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Zewdie A, Kassie TD, Anagaw TF, Mazengia EM, Gelaw SS, Fenta ET, Eshetu HB, Kebede N, Bogale EK. Advanced-stage breast cancer diagnosis and its determinants in Ethiopia: a systematic review and meta-analysis. BMC Womens Health 2024; 24:284. [PMID: 38734607 PMCID: PMC11088059 DOI: 10.1186/s12905-024-03133-9] [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: 11/03/2023] [Accepted: 05/06/2024] [Indexed: 05/13/2024] Open
Abstract
INTRODUCTION Worldwide, breast cancer is the primary cause of illness and death. Unless early detected and treated breast cancer is a life-threatening tumor. Advanced-stage presentation is greatly linked with short survival time and increased mortality rates. In Ethiopia nationally summarized evidence on the level of advanced-stage breast cancer diagnosis is scarce. Therefore, this systematic review and meta-analysis aimed to determine the pooled prevalence of advanced-stage breast cancer diagnosis and its determinants in Ethiopia. METHOD By following PRISMA guidelines, a systematic review and meta-analysis were carried out. To include relevant publications, a broad literature search was conducted in the African Online Journal, PubMed, Google Scholar, and Embase which are published until last search date; June 15, 2023. To prevent further duplication this review was registered in PROSPERO database with ID no of CRD42023435096. To determine the pooled prevalence, a weighted inverse variance random effect model was applied. I2 statistics and the Cochrane Q-test were computed to determine heterogeneity. To evaluate publication bias, a funnel plot, and Egger's regression test were used. RESULT A total of 924 articles were sought and finally 20 articles were included in this review. The pooled prevalence of advanced-stage breast cancer diagnosis in Ethiopia was 72.56% (95%CI; 68.46-76.65%). Use of traditional medicine as first choice (AOR = 1.32, 95% CI: (1.13-1.55)), delay of > 3 months in seeking care (AOR = 1.24, 95% CI: (1.09-1.41)), diagnosis or health system delay of > 2 months (AOR = 1.27, 95% CI: (1.11-1.46)), rural residence (AOR = 2.04, 95% CI: (1.42 - 2.92)), and chief complaint of a painless breast lump (AOR = 2.67, 95% CI: (1.76-4.06)) were significantly associated to advanced-stage diagnosis. CONCLUSION In Ethiopia, more than two-thirds of breast cancer cases are diagnosed at an advanced stage. Use of traditional medicine before diagnostic confirmation, delay in seeking care, health system delay, rural residence, and chief complaint of painless breast lump were positively associated with an advanced-stage diagnosis. Policymakers and program designers give great focus to those delays so as to seek and access modern diagnosis and treatment as early as possible specifically focusing on those who are rurally residing.
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Affiliation(s)
- Amare Zewdie
- Department of Public Health, College of Medicine and Health Science, Wolkite University, Wolkite, Ethiopia.
| | - Tadele Derbew Kassie
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Tadele Fentabel Anagaw
- Health Promotion and Behavioural science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Elyas Melaku Mazengia
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Sintayehu Shiferaw Gelaw
- Department of Public Health, College of Medicine and Health Science, Debre Markos University, Debre Markos, Ethiopia
| | - Eneyew Talie Fenta
- Department of Public Health, College of Medicine and Health Sciences, Injibara University, Injibara, Ethiopia
| | - Habitu Birhan Eshetu
- Department of Health Promotion and Health Behaviour, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, PO.Box.196, Gondar, Ethiopia
| | - Natnael Kebede
- Department of Health Promotion, School of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Eyob Ketema Bogale
- Health Promotion and Behavioural science department, College of medicine and health science, Bahir Dar University, Bahir Dar, Ethiopia
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Unger-Saldaña K, Arroyo-Valerio A, Turrubiates GS, Gómez-Navarro JA, Bargalló-Rocha E, Quintero-Beuló G, Isla-Ortiz D, Jiménez-Ríos MÁ, García HAM, Salgado IRL, Mohar A. Time intervals to care and health service use experiences of uninsured cancer patients treated under public financing in Mexico City. Cancer Epidemiol 2023; 84:102366. [PMID: 37086645 DOI: 10.1016/j.canep.2023.102366] [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: 02/01/2023] [Revised: 04/02/2023] [Accepted: 04/06/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND The present study assesses the time intervals from symptom discovery to treatment start and describes the health service use experiences of uninsured patients with cancer of the breast, cervix uteri, testicle, and prostate before their arrival to the cancer hospital. METHODS This cross-sectional study included 1468 patients who were diagnosed between June 2016 and May 2017 and received treatment for the selected cancers in two of the largest public cancer hospitals in Mexico City, financed through Seguro Popular. Data was collected through a survey administered via face-to-face interviews with patients and a review of their medical files. RESULTS The median time between detection (symptom discovery or first abnormal screening test) and treatment start was 6.6 months. For all types of cancer, the longest interval was the diagnostic interval -between the first use of healthcare services and the confirmation of cancer. Less than 20% cancer patients were diagnosed in the earliest stages that are associated with the best chances of long-term survival. The participants described a high use of private services for their first consultation, the use of several different types of health services and multiple consultations before arrival to the cancer centers, and 35% perceived being misdiagnosed by the first doctor they consulted. CONCLUSIONS Most cancer patients treated in the two largest public institutions available for the uninsured faced long delays to get diagnosed and started treatment at advanced stages. Strengthening quality and access for effective early cancer diagnosis and treatment is key to improve patient outcomes in low and middle-income settings.
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Affiliation(s)
| | - América Arroyo-Valerio
- Dirección de Investigación, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | | | | | - Enrique Bargalló-Rocha
- Departamento de Tumores Mamarios, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Gregorio Quintero-Beuló
- Servicio de Oncología, Hospital General de México "Dr. Eduardo Liceaga", Mexico City, Mexico
| | - David Isla-Ortiz
- Departmento de Tumores Ginecológicos, Instituto Nacional de Cancerología, Mexico City, Mexico
| | | | | | | | - Alejandro Mohar
- Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México and Instituto Nacional de Cancerología, Mexico City, Mexico
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Bright K. Understanding system barriers and facilitators in transnational clinical cancer research: The value of rapid and multimodal ethnographic inquiry. FRONTIERS IN SOCIOLOGY 2022; 7:991183. [PMID: 36530449 PMCID: PMC9751659 DOI: 10.3389/fsoc.2022.991183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 11/16/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION In middle and low resource countries worldwide, up to 70% of breast cancer cases are diagnosed as locally advanced (stages IIB-IIIC). Delays in referral from primary to specialty care have been shown to prolong routes to diagnosis and may be associated with higher burdens of advanced disease, but specific clinical and organizational barriers are not well understood. METHODS This article reports on the use of rapid ethnographic research (RER) within a largescale clinical trial for locally advanced breast cancer (LABC) in India, Mexico, South Africa, and the US. Our purpose is twofold. First, we demonstrate the value of ethnography as a mode of evaluative listening: appraising the perspectives of diverse patients and clinicians regarding prolonged routes to LABC diagnosis and treatment. Second, we show the value of ethnography as a compass for navigating among discrepant clinical research styles, IRB protocols, and institutional norms and practices. We discuss advantages and limits involved in each use of RER. RESULTS On the one hand, ethnographic interviews carried out before and during the clinical trial enabled more regular communication among investigators and research sites. On the other hand, the logistics of doing the trial placed limits on the extent and duration of inductive, immersive inquiry characteristic of traditional fieldwork. As a partial solution to this problem, we developed a multimodal ethnographic research (MER) approach, an augmentation of video-chat, phone, text, and email carried out with, and built upon the initial connections established in, the in-person fieldwork. This style has its limits; but it did allow us to materially improve the ways in which the medical research proceeded. DISCUSSION In conclusion, we highlight the value of not deferring to a presumed incommensurability of ethnographic fieldwork and clinical trialwork while still being appropriately responsive to moments when the two approaches should be kept apart.
