1
|
Reyes-Monasterio A, Möller MG, Lozada-Martinez ID, Narvaez-Rojas AR, De la Cruz Ku G, Metke R, Cabrera-Vargas LF, Torregrosa-Almonacid L, Lesmes LC, Eli A, Paulinelli RR. Bridging frontiers: The role of a Global Breast Research Working Group. J Surg Oncol 2024; 129:1507-1514. [PMID: 38685712 DOI: 10.1002/jso.27660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Accepted: 04/15/2024] [Indexed: 05/02/2024]
Abstract
Breast cancer remains a significant cause of death for women globally, despite advancements in detection and treatment, low- and middle-income countries face unique obstacles. Role of Research Working Group (RWG) can expedite research progress by fostering collaboration between scientists, clinicians, and stakeholders. Benefits of a Global RWG include pooling resources and expertise to develop new research ideas, addressing disparities, and building local research capacity, with the potential to improve breast cancer research and outcomes.
Collapse
Affiliation(s)
- Antonio Reyes-Monasterio
- Universidad Nacional Experimental Francisco de Miranda, Coro, Venezuela
- Global Breast Research Working Group, Miami, USA
| | - Mecker Geraldine Möller
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
- Pritzker School of Medicine, The University of Chicago, Chicago, Illinois, USA
| | - Ivan David Lozada-Martinez
- Global Breast Research Working Group, Miami, USA
- Department of Graduate Studies in Health Sciences, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia
| | - Alexis Rafael Narvaez-Rojas
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
- International Coalition on Surgical Research, Universidad Nacional Autónoma de Nicaragua, Managua, Nicaragua
| | - Gabriel De la Cruz Ku
- Global Breast Research Working Group, Miami, USA
- Universidad Científica del Sur, Lima, Perú
| | - Ricardo Metke
- Global Breast Research Working Group, Miami, USA
- Department of General Surgery, School of Medicine, Universidad Javeriana de Bogotá, Bogotá, Colombia
| | - Luis Felipe Cabrera-Vargas
- Global Breast Research Working Group, Miami, USA
- Department of Surgery, Fundación Santa Fe de Bogotá, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Lilian Torregrosa-Almonacid
- Global Breast Research Working Group, Miami, USA
- Department of General Surgery, School of Medicine, Universidad Javeriana de Bogotá, Bogotá, Colombia
| | | | - Avisar Eli
- Global Breast Research Working Group, Miami, USA
- DeWitt-Department of Surgery, Division of Surgical Oncology, Leonard M. Miller School of Medicine/Jackson Health System, University of Miami, Miami, Florida, USA
| | - Regis Resende Paulinelli
- Global Breast Research Working Group, Miami, USA
- Araujo Jorge Cancer Hospital, Albert Einstein Israeli Hospital Goiania, Federal University of Goias, Goiânia, Brazil
| |
Collapse
|
2
|
Trapani D, Murthy SS, Hammad N, Casolino R, Moreira DC, Roitberg F, Blay JY, Curigliano G, Ilbawi AM. Policy strategies for capacity building and scale up of the workforce for comprehensive cancer care: a systematic review. ESMO Open 2024; 9:102946. [PMID: 38507895 PMCID: PMC10966170 DOI: 10.1016/j.esmoop.2024.102946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 02/16/2024] [Accepted: 02/19/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Patients with cancer in low- and middle-income countries experience worse outcomes as a result of the limited capacity of health systems to deliver comprehensive cancer care. The health workforce is a key component of health systems; however, deep gaps exist in the availability and accessibility of cancer care providers. MATERIALS AND METHODS We carried out a systematic review of the literature evaluating the strategies for capacity building of the cancer workforce. We studied how the policy strategies addressed the availability, accessibility, acceptability, and quality (AAAQ) of the workforce. We used a strategic planning framework (SWOT: strengths, weaknesses, opportunities, threats) to identify actionable areas of capacity building. We contextualized our findings based on the WHO 2030 Global Strategy on Human Resources for Health, evaluating how they can ultimately be framed in a labour market approach and inform strategies to improve the capacity of the workforce (PROSPERO: CRD42020109377). RESULTS The systematic review of the literature yielded 9617 records, and we selected 45 eligible papers for data extraction. The workforce interventions identified were delivered mostly in the African and American Regions, and in two-thirds of cases, in high-income countries. Many strategies have been shown to increase the number of competent oncology providers. Optimization of the existing workforce through role delegation and digital health interventions was reported as a short- to mid-term solution to optimize cancer care, through quality-oriented, efficiency-improving, and acceptability-enforcing workforce strategies. The increased workload alone was potentially detrimental. The literature on retaining the workforce and reducing brain drain or attrition in underserved areas was commonly limited. CONCLUSIONS Workforce capacity building is not only a quantitative problem but can also be addressed through quality-oriented, organizational, and managerial solutions of human resources. The delivery of comprehensive, acceptable, and impact-oriented cancer care requires an available, accessible, and competent workforce for comprehensive cancer care. Efficiency-improving strategies may be instrumental for capacity building in resource-constrained settings.
Collapse
Affiliation(s)
- D Trapani
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy.
| | - S S Murthy
- Global Cancer Disparities Initiative, Division of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - N Hammad
- Michael's Hospital, University of Toronto, Toronto, Canada
| | - R Casolino
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| | - D C Moreira
- Department of Global Pediatric Medicine, St. Jude Children's Research Hospital, Memphis, USA
| | - F Roitberg
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - J-Y Blay
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milano, Milano; European Institute of Oncology, IRCCS, Milan, Italy
| | - A M Ilbawi
- Department of Noncommunicable Diseases, World Health Organization, Geneva, Switzerland
| |
Collapse
|
3
|
Song CV, van Gils CH, Yip CH, Soerjomataram I, Taib NAM, See MH, Lim A, Abdul Satar NF, Bhoo-Pathy N. Discriminatory Ability and Clinical Utility of the AJCC7 and AJCC8 Staging Systems for Breast Cancer in a Middle-Income Setting. Diagnostics (Basel) 2023; 13:674. [PMID: 36832162 PMCID: PMC9955895 DOI: 10.3390/diagnostics13040674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/25/2023] [Accepted: 02/03/2023] [Indexed: 02/15/2023] Open
Abstract
(1) Background: Differences in access to biomarker testing and cancer treatment in resource-limited settings may affect the clinical utility of the AJCC8 staging system compared to the anatomical AJCC7 system. (2) Methods: A total of 4151 Malaysian women who were newly diagnosed with breast cancer from 2010 to 2020 were followed-up until December 2021. All patients were staged using the AJCC7 and AJCC8 systems. Overall survival (OS) and relative survival (RS) were determined. Concordance-index was used to compare the discriminatory ability between the two systems. (3) Results: Migration from the AJCC7 to AJCC8 staging system resulted in the downstaging of 1494 (36.0%) patients and the upstaging of 289 (7.0%) patients. Approximately 5% of patients could not be staged using the AJCC8 classification. Five-year OS varied between 97% (Stage IA) and 66% (Stage IIIC) for AJCC7, and 96% (Stage IA) and 60% (Stage IIIC) for AJCC8. Concordance-indexes for predicting OS using the AJCC7 and AJCC8 models were 0.720 (0.694-0.747) and 0.745 (0.716-0.774), and for predicting RS they were 0.692 (0.658-0.728) and 0.710 (0.674-0.748), respectively. (4) Conclusions: Given the comparable discriminatory ability between the two staging systems in predicting the stage-specific survival of women with breast cancer in the current study, the continued use of the AJCC7 staging system in resource-limited settings seems pragmatic and justifiable.
