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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024; 403:1895-1950. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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Kolawole ID, Ong TP. Barriers to Early Presentation and Diagnosis of Breast Cancer in Nigerian Women. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00637-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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3
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Baral S, Silwal SR, Shrestha UM, Lamichhane D. Evaluation of Quality Indicators of Breast Cancer Management at a Tertiary Cancer Center in Nepal. JCO Glob Oncol 2022; 8:e2100303. [PMID: 35298295 PMCID: PMC8955076 DOI: 10.1200/go.21.00303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 12/03/2021] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Breast cancer is the second commonest cancer among female in Nepal. This is our first attempt to audit breast cancer management in our institute and compare with standard quality indicators (QIs) available. METHODS The retrospective study included 104 female patients with breast cancer who had taken treatment at Bhaktapur Cancer Hospital in 1 year. Participants were selected on the basis of convenience sampling. Of 33 QIs in breast cancer management according to European Society of Breast Cancer Specialists guidelines, 19 QIs were chosen relevant to our setup. These QIs were calculated for all patients and compared with the European Society of Breast Cancer Specialists standard target. Frequencies and percentages were calculated and presented in tables. Binomial 95% of the rates for QI adherence were also calculated for each QI. RESULTS One hundred four patients had a median age of 47.5 years (range 24-70 years). Applicable QIs were in the range of 5-15 with a mean of 9.66 per patient. Of 19 evaluable QIs, very high adherence rates were observed in six QIs, high adherence in three Qis, and low adherences in 10 QIs. High adherence rates were for QI 5 and QI 10a, which were 88.46% and 94.73%, respectively. The low compliance was for QI 1, QI 4a, QI 8, QI 9d, QI 10b, QI 11a, QI 11b, QI 13b, QI 13e, and 14b, which were 53.84%, 78.21%, 0%, 83.16%, 76.92%, 36.0%, 33.33%, 4.76%, 30.55%, and 10.81%, respectively. CONCLUSION There are several QIs that have low levels of adherence in our setting and suggest that there is significant room for improvement. We will be continuing auditing these QIs regularly to improve our quality of care.
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Affiliation(s)
- Shweta Baral
- Clinical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
| | | | | | - Deep Lamichhane
- Surgical Oncologist, Bhaktapur Cancer Hospital, Bhaktapur, Nepal
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4
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Radich JP, Briercheck E, Chiu DT, Menon MP, Sala Torra O, Yeung CCS, Warren EH. Precision Medicine in Low- and Middle-Income Countries. ANNUAL REVIEW OF PATHOLOGY 2022; 17:387-402. [PMID: 35073168 PMCID: PMC9275191 DOI: 10.1146/annurev-pathol-042320-034052] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Most cancer cases occur in low- and middle-income countries (LMICs). The sophisticated technical and human infrastructure needed for optimal diagnosis, treatment, and monitoring of cancers is difficult enough in affluent countries; it is especially challenging in LMICs. In Western, educated, industrial, rich, democratic countries, there is a growing emphasis on and success with precision medicine, whereby targeted therapy is directed at cancers based on the specific genetic lesions in the cancer. Can such precision approaches be delivered in LMICs? We offer some examples of novel partnerships and creative solutions that suggest that precision medicine may be possible in LMICs given heavy doses of will, creativity, and persistence and a little luck.
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Affiliation(s)
- Jerald P Radich
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Edward Briercheck
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Daniel T Chiu
- Departments of Chemistry and Bioengineering, University of Washington, Seattle, WA 98195, USA
| | - Manoj P Menon
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Olga Sala Torra
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
| | - Cecilia C S Yeung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Edus H Warren
- Global Oncology Program, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA;
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
- School of Medicine, University of Washington, Seattle, WA 98195, USA
- Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA 98109, USA
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5
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Menon MP, Niyonzima N, Gralow J, Orem J. Breast Cancer Clinical Trials: The Landscape at the Uganda Cancer Institute and Lessons Learned. JCO Glob Oncol 2021; 7:127-132. [PMID: 33449804 PMCID: PMC8081514 DOI: 10.1200/go.20.00185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The Uganda Cancer Institute, the sole national comprehensive cancer center in Uganda, has a long and rich history of clinical investigation and locally relevant cancer research. Given the increasing burden of breast cancer in Uganda and elsewhere in sub-Saharan Africa (SSA) and driven by the limited availability of immunohistochemistry (IHC), we launched a clinical trial aimed at evaluating locally available diagnostics to detect the presence of hormone receptors (estrogen receptor and progesterone receptor) and human epidermal growth factor receptor 2. Preliminary data from 32 women in the diagnostic component of the study reveal high sensitivity and specificity for estrogen receptor and progesterone receptor and high specificity for human epidermal growth factor receptor 2 when comparing reverse transcriptase polymerase chain reaction with the gold standard (IHC). Innovative diagnostic and treatment strategies are required to address the burden of breast cancer that is increasing throughout SSA. Given the costs, infrastructure, and trained personnel associated with IHC, alternative testing options (including reverse transcriptase polymerase chain reaction as tested in our study) may provide an expedited and cost-effective method to determine receptor testing in breast cancer. Clinical trials conducted in the local setting are critical to determining optimal strategies for effective breast cancer management in SSA.
