Journal of Cancer Policy最新文献

{"title":"An empirical investigation into concerns over quality-adjusted life-years: A review of cost-effectiveness analyses in oncology","authors":"Adam J.N. Raymakers ,&nbsp;Leah Z. Rand ,&nbsp;William B. Feldman ,&nbsp;Aaron S. Kesselheim","doi":"10.1016/j.jcpo.2025.100562","DOIUrl":"10.1016/j.jcpo.2025.100562","url":null,"abstract":"<div><h3>Background</h3><div>Health care payers often use cost-effectiveness analyses (CEA) using the quality-adjusted life-year (QALY), as the measure of benefit, to inform reimbursement decisions for new therapies. The QALY combines quantity of life and health-related quality of life into a single outcome measure and enables comparisons across diseases. Critics in the United States have attempted to ban the use of CEAs using QALYs based on the argument that these analyses identify subgroups of vulnerable patient populations for whom drugs are less cost-effective, thereby limiting access.</div></div><div><h3>Materials and methods</h3><div>We used the Tufts CEA Registry to identify QALY-based CEAs of cancer drugs conducted in the US from 1991 to 2023. We extracted the year of publication, cancer type, incremental cost-effectiveness ratio (including component incremental costs and QALYs), whether a subgroup analysis was performed, characteristics of that subgroup analysis, and how the subgroup affected cost-effectiveness.</div></div><div><h3>Results</h3><div>The final cohort included 322 full-text studies; 249 (77.3 %) analyzed treatments for solid tumors and the remainder treatments for blood cancers. Pembrolizumab was the most common therapy studied across all indications (10.2 %). Overall, 31 studies (9.6 %) included some form of subgroup analysis, all of which were age-related. Eleven (35.5 %) of the CEAs with age-related subgroup analyses were conducted following a pivotal clinical trial with the same subgroups.</div></div><div><h3>Conclusions</h3><div>QALY-based CEAs do not often include subgroups based on age, disease severity, chronic disease, or disability. In rare cases when these analyses are conducted, they are often motivated by clinically meaningful subgroup analyses performed in trials and not by payer budgetary considerations. Therefore, these results show concern about subgroup analyses does not justify efforts to exclude payers from using QALYs in CEA.</div></div><div><h3>Policy summary</h3><div>Concerns over CEAs identifying subgroups in their analyses do not appear to be justified and does not warrant precluding the use of QALYs for decision-making or price negotiation for drugs.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100562"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081618","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic, political, and policy contexts of cancer care: A comparative analysis of countries with the highest survival rates","authors":"Alejandra Fuentes-García ,&nbsp;Carla Flores-Figueroa ,&nbsp;Alondra Castillo-Delgado","doi":"10.1016/j.jcpo.2025.100559","DOIUrl":"10.1016/j.jcpo.2025.100559","url":null,"abstract":"<div><h3>Introduction</h3><div>Cancer remains a leading cause of mortality, with 20 million new cases and 10 million deaths in 2022 (WHO). Despite advances in detection and treatment, structural inequalities affect exposure to risk factors and healthcare access. This study compares the cancer care policy contexts of five countries with the highest five-year survival rates.</div></div><div><h3>Methods</h3><div>This qualitative review examines cancer care policies in Australia, Canada, Costa Rica, Belgium, and Japan countries through a critical comparative approach. Data was gathered from official and international documents, focusing on four domains: socio-demographic characteristics, socio-political traditions, health systems, and cancer policies.</div></div><div><h3>Results</h3><div>The countries share high life expectancy, and education, while face similar population challenges. Australia and Canada have implemented telemedicine and mobile services to address the needs of dispersed rural populations, while Belgium and Japan ensure equitable access in dense areas. All countries integrate public-private partnerships, and adapt governance structures to contexts, under a strong welfare state with universal health coverage. Cancer policies are characterised by participatory processes that emphasise equity, accessibility, and innovation</div></div><div><h3>Policy summary</h3><div>The study identifies consistent patterns in cancer care policies, highlighting contributing factors to high survival rates. Participatory and bottom-up policy design enables responses to complex contexts. Strategies focus on financial sustainability, equity, cultural relevance, and territorial adaptation. An innovative framework for assessing cancer care policy contexts is introduced.