the disease at the time of diagnosis, indicating inequalities in access to the early detection of breast cancer.
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Affiliation(s)
- Adriana de Souza Sérgio Ferreira
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
| | - Jane Rocha Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
| | - Vívian Assis Fayer
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Mário Círio Nogueira
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | | | - Maria Teresa Bustamante-Teixeira
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Alfredo Chaoubah
- Programa de Pós-Graduação em Saúde da Universidade Federal de Juiz de Fora (UFJF), Faculdade de Medicina, Juiz de Fora, Brazil
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
| | - Arthur Duarte Cintra
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Caroline Montes Simão
- Instituto Oncológico de Juiz de Fora/Hospital 9 de Julho, Departamento de Oncologia Clínica, Juiz de Fora, Brazil
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (SUPREMA), Juiz de Fora, Brazil
| | - Maximiliano Ribeiro Guerra
- Programa de Pós-Graduação em Saúde Coletiva da Universidade Federal de Juiz de Fora (UFJF), Departamento de Saúde Coletiva, Juiz de Fora, Brazil
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15
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Petrova D, Garrido D, Špacírová Z, Fernández-Martínez NF, Ivanova G, Rodríguez-Barranco M, Pollán M, Barrios-Rodríguez R, Sánchez MJ. Duration of the patient interval in breast cancer and factors associated with longer delays in low-and middle-income countries: A systematic review with meta-analysis. Psychooncology 2023; 32:13-24. [PMID: 36345154 PMCID: PMC10100001 DOI: 10.1002/pon.6064] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 10/02/2022] [Accepted: 10/31/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Breast cancer survival is lower in low- and middle-income countries (LMICs) partially due to many women being diagnosed with late-stage disease. The patient interval refers to the time elapsed between the detection of symptoms and the first consultation with a healthcare provider and is considered one of the core indicators for early diagnosis and treatment. The goal of the current research was to conduct a meta-analysis of the duration of the patient interval in LMICs and investigate the socio-demographic and socio-cultural factors related to longer delays in presentation. METHODS We conducted a systematic review with meta-analysis (pre-registered protocol CRD42020200752). We searched seven information sources (2009-2022) and included 50 articles reporting the duration of patient intervals for 18,014 breast cancer patients residing in LMICs. RESULTS The longest patient intervals were reported in studies from the Middle East (3-4 months), followed by South-East Asia (2 months), Africa (1-2 months), Latin America (1 month), and Eastern Europe (1 month). Older age, not being married, lower socio-economic status, illiteracy, low knowledge about cancer, disregarding symptoms or not attributing them to cancer, fear, negative beliefs about cancer, and low social support were related to longer delays across most regions. Longer delays were also related to use of alternative medicine in the Middle East, South-East Asia, and Africa and distrust in the healthcare system in Eastern Europe. CONCLUSIONS There is large variation in the duration of patient intervals across LMICs in different geographical regions. Patient intervals should be reduced and, for this purpose, it is important to explore their determinants taking into account the social, cultural, and economic context.
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Affiliation(s)
- Dafina Petrova
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Dunia Garrido
- Department of Developmental and Educational Psychology, University of Granada, Granada, Spain
| | - Zuzana Špacírová
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Nicolás Francisco Fernández-Martínez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Interlevel Clinical Management Unit for Prevention, Promotion and Health Surveillance, Reina Sofía University Hospital, Córdoba, Spain
| | - Ganka Ivanova
- Department of Applied Psychology, College of Education, Social Sciences and Humanities, Al-Ain University, Abu Dhabi, United Arab Emirates
| | - Miguel Rodríguez-Barranco
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Marina Pollán
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,National Center for Epidemiology, Health Institute Carlos III, Madrid, Spain
| | - Rocío Barrios-Rodríguez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.,Department of Preventive Medicine and Public Health, University of Granada, Granada, Spain
| | - Maria José Sánchez
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Escuela Andaluza de Salud Pública (EASP), Granada, Spain.,CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
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16
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Momenimovahed Z, Momenimovahed S, Allahqoli L, Salehiniya H. Factors Related to the Delay in Diagnosis of Breast Cancer in the Word: A Systematic Review. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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17
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Garduño-Alanis A, Morales-González L, Ángeles-Llerenas A, Delgado-Ramírez JZ, Ortega-Olvera C, Torres-Mejía G. The effect of the number of biopsies on the delay in the time from the delivery of mammography results to breast cancer histopathological diagnosis. Cancer Causes Control 2022; 33:1355-1361. [PMID: 36029415 DOI: 10.1007/s10552-022-01622-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/12/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The delay in the time (in calendar days) from the delivery of mammography results to histopathological breast cancer (BC) diagnosis could be associated with more advanced clinical stages, a worse prognosis and higher mortality. Therefore, we assessed the association between the number of biopsies and the delay in the time (in calendar days) from the delivery of mammography results to histopathological BC. METHODS A survey was performed on 563 women aged between 35 and 69 years with histopathologically confirmed BC who attended 11 Mexican hospitals. RESULTS After adjusting for potential confounders, the odds of having a delay in the time (in calendar days) from the delivery of mammography results to histopathological BC diagnosis (≥ 60 days) among women with ≥ 3 biopsies were 2.99 times the odds of those who had only one biopsy (95% CI 1.35, 6.63). CONCLUSION The number of biopsies should be considered as a predictor of the time delay between the delivery of the mammography result and the diagnostic result.
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Affiliation(s)
- Adriana Garduño-Alanis
- School of Nursing and Obstetrics, Autonomous University of the State of Mexico, Paseo Tollocan s/n, Esquina Jesús Carranza, Col. Moderna de la Cruz, C.P. 50180, Toluca, MEX., Mexico
| | - Lizbeth Morales-González
- Research Department, Universidad de la Salud del Estado de México, Vialidad Toluca Atlacomulco 1946, Col. La Aviación, C.P. 50295, Toluca, MEX., Mexico
| | - Angélica Ángeles-Llerenas
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - José Zaim Delgado-Ramírez
- Center for Population Health Research, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | - Carolina Ortega-Olvera
- School of Nursing and Nutrition, Autonomous University of San Luis Potosi, Av. Niño Artillero #130, Zona Universitaria, C.P. 78240, San Luis Potosí, Mexico
| | - Gabriela Torres-Mejía
- Center for Population Health Research, Instituto Nacional de Salud Pública, Mexico City, Mexico.
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18
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Sarvari P, Sarvari P, Ramírez-Díaz I, Mahjoubi F, Rubio K. Advances of Epigenetic Biomarkers and Epigenome Editing for Early Diagnosis in Breast Cancer. Int J Mol Sci 2022; 23:ijms23179521. [PMID: 36076918 PMCID: PMC9455804 DOI: 10.3390/ijms23179521] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/16/2022] [Accepted: 08/17/2022] [Indexed: 12/02/2022] Open
Abstract
Epigenetic modifications are known to regulate cell phenotype during cancer progression, including breast cancer. Unlike genetic alterations, changes in the epigenome are reversible, thus potentially reversed by epi-drugs. Breast cancer, the most common cause of cancer death worldwide in women, encompasses multiple histopathological and molecular subtypes. Several lines of evidence demonstrated distortion of the epigenetic landscape in breast cancer. Interestingly, mammary cells isolated from breast cancer patients and cultured ex vivo maintained the tumorigenic phenotype and exhibited aberrant epigenetic modifications. Recent studies indicated that the therapeutic efficiency for breast cancer regimens has increased over time, resulting in reduced mortality. Future medical treatment for breast cancer patients, however, will likely depend upon a better understanding of epigenetic modifications. The present review aims to outline different epigenetic mechanisms including DNA methylation, histone modifications, and ncRNAs with their impact on breast cancer, as well as to discuss studies highlighting the central role of epigenetic mechanisms in breast cancer pathogenesis. We propose new research areas that may facilitate locus-specific epigenome editing as breast cancer therapeutics.
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Affiliation(s)
- Pourya Sarvari
- Department of Clinical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran P.O. Box 14965/161, Iran
| | - Pouya Sarvari
- International Laboratory EPIGEN, Consejo de Ciencia y Tecnología del Estado de Puebla (CONCYTEP), Puebla 72160, Mexico
| | - Ivonne Ramírez-Díaz
- International Laboratory EPIGEN, Consejo de Ciencia y Tecnología del Estado de Puebla (CONCYTEP), Puebla 72160, Mexico
- Facultad de Biotecnología, Campus Puebla, Universidad Popular Autónoma del Estado de Puebla (UPAEP), Puebla 72410, Mexico
| | - Frouzandeh Mahjoubi
- Department of Clinical Genetics, National Institute of Genetic Engineering and Biotechnology, Tehran P.O. Box 14965/161, Iran
| | - Karla Rubio
- International Laboratory EPIGEN, Consejo de Ciencia y Tecnología del Estado de Puebla (CONCYTEP), Puebla 72160, Mexico
- Licenciatura en Médico Cirujano, Universidad de la Salud del Estado de Puebla (USEP), Puebla 72000, Mexico
- Correspondence:
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Errea RA, Garcia PJ, Pace LE, Galea JT, Franke MF. Understanding linkage to biopsy and treatment for breast cancer after a high-risk telemammography result in Peru: a mixed-methods study. BMJ Open 2022; 12:e050457. [PMID: 35487706 PMCID: PMC9058697 DOI: 10.1136/bmjopen-2021-050457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 01/06/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This mixed-method study aimed to understand the effectiveness of linkage to biopsy and treatment in women with a high-risk mammography result (Breast Imaging Reporting and Data System, BI-RADS 4 and 5) in the national telemammography programme and to explore women's experiences during this process. SETTING Quantitative component: we collected and linked health data from the telemammography reading centre, the national public health insurance, the national centre for disease control and the national referral cancer centre. Qualitative component: we interviewed participants from different regions of the country representing diverse social and geographical backgrounds. PARTICIPANTS Quantitative: women who underwent telemammography between July 2017 and September 2018 and had high-risk results (BI-RADS 4-5) were collected. Qualitative: women with a high-risk telemammography result, healthcare providers and administrators. OUTCOMES MEASURES Quantitative: we determined biopsy and treatment linkage rates and delays. Qualitative: we explored barriers and facilitators for obtaining a biopsy and initiating treatment. RESULTS Of 126 women with high-risk results, 48.4% had documentation of biopsy and 37.5% experienced a delay of >45 days to biopsy. Of 51 women diagnosed with breast cancer, 86.4% had evidence of treatment initiation, but 69.2% initiated treatment >45 days after biopsy. Travelling to major cities for care, administrative factors and breast cancer misconceptions, among other factors, impeded timely, continuous care for breast cancer. A multidisciplinary and culturally tailored patient education facilitated understanding of the disease and prompt decision making about subsequent medical care. CONCLUSIONS Strengthened breast cancer care capacity outside the capital city, standardised referral pathways, ensured financial support for travel expenses, and enhanced patient education are required to secure linkage to the breast cancer care continuum. Robust information systems are needed to track patients and to evaluate the programme's performance.