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Affiliation(s)
- Manoj P Menon
- Fred Hutchinson Cancer Research Center, Seattle, WA.,University of Washington, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
| | - Nixon Niyonzima
- Fred Hutchinson Cancer Research Center, Seattle, WA.,Uganda Cancer Institute, Kampala, Uganda
| | - Julie Gralow
- Fred Hutchinson Cancer Research Center, Seattle, WA.,University of Washington, Seattle, WA.,Seattle Cancer Care Alliance, Seattle, WA
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6
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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.
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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
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7
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Ziegenhorn HV, Frie KG, Ekanem IO, Ebughe G, Kamate B, Traore C, Dzamalala C, Ogunbiyi O, Igbinoba F, Liu B, Bauer M, Thomssen C, Parkin DM, Wickenhauser C, Kantelhardt EJ. Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries. BMC Health Serv Res 2020; 20:912. [PMID: 33008380 PMCID: PMC7531092 DOI: 10.1186/s12913-020-05752-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 09/21/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs. METHODS We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas. RESULTS The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10-386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres. CONCLUSIONS We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.
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Affiliation(s)
- Hannes-Viktor Ziegenhorn
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany
| | - Kirstin Grosse Frie
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany
| | - Ima-Obong Ekanem
- Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Godwin Ebughe
- Department of Pathology, University of Calabar, Cancer Registry, Calabar, Nigeria
- University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Bakarou Kamate
- Department of Pathology, University of Bamako, Bamako Cancer Registry, Bamako, Mali
| | - Cheick Traore
- Department of Pathology, University of Bamako, Bamako Cancer Registry, Bamako, Mali
| | - Charles Dzamalala
- University of Malawi College of Medicine, Cancer Registry, Blantyre, Malawi
| | - Olufemi Ogunbiyi
- University of Ibadan, Cancer registry, Ibadan, Nigeria
- University of Ibadan College of Medicine, Ibadan, Nigeria
| | | | - Biying Liu
- The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marcus Bauer
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Donald Maxwell Parkin
- The African Cancer Registry Network, INCTR African Registry Program, Oxford, UK
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
- International Agency for Research on Cancer, Lyon, France
| | - Claudia Wickenhauser
- Institute of Pathology, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Eva Johanna Kantelhardt
- Institute of Medical Epidemiology, Biometrics and Informatics, Martin-Luther-University Halle-Wittenberg, Magdeburgerstrasse 8, 06097, Halle, Germany.
- Department of Gynaecology, Martin-Luther-University Halle-Wittenberg, Halle, Germany.
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8
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- 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
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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9
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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.
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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
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10
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Lux MP, Emons J, Bani MR, Wunderle M, Sell C, Preuss C, Rauh C, Jud SM, Heindl F, Langemann H, Geyer T, Brandl AL, Hack CC, Adler W, Schulz-Wendtland R, Beckmann MW, Fasching PA, Gass P. Diagnostic Accuracy of Breast Medical Tactile Examiners (MTEs): A Prospective Pilot Study. Breast Care (Basel) 2019; 14:41-47. [PMID: 31019442 DOI: 10.1159/000495883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background The usefulness of clinical breast examination (CBE) in general and in breast cancer screening programs has been a matter of debate. This study investigated whether adding vision-impaired medical tactile examiners (MTEs) improves the predictiveness of CBE for suspicious lesions and analyzed the feasibility and acceptability of this approach. Methods The prospective study included 104 patients. Physicians and MTEs performed CBEs, and mammography and ultrasound results were used as the gold standard. Sensitivity and specificity were calculated and logistic regression models were used to compare the predictive value of CBE by physicians alone, MTEs alone, and physicians and MTEs combined. Results For CBEs by physicians alone, MTEs alone, and both combined, sensitivity was 71, 82, and 89% and specificity was 55, 45, and 35%, respectively. Using adjusted logistic regression models, the validated areas under the curve were 0.685, 0.692, and 0.710 (median bootstrapped p value (DeLong) = 0.381). Conclusion The predictive value for a suspicious breast lesion in CBEs performed by MTEs in patients without prior surgery was similar to that of physician-conducted CBEs. Including MTEs in the CBE procedure in breast units thus appears feasible and could be a way of utilizing their skills.
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Affiliation(s)
- Michael P Lux
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Julius Emons
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Mayada R Bani
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Marius Wunderle
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Charlotte Sell
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Caroline Preuss
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Claudia Rauh
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Sebastian M Jud
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Felix Heindl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Hanna Langemann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Thomas Geyer
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Anna-Lisa Brandl
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Carolin C Hack
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Werner Adler
- Institute of Biometry and Epidemiology, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | | | - Matthias W Beckmann
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Peter A Fasching
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
| | - Paul Gass
- Department of Gynecology and Obstetrics, Erlangen University Hospital, Comprehensive Cancer Center Erlangen - EMN, Friedrich Alexander University of Erlangen-Nuremberg, Erlangen
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Aribal E, Mora P, Chaturvedi AK, Hertl K, Davidović J, Salama DH, Gershan V, Kadivec M, Odio C, Popli M, Kisembo H, Sabih Z, Vujnović S, Kayhan A, Delis H, Paez D, Giammarile F. Improvement of early detection of breast cancer through collaborative multi-country efforts: Observational clinical study. Eur J Radiol 2019; 115:31-38. [PMID: 31084756 DOI: 10.1016/j.ejrad.2019.03.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 11/25/2022]
Abstract
AIM The aim of this paper is to present baseline imaging data and the improvement that was achieved by the participating centers after applying practice-specific interventions that were identified during the course of a multicentric multinational research coordinated project. INTRODUCTION The incidence and mortality rates from breast cancer are rising worldwide and particularly rapidly across the countries with limited resources. Due to lack of awareness and screening options it is usually detected at a later stage. Breast cancer screening programs and even clinical services on breast cancer have been neglected in such countries particularly due to lack of available equipment, funds, organizational structure and quality criteria. MATERIALS AND METHODS A harmonized form was designed in order to facilitate uniformity of data collection. Baseline data such as type of equipment, number of exams, type and number of biopsy procedures, stage of cancer at detection were collected from 10 centers (9 countries: Bosnia-Herzegovina, Costa Rica, Egypt, India, North Macedonia, Pakistan, Slovenia, Turkey, Uganda) were collected. Local practices were evaluated for good practice and specific interventions such as training of professionals and quality assurance programs were identified. The centers were asked to recapture the data after a 2-year period to identify the impact of the interventions. RESULTS The data showed increase in the number of training of relevant professionals, positive changes in the mammography practice and image guided interventions. All the centers achieved higher levels of success in the implementation of the quality assurance procedures. CONCLUSION The study has encountered different levels of breast imaging practice in terms of expertise, financial and human resources, infrastructure and awareness. The most common challenges were the lack of appropriate quality assurance programs and lack of trained skilled personnel and lack of high-quality equipment. The project was able to create higher levels of breast cancer awareness, collaboration amongst participating centers and professionals. It also improved quality, capability and expertise in breast imaging particularly in centers involved diagnostic imaging.
