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Putnam G, Williams T, Park S, Grundman K, Goel C, Huffman K, Galiano RD. Current Trends in Breast Cancer Treatment in Chinese and Chinese American Women: The Disparity Between Mastectomy and Breast Reconstruction. Ann Plast Surg 2024; 92:463-468. [PMID: 38527354 DOI: 10.1097/sap.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Breast cancer screening and surgical interventions are often underutilized in the Chinese community. For both Chinese American (CA) and native Chinese (NC) patients, screening rates are well below medical recommendations, which places these patients at risk for late diagnoses and larger tumors. There is also a notable reluctance to breast reconstruction after mastectomy. We investigated the role of sociodemographic and cultural barriers in breast treatment trends among Chinese breast cancer survivors. METHODS A literature search for full-text articles published between 2011 and 2021 was performed using PubMed, The Web of Science, and Embase. The articles that were selected contained information regarding Chinese individuals in the United States or China who had undergone breast cancer screening or diagnosis of breast cancer and received treatment with or without reconstructive surgery. RESULTS Both patient populations exhibited screening rates that were significantly lower than national recommendations. Of the CA patients, 25% reported never receiving a mammogram, whereas 450 million NCs have been left unscreened despite efforts made by the Chinese government. Misinformation, cultural beliefs, and fear significantly contributed to diminished breast health care among CA and NC women. Fear of recurrence, breast value, community influence, and limited health care resources were found to be the primary drivers of low breast reconstruction uptake. CONCLUSIONS In both NC and CA women, there is a critical need for improved breast health information dissemination and overall quality of care. The findings summarized in this review can guide such efforts.
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Affiliation(s)
- Geneviève Putnam
- From the Department of Surgery/Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Kuehnle E, Siggelkow W, Luebbe K, Schrader I, Noeding KH, Noeding S, Noesselt T, Hillemanns P, Dörk T, Park-Simon TW. First Prospective Cross-Sectional Study on the Impact of Immigration Background and Education in Early Detection of Breast Cancer. Breast Care (Basel) 2021; 16:516-522. [PMID: 34720811 DOI: 10.1159/000511654] [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: 07/17/2020] [Accepted: 09/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Although immigrant health is an important issue in national health policy, there is a serious shortage of data in many countries. Most studies lack information on educational status, which is a major limitation. This prospective cross-sectional study analyzed a real-world breast cancer population on the influence of immigration background and educational status on participation in breast cancer early detection programs in the federal state of Lower Saxony, Germany. Methods Data collection was conducted from 2012 to 2016 in six certified breast cancer centers using a standardized questionnaire for patients' interview and tumor-specific data from the patients' medical records. Results 2,145/3,047 primary breast cancer cases were analyzed. 17.5% of our patients had a history of immigration, including n = 202 first-generation immigrants and n = 168 second-generation immigrants. Most of them were citizens of EU27 member states. No significant difference was seen in age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status compared to the native cohort. 100% participation rate in the breast cancer early detection programs were seen in patients with no school graduation. With regards to the national mammography screening program, participation decreased significantly with educational status (p = 0.0003). Conclusions No tumor biological differences were seen between immigrants and German natives. In first-generation immigrants, early detection programs were well accepted despite sociocultural and language differences. Participation rate decreased significantly with higher education levels irrespective of country of origin. Immigration background does not have a negative effect on the participation in breast cancer screening. This mainly relates to immigrants from EU27 member states.