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100559"},"PeriodicalIF":2.0,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143081541","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Changes in employment status and income and workplace organizational support among cancer survivors: A descriptive study in Iran","authors":"Mohammadreza Sheikhy-Chaman ,&nbsp;Rajabali Daroudi ,&nbsp;Hamideh Rashidian ,&nbsp;Monireh Sadat Seyyedsalehi ,&nbsp;Azin Nahvijou ,&nbsp;Maryam Hadji ,&nbsp;Kazem Zendehdel","doi":"10.1016/j.jcpo.2025.100558","DOIUrl":"10.1016/j.jcpo.2025.100558","url":null,"abstract":"<div><h3>Purpose</h3><div>Cancer is the second leading cause of mortality in Iran, significantly impacting patients' lives and the public health system. This study aims to investigate changes in employment status and income and workplace organizational support among Iranian cancer survivors following their diagnosis.</div></div><div><h3>Methods</h3><div>This study was conducted at the Cancer Institute of Imam Khomeini Hospital complex in Tehran, Iran, in 2019. A total of 250 cancer survivors who were employed prior to their diagnosis and more than a year had passed since their diagnosis were selected from the IROPICAN study and participated in this research. Data collection was performed through telephone interviews using a validated researcher-made questionnaire. Statistical analyses were carried out using SPSS v.18 software.</div></div><div><h3>Results</h3><div>Cancer diagnosis led to changes in the employment status of 75 % (N = 188) of participants, with nearly half (N = 122) becoming unemployed. Financial necessity was the primary reason survivors continued working after treatment. Additionally, 76 % experienced income changes, with 85 individuals facing a complete loss of income. Only half of the 115 patients requiring organizational support in the workplace received assistance, while the rest primarily benefited from approved leave applications.</div></div><div><h3>Conclusion</h3><div>Iranian cancer patients face significant socioeconomic challenges, including unemployment, reduced income, and inadequate organizational support in the workplace.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100558"},"PeriodicalIF":2.0,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142972527","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Process evaluation of quality of precancerous cervical lesion screening program in selected public health centers in Addis Ababa, Ethiopia","authors":"Mikael Abraham ,&nbsp;Tilahun Fufa ,&nbsp;Asrat Arja ,&nbsp;Yesuneh Tefera Mekasha ,&nbsp;Gemmechu Hasen ,&nbsp;Meskerem Seboka","doi":"10.1016/j.jcpo.2025.100557","DOIUrl":"10.1016/j.jcpo.2025.100557","url":null,"abstract":"&lt;div&gt;&lt;div&gt;Cervical cancer is the second most prevalent disease among Ethiopian women of reproductive age and a serious gynecological malignancy affecting women regionally. About, 3235 deaths and 4648 new cases are reported nationwide each year. Precancerous cervical screening programs face many difficulties in settings with limited resources, despite their severity, such as a lack of medical supplies and equipment, poorly trained healthcare workers, a heavy workload for current staff, low professional compliance, and insufficient support from medical facilities. Furthermore, the quality of screening services is not well-supported by data in many places, which makes efforts to enhance these programs even more difficult. Improving service quality and customer satisfaction requires an understanding of the accessibility of critical screening tools and the skill of healthcare providers. Hence, this study aims to evaluate the process quality of the pre-cancerous cervical lesion screening program at selected public health centers in Gulele sub-city, Addis Ababa, Ethiopia. A case study design involving both quantitative and qualitative methods was conducted from April 09 to May 10, 2022. The study was conducted based on clinical guidelines and previously published evidence in peer-reviewed journals. A total of nine (n = 9) public health centers were involved in the study. A total of 223 study participants for service program evaluation. For the qualitative study, 12 key informants were interviewed at exit consecutively. Additionally, resource inventory and record review were conducted. Data were analyzed using SPSS for Windows version 25. Multi-variate logistic regression was used to check the association between the outcome and independent variables. Multivariate logistic regression was analyzed when the p-value was less than or equal to 0.25 in bivariate binary logistic regression, considering the statistical significance at p-value &lt; 0.05. Qualitative data were analyzed manually by summarizing into a key thematic area. The evaluation findings were interpreted based on a predetermined judgment matrix with stakeholders during the evaluability assessment. From quality perspectives, study found that, pre-cancerous cervical lesion screening service concerning program resource availability was measured to be 80 %, which was good. In terms of satisfaction, the study found that 88 % of clients were satisfied with the precancerous cervical lesion screening service provided by health centers. Occupational status of a government employee (AOR: 0.04; 95 % CI: 0.003,0.63), educational status with no formal education (AOR: 0.04; 95 %CI: 0.006, 0.23), long-term use of contraceptives (AOR: 3.70; 95 %CI: 1.34, 10.21), and having multiple children up to three (AOR: 3.27; 95 %CI: 1.3, 9.44) were significantly associated factors with client satisfaction on screening services for precancerous cervical. However, while the overall program implementation scored 78.67 %, c","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100557"},"PeriodicalIF":2.0,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142967226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Social Determinants of Health on Cancer Treatment Referrals in Patients Living with HIV in the United States: A Narrative Review.","authors":"Shebin George ,&nbsp;Heena Mansuri ,&nbsp;Michael Qureshi ,&nbsp;Sebastian Lopez ,&nbsp;Alejandra Viera ,&nbsp;Jeremy Purow ,&nbsp;Stephanie Ocejo ,&nbsp;Jannelle Vicens ,&nbsp;Marco Ruiz Andia","doi":"10.1016/j.jcpo.2024.100555","DOIUrl":"10.1016/j.jcpo.2024.100555","url":null,"abstract":"<div><h3>Introduction</h3><div>This narrative review aims to identify and explore the social determinants that prevent people living with HIV (PWH) from accessing specialized cancer centers in the United States and compare to patient experiences in other countries.</div></div><div><h3>Methods</h3><div>The review includes randomized controlled trials, cohort studies, case-control studies, qualitative studies, case series, and non-peer reviewed articles. The risk of bias was assessed using standardized tools, and data were synthesized narratively due to the heterogeneity of study designs and outcomes.</div></div><div><h3>Results</h3><div>Our findings highlight that PWH in the U.S. typically depend on public insurance or programs such as the Ryan White HIV/AIDS Program (RWHP), which offer better cancer care outcomes but are limited by income restrictions. Integrated health systems, such as Veterans Affairs (VA) centers, have successful cancer screening programs but limited accessibility. Limited health literacy among PWH is associated with poor clinical knowledge, misinterpretation of treatment outcomes, and underreporting of medical conditions. Although higher health literacy improves screening rates, its impact on referrals to specialized cancer centers is unclear. Racial and ethnic disparities result in lower screening rates and fewer referrals to specialized care, with Hispanic, Asian, and Black patients facing barriers like distrust in healthcare, cultural factors, and insurance status. HIV stigma further leads to healthcare avoidance and delayed interventions.</div></div><div><h3>Conclusion</h3><div>The review addresses systemic barriers including healthcare access, health literacy, racial, and ethnic disparities, and cultural stigma and highlights solutions to improve cancer treatment referrals among PWH. Recommendations include improving access to integrated health centers and developing culturally competent interventions to enhance referrals to advanced cancer care for PWH.