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Gu Y, Wang M, Gong Y, Li X, Wang Z, Wang Y, Jiang S, Zhang D, Li C. Unveiling breast cancer risk profiles: a survival clustering analysis empowered by an online web application. Future Oncol 2023; 19:2651-2667. [PMID: 38095059 DOI: 10.2217/fon-2023-0736] [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] [Indexed: 12/23/2023] Open
Abstract
Aim: To develop a shiny app for doctors to investigate breast cancer treatments through a new approach by incorporating unsupervised clustering and survival information. Materials & methods: Analysis is based on the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) dataset, which contains 1726 subjects and 22 variables. Cox regression was used to identify survival risk factors for K-means clustering. Logrank tests and C-statistics were compared across different cluster numbers and Kaplan-Meier plots were presented. Results & conclusion: Our study fills an existing void by introducing a unique combination of unsupervised learning techniques and survival information on the clinician side, demonstrating the potential of survival clustering as a valuable tool in uncovering hidden structures based on distinct risk profiles.
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Affiliation(s)
- Yuan Gu
- Department of Statistics, The George Washington University, Washington, DC 20052, USA
| | - Mingyue Wang
- Department of Mathematics, Syracuse University, Syracuse, NY 13244, USA
| | - Yishu Gong
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, NY 02115, USA
| | - Xin Li
- Department of Statistics, The George Washington University, Washington, DC 20052, USA
| | - Ziyang Wang
- Department of Computer Science, University of Oxford, Oxford, OX1 3QD, UK
| | - Yuli Wang
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, MD 21205, USA
| | - Song Jiang
- Department of Biochemistry, Huzhou Institute of Biological Products Co., Ltd., 313017, China
| | - Dan Zhang
- Department of Information Science and Engineering, Shandong University, Shan Dong, China
| | - Chen Li
- Department of Biology, Chemistry and Pharmacy, Free University of Berlin, Berlin, 14195, Germany
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Luo Z, Liu Z, Chen H, Liu Y, Tang N, Li H. Light at night exposure and risk of breast cancer: a meta-analysis of observational studies. Front Public Health 2023; 11:1276290. [PMID: 38106885 PMCID: PMC10722424 DOI: 10.3389/fpubh.2023.1276290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/01/2023] [Indexed: 12/19/2023] Open
Abstract
Objective The aim of this meta-analysis is to evaluate the impact of light at night (LAN) exposure on the risk of breast cancer across varying factors. Method We conducted a systematic search of literature up to July 15, 2023, including PubMed, Cochrane Library, and Embase databases, using keywords related to breast cancer and LAN exposure. Cohort study and case-control study literature on night light exposure and breast cancer risk were included. Statistical analyses were performed using Stata software version 17.0. To address heterogeneity among different studies, we employed a random-effects model for analysis and assessed publication bias using funnel plots and Egger's test. Results We included 13 case-control and 8 cohort studies with 734,372 participants worldwide. In the Newcastle-Ottawa Scale (NOS) assessments, the average score was 7.43 (ranging from 5 to 9). The overall meta-analysis demonstrated a significant association between exposure to LAN and risk of breast cancer (RR = 1.12; 95% CI: 1.06-1.17; I2 = 31.3%, p < 0.001). In the subgroup analysis, the results of the analysis for study types (case-control studies: RR = 1.16; 95% CI: 1.06-1.27; I2 = 40.4%, p = 0.001; cohort studies: RR = 1.08; 95% CI: 1.04-1.14; I2 = 0.0%, p < 0.001) and the results for light exposure types (outdoor LAN: RR = 1.07; 95% CI: 1.02-1.13; I2 = 30.9%, p = 0.004) are presented. In the analysis conducted for continents, the highest breast cancer risk was observed in the Asian population (Asian: RR = 1.24; 95% CI: 1.15-1.34; I2 = 0.0%, p < 0.001) and in the analysis of estrogen receptor status (ER+: RR = 1.10; 95% CI: 1.03-1.18; I2 = 17.0%, p = 0.005;). We also conducted an analysis on menopausal status and various lifestyles but did not find any statistically significant findings. Conclusion Our study demonstrates that LAN exposure is associated with an increased risk of breast cancer, particularly in the Asian population. Among the existing hypotheses, the idea that LAN exposure leads to a decrease in melatonin is widely accepted. However, until the mechanism of this effect is clearly elucidated, it is not recommended to take melatonin supplements for breast cancer prevention without medical advice. We hope to conduct more high-quality research, especially concerning the investigation of other environmental confounding factors, to further advance this field.
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Affiliation(s)
| | | | | | - Ying Liu
- *Correspondence: Zhenglong Liu, : Ying Liu,
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Ismail HM, Mokhtar S, El-Mansy H. Factors associated with late-stage diagnosis of breast cancer among Egyptian women. J Public Health Res 2022; 10:10.4081_jphr.2021.2874. [PMID: 35912393 PMCID: PMC9335192 DOI: 10.4081/jphr.2021.2874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 03/16/2022] [Indexed: 11/25/2022] Open
Abstract
Background Detecting Breast Cancer (BC) at earlier stages comes with a better prognosis,
while diagnosis at late stages has poor outcomes and escalating mortality
rates from the disease. The study aims to understand the factors associated
with the late-stage diagnosis of BC in Egypt. Design and Methods A sample of 400 women with a pathologically confirmed BC were enrolled from
one of the main tertiary cancer hospitals in Egypt. A cross-sectional study
design was conducted. The collected data included: clinical characteristics
of the tumor, socio-demographic characteristics of the studied women,
reproductive and medical history, screening practices, and the time from
symptom onset to definite diagnosis as suspected predictors to the stage of
BC at diagnosis. Data was analyzed by crude odds ratios (95% confidence
interval) and multivariate logistic regression analysis. Results The study revealed that 47.5% were diagnosed at late stages (40% at stage
III/ 7.5% at stage IV), while (52.5%) were diagnosed at early stages (6.5%
at stage I/46% at stage II). A binary logistic regression model showed that
unmarried females (p=0.012), had non-luminal molecular subtype of BC
including HER2 enriched and triple-negative tumors (p<0.001),
presentation with breast changes and a non-palpable lump (p=0.024) or
non-breast symptoms (P=0.002), a delay longer than 3 months to the first
presentation by patients (p<0.001), and a delay to definite diagnosis
longer than 1 month by providers (p<0.001) were significant risk factors
of late-stage diagnosis of BC. Conclusions Late-stage diagnosis of BC in Egypt is associated with the aggressiveness of
some molecular subtypes and other important modifiable factors that should
be addressed.
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LeBlanc G, Lee I, Carretta H, Luo Y, Sinha D, Rust G. Rural-Urban Differences in Breast Cancer Stage at Diagnosis. WOMEN'S HEALTH REPORTS 2022; 3:207-214. [PMID: 35262058 PMCID: PMC8896172 DOI: 10.1089/whr.2021.0082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/13/2022]
Abstract
Purpose: To analyze the extent to which rural-urban differences in breast cancer stage at diagnosis are explained by factors including age, race, tumor grade, receptor status, and insurance status. Methods: Using the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) 18 database, analysis was performed using data from women aged 50–74 diagnosed with breast cancer between the years 2013 and 2016. Patient rurality of residence was coded according to SEER's Rural-Urban Continuum Code 2013: Large Urban (RUCC 1), Small Urban (RUCC 2,3), and Rural (RUCC 4,5,6,7,8,9). Stage at diagnosis was coded according to SEER's Combined Summary Stage 2000 (2004+) criteria: Localized (0,1), Regional (2,3,4,5), and Distant (7). Descriptive statistics were analyzed, and variations were tested for across rural-urban categories using Kruskall–Wallis and Kendall's tau-b tests. Additionally, odds ratios (ORs) and 95% confidence intervals for the three ordinal levels of rural-urban residence were calculated while adjusting for other independent variables using ordinal logistic regression. Results: The rural residence category showed the largest proportion of women diagnosed with distant stage breast cancer. Additionally, we determined that patients with residence in both large and small urban areas had statistically significantly lower odds of higher stage diagnosis compared to rural patients even after controlling for age, race, tumor grade, receptor status, and insurance status. Conclusions: Rural women with breast cancer show small but statistically significant disparities in stage-at-diagnosis. Further research is needed to understand local area variation in these disparities across a wide range of rural communities, and to identify the most effective interventions to eliminate these disparities.
