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Introduction: This study was designed to assess the degree of cooperation between plastic surgeons and gynecologists in certified breast centers in Germany. The rate of breast reconstruction after mastectomy remains low at 8-13%. In certified breast centers plastic surgeons are often not members of the team., Methods: A total of 220 hospitals affiliated to the West German Breast Center (WBC) were contacted in 2007 and 80 breast centers and hospitals returned the questionnaire. This study is based on the data of approximately 24,000 patients., Results: At the time of the investigation 60 out of the 80 hospitals (75%) were certified breast centers. Many different criteria have been applied for certified breast centers: the state of Nordrhein-Westfalen, the DKG/DGS (German Cancer Society/German Society of Senology), EUSOMA and others. In 8 hospitals (10%) a plastic surgeon was part of the team in the breast center. Most breast centers (44 out of 80) function with 3-4 attending specialists for breast surgery., Discussion: The cooperation between gynecologists and plastic surgeons within a breast center can be strengthened. A microsurgical breast augmentation is not the ideal solution for every patient with a mastectomy but every patient has the right to obtain complete information about the whole spectrum of breast reconstruction including microsurgical free flap reconstruction.

Ehime Priority Hospitals of Cancer Care Network(Ehime Cancer Kyoten Hospitals)regularly have meetings to discus the current problems in cancer care in Ehime Prefecture. We established three subcommittees:"Registration of Cancer Incident," "Critical Paths for the Management of Patients with Cancer,"and"Palliative Care for Patients with Advanced Cancer"to exchange our opinions. We recently set up a new subcommittee related to the physical and spiritual care of patients undergoing chemotherapy treatment,"A Subcommittee dealing with Cancer Chemotherapy and its Management"."This subcommittee has tried to identify current problems with chemotherapy for outpatients in each institution through questionnaire and analysis. As a result of this survey, it was found that Ehime Priority Hospitals have total of seventy-three beds for outpatients undergoing chemotherapy, and that they performed chemotherapy 19, 671 times in 2008. A total of eight oncology physicians and sixteen oncology nurses were engaged in performing chemotherapy in this system. The questions patients most frequently asked during chemotherapy concerned the management of therapy-related complications, dealing with problems at night and during holidays after chemotherapy, and financial problems related to the costs of treatment. In this study we found three issues that need to be managed in Ehime Priority Hospitals. First, for the nursing of outpatients undergoing chemotherapy, more staff engaged in different types of care is required. Second, a new system to deal with emergencies at night and during holidays after chemotherapy is necessary, because Ehime Priority Hospitals use the same system to deal with chemotherapy patients as for other patients. Third, cooperation between pharmacies and out-clinics is important for patient compliance during chemotherapy, especially for the administration of oral anti-tumor agents. Ehime Priority Hospitals of Cancer Care Network is trying to improve each institution while dealing with these problems.

The purpose of this study was to characterize quantitative computed tomography (QCT) in our multi-detector computed tomography (MDCT) scanner with regard to the influence of the QCT phantom on dose and the influence of varying mA and CIRS phantom size on bone mineral density (BMD) measurements. We accomplish this by scanning a commercially available QCT phantom and a corresponding quality assurance phantom. To assess the feasibility of having the QCT phantom in place while patients are being scanned, we measured radiation dose difference in a CT body phantom with and without the QCT phantom on the CT table and also, with and without the use of dose modulation programs. We also analyzed reconstructed QCT phantom images with the manufacturer's software to measure BMD. Although patient characteristics may be different, leading to different mA values, the influence of the QCT phantom on the dose to patients was minimal when compared with doses measured without the phantom in place. Average BMD measurements were not significantly affected by varying mA, for a fixed-size phantom. The average BMD exhibited a weak dependence on computerized imaging reference systems (CIRS) torso phantom size, with a propensity for decreasing BMD with increasing size. Measurement precision was unaffected by varying CIRS size. Having the ability to measure bone density as part of the routine management of cancer patients, with no added cost, time, or radiation dose, will allow for the prospective evaluation of bone mineral changes. We believe that this ability will facilitate the detection of abnormal bone loss and will lead to better management of this loss and, thus, reduce the complications and associated morbidity in these cancer survivors., (Copyright © 2011 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.)