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Affiliation(s)
- Elna Kuehnle
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Wulf Siggelkow
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | - Iris Schrader
- DIAKOVERE Henriettenstift, Breast Center, Hannover, Germany
| | | | | | | | - Peter Hillemanns
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
| | - Thilo Dörk
- Department of Gynecology and Obstetrics, Hannover Medical School, Hannover, Germany
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Wong FY, Wong RX, Zhou S, Ong WS, Pek PP, Yap YS, Tan BKT, Ngeow JYY, Tan VKM, Sim Y, Tan SM, Lim SH, Madhukumar P, Tan TJY, Loh KWJ, Ong MEH, Wong TH. Effects of housing value and medical subsidy on treatment and outcomes of breast cancer patients in Singapore: A retrospective cohort study. LANCET REGIONAL HEALTH-WESTERN PACIFIC 2020; 6:100065. [PMID: 34327401 PMCID: PMC8315650 DOI: 10.1016/j.lanwpc.2020.100065] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/23/2020] [Accepted: 11/19/2020] [Indexed: 11/22/2022]
Abstract
Background Socioeconomic status (SES) is likely to affect survival in breast cancer patients. Housing value is a reasonable surrogate for SES in Singapore where most residents own their own homes, which could be public (subsidised) or private housing. We evaluated effects of housing value and enhanced medical subsidies on patients’ presentation, treatment choices, compliance and survival in a setting of good access to healthcare. Methods A retrospective analysis of breast cancer patients treated in a tertiary hospital cluster from 2000 to 2016 was performed. Individual-level Housing value Index (HI) was derived from each patient's address and then grouped into 3 tiers: HI(high)(minimal subsidy), HI(med)(medium subsidy) and HI(low)(high subsidy). Cox regression was performed to evaluate the associations between overall survival (OS) and cancer-specific survival (CSS) with HI and various factors. Findings We studied a multiracial cohort of 15,532 Stage 0–IV breast cancer patients. Median age was 53.7 years and median follow-up was 7.7 years. Patients with lower HI presented with more advanced disease and had lower treatment compliance. On multivariable analysis, compared to HI(high) patients, HI(med) patients had decreased OS (HR=1.14, 95% CI 1.05–1.23) and CSS (HR=1.15, 95% CI 1.03–1.27), and HI(low) patients demonstrated reduced OS (HR=1.16, 95% CI 1.01–1.33). Ten-year non-cancer mortality was higher in lower HI-strata. Enhanced medical subsidy approximately halved treatment noncompliance rates but its receipt was not an independent prognostic factor for survival. Interpretation Despite good healthcare access, lower-HI patients have poorer survival from both cancer and non-cancer causes, possibly due to delayed health-seeking and poorer treatment compliance. Enhanced subsidies may mitigate socioeconomic disadvantages. Funding None.
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Affiliation(s)
- Fuh Yong Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Ru Xin Wong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Siqin Zhou
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Whee Sze Ong
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Pin Pin Pek
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yoon-Sim Yap
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Benita Kiat Tee Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,SingHealth Duke NUS Breast Centre, 11 Hospital Crescent, Singapore, 169610, Singapore.,Sengkang General Hospital, 110 Sengkang E Way, Singapore, 544886, Singapore
| | | | - Veronique Kiak Mien Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Yirong Sim
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Su-Ming Tan
- Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore
| | - Swee Ho Lim
- KK Women's and Children's Hospital, Bukit Timah Rd, 100, Singapore, 229899, Singapore
| | - Preetha Madhukumar
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore.,Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Tira Jing Ying Tan
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Kiley Wei-Jen Loh
- National Cancer Centre Singapore, 11 Hospital Crescent, Singapore 169610, Singapore
| | - Marcus Eng Hock Ong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
| | - Ting Hway Wong
- Singapore General Hospital, Outram Rd, Singapore, 169608, Singapore.,Duke-NUS Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore
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Chung GKK, Dong D, Wong SYS, Wong H, Chung RYN. Perceived poverty and health, and their roles in the poverty-health vicious cycle: a qualitative study of major stakeholders in the healthcare setting in Hong Kong. Int J Equity Health 2020; 19:13. [PMID: 31992307 PMCID: PMC6986077 DOI: 10.1186/s12939-020-1127-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/13/2020] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Poverty and ill-health are closely inter-related. Existing studies on the poverty-health vicious cycle focus mainly on less developed countries, where the identified mechanisms linking between poverty and ill-health may not fit the situations in developed Asian regions. This study aims to qualitatively explore the perceived mechanisms and drivers of the poverty-health vicious cycle among major stakeholders in the healthcare setting in Hong Kong. METHODS Data were collected via focus group interviews with social workers (n = 8), chronically ill patients (n = 8), older adults (n = 6), primary care doctors (n = 7) and informal caregivers (n = 10). The transcribed data were then closely read to capture key themes using thematic analyses informed by social constructivism. RESULTS In this highly developed Asian setting with income inequality among the greatest in the world, the poverty-health vicious cycle operates. Material and social constraints, as a result of unequal power and opportunities, appear to play a pivotal role in creating uneven distribution of social determinants of health. The subsequent healthcare access also varies across the social ladder under the dual-track healthcare system in Hong Kong. As health deteriorates, financial hardship is often resulted in the absence of sufficient and coordinated healthcare, welfare and labour policy interventions. In addition to the mechanisms, policy drivers of the cycle were also discussed based on the respondents' perceived understanding of the nature of poverty and its operationalization in public policies, as well as of the digressive conceptions of disease among different stakeholders. CONCLUSIONS The poverty-health vicious cycle has remained a great challenge in Hong Kong despite its economic prosperity. To break the cycle, potential policy directions include the adoption of proportionate universalism, social integration and the strengthening of medical-social collaboration.