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Affiliation(s)
- Gabrielle LeBlanc
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Inkoo Lee
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - Henry Carretta
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Yi Luo
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
| | - Debajyoti Sinha
- Department of Statistics, Florida State University, Tallahassee, Florida, USA
| | - George Rust
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, Tallahassee, Florida, USA
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Sharma R. Breast cancer burden in Africa: evidence from GLOBOCAN 2018. J Public Health (Oxf) 2021; 43:763-771. [PMID: 32657321 DOI: 10.1093/pubmed/fdaa099] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 04/07/2020] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Breast cancer is the leading malignancy in African females. This study aims to examine the breast cancer burden in Africa using recently released GLOBOCAN 2018 estimates. METHODS The incidence and mortality estimates of age- and country-wise burden of breast cancer in 54 African countries were obtained from GLOBOCAN 2018. RESULTS In Africa, breast cancer caused 74 072 deaths, and 168 690 cases were estimated to have occurred in 2018. The age-standardized incidence rate stood at 37.9/100 000 in Africa, varying from 6.9/100 000 in the Gambia to 69.6/100 000 in Mauritius. The age-standardized mortality rate stood at 17.2/100 000 in 2018, ranging from 4/100 000 in the Gambia to 29.1/100 000 in Somalia in 2018. Nigeria was the leading country in terms of absolute burden with 26 310 cases and 11 564 deaths, followed by Egypt with 23 081 new cases and 9254 deaths. The mortality-to-incidence ratio for Africa stood at 0.44, varying from 0.24 in Libya to 0.68 in the Central African Republic. CONCLUSION To tackle breast cancer burden in Africa, the main challenges are late-stage disease presentation, lack of screening and therapeutic infrastructure, lack of awareness and limited resources.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi 110095, India
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6
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Fan Q, Yao XA, Han X. Spatial variation and disparity in female breast cancer relative survival in the United States. Cancer 2021; 127:4006-4014. [PMID: 34265081 DOI: 10.1002/cncr.33801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/25/2021] [Accepted: 06/28/2021] [Indexed: 11/07/2022]
Abstract
BACKGROUND Breast cancer is the most common cancer among women in the United States. However, data on spatial disparities in survival for breast cancer are limited in the country. This study estimated 5-year relative survival (RS) of female breast cancer and examined the spatial variations across the contiguous United States. METHODS Women newly diagnosed with breast cancer in 2003-2010 in the United States were identified from the National Cancer Database and followed up through 2016. The crude 5-year RS at the county level was estimated and adjusted for patients' key sociodemographic and clinical factors. To account for spatial effects, the RS estimates were smoothed using the Bayesian spatial survival model. A local spatial autocorrelation analysis with the Getis-Ord Gi* statistics was applied to identify geographic clusters of low or high RS. RESULTS Clusters of low RS were identified in more than 15 states covering 671 counties, mostly in the southeast and southwest regions, including Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Approximately 30% of these clusters can be explained by patients' characteristics: Race, insurance, and stage at diagnosis appeared to be the major attributable factors. CONCLUSIONS Significant spatial disparity in female breast cancer survival was found, with low RS clusters identified in Georgia, Alabama, Mississippi, Louisiana, Arkansas, Oklahoma, and Texas. Policies and interventions that focus on serving Black women, improvements in insurance coverage, and early detection in these areas could potentially mitigate the spatial disparities.
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Affiliation(s)
- Qinjin Fan
- Department of Geography, University of Georgia, Athens, Georgia
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Xiaobai A Yao
- Department of Geography, University of Georgia, Athens, Georgia
| | - Xuesong Han
- Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Osei-Twum JA, Gedleh S, Lofters A, Nnorom O. Differences in Breast Cancer Presentation at Time of Diagnosis for Black and White Women in High Resource Settings. J Immigr Minor Health 2021; 23:1305-1342. [PMID: 33721146 PMCID: PMC8599379 DOI: 10.1007/s10903-021-01161-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2021] [Indexed: 12/31/2022]
Abstract
This paper provides a narrative review of the existing literature on differences in demographic and biological features of breast cancer at time of diagnosis between Black and White women in Canada, the United Kingdom and the United States. Electronic database searches for published peer-reviewed articles on this topic were conducted, and 78 articles were included in the final narrative review. Differences between Black and White women were compared for eight categories including age, tumour stage, size, grade, lymph node involvement, and hormone status. Black women were significantly more likely to present with less favourable tumour features at the time of diagnosis than White women. Significant differences were reported in age at diagnosis, tumour stage, size, grade and hormone status, particularly triple negative breast cancer. Limitations on the generalizability of the review findings are discussed, as well as the implications of these findings on future research, especially within the Canadian context.
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Affiliation(s)
- Jo-Ann Osei-Twum
- Department of Physical Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
| | - Sahra Gedleh
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada.
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1V7, Canada
- Women's College Research Institute, 76 Grenville St, Toronto, ON, M5G 1N8, Canada
| | - Onye Nnorom
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
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8
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Sharma R. Global, regional, national burden of breast cancer in 185 countries: evidence from GLOBOCAN 2018. Breast Cancer Res Treat 2021; 187:557-567. [PMID: 33515396 DOI: 10.1007/s10549-020-06083-6] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 12/29/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aims to examine the burden of breast cancer in 185 countries in 2018. METHODS The estimates of incidence, mortality, and prevalence of breast cancer were drawn from GLOBOCAN 2018. The overall burden of breast cancer was gauged using breast cancer burden index (BRCBI)-a novel index comprising age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), mortality-to-incidence ratio (MIR), prevalence-to-incidence ratio (PIR), and prevalence-to-mortality ratio (PMR). The socioeconomic status of countries was measured using human development index (HDI) RESULTS: Globally, breast cancer was responsible for an estimated 626,679 deaths at age-standardized rate of 13/100,000; there were 2.1 million cases diagnosed in 2018 at age-standardized rate of 46.3/100,000. The ASIR varied 22-fold from 5/100,000 (Bhutan) to 113.2/100,000 (Belgium). The ASMR varied 13-fold from 2.7/100,000 (Bhutan) to 36.9/100,000 (Fiji). The HDI exhibited a positive gradient with ASIR (r = 0.73), PIR (r = 0.98), and PMR (r = 0.85); with MIR, however, it exhibited a negative association (r = - 0.83). The BRCBI spanned from 0.70 in Somalia to 78.92 in South Korea and exhibited a positive association with HDI (r = 0.76). An additional 46,823 female lives in 2018 and a cumulative total of 333,304 lives could have been saved over 2013-2018, had countries performed as per their HDI. CONCLUSIONS The substantial burden of breast cancer in developing and low-resource economies calls for a holistic approach to cancer management and control that includes oncologic infrastructure to provide cost-effective screening, diagnostic, therapeutic, and palliative services, greater breast cancer awareness, and mitigation of risk factors.
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Affiliation(s)
- Rajesh Sharma
- University School of Management and Entrepreneurship, Delhi Technological University, Delhi, India.
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Nelson D, Law GR, McGonagle I, Turner P, Jackson C, Kane R. The Effect of Rural Residence on Cancer-Related Self-Efficacy With UK Cancer Survivors Following Treatment. J Rural Health 2020; 38:28-33. [PMID: 33289206 DOI: 10.1111/jrh.12549] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE To examine rural and urban differences in cancer-related self-efficacy with UK cancer survivors following treatment. METHODS A cross-sectional postal survey with posttreatment cancer survivors in the East Midlands of England. The survey collected data on demographics and cancer-related self-efficacy using the Cancer Survivors Self-Efficacy Scale. Rural-urban residence was determined using Office for National Statistics classifications. Linear Regression models were developed using a Directed Acyclic Graph that determined confounding variables. When the model deviated from normal the outcome variable was transformed using the Box-Cox transformation. FINDINGS Of those surveyed, 227 responded, of whom 58% were female and 45% lived in a rural area. A linear regression model showed a significant increase in cancer-related self-efficacy in cancer survivors living in rural areas compared to urban residents (0.76, 95% CI: 0.25-1.27), although the residual plot deviated from a normal distribution. A model of the effect of rural living on a Box-Cox transformed outcome variable confirmed an increased cancer-related self-efficacy score in rural regions (9.06, 95% CI: 2.97-15.14). Rural living remained significant (7.98, 95% CI: 1.78-14.19) after adjustment for the respondents' income. Similarly adjusting for deprivation led to a significant increase in cancer-related self-efficacy in rural regions (8.64, 95% CI: 2.48-14.79). CONCLUSION This study has important implications when considering the impact of location of residence on cancer-related self-efficacy in cancer survivorship. The role of deprivation had some impact for sample respondents in both the urban and rural environment and merits further analysis.
