Spatial distribution of advanced stage diagnosis and mortality of breast cancer: Socioeconomic and health service offer inequalities in Brazil

Mapping the Distribution and Challenges of Long-Distance Travel for Patients With Breast Cancer at the Uganda Cancer Institute

PURPOSE

Breast cancer is a major public health concern in Uganda, with limited research on its spatial distribution. With the increasing burden of breast cancer in Uganda, ensuring equitable access to care is crucial. This study investigates the spatial distribution of breast cancer cases across Uganda and describes travel distances patients travel to reach the Uganda Cancer Institute (UCI), the national cancer treatment center. By analyzing geographic patterns and disparities in accessibility, this research aims to inform targeted interventions for improved patient outcomes and a more equitable health care system.

PATIENTS AND METHODS

This retrospective study analyzed data from patients with breast cancer treated at UCI from 2009 to 2023. We geocoded patient addresses and calculated the travel distance from each residence to UCI. Spatial analysis was performed using Moran I statistic to assess clustering patterns in breast cancer distribution.

RESULTS

This study mapped the residences of 1,926 patients with breast cancer. Over half (54.7%) were concentrated in the Central region, with a median distance to the UCI of 11.2 km. By contrast, patients from the Northern region faced a median journey of 291 km, highlighting a significant disparity in proximity to care. Distinct clusters of patients were identified beyond the capital, Kampala, notably in Mbale (Eastern region) and several towns within the Northern region (Arua, Adjumani, Gulu, and Lira), suggesting potential localized factors influencing breast cancer incidence.

CONCLUSION

This study highlights significant regional disparities in access to breast cancer care in Uganda, emphasizing the need for targeted interventions to improve health care access and reduce the burden of long-distance travel for patients in remote areas.

Geospatial patterns by cancer stage across Australia for three common cancers

BACKGROUND

Monitoring cancer stage is vital to interpret cancer incidence and survival patterns, yet there are currently no cancer stage estimates by small areas across Australia, despite demonstrated large disparities in cancer incidence and survival. While cancer stage data is not routinely collected in Australia, a pilot project collected stage information nationwide in 2011.

METHODS

Data on all primary invasive melanoma, female breast and prostate cancers (stages 1-4) diagnosed during 2011 in Australia were categorised into early and intermediate/advanced stage at diagnosis. Bayesian spatial models were used to estimate standardised incidence rates (SIRs) and proportions of cancer stage across 2148 statistical areas level 2. The correlation between early and more advanced cancer rates was explored using exceedance probabilities.

RESULTS

Both melanoma and prostate cancer had mainly early stage diagnoses. There was large variation in rates across the nation, and also substantial correlation between SIRs of early and more advanced stage for melanoma and prostate cancer. In contrast, breast cancer had a higher proportion of advanced cancers diagnosed, less pronounced variation in rates and limited correlation between early and more advanced stage SIRs. The proportion of cases diagnosed as early stage varied across Australia by type of cancer.

CONCLUSION

This study uncovered important spatial patterns in the diagnosis of cancer by stage across the country, which varied by cancer type and location. There is an urgent need to have contemporary information about stage at diagnosis routinely included in population-based cancer registries across the country.

Systems delay in women with breast cancer - A sequential explanatory mixed-methods study from central rural India

Background

Globally, breast cancer is the most common malignant tumor in both developed and developing nations, with an incidence of 2 million cases every year and around 6 lakh deaths. Even after the availability of healthcare facilities, delays in the management of breast cancer are seen in both developed and developing countries.

Objectives

To assess the patient and system-level delays and to determine the factors that cause the identified delays in women with breast cancer from central rural India.

Methodology

The present Mixed-method study was conducted in a tertiary care hospital in central rural India among 128 female breast cancer patients. Socio-demographic and clinical information of the patients was summarized using frequency and proportions. Delays were reported using a median number of days and interquartile range. To assess the factors associated with the delays, we used Negative log-binomial regression analysis. Qualitative data analysis was done by manual thematic analysis.

Results

The mean age of the study participants was 50.54, SD was 10.46, Median was 50, and the Interquartile range (IQR) was 43-58 years. A median patient delay of 45 days, and IQR was 15-120. A median system delay of 19 days and IQR was 7-35 days. We identified seven themes addressing the factors influencing delays at various levels by thematic analysis. Negative log-binomial regression models were built for the association of the socio- demographic and clinical variables with patient and system delays.

Conclusion

Our study concludes that there is a substantial delay at patient level reporting to healthcare care providers, which needs an increase in awareness levels in the community through dedicated Behavior Change Communication strategies along with addressing identified socio-cultural and economic determinants influencing delay at various levels.

Modular and Portable System Design for 3D Imaging of Breast Tumors Using Electrical Impedance Tomography

This paper presents a prototype of a portable and modular electrical impedance tomography (EIT) system for breast tumor detection. The proposed system uses MATLAB to generate three-dimensional representations of breast tissue. The modular architecture of the system allows for flexible customization and scalability. It consists of several interconnected modules. Each module can be easily replaced or upgraded, facilitating system maintenance and future enhancements. Testing of the prototype has shown promising results in preliminary screening based on experimental studies. Agar models were used for the experimental stage of this project. The 3D representations provide clinicians with valuable information for accurate diagnosis and treatment planning. Further research and refinement of the system is warranted to validate its performance in future clinical trials.

Spatial equity and factors associated with intensive care unit bed allocation in China

BACKGROUND

At present, unequal allocation of medical resources represents a major problem for medical service management in China and many other countries. Equity of intensive care unit (ICU) bed allocation is essential for timely and equitable access to medical care for critically ill patients. This study analysed the equity of ICU bed allocation in 31 provincial regions in China, and the associated factors, to provide a theoretical basis for improvement in the allocation of ICU beds.