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Affiliation(s)
- Gary Ka-Ki Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Dong Dong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Samuel Yeung-Shan Wong
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Hung Wong
- Department of Social Work, The Chinese University of Hong Kong, New Territories, Hong Kong
| | - Roger Yat-Nork Chung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, New Territories, Hong Kong.
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Taheri M, Tavakol M, Akbari ME, Anoshirvani AA, Aghabozorgi R, Almasi-Hashiani A, Abbasi M. Socioeconomic inequalities in metastasis, recurrence, stage and grade of breast cancer: a hospital-based retrospective cohort study. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E262-E269. [PMID: 31650064 PMCID: PMC6797882 DOI: 10.15167/2421-4248/jpmh2019.60.3.1162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Accepted: 06/17/2019] [Indexed: 01/04/2023]
Abstract
Introduction This study aims to estimate the Socio-Economic Status (SES) inequality on the metastasis, recurrence, stage and grade in Breast Cancer (BC). Methods This retrospective cohort study conducted on 411 BC patients in Arak, Iran. Asset-based questionnaire used to estimate the household SES. For calculate of SES inequality was used from Concentration Index (C). Moreover for investigate the association between recurrence and metastasis with other variables were used from multilevel logistic regression and analysis of variance were used to investigate the relationship between SES and other variables. The data were analyzed with Stata (v.13) software. Results Results of analysis of variance showed statistical significant relationship between SES with, insurance, surgery, grade, stage, recurrence and metastasis (p-value < 0.05). Moreover the Odds Ratio (OR) were significant of recurrence with age, academic level of education, supplementary insurance history of BC in first-degree relatives, stage and grade, also, metastasis with age of > 80 years, insurance, supplementary insurance, history of BC in first-degree relatives, chemotherapy, radiotherapy, stage and grade four. The total C index obtained 0.015 (0.002, 0.026), 0.011 (0.003, 0.031), – 0.014 (– 0.034, – 0.001) and – 0.042 (– 0.061, – 0.002) for metastasis, recurrence, stage and grade of BC respectively. Conclusions Our results showed evidence of inequality in the metastasis, recurrence, stage and grade in BC patients.
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Affiliation(s)
- M Taheri
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Tavakol
- Sociology Department, School of Social Sciences, University of Tehran, Tehran, Iran
| | - M E Akbari
- Cancer Research Center (CRC), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - A A Anoshirvani
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - R Aghabozorgi
- Department of Hematology and Medical Oncology, School of Medicine, Arak University of Medical Sciences, Arak, Iran
| | - A Almasi-Hashiani
- Department of Epidemiology, School of Health, Arak University of Medical Sciences, Arak, Iran
| | - M Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Dos Santos Figueiredo FW, Adami F. Effects of the high-inequality of income on the breast cancer mortality in Brazil. Sci Rep 2019; 9:4173. [PMID: 30862862 PMCID: PMC6414632 DOI: 10.1038/s41598-019-41012-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
As well as breast cancer mortality, the income inequality in Brazil is different between Federative units, including between units of the same region. To assess the effects of the high-inequality of income on breast cancer mortality in Brazilian Federative Units, in the 2010 year. This is an ecologic study. Deaths from breast cancer in Brazilian women according to Federative units were obtained from the Department of Informatics of the Unified Health System. Mortality by breast cancer was estimated per 100,000 women and age-standardized by the direct method according to World Health Organization population. Income inequality was measured by the Gini index obtained from the United Nations Development Programme. The High-inequality of income was classified by the third tercile of the distribution from the Gini index of the Federative units. Univariate analysis was performed according to data normality. Linear regressions were performed by the stepwise backward method. The confidence level was 5%. Stata® (Stata Corp, LC) 11.0. was used. The High-inequality of income was associated with worse social and demographic indicators. The age-standardized breast cancer mortality was larger in the high-inequality of income Federative units. In the adjusted analysis, these Federative units presented a mean of 2 more deaths (ranging from the 0.4 to 3.7 deaths, r² = 0.79; p = 0.018) by breast cancer per 100,000 women when compared to the Federative units without high-inequality of income. In the Brazilian Federative units, the high-inequality of income was associated with age-standardized breast cancer mortality more.
