The cancer journal
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Lung cancer with an estimated 342,000 deaths in 2008 (20% of total) is the most common cause of death from cancer, followed by colorectal cancer (12%), breast cancer (8%), and stomach cancer (7%) in Europe. In former smokers, the absolute lung cancer risk remains higher than in never-smokers; these data therefore call for effective secondary preventive measures for lung cancer in addition to smoking cessation programs. ⋯ An overview of randomized controlled computerized tomography-screening trials is given, and the role of bronchoscopy and new techniques is discussed. Finally, the approach of (noninvasive) biomarker testing in the blood, exhaled breath, sputum, and bronchoscopic specimen is reviewed.
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Currently, lobectomy is the preferred treatment for early-stage, non-small cell lung cancer primarily because of the increased local recurrence rate that has been reported with sublobar resection. Sublobar resection is typically used for high-risk, but still operable, patients with lung cancer. ⋯ Also, the potential for better preservation of pulmonary function with sublobar resection has fueled the debate arguing for sublobar resections even for patients who are considered to be "good risk" and able to tolerate a lobectomy. This article reviews the current status of sublobar resection for early-stage lung cancer, with particular attention to issues such as tumor size, type of sublobar resection, use of adjuvant brachytherapy, and preservation of pulmonary function.
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Prior studies have demonstrated that individuals without health insurance are less likely to have a usual source of health care and receive preventive services including cancer screening and are more likely to be diagnosed at late stages of cancer. To examine the potential impact of health care reform on stage at diagnosis, we analyzed the relationship between stage at diagnosis and insurance status for patients who were nearly elderly (55-64 years old) and younger elderly (65-74 years old). We examined patients diagnosed with 8 common cancers from January 1, 2005, to December 31, 2007, using data from the National Cancer Database, a hospital-based cancer registry jointly sponsored by the American Cancer Society and the American College of Surgeons, which includes approximately 70% of all malignant cancers in the United States treated at 1400 facilities throughout the United States. ⋯ Lower RRs (95% CI) observed for patients with Medicare coverage alone were 1.23 (1.17-1.29) for prostate, 1.05 (1.03-1.06) for lung/bronchus, 1.41 (1.33-1.48) for breast, 1.08 (1.05-1.10) for colorectal, 1.20 (1.11-1.31) for uterine corpus, 1.54 (1.40-1.70) for urinary bladder, 1.13 (1.01-1.26) for melanoma, and 1.10 (1.01-1.21) for thyroid. In contrast, there was no significant difference between RRs of late-stage diagnosis for any cancer site for patients insured by Medicare Advantage programs. If health care reform extends coverage to a large proportion of adults who are currently uninsured and provides benefits equal to or better than Medicare coverage, the proportion of patients diagnosed with late-stage cancer is likely to decrease, particularly in subpopulations with low rates of coverage.
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The Patient Protection and Affordable Care Act will make health coverage more available and affordable while also strengthening regulations on the scope of private health insurance coverage. Most of the law's key provisions take effect in 2014, at which time health insurers will be barred from charging more or denying coverage for individuals with a pre-existing condition. ⋯ In 2014, all insurance policies sold to individuals and small groups will have to cover an essential benefits package defined by the federal government. Although many Patient Protection and Affordable Care Act provisions do not apply to all types of private coverage, overall the law will provide more protections to cancer patients and survivors in the private health insurance marketplace.
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The US health care system has become increasingly unsustainable, threatened by poor quality and spiraling costs. Many Americans are not receiving recommended preventive care, including cancer screening tests. ⋯ In order for health care reform to succeed, it will require a stronger primary care workforce, a new emphasis on patient-centered care, and payment incentives that reward quality over quantity. Innovations such as patient-centered medical homes, accountable care organizations, and improved quality reporting methods are central features of a redesigned health care delivery system and will ultimately change the face of cancer care in the United States.