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Affiliation(s)
- Kristin Bright
- Department of Anthropology, Middlebury College, Middlebury, VT, United States
- Department of Anthropology, University of Toronto, Toronto, ON, Canada
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de Los A Jiménez Prieto P, Alvarez Bañuelos MT, Romero JM, Córdoba BC, Sampieri CL, Cuevas RZ, Guzmán García RE. Influence of type 2 diabetes mellitus on mortality in women with breast cancer: A matched case-control study. J Diabetes Complications 2022; 36:108249. [PMID: 35803840 DOI: 10.1016/j.jdiacomp.2022.108249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022]
Abstract
AIMS The study assessed the association between the presence of type2 diabetes mellitus (T2DM) and mortality in women with breast cancer (BC). METHODS A matched pair case-control study was conducted at the State Cancer Center, which is located in Xalapa, Veracruz, Mexico. It was matched by age (±3 years) within a cohort of 1442 patients with BC. Descriptive statistics were performed. Analysis through paired odds ratio (OR and multivariate analyses were used to calculate the association between BC mortality and the variables studied. RESULTS 166 cases and 166 controls with confirmed diagnosis of BC were studied, with a mean age of 52.9 ± 11.9 years. The T2DM was associated with an increased mortality of women with BC (OR = 1.75 95 %CI 1.06-2.89). Similarly, metastasis (OR = 14.17 95 %CI 6.19-32.342), advanced clinical stage (OR = 3.04 95 %CI 1.45 - 6.38), and the molecular subtypes Her2 (OR = 2.0 95 %CI 1.02-3.92), and triple negative (OR = 3.54 95 %CI 1.72-7.32). There was no difference in mean glucose between cases and controls (208.9 ± 132 vs 194.4 ± 90.4 mg/dL, respectively). CONCLUSION T2DM was found to be a relevant risk factor for BC mortality in this Mexican population. Thus, it is important to consider the presence and evolution of DM in the prevention programs, diagnostic algorithms and treatments established for BC.
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Affiliation(s)
| | | | - Jaime Morales Romero
- Universidad Veracruzana, Instituto de Salud Pública, Xalapa Veracruz 91190, Mexico.
| | - Betzaida Cuevas Córdoba
- Universidad Veracruzana, Instituto de Investigaciones Biológicas, Xalapa Veracruz, 91190, México.
| | - Clara L Sampieri
- Universidad Veracruzana, Instituto de Salud Pública, Xalapa Veracruz 91190, Mexico.
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Hewage SA, Samaraweera S, Joseph N, Kularatna S, Gunawardena N. Presentation, Diagnosis and Treatment Delays in Breast Cancer Care and Their Associations in Sri Lanka, a Low-resourced Country. Clin Oncol (R Coll Radiol) 2022; 34:598-607. [PMID: 35672184 DOI: 10.1016/j.clon.2022.05.007] [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: 12/07/2021] [Revised: 04/08/2022] [Accepted: 05/11/2022] [Indexed: 11/03/2022]
Abstract
AIMS Delays in breast cancer care, one important attributable factor for breast cancer being diagnosed at advanced stages, are not systematically studied in many countries. This study assessed the magnitude and factors associated with delays in breast cancer care in Sri Lanka, from symptom detection to treatment initiation. MATERIALS AND METHODS We interviewed 800 consecutively sampled female breast cancer patients, diagnosed within the last 12 months, using context-specific questionnaires and medical records. We defined the cut-off times for delays using international guidelines and features of the national health system and care-seeking patterns in the country. Delays were estimated as proportions with 95% confidence intervals and presented for: (i) presentation delay; (ii) diagnosis delay and (iii) treatment delay. We looked at how sociodemographic and healthcare availability and accessibility at the individual level were associated with delays using multivariate logistic regression, with a P value of 0.05 to define statistical significance. RESULTS Nearly two-thirds of patients reported a presentation delay (63.3%, 95% confidence interval 59.9-66.6%). A diagnosis delay (36.7%, 95% confidence interval 33.4-40.0%) was also seen among one-third, whereas treatment delays (13.2%, 95% confidence interval 10.8-15.5%) were less common. Low family monthly income (odds ratio 6.3; 95% confidence interval 4.2-9.3) and poor knowledge on breast cancer (odds ratio 2.7; 95% confidence interval 1.8-3.8) were associated with presentation delay. Poor health literacy (odds ratio 1.7; 95% confidence interval 1.1-2.7) and the need to make more than two visits to the first contact health provider prior to diagnosis (odds ratio 7.2; 95% confidence interval 4.6-11.1) were associated with diagnosis delays, whereas directly contacting an appropriate specialised health provider once the lump was detected reduced diagnosis delay (odds ratio 0.3; 95% confidence interval 0.2-0.4). Having undergone a core biopsy (odds ratio 0.5; 95% confidence interval 0.3-0.8) and having a mammogram (odds ratio 0.6; 95% confidence interval 4.7-32.7) reduced the likelihood of treatment delays. CONCLUSIONS Our study findings show that delays in breast cancer care in Sri Lanka are much lower than those in other lower-middle income countries. However, there is significant room for improvement, especially in relation to the excellence in quality of care, such as improving access to mammography services. Periodical estimation of breast cancer delays enabling temporal comparisons will probably provide useful information to policy makers in improving care delivery for breast cancer patients and, hence, is recommended. Such future assessments designed for comparisons between different treatment modalities would provide more information to assist policy decisions in care improvement.
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Affiliation(s)
- S A Hewage
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka.
| | - S Samaraweera
- National Cancer Control Programme, Elvitigala Mawatha, Colombo, Sri Lanka
| | - N Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - S Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
| | - N Gunawardena
- WHO Country Office for Sri Lanka, Colombo, Sri Lanka
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López-Vázquez J, Pérez-Martínez DE, Vargas I, Vázquez ML. [Barriers and factors associated with the use of coordination mechanisms between levels of care in Mexico]. CAD SAUDE PUBLICA 2021; 37:e00045620. [PMID: 33886705 DOI: 10.1590/0102-311x00045620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/26/2020] [Indexed: 11/22/2022] Open
Abstract
The aim was to analyze the level and characterize the use of clinical coordination mechanisms between levels of care, and their associated factors, in two public networks of health services in Mexico. A cross-sectional study was carried out using the COORDENA questionnaire to primary and specialized care physicians in the state of Veracruz. Differences were found between networks and levels of care, according to the mechanism. In both, the referral/counter-referral is mostly used to channel the patient to another level, mainly by primary care physicians. A high reception of referrals by specialists was identified, but few counterreferences in primary care. Being a man and recognizing the primary care physician, as responsible for monitoring the patient in his/her healthcare career, were factors associated with the frequent sending of the counter-referral by specialists. The discharge report is used in both networks to send clinical information to the other level, with more sending by specialist doctors, but with less reception in primary care. In both networks, the follow-up to the recommendations of the mechanisms to standardize clinical care was greater by primary care physicians than specialized ones. The use of coordination mechanisms between levels of care is deficient and limited, with greater use of mechanisms to transfer information than for clinical management. The need to implement strategies that consider the participation of professionals is evident, to favor local adaptation, appropriation and improve their use.