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Affiliation(s)
- Renato A Errea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Patricia J Garcia
- School of Public Health, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Lydia E Pace
- Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jerome T Galea
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
- School of Social Work and College of Public Health, University of South Florida, Tampa, Florida, USA
| | - Molly F Franke
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
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20
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Yang Y, Yu J, Bai Y, Liu A, Tian J, Guo L, Huo D, Zhao P, Ji W, Luo B. Self-detection remains a primary means of breast cancer detection in Beijing, China. TRANSLATIONAL BREAST CANCER RESEARCH : A JOURNAL FOCUSING ON TRANSLATIONAL RESEARCH IN BREAST CANCER 2022; 4:27. [PMID: 38751468 PMCID: PMC11093100 DOI: 10.21037/tbcr-22-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/01/2022] [Indexed: 05/18/2024]
Abstract
Background Breast cancer in China is usually identified at a later-stage compared to developed countries, and efforts have been made to improve early detection over the past years. This cross-sectional study aimed to determine the current situation of breast cancer detection and screening in a cohort of Chinese breast cancer patients. Methods Three hundred and ten consecutive female breast cancer patients newly diagnosed and treated in Beijing Tsinghua Changgung Hospital between 2015 and 2021 were recruited. Clinicopathological data were retrieved from the patient's medical records and every individual completed surveys assessing demographics, mode of detection, screening behavior and barriers to screening. Results Among the 310 patients, 72.6% had self-detected diseases (mostly through identification of a breast lump), 24.5% were ultrasound screening-detected, 0.3% were mammographic screening-detected and others were identified through clinical breast examination (CBE) (1.0%) or chest computed tomography (CT)/magnetic resonance imaging (MRI) (1.6%). Detection by screening was associated with earlier stages of breast cancer compared to self-detection, yet, 32.2% of self-detected diseases were at stage 0-I. A total of 166 (53.5%) patients had a screening history, with ultrasonography being mostly used and provided by employers. Leading self-perceived barrier to breast cancer screening was lack of awareness, followed by lack of access. And screening participation was associated with a younger age, higher education, being currently working, residence in urban area, and a high family income. Conclusions Self-detection still remains a major way of breast cancer detection in Beijing, but it is not necessarily associated with a late-stage disease. The suboptimal screening rate with disparity in screening behavior can be mostly attributed to lack of awareness of the public and insufficient screening providers.
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Affiliation(s)
- Yuyan Yang
- School of Medicine, Tsinghua University, Beijing, China
| | - Junping Yu
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yizhou Bai
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Anyang Liu
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Jinyi Tian
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Lijing Guo
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Dongfang Huo
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Peiliang Zhao
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Wuyang Ji
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Bin Luo
- Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
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21
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Shafaee MN, Silva LR, Ramalho S, Doria MT, De Andrade Natal R, Cabello V, Cons L, Pavanello M, Zeferino LC, Mano MS, Linck RDM, Batista LS, Pedro EP, De Paula BH, Zuca-Matthes G, Podany E, Makawita S, Ann Stewart K, Tsavachidis S, Tamimi R, Bondy M, Debord L, Ellis M, Bines J, Cabello C. Breast Cancer Treatment Delay in SafetyNet Health Systems, Houston Versus Southeast Brazil. Oncologist 2022; 27:344-351. [PMID: 35348756 PMCID: PMC9074991 DOI: 10.1093/oncolo/oyac050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 01/14/2022] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer outcomes among patients who use safety-net hospitals in the highly populated Harris County, Texas and Southeast Brazil are poor. It is unknown whether treatment delay contributes to these outcomes. Methods We conducted a retrospective cohort analysis of patients with non-metastatic breast cancer diagnosed between January 1, 2009 and December 31, 2011 at Harris Health Texas and Unicamp’s Women’s Hospital, Barretos Hospital, and Brazilian National Institute of Cancer, Brazil. We used Cox proportional hazards regression to evaluate association of time to treatment and risk of recurrence (ROR) or death. Results One thousand one hundred ninety-one patients were included. Women in Brazil were more frequently diagnosed with stage III disease (32.3% vs. 21.1% Texas; P = .002). Majority of patients in both populations had symptom-detected disease (63% in Brazil vs. 59% in Texas). Recurrence within 5 years from diagnosis was similar 21% versus 23%. Median time from diagnosis to first treatment defined as either systemic therapy (chemotherapy or endocrine therapy) or surgery, were comparable, 9.9 weeks versus 9.4 weeks. Treatment delay was not associated with increased ROR or death. Higher stage at diagnosis was associated with both increased ROR and death. Conclusion Time from symptoms to treatment was considerably long in both populations. Treatment delay did not affect outcomes. Impact Access to timely screening and diagnosis of breast cancer are priorities in these populations.
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Affiliation(s)
| | - Leonardo Roberto Silva
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Susana Ramalho
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Maira Teixeira Doria
- Department of Obstetrics and Gynecology, Clinical Hospital of Federal University of Paraná, Curitiba, Paraná, Brazil
| | - Rodrigo De Andrade Natal
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Victor Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Livia Cons
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Marina Pavanello
- School of Women's and Children's Health, Lowy Cancer Research Centre, University of New South Wales, Sydney, Australia
| | - Luiz Carlos Zeferino
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
| | - Max S Mano
- Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | | | | | | | - Kelsey Ann Stewart
- Department of Obstetrics and Gynecology, University of Minnesota, Minneapolis, MN, USA
| | | | - Rull Tamimi
- Department of Population Health Sciences, Weill Cornell Medicine, New York-Presbyterian, New York, NY, USA
| | - Melissa Bondy
- Center for Population Health Sciences, Stanford Cancer Institute, Stanford, CA, USA
| | - Logan Debord
- Department of Dermatology, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | | | - Jose Bines
- Instituto Nacional Do Câncer (INCA - HCIII), Rio de Janeiro, Brazil
| | - Cesar Cabello
- Department of Obstetrics and Gynecology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil
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22
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Ren S, Zhang Y, Qin P, Wang J. Factors Influencing Total Delay of Breast Cancer in Northeast of China. Front Oncol 2022; 12:841438. [PMID: 35311134 PMCID: PMC8924654 DOI: 10.3389/fonc.2022.841438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 01/19/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Delay in diagnosis and treatment, called total delay, could probably result in lower survival rates in breast cancer patients. This study aimed to investigate the factors associated with the comprehensive delay behaviors and to evaluate its effect on outcomes in patients with breast cancer in Dalian, a northeast city of China. Methods A retrospective chart review was conducted using a cancer registry dataset including 298 patients. The Kaplan–Meier survival analysis was used to identify the threshold of total delay, dividing the patients into a group with significant uncertainty and a group without substantial delay. The factors associated with the significant total delay were investigated from the potential candidates, like income level and marital status, by using the chi-squared test. The difference of the clinicopathologic characteristics between the patients grouped by the significant total delay, like tumor size and lymph node metastasis, was also investigated to find out the effect of the total delay. Results A total of 238 charts were used for analysis. The mean age was 57.3. The median of total delays was 3.75 months. Thirty days was identified as a threshold, more than which the total delay can lead to worse survival. Patients’ marital status (p = 0.010), income levels (p = 0.003), smoking status (p = 0.031), initial visiting hospital level (p = 0.005), self-health care (p = 0.001), and self-concern about initial symptom (p ≈ 0.000) were identified as the independent predictors of the total delay. Metastasis (p ≈ 0.000) was identified as the significant result relating to the significant total delay. Conclusions A total delay of more than 30 days predicts worse survival in breast cancer patients in Dalian. Several factors, like patients’ marital status and income levels, can be considered to be relevant to the significant total delay. We recommend that these factors be used to predict the potential patients with the significant total delay in the clinical practice.
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Affiliation(s)
- Sihang Ren
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
| | - Yuting Zhang
- Dalian No.3 People's Hospital, Dalian Medical University, Dalian, China
| | - Pan Qin
- Faculty of Electronic Information and Electrical Engineering, Dalian University of Technology, Dalian, China
| | - Jia Wang
- Department of Breast Surgery, Institute of Breast Disease, The Second Hospital of Dalian Medical University, Dalian, China
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23
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Santos LD, Stevanato KP, Roszkowski I, Pedroso RB, Pelloso FC, Freitas KMS, Carvalho MDDB, Pelloso SM. Impact of the Covid-19 Pandemic on Women's Health in Brazil. J Multidiscip Healthc 2021; 14:3205-3211. [PMID: 34819731 PMCID: PMC8607988 DOI: 10.2147/jmdh.s322100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/28/2021] [Indexed: 12/13/2022] Open
Abstract
Purpose The aim is to verify the impact of the Covid-19 pandemic on women’s healthcare and medical assistance in Brazil. Patients and Methods This exploratory cross-sectional study evaluated a non-probabilistic sample of women above 20 years old, carried out between August and September of 2020, through a snowball sampling using a Google Forms application. Results From a total of 2495 women, more than 70% have not been screened for cervical cancer (77.8% of 2244 women aged for screening), and more than 80% have not been screened for breast cancer (80.2% from 1325 women aged for mammography) during the pandemic. Also, 55.2% of the women did not undergo routine blood tests during the same period. The most frequent reasons for not performing screening and routine tests were: they were up to date; fear of contracting Covid-19; they decided to postpone it until after the end of the pandemic; they were unable to schedule the appointment at the healthcare center for whatever reason; and the healthcare center was only attending Covid-19 patients. Women with no comorbidities have performed significantly more mammograms and routine blood tests than women with comorbidities. In addition, women with comorbidities who were used to perform periodic medical follow-up have done it substantially more than women with no comorbidities during the pandemic. Conclusion As observed, there was a significant decrease in women’s access to the healthcare system during this pandemic. Many participants reported that they had not attended any screening tests, and some reasons included fear of getting infected and due to the public measures of social distancing. The consequences are late diagnoses and a worse prognosis. It might impact the healthcare systems around the world in the next few years. Further studies should be done to follow these consequences.
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Affiliation(s)
| | | | | | | | | | | | | | - Sandra Marisa Pelloso
- State University of Maringá, Maringá, Parana, Brazil.,Faculdade Ingá, Maringá, Parana, Brazil
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24
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Nguyen SM, Nguyen QT, Nguyen LM, Pham AT, Luu HN, Tran HTT, Tran TV, Shu X. Delay in the diagnosis and treatment of breast cancer in Vietnam. Cancer Med 2021; 10:7683-7691. [PMID: 34664428 PMCID: PMC8559509 DOI: 10.1002/cam4.4244] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Delays in diagnosis and treatment from first noticeable breast cancer symptoms are associated with poor outcomes. Understanding the reasons and barriers for patients' delay in seeking medical care is critical to mitigating the problem. METHODS In-person surveys were conducted among 462 women, aged 18-79, with incident breast cancer cases, recruited from two cancer hospitals in North Vietnam. Delay, defined as the time interval between symptom recognition to the diagnosis and initiation of treatment equal to or exceeding 3 months, was categorized as follows: no delay (<3 months), moderate delay (3-8 months), and serious delay (≥9 months). Multivariable multinomial logistic regression was applied in data analyses. RESULTS Over one-quarter patients (31.5%) experienced moderate delays, and close to one-fifth (17.5%) experienced serious delays. Adjusted odds ratios and 95% confidence intervals for moderate and serious delays were 5.60 (3.00-10.47) and 4.25 (2.05-8.85) for financial and physical barriers, respectively. Moderate delay was positively associated with psychological barriers (5.55 [1.75-17.57]) and lack of proper knowledge (3.15 [1.47-6.74]). The associations of barriers with delays in diagnosis and treatment appeared stronger among women living in rural areas. A lack of proper knowledge was significantly associated with delay among young women (<45 years old) and those with high incomes, while psychological barriers were significantly associated with delay among older women (≥45 years old). CONCLUSION Delays in diagnosis and treatment are common among Vietnamese breast cancer patients and are affected by several noted barriers. Proper policy needs to be developed to address this public health issue.