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Affiliation(s)
- David Nelson
- College of Social Science, Lincoln International Institute for Rural Health, University of Lincoln, Lincoln, UK
| | - Graham R Law
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Ian McGonagle
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Paul Turner
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Christine Jackson
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
| | - Ros Kane
- School of Health and Social Care, College of Social Science, University of Lincoln, Lincoln, UK
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Fahim SM, Hsu CH, Lin FJ, Qian J, Chou C. Association between prior use of anti-diabetic medication and breast cancer stage at diagnosis. Expert Opin Drug Saf 2020; 20:235-243. [PMID: 33207942 DOI: 10.1080/14740338.2021.1853703] [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] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knowledge regarding antidiabetic medication (ADM) use prior to breast cancer (BC) diagnosis remains limited. The objectives were to (1) evaluate if the prior use of ADM was associated with BC stage at diagnosis and (2) identify and compare patient characteristics among BC patients using different ADMs. RESEARCH DESIGN AND METHODS Newly diagnosed female BC patients exposed to any medication during one year prior to cancer diagnosis were identified in 2008-2013 Linked Surveillance, Epidemiology, and End Results (SEER)-Medicare database. Stage at diagnosis, categorized as early and advanced, was the primary outcome. Chi-square tests were used to compare characteristics and logistic regression models were applied to examine the effect while controlling for patient's characteristics. RESULTS A total of 1,719 female BC patients used ADM while 6,084 patients were non-ADM users. Although a higher proportion of ADM users (20.36%) were diagnosed with advanced stage compared to the non-ADM users (14.46%), the difference was not statistically significant after adjusting for the patients' characteristics. Besides, insulin users were more likely to be diagnosed with advanced stage (adjusted odds ratio 1.69; 95% CI 1.15, 2.48) compared to metformin users. CONCLUSIONS The association between ADM use and BC diagnostic characteristics varied based on different treatments.
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Affiliation(s)
- Shahariar Mohammed Fahim
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiu-Hsieh Hsu
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, the University of Arizona , Tucson, AZ, USA
| | - Fang-Ju Lin
- Graduate Institute of Clinical Pharmacy & School of Pharmacy, College of Medicine, National Taiwan University , Taipei, Taiwan.,Department of Pharmacy, National Taiwan University Hospital , Taipei, Taiwan
| | - Jingjing Qian
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA
| | - Chiahung Chou
- Department of Health Outcomes Research and Policy, Harrison School of Pharmacy, Auburn University , Auburn, AL, USA.,Department of Medical Research, China Medical University Hospital , Taichung, Taiwan
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Cubero DIG, Sette CVDM, Piscopo BDCP, Monteiro CRDA, Schoueri JHM, Tavares HDDA, Argani IL, Garcia MA, Passarela K, Del Giglio A. Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care. Rev Assoc Med Bras (1992) 2019; 64:814-818. [PMID: 30673002 DOI: 10.1590/1806-9282.64.09.814] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/13/2018] [Indexed: 11/21/2023] Open
Abstract
INTRODUCTION Structural disparities between different Brazilian regions in public health system cause patients to migrate in search of better conditions to treat their diseases. Besides patient's discomfort, there is a concentration of care in large centres, causing overload to current capacity. OBJECTIVE To evaluate migratory flow and associated factors in a reference service in oncology. METHODS Cross-sectional study conducted at a referral oncology service in Great ABC region of São Paulo. Patients were interviewed, and clinical and demographic data collected. RESULTS Between March-July 2016, 217 patients were included. Analysis showed a divergence between the postal code registered in the medical record and that recorded during the interview in approximately 10% of cases. Of these, 42.9% were residents of other states. Search for treatment motivated most patients to seek service outside their city. CONCLUSION Results reflect the informal search for medical care outside the home area. Besides the direct impact on patients' quality of life, migratory flow has an economic-social impact because these patients place a burden and impose costs on services of cities where they do not perform their responsibilities as citizens. Confirmation of the existence of a significant migratory flow demonstrates the need to discuss restructuring public health policies.
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Affiliation(s)
- Daniel I G Cubero
- . ABC School of Medicine (Faculdade de Medicina do ABC - FMABC), Santo André, São Paulo, Brasil
| | | | | | | | | | | | - Igor Luiz Argani
- . ABC School of Medicine (Faculdade de Medicina do ABC - FMABC), Santo André, São Paulo, Brasil
| | - Marília Arrais Garcia
- . ABC School of Medicine (Faculdade de Medicina do ABC - FMABC), Santo André, São Paulo, Brasil
| | - Karoline Passarela
- . ABC School of Medicine (Faculdade de Medicina do ABC - FMABC), Santo André, São Paulo, Brasil
| | - Auro Del Giglio
- . ABC School of Medicine (Faculdade de Medicina do ABC - FMABC), Santo André, São Paulo, Brasil
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Sowunmi A, Olatunji T, Ketiku K, Campbell O. Sociodemographic correlates and management of breast cancer in Radiotherapy Department, Lagos University Teaching Hospital: A 10-year review. JOURNAL OF CLINICAL SCIENCES 2019. [DOI: 10.4103/jcls.jcls_82_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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13
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Allen H, Wright B, Broffman L. The Impacts of Medicaid Expansion on Rural Low-Income Adults: Lessons From the Oregon Health Insurance Experiment. Med Care Res Rev 2017; 75:354-383. [PMID: 29148324 DOI: 10.1177/1077558716688793] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medicaid expansions through the Affordable Care Act began in January 2014, but we have little information about what is happening in rural areas where provider access and patient resources might be more limited. In 2008, Oregon held a lottery for restricted access to its Medicaid program for uninsured low-income adults not otherwise eligible for public coverage. The Oregon Health Insurance Experiment used this opportunity to conduct the first randomized controlled study of a public insurance expansion. This analysis builds off of previous work by comparing rural and urban survey outcomes and adds qualitative interviews with 86 rural study participants for context. We examine health care access and use, personal finances, and self-reported health. While urban and rural populations have unique demographic profiles, rural populations appear to have benefited from Medicaid as much as urban. Qualitative interviews revealed the distinctive challenges still facing low-income uninsured and newly insured rural populations.
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Affiliation(s)
| | - Bill Wright
- 2 Providence Health & Services Center for Outcomes Research and Education, Portland, OR, USA
| | - Lauren Broffman
- 2 Providence Health & Services Center for Outcomes Research and Education, Portland, OR, USA
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Khokher S, Qureshi MU, Mahmood S, Sadiq S. Determinants of Advanced Stage at Initial Diagnosis of Breast Cancer in Pakistan: Adverse Tumor Biology vs Delay in Diagnosis. Asian Pac J Cancer Prev 2017; 17:759-65. [PMID: 26925676 DOI: 10.7314/apjcp.2016.17.2.759] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Breast cancer is the most frequent cancer of women in Pakistan with the majority presenting with stage III or IV lesionsat initial diagnosis. Patient and health system related factors are well known determinants of delay in presentation and diagnosis. Additionally, breast cancer being a heterogeneous disease, the various molecular subtypes featuring different aggressiveness also need to be considered. The present study evaluated the association of stage at initial diagnosis of breast cancer with these two factors in local women at a tertiary level health care facility in Lahore, Pakistan. MATERIALS AND METHODS Patient and tumor features were recorded separately during diagnostic workup in Breast Clinics at INMOL and at Services Hospital, Lahore. Data were entered in MS Excel and analyzed by descriptive statistics and Chi-Square test. RESULTS Among the 261 patients, 64% were staged as late breast cancer (LBC), the mean age was 46.8 with standard deviation of 13 years. Some 92% had invasive ductal carcinoma (IDC), 61% had luminal types (LT) of non-aggressive tumor while 39% had the non-luminal types (NLT) of of HER2-enriched or basal aggressive tumors. While 70% of patients presented within one year of symptomatic disease (early report group "ERG"), 30% reported after a mean delay of 4 years with a standard deviation of 3.75 years. The stage distribution among ERG patients was not statistically different from those reporting late (P=0.123). Statistically larger proportion of patients with NLT presented as LBC as compared to the LT (P =0.034). Among the ERG, statistically different stage distribution of disease was observed for the NLT versus LT (P=0.047). Among those presenting late, this difference was insignificant (P=0.416). CONCLUSIONS Breast cancer is a distinct disease in Pakistan with a high frequency of aggressive molecular types affecting younger women, with the majority presenting as LBC. Association of NLT with higher stage at diagnosis is statistically significant whereas time delay in diagnosis is not. Further research is required to define the risk profile and features in local patients. The burden of LBC can be reduced by promoting breast health awareness and by establishing easily accessible dedicated breast care set ups in the hospitals.