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100555"},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond smoke: Status of flavored smokeless tobacco regulation in India","authors":"Amit Kumar Soni ,&nbsp;Mohit Kumar","doi":"10.1016/j.jcpo.2024.100554","DOIUrl":"10.1016/j.jcpo.2024.100554","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100554"},"PeriodicalIF":2.0,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142923305","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sexual health in women and sexual-gender-minority patients with cancer: A nationwide survey on healthcare professional awareness and attitude on behalf of MITO and AIRO-gynecology group","authors":"Amelia Barcellini ,&nbsp;Chiara Cassani ,&nbsp;Giulia Fontana ,&nbsp;Ester Orlandi ,&nbsp;Gabriella Macchia ,&nbsp;Giorgia Mangili ,&nbsp;Sandro Pignata ,&nbsp;Laura Deborah Locati ,&nbsp;Rossella E. Nappi","doi":"10.1016/j.jcpo.2024.100556","DOIUrl":"10.1016/j.jcpo.2024.100556","url":null,"abstract":"<div><h3>Background</h3><div>Compared to male patients, sexual health remains poorly studied in women and sexual gender minority (SGM) patients with cancers.</div></div><div><h3>Material and methods</h3><div>An online survey was developed by a multidisciplinary team to assess the awareness and attitude of Italian oncological providers facing sexual health during or after cancer treatment. On behalf of the respective scientific committees, the questionnaire was sent to Multicenter Italian Trials in Ovarian cancer and gynecologic malignancies group (MITO) and to Italian Association of Radiation Oncology (AIRO) Group. Four dedicated sections analyzed participants' demographic data, clinical context, communication and assessment practices, possible barriers, and treatment approaches.</div></div><div><h3>Results</h3><div>A total of 184 clinicians responded to the survey for an overall response rate of 20.8 %. Patient’s gender identity and sexual orientation were not routinely assessed, and several barriers were recorded. There was a high attitude to talk about the iatrogenic potential of sexual dysfunction with patients, even if up to 39.7 % of the respondents declared average/extreme difficulty in facing this issue. Radiation and medical oncologists more frequently refer patients to dedicated specialists to manage iatrogenic sexual dysfunctions.</div></div><div><h3>Conclusions</h3><div>Sexual health is a key component of comprehensive care for female and SGM patients during their oncological journey. Despite the high attitude to talk about iatrogenic sexual dysfunctions in Italian providers, the present study highlighted the need for specific training and guidelines on sex-related health issues encountered by women and SGM patients.</div></div><div><h3>Policy summary</h3><div>Despite the recognized need for specialized care, there remain significant gap and barriers in knowledge regarding sexual health management in women and SGM patients. Our study highlights the urgent need to enhance healthcare provider training, equipping them with the necessary tools to recognize, discuss, and treat this type of toxicity, which has a significant impact on the social well-being and quality of life of long-term survivors.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100556"},"PeriodicalIF":2.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142915747","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A National Cancer Plan for England: Remember the needs of people in rural and coastal areas","authors":"David Nelson,&nbsp;Mark Lawler,&nbsp;Ros Kane,&nbsp;Ben Pickwell-Smith,&nbsp;Samuel Cooke,&nbsp;Ava Harding-Bell,&nbsp;Kathie McPeake,&nbsp;Lynn Calman,&nbsp;Peter Selby","doi":"10.1016/j.jcpo.2024.100553","DOIUrl":"10.1016/j.jcpo.2024.100553","url":null,"abstract":"","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100553"},"PeriodicalIF":2.0,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142883068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking barriers: The impact of telemedicine on improving soft tissue and bone tumor management in Armenia","authors":"Ruzanna Papyan ,&nbsp;Shushan Hovsepyan ,&nbsp;Julieta Hoveyan ,&nbsp;Saten Hovhannisyan ,&nbsp;Tatev Arakelyan ,&nbsp;Gevorg Tamamyan ,&nbsp;Lilit Sargsyan ,&nbsp;Lusine Hakobyan ,&nbsp;Levon Davtyan ,&nbsp;Armine Lazaryan ,&nbsp;Davit Dallakyan ,&nbsp;Narek Manukyan ,&nbsp;Armen Mkhitaryan ,&nbsp;Nelli Grigoryan ,&nbsp;Sybille Perkowski ,&nbsp;Birgit Froehlich ,&nbsp;Andreas Groll ,&nbsp;Manfred Schiborr ,&nbsp;Katja Glutig ,&nbsp;Kai Kroeger ,&nbsp;Heribert Jürgens","doi":"10.1016/j.jcpo.2024.100530","DOIUrl":"10.1016/j.jcpo.2024.100530","url":null,"abstract":"<div><h3>Purpose</h3><div>Musculoskeletal sarcomas are a rare group of malignant neoplasms, accounting for approximately 12 % of all malignant neoplasms among children. Childhood cancer outcomes vary between developed and developing countries due to financial and educational inequalities. Telemedicine programs have a huge impact on the quality of cancer care, helping to optimize resources for better cancer care in a resource-limited setting. In 2019, Armenia established multidisciplinary teams (MDT) with the guidance of international experts via telemedicine, significantly improving patients’ management diagnosed with sarcomas.