The outlook for women with breast cancer has improved in recent years. Due to the combination of improved treatments and the benefits of mammography screening, breast cancer mortality has decreased steadily since 1989. Yet breast cancer remains a major problem, second only to lung cancer as a leading cause of death from cancer for women. To date, no means to prevent breast cancer has been discovered and experience has shown that treatments are most effective when a cancer is detected early, before it has spread to other tissues. These two facts suggest that the most effective way to continue reducing the death toll from breast cancer is improved early detection and diagnosis. Building on the 2001 report Mammography and Beyond, this new book not only examines ways to improve implementation and use of new and current breast cancer detection technologies but also evaluates the need to develop tools that identify women who would benefit most from early detection screening. Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis encourages more research that integrates the development, validation, and analysis of the types of technologies in clinical practice that promote improved risk identification techniques. In this way, methods and technologies that improve detection and diagnosis can be more effectively developed and implemented. Table of Contents Front Matter Executive Summary 1 Introduction 2 Benefits and Limitations of Mammography 3 Improving Breast Cancer Screening Services 4 Understanding Breast Cancer Risk 5 Biologically-Based Technologies 6 The Necessary Environment for Research and Development 7 Translating New Technologies into Improved Patient Outcomes 8 Recommendations Appendix A: Breast Cancer Technology Overview Appendix B: Workshop Agendas Appendix C: ROC Analysis: Key Statistical Tool for Evaluating Detection Technologies Appendix D: Common Weaknesses in Study Designs Glossary Index

We all want to believe that when people get cancer, they will receive medical care of the highest quality. Even as new scientific breakthroughs are announced, though, many cancer patients may be getting the wrong care, too little care, or too much care, in the form of unnecessary procedures. How close is American medicine to the ideal of quality cancer care for every person with cancer? Ensuring Quality Cancer Care provides a comprehensive picture of how cancer care is delivered in our nation, from early detection to end-of-life issues. The National Cancer Policy Board defines quality care and recommends how to monitor, measure, and extend quality care to all people with cancer. Approaches to accountability in health care are reviewed. What keeps people from getting care? The book explains how lack of medical coverage, social and economic status, patient beliefs, physician decision-making, and other factors can stand between the patient and the best possible care. The board explores how cancer care is shaped by the current focus on evidence-based medicine, the widespread adoption of managed care, where services are provided, and who provides care. Specific shortfalls in the care of breast and prostate cancer are identified. A status report on health services research is included. Ensuring Quality Cancer Care offers wide-ranging data and information in clear context. As the baby boomers approach the years when most cancer occurs, this timely volume will be of special interest to health policy makers, public and private healthcare purchasers, medical professionals, patient advocates, researchers, and people with cancer. Table of Contents Front Matter Summary 1 Introduction 2 The Cancer Care 'System' 3 Ensuring Access to Cancer Care 4 Defining and Assessing Quality Cancer Care 5 Health Care Delivery and Quality of Cancer Care 6 Cancer Care Quality Assurance 7 Health Services Research in Cancer Care 8 Findings and Recommendations Glossary Acronyms Index

In this report The Breast Cancer Research Foundation (BCRF) and the Institute of Medicine (IOM) present a one-day symposium that was held at the IOM to further disseminate the conclusions and recommendations of the joint IOM and National Research Council report, Saving Women's Lives: Strategies for Improving Breast Cancer Detection and Diagnosis. The committee assembled for this event was asked to share insights and consider ways in which the objectives of the report could be achieved from the standpoint of what women need to know, the best models of screening programs, manpower, risk stratification, basic research, and payment. This symposium seeks to provide continuing food for thought and ideas for actions in support of breast cancer detection and diagnosis and saving women's lives. Table of Contents Front Matter Abstract 1 Introduction 2 Plenary Session 3 Simultaneous Group Discussions with Invited Speakers 4 Wrap-Up Session References Appendix: Symposium Agenda

Only more recently has it been realized that the intense effort to care for and cure a child with cancer does not end with survival. Continued surveillance and a variety of interventions may, in many cases, be needed to identify and care for consequences of treatment that can appear early or only after several decades and impair survivors' health and quality of life. The more than two-thirds of childhood cancer survivors who experience late effects-that is, complications, disabilities, or adverse outcomes-as a result of their disease, its treatment, or both, are the focus of this report which outlines a comprehensive policy agenda that links improved health care delivery and follow-up, investments in education and training for health care providers, and expanded research to improve the long-term outlook for this growing population now exceeding 270,000 Americans. Table of Contents Front Matter Summary 1. Introduction 2. The Epidemiology of Childhood Cancer 3. The Trajectory of Childhood Cancer Care 4. Late Effects of Childhood Cancer 5. Delivering Survivorship Care 6. Assuring Appropriate Educational Support Services 7. Employment, Insurance, and Economic Issues 8. Research Issues 9. Findings and Recommendations

Interpreting the Volume-Outcome Relationship in the Context of Cancer Care is a summary of a workshop held on May 11, 2000, which brought together experts to review evidence of the relationship between volume of services and health-related outcomes for cancer and other conditions, discuss methodological issues related to the interpretation of the association between volume and outcome, assess the applicability of volume as an indicator of quality of care; and identify research needed to better understand the volume--outcome relationship and its application to quality improvement.

