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Sayed S, Ngugi AK, Nwosu N, Mutebi MC, Ochieng P, Mwenda AS, Salam RA. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Cochrane Database Syst Rev 2023; 4:CD012515. [PMID: 37070783 PMCID: PMC10122521 DOI: 10.1002/14651858.cd012515.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
BACKGROUND Most women living in low- and middle-income countries (LMICs) present with advanced-stage breast cancer. Limitations of poor serviceable health systems, restricted access to treatment facilities, and lack of breast cancer screening programmes all likely contribute to the late presentation of women with breast cancer living in these countries. Women are diagnosed with advanced disease and frequently do not complete their care due to a number of factors, including financial reasons as health expenditure is largely out of pocket resulting in financial toxicity; health system failures, such as missing services or health worker lack of awareness on common signs and symptoms of cancer; and sociocultural barriers, such as stigma and use of alternative therapies. Clinical breast examination (CBE) is an inexpensive early detection technique for breast cancer in women with palpable breast masses. Training health workers from LMICs to conduct CBE has the potential to improve the quality of the technique and the ability of health workers to detect breast cancers early. OBJECTIVES To assess whether training in CBE affects the ability of health workers in LMICs to detect early breast cancer. SEARCH METHODS We searched the Cochrane Breast Cancer Specialised Registry, CENTRAL, MEDLINE, Embase, the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) search portal, and ClinicalTrials.gov up to 17 July 2021. SELECTION CRITERIA We included randomised controlled trials (RCTs) (including individual and cluster-RCTs), quasi-experimental studies and controlled before-and-after studies if they fulfilled the eligibility criteria. DATA COLLECTION AND ANALYSIS Two review authors independently screened studies for inclusion, and extracted data, assessed risk of bias, and assessed the certainty of the evidence using the GRADE approach. We performed statistical analysis using Review Manager software and presented the main findings of the review in a summary of findings table. MAIN RESULTS We included four RCTs that screened a total population of 947,190 women for breast cancer, out of which 593 breast cancers were diagnosed. All included studies were cluster-RCTs; two were conducted in India, one in the Philippines, and one in Rwanda. Health workers trained to perform CBE in the included studies were primary health workers, nurses, midwives, and community health workers. Three of the four included studies reported on the primary outcome (breast cancer stage at the time of presentation). Amongst secondary outcomes, included studies reported CBE coverage, follow-up, accuracy of health worker-performed CBE, and breast cancer mortality. None of the included studies reported knowledge attitude practice (KAP) outcomes and cost-effectiveness. Three studies reported diagnosis of breast cancer at early stage (at stage 0+I+II), suggesting that training health workers in CBE may increase the number of women detected with breast cancer at an early stage compared to the non-training group (45% detected versus 31% detected; risk ratio (RR) 1.44, 95% confidence interval (CI) 1.01 to 2.06; three studies; 593 participants; I2 = 0%; low-certainty evidence). Three studies reported diagnosis at late stage (III+IV) suggesting that training health workers in CBE may slightly reduce the number of women detected with breast cancer at late stage compared to the non-training group (13% detected versus 42%, RR 0.58, 95% CI 0.36 to 0.94; three studies; 593 participants; I2 = 52%; low-certainty evidence). Regarding secondary outcomes, two studies reported breast cancer mortality, implying that the evidence is uncertain for the impact on breast cancer mortality (RR 0.88, 95% CI 0.24 to 3.26; two studies; 355 participants; I2 = 68%; very low-certainty evidence). Due to the study heterogeneity, we could not conduct meta-analysis for accuracy of health worker-performed CBE, CBE coverage, and completion of follow-up, and therefore reported narratively using the 'Synthesis without meta-analysis' (SWiM) guideline. Sensitivity of health worker-performed CBE was reported to be 