Experience with an ultrasound donation program in a low-income country

Increasing radiology capacity in low-income countries (LIC) can improve clinicians’ access to diagnostic imaging tools and improve patient care. Ultrasound (US) is important in LIC due to its lower cost compared to that of CT or MRI scans and its excellent diagnostic ability. The relative portability of the equipment makes it ideal for donation by charitable organizations. We describe our experience as a radiology-capacity-focused charity working with the Haitian healthcare system and propose strategies to increase ultrasound capacity in other poor countries

Improving breast cancer services for African-American women living in St. Louis

A mixed methods, community-based research study was conducted to understand how provider-level factors contribute to the African-American and white disparity in breast cancer mortality in a lower socioeconomic status area of North St. Louis. This study used mixed methods including: (1) secondary analysis of Missouri Cancer Registry data on all 885 African-American women diagnosed with breast cancer from 2000 to 2008 while living in the geographic area of focus; (2) qualitative interviews with a subset of these women; (3) analysis of data from electronic medical records of the women interviewed; and (4) focus group interviews with community residents, patient navigators, and other health care professionals. 565 women diagnosed with breast cancer from 2000 to 2008 in the geographic area were alive at the time of secondary data analysis; we interviewed (n = 96; 17 %) of these women. Provider-level obstacles to completion of prescribed treatment included fragmented navigation (separate navigators at Federally Qualified Health Centers, surgical oncology, and medical oncology, and no navigation services in surgical oncology). Perhaps related to the latter, women described radiation as optional, often in the same words as they described breast reconstruction. Discontinuous and fragmented patient navigation leads to failure to associate radiation therapy with vital treatment recommendations. Better integrated navigation that continues throughout treatment will increase treatment completion with the potential to improve outcomes in African Americans and decrease the disparity in mortality

Cardiovascular Effects of Chemotherapy Used in the Treatment of Breast Cancers

Attempts to carry out clinical trials to improve the treatment of breast cancers, including chemotherapy and targeted oncologic therapies, often exclude women with baseline cardiovascular compromise, such as low ejection fraction or arrhythmia. Therefore, despite concrete evidence of cardiotoxicity from a select number of chemotherapeutic agents, it has been difficult to better characterize the progression of cardiac dysfunction in women with preexisting cardiac conditions who receive chemotherapy. Women who have impaired cardiac function should be included in future clinical trials, or at least placed in separate trials with careful monitoring, to better assess this high-risk population. This article will discuss the epidemiology, mechanisms, diagnostic methods, and management of cardiotoxicity from systemic chemotherapy used to treat breast cancer