Purpose: To evaluate the ongoing structure of radiation oncology in Japan in terms of equipment, personnel, patient load, and geographic distribution to identify and improve any deficiencies., Methods and Materials: A questionnaire-based national structure survey was conducted from March to December 2008 by the Japanese Society of Therapeutic Radiology and Oncology (JASTRO). These data were analyzed in terms of the institutional stratification of the Patterns of Care Study., Results: The total numbers of new cancer patients and total cancer patients (new and repeat) treated with radiation in 2007 were estimated at 181,000 and 218,000, respectively. There were 807 linear accelerator, 15 telecobalt, 46 Gamma Knife, 45 (60)Co remote-controlled after-loading, and 123 (192)Ir remote-controlled after-loading systems in actual use. The linear accelerator systems used dual-energy function in 539 units (66.8%), three-dimensional conformal radiation therapy in 555 (68.8%), and intensity-modulated radiation therapy in 235 (29.1%). There were 477 JASTRO-certified radiation oncologists, 826.3 full-time equivalent (FTE) radiation oncologists, 68.4 FTE medical physicists, and 1,634 FTE radiation therapists. The number of interstitial radiotherapy (RT) administrations for prostate, stereotactic body radiotherapy, and intensity-modulated radiation therapy increased significantly. Patterns of Care Study stratification can clearly identify the maturity of structures based on their academic nature and caseload. Geographically, the more JASTRO-certified physicians there were in a given area, the more RT tended to be used for cancer patients., Conclusions: The Japanese structure has clearly improved during the past 17 years in terms of equipment and its use, although a shortage of personnel and variations in maturity disclosed by Patterns of Care Study stratification were still problematic in 2007., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Mexico, like many other middle-income countries, is experiencing a demographic and epidemiological transition resulting in an older population suffering from chronic diseases. At the present time, cancer is the second cause of death in the country. Until recently, cervical carcinoma was the most frequent type of cancer in the country, however, the incidence of breast, prostate and colon cancers is growing. The demand for health care and health expenditure represented by cancer treatment challenges the limited resources the country has, particularly as patients seek treatment in advanced stages of the disease. Interestingly enough, these types of cancers could be detected in the early stages with rather simple screening procedures. The purpose of this paper is to describe the Mexican health system, and the impact of its fragmentation on access to medicines. Focusing on colorectal cancer (CRC), we describe its epidemiology, screening procedures and the inequities in health care access for these patients.

Colorectal cancer (CRC) is the second most commonly identified malignant neoplasm diagnosed in men (12% of total cancers) and women (11%) in Poland, while CRC mortality is second in men (10.1%) and third in women (11.2%). The main reasons for increasing incidence and mortality are an aging population and an increase in environmental and lifestyle factors which may lead to cancer. In Poland there is a lack of historical (regularly published and accessible) data on cancer morbidity and survival rates. The Oncology Centre published cancer data for the first time in February 2009 the 2006, which, also for the first time, embraced the entire country. Oncology data collection in Poland is based on a network of 16 Regional Cancer Registries reporting to the Polish National Cancer Registry in Warsaw. An additional source of oncology data is the National Health Fund and the Central Statistical Office. The National Cancer Programme (2005) provides funding at ca 780 million euro, which includes amongst others the Early CRC Detection Programme to promote a free screening colonoscopy. Oncology services in Poland are funded almost entirely by public resources--the national budget as sustained by tax revenues (Ministry of Health) and the National Health Fund as sustained by the obligatory public health insurance contribution. Oncology expenditure covered by the national budget (Ministry of Health) and the National Cancer Programme in 2006 amounted to 44.8 million euro and 105.2 million euro, respectively. All these preventive, curative and organizational efforts have significantly improved access to efficient therapies (including radiotherapy) and diagnostic procedures in recent years in Poland, although, clearly, a lot remains to be done.