Collapse
Affiliation(s)
- Chin-Vern Song
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Carla H. van Gils
- Julius Center for Health Sciences and Primary Care, UMC Utrecht, Heidelberglaan 100, 3508 GA Utrecht, The Netherlands
| | - Cheng-Har Yip
- Ramsay Sime Darby Health Care, Jalan SS12, Subang Jaya 47500, Malaysia
| | - Isabelle Soerjomataram
- Cancer Surveillance Branch, International Agency for Research on Cancer, 150 Cr Albert Thomas, 69008 Lyon, France
| | - Nur Aishah Mohd Taib
- Department of Surgery, University of Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur 59100, Malaysia
| | - Mee-Hoong See
- Department of Surgery, University of Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur 59100, Malaysia
| | - Alexander Lim
- Hospital Seberang Jaya, Jalan Tun Hussein Onn, Seberang Jaya, Permatang Pauh, Pulau Pinang 13700, Malaysia
| | - Nur Fadhlina Abdul Satar
- Department of Clinical Oncology, University of Malaya Medical Centre, Jalan Professor Diraja Ungku Aziz, Lembah Pantai, Kuala Lumpur 59100, Malaysia
| | - Nirmala Bhoo-Pathy
- Centre for Epidemiology and Evidence-Based Practice, Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur 50603, Malaysia
| |
Collapse
|
4
|
González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: Description of the project, preliminary results, and impressions. RADIOLOGIA 2022; 64:256-265. [PMID: 35676057 DOI: 10.1016/j.rxeng.2021.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 04/12/2021] [Indexed: 10/18/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
Collapse
Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, IL, United States
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, CO, United States
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, WA, United States; Fred Hutchinson Cancer Research Center, Seattle, WA, United States
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.(a) Morales Meseguer, Murcia, Spain; RAD-AID Internacional
| |
Collapse
|
5
|
Yadav SK, Carpenter A, Rai R, Jha CK, Sharma D. Low-Cost Vacuum Assisted Core Needle Biopsy Technique for Breast Lumps. World J Surg 2022; 46:1445-1450. [PMID: 35166879 DOI: 10.1007/s00268-022-06475-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/22/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Core biopsy has replaced fine needle aspiration cytology in the assessment of breast lumps to diagnose malignancy and is now standard of care in developed countries. Unfortunately, cost of core biopsy system is a major limitation in low-and middle-income countries (LMICs). This prompted us to devise and appraise a low-cost technique of core biopsy using negative pressure. METHODS We devised and prospectively evaluated a simple model of core biopsy (vacuum assisted core needle biopsy-VACNB) using a 50 ml syringe, a 10 ml syringe and a 14G needle. RESULTS 57 consecutive women (median age 42.66 years) with breast lumps (median diameter 5.2 cm) underwent VACNB. The sensitivity for diagnosing malignancy was 92%, specificity was 100%, and diagnostic accuracy was 92.98%. The positive predictive value of this technique was 100%, and negative predictive value was 63.64%. The cost (~ 5.5 USD) of the system was significantly less than the cost of core biopsy needle (~ 41.00 USD) and vacuum assisted breast biopsy needle (~ 341.00 USD) in India. CONCLUSION Frugal innovations are needed to overcome cost constraints in LMICs. Our low-cost VACNB technique is easy to use and accurate.
Collapse
Affiliation(s)
| | | | - Roshni Rai
- Department of Surgery, NSCB Medical College, Jabalpur, India
| | | | | |
Collapse
|
6
|
Cellphone enabled point-of-care assessment of breast tumor cytology and molecular HER2 expression from fine-needle aspirates. NPJ Breast Cancer 2021; 7:85. [PMID: 34215753 PMCID: PMC8253731 DOI: 10.1038/s41523-021-00290-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 06/03/2021] [Indexed: 12/13/2022] Open
Abstract
Management of breast cancer in limited-resource settings is hindered by a lack of low-cost, logistically sustainable approaches toward molecular and cellular diagnostic pathology services that are needed to guide therapy. To address these limitations, we have developed a multimodal cellphone-based platform—the EpiView-D4—that can evaluate both cellular morphology and molecular expression of clinically relevant biomarkers directly from fine-needle aspiration (FNA) of breast tissue specimens within 1 h. The EpiView-D4 is comprised of two components: (1) an immunodiagnostic chip built upon a “non-fouling” polymer brush-coating (the “D4”) which quantifies expression of protein biomarkers directly from crude cell lysates, and (2) a custom cellphone-based optical microscope (“EpiView”) designed for imaging cytology preparations and D4 assay readout. As a proof-of-concept, we used the EpiView-D4 for assessment of human epidermal growth factor receptor-2 (HER2) expression and validated the performance using cancer cell lines, animal models, and human tissue specimens. We found that FNA cytology specimens (prepared in less than 5 min with rapid staining kits) imaged by the EpiView-D4 were adequate for assessment of lesional cellularity and tumor content. We also found our device could reliably distinguish between HER2 expression levels across multiple different cell lines and animal xenografts. In a pilot study with human tissue (n = 19), we were able to accurately categorize HER2-negative and HER2-positve tumors from FNA specimens. Taken together, the EpiView-D4 offers a promising alternative to invasive—and often unavailable—pathology services and may enable the democratization of effective breast cancer management in limited-resource settings.
Collapse
|
7
|
González Moreno IM, Trejo-Falcón J, Matsumoto MM, Huertas Moreno M, Martínez Gálvez M, Farfán Quispe GR, Chavez Pareja FY, Mollura DJ, Pollack E, Scheel JR, García Santos JM. Radiology volunteers to support a breast cancer screening program in Peru: description of the project, preliminary results, and impressions. RADIOLOGIA 2021; 64:S0033-8338(21)00089-8. [PMID: 34083079 DOI: 10.1016/j.rx.2021.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 03/31/2021] [Accepted: 04/12/2021] [Indexed: 11/20/2022]
Abstract
Breast cancer is the second most common cancer in Peruvian women. Due to limitations in national breast cancer screening programs, especially in rural areas, more than 50% of cases of breast cancer in Peru are diagnosed in advanced stages. In collaboration with a local clinic registered as a nongovernmental organization (CerviCusco), RAD-AID International aims to create a sustainable diagnostic structure to improve breast cancer screening in Cuzco. With the support of local, national, and international partners that have collaborated in analyzing radiological resources, raising awareness in the population, acquiring equipment, training clinical staff, and building referral networks, our teams of radiologists, included in the RAD-AID team, have participated in training CerviCusco staff in breast ultrasound, thus enabling additional training for radiology residents through a regulated international collaboration.
