Background: Breast cancer (BC) treatment is rapidly evolving with new and costly therapeutics. Existing costing models have a limited ability to capture current treatment costs. We used an Activity-Based Costing (ABC) method to determine a per-case cost for BC treatment by stage and molecular subtype. Methods: ABC was used to proportionally integrate multidisciplinary evidence-based patient and provider treatment options for BC, yielding a per-case cost for the total duration of treatment by stage and molecular subtype. Diagnostic imaging, pathology, surgery, radiation therapy, systemic therapy, inpatient, emergency, home care and palliative care costs were included. Results: BC treatment costs were higher than noted in previous studies and varied widely by molecular subtype. Cost increased exponentially with the stage of disease. The per-case cost for treatment (2023C$) for DCIS was C$ 14,505, and the mean costs for all subtypes were C$ 39,263, C$ 76,446, C$ 97,668 and C$ 370,398 for stage I, II, III and IV BC, respectively. Stage IV costs were as high as C$ 516,415 per case. When weighted by the proportion of molecular subtype in the population, case costs were C$ 31,749, C$ 66,758, C$ 111,368 and C$ 289,598 for stage I, II, III and IV BC, respectively. The magnitude of cost differential was up to 10.9 times for stage IV compared to stage I, 4.4 times for stage III compared to stage I and 35.6 times for stage IV compared to DCIS. Conclusion: The cost of BC treatment is rapidly escalating with novel therapies and increasing survival, resulting in an exponential increase in treatment costs for later-stage disease. We provide real-time, case-based costing for BC treatment which will allow for the assessment of health system economic impacts and an accurate understanding of the cost-effectiveness of screening.

The growing repertoire of approved immune-checkpoint inhibitors and targeted therapy has revolutionized the adjuvant treatment of melanoma. While the treatment of primary cutaneous melanoma remains wide local excision (WLE), the management of regional lymph nodes continues to evolve in light of practice-changing clinical trials and dramatically improved adjuvant therapy. With large multicenter studies reporting no benefit in overall survival for completion lymph node dissection (CLND) after a positive sentinel node biopsy (SLNB), controversy remains regarding patient selection and clinical decision-making. This review explores the evolution of the SLNB in cutaneous melanoma in the context of a rapidly changing adjuvant treatment landscape, summarizing the key clinical trials which shaped current practice guidelines.

The late onset of cancer symptoms can cause a significant delay in diagnosis, impacting patients’ prognosis and quality of life, thus prompting a need for alternative screening and detection methods. Neoplastic processes cause distinct and immediate changes to the body’s metabolism, creating unique patterns in the volatile organic compounds (VOCs) produced and released through exhaled breath. For this reason, VOC profiles have emerged as diagnostic indicators for several types of malignancies, facilitating early cancer detection. Both non-invasive and accessible, the analysis of breath VOCs for cancer screening and detection has gained recognition as a new frontier in cancer diagnostics. Using exhaled breath instead of gold-standard cancer detection and screening tools that are traditionally invasive and uncomfortable for the patient could be revolutionary in improving patient compliance. Further, compared to the gold-standard tools, breath testing is relatively inexpensive, and the method of analysis, storage, and transporting the samples is simplified. Several studies have demonstrated the accuracy of VOC analysis in detecting various types of cancer, including breast cancer, colon cancer, prostate cancer, gastric cancer, and melanoma. This article summarizes the evidence supporting VOC analysis for cancer screening and detection. It reviews the clinical utility, current limitations, and necessity for standardization across all VOC screening tools to ensure the standardization and reliability of measurements. The evidence supporting breath tests to detect cancer accurately is strong, demonstrating that VOC sampling improves patient outcomes and decreases the global burden of malignant conditions by detecting cancer earlier.