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Affiliation(s)
- Sang M. Nguyen
- Division of EpidemiologyDepartment of MedicineVanderbilt Epidemiology CenterVanderbilt‐Ingram Cancer CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Quang T. Nguyen
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | | | - Anh T. Pham
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Hung N. Luu
- UPMC Hillman Cancer CenterUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
- Department of EpidemiologyGraduate School of Public HealthUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Huong T. T. Tran
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
| | - Thuan V. Tran
- National Cancer HospitalVietnam National Cancer InstituteHanoiVietnam
- Hanoi Medical UniversityHanoiVietnam
- Ministry of HealthHanoiVietnam
| | - Xiao‐Ou Shu
- Division of EpidemiologyDepartment of MedicineVanderbilt Epidemiology CenterVanderbilt‐Ingram Cancer CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
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25
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Miller-Kleinhenz JM, Collin LJ, Seidel R, Reddy A, Nash R, Switchenko JM, McCullough LE. Racial Disparities in Diagnostic Delay Among Women With Breast Cancer. J Am Coll Radiol 2021; 18:1384-1393. [PMID: 34280379 DOI: 10.1016/j.jacr.2021.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Early diagnosis is fundamental to reducing breast cancer (BC) mortality, and understanding potential barriers from initial screening to confirmed diagnosis is essential. The aim of this study was to evaluate patient characteristics that contribute to delay in diagnosis of screen-detected cancers and the contribution of delay to tumor characteristics and BC mortality. METHODS Three hundred sixty-two White and 368 Black women were identified who were screened and received subsequent BC diagnoses within Emory Healthcare, a part of Emory University health care system (2010-2014). Multivariable-adjusted logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associating patient characteristics with delay to diagnostic evaluation (≥30 versus <30 days), delay to biopsy (≥15 versus <15 days), and total delay (≥45 versus <45 days). Additionally, the ORs and 95% CIs associating delay with tumor characteristics and BC mortality were computed. RESULTS Black women and women diagnosed at later stages, with larger tumor sizes, and with triple-negative tumors were more likely to experience ≥45 days to diagnosis. In multivariable-adjusted models, Black women had at least a two-fold increase in the odds of delay to diagnostic evaluation (OR, 1.98; 95% CI, 1.45-2.71), biopsy delays (OR, 2.41; 95% CI, 1.67-3.41), and total delays ≥45 days (OR, 2.22; 95% CI, 1.63-3.02) compared with White women. A 1.6-fold increased odds of BC mortality was observed among women who experienced total delays ≥45 days compared with women without delays in diagnosis (OR, 1.57, 95% CI, 0.96-2.58). CONCLUSIONS The study demonstrated racial disparities in delays in the diagnostic process for screen-detected malignancies. Total delay in diagnosis was associated with an increase in BC mortality.
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Affiliation(s)
| | - Lindsay J Collin
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Rebecca Seidel
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia
| | - Arthi Reddy
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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26
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Mutebi M, Anderson BO, Duggan C, Adebamowo C, Agarwal G, Ali Z, Bird P, Bourque JM, DeBoer R, Gebrim LH, Masetti R, Masood S, Menon M, Nakigudde G, Ng'ang'a A, Niyonzima N, Rositch AF, Unger-Saldaña K, Villarreal-Garza C, Dvaladze A, El Saghir NS, Gralow JR, Eniu A. Breast cancer treatment: A phased approach to implementation. Cancer 2021; 126 Suppl 10:2365-2378. [PMID: 32348571 DOI: 10.1002/cncr.32910] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 12/14/2022]
Abstract
Optimal treatment outcomes for breast cancer are dependent on a timely diagnosis followed by an organized, multidisciplinary approach to care. However, in many low- and middle-income countries, effective care management pathways can be difficult to follow because of financial constraints, a lack of resources, an insufficiently trained workforce, and/or poor infrastructure. On the basis of prior work by the Breast Health Global Initiative, this article proposes a phased implementation strategy for developing sustainable approaches to enhancing patient care in limited-resource settings by creating roadmaps that are individualized and adapted to the baseline environment. This strategy proposes that, after a situational analysis, implementation phases begin with bolstering palliative care capacity, especially in settings where a late-stage diagnosis is common. This is followed by strengthening the patient pathway, with consideration given to a dynamic balance between centralization of services into centers of excellence to achieve better quality and decentralization of services to increase patient access. The use of resource checklists ensures that comprehensive therapy or palliative care can be delivered safely and effectively. Episodic or continuous monitoring with established process and quality metrics facilitates ongoing assessment, which should drive continual process improvements. A series of case studies provides a snapshot of country experiences with enhancing patient care, including the implementation of national cancer control plans in Kenya, palliative care in Romania, the introduction of a 1-stop clinic for diagnosis in Brazil, the surgical management of breast cancer in India, and the establishment of a women's cancer center in Ghana.
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Affiliation(s)
- Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Clement Adebamowo
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, Maryland.,Greenebaum Comprehensive Cancer Center, University of Maryland School of Medicine, Baltimore, Maryland.,Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland.,Center for Bioethics and Research, Ibadan, Nigeria
| | - Gaurav Agarwal
- Endocrine and Breast Surgery, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Zipporah Ali
- Kenya Hospices and Palliative Care Association, Nairobi, Kenya
| | | | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Ontario, Canada.,Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Rebecca DeBoer
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Luiz Henrique Gebrim
- Department of Mastology, Federal University of São Paulo, São Paulo, Brazil.,Centro de Referência da Saúde da Mulher, São Paulo, Brazil
| | - Riccardo Masetti
- Department of Women and Child Health, Catholic University, Rome, Italy
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, Florida
| | - Manoj Menon
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | | | - Anne Ng'ang'a
- National Cancer Control Program, Ministry of Health, Nairobi, Kenya
| | - Nixon Niyonzima
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Uganda Cancer Institute, Kampala, Uganda
| | - Anne F Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Karla Unger-Saldaña
- Epidemiology Unit, Instituto Nacional de Cancerología - México, Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Tecnologico de Monterrey, Centro de Cancer de Mama, Hospital Zambrano Hellion, Monterrey, Mexico
| | - Allison Dvaladze
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | | | - Julie R Gralow
- Section of Surgical Oncology, Department of Surgery, University of Washington, Seattle, Washington
| | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
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27
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Alvarado-Cabrero I, Doimi F, Ortega V, de Oliveira Lima JT, Torres R, Torregrosa L. Recommendations for streamlining precision medicine in breast cancer care in Latin America. Cancer Rep (Hoboken) 2021; 4:e1400. [PMID: 33939336 PMCID: PMC8714537 DOI: 10.1002/cnr2.1400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 12/27/2022] Open
Abstract
Background The incidence of breast cancer (BC) in LMICs has increased by more than 20% within the last decade. In areas such as Latin America (LA), addressing BC at national levels evoke discussions surrounding fragmented care, limited resources, and regulatory barriers. Precision Medicine (PM), specifically companion diagnostics (CDx), links disease diagnosis and treatment for better patient outcomes. Thus, its application may aid in overcoming these barriers. Recent findings A panel of LA experts in fields related to BC and PM were provided with a series of relevant questions to address prior to a multi‐day conference. Within this conference, each narrative was edited by the entire group, through numerous rounds of discussion until a consensus was achieved. The panel proposes specific, realistic recommendations for implementing CDx in BC in LA and other LMIC regions. In these recommendations, the authors strived to address all barriers to the widespread use and access mentioned previously within this manuscript. Conclusion This manuscript provides a review of the current state of CDx for BC in LA. Of most importance, the panel proposes practical and actionable recommendations for the implementation of CDx throughout the Region in order to identify the right patient at the right time for the right treatment.
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Affiliation(s)
| | - Franco Doimi
- Department of Pathology, Oncosalud AUNA, Lima, Peru
| | - Virginia Ortega
- Department of Pathology, Diagnostico SRL, Montevideo, Uruguay
| | | | | | - Lilian Torregrosa
- Department of Breast and Soft Tissue Surgery, Pontificia Universidad Javeriana, Bogotá, Colombia
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28
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Vrdoljak E, Balja MP, Marušić Z, Avirović M, Blažičević V, Tomasović Č, Čerina D, Bajić Ž, Miše BP, Lovasić IB, Flam J, Tomić S. COVID-19 Pandemic Effects on Breast Cancer Diagnosis in Croatia: A Population- and Registry-Based Study. Oncologist 2021; 26:e1156-e1160. [PMID: 33856084 PMCID: PMC8250475 DOI: 10.1002/onco.13791] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 04/02/2021] [Indexed: 12/31/2022] Open
Abstract
Background Our objective was to assess the effects of COVID‐19 antiepidemic measures and subsequent changes in the function of the health care system on the number of newly diagnosed breast cancers in the Republic of Croatia. Subjects, Materials, and Methods We performed a retrospective, population‐ and registry‐based study during 2020. The comparator was the number of patients newly diagnosed with breast cancer during 2017, 2018, and 2019. The outcome was the change in number of newly diagnosed breast cancer cases. Results The average monthly percent change after the initial lockdown measures were introduced was −11.0% (95% confidence interval − 22.0% to 1.5%), resulting in a 24% reduction of the newly diagnosed breast cancer cases in Croatia during April, May, and June compared with the same period of 2019. However, during 2020, only 1% fewer new cases were detected than in 2019, or 6% fewer than what would be expected based on the linear trend during 2017–2019. Conclusion It seems that national health care system measures for controlling the spread of COVID‐19 had a detrimental effect on the number of newly diagnosed breast cancer cases in Croatia during the first lockdown. As it is not plausible to expect an epidemiological change to occur at the same time, this may result in later diagnosis, later initiation of treatment, and less favorable outcomes in the future. However, the effect weakened after the first lockdown and COVID‐19 control measures were relaxed, and it has not reoccurred during the second COVID‐19 wave. Although the COVID‐19 lockdown affected the number of newly diagnosed breast cancers, the oncology health care system has shown resilience and compensated for these effects by the end of 2020. Implications for Practice It is possible to compensate for the adverse effects of COVID‐19 pandemic control measures on breast cancer diagnosis relatively promptly, and it is of crucial importance to do it as soon as possible. Moreover, as shown by this study's results on the number of newly diagnosed breast cancer cases during the second wave of the pandemic, these adverse effects are preventable to a non‐negligible extent. This article assesses the effects of COVID‐19 on the number of newly diagnosed breast cancer patients in the Republic of Croatia.