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Affiliation(s)
- Samina Khokher
- Surgical Special Department, Services Hospital, Lahore, Pakistan E-mail :
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15
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Krieger N, Jahn JL, Waterman PD. Jim Crow and estrogen-receptor-negative breast cancer: US-born black and white non-Hispanic women, 1992-2012. Cancer Causes Control 2017; 28:49-59. [PMID: 27988896 DOI: 10.1007/s10552-016-0834-2] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 11/29/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE It is unknown whether Jim Crow-i.e., legal racial discrimination practiced by 21 US states and the District of Columbia and outlawed by the US Civil Rights Act in 1964-affects US cancer outcomes. We hypothesized that Jim Crow birthplace would be associated with higher risk of estrogen-receptor-negative (ER-) breast tumors among US black, but not white, women and also a higher black versus white risk for ER- tumors. METHODS We analyzed data from the SEER 13 registry group (excluding Alaska) for 47,157 US-born black non-Hispanic and 348,514 US-born white non-Hispanic women, aged 25-84 inclusive, diagnosed with primary invasive breast cancer between 1 January 1992 and 31 December 2012. RESULTS Jim Crow birthplace was associated with increased odds of ER- breast cancer only among the black, not white women, with the effect strongest for women born before 1965. Among black women, the odds ratio (OR) for an ER- tumor, comparing women born in a Jim Crow versus not Jim Crow state, equaled 1.09 (95% confidence interval [CI] 1.06, 1.13), on par with the OR comparing women in the worst versus best census tract socioeconomic quintiles (1.15; 95% CI 1.07, 1.23). The black versus white OR for ER- was higher among women born in Jim Crow versus non-Jim Crow states (1.41 [95% CI 1.13, 1.46] vs. 1.27 [95% CI 1.24, 1.31]). CONCLUSIONS The unique Jim Crow effect for US black women for breast cancer ER status underscores why analysis of racial/ethnic inequities must be historically contextualized.
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Affiliation(s)
- Nancy Krieger
- Department of Social and Behavioral Sciences (SBS), Harvard T.H. Chan School of Public Health (HSPH), 677 Huntington Avenue, Boston, MA, 02115, USA.
| | - Jaquelyn L Jahn
- Department of Social and Behavioral Sciences (SBS), Harvard T.H. Chan School of Public Health (HSPH), 677 Huntington Avenue, Boston, MA, 02115, USA
| | - Pamela D Waterman
- Department of Social and Behavioral Sciences (SBS), Harvard T.H. Chan School of Public Health (HSPH), 677 Huntington Avenue, Boston, MA, 02115, USA
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16
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Davis MM, Spurlock M, Dulacki K, Meath T, Li HF(G, McCarty D, Warne D, Wright B, McConnell KJ. Disparities in Alcohol, Drug Use, and Mental Health Condition Prevalence and Access to Care in Rural, Isolated, and Reservation Areas: Findings From the South Dakota Health Survey. J Rural Health 2016; 32:287-302. [PMID: 26515583 PMCID: PMC7331464 DOI: 10.1111/jrh.12157] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Research on urban/rural disparities in alcohol, drug use, and mental health (ADM) conditions is inconsistent. This study describes ADM condition prevalence and access to care across diverse geographies in a predominantly rural state. METHODS Multimodal cross-sectional survey in South Dakota from November 2013 to October 2014, with oversampling in rural areas and American Indian reservations. Measures assessed demographic characteristics, ADM condition prevalence using clinical screenings and participant self-report, perceived need for treatment, health service usage, and barriers to obtaining care. We tested for differences among urban, rural, isolated, and reservation geographic areas, controlling for participant age and gender. FINDINGS We analyzed 7,675 surveys (48% response rate). Generally, ADM condition prevalence rates were not significantly different across geographies. However, respondents in isolated and reservation areas were significantly less likely to have access to primary care. Knowledge of treatment options was significantly lower in isolated regions and individuals in reservation areas had significantly lower odds of reporting receipt of all needed care. Across the sample there was substantial discordance between ADM clinical screenings and participant self-reported need; 98.1% of respondents who screened positive for alcohol or drug misuse and 63.8% of respondents who screened positive for a mental health condition did not perceive a need for care. CONCLUSION In a predominantly rural state, geographic disparities in ADM conditions are related to differences in access as opposed to prevalence, particularly for individuals in isolated and reservation areas. Educational interventions about ADM condition characteristics may be as important as improving access to care.
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Affiliation(s)
- Melinda M. Davis
- Department of Family Medicine, Oregon Health & Science University, Portland, Oregon
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
| | - Margaret Spurlock
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Kristen Dulacki
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - Thomas Meath
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
| | - Hsin-Fang (Grace) Li
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - Dennis McCarty
- Department of Public Health and Preventive Medicine, Oregon Health & Science University, Portland, Oregon
| | - Donald Warne
- Master of Public Health Program, North Dakota State University, Fargo, North Dakota
| | - Bill Wright
- Center for Outcomes Research & Education, Providence Health & Services, Portland, Oregon
| | - K. John McConnell
- Oregon Rural Practice-based Research Network, Oregon Health & Science University, Portland, Oregon
- Center for Health Systems Effectiveness, Oregon Health & Science University, Portland, Oregon
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon
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Kim AY, Wakefield J. A Bayesian Method for Cluster Detection with Application to Brain and Breast Cancer in Puget Sound. Epidemiology 2016; 27:347-55. [PMID: 26841056 PMCID: PMC4821733 DOI: 10.1097/ede.0000000000000450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cluster detection is an important public health endeavor, and in this article, we describe and apply a recently developed Bayesian method. Commonly used approaches are based on so-called scan statistics and suffer from a number of difficulties, which include how to choose a level of significance and how to deal with the possibility of multiple clusters. The basis of our model is to partition the study region into a set of areas that are either "null" or "non-null," the latter corresponding to clusters (excess risk) or anticlusters (reduced risk). We demonstrate the Bayesian method and compare with a popular existing approach, using data on breast, brain, lung, prostate, and colorectal cancer, in the Puget Sound region of Washington State.
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Affiliation(s)
- Albert Y Kim
- From the aMathematics Department, Middlebury College, Middlebury, VT; and bDepartments of Statistics and Biostatistics, University of Washington, Seattle, WA
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Trieu PDY, Mello-Thoms C, Brennan PC. Female breast cancer in Vietnam: a comparison across Asian specific regions. Cancer Biol Med 2015; 12:238-45. [PMID: 26487968 PMCID: PMC4607827 DOI: 10.7497/j.issn.2095-3941.2015.0034] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Breast cancer is one of the most commonly diagnosed malignancies and the leading cause of cancer death of women over the world. A large number of females with breast cancer in Vietnam and other Southeast Asian (SEA) countries present at an early age with more aggressive tumors compared with women in Australia. Despite experiencing a low incidence rate, the increasing incidence rate among SEA countries exceeds that of the Westernized world. Changes in reproductive factors, environmental exposures, and lifestyle are the possible causes of this trend. However, limited evidence shows that these factors are associated with breast cancer in the Vietnamese population. Breast cancer incidence rates within Vietnam are not uniform and appear to be dependent on geographic location. Findings from this review have important implications for breast cancer control and treatment in Vietnam. A good understanding of the morphology of the breast and the type and nature of breast cancers presenting in Vietnam is required to facilitate the introduction of an effective national breast screening program.