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Affiliation(s)
- Julieta López-Vázquez
- Instituto de Salud Pública, Universidad Veracruzana, Xalapa, México.,Departamento de Pediatría, de Obstetricia y Ginecología, y de Medicina Preventiva, Universidad Autónoma de Barcelona, Bellaterra, España
| | | | - Ingrid Vargas
- Grup de Recerca en Politiques de Salut i Serveis Sanitaris, Consorci de Salut i Social de Catalunya, Barcelona, España
| | - María-Luisa Vázquez
- Grup de Recerca en Politiques de Salut i Serveis Sanitaris, Consorci de Salut i Social de Catalunya, Barcelona, España
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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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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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Hewage S, Samaraweera S, Joseph N, Kularatna S, Gunawardena N. Does the choice of care pathways matter in timely breast cancer care in Sri Lanka? Cancer Epidemiol 2020; 70:101862. [PMID: 33348244 DOI: 10.1016/j.canep.2020.101862] [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: 08/18/2020] [Revised: 10/23/2020] [Accepted: 11/20/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND An understanding on the use of care pathways facilitates identification of timeliness in breast cancer care. Aims of this study were to describe different breast cancer care pathways used by female breast cancer patients in Sri Lanka and to identify whether they experienced timely breast cancer care. METHODS We conducted a cross-sectional study among 800 female breast cancer patients with a histological/ cytological confirmation, from four state cancer treatment centers. We conceptualized five different care pathways with essential care points and in-between time intervals to be explored using an interviewer administered tool. Dates were cross-checked with the medical record. The difference of time intervals spent in different care pathways was tested for significance using one-way ANOVA test. RESULTS Mean (SD) age was 55.5 (10.7) years. A vast majority of 98.4 % (n = 787) self-detected the breast lesion, while only 13 had been detected through screening. Following self-detection, two thirds (n = 473, 59.1 %, 95 % CI = 55.7-62.5) had first consulted a primary healthcare physician, and a third n = 287, 35.8 %, 95 % CI = 32.6-39.3) had consulted an appropriate specialist first. Presentation interval among those who visited an Ayurvedic physician first was significantly longer than other pathways (p < 0.0001). Diagnosis interval for those who consulted an appropriate consultant was significantly shorter than other pathways (p < 0.0001). CONCLUSIONS Women take up numerous care paths following self-detection of a breast lesion. Empowering women on appropriate care pathways and expanding dedicated breast clinics where women to be first seen by an appropriate specialist are likely to improve timely breast cancer care in Sri Lanka.
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Affiliation(s)
- Sumudu Hewage
- National Cancer Control Programme, No. 555/5, Public Health Building Complex, Elvitigala Mawatha, Colombo 5, Sri Lanka.
| | - Sudath Samaraweera
- National Cancer Control Programme, No. 555/5, Public Health Building Complex, Elvitigala Mawatha, Colombo 5, Sri Lanka
| | - Nuradh Joseph
- Sri Lanka Cancer Research Group, Maharagama, Sri Lanka
| | - Sanjeewa Kularatna
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work, Queensland University of Technology, Australia
| | - Nalika Gunawardena
- WHO Country Office for Sri Lanka, No. 5, Anderson Road, Colombo 5, Sri Lanka
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Lozano-Esparza S, Stern D, Hernández-Ávila JE, Morales-Carmona E, Mohar A, Lajous M. Evaluation of Mexico's low cancer mortality using two national death registries. SALUD PUBLICA DE MEXICO 2020; 62:181-185. [PMID: 32237560 DOI: 10.21149/10635] [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: 06/03/2019] [Accepted: 10/21/2019] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To compare cancer mortality rates in Mexico from two national death registries that independently code and attribute cause of death. MATERIALS AND METHODS We compared 5-year age-standardized total cancer and sitespecific cancer mortality rates (2010-2014) from Mexico's official death registry with a death registry from a disease surveillance system. We obtained age-adjusted mortality rates and 95% confidence intervals using the direct method and World Population Prospects 2010 as a standard. RESULTS Cancer mortality estimates for Mexico were minimally affected by the use of two distinct death certificate-coding procedures. Cancer mortality was 73.3 for Instituto Nacional de Estadística y Geografía and 72.7 for System for Epidemiologic Death Statistics per 100 000 women. The corresponding estimates for men were 68.3 and 67.8. CONCLUSIONS Mexico's low cancer mortality is unlikely to be explained by death certificate processing. Further investigations into the process of death certification and cancer registration should be conducted in Mexico.
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Affiliation(s)
- Susana Lozano-Esparza
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | - Dalia Stern
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico
| | | | - Evangelina Morales-Carmona
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública. Cuernavaca City, Mexico
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología. Mexico City, Mexico
| | - Martín Lajous
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública. Mexico City, Mexico.,Department of Global Health and Population, Harvard T.H. Chan School of Public Health. Boston, MA
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11
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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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12
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de Lemos LLP, Carvalho de Souza M, Pena Moreira D, Ribeiro Fernandes Almeida PH, Godman B, Verguet S, Guerra AA, Leal Cherchiglia M. Stage at diagnosis and stage-specific survival of breast cancer in Latin America and the Caribbean: A systematic review and meta-analysis. PLoS One 2019; 14:e0224012. [PMID: 31618268 PMCID: PMC6799865 DOI: 10.1371/journal.pone.0224012] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 10/03/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Female breast cancer is the most common cancer in Latin American and Caribbean (LAC) countries and is the leading cause of cancer deaths. The high mortality-to-incidence ratio in the regions is associated with mainly the high proportion of advanced stage diagnosis, and also to inadequate access to health care. In this study we aimed to systematically review the proportion of advanced stage (III-IV) at diagnosis (pas) and the five-year stage-specific survival estimates of breast cancer in LAC countries. METHODS We searched MEDLINE, Embase, and LILACS (Latin American and Caribbean Health Science Literature) to identify studies, in any language, indexed before Nov 5, 2018. We also conducted manual search by reviewing citations of papers found. pas was summarized by random effects model meta-analysis, and meta-regression analysis to identify sources of variation. Stage-specific survival probabilities were described as provided by study authors, as it was not possible to conduct meta-analysis. PROSPERO CRD42017052493. RESULTS For pas we included 63 studies, 13 of which population-based, from 22 countries comprising 221,255 women diagnosed from 1966 to 2017. The distribution of patients by stage varied greatly in LAC (pas 40.8%, 95%CI 37.0% to 44.6%; I2 = 99%; p<0.0001). The heterogeneity was not explained by any variable included in the meta-regression. There was no difference in pas among the Caribbean (pas 43.0%, 95%CI 33.1% to 53.6%), Central America (pas 47.0%, 95%CI 40.4% to 53.8%) and South America (pas 37.7%, 95%CI 33.1% to 42.5%) regions. For 5-year stage-specific survival we included 37 studies, comprising 28,988 women from ten countries. Seven of these studies were included also for pas. Since we were unable to adjust for age, comparability between countries and regions was hampered, and as expected, the results varied widely from study to study. CONCLUSIONS LAC countries should look to address concerns with early detection and diagnosis of breast cancer, and wherever viable implement screening programs and to provide timely treatment.