Collapse
Affiliation(s)
- I M González Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España.
| | - J Trejo-Falcón
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M M Matsumoto
- Pritzker Medicine, University of Chicago, Chicago, Illinois, Estados Unidos
| | - M Huertas Moreno
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | - M Martínez Gálvez
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España
| | | | | | | | - E Pollack
- RAD-AID Internacional; Department of Radiology and Medical Imaging, Denver Health and Hospital Authority, Denver, Colorado, Estados Unidos
| | - J R Scheel
- RAD-AID Internacional; Departments of Radiology and Global Health, University of Washington, Seattle, Washington, Estados Unidos; Fred Hutchinson Cancer Research Center, Seattle, Washington, Estados Unidos
| | - J M García Santos
- Servicio de Radiodiagnóstico, Hospital General Universitario Jose M.ª Morales Meseguer, Murcia, España; RAD-AID Internacional
| |
Collapse
|
8
|
Anglade F, Milner DA, Brock JE. Can pathology diagnostic services for cancer be stratified and serve global health? Cancer 2021; 126 Suppl 10:2431-2438. [PMID: 32348564 DOI: 10.1002/cncr.32872] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/06/2020] [Accepted: 03/11/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Before initiating cancer therapy, a diagnostic tumor tissue sample evaluated within a pathology laboratory by a pathologist is essential to confirm the malignancy type and provide key prognostic factors that direct the treatment offered. METHODS Pathology evaluation includes multiple expensive reagents, complex equipment, and both laboratory and pathologist technical skills. By using breast cancer as an example, at a minimum, key tumor prognostic information required before the initiation of treatment includes subtype, tumor grade, tumor size, lymph node status when possible, and biomarker expression determined by immunohistochemistry for estrogen receptor. The additional determination of biomarker expression of progesterone receptor and human epidermal growth factor receptor (HER2) is the standard of care in high-resource settings, but assays may not be affordable in low-income and middle-income countries. RESULTS With positive tests, patients are eligible for either tamoxifen (for estrogen receptor-positive/progesterone receptor-positive cancers) or monoclonal antibody therapy (for HER2-positive cancers). For settings in which endocrine therapy and/or HER2-targeted therapy is unavailable, biomarker studies have no utility, and high-resource setting standards for pathology evaluation and reporting are unachievable. Resource-stratified pathology evaluation guidelines in cancer diagnosis have not been developed, in contrast to excellent comprehensive, resource-stratified clinical guidelines for use in low-income and middle-income countries, and these are long overdue. CONCLUSIONS The challenges of pathology evaluation in the context of global health are being met by innovative solutions, which may change the face of pathology practice.
Collapse
Affiliation(s)
- Fabienne Anglade
- Department of Pathology, Mirebalais Teaching Hospital, Mirebalais, Haiti
| | - Danny A Milner
- American Society for Clinical Pathology, Chicago, Illinois
| | - Jane E Brock
- Department of Pathology, Brigham and Women's Hospital, Boston, Massachusetts
| |
Collapse
|
9
|
Tejeswini V, Chaitra B, Renuka IV, Laxmi K, Ramya P, Sowjanya KKS. Effectuation of International Academy of Cytology Yokahama Reporting System of Breast Cytology to Assess Malignancy Risk and Accuracy. J Cytol 2021; 38:69-73. [PMID: 34321772 PMCID: PMC8280858 DOI: 10.4103/joc.joc_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 06/16/2020] [Accepted: 04/13/2021] [Indexed: 01/17/2023] Open
Abstract
Introduction Recently the International Academy of Cytology (IAC) proposed a new Yokahama reporting system for breast fine-needle aspiration cytology (2019) in order to standardize reporting pattern and to link cytology reporting to management algorithms. Aims and Objectives To categorize the samples according to the newly proposed IAC Yokahama reporting system of breast cytology and to assess diagnostic accuracy and corresponding risk of malignancy (ROM) for each category. Materials and Methods This is a retrospective study of breast cytology cases done at Department of Pathology. The slides are retrieved from pathology archives and classified using a recently proposed IAC, Yokahama reporting system of breast cytology into five categories. The risk of malignancy, sensitivity, specificity, and diagnostic accuracy were estimated on the basis of the final histopathological diagnosis. Results Of the 386 cases of breast FNAC, 226 (55.55%) had the corresponding histological diagnosis. The respective ROM for each category was 22.22% for category 1 (insufficient material), 5.32% for category 2 (benign), 26.31% for category 3 (atypical), 100% for category 4 (suspicious for malignancy), and 100 % category 5 (malignant). Malignant cases were considered only when positive tests, the sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 89.66%, 100%, 100%, 90.2%, and 94.69%, respectively. Conclusions The present study showed statistically significant sensitivity, specificity, and diagnostic accuracy, especially with malignant cases. Hence, using the IAC Yokahama reporting system of breast cytology is effective to standardize the reporting in various institutes and provide clear guidelines to clinician for further management.
Collapse
Affiliation(s)
- Vaddatti Tejeswini
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - B Chaitra
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - I V Renuka
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Kasula Laxmi
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - Potti Ramya
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| | - K K S Sowjanya
- Department of Pathology, NRI Medical College, Chinakakani, Mangalagiri, Guntur, Andhra Pradesh, India
| |
Collapse
|
10
|
Joseph AO, Li YH, Salako O, Doi S, Balogun OD, Awofeso OM, Abdulkareem F, Onitilo AA. A review of breast cancer pathology reports in Nigeria. Ecancermedicalscience 2021; 15:1190. [PMID: 33889199 PMCID: PMC8043685 DOI: 10.3332/ecancer.2021.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Indexed: 11/21/2022] Open
Abstract
Background Diagnosis and treatment of cancer rely heavily on imaging, histopathology and molecular information. Incomplete or missing tumour information can hinder the delivery of high-quality care in oncology practice, especially in resource-limited countries. To evaluate the completeness of histopathology reporting in a real-world setting and identify areas for future cancer care delivery research efforts, we retrospectively analysed reports from patients diagnosed with breast cancer who received care at a high-volume oncology department at a hospital in Lagos, Nigeria. Methods Demographic, institutional and histopathology characteristics were retrospectively obtained from 1,001 patient records from 2007 to 2016. Completeness was defined as reporting five tumour features (tumour histology, tumour grade, laterality, oestrogen receptor (ER) or progesterone receptor (PR) and human epidermal growth factor receptor 2 (HER2)) for biopsy specimens and seven tumour features (tumour size, tumour histology, tumour grade, laterality, ER/PR, HER2 and lymph node involvement) for surgical specimens. Results The mean age of patients was 48.6 ± 11.7 years with a predominantly female population (99.3%). A majority of pathologic reports were produced after 2011, and two-thirds of the reports originated from centres or labs within Lagos, Nigeria (67.7%). Most reports documented primary site (98.0%) and specimen type (85.0%) while other characteristics were less often recorded. This led to substantial variation in reporting between biopsy (13.4%) and surgical (6.1%) specimens for an overall low pathology report completeness <10%. Conclusion The majority of patient records analysed lacked complete documentation of breast cancer histopathological characteristics commonly used in oncology practice. Our study highlights a need to identify and address the contributing factors for incomplete histopathological reporting in Nigeria and will guide future clinical programmatic developments.