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Affiliation(s)
- Eduard Vrdoljak
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | - Melita Perić Balja
- Department of Pathology, Clinical Hospital Centre Sisters of Mercy, Zagreb, Croatia
| | - Zlatko Marušić
- Department of Pathology, Clinical Hospital Centre Zagreb, Zagreb, Croatia
| | - Manuela Avirović
- Department of Pathology, Clinical Hospital Centre Rijeka, Rijeka, Croatia
| | | | - Čedna Tomasović
- Department of Pathology, Clinical Hospital Dubrava, Zagreb, Croatia
| | - Dora Čerina
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | - Žarko Bajić
- Research unit "Dr. Mirko Grmek," University Psychiatric Hospital "Sveti Ivan," Zagreb, Croatia
| | - Branka Petrić Miše
- Department of Oncology, Clinical Hospital Centre Split, School of Medicine, University of Split, Split, Croatia
| | | | - Josipa Flam
- Department of Oncology, Clinical Hospital Centre Osijek, Osijek, Croatia
| | - Snježana Tomić
- Department of Pathology, University Hospital of Split, Split, Croatia
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29
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Tesfaw A, Tiruneh M, Tamire T, Yosef T. Factors associated with advanced-stage diagnosis of breast cancer in north-west Ethiopia: a cross-sectional study. Ecancermedicalscience 2021; 15:1214. [PMID: 33912239 PMCID: PMC8057775 DOI: 10.3332/ecancer.2021.1214] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Indexed: 11/08/2022] Open
Abstract
Background Breast cancer tumours are the most common malignant tumours among women in Ethiopia. Although advanced-stage diagnosis of breast cancer is a common problem, evidence-based information is lacking about the magnitude and determinants of advanced-stage presentation in north-west Ethiopia. Methods An institution-based, cross-sectional study was conducted at the oncology units of the University of Gondar and Felege Hiwot specialised hospitals. Stages III and IV were considered advanced stage, whereas stages I and II were considered early stages. Data were collected prospectively on newly diagnosed breast cancer patients and entered using the EPI Info version 7.2 and analysed using Statistical Package for the Social Sciences version 23. Multivariable logistic regression was used to identify the determinants of advanced-stage diagnosis of breast cancer. A p-value < 0.05 was used as the cut-off point to select the determinants of the advanced stage. Result About 71.2% of breast cancer patients presented with advanced-stage disease. The median age of patients was 40 years. Rural residence (adjusted odds ratio (AOR) = 1.7; 95% confidence interval (CI): 1.02, 2.96), painless breast lump/wound (AOR = 2.5; 95% CI: 1.45, 4.13), travel distance ≥5 km (AOR = 3.2; 95% CI: 1.72, 5.29), not practising breast self-examination (BSE) (AOR = 2.9; 95% CI: 1.30, 6.52), time to presentation ≥3 months (AOR = 1.4; 95% CI: 1.02, 2.37) and misdiagnosed at first visit (AOR = 1.9; 95% CI: 1.09, 3.59) were determinants of advanced-stage breast cancer. Conclusion Nearly three-quarters of the patients were diagnosed with advanced-stage breast cancer. Not practising BSE, travel distance ≥5 km, rural residence, painless breast wound/lump and being misdiagnosed at first visit were important determinants of advanced-stage diagnosis of breast cancer. Focused awareness creation programmes for the public and increasing cancer diagnostic centres in the country are crucial to downstage breast cancer at presentation.
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Affiliation(s)
- Aragaw Tesfaw
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Mulu Tiruneh
- Debre Tabor University, College of Health Sciences, Department of Public Health, PO Box 272, Debre Tabor, Ethiopia
| | - Tadese Tamire
- Debre Tabor University, College of Health Sciences, Department of Anesthesia, PO Box 272, Debre Tabor, Ethiopia
| | - Tewodros Yosef
- Mizan-Tepi University, Department of Epidemiology and Biostatistics, School of Public Health, College of Medicine and Health Sciences, PO Box 260, Mizan-Aman, Ethiopia
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Fidan E, Çelik S. Factors affecting medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer. Eur J Cancer Care (Engl) 2021; 30:e13436. [PMID: 33694269 DOI: 10.1111/ecc.13436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 01/18/2021] [Accepted: 02/25/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of study was to determine factors affecting the medical healthcare-seeking behaviours of female patients according to their stage of being diagnosed with breast cancer. METHODS This descriptive and correlational study was carried out with 150 women. The data were collected by a survey form, the Body Perception Scale, the Rosenberg Self-Esteem Scale and the Social Appearance Anxiety Scale. RESULTS About 54% of the women were diagnosed with early-stage breast cancer, 68.7% had high self-esteem, and 80% had positive body perceptions, while their social appearance anxiety levels were moderate. The patients with breast cancer at the 4th stage had a high body perception score of 174.00 ± 23.34. Self-esteem was the highest in the patients with stage 2B breast cancer with a value of 0.61 ± 0.91. The highest social anxiety mean score was found in the patients with stage 2A breast cancer as 31.65 ± 12.50. There was no statistically significant difference in the women's sociodemographic characteristics, health and breast cancer history, self-esteem, body perception and social appearance anxiety based on their stages of cancer (p > 0.05). CONCLUSION Nurses' identification of risky individuals in early diagnosis, information for the individual / family and society by planning trainings and raising awareness will contribute positively to the patients' medical health-seeking behaviours.
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Affiliation(s)
- Emine Fidan
- Faculty of Pharmacy, Zonguldak Bulent Ecevit University, Zonguldak, Turkey
| | - Sevim Çelik
- Nursing Department, Bartın University Health Science Faculty, Bartın, Turkey
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Song H, Bergman A, Chen AT, Ellis D, David G, Friedman AB, Bond AM, Bailey JM, Brooks R, Smith‐McLallen A. Disruptions in preventive care: Mammograms during the COVID-19 pandemic. Health Serv Res 2021; 56:95-101. [PMID: 33146429 PMCID: PMC7839639 DOI: 10.1111/1475-6773.13596] [Citation(s) in RCA: 63] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To measure the extent to which the provision of mammograms was impacted by the COVID-19 pandemic and surrounding guidelines. DATA SOURCES De-identified summary data derived from medical claims and eligibility files were provided by Independence Blue Cross for women receiving mammograms. STUDY DESIGN We used a difference-in-differences approach to characterize the change in mammograms performed over time and a queueing formula to estimate the time to clear the queue of missed mammograms. DATA COLLECTION We used data from the first 30 weeks of each year from 2018 to 2020. PRINCIPAL FINDINGS Over the 20 weeks following March 11, 2020, the volume of screening mammograms and diagnostic mammograms fell by 58% and 38% of expected levels, on average. Lowest volumes were observed in week 15 (April 8 to 14), when screening and diagnostic mammograms fell by 99% and 74%, respectively. Volumes began to rebound in week 19 (May), with diagnostic mammograms reaching levels to similar to previous years' and screening mammograms remaining 14% below expectations. We estimate it will take a minimum of 22 weeks to clear the queue of missed mammograms in our study sample. CONCLUSIONS The provision of mammograms has been significantly disrupted due to the COVID-19 pandemic.
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Affiliation(s)
- Hummy Song
- Operations, Information and Decisions DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Alon Bergman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Angela T. Chen
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Perelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Dan Ellis
- Independence Blue CrossPhiladelphiaPennsylvaniaUSA
| | - Guy David
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Health Care Management DepartmentThe Wharton SchoolUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Ari B. Friedman
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Emergency MedicinePerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| | - Amelia M. Bond
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvaniaUSA
- Department of Population Health SciencesWeill Cornell Medical CollegeNew YorkNew YorkUSA
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Tamez-Salazar J, Mireles-Aguilar T, de la Garza-Ramos C, Garcia-Garcia M, Ferrigno AS, Platas A, Villarreal-Garza C. Prioritization of Patients with Abnormal Breast Findings in the Alerta Rosa Navigation Program to Reduce Diagnostic Delays. Oncologist 2021; 25:1047-1054. [PMID: 33400352 DOI: 10.1634/theoncologist.2020-0228] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/25/2020] [Indexed: 12/09/2022] Open
Abstract
INTRODUCTION In Mexico, there are considerable health system delays in the diagnosis and treatment initiation of women with breast cancer. Alerta Rosa is a navigation program in Nuevo Leon that aims to reduce barriers that impede the timely management of these patients. PATIENTS AND METHODS Since December 2017, women who registered to receive medical evaluations by Alerta Rosa were stratified based on their clinical characteristics into three priority groups ("Red," "Yellow," and "Green"). According to the category assigned, patients were scheduled imaging studies and medical appointments with breast specialists on a preferential basis. RESULTS Up until December 2019, 561 patients were scheduled for medical evaluations. Of them, 59% were classified as "Red," 25% "Yellow," and 16% "Green" priority. The median time from stratification to first medical evaluation was 4, 6, and 7 days, respectively (p = .003). Excluding those who had a prior breast cancer diagnosis, 21 patients were diagnosed by Alerta Rosa, with the initial "Red" priority classification demonstrating a sensitivity of 95% (95% confidence interval [CI], 75.1%-99.9%) and specificity of 42% (95% CI, 37.1%-47.1%) for breast cancer. The median time elapsed from initial patient contact to diagnosis and treatment initiation was 16 days and 39 days, respectively. The majority (72%) of patients were diagnosed at an early stage (0-II). CONCLUSION This patient prioritization system adequately identified women with different probabilities of having breast cancer. Efforts to replicate similar triage systems in resource-constrained settings where screening programs are ineffective could prove to be beneficial in reducing diagnostic intervals and achieving early-stage diagnoses. IMPLICATIONS FOR PRACTICE Low- and middle-income countries such as Mexico currently lack the infrastructure to achieve effective breast cancer screening and guarantee prompt access to health care when required. To reduce the disease burden in such settings, strategies targeting early detection are urgently needed. Patient navigation programs aid in the reduction of health system intervals and optimize the use of available resources. This article presents the introduction of a triage system based on initial patient concern. Appointment prioritization proved to be successful at reducing health system intervals and achieving early-stage diagnoses by overcoming barriers that impede early access to quality medical care.