</div></div><div><h3>Methods</h3><div>The musculoskeletal cancer working group, mentored by the University Hospital of Münster (UKM), conducted weekly virtual tumor boards to discuss cases, focusing on the review of pathological and radiological examinations. <strong>Results:</strong></div><div>From August 2019 to December 2023, the musculoskeletal cancer MDT discussed 151 musculoskeletal tumor cases via 74 MDT meetings. Imaging studies of all discussed cases were reviewed, while the review of histology images was performed for 93 % of cases. The pathology review led to changes in previously established diagnoses in eleven cases, which subsequently changed management. These led to altered local control strategies for 32 patients, with 5 requiring treatment abroad, and changes in chemotherapy regimens for 17 patients. Notably, there were no cases of treatment refusal post-implementation, a reduction from the previous 3 % refusal rate.</div></div><div><h3>Conclusion</h3><div>The successful telemedicine initiative, coupled with institutional support, improved the care of patients diagnosed with musculoskeletal tumors. The investment in telemedicine in developing countries not only enhances communications with international and local experts across various disciplines but also significantly improves the handling of patients diagnosed with sarcomas.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100530"},"PeriodicalIF":2.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breast cancer in Bulgaria prior implementation of a national breast cancer screening program and certified breast centers","authors":"Mariela Vasileva-Slaveva ,&nbsp;Desislava Kostova-Lefterova ,&nbsp;Filip Simeonov ,&nbsp;Angel Yordanov ,&nbsp;Metodi Metodiev","doi":"10.1016/j.jcpo.2024.100531","DOIUrl":"10.1016/j.jcpo.2024.100531","url":null,"abstract":"<div><h3>Introduction</h3><div>Breast cancer (BC) survival has improved globally in the past years. Eastern Europe is a region with lack of epidemiological data and traditionally lower BC overall survival (OS). We aimed to investigate the epidemiology of BC in Bulgaria between 2012 and 2022 and the readiness of the state for implementing population based organized screening program.</div></div><div><h3>Methods and materials</h3><div>This is a retrospective study of 38 576 invasive BC cases registered in Bulgarian National Cancer Registry. We obtained data from publicly available sources - national institutes and regulatory agencies. We report descriptive statistics of distribution of cases and mammography units among the country and the compared survival of patient’s groups.</div></div><div><h3>Results</h3><div>75 % of patients are treated in the 9 biggest cities. They are younger, diagnosed earlier and have significantly better OS than the rest of the patients. Patients over 75 years represent 18.7 % of all. The 211 installed mammography systems can secure the implementation of organized BC screening.</div></div><div><h3>Discussion</h3><div>The survival gap between cities can be due to the limited access to care of older patients living in smaller cities. The model of collaboration between private and state centers can be highly effective in implementing of organized screening since in Bulgaria both can be reimbursed by the National Insurance Fund.</div></div><div><h3>Conclusion</h3><div>Further centralization of care probably would not have such an impact on treatment outcomes as improvement and monitoring the quality of the provided treatment. Organized BC screening in Bulgaria is needed and technically possible step towards improving survival.</div></div>","PeriodicalId":38212,"journal":{"name":"Journal of Cancer Policy","volume":"43 ","pages":"Article 100531"},"PeriodicalIF":2.0,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}