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Affiliation(s)
| | - Fernando Adami
- Epidemiology and Data Analysis Laboratory, Faculdade de Medicina do ABC, Santo André, São Paulo, Brazil
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Yeung MPS, Chan EYY, Wong SYS, Yip BHK, Cheung PSY. Hong Kong female’s breast cancer awareness measure: Cross-sectional survey. World J Clin Oncol 2019; 10:98-109. [PMID: 30815376 PMCID: PMC6390121 DOI: 10.5306/wjco.v10.i2.98] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 11/05/2018] [Accepted: 01/09/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In women worldwide, breast cancer is the most common cancer. Breast cancer accounted for 26.6% of all new cancers in females diagnosed in 2015 in Hong Kong.
AIM To examine women’s awareness, perception, knowledge, and screening practice of breast cancer in Hong Kong.
METHODS We carried out a population-based survey using random telephone interviews to women aged 18 or above using the United Kingdom Cancer Research Breast Cancer Awareness Measure (United Kingdom CAM). The data was analysed using proportions, chi-square test (χ2-test) and adjusted odds ratios (ORs).
RESULTS A total of 1000 participants completed the CAM questionnaire from 1,731 responses (response rate = 57.8%) from September to October 2017. One in five and one in four respondents recalled ≥ 3 early warning signs and ≥ 2 risk factors of breast cancer respectively. The majority (62.6%) reported they were not confident that they would notice a change in their breasts. Among the respondents, 16.8% would have regular mammography at least every two years. In general, 4 in 10 women had tried practices on preventing breast cancer. Respondents with better result in recalling breast cancer signs and symptoms were more likely to seek immediate medical help when noticed a change in their breasts (χ2-test P = 0.038), and more likely had tried prevention practice (χ2-test P < 0.001). Respondents received higher education (secondary school or above) had higher breast cancer awareness (OR = 2.83, CI: 1.61-4.97), more frequent screening (OR = 2.64, CI: 1.63-4.26) and more had tried prevention practices (OR = 2.80, CI: 1.96-4.02) when compared to those with lower education. Those in age groups 31-45 and 46-60 had higher percentages in performing breast self-exam and mammography when compared to the 18-30 and 61 or above age groups.
CONCLUSION Population-wide public health initiatives should emphasize on prevention and early detection of breast cancer in women, with targeted strategy for those with low education level and advance in age.