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Affiliation(s)
- Lívia Lovato Pires de Lemos
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Mirian Carvalho de Souza
- Divisão de Pesquisa Populacional, Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Daniela Pena Moreira
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Paulo Henrique Ribeiro Fernandes Almeida
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, Scotland
- Division of Clinical Pharmacology, Karolinska University Hospital Huddinge, Karolinska Institutet, Huddinge, Sweden
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - Augusto Afonso Guerra
- SUS Collaborating Centre for Technology Assessment and Excellence in Health, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
- Programa de Pós-Graduação em Medicamentos e Assistência Farmacêutica, Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Mariangela Leal Cherchiglia
- Programa de Pós-Graduação em Saúde Pública, Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
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13
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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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14
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Uhl CG, Liu Y. Microfluidic device for expedited tumor growth towards drug evaluation. LAB ON A CHIP 2019; 19:1458-1470. [PMID: 30888358 PMCID: PMC6526058 DOI: 10.1039/c8lc01250d] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Patient derived organoids have emerged as robust preclinical models for screening anti-cancer therapeutics. Current 2D culturing methods do not provide physiological responses to therapeutics, therefore 3D models are being developed to better reproduce physiological responses. 3D culturing however often requires large initial cell populations and one week to one month to grow tumors ready for therapeutic testing. As a solution a 3D culturing system has been developed capable of producing physiologically relevant tumors in an expedited fashion while only requiring a small number of initial cancer cells. A bi-layer microfluidic system capable of facilitating active convective nutrient supply to populations of cancer cells facilitates expedited growth of cancer cells when starting with populations as small as 8 cells. The system has been shown to function well with adherent and non-adherent cell types by expediting cell growth by a factor ranging from 1.27 to 4.76 greater than growth under static conditions. Utilizing such an approach has enable to formation of tumors ready for therapeutic screening within 3 days and the ability to perform therapeutic screening within the microfluidic system is demonstrated. A mathematical model has been developed which allows for adjustments to be made to the dynamic delivery of nutrients in order to efficiently use culture media without excessive waste. We believe this work to be the first attempt to grow cancers in an expedited fashion utilizing only a convective nutrient supply within a microfluidic system which also facilitates on-device therapeutic screening. The developed microfluidic system and cancer growth method have the potential to offer improved drug screening for patients in clinical settings.
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15
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Villarreal-Garza C, Lopez-Martinez EA, Muñoz-Lozano JF, Unger-Saldaña K. Locally advanced breast cancer in young women in Latin America. Ecancermedicalscience 2019; 13:894. [PMID: 30792811 PMCID: PMC6372300 DOI: 10.3332/ecancer.2019.894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this review is to organise, summarise and critically assess existing knowledge on locally advanced breast cancer (LABC) among young women in Latin America. We discuss the most relevant findings in six sections: 1) epidemiology of breast cancer in young women in Latin America; 2) being young as a factor for worse prognosis; 3) LABC in young women in the region; 4) aggressive tumour behaviour among young women; 5) delays in diagnosis and treatment and 6) burden of advanced disease. We point out the need to dedicate resources to enhance earlier diagnosis and prompt referrals of young women with breast cancer; promote research regarding prevalence, biologic characteristics, outcomes and reasons for diagnosis and treatment delays for this age group; and finally, implement supportive care programmes as a means of improving patients and their families’ well-being. The recognition of the current standpoint of breast cancer in young patients across the continent should shed some light on the importance of this pressing matter.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Research and Breast Cancer Department, Mexican National Cancer Institute, Mexico City 14080, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Edna A Lopez-Martinez
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Jose Felipe Muñoz-Lozano
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Karla Unger-Saldaña
- CONACYT fellow-Epidemiology Unit, Mexican National Cancer Institute, Mexico City 14080, Mexico
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16
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Sarveazad A, Babahajian A, Shamseddin J, Bahardoust M. 5-Year Survival Rates and Prognostic Factors in Patients with Synchronus and Metachronus Breast Cancer from 2010 to 2015. Asian Pac J Cancer Prev 2018; 19:3489-3493. [PMID: 30583674 PMCID: PMC6428561 DOI: 10.31557/apjcp.2018.19.12.3489] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Introduction: Currently breast (BC) cancer is a serious medical problem in all countries of the world. Survival depends on many factors. The present study focused on 5-year survival and its related factors in patients with BC in Iran. Material and methods. The present analytical retrospective study was performed (from March 2010 until March 2015) on patients with BC followed for at least 6 months. The main variables assessed were tumor size, grade of lymph node involvement, metastasis, stage, history, human epidermal growth factor receptor expression, and tumor origin. Analysis of survival was accomplished using the Kaplan- Meier method. Results: Some 351 (80.2%) of the total of 438 individuals had unilateral and 87(19.8%) had bilateral cancer, 28 (35.6%) of the latter being synchronous and 56(64.4%) metachronous. Mean duration of follow-up was 47.44±28.19 months, during which 61 (17.3%) patients with unilateral and 18 with bilateral cancer eventually died. The 5-year survival rate in patients with unilateral BC was significantly higher than those with bilateral BC (Log-rank Test chi2= 3.11, p=0.032). In addition, with metachronous cases, the survival rate was 64.2% in comparison with 51.6% for synchronous BCs. Survival rate was significantly (p value =0.038) higher with metachronous than with synchronous cancers (Log-rank Test chi2=3.54, p=0.038). The highest survival rate was reported for BCs originating from lobule tissue and the lowest rate examples of interstitial tissue origin (Log-rank Test chi2=11.54, p=0.0001). Patients with earl stage lesions (M1) survived longer than with other stages (Log-rank Test chi2= 9.55, p=0.001). Conclusion: In this study, most women with BC had a positive family history and were married. The 5-year survival rate was lower with advanced stages of cancer. According to our findings, survival rates might improve if patients undergo screening and diagnosis is made at an early stage of the disease.
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Affiliation(s)
- Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran.