Collapse
Affiliation(s)
- Adedayo O Joseph
- NSIA-LUTH Cancer Treatment Center, Lagos University Teaching Hospital, Lagos, Nigeria
| | - Ya-Huei Li
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin 54449, USA
| | - Omolola Salako
- Department of Radiotherapy, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Suhail Doi
- Department of Population Medicine, College of Medicine, Doha, Qatar
| | - Onyinye D Balogun
- Department of Radiation Oncology, Weill Cornell Medicine, New York 10065, USA
| | | | | | - Adedayo A Onitilo
- Cancer Care and Research Center, Marshfield Clinic Research Institute, Marshfield, Wisconsin 54449, USA.,Department of Oncology, Marshfield Clinic Health System-Weston Center, 3501 Cranberry Blvd, Weston, WI 54476, USA.,https://orcid.org/0000-0001-9185-0606
| |
Collapse
|
11
|
Duggan C, Dvaladze A, Rositch AF, Ginsburg O, Yip CH, Horton S, Rodriguez RC, Eniu A, Mutebi M, Bourque JM, Masood S, Unger-Saldaña K, Cabanes A, Carlson RW, Gralow JR, Anderson BO. The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation: Methods and overview. Cancer 2020; 126 Suppl 10:2339-2352. [PMID: 32348573 PMCID: PMC7482869 DOI: 10.1002/cncr.32891] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Breast Health Global Initiative (BHGI) established a series of resource-stratified, evidence-based guidelines to address breast cancer control in the context of available resources. Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice. METHODS In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource-Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource-appropriate breast cancer control guidelines into real-world practice. Three expert consensus panels developed stepwise, resource-appropriate recommendations for implementing these guidelines in low-income and middle-income countries as well as underserved communities in high-income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening. RESULTS Key findings from the summit and subsequent article preparation included the identification of phased-implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real-world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits. CONCLUSIONS Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.
Collapse
Affiliation(s)
| | | | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | | | - Susan Horton
- University of Waterloo, Waterloo, Ontario, Canada
| | | | - Alexandru Eniu
- Hopital Riviera Chablais, Vaud-Valais, Rennaz, Switzerland
| | - Miriam Mutebi
- Breast Surgical Oncology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jean-Marc Bourque
- Department of Radiation Oncology, University of Ottawa, Ottawa, Canada
- Department of Medicine, McGill University, Montreal, Canada
| | - Shahla Masood
- University of Florida Health Jacksonville Breast Center, Jacksonville, FL, USA
| | | | | | - Robert W. Carlson
- National Comprehensive Cancer Center, Plymouth Meeting, Pennsylvania, USA
| | | | - Benjamin O Anderson
- Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| |
Collapse
|
12
|
Yesufe AA, Assefa M, Bekele A, Ergete W, Aynalem A, Wondemagegnehu T, Tausjø J, Assefa Tessema G, Kantelhardt EJ, Gansler T, Jemal A. Adequacy of Pathologic Reports of Invasive Breast Cancer From Mastectomy Specimens at Tikur Anbessa Specialized Hospital Oncology Center in Ethiopia. J Glob Oncol 2019; 4:1-12. [PMID: 30084708 PMCID: PMC6223529 DOI: 10.1200/jgo.17.00198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Purpose Although information from pathology reports is essential to the care of individuals with cancer and to population-level cancer control, no systematic evidence exists regarding the adequacy of breast pathology reporting in Ethiopia. This study audited pathology reports of mastectomy specimens from patients evaluated at the Tikur Anbessa Specialized Hospital Oncology Center in Addis Ababa, Ethiopia. Methods Mastectomy pathology reports from February 2014 through January 2016 were assessed for gross and microscopic information considered by the Breast Cancer Initiative 2.5 (BCI 2.5; formerly the Breast Health Global Initiative) guideline to be necessary for care of patients with breast cancer stratified according to basic, limited, and enhanced resource settings. Results Fewer than two thirds (61.6%) of the 417 reports we reviewed included all four of the BCI 2.5 basic pathology data elements we could evaluate with available data (tumor category, lymph node category, histologic type, and histologic grade). Only 1.0% of reports included all three pathology data elements recommended for limited resource settings (estrogen receptor status, margin status, and lymphovascular invasion). Several elements were significantly more likely to be noted in reports from nonpublic hospitals than from public hospitals. Although only three of 417 reports included checklists or templates, all three of these reports included all of the basic pathology information, and they all included at least two of the three limited pathology elements not already on the basic list. Conclusion More than one third (38.4%) of mastectomy pathology reports did not meet BCI 2.5 standards for basic resource settings. Quality measurement and improvement programs and capacity-building interventions by national pathology and oncology organizations, collaboration with medical and public health organizations in neighboring countries, adoption of synoptic reporting templates, use of electronic pathology reporting, and histotechnology and histopathology training collaborations with laboratories in high-resource regions are recommended.
Collapse
Affiliation(s)
- Abdu A Yesufe
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Mathewos Assefa
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abebe Bekele
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Wondwossen Ergete
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Abreha Aynalem
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Tigeneh Wondemagegnehu
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Johan Tausjø
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Gizachew Assefa Tessema
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Eva Johanna Kantelhardt
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Abdu A. Yesufe, Mathewos Assefa, Abebe Bekele, Wondwossen Ergete, Abreha Aynalem, and Tigeneh Wondemagegnehu, Addis Ababa University, Tikur Anbessa Specialized Hospital, Addis Ababa; Gizachew Assefa Tessema, University of Gondar, Gondar, Ethiopia; Johan Tausjø, Norwegian Radium Hospital, Oslo University, Oslo, Norway; Eva Johanna Kantelhardt, Institute of Medical Epidemiology, Martin-Luther-University, Halle an der Saale, Germany; and Ted Gansler and Ahmedin Jemal, American Cancer Society, Atlanta, GA
| |
Collapse
|
13
|
Egurrola-Pedraza JA, Gómez-Wolff LR, Ossa-Gómez CA, Sánchez-Jiménez V, Herazo-Maya F, García-García HI. [Survival difference due to types of health coverage in breast cancer patients treated at a specialized cancer center in Medellín, Colombia]. CAD SAUDE PUBLICA 2018; 34:e00114117. [PMID: 30570037 DOI: 10.1590/0102-311x00114117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 08/29/2018] [Indexed: 01/07/2023] Open
Abstract
The study aimed to estimate the effect of health insurance on overall survival and disease-free survival in breast cancer patients undergoing surgery at the Las Américas Oncology Institute in Medellín, Colombia, with data from the institutional registry. The variables were compared between subsidized coverage and contributive coverage with chi-squared test (χ2) or Student t test, Kaplan-Meier, and log-rank test. The target variable was adjusted with Cox regression. There were 2,732 patients with a median follow-up of 36 months. Ten percent of the women with contributive coverage died, compared to 23% of the subsidized coverage group. There were differences in time-to-treatment (contributive group with 52 days versus subsidized group with 112 days, p < 0.05). Disease-free survival and overall survival were better in women with contributive coverage compared to those with subsidized coverage (p < 0.05), and overall survival varied according to tumor and treatment variables. Overall survival and disease-free survival and early time-to-diagnosis and treatment were better in patients with contributive coverage compared to those with subsidized coverage.