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Affiliation(s)
| | - Claudia Mello-Thoms
- Faculty of Health Sciences, University of Sydney, New South Wales 2141, Australia
| | - Patrick C Brennan
- Faculty of Health Sciences, University of Sydney, New South Wales 2141, Australia
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Boukovalas S, Sariego J. The Urban/Rural Dichotomy in the Distribution of Breast Cancer across Pennsylvania. Am Surg 2015. [DOI: 10.1177/000313481508100922] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Breast cancer rates clearly differ across the United States. This is due to a variety of factors, but at least one determinant is the population density. Breast cancer detection rates and treatment paradigms may differ in rural areas when compared with more urban ones. As the population becomes more mobile and diffuse, this may or may not be a worsening problem. The current analysis was undertaken to examine the breast cancer incidence and outcomes in a single state in an attempt to plan for resource allocation in the future. A retrospective analysis was performed using data available from the Pennsylvania Department of Health regarding breast cancer rates by county, the distribution of cases with regard to degree of rurality, death rates by county as a function of rurality, and the age distribution of all presenting cases. Data from 1999 were compared with those of 2009. The United States Census Bureau definition of rurality was used, which specifies that a county be classified as rural if the population density is less than 284 persons/square mile. Between 1999 and 2009, the population of Pennsylvania increased by approximately 3.4 per cent (421,325 people). The urban population increased by 3.9 per cent, whereas the rural population increased by only 2.2 per cent. During that same period, the number of cancer cases/100,000 population remained about the same: 391.41 in 1999; 390.7 in 2009. However, the distribution of cases shifted during that time toward more rural areas of the state: in 1999, there were 372.3 breast cancer cases/100,000 population compared with 2009 when the rate was 384.4/100,000 population. The number of cancer deaths/100,000 population actually dropped overall during the decade: 98.5 in 1999 versus 82.3 in 2009. Though this was true in both urban and rural counties, the decrease was much less pronounced in the rural areas. In urban counties, the death rate dropped from 100.5 to 81.5/100,000 population, whereas in rural counties, the drop was only from 93.3 to 84.3. The greater increase in cases diagnosed in rural areas of Pennsylvania is only partially explained by the relatively greater increase in rural population. There are undoubtedly other issues at work in rural areas: environmental factors, diffusion of resources, less access to surveillance programs. In addition, though the death rate has dropped in both rural and urban areas, this is much less pronounced in rural counties. Coupled with the increase in prevalence in those areas, this suggests that breast cancer care may be lagging in rural areas. There is a need to examine allocation of resources and surveillance programs.
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Affiliation(s)
| | - Jack Sariego
- Temple University School of Medicine, Philadelphia, Pennsylvania
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Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, El-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 2015; 386:569-624. [PMID: 25924834 DOI: 10.1016/s0140-6736(15)60160-x] [Citation(s) in RCA: 2194] [Impact Index Per Article: 243.8] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- John G Meara
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA.
| | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Lars Hagander
- Pediatric Surgery and Global Pediatrics, Department of Pediatrics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Blake C Alkire
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA
| | - Nivaldo Alonso
- Plastic Surgery Department, University of São Paulo, São Paulo, Brazil
| | - Emmanuel A Ameh
- Department of Surgery, Division of Peadiatric Surgery, National Hospital, Abuja, Nigeria
| | - Stephen W Bickler
- Rady Children's Hospital, University of California, San Diego, San Diego, CA, USA
| | - Lesong Conteh
- School of Public Health, Imperial College London, London, UK
| | - Anna J Dare
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | | | | | | | - Paul E Farmer
- Department of Global Health and Social Medicine, Division of Global Health Equity, Harvard Medical School and Brigham and Women's Hospital, Boston, MA, USA; Partners in Health, Boston, MA, USA
| | - Atul Gawande
- Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; Ariadne Labs Boston, MA, USA
| | - Rowan Gillies
- Royal North Shore Hospital, St Leonards, NSW, Australia
| | - Sarah L M Greenberg
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Medical College of Wisconsin, Milwaukee, WI, USA
| | - Caris E Grimes
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - Russell L Gruen
- The Alfred Hospital and Monash University, Melbourne, VIC, Australia; Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Thaim Buya Kamara
- Connaught Hospital, Freetown, Sierra Leone; Department of Surgery, University of Sierra Leone, Freetown, Sierra Leone
| | - Chris Lavy
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ganbold Lundeg
- Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Nyengo C Mkandawire
- Department of Surgery, College of Medicine, University of Malawi, Blantyre, Malawi; School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Nakul P Raykar
- Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA; Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Johanna N Riesel
- Department of Surgery, Massachusetts General Hospital, Boston, MA, USA
| | - Edgar Rodas
- The Cinterandes Foundation, Universidad del Cuenca, and Universidad del Azuay, Cuenca, Ecuador; Universidad del Azuay, Cuenca, Ecuador
| | - John Rose
- Department of Surgery, University of California, San Diego, CA, USA
| | | | - Mark G Shrime
- Department of Otology and Laryngology, Harvard Medical School, Boston, USA; Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA, USA; Harvard Interfaculty Initiative in Health Policy, Cambridge, MA, USA
| | - Richard Sullivan
- Institute of Cancer Policy, Kings Health Partners Integrated Cancer Centre, King's Centre for Global Health, King's College London, London, UK
| | - Stéphane Verguet
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - David Watters
- Royal Australasian College of Surgeons, East Melbourne, and Deakin University, Melbourne, VIC, Australia
| | - Thomas G Weiser
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Iain H Wilson
- Department of Anaesthesia, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Gavin Yamey
- Evidence to Policy Initiative, Global Health Group, University of California, San Francisco, CA, USA
| | - Winnie Yip
- Blavatnik School of Government, University of Oxford, Oxford, UK
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Williams F, Thompson E. Disparity in Breast Cancer Late Stage at Diagnosis in Missouri: Does Rural Versus Urban Residence Matter? J Racial Ethn Health Disparities 2015; 3:233-9. [PMID: 27271063 DOI: 10.1007/s40615-015-0132-9] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 05/14/2015] [Accepted: 05/19/2015] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Despite the fact that black women have a lower incidence of breast cancer compared to white women, black women experience higher death rates than any other group. We examined the stage of breast cancer presentation by race and geographic region using population-based breast cancer incidence in all 115 counties in the state of Missouri. METHODS We used 2003-2008 breast cancer incidence data from Missouri Cancer Registry and Research Center. County of residence was categorized as urban or rural using the rural-urban continuum code. We computed the conditional proportion of stage at diagnosis by race and metropolitan status and also used Pearson's chi-squared test with Yates' continuity correction to determine statistical significance of association. RESULTS Results of the study indicate that a greater proportion of black women (38.8 %) compared to white women (30.2 %) were diagnosed with more advanced breast metastasis. Our results further suggest that stage at diagnosis depended on county of residence or metropolitan status (p = .04). Women living in non-metropolitan counties were slightly more likely to have late-stage breast cancer than their metropolitan counterparts (32.0 vs 30.7 %). Overall, black women had 1.5-fold increased odds of late-stage breast cancer diagnosis compared to their white counterparts (OR = 1.50; 95 % CI, 1.39, 1.63; p < 0.0001). While the odds of late diagnosis among women living in non-metropolitan or rural counties was over 11 % higher compared with their metropolitan or urban counterpart. CONCLUSION The current study corroborates previous findings that the risk of late-stage breast cancer diagnosis was higher among women residing in non-metropolitan rural counties.