53.2% and 51.7%; while specificity was reported to be 100% and 94.3% respectively in two included studies (very low-certainty evidence). One trial reported CBE coverage with a mean adherence of 67.07% for the first four screening rounds (low-certainty evidence). One trial reported follow-up suggesting that compliance rates for diagnostic confirmation following a positive CBE were 68.29%, 71.20%, 78.84% and 79.98% during the respective first four rounds of screening in the intervention group compared to 90.88%, 82.96%, 79.56% and 80.39% during the respective four rounds of screening in the control group. AUTHORS' CONCLUSIONS Our review findings suggest some benefit of training health workers from LMICs in CBE on early detection of breast cancer. However, the evidence regarding mortality, accuracy of health worker-performed CBE, and completion of follow up is uncertain and requires further evaluation.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Nairobi, Kenya
| | - Anthony K Ngugi
- Department of Population Health, Aga Khan University, Nairobi, Kenya
| | - Nicole Nwosu
- Department of Medical Sciences, Western University, London, Canada
| | - Miriam C Mutebi
- Department of Surgery, Aga Khan University Hospital, Nairobi, Kenya
| | - Powell Ochieng
- Department of Post Graduate Medical Education, Aga Khan University, Nairobi, Kenya
| | | | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Sayed S, Fan S, Moloo Z, Wasike R, Bird P, Saleh M, Shaikh AJ, Figueroa JD, Naidoo R, Makokha FW, Gardner K, Oigara R, Njoroge FW, Magangane P, Mutebi M, Chauhan R, Mwanzi S, Govender D, Yang XR. Breast cancer risk factors in relation to molecular subtypes in breast cancer patients from Kenya. Breast Cancer Res 2021; 23:68. [PMID: 34174935 PMCID: PMC8235821 DOI: 10.1186/s13058-021-01446-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/07/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Few studies have investigated risk factor heterogeneity by molecular subtypes in indigenous African populations where prevalence of traditional breast cancer (BC) risk factors, genetic background, and environmental exposures show marked differences compared to European ancestry populations. METHODS We conducted a case-only analysis of 838 pathologically confirmed BC cases recruited from 5 groups of public, faith-based, and private institutions across Kenya between March 2012 to May 2015. Centralized pathology review and immunohistochemistry (IHC) for key markers (ER, PR, HER2, EGFR, CK5-6, and Ki67) was performed to define subtypes. Risk factor data was collected at time of diagnosis through a questionnaire. Multivariable polytomous logistic regression models were used to determine associations between BC risk factors and tumor molecular subtypes, adjusted for clinical characteristics and risk factors. RESULTS The median age at menarche and first pregnancy were 14 and 21 years, median number of children was 3, and breastfeeding duration was 62 months per child. Distribution of molecular subtypes for luminal A, luminal B, HER2-enriched, and triple negative (TN) breast cancers was 34.8%, 35.8%, 10.7%, and 18.6%, respectively. After adjusting for covariates, compared to patients with ER-positive tumors, ER-negative patients were more likely to have higher parity (OR = 2.03, 95% CI = (1.11, 3.72), p = 0.021, comparing ≥ 5 to ≤ 2 children). Compared to patients with luminal A tumors, luminal B patients were more likely to have lower parity (OR = 0.45, 95% CI = 0.23, 0.87, p = 0.018, comparing ≥ 5 to ≤ 2 children); HER2-enriched patients were less likely to be obese (OR = 0.36, 95% CI = 0.16, 0.81, p = 0.013) or older age at menopause (OR = 0.38, 95% CI = 0.15, 0.997, p = 0.049). Body mass index (BMI), either overall or by menopausal status, did not vary significantly by ER status. Overall, cumulative or average breastfeeding duration did not vary significantly across subtypes. CONCLUSIONS In Kenya, we found associations between parity-related risk factors and ER status consistent with observations in European ancestry populations, but differing associations with BMI and breastfeeding. Inclusion of diverse populations in cancer etiology studies is needed to develop population and subtype-specific risk prediction/prevention strategies.
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Affiliation(s)
- Shahin Sayed
- Department of Pathology, Aga Khan University, Nairobi, Kenya.