Collapse
Affiliation(s)
| | | | | | | | | | - Héctor Iván García-García
- Universidad de Antioquia, Medellín, Colombia.,Instituto de Cancerología Las Américas, Medellín, Colombia
| |
Collapse
|
14
|
Field AS. Breast FNA biopsy cytology: Current problems and the International Academy of Cytology Yokohama standardized reporting system. Cancer Cytopathol 2017; 125:229-230. [PMID: 28222244 DOI: 10.1002/cncy.21822] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 12/29/2016] [Indexed: 12/17/2022]
|
15
|
Anderson BO, Duggan C. Resource-Stratified Guidelines for Cancer Management: Correction and Commentary. J Glob Oncol 2016; 3:84-88. [PMID: 28717747 PMCID: PMC5493239 DOI: 10.1200/jgo.2016.006213] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Benjamin O Anderson
- , Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; , Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Catherine Duggan
- , Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA; , Fred Hutchinson Cancer Research Center, Seattle, WA
| |
Collapse
|
16
|
El Saghir NS, Kreidieh FY, El-Baba S, Anderson BO. Management of locally advanced and metastatic breast cancer: guidelines, infrastructures and low resource settings. BREAST CANCER MANAGEMENT 2016. [DOI: 10.2217/bmt-2016-0012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Breast cancer incidence is rising and it accounts for over 1.6 million cases per year worldwide. It represents about one-third of female cancers and is a significant health issue in countries at all economic levels. In this article, we review global cancer statistics, breast cancer staging including late-stage presentation in limited resource settings, disparities in the breast cancer outcomes and requirements for optimal management, including infrastructure needs for optimal surgery, radiation treatment and systemic therapy. We will discuss controversies related to drug pricing and availability, process and delays in registration of new drugs as well as resource stratification and resource-stratified guidelines for locally advanced breast cancer and metastatic breast cancer.
Collapse
Affiliation(s)
- Nagi S El Saghir
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Firas Y Kreidieh
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Sarah El-Baba
- Department of Internal Medicine, Breast Center of Excellence, Naef K. Basile Cancer Institute, American University of Beirut Medical Center, Beirut, Lebanon
| | - Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Departments of Surgery & Global Health-Medicine, University of Washington, Seattle, Washington, DC, USA
| |
Collapse
|
17
|
Demment MM, Peters K, Dykens JA, Dozier A, Nawaz H, McIntosh S, Smith JS, Sy A, Irwin T, Fogg TT, Khaliq M, Blumenfeld R, Massoudi M, De Ver Dye T. Developing the Evidence Base to Inform Best Practice: A Scoping Study of Breast and Cervical Cancer Reviews in Low- and Middle-Income Countries. PLoS One 2015; 10:e0134618. [PMID: 26325181 PMCID: PMC4556679 DOI: 10.1371/journal.pone.0134618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/12/2015] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Breast and cervical cancers have emerged as major global health challenges and disproportionately lead to excess morbidity and mortality in low- and middle-income countries (LMICs) when compared to high-income countries. The objective of this paper was to highlight key findings, recommendations, and gaps in research and practice identified through a scoping study of recent reviews in breast and cervical cancer in LMICs. METHODS We conducted a scoping study based on the six-stage framework of Arskey and O'Malley. We searched PubMed, Cochrane Reviews, and CINAHL with the following inclusion criteria: 1) published between 2005-February 2015, 2) focused on breast or cervical cancer 3) focused on LMIC, 4) review article, and 5) published in English. RESULTS Through our systematic search, 63 out of the 94 identified cervical cancer reviews met our selection criteria and 36 of the 54 in breast cancer. Cervical cancer reviews were more likely to focus upon prevention and screening, while breast cancer reviews were more likely to focus upon treatment and survivorship. Few of the breast cancer reviews referenced research and data from LMICs themselves; cervical cancer reviews were more likely to do so. Most reviews did not include elements of the PRISMA checklist. CONCLUSION Overall, a limited evidence base supports breast and cervical cancer control in LMICs. Further breast and cervical cancer prevention and control studies are necessary in LMICs.
Collapse
Affiliation(s)
- Margaret M. Demment
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Karen Peters
- Division of Community Health Sciences, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - J. Andrew Dykens
- Department of Family Medicine, University of Illinois at Chicago, Chicago, Illinois, United States of America
| | - Ann Dozier
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Haq Nawaz
- Department of Medicine, Griffin Hospital & Yale University-Griffin Prevention Research Center, New Haven, Connecticut, United States of America
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester, Rochester, New York, United States of America
| | - Jennifer S. Smith
- Department of Epidemiology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Angela Sy
- School of Nursing and Dental Hygiene, University of Hawai’i at Mānoa, Honolulu, Hawaii, United States of America
| | - Tracy Irwin
- Department of Obstetrics and Gynecology, University of Washington, Seattle, Washington, United States of America
| | - Thomas T. Fogg
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
| | - Mahmooda Khaliq
- Department of Community and Family Health, University of South Florida, Tampa, Florida, United States of America
| | - Rachel Blumenfeld
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Mehran Massoudi
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
| | - Timothy De Ver Dye
- Clinical and Translational Research Institute, University of Rochester, Rochester, New York, United States of America
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, United States of America
- * E-mail:
| |
Collapse
|
18
|
Rajaraman P, Anderson BO, Basu P, Belinson JL, Cruz AD, Dhillon PK, Gupta P, Jawahar TS, Joshi N, Kailash U, Kapambwe S, Katoch VM, Krishnan S, Panda D, Sankaranarayanan R, Selvam JM, Shah KV, Shastri S, Shridhar K, Siddiqi M, Sivaram S, Seth T, Srivastava A, Trimble E, Mehrotra R. Recommendations for screening and early detection of common cancers in India. Lancet Oncol 2015; 16:e352-61. [PMID: 26149887 DOI: 10.1016/s1470-2045(15)00078-9] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 12/16/2022]
Abstract
Cancers of the breast, uterine cervix, and lip or oral cavity are three of the most common malignancies in India. Together, they account for about 34% of more than 1 million individuals diagnosed with cancer in India each year. At each of these cancer sites, tumours are detectable at early stages when they are most likely to be cured with standard treatment protocols. Recognising the key role that effective early detection and screening programmes could have in reducing the cancer burden, the Indian Institute for Cytology and Preventive Oncology, in collaboration with the US National Cancer Institute Center for Global Health, held a workshop to summarise feasible options and relevant evidence for screening and early detection of common cancers in India. The evidence-based recommendations provided in this Review are intended to act as a guide for policy makers, clinicians, and public health practitioners who are developing and implementing strategies in cancer control for the three most common cancers in India.