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17
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Rangel-Méndez JA, Novelo-Tec JF, Sánchez-Cruz JF, Cedillo-Rivera R, Moo-Puc RE. Healthcare delay in breast cancer patients: a case study in a low-density population region from Mexico. Future Oncol 2018; 14:2067-2082. [DOI: 10.2217/fon-2017-0713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aim: To describe delay intervals, their impact on clinical stage and initiation of first oncologic treatment, and evaluate associated factors in breast cancer patients in Yucatan, Mexico, a low-density population region. Patients & methods: A retrospective analysis was done of 92 medical records, and bivariate and multivariate models applied to identify associations between healthcare delay and several factors. Results: System delay accounted for most of the delay (median: 86 days; 61% of delay). Socioeconomic status and delivery to tertiary-care hospital predicted delay. Clinical stage determined initiation of first oncologic treatment. Conclusion: Delay in treatment was largely due to system delay. Only a few variables explained this delay. Clinical stage had the strongest effect on initiation of first oncologic 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, Mérida, Yucatán 97150, México
| | - José Feliciano Novelo-Tec
- Unidad de Medicina Familiar número 58, Delegación Estatal Yucatán, Instituto Mexicano del Seguro Social, Calle 42 999 X 127 A Y 131, Serapio Rendón II, Mérida, Yucatán 97285, México
| | - Juan Francisco Sánchez-Cruz
- Coordinación de Investigación, Delegación Estatal Yucatán, Instituto Mexicano del Seguro Social, Calle 41 No. 439, Col. Industrial, Mérida, Yucatán 97150, México
| | - Roberto Cedillo-Rivera
- Unidad Interinstitucional de Investigación Clínica y Epidemiológica, Facultad de Medicina, Universidad Autónoma de Yucatán, Avenida Itzáes No. 498 x 86 Y 59A, Centro, Mérida, Yucatán 97000, 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, Mérida, Yucatán 97150, México
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18
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Rivera-Franco MM, Leon-Rodriguez E. Delays in Breast Cancer Detection and Treatment in Developing Countries. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2018; 12:1178223417752677. [PMID: 29434475 PMCID: PMC5802601 DOI: 10.1177/1178223417752677] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 12/18/2017] [Indexed: 01/07/2023]
Abstract
Breast cancer is the most common cancer in women in both developed and developing countries and the second most common cancer in the world. Developing countries are increasingly adopting a Western lifestyle, such as changes in diet and delayed first childbirth, lower parity, and shorter periods of breastfeeding, which are important determinants of a higher incidence of breast cancer among those regions. Low- and middle-income countries (LMICs) represent most of the countries with the highest mortality rates, ranging from 40% to 60%. Furthermore, developing countries account for scarce survival data, and the few data available coincide with the observed incidence and mortality differences. Five-year survival rates for breast cancer are much worse for LMICs countries such as Brazil, India, and Algeria in comparison with the United States and Sweden. Paucity of early detection programs explain these poor survival rates, which results in a high proportion of women presenting with late-stage disease, along with lack of adequate diagnosis and treatment facilities. Emphasis is urgently needed on health education, to promote early diagnosis of breast cancer, highlighting the importance of creating more public facilities that provide treatment, which are key components for the improvement in breast cancer care in developing countries.
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Affiliation(s)
- Monica M Rivera-Franco
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | - Eucario Leon-Rodriguez
- Department of Hematology and Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
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19
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Romeiro Lopes TC, Gravena AAF, Demitto MDO, Borghesan DHP, Dell`Agnolo CM, Brischiliari SCR, Carvalho MDDB, Pelloso SM. Delay in Diagnosis and Treatment of Breast Cancer among Women Attending a Reference Service in Brazil. Asian Pac J Cancer Prev 2017; 18:3017-3023. [PMID: 29172274 PMCID: PMC5773786 DOI: 10.22034/apjcp.2017.18.11.3017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background: Cancer is a major public health problem. Early diagnosis and treatment are essential for reducing mortality. This study aimed to analyze factors associated with delay in breast cancer diagnosis and treatment among women attending a reference cancer service. Methods: This retrospective, cross-sectional study was performed with data collected from medical records and interviews conducted with women diagnosed with breast cancer and treated from October 2013 to October 2014 at a cancer reference hospital in Paraná, Southern Brazil. Results: A total of 82 participants were enrolled during the study period; their average age was 58.2 ± 11.5 years. The average time taken for final diagnosis of breast cancer was 102.5 ± 165.5 days. Treatment onset was delayed in the majority of cases, and the average time elapsing from diagnostic biopsy to onset of primary treatment was 72.3 ± 54.0 days. The odds of treatment delay were higher among the women with a low educational level. Conclusions: The results underline the need for proposals aimed at early detection, identification of risk factors and timely provision of treatment by health managers that focus on this group.
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Affiliation(s)
- Tiara Cristina Romeiro Lopes
- Department of Health Science, Faculty Post Graduate in Health Science, State University Maringa, Parana, Brazil.
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20
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Mohd Mujar NM, Dahlui M, Emran NA, Abdul Hadi I, Wai YY, Arulanantham S, Hooi CC, Mohd Taib NA. Complementary and alternative medicine (CAM) use and delays in presentation and diagnosis of breast cancer patients in public hospitals in Malaysia. PLoS One 2017; 12:e0176394. [PMID: 28448541 PMCID: PMC5407802 DOI: 10.1371/journal.pone.0176394] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 04/10/2017] [Indexed: 02/06/2023] Open
Abstract
Complementary and alternative medicine (CAM) is widely used among the breast cancer patients in Malaysia. Delays in presentation, diagnosis and treatment have been shown to impact the disease prognosis. There is considerable use of CAM amongst breast cancer patients. CAM use has been cited as a cause of delay in diagnosis and treatments in qualitative studies, however there had not been any confirmatory study that confirms its impact on delays. The purpose of this study was to evaluate whether the use of CAM among newly diagnosed breast cancer patients was associated with delays in presentation, diagnosis or treatment of breast cancer. This multi-centre cross-sectional study evaluating the time points of the individual breast cancer patients' journey from first visit, resolution of diagnosis and treatments was conducted in six public hospitals in Malaysia. All newly diagnosed breast cancer patients from 1st January to 31st December 2012 were recruited. Data were collected through medical records review and patient interview by using a structured questionnaire. Complementary and alternative medicine (CAM) was defined as the use of any methods and products not included in conventional allopathic medicine before commencement of treatments. Presentation delay was defined as time taken from symptom discovery to first presentation of more than 3 months. The time points were categorised to diagnosis delay was defined as time taken from first presentation to diagnosis of more than 1 month and treatment delay was defined as time taken from diagnosis to initial treatment of more than 1 month. Multiple logistic regression was used for analysis. A total number of 340 patients participated in this study. The prevalence of CAM use was 46.5% (n = 158). Malay ethnicity (OR 3.32; 95% CI: 1.85, 5.97) and not interpreting symptom as cancerous (OR 1.79; 95% CI: 1.10, 2.92) were significantly associated with CAM use. The use of CAM was associated with delays in presentation (OR 1.65; 95% CI: 1.05, 2.59), diagnosis (OR 2.42; 95% CI: 1.56, 3.77) and treatment of breast cancer (OR 1.74; 95% CI: 1.11, 2.72) on univariate analyses. However, after adjusting with other covariates, CAM use was associated with delays in presentation (OR 1.71; 95% CI: 1.05, 2.78) and diagnosis (OR 2.58; 95% CI: 1.59, 4.17) but not for treatment of breast cancer (OR 1.58; 95% CI: 0.98, 2.55). The prevalence of CAM use among the breast cancer patients was high. Women of Malay ethnicity and not interpreting symptom as cancerous were significantly associated with CAM use. The use of CAM is significantly associated with delay in presentation and resolution of diagnosis. This study suggests further evaluation of access to breast cancer care is needed as poor access may cause the use of CAM. However, since public hospitals in Malaysia are heavily subsidized and readily available to the population, CAM use may impact delays in presentation and diagnosis.