- University of Cape Town, Cape Town, South Africa.
| | - Shaoqi Fan
- National Cancer Institute of the National Institutes of Health (NCI/NIH) Bethesda, Maryland, Rockville, USA
| | - Zahir Moloo
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Ronald Wasike
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | | | - Mansoor Saleh
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | | | | | | | | | | | - Raymond Oigara
- St. Mary's Mission Hospital, Nairobi, Kenya
- Kisii University, Kisii, Kenya
| | | | | | - Miriam Mutebi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | | | - Sitna Mwanzi
- Department of Pathology, Aga Khan University, Nairobi, Kenya
| | - Dhirendra Govender
- University of Cape Town, Cape Town, South Africa
- PathCare, Cape Town, South Africa
| | - Xiaohong R Yang
- National Cancer Institute of the National Institutes of Health (NCI/NIH) Bethesda, Maryland, Rockville, USA
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3
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Jatho A, Mugisha NM, Kafeero J, Holoya G, Okuku F, Niyonzima N, Orem J. Capacity building for cancer prevention and early detection in the Ugandan primary healthcare facilities: Working toward reducing the unmet needs of cancer control services. Cancer Med 2020; 10:745-756. [PMID: 33319508 PMCID: PMC7877353 DOI: 10.1002/cam4.3659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 11/16/2020] [Accepted: 11/17/2020] [Indexed: 11/25/2022] Open
Abstract
Background In 2018, approximately 60,000 Ugandans were estimated to be suffering from cancer. It was also reported that only 5% of cancer patients access cancer care and 77% present with late‐stage cancer coupled with low level of cancer health literacy in the population despite a wide coverage of primary healthcare facilities in Uganda. We aimed to contribute to reducing the unmet needs of cancer prevention and early detection services in Uganda through capacity building. Methods In 2017, we conducted two national and six regional cancer control stakeholders’ consultative meetings. In 2017 and 2018, we trained district primary healthcare teams on cancer prevention and early detection. We also developed cancer information materials for health workers and communities and conducted a follow‐up after the training. Results A total of 488 primary healthcare workers from 118 districts were trained. Forty‐six health workers in the pilot East‐central subregion were further trained in cervical, breast, and prostate cancer early detection (screening and early diagnosis) techniques. A total of 32,800 cancer information, education and communication materials; breast, cervical, prostate childhood and general cancer information booklets; health education guide, community cancer information flipcharts for village health teams and referral guidelines for suspected cancer were developed and distributed to 122 districts. Also, 16 public and private‐not‐for‐profit regional hospitals, and one training institution received these materials. Audiovisual clips on breast, cervical, and prostate cancer were developed for mass and social media dissemination. A follow‐up after six months to one year indicated that 75% of the districts had implemented at least one of the agreed actions proposed during the training. Conclusions In Uganda, the unmet needs for cancer control services are enormous. However, building the capacity of primary healthcare workers to integrate prevention and early detection of cancer into primary health care based on low‐cost options for low‐income countries could contribute to reducing the unmet needs of cancer prevention and early detection in Uganda. In Uganda, the unmet needs for cancer control services are enormous. We engaged district leaders and healthcare managers, developed cancer information materials, and trained the district PHC workers to integrate prevention and early detection of cancer into the primary healthcare system. This could contribute to reducing the unmet needs of cancer control services in Uganda.
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Affiliation(s)
- Alfred Jatho
- National Cancer Center Graduate School of Cancer Science and Policy, Goyang, Republic of Korea.,Uganda Cancer Institute, Kampala, Uganda
| | | | | | | | - Fred Okuku
- Uganda Cancer Institute, Kampala, Uganda
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Knaul FM, Arreola-Ornelas H, Rodriguez NM, Méndez-Carniado O, Kwete XJ, Puentes-Rosas E, Bhadelia A. Avoidable Mortality: The Core of the Global Cancer Divide. J Glob Oncol 2019; 4:1-12. [PMID: 30096010 PMCID: PMC6223530 DOI: 10.1200/jgo.17.00190] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose The incidence of infection-associated cancers and lethality of cancers amenable to treatment are closely correlated with the income of countries. We analyzed a core part of this global cancer divide—the distribution of premature mortality across country income groups and cancers—applying novel approaches to measure avoidable mortality and identify priorities for public policy. Methods We analyzed avoidable cancer mortality using set lower- and upper-bound age limits of 65 and 75 years (empirical approach), applying cancer-specific and country income group–specific ages of death (feasibility approach), and applying cancer-specific ages of death of high-income countries to all low- and middle-income countries (LMICs; social justice approach). We applied these methods to 2015 mortality data on 16 cancers for which prevention is possible and/or treatment is likely to result in cure or significant increase in life expectancy. Results At least 30% and as much as 50% of cancer deaths are premature, corresponding to between 2.6 and 4.3 million deaths each year, and 70% to 80% are concentrated in LMICs. Using the feasibility approach, 36% of cancer deaths are avoidable; with the social justice approach, 45% of cancer deaths are avoidable. Five cancer types—breast, colorectal, lung, liver, and stomach—account for almost 75% of avoidable cancer deaths in LMICs and worldwide. Conclusion Each year, millions of premature cancer deaths could be avoided with interventions focused on four priority areas: infection-associated cancers, lifestyle and risk factors, women’s cancers, and children’s cancers. Our analysis of the global burden and the specific cancer types associated with avoidable cancer mortality suggests significant opportunities for health systems to redress the inequity of the global cancer divide.