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Affiliation(s)
- Erkin Aribal
- Acibadem M.A.A.University, Radiology Department, Altunizade Hospital, Breast Health Center, Istanbul, Turkey.
| | - Patricia Mora
- Centro de Investigación en Ciencias Atómicas, Nucleares y Moleculares, Universidad de Costa Rica, Costa Rica
| | | | | | - Jasna Davidović
- University Clinical Centre of the Republic of Srpska, Department of Medical Physics and Radiation Protection, Banja Luka, Bosnia and Herzegovina
| | - Dina H Salama
- National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Egypt
| | - Vesna Gershan
- Faculty of Natural Sciences and Mathematics, Skopje, The Former Yugolav Republic of Macedonia
| | | | - Clara Odio
- Departamento de Radiología, Hospital Max Peralta, Costa Rica
| | - Manju Popli
- Institute of Nuclear Medicine and Allied Sciences, Delhi, India
| | - Harriet Kisembo
- Mulago National Referral and Teaching Hospital, Kampala, Uganda
| | - Zahida Sabih
- Multan Institute of Nuclear Medicine and Radiotherapy, Multan, Pakistan
| | - Saša Vujnović
- University Clinical Centre of the Republic of Srpska, Department of Clinical Radiology, Banja Luka, Bosnia and Herzegovina; Faculty of Medicine, Banja Luka, Department of Radiology and Nuclear Medicine, Bosnia and Herzegovina
| | - Arda Kayhan
- Saglik Bilimleri University, Kanuni Sultan Suleyman Teaching and Research Hospital, Istanbul, Turkey
| | - Harry Delis
- International Atomic Energy Agency, Vienna, Austria
| | - Diana Paez
- International Atomic Energy Agency, Vienna, Austria
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Birnbaum JK, Duggan C, Anderson BO, Etzioni R. Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study. LANCET GLOBAL HEALTH 2019; 6:e885-e893. [PMID: 30012269 DOI: 10.1016/s2214-109x(18)30257-2] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 04/23/2018] [Accepted: 05/04/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Poor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs. METHODS We adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30-49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50-69 years in a middle-income setting (Colombia). FINDINGS In the East African setting, relative mortality reductions were 8-41%, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100 000 women over 10 years. In Colombia, mortality reductions were 7-25%, corresponding to 32 (-29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. INTERPRETATION The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. FUNDING Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
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Affiliation(s)
- Jeanette K Birnbaum
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Catherine Duggan
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Benjamin O Anderson
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Surgery, University of Washington, Seattle, WA, USA; Department of Global Health, University of Washington, Seattle, WA, USA
| | - Ruth Etzioni
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; Department of Statistics, University of Washington, Seattle, WA, USA.
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El Saghir NS, El Tomb PA, Carlson RW. Breast Cancer Diagnosis and Treatment in Low- and Mid-Resource Settings: the Role of Resource-Stratified Clinical Practice Guidelines. CURRENT BREAST CANCER REPORTS 2018. [DOI: 10.1007/s12609-018-0287-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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14
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Resource-stratified implementation of a community-based breast cancer management programme in Peru. Lancet Oncol 2017; 18:e607-e617. [PMID: 28971827 DOI: 10.1016/s1470-2045(17)30592-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 01/26/2017] [Accepted: 02/09/2017] [Indexed: 11/24/2022]
Abstract
Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country.