Mammography is an important tool for detecting breast cancer at an early stage. When coupled with appropriate treatment, early detection can reduce breast cancer mortality. At the request of Congress, the Food and Drug Administration (FDA) commissioned a study to examine the current practice of mammography and breast cancer detection, with a focus on the FDAa (TM)s oversight via the Mammography Quality Standards Act (MQSA), to identify areas in need of improvement. Enacted in 1993, MQSA provides a general framework for ensuring national quality standards in facilities performing screening mammography, requires that each mammography facility be accredited and certified, and mandates that facilities will undergo annual inspections. This book recommends strategies for achieving continued progress in assuring mammography quality, including changes to MQSA regulation, as well as approaches that do not fall within the purview of MQSA. Specifically, this book provides recommendations aimed at improving mammography interpretation; revising MQSA regulations, inspections, and enforcement; ensuring an adequate workforce for breast cancer screening and diagnosis; and improving breast imaging quality beyond mammography.

The National Cancer Policy Board and the Board on Science, Engineering, and Economic Policy convened a workshop in January 2004 on a /Economic Models of Colorectal Cancer (CRC) Screening in Average-Risk Adultsa . The purpose of the workshop was to explore the reasons for differences among leading cost-effectiveness analysis (CEA) models of CRC screening, which public health policy makers increasingly rely on to help them sift through the many choices confronting them. Participants discussed the results of a collaborative pre-workshop exercise undertaken by five research teams that have developed and maintained comprehensive models of CRC screening in average-risk adults, to gain insight into each modela (TM)s structure and assumptions and possible explanations for differences in their published analyses. Workshop participants also examined the current state of knowledge on key inputs to the models with a view toward identifying areas where further research may be warranted. This document summarized the presentations and discussion at the workshop.

Shortly after 1998, leading members of Georgia's government, medical community, and public-spirited citizenry began considering ways in which some of Georgia's almost $5 billion, 25-year settlement from the tobacco industry's Master Settlement Agreement with the 50 states could be used to benefit Georgia residents. Given tobacco's role in causing cancer, they decided to create an entity and program with the mission of making Georgia a national leader in cancer prevention, treatment, and research. This new entity--called the Georgia Cancer Coalition, Inc. (GCC)-- and the state of Georgia subsequently began implementing a far-reaching state cancer initiative that includes five strategic goals: (1) preventing cancer and detecting existing cancers earlier; (2) improving access to quality care for all state residents with cancer; (3) saving more lives in the future; (4) training future cancer researchers and caregivers; and (5) turning the eradication of cancer into economic growth for Georgia.
"Assessing the Quality of Cancer Care" identifies a set of measures that could be used to gauge Georgia's progress in improving the quality of its cancer services and in reducing cancer-related morbidity and mortality.

In Meeting Psychosocial Needs of Women with Breast Cancer, the National Cancer Policy Board of the Institute of Medicine examines the psychosocial consequences of the cancer experience. The book focuses specifically on breast cancer in women because this group has the largest survivor population (over 2 million) and this disease is the most extensively studied cancer from the standpoint of psychosocial effects. The book characterizes the psychosocial consequences of a diagnosis of breast cancer, describes psychosocial services and how they are delivered, and evaluates their effectiveness. It assesses the status of professional education and training and applied clinical and health services research and proposes policies to improve the quality of care and quality of life for women with breast cancer and their families. Because cancer of the breast is likely a good model for cancer at other sites, recommendations for this cancer should be applicable to the psychosocial care provided generally to individuals with cancer. For breast cancer, and indeed probably for any cancer, the report finds that psychosocial services can provide significant benefits in quality of life and success in coping with serious and life-threatening disease for patients and their families. Table of Contents Front Matter Executive Summary 1 Introduction 2 Epidemiology of Breast Cancer 3 Psychosocial Needs of Women with Breast Cancer 4 Psychosocial Services and Providers 5 The Effectiveness of Psychosocial Interventions for Women with Breast Cancer 6 Delivering Psychosocial Services 7 Barriers to Appropriate Use of Psychosocial Services 8 Research Appendix A Meeting Psychosocial Needs of Women with Breast Cancer Appendix B Tables and Boxes Summarizing Evidence from Clinical Trials