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Affiliation(s)
- Felicia Marie Knaul
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Hector Arreola-Ornelas
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Natalia M Rodriguez
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Oscar Méndez-Carniado
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Xiaoxiao Jiang Kwete
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Esteban Puentes-Rosas
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
| | - Afsan Bhadelia
- Felicia Marie Knaul, Sylvester Comprehensive Cancer Center at the University of Miami; Felicia Marie Knaul and Natalia M. Rodriguez, University of Miami Institute for Advanced Study of the Americas; Hector Arreola-Ornelas, Afsan Bhadelia, and Xiaoxiao Jiang Kwete, University of Miami, Miami, FL; Felicia Marie Knaul, Hector Arreola-Ornelas, and Oscar Méndez-Carniado, Fundación Mexicana para la Salud, A.C.; Felicia Marie Knaul and Hector Arreola-Ornelas, Tómateloa a Pecho A.C., Mexico City; and Esteban Puentes-Rosas, Sanofi Pasteur, LATAM Region, Mexico
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Mahajan M, Naik N, Jain K, Patira N, Prasad S, Mogri S, Muwonge R, Lucas E, Faruq F, Sankaranarayanan R, Iyer S, Basu P. Study of Knowledge, Attitudes, and Practices Toward Risk Factors and Early Detection of Noncommunicable Diseases Among Rural Women in India. J Glob Oncol 2019; 5:1-10. [PMID: 30998427 PMCID: PMC6528727 DOI: 10.1200/jgo.18.00181] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE In recognition of the growing burden of noncommunicable diseases (NCDs), including cancer, we assessed the knowledge, attitudes, and practices of rural women in low-resourced countries toward common NCDs and the barriers they face in receiving NCD early detection services. PATIENTS AND METHODS The study was conducted in a rural block of India using the Rapid Assessment and Response Evaluation ethnographic assessment, which included in-depth interviews of key health officials; focus group discussions with women, men, teachers, and health workers from the block; and a knowledge, attitudes, and practices questionnaire survey. The home-based survey was conducted among 1,192 women selected from 50 villages of the block using a two-stage randomization process and stratified to 30- to 44-year and 45- to 60-year age-groups. RESULTS Our study revealed low awareness among women with regard to tobacco as a risk factor; hypertension, diabetes, and cancer as major health threats; and the importance of their early detection. Only 4.8% of women reported to have ever consumed tobacco, and many others consumed smokeless tobacco without knowing that the preparations contained tobacco. Only 27.3% and 11.5% of women had any knowledge about breast and cervical cancer, respectively, and only a few could describe at least one common symptom of either cancer. Self-reported diagnosis of hypertension and diabetes was significantly lower than the reported national prevalence. Only 0.9% and 1.3% of women reported having had a breast examination or gynecologic checkup, respectively, in the past 5 years. Low female empowerment and misconceptions were major barriers. CONCLUSION Barriers need to be addressed to improve uptake of NCD early detection services.