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Affiliation(s)
- Jaime Tamez-Salazar
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Teresa Mireles-Aguilar
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Cynthia de la Garza-Ramos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Marisol Garcia-Garcia
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Alejandra Platas
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
| | - Cynthia Villarreal-Garza
- Médicos e Investigadores en la Lucha contra el Cáncer de Mama (MILC), Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
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Koo MM, Unger-Saldaña K, Mwaka AD, Corbex M, Ginsburg O, Walter FM, Calanzani N, Moodley J, Rubin GP, Lyratzopoulos G. Conceptual Framework to Guide Early Diagnosis Programs for Symptomatic Cancer as Part of Global Cancer Control. JCO Glob Oncol 2021; 7:35-45. [PMID: 33405957 PMCID: PMC8081530 DOI: 10.1200/go.20.00310] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 10/06/2020] [Accepted: 11/06/2020] [Indexed: 12/15/2022] Open
Abstract
Diagnosing cancer earlier can enable timely treatment and optimize outcomes. Worldwide, national cancer control plans increasingly encompass early diagnosis programs for symptomatic patients, commonly comprising awareness campaigns to encourage prompt help-seeking for possible cancer symptoms and health system policies to support prompt diagnostic assessment and access to treatment. By their nature, early diagnosis programs involve complex public health interventions aiming to address unmet health needs by acting on patient, clinical, and system factors. However, there is uncertainty regarding how to optimize the design and evaluation of such interventions. We propose that decisions about early diagnosis programs should consider four interrelated components: first, the conduct of a needs assessment (based on cancer-site-specific statistics) to identify the cancers that may benefit most from early diagnosis in the target population; second, the consideration of symptom epidemiology to inform prioritization within an intervention; third, the identification of factors influencing prompt help-seeking at individual and system level to support the design and evaluation of interventions; and finally, the evaluation of factors influencing the health systems' capacity to promptly assess patients. This conceptual framework can be used by public health researchers and policy makers to identify the greatest evidence gaps and guide the design and evaluation of local early diagnosis programs as part of broader cancer control strategies.
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Affiliation(s)
- Minjoung Monica Koo
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Karla Unger-Saldaña
- CONACYT (National Council of Science and Technology)–National Cancer Institute, Mexico City, Mexico
| | - Amos D. Mwaka
- Department of Medicine, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Ophira Ginsburg
- Perlmutter Cancer Center and the Department of Population Health, NYU Grossman School of Medicine, NYU Langone Health, New York, NY
| | - Fiona M. Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Natalia Calanzani
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Jennifer Moodley
- Women's Health Research Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Cancer Research Initiative, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- SAMRC Gynaecology Cancer Research Centre, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Greg P. Rubin
- Institute of Health and Society, Newcastle University, Sir James Spence Institute, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom
| | - Georgios Lyratzopoulos
- Epidemiology of Cancer Healthcare and Outcomes (ECHO) Research Group, Department of Behavioural Science and Health, University College London, London, United Kingdom
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Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study. Sci Rep 2020; 10:21477. [PMID: 33293634 PMCID: PMC7723040 DOI: 10.1038/s41598-020-78517-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 11/26/2020] [Indexed: 12/19/2022] Open
Abstract
One of the reasons for high mortality of breast cancer (BC) is long delay in seeking medical care and end stage at presentation. This study was designed to measure the association between a wide range of socio-demographic and clinical factors with diagnostic delay in BC and stage at presentation among Iranian patients. From June 2017 to December 2019, 725 patients with newly diagnosed BC in Shiraz and Kermanshah were selected and information on BC diagnosis delay was obtained from the patient’s medical record. Data on socio-economic status was obtained via a structured interview. Our findings suggest that 45.8% of the patients were diagnosed at a late stage (stage 3 or higher). A total of 244 (34%) patients had more than 3 months delay in diagnosis. We found a significant association between stage at diagnosis and place of residence (adjusted odds ratio (aOR rural vs. urban = 1.69, 95% CI 1.49–1.97), marital status (aOR 1.61, 95% CI 1.42–1.88), family history of BC (aOR 1.46, 95% CI 1.01–2.13), and history of benign breast disease (BBD) (aOR 1.94, 95% CI 1.39–2.72) or unaware of breast self-examination (BSE) (aOR 1.42, 95% CI 1.42–1.85), delay time (aOR 3.25, 95% CI 1.04–5.21), and left breast tumor (aOR right vs. left 2.64, 95% CI 1.88–3.71) and smoking (aOR no vs. yes 1.59, 95% CI 1.36–1.97). Also, delay in diagnosis was associated with age, family income, health insurance, place of residence, marital status, menopausal status, history of BBD, awareness of breast self-examination, type of first symptoms, tumor histology type, BMI and comorbidity (p < 0.05 for all). Factors including history of BBD, awareness of BSE, and suffering from chronic diseases were factors associated with both delay in diagnosis and end stage of disease. These mainly modifiable factors are associated with the progression of the disease.
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Cabrera‐Galeana P, Soto‐Perez‐de‐Celis E, Reynoso‐Noveron N, Villarreal‐Garza C, Lara‐Medina F, Alvarado‐Miranda A, Espinosa‐Fernandez JR, Esparza‐Arias N, Mohar A, Bargallo‐Rocha JE. Real-World Outcomes Among Older Mexican Women with Breast Cancer Treated with Neoadjuvant Chemotherapy. Oncologist 2020; 25:1023-1031. [PMID: 32275801 PMCID: PMC7938403 DOI: 10.1634/theoncologist.2019-0891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/24/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Older patients with breast cancer treated in high-income countries often present with early-stage disease, leading to a lack of information on the use of neoadjuvant chemotherapy in this population. We analyzed the real-world outcomes of older women with breast cancer treated with neoadjuvant chemotherapy at a single institution in Mexico. MATERIALS AND METHODS The study included 2,216 patients treated with neoadjuvant chemotherapy. Regarding achievement of pathologic complete response (defined as no invasive residual tumor in the breast and lymph nodes), 243 patients aged ≥65 years were compared with 1,973 patients aged <65 years. Disease-free survival and overall survival were compared between groups according to pathologic complete response and subtype, defined by hormone receptor and human epidermal growth receptor 2 (HER2) status. RESULTS Older women were less likely to have a pathologic complete response than their younger counterparts (26.3 vs. 35.3%, p < .001). When response rates by subtype were analyzed, this difference was significant only for women with triple-negative tumors. Achieving less than a pathologic complete response was associated with a greater chance of recurrence, but age was not an independent factor for recurrence for any subtype. Reaching a pathologic complete response was significantly associated with improved survival among older women with breast cancer, with the exception of those with hormone receptor-positive, HER2- disease. CONCLUSION Although older women have fewer pathological complete responses, their outcomes after neoadjuvant chemotherapy are comparable to those of younger patients. This is particularly relevant for the treatment of older adults with breast cancer in developing countries, who present in advanced stages and more often need neoadjuvant therapy. IMPLICATIONS FOR PRACTICE The majority of older patients with breast cancer in high-income countries present with early-stage disease, leading to a lack of information regarding the use of neoadjuvant chemotherapy in real-world settings. This article reports the outcomes of older Mexican women with breast cancer who received neoadjuvant chemotherapy compared with their younger counterparts. Although older women (particularly those with triple-negative tumors) were less likely to have a pathologic complete response after neoadjuvant treatment, age was not an independent factor for recurrence. Achieving a pathologic complete response was associated with improved survival, regardless of age.
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Affiliation(s)
- Paula Cabrera‐Galeana
- Departamento de Oncología Médica—Tumores Mamarios, Instituto Nacional de CancerologíaMexico CityMexico
| | - Enrique Soto‐Perez‐de‐Celis
- Programa de Atención a Pacientes Post‐Mastectomía, Instituto Nacional de CancerologíaMexico CityMexico
- Cancer Care in the Elderly Clinic, Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador ZubiránMexico CityMexico
| | - Nancy Reynoso‐Noveron
- Subdirección de Investigación Clínica, y, Instituto Nacional de CancerologíaMexico CityMexico
| | - Cynthia Villarreal‐Garza
- Subdirección de Investigación Clínica, y, Instituto Nacional de CancerologíaMexico CityMexico
- Centro de Cancer de Mama del Hospital Zambrano Hellion, Tecnologico de MonterreySan Pedro Garza GarcíaMexico
| | - Fernando Lara‐Medina
- Departamento de Oncología Médica—Tumores Mamarios, Instituto Nacional de CancerologíaMexico CityMexico
| | - Alberto Alvarado‐Miranda
- Departamento de Oncología Médica—Tumores Mamarios, Instituto Nacional de CancerologíaMexico CityMexico
| | | | - Nereida Esparza‐Arias
- Departamento de Oncología Médica—Tumores Mamarios, Instituto Nacional de CancerologíaMexico CityMexico
- Programa de Atención a Pacientes Post‐Mastectomía, Instituto Nacional de CancerologíaMexico CityMexico
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de CancerologíaMexico CityMexico
- Instituto de Biomédicas, Universidad Nacional Autónoma de México (UNAM)Mexico CityMexico
| | - Juan Enrique Bargallo‐Rocha
- Departamento de Oncología Médica—Tumores Mamarios, Instituto Nacional de CancerologíaMexico CityMexico
- Programa de Atención a Pacientes Post‐Mastectomía, Instituto Nacional de CancerologíaMexico CityMexico
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Medina-Lara A, Grigore B, Lewis R, Peters J, Price S, Landa P, Robinson S, Neal R, Hamilton W, Spencer AE. Cancer diagnostic tools to aid decision-making in primary care: mixed-methods systematic reviews and cost-effectiveness analysis. Health Technol Assess 2020; 24:1-332. [PMID: 33252328 PMCID: PMC7768788 DOI: 10.3310/hta24660] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tools based on diagnostic prediction models are available to help general practitioners diagnose cancer. It is unclear whether or not tools expedite diagnosis or affect patient quality of life and/or survival. OBJECTIVES The objectives were to evaluate the evidence on the validation, clinical effectiveness, cost-effectiveness, and availability and use of cancer diagnostic tools in primary care. METHODS Two systematic reviews were conducted to examine the clinical effectiveness (review 1) and the development, validation and accuracy (review 2) of diagnostic prediction models for aiding general practitioners in cancer diagnosis. Bibliographic searches were conducted on MEDLINE, MEDLINE In-Process, EMBASE, Cochrane Library and Web of Science) in May 2017, with updated searches conducted in November 2018. A decision-analytic model explored the tools' clinical effectiveness and cost-effectiveness in colorectal cancer. The model compared patient outcomes and costs between strategies that included the use of the tools and those that did not, using the NHS perspective. We surveyed 4600 general practitioners in randomly selected UK practices to determine the proportions of general practices and general practitioners with access to, and using, cancer decision support tools. Association between access to these tools and practice-level cancer diagnostic indicators was explored. RESULTS Systematic review 1 - five studies, of different design and quality, reporting on three diagnostic tools, were included. We found no evidence that using the tools was associated with better outcomes. Systematic review 2 - 43 studies were included, reporting on prediction models, in various stages of development, for 14 cancer sites (including multiple cancers). Most studies relate to QCancer® (ClinRisk Ltd, Leeds, UK) and risk assessment tools. DECISION MODEL In the absence of studies reporting their clinical outcomes, QCancer and risk assessment tools were evaluated against faecal immunochemical testing. A linked data approach was used, which translates