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Affiliation(s)
- Faustine Williams
- Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, MO, 63110, USA.
| | - Emmanuel Thompson
- Department of Mathematics, Southeast Missouri State University, Cape Girardeau, MO, 63701, USA
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Vettuparambil A, Rajan G, Chirukandath R, Culas TB. Epidemiology, Pathological Characteristics and Estrogen and Progesterone Receptor Status of Operated Cases of Female Breast Cancer: A Retrospective Review of 266 Cases from Kerala. Indian J Surg Oncol 2015; 6:352-5. [PMID: 27065660 DOI: 10.1007/s13193-015-0425-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022] Open
Abstract
Breast cancer is presently the most common cancer among women in Kerala, in Southern India. The objectives of this study were to analyze the epidemiology and pathological characteristics of female breast carcinoma in Kerala. 266 patients who were diagnosed with operable breast cancer between April 2009 and June 2010 were studied. Various pathological characteristics including stage, grade, axillary lymph nodal status, tumor size, and estrogen and progesterone receptor status were studied. Estrogen and progesterone receptor status were evaluated by immunohistochemistry. Chi-square test and frequency tables were used for statistical analysis. The mean age at presentation was 50 years. 48.9 % of the patients were premenopausal. 53.76 % had grade II tumors. Positive axillary lymph nodes were found in 70.3 % patients, and 68 % presented with stage II disease. 54.13 % were ER positive and 62 % were PR positive. The relatively young age at diagnosis, late presentation of the disease, and lower estrogen and progesterone receptor expression compared to patients from the West point toward the need for better breast cancer awareness and screening programmes in Kerala.
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Affiliation(s)
| | - Gautham Rajan
- Government Medical College, Thrissur, Kerala 680596 India
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Pal L, Kidwai N, Kayani J, Grant WB. Donor egg IVF model to assess ecological implications for ART success. J Assist Reprod Genet 2014; 31:1453-60. [PMID: 25179156 DOI: 10.1007/s10815-014-0322-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/19/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE Environmental influences on reproductive success are recognized. We hypothesized that location of fertility clinics may influence treatment success and explored this hypothesis utilizing donor egg IVF (IVF) embryo transfer (ET) model. METHODS Publicly accessible national registry data (Society for Assisted Reproductive Technology) on fresh & frozen (FET) ET cycles undertaken at participating clinics across North America (n = 444 IVF centers) for 2007 were utilized. Information on number of donor egg IVF cycles, live birth (LB) rate following fresh and frozen ET(FET), average number (#) of ET and IVF center's location, geographical coordinates (latitude, longitude, altitude), annualized average temperatures and midyear regional ultraviolet B (UVB) radiation intensity were obtained. Multivariable logistic regression analyses assessed relationship between LBR (in tertile and uppermost versus lesser quartiles) following fresh and FET with geographical coordinates (region and altitude of clinic location) and ecological influences (average temperature and midyear UVB intensity), adjusting for #ET and clinic experience with donor egg IVF. RESULTS Average number of fresh ET, clinic location (region) and midyear UVB intensity were positive predictors of LBR following fresh ET, whereas altitude and annualized average regional temperature demonstrated an inverse relationship with LBR following fresh ET. For FET cycles, #ET, clinic region and altitude were positive determinants of increasing LBR's. Annualized regional temperature and midyear UVB failed to demonstrate any relationship with LB following donor egg FET. CONCLUSION Our data suggest that ecological influences may relate to donor egg IVF cycle success. Future studies are needed to better elucidate the mechanisms that could explain the observed associations.
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Affiliation(s)
- Lubna Pal
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, 333 Cedar Street, FMB329, New Haven, CT, 06510, USA,
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Naughton MJ, Weaver KE. Physical and mental health among cancer survivors: considerations for long-term care and quality of life. N C Med J 2014; 75:283-6. [PMID: 25046097 PMCID: PMC4503227 DOI: 10.18043/ncm.75.4.283] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The physical and mental health of cancer patients needs to be addressed not only during active treatment but also throughout the continuum of survivorship care. This commentary provides an overview of issues pertinent to cancer survivors, with an emphasis on mental health issues and recommendations for annual clinical screening and monitoring using recently published guidelines from the American Society of Clinical Oncology.
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Affiliation(s)
- Michelle J Naughton
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA.
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina, USA
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Hsieh JCF, Cramb SM, McGree JM, Baade PD, Dunn NA, Mengersen KL. Bayesian Spatial Analysis for the Evaluation of Breast Cancer Detection Methods. AUST NZ J STAT 2014. [DOI: 10.1111/anzs.12059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jeff Ching-Fu Hsieh
- Queensland University of Technology; (QUT); GPO Box 2434 Brisbane QLD 4001 Australia
| | - Susanna M. Cramb
- Cancer Council Queensland; (CCQ); PO Box 201 Spring Hill QLD 4004 Australia
| | - James M. McGree
- Queensland University of Technology; (QUT); GPO Box 2434 Brisbane QLD 4001 Australia
| | - Peter D. Baade
- Cancer Council Queensland; (CCQ); PO Box 201 Spring Hill QLD 4004 Australia
| | - Nathan A.M. Dunn
- BreastScreen Queensland; (BSQ), Preventive Health Unit, Department of Health; PO Box 2368 Fortitude Valley BC QLD 4006 Australia
| | - Kerrie L. Mengersen
- Queensland University of Technology; (QUT); GPO Box 2434 Brisbane QLD 4001 Australia
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Weaver KE, Geiger AM, Lu L, Case LD. Rural-urban disparities in health status among US cancer survivors. Cancer 2013; 119:1050-7. [PMID: 23096263 PMCID: PMC3679645 DOI: 10.1002/cncr.27840] [Citation(s) in RCA: 177] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/20/2012] [Accepted: 08/13/2012] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although rural residents are more likely to be diagnosed with more advanced cancers and to die of cancer, little is known about rural-urban disparities in self-reported health among survivors. METHODS The authors identified adults who had a self-reported history of cancer from the National Health Interview Survey (2006-2010). Rural-urban residence was defined using US Census definitions. Logistic regression with weighting to account for complex sampling was used to assess rural-urban differences in health status after accounting for differences in demographic characteristics. RESULTS Of the 7804 identified cancer survivors, 20.8% were rural residents. This translated to a population of 2.8 million rural cancer survivors in the United States. Rural survivors were more likely than urban survivors to be non-Hispanic white (P < .001), to have less education (P < .001), and to lack health insurance (P < .001). Rural survivors reported worse health in all domains. After adjustment for sex, race/ethnicity, age, marital status, education, insurance, time since diagnosis, and number of cancers, rural survivors were more likely to report fair/poor health (odds ratio, 1.39; 95% confidence interval, 1.20-1.62), psychological distress (odds ratio, 1.23; 95% confidence interval, 1.00-1.50), ≥2 noncancer comorbidities (odds ratio, 1.15; 95% confidence interval, 1.01-1.32), and health-related unemployment (odds ratio, 1.66; 95% confidence interval, 1.35-2.03). CONCLUSIONS The current results provide the first estimates of the proportion and number of US adult cancer survivors who reside in rural areas. Rural cancer survivors are at greater risk for a variety of poor health outcomes, even many years after their cancer diagnosis, and should be a target for interventions to improve their health and well being.
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Affiliation(s)
- Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA.
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Jacke CO, Reinhard I, Albert US. Using relative survival measures for cross-sectional and longitudinal benchmarks of countries, states, and districts: the BenchRelSurv- and BenchRelSurvPlot-macros. BMC Public Health 2013; 13:34. [PMID: 23316692 PMCID: PMC3602052 DOI: 10.1186/1471-2458-13-34] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 12/19/2012] [Indexed: 11/10/2022] Open
Abstract
Background The objective of screening programs is to discover life threatening diseases in as many patients as early as possible and to increase the chance of survival. To be able to compare aspects of health care quality, methods are needed for benchmarking that allow comparisons on various health care levels (regional, national, and international). Objectives Applications and extensions of algorithms can be used to link the information on disease phases with relative survival rates and to consolidate them in composite measures. The application of the developed SAS-macros will give results for benchmarking of health care quality. Data examples for breast cancer care are given. Methods A reference scale (expected, E) must be defined at a time point at which all benchmark objects (observed, O) are measured. All indices are defined as O/E, whereby the extended standardized screening-index (eSSI), the standardized case-mix-index (SCI), the work-up-index (SWI), and the treatment-index (STI) address different health care aspects. The composite measures called overall-performance evaluation (OPE) and relative overall performance indices (ROPI) link the individual indices differently for cross-sectional or longitudinal analyses. Results Algorithms allow a time point and a time interval associated comparison of the benchmark objects in the indices eSSI, SCI, SWI, STI, OPE, and ROPI. Comparisons between countries, states and districts are possible. Exemplarily comparisons between two countries are made. The success of early detection and screening programs as well as clinical health care quality for breast cancer can be demonstrated while the population’s background mortality is concerned. Conclusions If external quality assurance programs and benchmark objects are based on population-based and corresponding demographic data, information of disease phase and relative survival rates can be combined to indices which offer approaches for comparative analyses between benchmark objects. Conclusions on screening programs and health care quality are possible. The macros can be transferred to other diseases if a disease-specific phase scale of prognostic value (e.g. stage) exists.