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15
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Pinder LF, Henry-Tillman R, Linyama D, Kusweje V, Nzayisenga JB, Shibemba A, Sahasrabuddhe V, Lishimpi K, Mwanahamuntu M, Hicks M, Parham GP. Leverage of an Existing Cervical Cancer Prevention Service Platform to Initiate Breast Cancer Control Services in Zambia: Experiences and Early Outcomes. J Glob Oncol 2017; 4:1-8. [PMID: 30241176 PMCID: PMC6180756 DOI: 10.1200/jgo.17.00026] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In 2005, the Cervical Cancer Prevention Program in Zambia (CCPPZ) was implemented and has since provided cervical cancer screen-and-treat services to more than 500,000 women. By leveraging the successes and experiences of the CCPPZ, we intended to build capacity for the early detection and surgical treatment of breast cancer. METHODS Our initiative sought to build capacity for breast cancer care through the (1) formation of a breast cancer advocacy alliance to raise awareness, (2) creation of resource-appropriate breast cancer care training curricula for mid- and high-level providers, and (3) implementation of early detection and treatment capacity within two major health care facilities. RESULTS Six months after the completion of the initiative, the following outcomes were documented: Breast health education and clinical breast examination (CBE) services were successfully integrated into the service platforms of four CCPPZ clinics. Two new breast diagnostic centers were opened, which provided access to breast ultrasound, ultrasound-guided core needle biopsy, and needle aspiration. Breast health education and CBE were provided to 1,955 clients, 167 of whom were evaluated at the two diagnostic centers; 55 of those evaluated underwent core-needle biopsy, of which 17 were diagnosed with invasive cancer. Newly trained surgeons performed six sentinel lymph node mappings, eight sentinel lymph node dissections, and 10 breast conservation surgeries (lumpectomies). CONCLUSION This initiative successfully established clinical services in Zambia that are critical for the early detection and surgical management of breast cancer.
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Affiliation(s)
- Leeya F Pinder
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Ronda Henry-Tillman
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - David Linyama
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Victor Kusweje
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Jean-Baptiste Nzayisenga
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Aaron Shibemba
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Vikrant Sahasrabuddhe
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Kennedy Lishimpi
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Mulindi Mwanahamuntu
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Michael Hicks
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
| | - Groesbeck P Parham
- Leeva F. Pinder, David Linyama, Jean-Baptiste Nzayisenga, Aaron Shibemba, Mulindi Mwanahamuntu, and Groesbeck P. Parham, University of Zambia School of Medicine; Kennedy Lishimpi, Cancer Diseases Hospital, Lusaka; Victor Kusweje, Kabwe General Hospital, Kabwe, Zambia; Leeya F. Pinder, Michael Hicks, and Groesbeck P. Parham, University of North Carolina at Chapel Hill, Chapel Hill, NC; Ronda Henry-Tillman, University of Arkansas for Medical Sciences, Little Rock, AR; and Vikrant Sahasrabuddhe, National Cancer Institute, Bethesda, MD
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Denny L, de Sanjose S, Mutebi M, Anderson BO, Kim J, Jeronimo J, Herrero R, Yeates K, Ginsburg O, Sankaranarayanan R. Interventions to close the divide for women with breast and cervical cancer between low-income and middle-income countries and high-income countries. Lancet 2017; 389:861-870. [PMID: 27814963 DOI: 10.1016/s0140-6736(16)31795-0] [Citation(s) in RCA: 140] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 07/11/2016] [Accepted: 07/19/2016] [Indexed: 01/06/2023]
Abstract
Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers.
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Affiliation(s)
- Lynette Denny
- Department of Obstetrics and Gynaecology, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
| | - Silvia de Sanjose
- Cancer Epidemiology Research Programme, Catalan Institute of Oncology, IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Miriam Mutebi
- Department of Surgery, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa; Department of Surgery, Aga Khan University, Nairobi, Kenya
| | - Benjamin O Anderson
- Department of Surgery and Global Health Medicine, University of Washington, Division of Public Health Sciences, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Jane Kim
- Department of Health Policy and Management, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Jose Jeronimo
- Program for Appropriate Technology in Health (PATH), Seattle, WA, USA
| | - Rolando Herrero
- Prevention and Implementation Group, International Agency for Research on Cancer, Lyon, France
| | - Karen Yeates
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Ophira Ginsburg
- Institute of Cancer Policy, Women's College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada; WHO, Geneva, Switzerland
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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