The nature of biomedical research has been evolving in recent years. Technological advances that make it easier to study the vast complexity of biological systems have led to the initiation of projects with a larger scale and scope. In many cases, these large-scale analyses may be the most efficient and effective way to extract functional information from complex biological systems. Large-Scale Biomedical Science: Exploring Strategies for Research looks at the role of these new large-scale projects in the biomedical sciences. Though written by the National Academies' Cancer Policy Board, this book addresses implications of large-scale science extending far beyond cancer research. It also identifies obstacles to the implementation of these projects, and makes recommendations to improve the process. The ultimate goal of biomedical research is to advance knowledge and provide useful innovations to society. Determining the best and most efficient method for accomplishing that goal, however, is a continuing and evolving challenge. The recommendations presented in Large-Scale Biomedical Science are intended to facilitate a more open, inclusive, and accountable approach to large-scale biomedical research, which in turn will maximize progress in understanding and controlling human disease. Table of Contents Front Matter Executive Summary 1. Introduction 2. Defining "Large-Scale Science" in Biomedical Research 3. Models of Large-Scale Science 4. Funding for Large-Scale Science 5. Organization and Management of Large-Scale Biomedical Research Projects 6. Training and Career Structures in Biomedical Research 7. Intellectual Property and Access to Research Tools and Data 8. Findings and Recommendations References Appendix Index

Cancer ranks second only to heart disease as a leading cause of death in the United States, making it a tremendous burden in years of life lost, patient suffering, and economic costs. Fulfilling the Potential for Cancer Prevention and Early Detection reviews the proof that we can dramatically reduce cancer rates. The National Cancer Policy Board, part of the Institute of Medicine, outlines a national strategy to realize the promise of cancer prevention and early detection, including specific and wide-ranging recommendations. Offering a wealth of information and directly addressing major controversies, the book includes: A detailed look at how significantly cancer could be reduced through lifestyle changes, evaluating approaches used to alter eating, smoking, and exercise habits. An analysis of the intuitive notion that screening for cancer leads to improved health outcomes, including a discussion of screening methods, potential risks, and current recommendations. An examination of cancer prevention and control opportunities in primary health care delivery settings, including a review of interventions aimed at improving provider performance. Reviews of professional education and training programs, research trends and opportunities, and federal programs that support cancer prevention and early detection. This in-depth volume will be of interest to policy analysts, cancer and public health specialists, health care administrators and providers, researchers, insurers, medical journalists, and patient advocates. Table of Contents Front Matter Executive Summary 1. Introduction 2. Potential to Reduce the Cancer Burden Through Cancer Prevention and Early Detection 3. Lifestyle Behaviors Contributing to the Burden of Cancer 4. Modifying Health Risk Behaviors 5. Potential of Screening to Reduce the Burden of Cancer 6. Improving Participation in Cancer Screening Programs 7. Adopting New Technology in the Face of Uncertain Science: The Case of Screening for Lung Cancer 8. Professional Education and Training 9. Federal Programs That Support Cancer Prevention and Early Detection 10. Research Trends and Opportunities 11. Findings, Policy Implications, and Recommendations References Glossary Index

With the risk of more than one in three getting cancer during a lifetime, each of us is likely to experience cancer, or know someone who has survived cancer. Although some cancer survivors recover with a renewed sense of life and purpose, what has often been ignored is the toll taken by cancer and its treatment?on health, functioning, sense of security, and well-being. Long lasting effects of treatment may be apparent shortly after its completion or arise years later. The transition from active treatment to post-treatment care is critical to long-term health. From Cancer Patient to Cancer Survivor focuses on survivors of adult cancer during the phase of care that follows primary treatment. The book raises awareness of the medical, functional, and psychosocial consequences of cancer and its treatment. It defines quality health care for cancer survivors and identifies strategies to achieve it. The book also recommends improvements in the quality of life of cancer survivors through policies that ensure their access to psychosocial services, fair employment practices, and health insurance. This book will be of particular interest to cancer patients and their advocates, health care providers and their leadership, health insurers, employers, research sponsors, and the public and their elected representatives. Table of Contents Front Matter Executive Summary 1 Introduction 2 Cancer Survivors 3 The Medical and Psychological Concerns of Cancer Survivors After Treatment 4 Delivering Cancer Survivorship Care 5 Providers of Survivorship Care: Their Supply and Education and Training 6 Employment, Insurance, and Economic Issues 7 Research Glossary Index