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Affiliation(s)
- Manoj Mahajan
- GBH Memorial Cancer Hospital, Udaipur, Rajasthan, India
| | - Navami Naik
- Indo-American Cancer Association, Houston, TX
| | - Kirti Jain
- Indo-American Cancer Association, Houston, TX
| | - Nilesh Patira
- GBH Memorial Cancer Hospital, Udaipur, Rajasthan, India
| | | | - Sushma Mogri
- GBH Memorial Cancer Hospital, Udaipur, Rajasthan, India
| | | | - Eric Lucas
- International Agency for Research on Cancer, Lyon, France
| | | | | | - Swami Iyer
- University of Texas MD Anderson Cancer Center, Houston, TX
| | - Partha Basu
- International Agency for Research on Cancer, Lyon, France
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Ariza Márquez YV, Briceño I, Aristizábal F, Niño LF, Yosa Reyes J. Dynamic Effects of CYP2D6 Genetic Variants in a Set of Poor Metaboliser Patients with Infiltrating Ductal Cancer Under Treatment with Tamoxifen. Sci Rep 2019; 9:2521. [PMID: 30792473 PMCID: PMC6385267 DOI: 10.1038/s41598-018-38340-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 12/19/2018] [Indexed: 12/28/2022] Open
Abstract
Breast cancer is a group of multigenic diseases. It is the most common cancer diagnosed among women worldwide and is often treated with tamoxifen. Tamoxifen is catalysed by cytochrome P450 2D6 (CYP2D6), and inter-individual variations in the enzyme due to single nucleotide polymorphisms (SNPs) could alter enzyme activity. We evaluated SNPs in patients from Colombia in South America who were receiving tamoxifen treatment for breast cancer. Allelic diversity in the CYP2D6 gene was found in the studied population, with two patients displaying the poor-metaboliser phenotype. Molecular dynamics and trajectory analyses were performed for CYP2D6 from these two patients, comparing it with the common allelic form (CYP2D6*1). Although we found no significant structural change in the protein, its dynamics differ significantly from those of CYP2D6*1, the effect of such differential dynamics resulting in an inefficient enzyme with serious implications for tamoxifen-treated patients, increasing the risk of disease relapse and ineffective treatment.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/administration & dosage
- Antineoplastic Agents, Hormonal/metabolism
- Breast Neoplasms/drug therapy
- Breast Neoplasms/genetics
- Breast Neoplasms/metabolism
- Breast Neoplasms/pathology
- Carcinoma, Ductal/drug therapy
- Carcinoma, Ductal/genetics
- Carcinoma, Ductal/metabolism
- Carcinoma, Ductal/pathology
- Chemotherapy, Adjuvant
- Cytochrome P-450 CYP2D6/genetics
- Cytochrome P-450 CYP2D6/metabolism
- Female
- Genotype
- Humans
- Inactivation, Metabolic/genetics
- Middle Aged
- Pharmacogenomic Variants/genetics
- Phenotype
- Polymorphism, Single Nucleotide/genetics
- Tamoxifen/administration & dosage
- Tamoxifen/adverse effects
- Tamoxifen/metabolism
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Affiliation(s)
- Yeimy Viviana Ariza Márquez
- Universidad Nacional de Colombia, Instituto de Biotecnología IBUN, Departamento de Farmacia, Bogota, 111321, Colombia
| | - Ignacio Briceño
- Universidad de la Sabana, Facultad de Medicina, Bogota, 140013, Colombia
- Pontificia Universidad Javeriana, Facultad de Medicina, Instituto de Genética Humana IGH, Bogota, 110231, Colombia
| | - Fabio Aristizábal
- Universidad Nacional de Colombia, Instituto de Biotecnología IBUN, Departamento de Farmacia, Bogota, 111321, Colombia
| | - Luis Fernando Niño
- Universidad Nacional de Colombia, Facultad de Ingeniería, Departamento de Ingeniería de Sistemas e Industrial, Bogota, 111321, Colombia
| | - Juvenal Yosa Reyes
- Universidad Simón Bolivar, Facultad de Ciencias Básicas y Biomédicas, Laboratorio de Simulación Molecular y Bioinformática, Barranquilla, 080002, Colombia.