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Sayed S, Moloo Z, Ngugi A, Allidina A, Ndumia R, Mutuiri A, Wasike R, Wahome C, Abdihakin M, Kasmani R, Spears CD, Oigara R, Mwachiro EB, Busarla SVP, Kibor K, Ahmed A, Wawire J, Sherman O, Saleh M, Zujewski JA, Dawsey SM. Breast Camps for Awareness and Early Diagnosis of Breast Cancer in Countries With Limited Resources: A Multidisciplinary Model From Kenya. Oncologist 2016; 21:1138-48. [PMID: 27401898 DOI: 10.1634/theoncologist.2016-0004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/06/2016] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Breast cancer is the most common cancer of women in Kenya. There are no national breast cancer early diagnosis programs in Kenya. OBJECTIVE The objective was to conduct a pilot breast cancer awareness and diagnosis program at three different types of facilities in Kenya. METHODS This program was conducted at a not-for-profit private hospital, a faith-based public hospital, and a government public referral hospital. Women aged 15 years and older were invited. Demographic, risk factor, knowledge, attitudes, and screening practice data were collected. Breast health information was delivered, and clinical breast examinations (CBEs) were performed. When appropriate, ultrasound imaging, fine-needle aspirate (FNA) diagnoses, core biopsies, and onward referrals were provided. RESULTS A total of 1,094 women were enrolled in the three breast camps. Of those, 56% knew the symptoms and signs of breast cancer, 44% knew how breast cancer was diagnosed, 37% performed regular breast self-exams, and 7% had a mammogram or breast ultrasound in the past year. Of the 1,094 women enrolled, 246 (23%) had previously noticed a lump in their breast. A total of 157 participants (14%) had abnormal CBEs, of whom 111 had ultrasound exams, 65 had FNAs, and 18 had core biopsies. A total of 14 invasive breast cancers and 1 malignant phyllodes tumor were diagnosed CONCLUSION Conducting a multidisciplinary breast camp awareness and early diagnosis program is feasible in different types of health facilities within a low- and middle-income country setting. This can be a model for breast cancer awareness and point-of-care diagnosis in countries with limited resources like Kenya. IMPLICATIONS FOR PRACTICE This work describes a novel breast cancer awareness and early diagnosis demonstration program in a low- and middle-income country within a limited resource setting. The program includes breast self-awareness and breast cancer education, clinical exams, and point-of-care diagnostics for women in three different types of health facilities in Kenya. This pilot program has the potential of being replicated on a national scale to create awareness about breast cancer and downstage its presentation.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Zahir Moloo
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Anthony Ngugi
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Amyn Allidina
- Department of Medicine, Aga Khan Hospital Dar es Salaam, Dar es Salaam, Tanzania
| | - Rose Ndumia
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Anderson Mutuiri
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Ronald Wasike
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Charles Wahome
- Department of Pathology, Aga Khan Hospital Mombasa, Mombasa Kenya
| | | | - Riaz Kasmani
- Department of Medicine, Aga Khan Hospital Mombasa, Mombasa Kenya
| | - Carol D Spears
- Department of Surgery, Tenwek Mission Hospital, Bomet, Kenya University of Kentucky, Lexington, Kentucky, USA
| | - Raymond Oigara
- Department of Surgery, Kisii Teaching and Referral Hospital, Kisii, Kenya
| | | | | | - Kibet Kibor
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Abdulaziz Ahmed
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Jonathan Wawire
- Department of Pathology, Aga Khan University Hospital, Nairobi, Kenya
| | - Omar Sherman
- Department of Pathology, Aga Khan Hospital Dar es Salaam, Dar es Salaam, Tanzania
| | - Mansoor Saleh
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA University of Alabama Comprehensive Cancer Center, Birmingham, Alabama, USA
| | - Jo Anne Zujewski
- Breast Cancer Therapeutics, Clinical Investigations Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Rockville, Maryland, USA
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, Maryland, USA
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Sullivan R, Alatise OI, Anderson BO, Audisio R, Autier P, Aggarwal A, Balch C, Brennan MF, Dare A, D'Cruz A, Eggermont AMM, Fleming K, Gueye SM, Hagander L, Herrera CA, Holmer H, Ilbawi AM, Jarnheimer A, Ji JF, Kingham TP, Liberman J, Leather AJM, Meara JG, Mukhopadhyay S, Murthy SS, Omar S, Parham GP, Pramesh CS, Riviello R, Rodin D, Santini L, Shrikhande SV, Shrime M, Thomas R, Tsunoda AT, van de Velde C, Veronesi U, Vijaykumar DK, Watters D, Wang S, Wu YL, Zeiton M, Purushotham A. Global cancer surgery: delivering safe, affordable, and timely cancer surgery. Lancet Oncol 2016; 16:1193-224. [PMID: 26427363 DOI: 10.1016/s1470-2045(15)00223-5] [Citation(s) in RCA: 409] [Impact Index Per Article: 51.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/20/2022]
Abstract
Surgery is essential for global cancer care in all resource settings. Of the 15.2 million new cases of cancer in 2015, over 80% of cases will need surgery, some several times. By 2030, we estimate that annually 45 million surgical procedures will be needed worldwide. Yet, less than 25% of patients with cancer worldwide actually get safe, affordable, or timely surgery. This Commission on global cancer surgery, building on Global Surgery 2030, has examined the state of global cancer surgery through an analysis of the burden of surgical disease and breadth of cancer surgery, economics and financing, factors for strengthening surgical systems for cancer with multiple-country studies, the research agenda, and the political factors that frame policy making in this area. We found wide equity and economic gaps in global cancer surgery. Many patients throughout the world do not have access to cancer surgery, and the failure to train more cancer surgeons and strengthen systems could result in as much as US $6.2 trillion in lost cumulative gross domestic product by 2030. Many of the key adjunct treatment modalities for cancer surgery--e.g., pathology and imaging--are also inadequate. Our analysis identified substantial issues, but also highlights solutions and innovations. Issues of access, a paucity of investment in public surgical systems, low investment in research, and training and education gaps are remarkably widespread. Solutions include better regulated public systems, international partnerships, super-centralisation of surgical services, novel surgical clinical trials, and new approaches to improve quality and scale up cancer surgical systems through education and training. Our key messages are directed at many global stakeholders, but the central message is that to deliver safe, affordable, and timely cancer surgery to all, surgery must be at the heart of global and national cancer control planning.
