Breast Cancer Care: Developments in 1998

1998 ◽  
Vol 5 (4) ◽  
pp. 338-345
Author(s):  
John Horton

Background Breast cancer is a significant cause of mortality and morbidity worldwide, although death rates in the United States and some other countries are beginning to fall. Methods Several sources of information in 1998, including publications and presentations at the 1998 meeting of the American Society of Clinical Oncology, are pertinent to contemporary breast cancer care. Results It is now possible to prescribe hormonal therapy that will reduce the incidence of breast cancer. Methods are available to reduce the morbidity from axillary node dissection, and improvements in adjuvant therapy and management of metastatic breast cancer are now at hand. Conclusions The information presented provides a broad-based platform for new standards of care for breast cancer that will serve as a sound base for further progress in this important disease.

Author(s):  
Mary Ann G. Cutter

Philosophically speaking, the question “What are the ethical implications of understanding breast cancer?” raises a host of issues, including informed consent, risk assessment, and access to breast cancer care. What we find is that, initially, there are adequate guidelines for informed consent, adequate efforts to develop risk assessment measures, and a decent level of access to breast cancer care in the United States. But things can be improved from an ethical standpoint. Upon reflection, the informed consent process would benefit from a more explicit discussion of uncertainty in breast cancer medicine and the ways breast cancer patients make decisions about their care. Risk assessments would benefit from a more personalized approach. Access to breast cancer care could be improved by continued studies of the diverse forces that limit access to proper breast cancer care.


JAMA Oncology ◽  
2017 ◽  
Vol 3 (7) ◽  
pp. 928 ◽  
Author(s):  
Bobby Daly ◽  
Olufunmilayo I. Olopade ◽  
Ningqi Hou ◽  
Katharine Yao ◽  
David J. Winchester ◽  
...  

2009 ◽  
Vol 32 (3) ◽  
pp. 239 ◽  
Author(s):  
Kevin M Gorey ◽  
Isaac N Luginaah ◽  
Eric J Holowaty ◽  
Karen Y Fung ◽  
Caroline Hamm

Purpose. The demand for cancer care has increased among aging North American populations as cancer treatment innovations have proliferated. Gaps between supply and demand may be growing. This study examined whether socioeconomic status has a differential effect on waits for surgical and adjuvant radiation treatment (RT) of breast cancer in Canada and the US. Methods. Ontario and California cancer registries provided 929 and 984 breast cancer cases diagnosed between 1998 and 2000 in diverse urban and rural places. Residence-based socioeconomic data were taken from censuses. Cancer care variables were reliably abstracted from health records: stage, receipt of surgery and RT, and waits from diagnosis to initial and initial to adjuvant treatment. Median waits were compared within- and between-country with the non-parametric Mann-Whitney U-test. Categorically long, age-adjusted wait comparisons used the Mantel-Haenszel chi-square test. Results. There were significant associations between lower socioeconomic status and longer surgical waits, lower access to adjuvant RT and to longer RT waits across diverse places in California. None were observed in Ontario. The two cohorts did not practically differ on access to surgery or on surgical waits. Compared with their counterparts in California, low-income Ontarians, particularly those in small urban places, gained greater access to RT, while high-income Americans had shorter waits for RT. Conclusions. This historical study contextualized Canada’s “waiting-list problems” with evidence on breast cancer care, where lower income Americans seemed to have waited as long as similar Canadians. Many more low-income Americans seemed to experience the longest wait of all for adjuvant care. They simply did not receive it. In contrast to stark American socioeconomic inequity, this study evidenced remarkable equity in Canadian breast cancer care.


2010 ◽  
Vol 16 (1) ◽  
pp. 156-163 ◽  
Author(s):  
Kevin M. Gorey ◽  
Isaac N. Luginaah ◽  
Caroline Hamm ◽  
Karen Y. Fung ◽  
Eric J. Holowaty

Cancer ◽  
2021 ◽  
Author(s):  
Tonia C. Poteat ◽  
Mary Anne Adams ◽  
Jowanna Malone ◽  
Sophia Geffen ◽  
Naomi Greene ◽  
...  

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