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Villarreal-Garza C, Lopez-Martinez EA, Muñoz-Lozano JF, Unger-Saldaña K. Locally advanced breast cancer in young women in Latin America. Ecancermedicalscience 2019; 13:894. [PMID: 30792811 PMCID: PMC6372300 DOI: 10.3332/ecancer.2019.894] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Indexed: 01/07/2023] Open
Abstract
The purpose of this review is to organise, summarise and critically assess existing knowledge on locally advanced breast cancer (LABC) among young women in Latin America. We discuss the most relevant findings in six sections: 1) epidemiology of breast cancer in young women in Latin America; 2) being young as a factor for worse prognosis; 3) LABC in young women in the region; 4) aggressive tumour behaviour among young women; 5) delays in diagnosis and treatment and 6) burden of advanced disease. We point out the need to dedicate resources to enhance earlier diagnosis and prompt referrals of young women with breast cancer; promote research regarding prevalence, biologic characteristics, outcomes and reasons for diagnosis and treatment delays for this age group; and finally, implement supportive care programmes as a means of improving patients and their families’ well-being. The recognition of the current standpoint of breast cancer in young patients across the continent should shed some light on the importance of this pressing matter.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Research and Breast Cancer Department, Mexican National Cancer Institute, Mexico City 14080, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Edna A Lopez-Martinez
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Jose Felipe Muñoz-Lozano
- Breast Cancer Center, TecSalud, Tecnologico de Monterrey, Monterrey 66278, Mexico.,Joven and Fuerte Program for Young Women with Breast Cancer, Mexico City 03720, Mexico
| | - Karla Unger-Saldaña
- CONACYT fellow-Epidemiology Unit, Mexican National Cancer Institute, Mexico City 14080, Mexico
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Bollyky TJ, Templin T, Cohen M, Dieleman JL. Lower-Income Countries That Face The Most Rapid Shift In Noncommunicable Disease Burden Are Also The Least Prepared. Health Aff (Millwood) 2018; 36:1866-1875. [PMID: 29137514 PMCID: PMC7705176 DOI: 10.1377/hlthaff.2017.0708] [Citation(s) in RCA: 130] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Demographic and epidemiological changes are shifting the disease burden from communicable to noncommunicable diseases in lower-income countries. Within a generation, the share of disease burden attributed to noncommunicable diseases in some poor countries will exceed 80 percent, rivaling that of rich countries, but this burden is likely to affect much younger people in poorer countries. The health systems of lower-income countries are unprepared for this change. We examined the shift to noncommunicable diseases and estimated preparedness for the shift by ranking 172 nations using a health system capacity index for noncommunicable disease. We project that the countries with the greatest increases in the share of disease burden attributable to noncommunicable disease over the next twenty-five years will also be the least prepared for the change, as they ranked low on our capacity index and are expected to have the smallest increases in national health spending. National governments and donors must invest more in preparing the health systems of lower-income countries for the dramatic shift to noncommunicable diseases and in reducing modifiable noncommunicable disease risks.
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Affiliation(s)
- Thomas J Bollyky
- Thomas J. Bollyky is a senior fellow for global health, economics, and development at the Council on Foreign Relations, in Washington, D.C
| | - Tara Templin
- Tara Templin is a graduate student in the Department of Health Research and Policy, Stanford University, in Palo Alto, California
| | - Matthew Cohen
- Matthew Cohen is a research associate for global health, economics, and development at the Council on Foreign Relations
| | - Joseph L Dieleman
- Joseph L. Dieleman ( ) is an assistant professor at the Institute for Health Metrics and Evaluation, University of Washington, in Seattle
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Knaul FM, Rodriguez NM, Bhadelia A, Garcia P, Atun R. Progress on women's health—lessons and opportunities for global cancer control. LANCET GLOBAL HEALTH 2018. [DOI: 10.1016/s2214-109x(18)30085-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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10
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Zhang JJ, Cao XC, Zheng XY, Wang HY, Li YW. Feasibility study of a human papillomavirus E6 and E7 oncoprotein test for the diagnosis of cervical precancer and cancer. J Int Med Res 2018; 46:1033-1042. [PMID: 29322839 PMCID: PMC5972251 DOI: 10.1177/0300060517736913] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate the clinical value of human papillomavirus (HPV) E6 and E7 oncoprotein (HPV E6/E7) detection in the early screening of cervical cancer. Methods This prospective study evaluated all patients with suspected cervical intraepithelial neoplasia (CIN) as identified by the presence of at least one positive indicator from a ThinPrep cytologic test (TCT) and/or a Hybrid Capture 2 (HC2) HPV DNA test. The levels of E6/E7 oncoproteins were determined using Western blot analysis. The diagnostic value of the HPV E6/E7 protein assay was compared with the clinical diagnosis from TCT, HC2 and the gold standard of cervical biopsy histology. Results A total of 450 patients were enrolled in the study and based on histological findings, 102 patients were diagnosed with CIN1 (22.7%), 241 with CIN2 (53.6%), 96 with CIN3 (21.3%) and 11 with squamous cell carcinoma (2.4%). For a diagnosis of CIN2+, although the sensitivity of the HPV E6/E7 assay was lower than HC2 (65.5% versus 96.6%, respectively), the specificity was higher (38.2% versus 5.9%, respectively). The sensitivity of the HPV E6/E7 assay was higher than TCT (65.5% versus 36.2%, respectively). Conclusion Measuring HPV E6/E7 oncoprotein levels is a potential new biomarker for HPV type 16.