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Affiliation(s)
- Christian O Jacke
- Central Institute of Mental Health, Medical Faculty Mannheim/University Heidelberg, Square J5, 68159 Mannheim, Germany.
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Khokher S, Qureshi MU, Riaz M, Akhtar N, Saleem A. Clinicopathologic profile of breast cancer patients in Pakistan: ten years data of a local cancer hospital. Asian Pac J Cancer Prev 2012; 13:693-8. [PMID: 22524846 DOI: 10.7314/apjcp.2012.13.2.693] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Breast cancer is the most frequent cancer of women worldwide, with considerable geographic and racial/ethnic variation. Data are generally derived from population based cancer registries in the developed countries but hospital data are the most reliable source in the developing countries. Ten years data from 1st Jan 2000 to 31st Dec 2009 of a cancer hospital in Pakistan were here analyzed by descriptive statistics to evaluate the clinicopathologic profile of local breast cancer patients. Among 28,740 cancer patients, 6,718 were registered as breast cancer. The female to male ratio was 100:2. Breast cancer accounted for 23% of all and 41% of female cancers. Some 46% were residents of Lahore, with a mean age of 47±12 years. Less than 1% were at Stage 0 and 10%, 32%, 35% and 23% were at Stage I, II, III and IV respectively. Histopathology was unknown in 4% while 91%, 2% and 1% had invasive ductal carcinoma (IDC), invasive lobular carcinoma (ILC) and mucinous carcinoma respectively. Rare carcinomas accounted for the rest. Tumor grade 1, 2 and 3 was 11%, 55% and 34% among the known. Profile of breast cancer patients in Pakistan follows a pattern similar to that of other developing countries with earlier peak age and advanced disease stage at presentation. The male breast cancer accounts for higher proportion in the local population. Local women have higher frequency of IDC and lower frequency of ILC and DCIS, owing probably to a different risk profile. Use of hospital information systems and establishment of population based cancer registry is required to have accurate and detailed local data. Promotion of breast health awareness and better health care system is required to decrease the burden of advanced disease.
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Keller D, Guilfoyle C, Sariego J. Geographical Influence on Racial Disparity in Breast Cancer Presentation in the United States. Am Surg 2011. [DOI: 10.1177/000313481107700734] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It has been shown that breast cancer presentation varies between racial groups nationwide. Several studies have suggested that this is more a function of geographic rather than true racial disparity. The current study was undertaken to examine racial disparity in breast cancer presentation and to determine whether such disparity continues to be seen once geographic factors are taken into account. Breast cancer data were reviewed for all programs reporting to the American College of Surgeons Commission on Cancer National Cancer Database (NCDB) between 2000 and 2007, inclusive. These data were readily available online. Variables reviewed were: stage at the time of presentation; race; histology; and geographic location within the United States. Four broad regions of the country were chosen, corresponding to the U.S. Census Regions: Northeast, South, Midwest, and West. Patient data were classified as either “early” (stages 0, I, and II) or “late” (stages III and IV) at the time of presentation. A total of 1,388,186 patients were reported during the study period; 1,132,128 white and 256,058 nonwhite. There was a statistically significant difference in presentation between the two racial cohorts; a significantly higher percentage of whites presented with “early” disease (88.8%) when compared with nonwhites (83.8%). This statistically significant difference persisted even when the data were corrected for geographic location within the United States. There is a racial disparity with regard to breast cancer presentation throughout the United States which seems to be independent of geographic location. Nonwhites in all geographic regions present with later-stage disease than whites.
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Affiliation(s)
- Deborah Keller
- Department of Surgery, Temple University, Philadelphia, Pennsylvania
| | - Cara Guilfoyle
- Department of Surgery, Temple University, Philadelphia, Pennsylvania
| | - Jack Sariego
- Department of Surgery, Temple University, Philadelphia, Pennsylvania
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Boehmer U, Clark MA, Timm A, Glickman M, Sullivan M. Comparing sexual minority cancer survivors recruited through a cancer registry to convenience methods of recruitment. Womens Health Issues 2011; 21:345-52. [PMID: 21703869 DOI: 10.1016/j.whi.2011.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2010] [Revised: 03/09/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Sexual minority women, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, are not considered by cancer surveillance. This study assesses the representativeness of sexual minority breast cancer survivors, defined as having a lesbian or bisexual identity or reporting a preference for a female partner, who were recruited into a convenience sample compared with a population-based registry sample of sexual minority breast cancer survivors. METHODS Long-term survivors of non-metastatic breast cancer who self-reported as sexual minority were recruited from a cancer registry and subsequently from the community using convenience recruitment methods. Sexual minority breast cancer survivors who screened eligible participated in a telephone survey about their quality of life and factors associated therewith. RESULTS Participants in the convenience sample were similar to the registry-based sample with respect to adjustment to cancer, physical health, trust in physician, coping, social support, and sexual minority experiences. Compared with the convenience sample, breast cancer survivors in the registry sample were more likely married, more educated, diagnosed more recently, at an earlier stage of cancer, and more likely treated with breast-conserving surgery; they differed on adjuvant therapies. DISCUSSION Because sexual minority breast cancer survivors who volunteered for the community-based sample shared most characteristics of the sample recruited from the cancer registry, we concluded that the community sample had comparable representational quality. In the absence of cancer surveillance of sexual minorities, thoughtful convenience recruitment methods provide good representational quality convenience samples.
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Affiliation(s)
- Ulrike Boehmer
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts 02118, USA.
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Health-related quality of life in breast cancer survivors of different sexual orientations. Qual Life Res 2011; 21:225-36. [PMID: 21660650 DOI: 10.1007/s11136-011-9947-y] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Sexual minority women, e.g., lesbians and bisexuals, are an underserved population but not much is known about their quality of life (QOL) after a breast cancer diagnosis. For this reason, this study examines the physical and mental QOL and its association with sexual orientation in a cohort of long-term nonrecurring breast cancer survivors. METHODS Survivors were recruited from a cancer registry and additional sexual minority survivors through convenience methods. Data were collected via telephone survey from all 438 survivors, who were disease free and diagnosed with nonmetastatic breast cancer an average of 5 years earlier. Sexual orientation was the primary independent factor, and QOL, measured with the SF-12, was the outcome. Demographic and clinical factors were considered as correlates. RESULTS Sexual orientation was not significantly associated with survivors' physical or mental QOL. The majority of survivors reported good physical and mental QOL. The demographic and clinical factors explained about one-third of the variation in survivors' physical QOL, but did not account for most of survivors' mental QOL. CONCLUSIONS The lack of an association between sexual orientation and QOL suggests that if there is a link, it does not relate directly to clinical and demographic factors. Future studies need to identify areas of similarity and difference between sexual minority and heterosexual survivors and mechanisms to explain the similarity in QOL.