Collapse
Affiliation(s)
- Preetha Rajaraman
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA.
| | - Benjamin O Anderson
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Partha Basu
- Department of Gynecological Oncology, Chittaranjan National Cancer Institute, Kolkata, India
| | - Jerome L Belinson
- Preventive Oncology International and Department of Surgery, Women's Health Institute, Lerner School of Medicine, Cleveland Clinic, Cleveland, OH, USA
| | - Anil D' Cruz
- Department of Head and Neck Services, Tata Memorial Hospital, Mumbai, India
| | - Preet K Dhillon
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | - Prakash Gupta
- Healis-Sekhsaria Institute for Public Health, Navi Mumbai, India
| | | | - Niranjan Joshi
- Healthcare Technology Innovation Centre, IIT Madras Research Park, Chennai, India
| | - Uma Kailash
- Institute of Cytology and Preventive Oncology, Noida, India
| | - Sharon Kapambwe
- Africa Centre of Excellence for Women's Cancer Control, Centre for Infectious Disease Research, Lusaka, Zambia
| | | | - Suneeta Krishnan
- Women's Global Health Imperative, Research Triangle Institute International, San Francisco, CA, USA
| | - Dharitri Panda
- Institute of Cytology and Preventive Oncology, Noida, India
| | - R Sankaranarayanan
- Early Detection & Prevention Section and Screening Group, International Agency for Research on Cancer, Lyon, France
| | | | - Keerti V Shah
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA
| | - Surendra Shastri
- Department of Preventive Oncology, Tata Memorial Center, Mumbai, India
| | - Krithiga Shridhar
- Centre for Control of Chronic Conditions, Public Health Foundation of India, Gurgaon, India
| | | | - Sudha Sivaram
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Tulika Seth
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Edward Trimble
- Center for Global Health, National Cancer Institute, National Institutes of Health, US Department of Health and Human Services, Bethesda, MD, USA
| | - Ravi Mehrotra
- Institute of Cytology and Preventive Oncology, Noida, India
| |
Collapse
|
19
|
Masood S, Rosa M, Kraemer DF, Smotherman C, Mohammadi A. Comparative cost-effectiveness of fine needle aspiration biopsy versus image-guided biopsy, and open surgical biopsy in the evaluation of breast cancer in the era of affordable care act: A changing landscape. Diagn Cytopathol 2015; 43:605-12. [DOI: 10.1002/dc.23270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Revised: 01/20/2015] [Accepted: 02/04/2015] [Indexed: 11/08/2022]
Affiliation(s)
- Shahla Masood
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
| | - Marilin Rosa
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
| | - Dale F. Kraemer
- Center for Health Equity and Quality Research, University of Florida; Jacksonville Florida
- Department of Neurology; University of Florida; Jacksonville Florida
| | - Carmen Smotherman
- Center for Health Equity and Quality Research, University of Florida; Jacksonville Florida
| | - Amir Mohammadi
- Department of Pathology and Laboratory Medicine; University of Florida; Jacksonville Florida
| |
Collapse
|
20
|
Involvement of low- and middle-income countries in randomized controlled trial publications in oncology. Global Health 2014; 10:83. [PMID: 25498958 PMCID: PMC4273324 DOI: 10.1186/s12992-014-0083-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 11/18/2014] [Indexed: 11/14/2022] Open
Abstract
Background We describe trends in participation by investigators from low- and middle-income countries (LMCs) in publications describing oncology randomized control trials (RCTs) over a decade. Methods We used Medline to identify RCTs published in English from 1998 to 2008 evaluating treatment in lung, breast, colorectal, stomach and liver cancers. Data on author affiliations, authorship roles, trial characteristics, funding and interventions were extracted from each article. Countries were stratified as low-, middle- or high-income using World Bank data. Interventions were categorized as requiring basic, limited, enhanced or maximal resources as per the Breast Health Global Initiative classification. Logistic regression was used to identify factors associated with authorship by investigators from LMCs. Results 454 publications were identified. Proportion of articles with at least one LMC author increased over time from 20% in 1998 to 29% in 2008 (p = 0.01), but almost all LMC authors were from middle-income countries. Proportion of articles with at least one LMC author was higher among articles that explicitly reported recruitment in at least one LMC vs those that did not (76% vs 13%). Among 87 articles (19%) that involved authors from LMCs, 17% had LMC authors as first or corresponding authors, and 67% evaluated interventions requiring enhanced or maximal resources. Factors associated with LMC authorship included industry funding (OR = 3.54, p = 0.0001), placebo comparator arm (OR = 2.57, p = 0.02) and palliative intent treatment (OR = 4.00, p = 0.0003). Conclusion An increasing number of publications describing oncology RCTs involve authors from LMC countries but primarily in non-leadership roles in industry-funded trials.
Collapse
|
21
|
Anderson BO, Ilbawi AM, El Saghir NS. Breast cancer in low and middle income countries (LMICs): a shifting tide in global health. Breast J 2014; 21:111-8. [PMID: 25444441 DOI: 10.1111/tbj.12357] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Cancer control planning has become a core aspect of global health, as rising rates of noncommunicable diseases in low-resource settings have fittingly propelled it into the spotlight. Comprehensive strategies for cancer control are needed to effectively manage the disease burden. As the most common cancer among women and the most likely reason a woman will die from cancer globally, breast cancer management is a necessary aspect of any comprehensive cancer control plan. Major improvements in breast cancer outcomes in high-income countries have not yet been mirrored in low-resource settings, making it a targeted priority for global health planning. Resource-stratified guidelines provide a framework and vehicle for designing programs to promote early detection, diagnosis, and treatment using existing infrastructure and renewable resources. Strategies for evaluating the current state and projecting future burden is a central aspect of developing national strategies for improving breast cancer outcomes at the national and international levels.
Collapse
Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Departments of Surgery and Global Health-Medicine, University of Washington, Seattle, Washington
| | | | | |
Collapse
|
22
|
Tsu VD, Jeronimo J, Anderson BO. Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull World Health Organ 2014; 91:683-90. [PMID: 24101784 DOI: 10.2471/blt.12.116020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023] Open
Abstract
The health concerns of women in their mid-adult years - when the prime age of reproduction has passed - have been traditionally given little or no attention by health systems and donors, despite the heavy burden that diseases such as breast and cervical cancer impose on women and their families. The risk of sexually transmitted infections that accompanies sexual relations and the risk of death and morbidity associated with pregnancy have long been recognized and have stimulated major control efforts that are finally yielding positive results. Much less attention has been focused, however, on how experiences in early life can affect women's health in adulthood. Breast and cervical cancers kill more women than any other types of cancer in all parts of the developing world. In most of Asia and Latin America and some African countries, deaths from these two forms of cancer now outnumber pregnancy-related deaths. There are five compelling reasons for focusing on these cancers now to try to reverse these epidemiologic trends: (i) the burden of breast and cervical cancer is large and is growing; (ii) effective screening and treatment are available; (iii) research is generating new knowledge; (iv) there are opportunities for synergy with other health programmes; and (v) noncommunicable diseases are the focus of much current interest.