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Affiliation(s)
- May Pui Shan Yeung
- Division of Global Health and Humanitarian Medicine, the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Emily Ying Yang Chan
- Division of Global Health and Humanitarian Medicine, the Jockey Club School of Public Health and Primary Care, the Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Samuel Yeung Shan Wong
- Division of Family Medicine and Primary Healthcare, the Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | - Benjamin Hon Kei Yip
- Division of Family Medicine and Primary Healthcare, the Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
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Taheri M, Tavakol M, Akbari ME, Mohammadbeigi A, Abbasi M. Socio-Economic Status Inequity in Self Rated Health in Patients with Breast Cancer. Open Access Maced J Med Sci 2019; 7:152-156. [PMID: 30740181 PMCID: PMC6352461 DOI: 10.3889/oamjms.2019.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 12/01/2018] [Accepted: 12/15/2018] [Indexed: 11/24/2022] Open
Abstract
AIM: We investigate the evaluation of socio-economic status (SES) inequality on self-rated health (SRH) at women with breast cancer. STUDY DESIGN: Cross-sectional study METHODS: The current study conducted on all 270 breast cancer patients that were admitted to one of the hospitals of Arak University Medical Sciences (Arak, Iran from April to July 2018) by census (using non-random sampling (accessible sampling). SES was calculated by asset-based questionnaire and Principle Component Analysis (PCA) was performed to estimate the families’ SES. Concentration Index (C) and Curve (CC) was used to measure SES inequality in SRH. The data were analysed with Stata software. RESULTS: The number of persons with good SRH by the level of SES was 165 (61.1%) and with poor SRH was 105 (38.9%). The number of persons with good SRH in comparison to same-aged people by level of SES was 135 (50%) and with poor SRH was 135 (50%). Concentration index of SRH in all level of SES was 0.061 (SE = 0.03). Also, Concentration index for SRH in comparison to same-aged people at different levels of SES was -0.044 (SE = 0.03). CONCLUSION: The results of this study showed that there is inequality in SRH in a patient with breast cancer of the richest level of SES.
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Affiliation(s)
- Majid Taheri
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mohammad Tavakol
- Sociology Department, School of Social Sciences, University of Tehran, Tehran, Iran
| | | | - Abolfazl Mohammadbeigi
- Neurology and Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
| | - Mahmoud Abbasi
- Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Zaitsu M, Kaneko R, Takeuchi T, Sato Y, Kobayashi Y, Kawachi I. Occupational inequalities in female cancer incidence in Japan: Hospital-based matched case-control study with occupational class. SSM Popul Health 2018; 5:129-137. [PMID: 30014030 PMCID: PMC6019265 DOI: 10.1016/j.ssmph.2018.06.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/01/2018] [Accepted: 06/04/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in female cancer incidence have previously been undocumented in Japan. METHODS Using a nationwide inpatient dataset (1984-2016) in Japan, we identified 143,806 female cancer cases and 703,157 controls matched for sex, age, admission date, and admitting hospital, and performed a hospital-based matched case-control study. Based on standardized national classification, we categorized patients' socioeconomic status (SES) by occupational class (blue-collar, service, professional, manager), cross-classified by industry sector (blue-collar, service, white-collar). Using blue-collar workers in blue-collar industries as the reference group, we estimated the odds ratio (OR) for each cancer incidence using conditional logistic regression with multiple imputation, adjusted for major modifiable risk factors (smoking, alcohol consumption). RESULTS We identified lower risks among higher-SES women for common and overall cancers: e.g., ORs for managers in blue-collar industries were 0.67 (95% confidence interval [CI], 0.46-0.98) for stomach cancer and 0.40 (95% CI, 0.19-0.86) for lung cancer. Higher risks with higher SES were evident for breast cancer: the OR for professionals in service industries was 1.60 (95% CI, 1.29-1.98). With some cancers, homemakers showed a similar trend to subjects with higher SES; however, the magnitude of the OR was weaker than those with higher SES. CONCLUSIONS Even after controlling for major modifiable risk factors, socioeconomic inequalities were evident for female cancer incidence in Japan.
