What If All Patients with Breast Cancer in Malaysia Have Access to the Best Available Care: How Many Deaths Are Avoidable?

Abstract

Background: Cancer is a leading cause of death in the world and the fourth leading cause in Malaysia. A widening disparity in cancer burden has emerged between high and low-middle income countries. A similar disparity due to differential access to cancer care between affluent and deprived groups is likely to exist within developing country too. We assess this inequality by estimating the number of deaths due to cancer that would be avoidable if all patients had access to the best available care in Malaysia, a high middle income country. Methods:The number of avoidable deaths is the difference between the number of deaths estimated by GLOBOCAN12 for Malaysia (which is consistent with published estimates on cancer survival), and the expected number of deaths if all patients with Breast Cancer (BC) had experienced the age-ethnic-stage specific survival outcomes observed in a leading private cancer centre in Malaysia. Data on age-ethnic-stage composition of the general BC population were from local cancer registry and public hospitals providing safety net cancer services. Findings:Of the 2312 excess deaths due to BC, 2048 (88%) were avoidable. Of these avoidable deaths, 1167 (57%) were attributable to late stage presentation while 881 (43%) were due to lack of access to optimal treatment. Sensitivity analyses however show that the 88% avoidable deaths may be as low as 50%, taking into account differences in socio-economic status, over-diagnosis and lack of very long term survival data.Interpretation: The huge number of avoidable deaths highlights the high cancer mortality rate among the deprived and the vast disparity in access to cancer care between the rich and poor within Malaysia, which mirrors the global cancer divide between rich and poor countries.Cancer care system that deliver such disastrous and inequitable outcomes is clearly under-performing. It is in urgent need of reform.

A Review on Communication Issues Related to The Process and Treatment for Breast Cancer Patients in Malaysia

“…In addition, the mortality rate is higher among patients receiving treatment in public hospitals than in private hospitals. This is in line with the study conducted by Ho, et al (2017) found that almost 2048 (88%) cases of death due to breast cancer in Malaysia could be avoided because 1167 (57%) cases were due to late patients in screening. While 881 (43%) cases of death due to not receiving complete treatment which indirectly indicates that there is a difference between the socioeconomic status of patients.…”

O Itinerário Terapêutico de Pacientes com Câncer de Mama e de Próstata

“…28 Na Malásia, observouse que cerca de 50% a 88% das mortes seriam evitáveis se o diagnóstico do câncer fosse precoce e os indivíduos tivessem um acesso ideal ao serviço. 29 Reforça-se, portanto, a importância de que os pacientes diagnosticados com neoplasias devem ter acesso imediato ao tratamento ideal, para otimizar as chances de sobrevida.…”

Caracterização de mulheres hospitalizadas por neoplasia maligna da mama na Bahia, Brasil, 2012-2016

“…Estudo aponta que grande número de mortes evitáveis se deve em grande parte ao acesso diferenciado ao tratamento do câncer entre os grupos com maior poder aquisitivo e carentes, e que muitas das mortes seriam evitáveis, principalmente se serviços de boa qualidade fossem acessíveis a toda a população feminina 15 .…”