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Affiliation(s)
- Richard Sullivan
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK.
| | | | - Benjamin O Anderson
- University of Washington School of Medicine, Seattle, WA, USA; Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | | | | | - Ajay Aggarwal
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK; London School of Hygiene & Tropical Medicine, London, UK
| | - Charles Balch
- Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | | | - Anna Dare
- Centre for Global Health Research, St Michael's Hospital, Toronto, ON, Canada; Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anil D'Cruz
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | | | - Kenneth Fleming
- Green Templeton College, University of Oxford, Oxford, UK; Oxford University Hospitals NHS Trust, Oxford, UK
| | - Serigne Magueye Gueye
- University Cheikh Anta Diop, Dakar, Senegal; Grand Yoff General Hospital, Dakar, Senegal
| | - Lars Hagander
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - Cristian A Herrera
- Cabinet of the Minister, Ministry of Health, Santiago, Chile; Department of Public Health, School of Medicine, Pontificia Universidad Católica, Santiago, Chile
| | - Hampus Holmer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden
| | - André M Ilbawi
- University of Texas MD Anderson Cancer Centre, Houston, TX, USA; Union for International Cancer Control, Geneva, Switzerland
| | - Anton Jarnheimer
- Paediatric Surgery and Global Paediatrics, Department of Paediatrics, Lund University, Lund, Sweden; Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jia-Fu Ji
- Peking University Cancer Hospital and Institute, Beijing, China; Chinese Anti-Cancer Association, Tianjin, China
| | | | | | - Andrew J M Leather
- King's Centre for Global Health, King's Health Partners and King's College London, London, UK
| | - John G Meara
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Swagoto Mukhopadhyay
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Shilpa S Murthy
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA; Department of General Surgery, Indiana University, Bloomington, IN, USA
| | | | - Groesbeck P Parham
- Department of Obstetrics and Gynecology, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA; University of Zambia, Lusaka, Zambia
| | - C S Pramesh
- Department of Surgical Oncology, Tata Memorial Centre, Mumbai, Maharashtra, India
| | - Robert Riviello
- Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Luiz Santini
- INCA (Brazilian National Cancer Institute), Rio de Janeiro, Brazil
| | | | - Mark Shrime
- Program in Global Surgery and Social Change, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Robert Thomas
- Department of Health & Human Services, Melbourne, VIC, Australia
| | - Audrey T Tsunoda
- Gyne-Oncology Department, Barretos Cancer Hospital, Barretos, Brazil
| | - Cornelis van de Velde
- Department of Surgical Oncology, Endocrine and Gastrointestinal Surgery, Leiden University Medical Centre, Leiden, Netherlands
| | | | | | - David Watters
- Deakin University, Geelong, VIC, Australia; Barwon Health, Geelong, VIC, Australia
| | - Shan Wang
- Peking University People's Hospital, Beijing, China; Chinese College of Surgeons, Beijing, China
| | - Yi-Long Wu
- Guangdong Lung Cancer Institute, Guangdong General Hospital, Guangzhou, China; Guangdong Academy of Medical Sciences, Guangzhou, China; Chinese Society of Clinical Oncology, Beijing, China
| | - Moez Zeiton
- Sadeq Institute, Tripoli, Libya; Trauma and Orthopaedic Rotation, North-West Deanery, Manchester, UK
| | - Arnie Purushotham
- Institute of Cancer Policy, King's Health Partners Comprehensive Cancer Centre, London, UK; King's Centre for Global Health, King's Health Partners and King's College London, London, UK; Guy's and St Thomas' NHS Foundation Trust, London, UK
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Scheel JR, Nealey EM, Orem J, Bugeza S, Muyinda Z, Nathan RO, Porter PL, Lehman CD. ACR BI-RADS Use in Low-Income Countries: An Analysis of Diagnostic Breast Ultrasound Practice in Uganda. J Am Coll Radiol 2015; 13:163-9. [PMID: 26419306 DOI: 10.1016/j.jacr.2015.07.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2015] [Revised: 07/24/2015] [Accepted: 07/28/2015] [Indexed: 11/15/2022]
Affiliation(s)
- John R Scheel
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington.
| | - Erika M Nealey
- Department of Radiology, University of Washington, Seattle, Washington
| | | | - Samuel Bugeza
- Department of Radiology, Mulago Hospital, Kampala, Uganda
| | | | - Robert O Nathan
- Department of Radiology, University of Washington, Seattle, Washington
| | - Peggy L Porter
- Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Constance D Lehman
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, Washington
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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.
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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:
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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.
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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.
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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
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24
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25
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Pandey S, Chandravati. Breast screening in north India: a cost-effective cancer prevention strategy. Asian Pac J Cancer Prev 2014; 14:853-7. [PMID: 23621251 DOI: 10.7314/apjcp.2013.14.2.853] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Breast cancer is a leading cause of morbidity and mortality in women worldwide. Breast screening in normal and/or asymptomatic women is essential to reduce the burden of breast malignancies. Our study aimed to identify possible risk- and/or co-factors associated with breast screening in North Indian women. METHODS A public health research survey was conducted among 100 women of North Indian ethnicity during clinic visits in a 6-month timeline (April-October 2012). Demographic and clinical data, including mammography screening, were recorded in the questionnaire-based proforma after conducting a 10 minute interview. Written informed consent was taken from all the participants. RESULTS The mean age of the participants was 32.2±9.9 years. Out of 100 women, 6% had family history of breast disease. Breast-related complaints/malignancy, including galactorrhoea, mastitis, axillary lump, fibrocystic disease, fibroadenosis and adenocarcinoma were observed in 41% participants; age stratification revealed that 82.9% of this group (n=41) were <30 years, while 9.7% and 7.3% were >30 years and 30 years of age, respectively. 32% participants underwent mammography screening and 8% had breast ultrasound imaging. Age stratification in the mammography screening group demonstrated that 24 women were <40 years, while 7 women were >40 years. CONCLUSIONS Our pilot study identified possible co-factors affecting breast screening in North Indian women. These findings may be beneficial in early detection of breast abnormalities, including malignancies in women susceptible to breast cancer, and thus aid in future design of cost-effective screening strategies to reduce the increasing burden of breast carcinoma in women worldwide.