Collapse
Affiliation(s)
- Vivien Davis Tsu
- PATH, PO Box 900922, Seattle, WA 98109, United States of America (USA)
| | | | | |
Collapse
|
23
|
Patani N, Martin LA, Dowsett M. Biomarkers for the clinical management of breast cancer: international perspective. Int J Cancer 2013; 133:1-13. [PMID: 23280579 DOI: 10.1002/ijc.27997] [Citation(s) in RCA: 125] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Accepted: 12/07/2012] [Indexed: 12/14/2022]
Abstract
The higher incidence of breast cancer in developed countries has been tempered by reductions in mortality, largely attributable to mammographic screening programmes and advances in adjuvant therapy. Optimal systemic management requires consideration of clinical, pathological and biological parameters. Oestrogen receptor alpha (ERα), progesterone receptor (PgR) and human epidermal growth factor receptor 2 (HER2) are established biomarkers evaluated at diagnosis, which identify cardinal subtypes of breast cancer. Their prognostic and predictive utility effectively guides systemic treatment with endocrine, anti-HER2 and chemotherapy. Hence, accurate and reliable determination remains of paramount importance. However, the goals of personalized medicine and targeted therapies demand further information regarding residual risk and potential benefit of additional treatments in specific circumstances. The need for biomarkers which are fit for purpose, and the demands placed upon them, is therefore expected to increase. Technological advances, in particular high-throughput global gene expression profiling, have generated multi-gene signatures providing further prognostic and predictive information. The rational integration of routinely evaluated clinico-pathological parameters with key indicators of biological activity, such as proliferation markers, also provides a ready opportunity to improve the information available to guide systemic therapy decisions. The additional value of such information and its proper place in patient management is currently under evaluation in prospective clinical trials. Expanding the utility of biomarkers to lower resource settings requires an emphasis on cost effectiveness, quality assurance and possible international variations in tumor biology; the potential for improved clinical outcomes should be justified against logistical and economic considerations.
Collapse
Affiliation(s)
- Neill Patani
- The Breakthrough Breast Cancer Research Center, The Institute of Cancer Research, London, United Kingdom
| | | | | |
Collapse
|
24
|
Masood S. Building access to quality breast pathology diagnosis across the globe: a call for action. Breast J 2013; 19:229-30. [PMID: 23614362 DOI: 10.1111/tbj.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
25
|
Garud HT, Sheet D, Mahadevappa M, Chatterjee J, Ray AK, Ghosh A. Breast fine needle aspiration cytology practices and commonly perceived diagnostic significance of cytological features: A pan- India survey. J Cytol 2012; 29:183-9. [PMID: 23112459 PMCID: PMC3480767 DOI: 10.4103/0970-9371.101168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Methodical and meticulous understanding of clinico-pathological procedures and decision making process of cancer diagnosis and identification of aspects that are well-suited for computer-aided analysis are first steps toward development of assistive computational tool for analysis of breast fine needle aspiration cytology (FNAC) slides. Aims: To identify variables in practice of FNAC as used for diagnosis of breast lesions and commonly perceived diagnostic significance of cytological features for diagnosis of benign or malignant condition of breast lesions. Materials and Methods: An India-wide questionnaire-based survey of cytopathologists/pathologists’ breast FNAC reporting practices and their opinion on diagnostic significance of cytological features in diagnosis of benign or malignant nature of breast lesion were conducted. Results: Fifty-one experts working with various medical education institutes (~52% of participants), oncological tertiary care centers (~28%) and primary care centers/private diagnostic pathology laboratories (~20%) spread over 13 states of India have participated in the survey. Constants and variables observed in clinico-cytopathological practices and combined opinion of the participants on diagnostic significance of cytological features are presented here. Conclusions: There exist analogous as well as varied components in clinico-pathological procedures and diagnostic interpretation by individuals. These constants and variables in the practice of breast FNAC should be considered, when drawing up specifications for an assistive computational tool for analysis of breast FNAC slides. The estimate for commonly perceived significance of cytological features obtained through this study will help in their selection for computer-aided analysis of breast FNAC slides and further in selection of corresponding feature quantification techniques.
Collapse
Affiliation(s)
- Hrushikesh Tukaram Garud
- School of Medical Science and Technology, Indian Institute of Technology Kharagpur, Kharagpur, India ; Video Signal Processing, Texas Instruments (India) Pvt. Ltd., Bangalore, India
| | | | | | | | | | | |
Collapse
|
26
|
Runnak MA, Hazha MA, Hemin HA, Wasan AA, Rekawt RM, Michael HD. A population-based study of Kurdish breast cancer in northern Iraq: hormone receptor and HER2 status. A comparison with Arabic women and United States SEER data. BMC WOMENS HEALTH 2012; 12:16. [PMID: 22727195 PMCID: PMC3403969 DOI: 10.1186/1472-6874-12-16] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 06/22/2012] [Indexed: 11/10/2022]
Abstract
Background Hormone receptor (HR) and HER2 expression predict the therapeutic response and prognosis of breast cancer. In the Middle-East, breast cancer is diagnosed at a young age, and Arabic women are reported to have a low frequency of HR positive tumors. This study investigates HR and HER2 expression among Kurdish and Arabic women. Methods During 2008–2010, the Sulaimaniyah Directorate of Health records identified 514 Sulaimaniyah Kurdish women, 227 Kurdish women of other Governates, and 83 Arabic women with a first diagnosis of breast cancer. The breast cancers of 432 women had immunohistochemistry (IHC) performed for estrogen and progesterone receptors (ER and PR) and HER2. Age specific and age standardized incidence rates were calculated for Sulaimaniyah Kurds. Results were compared with Egypt and with United States (US) SEER data. Results The median patient age was 46 years and 60.4% were < 50 years old. Tumors of 65.2% of women were ER+/HER2- with the rate increasing to 78.3% in patients ≥ 60 years old in proportions similar to US whites. The total annual age standardized incidence for breast cancer among Sulaimaniyah Kurds was 40.5/100,000 women, a rate similar to Egypt but much lower than the US. By HR/HER2 subtype, the highest age specific incidence rates were 16.4 and 45.4/100,000 for ER+/PR+/HER2- tumors in women < 50 or ≥ 50 years old, respectively (US whites: 37.7 and 226.1/100,000). Tumors of 20.4% of Sulaimaniyah women were HER2+ with annual incidence rates for ER-/PR-/HER2+ tumors of women <50 or ≥ 50 years old being 4.0 and 6.3/100,000 (US whites: 3.2 and 14.4/100,000). No significant differences in ER or HER2 status were found between Kurdish and Arabic patients. Conclusions Compared to the US, low age standardized and age specific breast cancer incidence rates were found in Kurdish women; nevertheless, the proportional expression of HR and HER2 for both Kurds and Arabs was comparable to that of US white women. The great majority of the breast cancer was ER+/HER2- and should respond to anti-estrogen therapy.