Spain's radiation oncology infrastructure has evolved in terms of both quantity and structure since the last analysis was carried out in 1999. The purpose of this paper is to describe the current facilities, basically consisting of external radiotherapeutic units, and to present a calculation model for estimating the number of irradiation units required to guarantee equitable cover for radiotherapeutic treatment. An electronic questionnaire was designed to be accessed via a link on the Spanish Association of Radiotherapy and Oncology Web page. The questionnaire provides details of the current state of Spain's radiotherapeutic facilities, and a descriptive study has been performed with analytical data. The scope of the study included all the centres providing oncology-radiotherapy in Spain. The units analysed encompassed the centres and irradiation units actively providing care in 2004. Ninety-seven centres were detected, in which 177 external radiotherapy units were registered. Forty-five of these were cobalt units and 132 were accelerators. The rate of radiotherapy use in Spain based on the best scientific evidence available and on its rate of use with cancer has been estimated at 61%. The number of external irradiation units available in 2004 (177) is clearly lower than the number desirable (266-316).

Purpose: This study aimed to investigate the growth of radiation oncology in mainland China during the last 10 years., Methods and Materials: Survey questionnaires were sent to board members of the Chinese Society of Therapeutic Radiology and Oncology on Jan 1, 2006, and collected on Sept 30, 2006. Results were compared with those from 1997., Results: There were 952 registered radiation oncology centers, 5,247 radiation oncologists, 1,181 physicists, 6,864 nurses, 4,559 radiotherapists, and 1,141 engineers, corresponding to 210%, 153%, 279%, 222%, 203%, and 156% growth from 1997. There were 918 linear accelerators, 472 telecobalt units, 146 deep X-ray machines, 827 fluoroscopy simulators, 796 ionization-chamber dosimeters, 400 brachytherapy units, and 851 treatment planning systems, corresponding to 321%, 124%, 82%, 249%, 264%, 142%, and 481% changes from 1997, respectively. In 2006, there were 214 computed tomography simulators, 149 Gamma Knives, and 467 x-knife machines. Approximately 61%, 48%, and 12% of radiation oncology centers performed treatments using three-dimensional conformal radiotherapy, Gamma Knife or x-knife, and intensity-modulated radiotherapy, respectively., Conclusion: Radiation oncology has grown remarkably, and advanced techniques have been implemented very quickly in mainland China during last 10 years, but resources are still far less than the recommendation of the World Health Organization for the population.

There is growing evidence of inequalities in access to high-quality cancer services between minority and majority ethnic groups. However, little research has been carried out from the perspective of users from minority ethnic groups themselves. This paper reports a review of the British literature exploring the views and experiences of cancer service users from minority ethnic groups. We reviewed 25 qualitative studies that reported the experiences of people from minority ethnic groups. The studies highlighted significant issues and challenges, including comprehension and communication barriers, a lack of awareness of the existence of services and a perceived failure by providers to accommodate religious and cultural diversity. This paper critically discusses some of the explanations commonly invoked for ethnic inequalities in access to high-quality care, such as the belief that the lack of use of services reflects a lack of need. Despite positive initiatives to respond better to the needs of minority groups, we suggest the impact of these remains highly variable. Institutional racism within services is still much in evidence.

Among the most important decisions facing the British Government regarding the treatment of cancer in the National Health Service (NHS) is the purchase of charged particle therapy (CPT) centres. CPT is different from conventional radiotherapy: the dose is deposited far more selectively in Bragg Peaks by either protons or "heavy" ions, such as carbon. In this way, it is possible to "dose paint" targets, voxel by voxel, with far less dose to surrounding tissues than with X-ray techniques. At present the UK possesses a 62 MeV cyclotron proton facility at Clatterbridge (Wirral), which provides therapy for intraocular cancers such as melanoma; for deeper situated cancers in the pelvis, chest etc., much higher energies, over 200 MeV are required from a synchrotron facility. There is an impressive expansion in particle beam therapy (PBT) centres worldwide, since they offer good prospects of improved quality of life with enhanced cancer cures in situations where conventional therapy is limited due to radioresistance or by the close proximity of critical normal tissues. There is a threat to UK Oncology, since it is anticipated that several thousand British patients may require referral abroad for therapy; this would severely disrupt their multidisciplinary management and require demanding logistical support.