diagnostic accuracy into time to diagnosis and treatment, and stage at diagnosis. Given the current lack of evidence, the model showed that the cost-effectiveness of diagnostic tools in colorectal cancer relies on demonstrating patient survival benefits. Sensitivity of faecal immunochemical testing and specificity of QCancer and risk assessment tools in a low-risk population were the key uncertain parameters. SURVEY Practitioner- and practice-level response rates were 10.3% (476/4600) and 23.3% (227/975), respectively. Cancer decision support tools were available in 83 out of 227 practices (36.6%, 95% confidence interval 30.3% to 43.1%), and were likely to be used in 38 out of 227 practices (16.7%, 95% confidence interval 12.1% to 22.2%). The mean 2-week-wait referral rate did not differ between practices that do and practices that do not have access to QCancer or risk assessment tools (mean difference of 1.8 referrals per 100,000 referrals, 95% confidence interval -6.7 to 10.3 referrals per 100,000 referrals). LIMITATIONS There is little good-quality evidence on the clinical effectiveness and cost-effectiveness of diagnostic tools. Many diagnostic prediction models are limited by a lack of external validation. There are limited data on current UK practice and clinical outcomes of diagnostic strategies, and there is no evidence on the quality-of-life outcomes of diagnostic results. The survey was limited by low response rates. CONCLUSION The evidence base on the tools is limited. Research on how general practitioners interact with the tools may help to identify barriers to implementation and uptake, and the potential for clinical effectiveness. FUTURE WORK Continued model validation is recommended, especially for risk assessment tools. Assessment of the tools' impact on time to diagnosis and treatment, stage at diagnosis, and health outcomes is also recommended, as is further work to understand how tools are used in general practitioner consultations. STUDY REGISTRATION This study is registered as PROSPERO CRD42017068373 and CRD42017068375. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 66. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Antonieta Medina-Lara
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Bogdan Grigore
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Ruth Lewis
- North Wales Centre for Primary Care Research, Bangor University, Bangor, UK
| | - Jaime Peters
- Exeter Test Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sarah Price
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Paolo Landa
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Sophie Robinson
- Peninsula Technology Assessment Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Richard Neal
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Hamilton
- Primary Care Diagnostics, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
| | - Anne E Spencer
- Health Economics Group, College of Medicine and Health, University of Exeter Medical School, Exeter, UK
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Tesfaw A, Getachew S, Addissie A, Jemal A, Wienke A, Taylor L, Kantelhardt EJ. Late-Stage Diagnosis and Associated Factors Among Breast Cancer Patients in South and Southwest Ethiopia: A Multicenter Study. Clin Breast Cancer 2020; 21:e112-e119. [PMID: 33536135 DOI: 10.1016/j.clbc.2020.08.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/19/2020] [Accepted: 08/30/2020] [Indexed: 01/22/2023]
Abstract
BACKGROUND Breast cancer is a leading cause of cancer death in women in low- and middle-income countries, largely because of late-stage diagnosis. Yet studies are very limited in the Ethiopian context. Therefore, we determined the occurrence of late-stage disease and associated factors in selected public hospitals in south and southwest Ethiopia. PATIENTS AND METHODS A 5-year retrospective cross-sectional study was conducted on breast cancer patient medical records from January 2013 to December 2017 in 6 hospitals. Multivariable logistic regression was performed to identify factors associated with late-stage disease (stage III and IV). Adjusted odds ratios (AOR) with 95% confidence intervals were used. P < .05 was considered statistically significant. RESULTS Overall, 426 breast cancer patients were identified, and 72.5% were diagnosed with late-stage disease. The mean ± standard deviation patient age was 42.8 ± 13.4 years. Factors associated with late diagnosis were patient delay in seeking care (AOR = 2.50; 95% confidence interval [CI], 1.51-4.16); health system delays (AOR = 1.62; 95% CI, 1.02-2.59); female sex (AOR = 3.46; 95% CI, 1.50-7.98); rural residence (AOR = 2.37; 95% CI, 1.45-3.86); chief complaint of breast lump (AOR = 3.01; 95% CI, 1.49-6.07); and history of comorbidities (AOR = 1.72; 95% CI, 1.02-2.91). CONCLUSION The majority of patients were diagnosed with late-stage diagnosis of breast cancer. Patient delays in seeking care, health system delays, being female, rural residence, and patient comorbidities were associated factors. These findings provide evidence that efforts to increase public and health provider awareness to promote early breast cancer diagnosis, particularly in rural areas, are needed in south and southwest Ethiopia.
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Affiliation(s)
- Aragaw Tesfaw
- Department of Public Health, College of Health Science, Debre Tabor University, Debre Tabor, Ethiopia
| | - Sefonias Getachew
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia; Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Adamu Addissie
- Department of Preventive Medicine, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Ahmedin Jemal
- American Cancer Society, Surveillance & Health Services Research, Atlanta, GA
| | - Andreas Wienke
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany
| | - Lesley Taylor
- City of Hope National Medical Center, Division of Breast Surgery, Department of Surgery, Duarte, Los Angeles County, CA
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics, and Informatics, Martin-Luther-University Halle-Wittenberg, Germany; Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Germany.
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Martinez-Cannon BA, Zertuche-Maldonado T, de la Rosa Pacheco S, Cardona-Huerta S, Canavati-Marcos M, Gomez-Macias GS, Villarreal-Garza C. Comparison of characteristics in Mexican women with breast cancer according to healthcare coverage. WOMENS HEALTH 2020; 16:1745506520949416. [PMID: 32811351 PMCID: PMC7444103 DOI: 10.1177/1745506520949416] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objective: To compare the sociodemographic, diagnostic, clinical, and treatment-related characteristics and outcomes of patients with breast cancer in two hospitals in Mexico according to type of healthcare coverage. Methods: A retrospective cohort study of women with breast cancer according to public or private healthcare coverage in two hospitals was done. Patients were treated by the same group of physicians and healthcare infrastructure. Groups were compared using the chi-square test for categorical variables, Mann–Whitney U-test and Student’s t-test for quantitative variables, and Kaplan–Meier estimator and log-rank test for time dependent outcomes (including recurrence-free and overall survival). A value of p < 0.05 was considered statistically significant. Results: A total of 282 women were included. Mean age at diagnosis was 52 years. Women with public healthcare coverage were diagnosed more frequently with self-detected tumors (82.8% vs 47.9%, p < 0.001) and advanced clinical stage (III and IV) (31.1% vs 17.8%, p = 0.014). More women with public healthcare insurance underwent initial systemic treatment (41.1% vs 17.8%, p < 0.001) and mastectomy (70.1% vs 54.9%, p = 0.020), and received more chemotherapy (79.4% vs 43.8%, p < 0.001) and adjuvant radiotherapy (68.9% vs 53.4%, p = 0.017). Overall, no differences were found in survival outcomes according to healthcare coverage. Trends suggesting worse recurrence-free and overall survival were observed in patients with public coverage at 3 years follow-up in stage III (85.7% vs 67.3% and 100% vs 84.6%, respectively) and triple negative disease (83.3% vs 74.5% and 100% vs 74.1%, respectively). Conclusion: Strategies to promote preventive medicine, diagnostic mammograms, and prompt diagnosis of breast cancer in Mexican women with public health coverage are needed. Access to the main treatment modalities by Seguro Popular and good quality care by an experienced group of physicians likely explains the similar outcomes between patients with private and public healthcare coverage. However, trends suggesting worse survival for patients with public medical coverage with stage III and triple-negative disease should encourage close follow-up.
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Affiliation(s)
- Bertha Alejandra Martinez-Cannon
- School of Medicine, Tecnologico de Monterrey, Monterrey, Mexico.,Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | | | | | - Servando Cardona-Huerta
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Mauricio Canavati-Marcos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Jorge-Aarón RM, Rodrigo RC, Esther MPR. Endoxifen levels and metabolic phenotype-associated factors in Mexican Mestizo patients under tamoxifen treatment. Pharmacogenomics 2020; 21:929-943. [PMID: 32808577 DOI: 10.2217/pgs-2020-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To evaluate plasma endoxifen levels and metabolic phenotype-associated factors in Mexican Mestizo patients under tamoxifen treatment. Patients & methods: A total of 138 breast cancer patients under tamoxifen treatment were cross-sectionally evaluated and side effects (SE) were recorded. CYP2D6 genetic phenotypes (GP) and metabolic phenotypes (MP) were assessed (metabolic poor [mPM], intermediate [mIM], normal [mNM], and ultrarapid [mUM] metabolizer). Associations were tested in uni-multivariate models for endoxifen >5.9 ng/ml and for mNM + mUM MP. Results: The main SE was hot flashes (62%). Distribution of the CYP2D6 MP was 4.3% mPM; 14.5% mIM; 75.4% mNM; and 5.8% mUM. Endoxifen >5.9 ng/ml was partially associated with SE (p = 0.06); the mNM + mUM MP was associated with treatment time (p = 0.03). Conclusion: The endoxifen-associated factors in Mexican Mestizo patients remain inconclusive, although treatment time was associated with MP.
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Affiliation(s)
- Rangel-Méndez Jorge-Aarón
- Unidad de Investigación Biomédica, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán, 97150, México
| | - Rubi-Castellanos Rodrigo
- Centro de Investigaciones Regionales "Dr. Hideyo Noguchi" Calle 96 S/N, Avenida Jacinto Canek y calle 47, Paseo de las Fuentes, Merida, Yucatan, 97225, Mexico
| | - Moo-Puc Rosa Esther
- Unidad de Investigación Biomédica, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional "Ignacio García Téllez", Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán, 97150, México
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Martínez-Pérez DC, Gómez-Wolff LR, Ossa-Gómez CA, Hernández-Herrera GN, Rivas-Bedoya Y, García-García HI. [Association between delayed diagnosis and breast cancer in advanced clinical stage at the time of consultation in four oncology centers in Medellin- Colombia, 2017. Cross-sectional study]. ACTA ACUST UNITED AC 2020; 71:87-102. [PMID: 32770869 DOI: 10.18597/rcog.3410] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 04/28/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the association between delayed diagnosis and advanced clinical stage breast cancer, and to explore the factors that influence this delay. METHODS Cross-sectional study of women over 18 years of age with breast cancer who attended 4 oncology centers in Medellín, Colombia, in 2017. The "Breast Cancer Delay Questionnaire" which includes sociodemographic and clinical variables as well as time intervals was used. Crude and adjusted odds ratio (OR) were estimated, using advanced clinical stage as outcome and delayed diagnosis as exposure. RESULTS 42 patients were included. The median time interval between the identification of the problem and the diagnostic biopsy was 104.5 days; between the identification of the problem and the first medical visit, 20 days; and between the first visit and the diagnostic biopsy, 53 days. Of all the cases, 52.1 % were diagnosed at an advanced stage. An association was found between delayed diagnosis and advanced clinical stage (OR = 2.15 95 % CI 1.21-3.79). Age above 40 was found to be a protective factor against having an advanced-stage lesion (OR = 0.35; 95 % CI: 0.14-0.83). Delayed diagnosis was associated with affiliation to the government subsidized health system (OR = 9.67; 95 % CI 2.76- 33.9) and age over 40 years (OR = 2.75; 95 % CI1.16-6.53). CONCLUSIONS Patient education is required in order to ensure adherence to early screening programs or timely consultation whenever a sign or symptom is identified, thus allowing diagnosis at an early stage of the disease. Moreover, prospective studies are needed in order to identify factors associated with delays in treatment after the diagnosis of breast cancer, and to assess interventions designed to reduce delays in the care of this form of cancer.