Collapse
Affiliation(s)
- Majid A Runnak
- Department of Pathology, Shorsh General Hospital, Sulaimaniyah, Iraq
| | | | | | | | | | | |
Collapse
|
27
|
Zheng S, Bai JQ, Li J, Fan JH, Pang Y, Song QK, Huang R, Yang HJ, Xu F, Lu N, Qiao YL. The pathologic characteristics of breast cancer in China and its shift during 1999-2008: a national-wide multicenter cross-sectional image over 10 years. Int J Cancer 2012; 131:2622-31. [PMID: 22377956 DOI: 10.1002/ijc.27513] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2011] [Accepted: 02/15/2012] [Indexed: 12/23/2022]
Abstract
In China, breast cancer is currently the most common malignancy and the sixth leading cause of cancer death in women. But, the characteristics of breast cancer in the whole population are not determined. The aim of this study was to perform a detailed study on pathologic characteristics of breast cancer representing the whole population in China during 1999-2008 and to compare the difference in invasive breast cancer between the Western and Chinese. We randomly collected 4,211 inpatient at seven hospitals in representative geographical regions of China during 1999-2008. All the hospitals had the ability of comprehensive cancer treatment. The pathologic characters including estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status were surveyed. The shift of pathologic characters was evaluated and the data from China were also compared with those of the Western, both using Chi-square test. We found as follow. (i) The median age of the patients was 48 years and showed the similar characters of Asia. (ii) Breast cancer in China showed more invasive ductal carcinoma with larger tumor size, later stage, lower ER and PR expression and higher HER2 overexpression than those in the Western (p < 0.001). (iii) Both tumor size and stage at diagnosis decreased year by year (p < 0.001). Breast cancer in China showed more aggressive behavior than those in western countries, although tumor size and stage at diagnosis decreased by year during 1999-2008. We addressed the urgent needs for employ race-specific breast cancer screen, diagnosis methods, and therapeutic models in China.
Collapse
Affiliation(s)
- Shan Zheng
- Department of Pathology, Cancer Institute & Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, 17 South Panjiayuan Lane, Beijing 100021, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Trinkaus ME, Sayed S, Gakinya SM, Moloo Z, Hanna W, Rahim Y. Triple Negative and Basal-like Breast Cancer in East Africa. Breast J 2011; 17:438-40. [DOI: 10.1111/j.1524-4741.2011.01096.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
El Saghir NS, Adebamowo CA, Anderson BO, Carlson RW, Bird PA, Corbex M, Badwe RA, Bushnaq MA, Eniu A, Gralow JR, Harness JK, Masetti R, Perry F, Samiei M, Thomas DB, Wiafe-Addai B, Cazap E. Breast cancer management in low resource countries (LRCs): consensus statement from the Breast Health Global Initiative. Breast 2011; 20 Suppl 2:S3-11. [PMID: 21392996 DOI: 10.1016/j.breast.2011.02.006] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2010] [Revised: 01/18/2011] [Accepted: 01/20/2011] [Indexed: 01/10/2023] Open
Abstract
The Breast Health Global Initiative (BHGI) brought together international breast cancer experts to discuss breast cancer in low resource countries (LRCs) and identify common concerns reviewed in this consensus statement. There continues to be a lack of public and health care professionals' awareness of the importance of early detection of breast cancer. Mastectomy continues to be the most common treatment for breast cancer; and a lack of surgeons and anesthesia services was identified as a contributing factor in delayed surgical therapy in LRCs. Where available, radiation therapy is still more likely to be used for palliation rather than for curative treatment. Tumor receptor status is often suboptimally performed due to lack of advanced pathology services and variable quality control of tissue handling and processing. Regional pathology services can be a cost-effective approach and can serve as reference, training and research centers. Limited availability of medical oncologists in LRCs often results in non-specialist providing chemotherapeutic services, which requires additional supervision and training. Palliative care is an emerging field in LRCs that requires investment in training and infrastructure development. A commitment and investment in the development of breast cancer care services by LRC governments and health authorities remains a critical need in LRCs.
Collapse
Affiliation(s)
- Nagi S El Saghir
- Breast Cancer Center of Excellence, NK Basile Cancer Institute, American University of Beirut, Beirut, Lebanon
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
31
|
Verderio P, Pizzamiglio S, Paradiso A. Breast pathology guideline implementation in low- and middle-income countries. Cancer 2009; 115:5607. [PMID: 19626647 DOI: 10.1002/cncr.24611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
32
|
Anderson BO, Jakesz R, El Saghir NS, Yip CH, Khaled HM, Otero IV, Adebamowo CA, Badwe RA, Harford JB. Breast cancer issues in developing countries: an overview of the Breast Health Global Initiative. World J Surg 2009; 12:387-98. [PMID: 18283512 DOI: 10.1016/s1470-2045(11)70031-6] [Citation(s) in RCA: 210] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided. METHODS Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery. RESULTS The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice. CONCLUSIONS The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.
Collapse
Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Anderson BO, Yip CH, Smith RA, Shyyan R, Sener SF, Eniu A, Carlson RW, Azavedo E, Harford J. Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the Breast Health Global Initiative Global Summit 2007. Cancer 2009; 113:2221-43. [PMID: 18816619 DOI: 10.1002/cncr.23844] [Citation(s) in RCA: 306] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion. The Breast Health Global Initiative (BHGI) invited international experts to review and revise previously developed BHGI resource-stratified guideline tables for early detection, diagnosis, treatment, and healthcare systems. Focus groups addressed specific issues in breast pathology, radiation therapy, and management of locally advanced disease. Process metrics were developed based on the priorities established in the guideline stratification. The groups indicated that cancer prevention through health behavior modification could influence breast cancer incidence in LMCs. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies. Government intervention is needed to address drug-delivery problems relating to high cost and poor access. Guideline dissemination and implementation research plays a crucial role in improving care. Adaptation of technology is needed in LMCs, especially for breast imaging, pathology, radiation therapy, and systemic treatment. Curricula for education and training in LMCs should be developed, applied, and studied in LMC-based learning laboratories to aid information transfer of evidence-based BHGI guidelines.
Collapse
Affiliation(s)
- Benjamin O Anderson
- Department of Surgery, University of Washington, Seattle, Washington 98195, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Guideline implementation for breast healthcare in low- and middle-income countries. Cancer 2008; 113:2257-68. [DOI: 10.1002/cncr.23840] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|