Purpose: To study the structural characteristics of radiation oncology facilities for France and to examine how technological evolutions had to be taken into account in terms of accessibility and costs. This study was initiated by the three health care financing administrations that cover health care costs for the French population. The needs of the population in terms of the geographic distribution of the facilities were also investigated. The endpoint was to make proposals to enable an evolution of the practice of radiotherapy (RT) in France., Methods and Materials: A survey designed by a multidisciplinary committee was distributed in all RT facilities to collect data on treatment machines, other equipment, personnel, new patients, and new treatments. Medical advisors ensured site visits in each facility. The data were validated at the regional level and aggregated at the national level for analysis., Results: A total of 357 machines had been installed in 179 facilities: 270 linear accelerators and 87 cobalt units. The distribution of facilities and megavoltage units per million inhabitants over the country was good, although some disparities existed between areas. It appeared that most megavoltage units had not benefited from technological innovation, because 25% of the cobalt units and 57% of the linear accelerators were between 6 and 15 years old. Computed tomography access for treatment preparation was not sufficient, and complete data management systems were scarce (15% of facilities). Seven centers had no treatment planning system. Electronic portal imaging devices were available in 44.7% of RT centers and in vivo dosimetry in 35%. A lack of physicians and medical physicists was observed; consequently, the workload exceeded the normal standard recommended by the French White Book. Discrepancies were found between the number of patients treated per machine per year in each area (range, 244.5-604). Most treatments were delivered in smaller facilities (61.6%)., Conclusion: On the basis of the findings of this study, measures were taken to update the infrastructure of RT in France. A first evaluation showed an improvement of care supply in RT in the country.

During the last 25 years, numerous studies have been conducted to promote breast cancer and cervical cancer screening. Most of these studies focused on individual-level factors predicting screening, but we are unaware of any that directly examined community and ecological influences. The goal of this project, Promoting Access to Health for Pacific Islander and Southeast Asian Women (PATH for Women), was to increase community capacity for breast and cervical cancer screening and follow up in Los Angeles and Orange counties. We focused on Southeast Asian and Pacific Islander women because, although they have the lowest rates for cancer, compared to all other ethnic groups, relatively few programs have specifically targeted Asian-American and Pacific Islander (AAPI) women to promote and sustain screening practices. The PATH for Women project involved a partnership between 5 community-based organizations and 2 universities, and included 7 Asian-American and Pacific Islander communities: Cambodians, Chamorros, Laotians, Thais, Tongans, Samoans, and Vietnamese. In this paper, we share our experiences in developing a Geographic Information System (GIS)-mapping evaluation component that was used to explore availability and accessibility to culturally responsive breast and cervical cancer screening services for Southeast Asian and Pacific Islander women in all 7 communities. We describe the methods used to develop the maps, and present the preliminary findings that demonstrate significant geographic and language barriers to accessing healthcare providers, services for breast and cervical cancer screening, and follow up, in each of the communities. Finally, we discuss implications for programs designed to promote breast and cervical screening and policy education.

Cancer is an emerging public health problem in Africa especially with increasing frequency of HIV-associated malignancies and exposure to environmental carcinogens. This review attempts to highlight steps that can be taken to achieve effective control programmes in low-resource areas of Africa. The author reviews the areas of importance in cancer control programmes based on local experience. To implement cancer control programmes, steps must be taken to improve the data collection on incidence and trends of common cancers with the establishment of local cancer registries. There is the necessity to increase the level of awareness of the population about common cancers, to dispel the cultural taboos and myths, and teach basic preventive health measures. These can be achieved by well-organized sustained educational programmes extended to the grass-roots with community participation. The training of personnel at community level to recognize the early signs and symptoms coupled with provision of primary health care facilities and basic sustained well-planned referral system will be necessary to accommodate the fall-out of educational programmes and anti-cancer campaign. The integration of cancer control activities into the existing health care structure would make it easier to sustain these programmes. The cost-effectiveness of prevention and early diagnosis of cancer cannot be over-emphasized in Africa. With government investment in national health and provision of facilities for early diagnosis and treatment, effective cancer control can be achieved.

Background: Surgery for rectal cancer is associated with high morbidity and mortality rates. The reason for this has been much debated. This population-based study reports the findings on postoperative morbidity and mortality after rectal cancer surgery following the introduction of a centralized colorectal unit in a county central hospital, supervised by a colorectal surgeon using the most recent techniques., Methods: All consecutive patients with rectal cancer who underwent surgery at four county hospitals in the Västmanland county in Sweden during 1993-1996 (n = 133) were compared with patients who underwent surgery at the new colorectal unit in the county central hospital from 1996 to 1999 (n = 144)., Results: The number of operating surgeons was reduced from 26 to four. The postoperative mortality rate decreased from 8 to 1 per cent (P = 0.002) and the total postoperative complication rate was reduced from 57 to 24 per cent (P < 0.001). Surgical complications dropped from 37 to 11 per cent (P < 0.001). The relaparotomy rate fell from 11 to 4 per cent (P < 0.05). Postoperative stay in hospital was reduced from a median of 13 to 9 days (P < 0.001)., Conclusion: The new organization, with centralized rectal cancer surgery using modern techniques, reduced postoperative mortality and overall morbidity rates to less than half.