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Affiliation(s)
- Noor Mastura Mohd Mujar
- Cluster of Healthy Lifestyle, Advanced Medical and Dental Institute, University Science of Malaysia, Penang, Malaysia
| | - Maznah Dahlui
- Department of Social & Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | | | | | | | | | | | - Nur Aishah Mohd Taib
- Department of Surgery, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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21
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Breast self-exam and patient interval associate with advanced breast cancer and treatment delay in Mexican women. Clin Transl Oncol 2017; 19:1276-1282. [PMID: 28444642 DOI: 10.1007/s12094-017-1666-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 04/19/2017] [Indexed: 12/29/2022]
Abstract
PURPOSE The objective of this study was to compare treatment intervals in breast cancer patients according to the detection method (breast self-exam vs screening). PATIENTS AND METHODS We conducted a retrospective analysis including 291 breast cancer patients at a Mexican tertiary referral hospital. RESULTS Breast cancer detection method was mostly breast self-exam (60%). The median patient interval was 60.5 days, and was associated with marital status and socioeconomic level. Differences between the two groups were statistically significant for global interval, p = 0.002; however, health system interval was not statistically different. CONCLUSION In our country, breast cancer screening is opportunistic, with several weaknesses within its management and quality systems. Our study showed that even in specialized health care centers, breast cancer is detected by self-exam in up to 2/3 of patients, which can explain the advanced stages at diagnosis in our country. In developing countries, the immediate health care access for breast cancer patients should be prioritized as an initial step to reduce the global treatment initiation interval in order to reduce mortality.
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Bright K. What health care system delays reveal about inequalities in breast cancer medicine and global health. Cancer 2015; 121:2124-6. [DOI: 10.1002/cncr.29333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Revised: 02/16/2015] [Accepted: 02/16/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Kristin Bright
- Department of Sociology and Anthropology; Carleton University; Ottawa Ontario Canada
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Torres-Mejía G, Smith RA, Carranza-Flores MDLL, Bogart A, Martínez-Matsushita L, Miglioretti DL, Kerlikowske K, Ortega-Olvera C, Montemayor-Varela E, Angeles-Llerenas A, Bautista-Arredondo S, Sánchez-González G, Martínez-Montañez OG, Uscanga-Sánchez SR, Lazcano-Ponce E, Hernández-Ávila M. Radiographers supporting radiologists in the interpretation of screening mammography: a viable strategy to meet the shortage in the number of radiologists. BMC Cancer 2015; 15:410. [PMID: 25975383 PMCID: PMC4436872 DOI: 10.1186/s12885-015-1399-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Accepted: 04/29/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND An alternative approach to the traditional model of radiologists interpreting screening mammography is necessary due to the shortage of radiologists to interpret screening mammograms in many countries. METHODS We evaluated the performance of 15 Mexican radiographers, also known as radiologic technologists, in the interpretation of screening mammography after a 6 months training period in a screening setting. Fifteen radiographers received 6 months standardized training with radiologists in the interpretation of screening mammography using the Breast Imaging Reporting and Data System (BI-RADS) system. A challenging test set of 110 cases developed by the Breast Cancer Surveillance Consortium was used to evaluate their performance. We estimated sensitivity, specificity, false positive rates, likelihood ratio of a positive test (LR+) and the area under the subject-specific Receiver Operating Characteristic (ROC) curve (AUC) for diagnostic accuracy. A mathematical model simulating the consequences in costs and performance of two hypothetical scenarios compared to the status quo in which a radiologist reads all screening mammograms was also performed. RESULTS Radiographer's sensitivity was comparable to the sensitivity scores achieved by U.S. radiologists who took the test but their false-positive rate was higher. Median sensitivity was 73.3 % (Interquartile range, IQR: 46.7-86.7 %) and the median false positive rate was 49.5 % (IQR: 34.7-57.9 %). The median LR+ was 1.4 (IQR: 1.3-1.7 %) and the median AUC was 0.6 (IQR: 0.6-0.7). A scenario in which a radiographer reads all mammograms first, and a radiologist reads only those that were difficult for the radiographer, was more cost-effective than a scenario in which either the radiographer or radiologist reads all mammograms. CONCLUSIONS Given the comparable sensitivity achieved by Mexican radiographers and U.S. radiologists on a test set, screening mammography interpretation by radiographers appears to be a possible adjunct to radiologists in countries with shortages of radiologists. Further studies are required to assess the effectiveness of different training programs in order to obtain acceptable screening accuracy, as well as the best approaches for the use of non-physician readers to interpret screening mammography.
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Affiliation(s)
- Gabriela Torres-Mejía
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Robert A Smith
- American Cancer Society, 250 Williams St., Atlanta, GA, 30303, USA.
| | - María de la Luz Carranza-Flores
- Centro de Diagnóstico Digital México-España, Secretaria de Salud Pública del Distrito Federal, Mariano Escobedo No. 148 col. Anáhuac, Ciudad de México D. F., 11320, Mexico.
| | - Andy Bogart
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA.
| | - Louis Martínez-Matsushita
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Diana L Miglioretti
- Group Health Research Institute, Group Health Cooperative, 1730 Minor Ave #1600, Seattle, WA, 98101, USA.
- Division of Biostatistics, Department of Public Health Sciences, School of Medicine, University of California, 1 Shields Ave, Davis, CA, 95616, USA.
| | - Karla Kerlikowske
- Department of Epidemiology and Biostatistics and the General Internal Medicine Section, University of California, 4150 Clement St, San Francisco, CA, 94121, USA.
- Department of Veterans Affairs, University of California, 4150 Clement St, San Francisco, CA, 94121, USA.
| | - Carolina Ortega-Olvera
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Ernesto Montemayor-Varela
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Angélica Angeles-Llerenas
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Sergio Bautista-Arredondo
- Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico.
| | - Gilberto Sánchez-González
- Dirección de Economía de la Salud, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, CP. 62100, Cuernavaca, Morelos, Mexico.
| | - Olga G Martínez-Montañez
- Hospital de Oncología, Centro Médico Siglo XXI, Instituto Mexicano del Seguro Social, Av. Cuauhtémoc 330, Cuauhtemoc Doctores, Ciudad de México, D.F. 06720, Mexico.
| | - Santos R Uscanga-Sánchez
- Federación Mexicana de Colegios de Ginecología y Obstetricia, Nueva York 38, Col. Nápoles, Benito Juárez, Ciudad de México, D.F. 03810, Mexico.
| | - Eduardo Lazcano-Ponce
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
| | - Mauricio Hernández-Ávila
- Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Avenida Universidad No. 655, Colonia Santa María Ahuacatitlán, Cuernavaca, 62100, , Morelos, Mexico.