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Affiliation(s)
| | | | | | | | - Yamile Rivas-Bedoya
- Gerente en Sistemas de Información en Salud, Instituto de Cancerología Las Américas, Medellín, Colombia
| | - Héctor Iván García-García
- Magíster en Salud Pública y Epidemiología, Universidad de Antioquia, Instituto de Cancerología Las Américas, Medellín, Colombia
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41
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Rangel-Méndez JA, Rubi-Castellanos R, Ascencio-Montiel IDJ, Moo-Puc RE. CYP2D6 does not impact on breast cancer-free survival in Southeast Mexican patients under tamoxifen treatment. Per Med 2020; 17:261-270. [DOI: 10.2217/pme-2019-0135] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Aim: We conducted a retrospective analysis in 71 Mexican Mestizo patients to evaluate the breast cancer-free survival (BCFS) among the inferred genetic phenotypes (GP) of CYP2D6. Patients & methods: CYP2D6 was genotyped through Taqman-probe analysis; GP were inferred according to international guidelines. The BCFS was estimated through Kaplan–Meier method and analyzed with a log-rank test; hazard ratios were calculated with 95% CI and p < 0.05. Results: The BCFS did not differ among CYP2D6 GP (p = 0.45) and recurrence risk was similar between gNM + gUM and gPM + gIM groups (hazard ratio: 1.54, 95% CI: 0.37–6.38; p = 0.55). Conclusion: The findings do not support any impact of CYP2D6 on BCFS. Evaluation of other genetic/nongenetic biomarkers is needed in Mexican Mestizo patients under tamoxifen treatment.
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Affiliation(s)
- Jorge-Aarón Rangel-Méndez
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional ‘Ignacio García Téllez’, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, 97150 Mérida, Yucatán, México
| | - Rodrigo Rubi-Castellanos
- Centro de Investigaciones Regionales ‘Dr Hideyo Noguchi’ Calle 96 S/N, Avenida Jacinto Canek y calle 47, Paseo de las Fuentes, 97225 Mérida, Yucatán, México
| | - Iván de Jesús Ascencio-Montiel
- División Vigilancia Epidemiológica de Enfermedades No Transmisibles, Instituto Mexicano del Seguro Social, Mier y Pesado 120, Col. Del Valle, Benito Juárez, 03100 Ciudad de México, México
| | - Rosa Esther Moo-Puc
- Unidad de Investigación Médica Yucatán, Unidad Médica de Alta Especialidad, Hospital de Especialidades del Centro Médico Nacional ‘Ignacio García Téllez’, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, 97150 Mérida, Yucatán, México
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Barriers to Timely Diagnosis and Management of Breast Cancer: Observations from a Tertiary Referral Center in Resource Poor Setting. Indian J Surg Oncol 2020; 11:287-293. [PMID: 32523277 DOI: 10.1007/s13193-020-01037-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 01/03/2020] [Indexed: 12/24/2022] Open
Abstract
Breast cancer (BC) is the most common cancer among females worldwide, with over 2 million cases diagnosed every year. In India, it is the most common malignancy overall (15.4%) and accounts for about 27% female cancers. Morbidity and mortality remain high despite improvements in BC therapeutics. Conventionally, a gap of more than 3 months between noticing symptoms and commencing treatment is considered delay in BC management. Delays make BC an important public health problem and lead to poor outcomes. This study aims to identify patient perceived barriers to BC management. A self-designed structured questionnaire consisting of questions pertaining to multiple aspects of BC presentation and management was prepared. The study was conducted from October 2017 to September 2018 and results were analyzed. A delay of 3 months or more was seen in 284 of the 435 patients (65.3%), among which 179 was patient delay, 69 due to provider delay, and 36 due to a combined contribution of both factors. Provider factors were associated with prolonged delay. Misdiagnosis at first consult was the most common factor perceived by patients as a barrier, followed by delay in referral, distance from hospitals, lack of information, financial constraints, and logistic issues. A significant patient and provider delay exists in BC management which prevents effective early therapy. Effective tackling of these barriers may result in the betterment of BC management outcomes. Robust screening, education of patients and providers, and awareness promotion and infrastructure development will be useful in this regard.
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Unger-Saldaña K, Fitch-Picos K, Villarreal-Garza C. Breast Cancer Diagnostic Delays Among Young Mexican Women Are Associated With a Lack of Suspicion by Health Care Providers at First Presentation. J Glob Oncol 2020; 5:1-12. [PMID: 31335236 PMCID: PMC6690634 DOI: 10.1200/jgo.19.00093] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
PURPOSE There is insufficient evidence in the literature regarding the association between young age and diagnostic delay of breast cancer (BC). This study aimed to determine whether young age increases the risk of diagnostic delays among patients with BC and also to identify the mechanisms through which young age affects diagnostic delay. PATIENTS AND METHODS This was a cross-sectional study of 592 patients with symptomatic BC treated at two of the largest public cancer hospitals in Mexico City available for the uninsured and those covered by Seguro Popular. A validated questionnaire was administered via face-to-face interviews with the patients, and their medical files were reviewed. Path analyses, using multivariable logistic regression models, were conducted to assess the relationship between age and diagnostic delay, as well as the role of potential confounders. RESULTS Younger participants (40 years of age or younger) had significantly longer diagnostic intervals and presented with more advanced cancer stage than did their older counterparts. Younger participants more often sought initial health care in private services led by gynecologists, more frequently experienced a lack of cancer suspicion by the first physician they consulted, used a higher number of different health services, and had more medical consultations before arrival to a cancer care center. Younger age was significantly associated with longer diagnostic delays after controlling for education, occupation, lack of health insurance, history of benign breast conditions, type of first health service used, specialty of the first physician consulted, first symptom presented, and benign interpretation of the first breast image study. CONCLUSION Young age increased the risk of diagnostic delays, which seems to be a result of an increased risk of lack of cancer suspicion at the first health care service consulted.
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Affiliation(s)
| | | | - Cynthia Villarreal-Garza
- Instituto Nacional de Cancerología, Mexico City, Mexico.,Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Monterrey, Mexico
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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Flores-Balcázar CH, Flores-Luna ML, Villarreal-Garza CM, Bargalló-Rocha JE. Provider delay in treatment initiation and its influence on survival outcomes in women with operable breast cancer. Rep Pract Oncol Radiother 2020; 25:271-275. [PMID: 32140085 DOI: 10.1016/j.rpor.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/18/2019] [Accepted: 02/19/2020] [Indexed: 01/03/2023] Open
Abstract
Aim The goal of this study was to determine whether a delay in starting treatment via surgery or neoadjuvant chemotherapy is related to a decrease in cancer-specific survival (CSS) in women with operable breast cancer (BrCr). Background Limited medical infrastructure and a lack of cancer prevention awareness in low- and middle-income countries have caused high BrCr incidence and mortality rates. Methods We analyzed a retrospective cohort of 720 women treated at a single center from 2005 to 2012. CSS estimates were obtained by the Kaplan-Meier method. A Cox model of proportional risks was performed to obtain the risk of dying from BrCr. We also obtained the risk according to the category of treatment initiation. Results Women with locally advanced stages and without hormone receptor expression were more likely to initiate treatment after 45 days. Patients in Stage IIIA had a 78.1% survival if treatment was initiated before 45 days (95% CI, 0.70-0.84) and 63.6% survival if treatment was started after 45 days (95% CI, 0.44-0.78; p < 0.001). Patients in Stage IIIB had a 62.9% survival if treatment was initiated before 45 days (95% CI, 0.53-0.72) and 57.4% survival if treatment started after 45 days (95% CI, 0.31-0.89; p < 0.001). Prognostic factors in which lower survival was recognized were Stage IIIA, Stage IIIB, treatment initiation after 45 days, and triple-negative tumors. Conclusions The initiation of treatment within the first 45 days of diagnosis of BrCr in women portends better survival compared with those who began treatment longer than 45 days from diagnosis.
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Affiliation(s)
- Christian H Flores-Balcázar
- Department of Radiation-Oncology, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Ma L Flores-Luna
- Department of Epidemiology, National Institute of Public Health, 50 Fray Pedro de Gante, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Cynthia M Villarreal-Garza
- Department of Breast Tumors, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
| | - Juan E Bargalló-Rocha
- Department of Breast Tumors, National Cancer Institute, 22 San Fernando Ave, Section XVI, Tlalpan, Mexico City 14080, Mexico
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Recondo G, Cosacow C, Cutuli HJ, Cermignani L, Straminsky S, Naveira M, Pitzzu M, De Ronato G, Nacuzzi G, Taetti G, Corsico S, Berrueta M, Colucci G, Gibbons L, Gutierrez L, García-Elorrio E. Access of patients with breast and lung cancer to chemotherapy treatment in public and private hospitals in the city of Buenos Aires. Int J Qual Health Care 2019; 31:682-690. [PMID: 31125084 DOI: 10.1093/intqhc/mzz047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 04/14/2019] [Accepted: 04/26/2019] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Describe the time elapsed from the diagnosis to treatment with chemotherapy for patients with breast and lung cancer at public and private hospitals in Buenos Aires. DESIGN Retrospective cohort study. SETTING Three public and three private academic hospitals in Buenos Aires. PARTICIPANTS Patients with breast (n = 168) or lung cancer (n = 100) diagnosis treated with chemotherapy. MAIN OUTCOMES MEASURES Clinical and sociodemographic data were collected in a stratified sample. We used the Kaplan-Meier estimator to analyse the time elapsed and the log rank test to compare both groups. RESULTS For breast cancer patients, median time elapsed between diagnosis and treatment with chemotherapy was 76 days (95% CI: 64-86) in public and 60 days (95% CI: 52-65) in private hospitals (P = 0.0001). For adjuvant and neoadjuvant treatments, median time was 130 (95% CI: 109-159) versus 64 (95% CI: 56-73) days (P < 0.0001) and 57 days (95% CI: 49-75) versus 26 (95% CI: 16-41) days, respectively (P = 0.0002). There were no significant differences in the time from first consultation to diagnosis. In patients with lung cancer, median time from diagnosis to treatment was 71 days (95% CI: 60-83) in public hospitals and 31 days (95% CI: 24-39) in private hospitals (P = 0.0002). In the metastatic setting, median time to treatment was 63 days (95% CI: 45-83) in public and 33 (95% CI: 26-44) days in private hospitals (P = 0.005). CONCLUSIONS There are significant disparity in the access to treatment with chemotherapy for patients in Buenos Aires, Argentina.
