scholarly journals Female Breast Cancer in Suriname: Pathways to Treatment—A Patient’s Perception

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 49-49
Author(s):  
Euridice R. Irving ◽  
Dennis R. A. Mans ◽  
Els Th. M. Dams ◽  
Maureen Y. Lichtveld
Keyword(s):  
Breast Cancer ◽  
Health Care ◽  
Access To Health Care ◽  
Early Stage ◽  
Diagnosis And Treatment ◽  
Related Factors ◽  
Entire Interval ◽  
Early Stage Disease ◽  
Resource Setting ◽  
Stage Disease

PURPOSE Delays across the entire cancer care continuum are not uncommon. This cross-sectional study explored the health care trajectories of Surinamese women with breast cancer and identified predictors of timely diagnosis and treatment initiation. METHODS One hundred women age 30 years or older who were newly diagnosed with breast cancer in 2017 to 2018 were recruited from all 4 hospitals in Paramaribo. Data on their demographics, lifestyle, reproductive and medical history, health status, and family history of breast cancer and other malignancies were collected using a validated semistructured questionnaire. Using Anderson’s Model of Pathways to Treatment, we defined a patient interval (from detection to first consultation), diagnostic interval (from consultation to histopathologic diagnosis), and treatment interval (from diagnosis to first treatment). Log-transformed data were analyzed using linear regression, and variables with P ≤ .05 were considered statistically significant predictors of intervals. RESULTS All participants had health insurance and access to health care. Eighty-five percent of patients presented with early-stage disease. Ninety percent of patients had self-detected their disease, with 70% finding a lump. Average age was 55.6 years (± 11.8 years). Median durations of patient, diagnostic, and treatment intervals were 13 days (interquartile, range, 4-63 days), 40 days (IQR, 21-57 days), and 18 days (IQR, 8-38 days), respectively. Median duration of the entire interval was 95 days (IQR, 59-272 days). Patient-related factors associated with the intervals were religion (β = −530; P = .003), being employed (β = 149.4; P = .007), and age 50 years and older (β = −195.8; P = .037). Disease-related factors were lump as first symptom (β = −175.6; P = .038) and late-stage disease at diagnosis (β = 213.5; P = .004). CONCLUSION Given the limited-resource setting, delays in Suriname’s health care can be minimized by programs aimed at increasing breast cancer awareness and education; however, delays may have been underestimated as a result of the over-representation of early-stage disease and recall bias regarding the first symptom detected.

scholarly journals Tumor Characteristics and Treatment Outcomes of Older Women with Breast Cancer in Jordan

2019 ◽  
Author(s):  
Hikmat Abdel-Razeq ◽  
Fadwa Abdel Rahman ◽  
Hanan Al-Masri ◽  
Hazem Abdulelah ◽  
Mahmoud Abu Nasser ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Treatment Outcomes ◽  
Metastatic Disease ◽  
Cox Regression ◽  
Early Stage ◽  
Poor Performance Status ◽  
Tumor Characteristics ◽  
Early Stage Disease ◽  
Node Positive ◽  
Stage Disease

Abstract Background : Less than 10% of newly diagnosed breast cancer in our region are diagnosed in women 70 years or older. Treatment plans of such patients is less clear and have poor outcomes. In this paper, we describe clinical presentation, tumor characteristics and treatment outcomes in such patients. Methods : Consecutive patients aged 65 years or older with pathologically-confirmed diagnosis of breast cancer were included. Medical records and hospital databases were searched for patients’ characteristics and treatment outcomes. Results : A total of 553 patients, median age 70 (range: 65-91) years, were included. On presentation, 114 (20.6%) patients had metastatic disease and was mostly visceral (81; 71.1%). Patients with non-metastatic disease had poor pathological features including node-positive in 244 (55.6%), GIII in 170 (38.7%) and lymphovascular invasion in 173 (39.4%). Patients were treated less aggressively; 144 (32.8%) patients with early-stage disease and 98 (86.0%) with metastatic disease never had chemotherapy. After a median follow up of 45 months, 5-year overall survival for the whole group was 67.6%. Survival was better for patients with non-metastatic disease (78.8% vs. 25.4%, P<0.001) and for those with node-negative compared to node-positive disease (85.4% vs. 74.1%, P=0.002). On Cox regression, only positive lymph nodes were associated with poor outcome in patients with non-metastatic disease (Hazard Ratio [HR], 1.75; 95% CI: 1.006-3.034, P=0.048). Conclusions : Older Jordanian women with breast cancer present with more aggressive features and advanced-stage disease that reflect poorly on treatment outcomes. Because of comorbidities and poor performance status, some patients were not aggressively treated.