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Aggarwal A, Unger-Saldaña K, Lewison G, Sullivan R. The challenge of cancer in middle-income countries with an ageing population: Mexico as a case study. Ecancermedicalscience 2015; 9:536. [PMID: 26015805 PMCID: PMC4435755 DOI: 10.3332/ecancer.2015.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Indexed: 11/06/2022] Open
Abstract
Mexico is undergoing rapid population ageing as a result of its epidemiological transition. This study explores the interface between this rapid population ageing and the burden of cancer. The number of new cancer cases is expected to increase by nearly 75% by 2030 (107,000 additional cases per annum), with 60% of cases in the elderly (aged ≥ 65). A review of the literature was supplemented by a bibliometric analysis of Mexico's cancer research output. Cancer incidence projections for selected sites were estimated with Globocan software. Data were obtained from recent national census, surveys, and cancer death registrations. The elderly, especially women and those living in rural areas, face high levels of poverty, have low rates of educational attainment, and many are not covered by health insurance schemes. Out of pocket payments and private health care usage remain high, despite the implementation of Seguro Popular that was designed to achieve financial protection for the lowest income groups. A number of cancers that predominate in elderly persons are not covered by the scheme and individuals face catastrophic expenditure in seeking treatment. There is limited research output in those cancer sites that have a high burden in the elderly Mexican population, especially research that focuses on outcomes. The elderly population in Mexico is vulnerable to the effects of the rising cancer burden and faces challenges in accessing high quality cancer care. Based on our evidence, we recommend that geriatric oncology should be an urgent public policy priority for Mexico.
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Affiliation(s)
- Ajay Aggarwal
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
- Department of Clinical Oncology, Guys and St Thomas’ NHS Trust, London SE1 9RT, UK
| | | | - Grant Lewison
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
| | - Richard Sullivan
- Institute of Cancer Policy, Kings College London, Guys Campus, Department of Research Oncology, Bermondsey Wing, London, SE1 9RT, UK
- International Prevention Research Institute (iPRI), Lyon 69006, France
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Balogun OD, Formenti SC. Locally advanced breast cancer - strategies for developing nations. Front Oncol 2015; 5:89. [PMID: 25964882 PMCID: PMC4410621 DOI: 10.3389/fonc.2015.00089] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 03/25/2015] [Indexed: 12/29/2022] Open
Affiliation(s)
- Onyinye D Balogun
- Department of Radiation Oncology and Surgery, New York University Langone Medical Center, New York University School of Medicine , New York, NY , USA
| | - Silvia C Formenti
- Department of Radiation Oncology and Surgery, New York University Langone Medical Center, New York University School of Medicine , New York, NY , USA
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26
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Unger-Saldaña K, Miranda A, Zarco-Espinosa G, Mainero-Ratchelous F, Bargalló-Rocha E, Miguel Lázaro-León J. Health system delay and its effect on clinical stage of breast cancer: Multicenter study. Cancer 2015; 121:2198-206. [PMID: 25809536 PMCID: PMC6681165 DOI: 10.1002/cncr.29331] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/21/2014] [Accepted: 09/24/2014] [Indexed: 12/29/2022]
Abstract
BACKGROUND The objective of this study was to determine the correlation between health system delay and clinical disease stage in patients with breast cancer. METHODS This was a cross‐sectional study of 886 patients who were referred to 4 of the largest public cancer hospitals in Mexico City for the evaluation of a probable breast cancer. Data on time intervals, sociodemographic factors, and clinical stage at diagnosis were retrieved. A logistic regression model was used to estimate the average marginal effects of delay on the probability of being diagnosed with advanced breast cancer (stages III and IV). RESULTS The median time between problem identification and the beginning of treatment was 7 months. The subinterval with the largest delay was that between the first medical consultation and diagnosis (median, 4 months). Only 15% of the patients who had cancer were diagnosed with stage 0 and I disease, and 48% were diagnosed with stage III and IV disease. Multivariate analyses confirmed independent correlations for the means of problem identification, patient delay, health system delay, and age with a higher probability that patients would begin cancer treatment in an advanced stage. CONCLUSIONS In the sample studied, the majority of patients with breast cancer began treatment after a delay. Both patient delays and provider delays were associated with advanced disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies that go beyond the promotion of breast care awareness and screening participation to include improvements in health services that facilitate access to timely diagnosis and treatment. Cancer 2015;121:2198–2206. Both patient delays and provider delays are associated with higher probabilities of patients starting cancer treatment with advanced‐stage disease. Research aimed at identifying specific access barriers to medical services is much needed to guide the design of tailored health policies, especially in developing countries.
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Affiliation(s)
- Karla Unger-Saldaña
- Unit of Epidemiology, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Alfonso Miranda
- Economics Division, Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico
| | - Gelasio Zarco-Espinosa
- Oncology Hospital, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
| | - Fernando Mainero-Ratchelous
- Breast Tumors Department, Clínica de Ginecología y Obstetricia Número 4 del Instituto Mexicano del Seguro Social (IMSS), Mexico City, Mexico
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Chavarri-Guerra Y, St Louis J, Liedke PER, Symecko H, Villarreal-Garza C, Mohar A, Finkelstein DM, Goss PE. Access to care issues adversely affect breast cancer patients in Mexico: oncologists' perspective. BMC Cancer 2014; 14:658. [PMID: 25199766 PMCID: PMC4165903 DOI: 10.1186/1471-2407-14-658] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 08/22/2014] [Indexed: 02/07/2023] Open
Abstract
Background Despite recently implemented access to care programs, Mexican breast cancer (BC) mortality rates remain substantially above those in the US. We conducted a survey among Mexican Oncologists to determine whether practice patterns may be responsible for these differences. Methods A web-based survey was sent to 851 oncologists across Mexico using the Vanderbilt University REDCap database. Analyses of outcomes are reported using exact and binomial confidence bounds and tests. Results 138 participants (18.6% of those surveyed) from the National capital and 26 Mexican states, responded. Respondents reported that 58% of newly diagnosed BC patients present with stage III-IV disease; 63% undergo mastectomy, 52% axillary lymph node dissection (ALND) and 48% sentinel lymph node biopsy (SLNB). Chemotherapy is recommended for tumors > 1 cm (89%), positive nodes (86.5%), triple-negative (TN) (80%) and HER2 positive tumors (58%). Trastuzumab is prescribed in 54.3% and 77.5% for HER2 < 1 cm and > 1 cm tumors, respectively. Tamoxifen is indicated for premenopausal hormone receptor (HR) positive tumors in 86.5% of cases and aromatase inhibitors (AI’s) for postmenopausal in 86%. 24% of physicians reported treatment limitations, due to delayed or incomplete pathology reports and delayed or limited access to medications. Conclusions Even though access to care programs have been recently applied nationwide, women commonly present with advanced BC, leading to increased rates of mastectomy and ALND. Mexican physicians are dissatisfied with access to appropriate medical care. Our survey detects specific barriers that may impact BC outcomes in Mexico and warrant further investigation. Electronic supplementary material The online version of this article (doi:10.1186/1471-2407-14-658) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | | | | | - Paul E Goss
- MGH-Avon International Breast Cancer Program, Massachusetts General Hospital, Boston, MA, USA.
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Unger-Saldaña K. Challenges to the early diagnosis and treatment of breast cancer in developing countries. World J Clin Oncol 2014; 5:465-477. [PMID: 25114860 PMCID: PMC4127616 DOI: 10.5306/wjco.v5.i3.465] [Citation(s) in RCA: 212] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/23/2014] [Accepted: 06/03/2014] [Indexed: 02/06/2023] Open
Abstract
This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.