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Affiliation(s)
- Masayoshi Zaitsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Rena Kaneko
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
- Department of Gastroenterology, Kanto Rosai Hospital, Japan
| | | | - Yuzuru Sato
- Department of Gastroenterology, Kanto Rosai Hospital, Japan
| | - Yasuki Kobayashi
- Department of Public Health, Graduate School of Medicine, The University of Tokyo, Japan
| | - Ichiro Kawachi
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, USA
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Moriceau G, Bourmaud A, Tinquaut F, Oriol M, Jacquin JP, Fournel P, Magné N, Chauvin F. Social inequalities and cancer: can the European deprivation index predict patients' difficulties in health care access? a pilot study. Oncotarget 2016; 7:1055-65. [PMID: 26540571 PMCID: PMC4808051 DOI: 10.18632/oncotarget.6274] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/30/2015] [Indexed: 12/04/2022] Open
Abstract
Context The European Deprivation Index (EDI), is a new ecological estimate for Socio-Economic Status (SES). This study postulates that Time-To-Treatment could be used as a cancer quality-of -care surrogate in order to identify the association between cancer patient's SES and quality of care in a French comprehensive cancer center. Methods retrospective mono-centered cohort study. All consecutive incoming adult patients diagnosed for breast cancer(BC), prostate cancer(PC), colorectal cancer (CRC), lung cancer(LC) or sarcoma(S) were included between January 2013 and December 2013. The association of EDI and Time-To-Diagnosis(TTD), as well as Time-To-Treatment(TTT) was analyzed using a cox regression, and a strata analysis per tumor site was performed. Results 969 patients were included. Primitive tumor site was 505 BC(52%), 169 PC(17%), 145 LC(15%), 116 CRC(12%), and 34 S(4%). Median TTD was 1.41 months (Q1-Q3 0.5 to 3.5 months). Median TTT was 0.9 months (0.4 - 1.4). In a multivariate analysis, we identified the tumor site as a predictive factor to influence TTD, shorter for BC (0.75months, [0.30- 1.9]) than PC (4.69 months [1.6-29.7]), HR 0.27 95%CI= [0.22-0.34], p < 0.001. TTT was also shorter for BC (0.75months [0.4-1.1]) than PC (2.02 [0.9-3.2]), HR 0.32 95%CI= [0.27-0.39], p < 0.001. EDI quintiles were not found associated with either TTT or TTD. Conclusions Deprivation estimated by the EDI does not appear to be related to an extension of the Time-to-Diagnosis or Time-to-Treatment in our real-life population. Further research should be done to identify other frailty-sensitive factors that could be responsible for delays in care.
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Affiliation(s)
- Guillaume Moriceau
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Aurélie Bourmaud
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France
| | - Fabien Tinquaut
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Mathieu Oriol
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | | | - Pierre Fournel
- Medical Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Nicolas Magné
- Radiation Oncology Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France
| | - Franck Chauvin
- Department of Public Health, Hygée Centre, Lucien Neuwirth Cancer Institute, Saint Priest en Jarez, France.,Therapeutic Targeting in Oncology, EMR3738, Claude Bernard University, Lyon, France.,Clinical Investigation Center and Clinical Epidemiology, Jean Monnet University, Saint-Etienne, France
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Health care access dimensions and cervical cancer screening in South Africa: analysis of the world health survey. BMC Public Health 2015; 15:382. [PMID: 25886513 PMCID: PMC4404041 DOI: 10.1186/s12889-015-1686-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 03/26/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cervical cancer is the most commonly diagnosed cancer and the leading cause of cancer mortality among women in sub-Saharan Africa. Recent recommendations for cervical cancer primary prevention highlight HPV vaccination, and secondary prevention through screening. However, few studies have examined the different dimensions of health care access, and how these may influence screening behavior, especially in the context of clinical preventive services. METHODS Using the 2003 South Africa World Health Survey, we determined the prevalence of cervical cancer screening with pelvic examinations and/or pap smears among women ages 18 years and older. We also examined the association between multiple dimensions of health care access and screening focusing on the affordability, availability, accessibility, accommodation and acceptability components. RESULTS About 1 in 4 (25.3%, n = 65) of the women who attended a health care facility in the past year got screened for cervical cancer. Screened women had a significantly higher number of health care providers available compared with unscreened women (mean 125 vs.12, p-value <0.001), and were more likely to have seen a medical doctor compared with nurses/midwives (73.1% vs. 45.9%, p-value = 0.003). In multivariable analysis, every unit increase in the number of health care providers available increased the likelihood of screening by 1% (OR = 1.01, 95% CI: 1.00, 1.01). In addition, seeing a nurse/midwife compared to a medical doctor reduced the likelihood of screening by 87% (OR = 0.13, 95% CI: 0.04, 0.42). CONCLUSIONS Our findings suggest that cost issues (affordability component) and other patient level factors (captured in the acceptability, accessibility and accommodation components) were less important predictors of screening compared with availability of physicians in this population. Meeting cervical cancer screening and HPV vaccination goals will require significant investments in the health care workforce, improving health care worker density in poor and rural areas, and improved training of the existing workforce.
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