Frequency of late-stage breast cancer diagnoses despite high mammography screening rates in an HMO

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 1526-1526
Author(s):  
R. Haque ◽  
J. E. Schottinger ◽  
M. H. Kanter ◽  
C. C. Avila ◽  
R. Contreras ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Late Stage ◽  
Mammography Screening ◽  
Early Stage ◽  
Advanced Tumor Stage ◽  
Early Stage Disease ◽  
Advanced Tumor ◽  
Stage Disease ◽  
Late Stage Diagnosis ◽  
The Impact

1526 Background: Kaiser Permanente Southern California (KPSC) led the nation in screening women for breast cancer (BCa) with a mammography rate of nearly 90% in 2007 according to 2008 Healthcare Effectiveness Data and Information Set (HEDIS) measures. Despite successes in improving screening rates in this health plan that serves 3+ million diverse members, the percentage of women diagnosed with late stage BCa (stage III, IV) remained stable, varying from 12.9% (N∼323) in 2003 to 10.8% (N∼270) in 2007. To identify patient and health care factors associated with late stage diagnosis and the impact of its enhanced screening implementation guidelines, KPSC undertook this study. Methods: This cross-sectional study included a cohort of 10,580 BCa patients from 2003–2007. We compared women diagnosed with late stage disease versus those with early stage disease (stages I, II). P values (2-sided) were based on the chi-square distribution. Adjusted odds ratios and 95% confidence intervals were estimated using unconditional logistic regression. Results: Factors that were positively associated with late stage diagnosis in the univariate analyses included age, lack of recent mammography screening, worse tumor features, 80+ years of age, minority race, lower geocoded household income, increased healthcare visits, and use of Pap testing (P < 0.01 for all variables). Factors significantly associated with late stage diagnosis in the multivariate model included only lack of recent mammography screening (OR = 1.35, 95% CI: 1.14–1.58) and worse tumor features including high grade (grade 3, OR = 2.58, 95% CI: 1.96–3.40), positive lymph nodes (OR = 53.49, 95% CI: 39.90–71.72), and HER-2+ tumors (OR = 1.40, 95% CI: 1.13–1.72). Conclusions: Targeting older women, those with lower utilization, and women who did not have a recent mammogram may help further lower the prevalence of late stage diagnoses. However, given the extent of the health plan's previous efforts to enhance BCa screening rates, a ceiling effect may limit additional benefit. Additional efforts to decrease the rate of advanced tumor stage at diagnosis may include improving interpretation of mammograms or earlier detection of aggressive tumors by enhanced BRCA genetic testing. No significant financial relationships to disclose.

Loss in working years after a breast cancer diagnosis: A population-based study (Sweden).

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 209-209
Author(s):  
Mats Lambe ◽  
Paul Lambert ◽  
Irma Fredriksson ◽  
Anna Plym
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Early Stage ◽  
Stage Iv ◽  
Population Level ◽  
Breast Cancer Diagnosis ◽  
Early Stage Disease ◽  
Cancer Data ◽  
Stage Disease ◽  
Working Age

209 Background: More than half of all women with breast cancer are diagnosed during working age. We present a new measure of clinical and public health relevance to estimate the loss in working years after a breast cancer diagnosis. Methods: Women of working age diagnosed with breast cancer between 1997 and 2012 were identified in the Breast Cancer Data Base Sweden (N = 19,661), together with a breast cancer-free comparison cohort (N = 81,303). Women were followed until permanent exit from the labour market (defined as receipt of disability pension, old-age retirement or death) or censoring. Using flexible parametric survival modelling, the loss in working years was calculated as the difference in the remaining years in the work force between women with and women without breast cancer. Results: The loss in working years was most pronounced in women of younger ages and in women with advanced stage disease. Women aged 50 years at diagnosis with stage I disease lost on average 0.6 years (95% CI, 0.4-0.8) of their remaining working time; the corresponding estimates were 1.2 years (1.0-1.5) in stage II, 3.2 years (2.7-3.7) in stage III, and 8.8 years (7.9-9.8) in stage IV disease. Type of treatment was a clear determinant in women with early stage disease, with a higher loss in working years among women treated with axillary surgery, mastectomy and chemotherapy. Conclusions: Our measure provides a new perspective of the burden of breast cancer in women of working age. The modest loss in working years in women with early stage disease is reassuring, although the economic consequences on a population-level are likely to be high given the large number of women diagnosed with breast cancer every year.