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Gyenwali D, Khanal G, Paudel R, Amatya A, Pariyar J, Onta SR. Estimates of delays in diagnosis of cervical cancer in Nepal. BMC WOMENS HEALTH 2014; 14:29. [PMID: 24533670 PMCID: PMC3932513 DOI: 10.1186/1472-6874-14-29] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 02/13/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer related deaths among women in Nepal. The long symptom to diagnosis interval means that women have advanced disease at presentation. The aim of this study was to identify, estimate and describe the extent of different delays in diagnosis of cervical cancer in Nepal. METHODS A cross-sectional descriptive study was conducted in two tertiary cancer hospitals of Nepal. Face to face interview and medical records review were carried out among 110 cervical cancer patients. Total diagnostic delay was categorized into component delays: patient delay, health care providers delay, referral delay and diagnostic waiting time. RESULTS Total 110 patients recruited in the study represented 40 districts from all three ecological regions of the country. Median total diagnostic delay was 157 days with more than three fourth (77.3%) of the patients having longer total diagnostic delay of >90 days. Out of the total diagnostic delay, median patient delay, median health care provider delay, median referral delay and median diagnostic waiting time were 68.5 days, 40 days, 5 days and 9 days respectively. Majority of the patients had experienced longer delay of each type except referral delay. Fifty seven percent of the patients had experienced longer patient delay of >60 days, 90% had suffered longer health care provider delay of >1 week, 31.8% had longer referral delay of >1 week and 66.2% had waited >1 week at diagnostic center for final diagnosis. Variation in each type of delay was observed among women with different attributes and in context of health care service delivery. CONCLUSIONS Longer delays were observed in all the diagnostic pathways except for referral delay and diagnostic waiting time. Among the delays, patient delay is of crucial importance because of its longer span, although health care provider delay is equally important. In the context of limited screening services in Nepal, the efforts should be to reduce the diagnostic delay especially patient and health care provider delay for early detection and reduction of mortality rate of cervical cancer.
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Affiliation(s)
- Deepak Gyenwali
- Department of Community Medicine and Public Health, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal.
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Goss PE, Lee BL, Badovinac-Crnjevic T, Strasser-Weippl K, Chavarri-Guerra Y, St Louis J, Villarreal-Garza C, Unger-Saldaña K, Ferreyra M, Debiasi M, Liedke PER, Touya D, Werutsky G, Higgins M, Fan L, Vasconcelos C, Cazap E, Vallejos C, Mohar A, Knaul F, Arreola H, Batura R, Luciani S, Sullivan R, Finkelstein D, Simon S, Barrios C, Kightlinger R, Gelrud A, Bychkovsky V, Lopes G, Stefani S, Blaya M, Souza FH, Santos FS, Kaemmerer A, de Azambuja E, Zorilla AFC, Murillo R, Jeronimo J, Tsu V, Carvalho A, Gil CF, Sternberg C, Dueñas-Gonzalez A, Sgroi D, Cuello M, Fresco R, Reis RM, Masera G, Gabús R, Ribeiro R, Knust R, Ismael G, Rosenblatt E, Roth B, Villa L, Solares AL, Leon MX, Torres-Vigil I, Covarrubias-Gomez A, Hernández A, Bertolino M, Schwartsmann G, Santillana S, Esteva F, Fein L, Mano M, Gomez H, Hurlbert M, Durstine A, Azenha G. Planning cancer control in Latin America and the Caribbean. Lancet Oncol 2013; 14:391-436. [PMID: 23628188 DOI: 10.1016/s1470-2045(13)70048-2] [Citation(s) in RCA: 316] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Non-communicable diseases, including cancer, are overtaking infectious disease as the leading health-care threat in middle-income and low-income countries. Latin American and Caribbean countries are struggling to respond to increasing morbidity and death from advanced disease. Health ministries and health-care systems in these countries face many challenges caring for patients with advanced cancer: inadequate funding; inequitable distribution of resources and services; inadequate numbers, training, and distribution of health-care personnel and equipment; lack of adequate care for many populations based on socioeconomic, geographic, ethnic, and other factors; and current systems geared toward the needs of wealthy, urban minorities at a cost to the entire population. This burgeoning cancer problem threatens to cause widespread suffering and economic peril to the countries of Latin America. Prompt and deliberate actions must be taken to avoid this scenario. Increasing efforts towards prevention of cancer and avoidance of advanced, stage IV disease will reduce suffering and mortality and will make overall cancer care more affordable. We hope the findings of our Commission and our recommendations will inspire Latin American stakeholders to redouble their efforts to address this increasing cancer burden and to prevent it from worsening and threatening their societies.
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Affiliation(s)
- Paul E Goss
- Avon International Breast Cancer Research Program, Massachusetts General Hospital, Boston, MA 02114, USA.
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Unger-Saldaña K, Peláez-Ballestas I, Infante-Castañeda C. Development and validation of a questionnaire to assess delay in treatment for breast cancer. BMC Cancer 2012; 12:626. [PMID: 23272645 PMCID: PMC3543238 DOI: 10.1186/1471-2407-12-626] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023] Open
Abstract
Background This study reports the reliability and validity of a questionnaire designed to measure the time from detection of a breast cancer to arrival at a cancer hospital, as well as the factors that are associated with delay. Methods The proposed questionnaire measures dates for estimation of the patient, provider and total intervals from detection to treatment, as well as factors that could be related to delays: means of problem identification (self-discovery or screening), the patients’ initial interpretations of symptoms, patients’ perceptions of delay, reasons for delay in initial seeking of medical care, barriers perceived to have caused provider delay, prior utilisation of health services, use of alternative medicine, cancer-screening knowledge and practices, and aspects of the social network of support for medical attention. The questionnaire was assembled with consideration for previous research results from a review of the literature and qualitative interviews of patients with breast cancer symptoms. It was tested for face validity, content validity, reliability, internal consistency, convergent and divergent validity, sensitivity and specificity in a series of 4 tests with 602 patients. Results The instrument showed good face and content validity. It allowed discrimination of patients with different types and degrees of delay, had quite good reliability for the time intervals (with no significant mean differences between the two measurements), and fairly good internal consistency of the item dimensions (with Cronbach’s alpha values for each dimension between 0.42 and 0.85). Finally, sensitivity and specificity were 74.68% and 48.81%, respectively. Conclusions To the best of our knowledge, this is the first published report of the development and validation of a questionnaire for estimation of breast cancer delay and its correlated factors. It is a valid, reliable and sensitive instrument.
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Affiliation(s)
- Karla Unger-Saldaña
- Faculty of Medicine, Universidad Nacional Autónoma de México & Instituto Nacional de Cancerología de México, Mexico City, Mexico.
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Abstract
Breast cancer is a major public health issue in low-income and middle-income countries. In Mexico, incidence and mortality of breast cancer have risen in the past few decades. Changes in health-care policies in Mexico have incorporated programmes for access to early diagnosis and treatment of this disease. This Review outlines the status of breast cancer in Mexico, regarding demographics, access to care, and strategies to improve clinical outcomes. We identify factors that contribute to the existing disease burden, such as low mammography coverage, poor quality control, limited access to diagnosis and treatment, and insufficient physical and human resources for clinical care.
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Current World Literature. Curr Opin Obstet Gynecol 2012; 24:49-55. [DOI: 10.1097/gco.0b013e32834f97d4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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