With 90% of world children living in developing countries and a rising cancer incidence, the third world bears the greatest burden of pediatric cancer. Pediatric cancers today are highly treatable, but 80% of children with malignancies die because they live in the developing countries where access to medical care is inadequate. Pediatric cancer care is expensive and available at only a few centers, which deal with excessive patient numbers and are staffed by inadequate numbers of physicians and nurses. There are marked geographic variations in incidences and presentations observed in the spectrum of pediatric malignancies. Initiatives to improve cancer care include setting up worldwide pediatric care units; establishing standard guidelines for treating patients; undertaking research and lobbying international organizations like the World Health Organization, United Nations Children's Emergency Fund (UNICEF), International Union Against Cancer (UICC), and the International Society of Pediatric Oncology (SIOP); to make chemotherapy, supportive care drugs, and opioids for palliation uniformly available. New outreach training programs would alleviate manpower shortages by linking centers from the two world regions for training and facilitate collaboration with international organizations.

Background: Cancer has become a significant health concern in American Indian communities. Over the past several decades Native peoples have experienced significant increases in life expectancy and, with these gains, significant increases in cancer incidence and mortality. Limited data are available concerning cancer-control activities accessible to American Indian communities. Even less is known about control programs in place for American Indians resident in urban areas, where more that half of all Native peoples reside., Methods: To ascertain the extent of available services and perceptions of health directors, a survey of all Indian-Health-Service-recognized urban clinics was undertaken., Results: Results indicate that the cancer needs of American Indians resident in urban areas are not being adequately addressed. Only one-third of urban health directors reported perceived increases in cancer incidence and mortality rates. The directors ranked cancer fifth among seven health problems in terms of their clinics' commitment to addressing them. Findings from this study are juxtaposed with whose obtained in a separate survey of reservation-based health directors., Conclusions: Results indicate a need to develop more responsive cancer-control programs in Indian country and to sensitize researchers to other health needs of these communities.

Although the concept of outpatient care is not a new one, the growth in ambulatory facilities has revolutionized medical care in the United States. The growth in ambulatory surgery centers, imaging centers, and cancer centers in Florida is explored in detail. With the many changes forthcoming in health care, ambulatory care will play an increasing role in delivering good health care at a reasonable cost.

Migration adds a complex dimension to the task of those who plan and allocate resources for health care. The authors offer a methodology for estimating the contribution of migration to the incidence of cancer, allow for age- and sex-specific cancer risks, and estimate, by country, the impact of recent migration on the annual incidence of cancer in Florida. Cancer and migration data were used to develop estimates of the number of cancer cases for Florida counties that were attributable to recent migrants. A net gain and loss ratio was calculated for new cancer cases in 1980 resulting from the 1975-80 migration pattern. Florida data was used because that State has one of the highest crude cancer incidence rates in the nation, is one of the most populous States, and has a population growth from migration rather than from natural increase. Preliminary findings on the relationship between cancer health services resources and net cancer rates from migration are discussed. County cancer health services resources had a strong positive relationship to population size, but the impact of migration on cancer incidence was in a curvilinear relationship to population size.

The problems associated with cancer management particularly by radiotherapy in the developing countries are well known. This paper attempts to present the case as it is in Anglophone West Africa, and to quantify the severity of the problem through a critical analysis of available data based on the experience at the oldest radiotherapy center in West Africa between January 1981 and December 1988. In the whole of the Anglophone West African states with a population estimated at 140 million people, there was only one functional radiotherapy center until 1986 when another unit was commissioned. The paper analyzes the types of tumors managed, radiotherapy facilities available, staffing, and the other operational problems encountered by the Radiotherapy Department of the Lagos University Teaching Hospital in Nigeria. Suggestions are made for the overall improvement of radiotherapy services in the region.