Cancer care underuse, overuse, and inequalities

Although large socioeconomic inequalities in cancer outcomes exist between and within countries, financial and human resources are increasingly allocated to medical interventions that have minimal impact or that cause harm, including overdiagnosis and overtreatment. Underuse and overuse of medical cancer care stem from similar underlying mechanisms, including environmental, social, economic, and cultural factors, as well as health-care system organizations and medical practices, and their coexistence represents 2 opposing yet interconnected aspects of health-care inefficiency. Identifying and measuring low value in cancer prevention and care is challenging. However, emerging evidence shows that the magnitude and consequences of underuse and overuse are vast, shaping the current epidemiological landscape of cancer, causing physical, psychological, and social harm to millions of individuals and posing serious challenges to the sustainability of health systems. In this article, we propose a novel perspective and a comprehensive road map that examines inefficiencies of health systems through the lens of simultaneous underuse of cancer care by underserved populations and overuse by groups with greater access to health-care systems.