METHODS

The equity of ICU bed allocation was investigated in 31 provincial regions in China in 2021. The Gini coefficient combined with Lorenz curves were used to analyse the current status of ICU bed allocation by both population and service area. The spatial heterogeneity and aggregation of ICU bed density were analysed using the Global Moran's index. The spatial distribution pattern was visualized via LISA maps using the Local Moran's index. Three grey correlation models were constructed to assess the key factors influencing ICU bed density. Finally, robustness analysis was performed to test the reliability of the results.

RESULTS

The allocation of ICU beds in China was highly inequitable by service area (Gini = 0.68) and showed better balance by population distribution (Gini = 0.14). The distribution of ICU beds by service area was highly spatially clustered (Global Moran's I = 0.22). The bed utilization rate exhibited the strongest association with ICU bed density by population. Registered nurses per 10,000 square kilometres was the strongest factor affecting ICU bed density by service area.

CONCLUSIONS

The allocation of ICU beds by population is better than by service area; the allocation by service area is less equitable in China. These findings emphasise the need to implement better measures to reduce ICU bed equity differences between regions and balance and coordinate medical resources. Service area size, bed utilization, the number of registered nurses and other key factors should be considered when performing regional health planning for ICU bed supply. This will increase the equitable access to critical medical services for all populations.

Role of geographic characteristics in the spatial cluster detection of cancer: Evidence in South Korea, 1999-2013

BACKGROUND

Identification of high-risk areas of cancer, referred to as spatial clusters, can inform targeted policies for cancer control. Although cancer cluster detection could be affected by various geographic characteristics including sociodemographic and environmental factors which impacts could also vary over time, studies accounting for such influence remain limited. This study aims to assess the role of geographic characteristics in the spatial cluster detection for lung and stomach cancer over an extended period.

METHODS

We obtained sex-specific age-standardized incidence and mortality rates of lung and stomach cancer as well as geographic characteristics across 233 districts in South Korea for three five-year periods between 1999 and 2013. We classified geographic characteristics of each district into four categories: demography, socioeconomic status, behaviors, and physical environments. Specifically, we quantified physical environments using measures of greenness, concentrations of particulate matter and nitrogen dioxide, and air pollution emissions. Finally, we conducted cluster detection analyses using weighted normal spatial scan statistics with the residuals from multiple regression analyses performed with the four progressive sets of geographic attributes.

RESULTS

We found that the size of clusters reduced as we progressively adjusted for geographic covariates. Among the four categories, physical environments had the greatest impact on the reduction or disappearance of clusters particularly for lung cancer consistently over time. Whereas older population affected a decrease of lung cancer clusters in the early period, the contribution of education was large in the recent period. The impact was less clear in stomach cancer than lung cancer.

CONCLUSION

Our findings highlight the importance of geographic characteristics in explaining the existing cancer clusters and identifying new clusters, which jointly provides practical guidance to cancer control.

Epidermal growth factor receptor (EGFR) expression in the serum of patients with triple-negative breast carcinoma: prognostic value of this biomarker

Background

Epidermal growth factor receptor (EGFR) overexpression has been considered a poor prognostic factor in breast cancer.

Methodology

A prospective study of 206 women with breast cancer analysed by stages (I, II, III and IV) and by immunohistochemical subtype (Luminal A, Luminal B, HER2+ and triple-negative (TN)); 89 healthy controls with normal recent mammography were included. The EGFR measured in the serum (sEGFR) was detected by the Enzyme-Linked Immunosorbent Assay (ELISA) method (R&D Systems kit DY231) collected by blood before any treatment in patients. Kaplan-Meier method and Cox regression were carried out to obtain the prognostic value, considering significance if p < 0.05.

Results

With a median follow-up of 36.6 months, 47 deaths occurred. Multivariable Cox regression showed difference of overall survival (OS) associated with sEGFR levels (sEGFR ≤ or > 47.8 ng/mL) in patients with TN cancers, but not of Luminal A, Luminal B or HER2+ subtypes; adjusted by stage, the death risk increased by approximately 415% [hazard ratio (HR): 5.149 (1.900-13.955), p = 0.001] for patients with sEGFR > 47.8 ng/mL compared to patients with a lower sEGFR value. There was no significant correlation of sEGFR with staging, histological tumour grade (G1/G2/G3), Ki67 (< or ≥14%) or body mass index.

Conclusions

Increased sEGFR expression in patients with TN tumours is a significant predictor of lower OS and its quantification is inexpensive and straightforward.

HDAC Inhibitors: Innovative Strategies for Their Design and Applications

Histone deacetylases (HDACs) are a large family of epigenetic metalloenzymes that are involved in gene transcription and regulation, cell proliferation, differentiation, migration, and death, as well as angiogenesis. Particularly, disorders of the HDACs expression are linked to the development of many types of cancer and neurodegenerative diseases, making them interesting molecular targets for the design of new efficient drugs and imaging agents that facilitate an early diagnosis of these diseases. Thus, their selective inhibition or degradation are the basis for new therapies. This is supported by the fact that many HDAC inhibitors (HDACis) are currently under clinical research for cancer therapy, and the Food and Drug Administration (FDA) has already approved some of them. In this review, we will focus on the recent advances and latest discoveries of innovative strategies in the development and applications of compounds that demonstrate inhibitory or degradation activity against HDACs, such as PROteolysis-TArgeting Chimeras (PROTACs), tumor-targeted HDACis (e.g., folate conjugates and nanoparticles), and imaging probes (positron emission tomography (PET) and fluorescent ligands).