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Affiliation(s)
- Saumya Pandey
- Krishna Medical Centre, Rana Pratap Marg, Lucknow, Uttar Pradesh, India.
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26
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Cardoso F, Bese N, Distelhorst SR, Bevilacqua JLB, Ginsburg O, Grunberg SM, Gralla RJ, Steyn A, Pagani O, Partridge AH, Knaul FM, Aapro MS, Andersen BL, Thompson B, Gralow JR, Anderson BO. Supportive care during treatment for breast cancer: resource allocations in low- and middle-income countries. A Breast Health Global Initiative 2013 consensus statement. Breast 2013; 22:593-605. [PMID: 24001709 PMCID: PMC7442957 DOI: 10.1016/j.breast.2013.07.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/23/2013] [Indexed: 12/20/2022] Open
Abstract
Breast cancer patients may have unmet supportive care needs during treatment, including symptom management of treatment-related toxicities, and educational, psychosocial, and spiritual needs. Delivery of supportive care is often a low priority in low- and middle-income settings, and is also dependent on resources available. This consensus statement describes twelve key recommendations for supportive care during treatment in low- and middle-income countries, identified by an expert international panel as part of the 5th Breast Health Global Initiative (BHGI) Global Summit for Supportive Care, which was held in October 2012, in Vienna, Austria. Panel recommendations are presented in a 4-tier resource-stratified table to illustrate how health systems can provide supportive care services during treatment to breast cancer patients, starting at a basic level of resource allocation and incrementally adding program resources as they become available. These recommendations include: health professional and patient and family education; management of treatment related toxicities, management of treatment-related symptoms of fatigue, insomnia and non-specific pain, and management of psychosocial and spiritual issues related to breast cancer treatment. Establishing supportive care during breast cancer treatment will help ensure that breast cancer patients receive comprehensive care that can help 1) improve adherence to treatment recommendations, 2) manage treatment-related toxicities and other treatment related symptoms, and 3) address the psychosocial and spiritual aspects of breast cancer and breast cancer treatments.
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Affiliation(s)
| | - Nuran Bese
- Acibadem Maslak Hospital Breast Health, Istanbul, Turkey
| | | | | | - Ophira Ginsburg
- Women’s College Research Institute, Faculty of Medicine, Dalla Lana School of Public Health, University of Toronto, Canada
| | - Steven M. Grunberg
- Multinational Association of Supportive Care in Cancer, Shelburne, Vermont, USA
| | | | - Ann Steyn
- Reach to Recovery International; Reach to Recovery South Africa, Cape Town. South Africa
| | - Olivia Pagani
- European School of Oncology and Institute of Oncology of Southern Switzerland, Viganello, Switzerland
| | | | - Felicia Marie Knaul
- Harvard Global Equity Initiative, Boston, Massachusetts, USA; Tómatelo a Pecho A.C., Mexico City, Mexico
| | | | | | - Beti Thompson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Julie R. Gralow
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Seattle Cancer Care Alliance, University of Washington, Seattle, Washington, USA
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Zheng S, Song QK, Zhao L, Huang R, Sun L, Li J, Fan JH, Zhang BN, Yang HJ, Xu F, Zhang B, Qiao YL. Characteristics of mammary Paget's disease in China: a national-wide multicenter retrospective study during 1999-2008. Asian Pac J Cancer Prev 2013; 13:1887-93. [PMID: 22901142 DOI: 10.7314/apjcp.2012.13.5.1887] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The aim of this study was to detail characteristics of mammary Paget's disease (PD) representing the whole population in China. A total of 4211 female breast cancer inpatients at seven tertiary hospitals from seven representative geographical regions of China were collected randomly during 1999 to 2008. Data for demography, risk factors, diagnostic imaging test, physical examination and pathologic characters were surveyed and biomarker status was tested by immunohistochemistry. The differences of demography and risk factors between PD with breast cancer and other lesions were compared using Chi-square test or t-test, with attention to physical examination and pathological characters. The percentage of PD was 1.6% (68/4211) in all breast cancers. The mean age at diagnosis was 48.1, and 63.2% (43/68) patients were premenopausal. There is no difference in demography and risk factors between PD with breast cancer and other breast cancer (P>0.05). The main pattern of PD in physical exam and pathologic pattern were patients presenting with a palpable mass in breast (65/68, 95.6%) and PD with underlying invasive cancer (82.4%, 56/68) respectively. The rate of multifocal disease was 7.4% (5/68). PD with invasive breast cancer showed larger tumor size, more multifocal disease, lower ER and PR expression and higher HER2 overexpression than those in other invasive breast cancer (P<0.05). These results suggested that PD in China is a concomitant disease of breast cancer, and that PD with underlying invasive cancer has more multiple foci and more aggressive behavior compared with other breast invasive cancer. We address the urgent needs for establishing diagnostic and therapeutic guidelines for mammary PD in China.
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Affiliation(s)
- Shan Zheng
- Department of Pathology, Center of Breast Disease, Cancer Institute and Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, Blakemore A, Bull AMJ, Car J, Conteh L, Cooke GS, Ford N, Gregson SAJ, Kerr K, King D, Kulendran M, Malkin RA, Majeed A, Matlin S, Merrifield R, Penfold HA, Reid SD, Smith PC, Stevens MM, Templeton MR, Vincent C, Wilson E. Technologies for global health. Lancet 2012; 380:507-35. [PMID: 22857974 DOI: 10.1016/s0140-6736(12)61127-1] [Citation(s) in RCA: 190] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Peter Howitt
- Institute for Global Health Innovation, Imperial College London, London, UK.