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Bennett KJ, Pumkam C, Bellinger JD, Probst JC. Cancer Screening Delivery in Persistent Poverty Rural Counties. J Prim Care Community Health 2011; 2:240-9. [DOI: 10.1177/2150131911406123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Rural populations are diagnosed with cancer at different rate and stages than nonrural populations, and race/ethnicity as well as the area-level income exacerbates the differences. The purpose of this analysis was to explore cancer screening rates across persistent poverty rural counties, with emphasis on nonwhite populations. Methods: The 2008 Behavioral Risk Factor Surveillance System was used, combined with data from the Area Resource File (analytic n = 309 937 unweighted, 196 344 347 weighted). Unadjusted analysis estimated screening rates for breast, cervical, and colorectal cancer. Multivariate analysis estimated the odds of screening, controlling for individual and county-level effects.Results: Rural residents, particularly those in persistent poverty counties, were less likely to be screened than urban residents. More African Americans in persistent poverty rural counties reported not having mammography screening (18.3%) compared to 15.9% of urban African Americans. Hispanics had low screening rates across all service types. Multivariate analysis continued to find disparities in screening rates, after controlling for individual and county-level factors. African Americans in persistent poverty rural counties were more likely to be screened for both breast cancer (odds ratio, 1.44; 95% confidence interval, 1.12-1.85) and cervical cancer (1.46; 1.07-1.99) when compared with urban whites. Conclusions: Disparities in cancer screening rates exist across not only race/ethnicity but also county type. These disparities cannot be fully explained by either individual or county-level effects. Programs have been successful in improving screening rates for African American women and should be expanded to target other vulnerable women as well as other services such as colorectal cancer screening.
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Affiliation(s)
- Kevin J. Bennett
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Chaiporn Pumkam
- Department of Family and Preventive Medicine, University of South Carolina School of Medicine, Columbia, SC, USA
| | - Jessica D. Bellinger
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Janice C. Probst
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
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Chen F, Puig M, Yermilov I, Malin J, Schneider EC, Epstein AM, Kahn KL, Ganz PA, Gibbons MM. Using breast cancer quality indicators in a vulnerable population. Cancer 2011; 117:3311-21. [PMID: 21264846 DOI: 10.1002/cncr.25915] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 11/16/2010] [Accepted: 12/02/2010] [Indexed: 11/08/2022]
Abstract
BACKGROUND Adherence to quality indicators may be especially important to disease-specific outcomes for uninsured, vulnerable patients. The objective of this study was to measure adherence to National Initiative for Cancer Care Quality (NICCQ) breast cancer quality indicators in a public hospital and compare performance to published rates in a previously collected 5-city cohort. METHODS One hundred five consecutive, newly diagnosed, stage I-III, breast cancer patients at a public hospital (from 2005 to 2007) were identified. Adherence rates to 31 quality indicators were measured by using medical record abstraction. Rates were calculated for individual indicators, aggregated domains, and components of care and were compared with the 5-city cohort results by using a 2-sided test of proportions. RESULTS Overall adherence to the NICCQ indicators at the public hospital was 82%, versus 86% in the 5-city cohort. Public hospital adherence was better in 3 domains and components (Management of Treatment Toxicity 95% vs 73%, Referrals 76% vs 15%, and Documentation of Key Clinical Factors 72% vs 64%, P < .05 for all), but it was lower in others (Testing 82% vs 96%, Adjuvant Therapy 76% vs 83%, Surgery 72% vs 86%, Surveillance 63% vs 94%, and Respect for Patient Preferences 52% vs 72%, P < .001 for all). CONCLUSIONS The results showed that it is possible to deliver breast cancer care to vulnerable patients comparable in quality to the care received by the broader population. Further study should identify the factors that lead to variation in adherence across domains of quality.
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Affiliation(s)
- Formosa Chen
- Department of Surgery, Olive View-UCLA Medical Center, Sylmar, CA, USA
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Athanasakis K, Souliotis K, Kyriopoulos EJ, Loukidou E, Kritikou P, Kyriopoulos J. Inequalities in access to cancer treatment: an analysis of cross-regional patient mobility in Greece. Support Care Cancer 2011; 20:455-60. [DOI: 10.1007/s00520-011-1093-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2010] [Accepted: 01/10/2011] [Indexed: 01/24/2023]
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Chen F, Mercado C, Yermilov I, Puig M, Ko CY, Kahn KL, Ganz PA, Gibbons MM. Improving Breast Cancer Quality of Care with the Use of Patient Navigators. Am Surg 2010. [DOI: 10.1177/000313481007601003] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The continuum of breast cancer care requires multidisciplinary efforts. Patient navigators, who perform outreach, coordination, and education, have been shown to improve some areas of care. However, little research has assessed the impact of navigators on breast cancer treatment in uninsured populations. Our objective is to report on the impact of a patient navigator program on breast cancer quality of care at a public hospital. One hundred consecutive newly diagnosed patients with breast cancer (Stages I to III) were identified (2005 to 2007). Forty-nine patients were treated before the use of navigators and 51 after program implementation. Nine breast cancer quality indicators were used to evaluate quality of care. Overall adherence to the quality indicators improved from 69 to 86 per cent with the use of patient navigators ( P < 0.01). Only one individual indicator, use of surveillance mammography, improved significantly (52 to 76%, P < 0.05). All nine indicators reached 75 per cent or greater adherence rates after implementation of the navigator program compared with only four before implementation. Patient navigators appear to improve breast cancer quality of care in a public hospital. In populations in which cultural, linguistic, and financial barriers are prevalent, navigator programs can be effective in narrowing the observed gaps in the quality of cancer care.
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Affiliation(s)
- Formosa Chen
- Olive View–UCLA Medical Center, Sylmar, California
- Departments of Surgery and University of California, Los Angeles, California
- Greater West Los Angeles Veterans Administration, Los Angeles, California
| | - Cheryl Mercado
- Departments of Surgery and University of California, Los Angeles, California
- Greater West Los Angeles Veterans Administration, Los Angeles, California
| | | | - Melissa Puig
- Olive View–UCLA Medical Center, Sylmar, California
| | - Clifford Y. Ko
- Departments of Surgery and University of California, Los Angeles, California
- Greater West Los Angeles Veterans Administration, Los Angeles, California
| | - Katherine L. Kahn
- Departments of Medicine, University of California, Los Angeles, California
| | - Patricia A. Ganz
- Departments of Medicine, University of California, Los Angeles, California
| | - Melinda Maggard Gibbons
- Olive View–UCLA Medical Center, Sylmar, California
- Departments of Surgery and University of California, Los Angeles, California
- Greater West Los Angeles Veterans Administration, Los Angeles, California
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Leong SPL, Shen ZZ, Liu TJ, Agarwal G, Tajima T, Paik NS, Sandelin K, Derossis A, Cody H, Foulkes WD. Is breast cancer the same disease in Asian and Western countries? World J Surg 2010; 34:2308-24. [PMID: 20607258 PMCID: PMC2936680 DOI: 10.1007/s00268-010-0683-1] [Citation(s) in RCA: 392] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
UNLABELLED A mini-symposium was held in Montreal, Canada, at the International Surgical Week for the Breast Surgical International in 2007 addressing the question whether breast cancer is the same disease in Asian and Western countries. Numerous investigators from Asian and Western countries presented the epidemiologic and clinical outcome data of women with breast cancer. Although there are significant similarities, the striking difference is that the peak age for breast cancer is between 40 and 50 years in the Asian countries, whereas the peak age in the Western countries is between 60 and 70 years. Also, the incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is increasing, the mortality rate is definitely decreasing. Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries. BACKGROUND Whether breast cancer is the same disease in Asian and Western countries was the topic of a 2007 Breast Surgery International symposium at International Surgical Week. METHODS Participating investigators from China, Taiwan, India, Japan, South Korea, Sweden, Canada, and the United States were asked beforehand to provide data on the epidemiology and treatment outcome of women in their countries. RESULTS Comparisons of the epidemiologic and clinical outcome data of women with breast cancer showed significant similarities, but the striking difference is that the peak age is between 40 and 50 years in Asian countries, but is between 60 and 70 years in Western countries. The incidence of breast cancer in Asia is rising and is associated with increased mortality. In the West, although the incidence is also increasing, the mortality rate is definitely decreasing. DISCUSSION Future prospective data collection from Asian and Western countries may provide further interesting epidemiologic and outcome data regarding the outcome of women with breast cancer from Asian and Western countries.
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Affiliation(s)
- Stanley P L Leong
- Department of Surgery, California Pacific Medical Center and Sutter Pacific Medical Foundation, 2340 Clay Street, 2nd Floor, San Francisco, CA 94115, USA.
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