scholarly journals Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women

2021 ◽  
Author(s):  
Jennifer Erdrich ◽  
Felina Cordova-Marks ◽  
Angela R. Monetathchi ◽  
Manxia Wu ◽  
Arica White ◽  
...  
Keyword(s):  
Breast Cancer ◽  
American Indian ◽  
Alaska Native ◽  
White Women ◽  
Early Stage ◽  
Breast Conservation ◽  
Lower Percentage ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Hispanic White

Abstract Background Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. Methods Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010–2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. Results From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. Conclusion This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.

scholarly journals Establishing the Role of Stereotactic Ablative Body Radiotherapy in Early-Stage Breast Cancer

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Aisling Barry ◽  
Anthony Fyles
Keyword(s):  
Breast Cancer ◽  
Early Stage ◽  
Feasibility Studies ◽  
Definitive Treatment ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Stereotactic Ablative Body Radiotherapy ◽  
Definitive Therapy ◽  
Extracranial Disease ◽  
Hospital Stays

Stereotactic ablative body radiotherapy (SABR) has a role as definitive therapy in many tumor sites; however, its role in the treatment of breast cancer is less well explored. Currently, SABR has been investigated in the neoadjuvant and adjuvant setting with a number of ongoing feasibility studies. However, its use comes with a number of radiobiological and technical challenges that require further evaluation. We have learned much from other extracranial disease sites such as lung, brain, and spine, where definitive treatment with SABR has shown encouraging outcomes. In women with breast cancer, SABR may eliminate the need for invasive surgery, reducing healthcare costs and hospital stays and providing an additional curative option for early-stage disease. This poses the following question: is there a role for SABR as a definitive therapy in breast cancer?

scholarly journals A population-based comparison of treatment, resource utilization, and costs by cancer stage for Ontario patients with HER2-positive breast cancer

2020 ◽  
Author(s):  
Christine Brezden-Masley ◽  
Kelly E. Fathers ◽  
Megan E. Coombes ◽  
Behin Pourmirza ◽  
Cloris Xue ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Costs ◽  
Early Stage ◽  
Stage Iv ◽  
Population Based ◽  
Stage I ◽  
Publicly Funded ◽  
Early Stage Disease ◽  
Stage Disease ◽  
Care Costs

Abstract Purpose We sought to expand the currently limited, Canadian, population-based data on the characteristics, treatment pathways, and health care costs according to stage in patients with human epidermal growth factor receptor-2 positive (HER2+) breast cancer (BC). Methods We extracted data from the publicly funded health care system in Ontario. Baseline characteristics, treatment patterns, and health care costs were descriptively compared by cancer stage (I–III vs. IV) for adult women diagnosed with invasive HER2+ BC between 2012 and 2016. Resource use was multiplied by unit costs for publicly funded health care services to calculate costs. Results Overall, 4535 patients with stage I–III and 354 with stage IV HER2+ BC were identified. Most patients with stage I–III disease were treated with surgery (4372, 96.4%), with the majority having a lumpectomy, and 3521 (77.6%) received radiation. Neoadjuvant (NAT) and adjuvant (AT) systemic treatment rates were 20.1% (n = 920) and 88.8% (n = 3065), respectively. Systemic treatment was received by 311 patients (87.9%) with metastatic HER2+ BC, 264 of whom (84.9%) received trastuzumab. Annual health care costs per patient were nearly 3 times higher for stage IV vs. stage I–III HER2+ BC. Conclusion Per-patient annual costs were substantially higher for women with metastatic HER2+ BC, despite less frequent exposure to surgery and radiation compared to those with early stage disease. Increasing NAT rates in early stage disease represent a critical opportunity to prevent recurrence and reduce the costs associated with treating metastatic HER2+ BC.

Sign in / Sign up

Export Citation Format

Share Document