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29
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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.
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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
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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.
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Affiliation(s)
- Nagi S El Saghir
- Breast Cancer Center of Excellence, NK Basile Cancer Institute, American University of Beirut, Beirut, Lebanon
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Breast cancer management in middle-resource countries (MRCs): Consensus statement from the Breast Health Global Initiative. Breast 2011; 20 Suppl 2:S12-9. [DOI: 10.1016/j.breast.2011.02.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Accepted: 02/11/2011] [Indexed: 11/27/2022] Open
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Anderson BO, Azavedo E. Must Breast Care Delivery Models from Resource Rich Environments Be Applied to Resource Limited Environment: Reply. World J Surg 2010. [DOI: 10.1007/s00268-010-0793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Burson AM, Soliman AS, Ngoma TA, Mwaiselage J, Ogweyo P, Eissa MS, Dey S, Merajver SD. Clinical and epidemiologic profile of breast cancer in Tanzania. Breast Dis 2010; 31:33-41. [PMID: 21109721 PMCID: PMC4276128 DOI: 10.3233/bd-2009-0296] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE breast cancer is a highly heterogeneous disease globally. Public health prevention measures require an understanding of the burden of breast cancer and its risk factors. The purpose of this study was to describe the clinical, pathologic, and epidemiologic characteristics of breast cancer patients in Tanzania. METHODS data was abstracted from the medical records of all breast cancer patients attending Ocean Road Cancer Institute (ORCI) over a 2-year period from July 2007 to June 2009. Tumor tissue paraffin blocks were collected for all patients with available tissues for the determination of estrogen receptor (ER) and progesterone receptor (PR). Data for all patients was analyzed descriptively and by using unconditional logistic regression, by comparing early stage (ES), defined as stages I and II and late stage (LS), defined as stages III and IV patients to obtain odds ratios (ORs), 95% confidence intervals (CIs), and P-values. RESULTS among the 488 patients, stage was determined for 356~patients, 90.7% of whom presented in LS. Of the 57 tumor tissues, 49.1% were ER-/PR-. Patients with ulceration (OR = 4.97; 95% CI= 1.07, 23.04; p=0.04) and peau d'orange (OR= 6.78; 95{\%} CI $=$ 1.48, 31.17; p=0.01) were more likely to present in LS rather than ES. Male breast cancer accounted for 2.9% of all breast cancers and inflammatory breast cancer (IBC) comprised 4.3-5.5% of cases based on registered t4d diagnosis or the criteria of IBC signs, if t4d was not reported in the medical records. CONCLUSION most breast cancer patients in Tanzania are diagnosed at advanced disease stages with about half of the tumors being ER-/PR-. These data strongly support that reducing barriers to care, down-staging of disease at diagnosis, implementation of clinical guidelines for management of advanced cases, and palliative care are the four most essential factors that need to be addressed to reduce morbidity and mortality from breast cancer in Tanzania. Further research is needed to quantify the magnitude and molecular features of two relatively rare forms of breast cancer that may account for a greater proportion of the burden of breast cancer in Tanzania compared to the USA and Western Europe: male breast cancer and IBC.
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Affiliation(s)
- Ashley M. Burson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Amr S. Soliman
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | | | | | - P. Ogweyo
- Muhimbili National Hospital, Pathology Department, Dar Es Salaam, Tanzania
| | - Mohab S. Eissa
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Subhojit Dey
- Indian Institute of Public Health, Public Health Foundation of India, New Delhi, India
| | - Sofia D. Merajver
- Center for Global Health, University of Michigan, Ann Arbor, MI, USA
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Management of HER2-positive breast cancer in Asia: consensus statement from the Asian Oncology Summit 2009. Lancet Oncol 2009; 10:1077-85. [PMID: 19880061 DOI: 10.1016/s1470-2045(09)70230-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Patients with breast cancer positive for human epidermal growth-factor receptor type 2 (HER2) are an important subgroup for consideration in the Asian context. Rationally designed, anti-HER2 targeted agents that can substantially improve treatment outcomes have become commercially available, but are still too costly for some groups in developed countries and for underdeveloped and developing nations. This review discusses the available evidence for optimum management of HER2-positive early and advanced breast cancer, and how this evidence can be applied to Asian countries with different levels of health-care resources and economic development--using framework provided by the Breast Health Global Initiative. We provide a brief overview of HER2 testing and discuss management of early and advanced HER2-positive breast cancer, and formulate a consensus statement for the management of breast cancer in the context of basic, limited, enhanced, and maximum health-care resource availability.
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Breast cancer hormone receptor status in Egypt: are we asking the questions that matter most? Breast Cancer Res Treat 2009; 120:161-3. [PMID: 19618263 DOI: 10.1007/s10549-009-0474-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 07/08/2009] [Indexed: 10/20/2022]
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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.
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Affiliation(s)
- Benjamin O Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
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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.
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Affiliation(s)
- Benjamin O Anderson
- Department of Surgery, University of Washington, Seattle, Washington 98195, USA.
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Masood S, Vass L, Ibarra JA, Ljung BM, Stalsberg H, Eniu A, Carlson RW, Anderson BO. Breast pathology guideline implementation in low- and middle-income countries. Cancer 2008; 113:2297-304. [PMID: 18837021 DOI: 10.1002/cncr.23833] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Shahla Masood
- Department of Pathology, College of Medicine, University of Florida, Jacksonville, Florida 32209, USA.
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