In addition, although a major study in 2006 showed that pumping chemotherapy directly into the abdomen, instead of dripping it into a vein, added an average of 16 months to women's lives and the National Cancer Institute endorsed the technique, some oncologists still do not offer it.
Uneven quality persists even in colon cancer, one of the most common types. Jane Weeks, a professor of medicine at Harvard, said half a dozen studies had found that in stage 3, when tumor cells have spread to lymph nodes, only about 65 percent of patients are given chemotherapy - even though it has been proved beneficial and is recommended for about 80 percent of patients.
Numerous studies have suggested that men with prostate cancer face the opposite problem polyp too much treatment, which wastes resources and money and needlessly subjects men to the pain and risks of surgery or radiation.
Prostate cancer often grows so slowly that men can be treated with "watchful waiting," which means monitoring the cancer and treating it only if it starts to grow rapidly or turns more aggressive.
The surgeon's expertise is crucial in prostate cancer. A study published this month in The Journal of the National Cancer Institute found that the cancer was less likely to come back in patients whose doctors had performed 250 or more operations. Their recurrence rate was 10.7 percent, compared with 17.9 percent in men whose doctors had performed the operation only 10 times.
FAR FROM TYPICAL
"They got them all," Pasqualetto's husband, Chris Hartinger, said shortly after her operation ended on June 21. "It turned out to be five tumors."
A few days after surgery, Pasqualetto was walking laps around the hospital corridors.
"I can't believe it," she said. "This is pretty exciting."
But weeks later, at home again, she found herself back in the trenches, unsure of what the next step in her care would be. "It's like I'm flapping in the wind," she said.
Pasqualetto is exceptional not only for her determination and confidence in dealing with problems that would intimidate many other people, but also for her financial wherewithal. So far her treatment has cost more than US$400,000, almost all of it covered by health insurance from Starbucks, where her husband works in disaster-response planning.
When she joined a cancer support group, she recalled, "It was amazing to me the different experiences people were having based on what they could afford or who their provider was. I was able to say, 'If the provider won't pay, my family will. I don't care, I'm going for a second opinion.'"
In the support group, Pasqualetto said it saddened her to hear other patients with advanced disease take the word of a single oncologist, because she believes that if she had done that, she would already be dead. She has come to think that survival may depend on money and access, and, she said, on "your own drive and motivation, your education and your ability to sort through the medical world and the insurance world terminology."
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