scholarly journals Wait times for surgical and adjuvant radiation treatment of breast cancer in Canada and the United States: Greater socioeconomic inequity in America

2009 ◽  
Vol 32 (3) ◽  
pp. 239 ◽  
Author(s):  
Kevin M Gorey ◽  
Isaac N Luginaah ◽  
Eric J Holowaty ◽  
Karen Y Fung ◽  
Caroline Hamm
Keyword(s):  
Breast Cancer ◽  
Socioeconomic Status ◽  
Low Income ◽  
Cancer Care ◽  
Radiation Treatment ◽  
The United States ◽  
Historical Study ◽  
Adjuvant Radiation ◽  
Breast Cancer Care ◽  
Socioeconomic Inequity

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.

Breast Cancer Care: Developments in 1998

1998 ◽  
Vol 5 (4) ◽  
pp. 338-345
Author(s):  
John Horton
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Metastatic Breast ◽  
The United States ◽  
Axillary Node ◽  
Standards Of Care ◽  
Sources Of Information ◽  
Breast Cancer Care ◽  
Mortality And Morbidity ◽  
American Society

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.

What Are the Ethical Implications of Understanding and Treating Breast Cancer?

2018 ◽  
Author(s):  
Mary Ann G. Cutter
Keyword(s):  
Breast Cancer ◽  
Risk Assessment ◽  
Informed Consent ◽  
Cancer Care ◽  
The United States ◽  
Breast Cancer Patients ◽  
Breast Cancer Care ◽  
Ethical Implications ◽  
Personalized Approach ◽  
Limit Access

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.

scholarly journals Breast Cancer Care in California and Ontario: Primary Care Protections Greatest Among the Most Socioeconomically Vulnerable Women Living in the Most Underserved Places

2017 ◽  
Vol 8 (3) ◽  
pp. 127-134 ◽  
Author(s):  
Kevin M. Gorey ◽  
Caroline Hamm ◽  
Isaac N. Luginaah ◽  
Guangyong Zou ◽  
Eric J. Holowaty
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Health Insurance ◽  
Cancer Care ◽  
Primary Care Physicians ◽  
Rate Ratio ◽  
Adjuvant Radiation ◽  
Breast Cancer Care ◽  
Optimal Care ◽  
Cancer Data

Background: Better health care among Canada’s socioeconomically vulnerable versus America’s has not been fully explained. We examined the effects of poverty, health insurance and the supply of primary care physicians on breast cancer care. Methods: We analyzed breast cancer data in Ontario (n = 950) and California (n = 6300) between 1996 and 2000 and followed until 2014. We obtained socioeconomic data from censuses, oversampling the poor. We obtained data on the supply of physicians, primary care and specialists. The optimal care criterion was being diagnosed early with node negative disease and received breast conserving surgery followed by adjuvant radiation therapy. Results: Women in Ontario received more optimal care in communities well supplied by primary care physicians. They were particularly advantaged in the most disadvantaged places: high poverty neighborhoods (rate ratio = 1.65) and communities lacking specialist physicians (rate ratio = 1.33). Canadian advantages were explained by better health insurance coverage and greater primary care access. Conclusions: Policy makers ought to ensure that the newly insured are adequately insured. The Medicaid program should be expanded, as intended, across all 50 states. Strengthening America’s system of primary care will probably be the best way to ensure that the Affordable Care Act’s full benefits are realized.

scholarly journals Evaluation of the Quality of Adjuvant Endocrine Therapy Delivery for Breast Cancer Care in the United States

JAMA Oncology ◽  
2017 ◽  
Vol 3 (7) ◽  
pp. 928 ◽  
Author(s):  
Bobby Daly ◽  
Olufunmilayo I. Olopade ◽  
Ningqi Hou ◽  
Katharine Yao ◽  
David J. Winchester ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Endocrine Therapy ◽  
Cancer Care ◽  
The United States ◽  
Adjuvant Endocrine Therapy ◽  
Breast Cancer Care ◽  
Therapy Delivery

scholarly journals Breast cancer care in the Canada and the United States: Ecological comparisons of extremely impoverished and affluent urban neighborhoods

2010 ◽  
Vol 16 (1) ◽  
pp. 156-163 ◽  
Author(s):  
Kevin M. Gorey ◽  
Isaac N. Luginaah ◽  
Caroline Hamm ◽  
Karen Y. Fung ◽  
Eric J. Holowaty
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Cancer Care ◽  
The United States ◽  
Urban Neighborhoods ◽  
Breast Cancer Care

scholarly journals Delays in breast cancer care by race and sexual orientation: Results from a national survey with diverse women in the United States

Cancer ◽  
2021 ◽  
Author(s):  
Tonia C. Poteat ◽  
Mary Anne Adams ◽  
Jowanna Malone ◽  
Sophia Geffen ◽  
Naomi Greene ◽  
...  
Keyword(s):  
Breast Cancer ◽  
United States ◽  
Sexual Orientation ◽  
National Survey ◽  
Cancer Care ◽  
The United States ◽  
Breast Cancer Care

Breast cancer care in Latin America and the Caribbean (LAC)

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 21140-21140 ◽  
Author(s):  
E. L. Cazap ◽  
A. Buzaid ◽  
R. Chacon ◽  
C. Garbino ◽  
J. de la Garza ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Care ◽  
Radiation Treatment ◽  
Conservative Surgery ◽  
Developed Countries ◽  
Public Institutions ◽  
International Standards ◽  
Insurance Companies ◽  
Breast Cancer Care ◽  
The Caribbean

21140 Background: This study was designed to evaluate breast cancer care (BCC) in LAC trough a survey of 65 questions. Methods: We surveyed 96 opinion leaders (OL) from 12 countries that were first contacted by a researcher explaining the project and methodology. A phone interview was done by a specialist in epidemiology surveys. Answers were analyzed by center or country with Intercooled State 8 software (State Corp.) Results: 92 % OL confirm that there is no country law or guidelines making mandatory mammographyc screening. Nearly 75% of the OL stated that some type of cancer registry was available. The first consultation is done by gynecologists or breast cancer surgeons (83%), clinicians (13%) and surgeons (4%).Time lapsed from consultation until pathologic diagnosis was less than 3 months in 62% (country) and 91% (centers). Accessibility for hormone receptor and molecular markers is very good in specialized centers: 90% and 83% respectively but it is only available to 52% and 5% of country patients. Conservative surgery is widely accepted (87%) and 71% OL are able to perform sentinel node biopsies (centers). Systemic treatment is mainly based in Anthracyclines and Tamoxifen. The treatment coverage at centers is through medical insurance companies (53%), government (28%) and patient (19%) while 67% of country patients are government covered. Radiation treatment is mainly indicated by oncologists and 62% consider that radiotherapy centers in their countries are insufficient. There is adequate availability of morphine for 93% (centers) and 82% (countries).The choice of the chemotherapy or hormonal adjuvant treatment is free for 74% of those surveyed at their centers and in 23% is pre-established by the coverage. Majority of opinions are that all types of research are deficient. It is mainly organized in public institutions and sponsored by pharmaceutical companies (76%). Full results will be presented. Conclusions: We obtained data about the reality of BCC in the region. There is a general lack of prevention plans. Time to diagnosis and first treatment is similar to developed countries. Treatment according to stage is similar to international standards. Radiotherapy availability is poor. Based on this data a strategic plan for BCC in LAC will be developed. Supported by a grant from The Breast Cancer Research Foundation No significant financial relationships to disclose.

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