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Affiliation(s)
- Gonzalo Recondo
- Medical Oncology, Centro de Educación Médica e Investigaciones Clínicas 'Norberto Quirno' (CEMIC), Buenos Aires, Argentina
| | - César Cosacow
- Instituto Universitario CEMIC, Buenos Aires, Argentina
| | - Hernán Javier Cutuli
- Medical Oncology, Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Luciano Cermignani
- Medical Oncology, Hospital Alemán de Buenos Aires, Buenos Aires, Argentina
| | - Samanta Straminsky
- Medical Oncology, Hospital General de Agudos 'Dr. Juan A. Fernández', Buenos Aires, Argentina
| | - Martin Naveira
- Medical Oncology, Hospital Británico de Buenos Aires. Buenos Aires, Argentina
| | - Martin Pitzzu
- Medical Oncology, Hospital General de Agudos 'Carlos G. Durand', Buenos Aires, Argentina
| | - Gabriela De Ronato
- Medical Oncology, Hospital General de Agudos 'Dr. Juan A. Fernández', Buenos Aires, Argentina
| | - Gabriela Nacuzzi
- Medical Oncology, Hospital General de Agudos 'Carlos G. Durand', Buenos Aires, Argentina
| | - Gonzalo Taetti
- Medical Oncology, Instituto de Oncología Ángel H. Roffo, Buenos Aires, Argentina
| | - Santiago Corsico
- Medical Oncology, Hospital Británico de Buenos Aires. Buenos Aires, Argentina
| | - Mabel Berrueta
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | | | - Luz Gibbons
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Laura Gutierrez
- Data Unit, Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ezequiel García-Elorrio
- Quality of Care and Patient Safety Department, Institute for Clinical Effectiveness and Health Policy (IECS)
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Breast Cancer Provider Interval Length in Fukushima, Japan, After the 2011 Triple Disaster: A Long-Term Retrospective Study. Clin Breast Cancer 2019; 20:e127-e150. [PMID: 31980405 DOI: 10.1016/j.clbc.2019.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/29/2019] [Accepted: 07/07/2019] [Indexed: 11/20/2022]
Abstract
BACKGROUND Minimizing the interval from symptom onset to treatment commencement is essential for a favorable outcome among breast cancer (BC) patients. This study examined whether provider interval (time elapsed from first consultation to treatment initiation) lengthened among BC patients after Japan's 2011 earthquake, tsunami, and nuclear disaster in Fukushima. Factors associated with the length of postdisaster interval and whether the interval was associated with BC stage were also investigated. PATIENTS AND METHODS So-so District (study site) was an area damaged by the 2011 disasters. Data of all BC patients who made their first medical consultation and received initial treatment at the core medical institutions in the area 5 years before or after the disaster were extracted from patient medical records. We used several regression approaches to fulfill our study objectives. RESULTS We included 263 (140 predisaster and 123 postdisaster) patients. After adjustment for covariates, the interval did not significantly change after the disaster compared to before the disaster. Those with 4 or 5 cohabiting family members experienced a shorter interval after the disaster than those with 0 or 1 cohabiting family members (relative length, 0.47; 95% confidence interval, 0.28-0.78). Those with an interval of > 60 days had lower odds of stage III or IV cancer after the disaster than those with an interval of < 30 days (odds ratio, 0.09; 95% confidence interval, 0.01-0.84). CONCLUSION Overall, provider interval did not lengthen after the disaster. However, those with fewer cohabiting family members might have experienced a longer total interval. Cancer stage may not necessarily reflect the influence of interval on patient outcome.
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Agodirin O, Olatoke S, Rahman G, Olaogun J, Kolawole O, Agboola J, Olasehinde O, Katung A, Ayandipo O, Etonyeaku A, Ajiboye A, Oguntola S, Fatudimu O. Impact of Primary Care Delay on Progression of Breast Cancer in a Black African Population: A Multicentered Survey. J Cancer Epidemiol 2019; 2019:2407138. [PMID: 31485229 PMCID: PMC6702851 DOI: 10.1155/2019/2407138] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Revised: 05/30/2019] [Accepted: 07/07/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reports are scanty on the impact of long primary care interval in breast cancer. Exploratory reports in Nigeria and other low-middle-income countries suggest detrimental impact. The primary aim was to describe the impact of long primary care interval on breast cancer progression, and the secondary aim was to describe the factors perceived by patients as the reason(s) for long intervals. METHOD Questionnaire-based survey was used in 9 Nigerian tertiary institutions between May 2017 and July 2018. The study hypothesis was that the majority of patients stayed >30 days, and the majority experienced stage migration in primary care interval. Assessment of the impact of the length of interval on tumor stage was done by survival analysis technique, and clustering analysis was used to find subgroups of the patient journey. RESULTS A total of 237 patients presented to primary care personnel with tumor ≤5cm (mean 3.4±1.2cm). A total of 151 (69.3%, 95% CI 62.0-75.0) stayed >30 days in primary care interval. Risk of stage migration in primary care interval was 49.3% (95% CI 42.5%-56.3%). The most common reasons for long intervals were symptom misinformation and misdiagnosis. Clustering analysis showed 4 clusters of patients' experience and journey: long interval due to distance, long interval due to misinformation, long interval due to deliberate delaying, and not short interval-prepared for treatment. CONCLUSION The majority of patients stayed longer than 30 days in primary care interval. Long primary care interval was associated with a higher risk of stage migration, and more patients reported misinformation and misdiagnosis as reasons for a long interval.
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Affiliation(s)
- Olayide Agodirin
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Samuel Olatoke
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | - Ganiyu Rahman
- Department of Surgery, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Julius Olaogun
- Department of Surgery, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - Oladapo Kolawole
- Department of Surgery, LAUTECH Teaching Hospital, Osogbo, Nigeria
| | - John Agboola
- Department of Surgery, University of Ilorin and University of Ilorin Teaching Hospital, Nigeria
| | | | - Aba Katung
- Department of Surgery, Federal Medical Center, Owo, Nigeria
| | | | | | - Anthony Ajiboye
- Department of Surgery, Bowen University Teaching Hospital, Nigeria
| | - Soliu Oguntola
- Department of Surgery, LAUTECH Teaching Hospital, Ogbomoso, Nigeria
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Li Y, Zhou Y, Mao F, Guan J, Lin Y, Wang X, Zhang Y, Zhang X, Shen S, Sun Q. The influence on survival of delay in the treatment initiation of screening detected non-symptomatic breast cancer. Sci Rep 2019; 9:10158. [PMID: 31308467 PMCID: PMC6629625 DOI: 10.1038/s41598-019-46736-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 07/04/2019] [Indexed: 12/14/2022] Open
Abstract
We aimed to determine whether the detection-to-treatment interval of non-symptomatic breast cancer is associated with factors that can predict survival outcomes. A retrospective review of the Breast Surgery Department Database at Peking Union Medical College Hospital (PUMCH) was performed, and a total of 1084 non-symptomatic invasive breast cancer patients were included. The findings revealed that detection-to-treatment interval was significantly longer for women who were older (p = 0.001), lived in rural areas (p = 0.024), had lower education (p = 0.024), and had detection in other institutions (p = 0.006). Other sociodemographic and clinicopathological characteristics were not associated to longer interval. A median follow-up of 35 months (range: 6–60 months) was carried out and a long delay at more than 90 days did not significantly decrease the DFS (univariate, P = 0.232; multivariate, P = 0.088). For triple negative breast cancer, there was a worse DFS if the interval was longer than 90 days both in multivariate analysis (hazard ratio [HR] = 3.40; 95% CI, 1.12–10.35; P = 0.031) and univariate analysis (HR = 2.86; 95% CI, 1.03–7.91; P = 0.042). Further studies on care before initial treatment of non-symptomatic breast cancers are warranted.
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Affiliation(s)
- Yan Li
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yidong Zhou
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Feng Mao
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Jinghong Guan
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yan Lin
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Xuejing Wang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Yanna Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Xiaohui Zhang
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Songjie Shen
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China
| | - Qiang Sun
- Department of Breast Surgery, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, 100730, P.R. China.
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50
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Iyer HS, Kohler RE, Ramogola-Masire D, Brown C, Molebatsi K, Grover S, Kablay I, Bvochora-Nsingo M, Efstathiou JA, Lockman S, Tapela N, Dryden-Peterson SL. Explaining disparities in oncology health systems delays and stage at diagnosis between men and women in Botswana: A cohort study. PLoS One 2019; 14:e0218094. [PMID: 31170274 PMCID: PMC6553768 DOI: 10.1371/journal.pone.0218094] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2019] [Accepted: 05/24/2019] [Indexed: 01/04/2023] Open
Abstract
Purpose Men in Botswana present with more advanced cancer than women, leading to poorer outcomes. We sought to explain sex-specific differences in time to and stage at treatment initiation. Methods Cancer patients who initiated oncology treatment between October 2010 and June 2017 were recruited at four oncology centers in Botswana. Primary outcomes were time from first visit with cancer symptom to treatment initiation, and advanced cancer (stage III/IV). Sociodemographic and clinical covariates were obtained retrospectively through interviews and medical record review. We used accelerated failure time and logistic models to estimate standardized sex differences in treatment initiation time and risk differences for presentation with advanced stage. Results were stratified by cancer type (breast, cervix, non-Hodgkin’s lymphoma, anogenital, head and neck, esophageal, other). Results 1886 participants (70% female) were included. After covariate adjustment, men experienced longer excess time from first presentation to treatment initiation (8.4 months) than women (7.0 months) for all cancers combined (1.4 months, 95% CI: 0.30, 2.5). In analysis stratified by cancer type, we only found evidence of a sex disparity (Men: 8.2; Women: 6.8 months) among patients with other, non-common cancers (1.4 months, 95% CI: 0.01, 2.8). Men experienced an increased risk of advanced stage (Men: 67%; Women: 60%; aRD: 6.7%, 95% CI: -1.7%, 15.1%) for all cancers combined, but this disparity was only statistically significant among patients with anogenital cancers (Men: 72%; Women: 50%; aRD: 22.0%, 95% CI: 0.5%, 43.5%). Conclusions Accounting for the types of cancers experienced by men and women strongly attenuated disparities in time to treatment initiation and stage. Higher incidence of rarer cancers among men could explain these disparities.
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Affiliation(s)
- Hari S. Iyer
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- * E-mail:
| | - Racquel E. Kohler
- Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
| | - Doreen Ramogola-Masire
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Obstetrics and Gynecology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Carolyn Brown
- Department of Epidemiology, Emory Rollins School of Public Health, Atlanta, GA, United States of America
| | | | - Surbhi Grover
- Botswana University of Pennsylvania Partnership, Gaborone, Botswana
- School of Medicine, University of Botswana, Gaborone, Botswana
- Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Princess Marina Hospital, Gaborone, Botswana
| | | | | | - Jason A. Efstathiou
- Dana-Farber Cancer Institute, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
| | - Shahin Lockman
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
| | - Neo Tapela
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Botswana Ministry of Health and Wellness, Gaborone, Botswana
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Scott L. Dryden-Peterson
- Harvard Medical School, Boston, Massachusetts, United States of America
- Division of Infectious Diseases, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, United States of America
- Botswana Harvard AIDS Institute Partnership, Gaborone, Botswana
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, United States of America
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