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Affiliation(s)
- Jin-Jun Zhang
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Xin-Chun Cao
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Xiang-Yu Zheng
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Hai-Ying Wang
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
| | - Yong-Wei Li
- Department of Laboratory Medicine, Henan Province Chinese Medicine Hospital, Zhengzhou, Henan Province, China
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Rodriguez NM, Brant JM, Pendharkar D, Arreola-Ornelas H, Bhadelia A, de Lima Lopes G, Knaul FM. Thinking Differently in Global Health in Oncology Using a Diagonal Approach: Harnessing Similarities, Improving Education, and Empowering an Alternative Oncology Workforce. Am Soc Clin Oncol Educ Book 2017; 37:416-425. [PMID: 28561680 DOI: 10.1200/edbk_175246] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Cancer is a leading global cause of death, and diverse and minority populations suffer worse outcomes compared with white people from Western societies. Within the United States, African Americans and other blacks, Hispanics, Asians, and American Indians have lower cancer survival rates than whites. In the rest of the world, those from low- and middle-income countries have the greatest disparities, but even those from non-Western high-income countries such as Oman and the United Arab Emirates are diagnosed with cancer at later stages and suffer increased mortality. Although considerable differences exist among these populations, similarities and synergies are also apparent. Challenges can be very similar in reaching these populations effectively for cancer control to improve outcomes, and innovative strategies are needed to effectively make change. In this review, the authors discuss new approaches to the prevention and early detection of cancer as well as the implementation of programs in global oncology and put in evidence cultural similarities and challenges of different populations, highlighting strategies to improve cancer survival and quality care around the world through innovations in training and education, empowerment of an alternative workforce, and a diagonal approach to cancer care using case studies drawn from the authors' work and experience.
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Affiliation(s)
- Natalia M Rodriguez
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Jeannine M Brant
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Dinesh Pendharkar
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Hector Arreola-Ornelas
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Afsan Bhadelia
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Gilberto de Lima Lopes
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
| | - Felicia M Knaul
- From the Harvard T. H. Chan School of Public Health, Boston, MA; Billings Clinic, Billings, MT; Asian Cancer Institute, Mumbai, India; Mexican Health Foundation, Mexico City, Mexico; Harvard Global Equity Initiative, Boston, MA; Sylvester Comprehensive Cancer Center, Miami, FL; University of Miami Institute for Advanced Study of the Americas, Coral Gables, FL
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12
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Shi WJ, Liu H, Wu D, Tang ZH, Shen YC, Guo L. E6/E7 proteins are potential markers for the screening and diagnosis of cervical pre-cancerous lesions and cervical cancer in a Chinese population. Oncol Lett 2017; 14:6251-6258. [PMID: 29113275 DOI: 10.3892/ol.2017.6932] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/14/2017] [Indexed: 12/14/2022] Open
Abstract
The present prospective study aimed to evaluate the effects of E6/E7 protein detection by western blotting on cervical cancer (CC) early screening compared with detection by Hybrid Capture 2 (HC2) test and ThinPrep cytological test (TCT) in a Chinese population. A total of 450 cases of cervical intraepithelial neoplasia (CIN) suspected samples (positive in ≥1 indicator of TCT and HC2 test) were recruited from women who were treated at the International Peace Maternity and Child Health Hospital (Shanghai, China) from March 2014 to February 2015. Each sample was analyzed by cytological test. In addition, human papillomavirus (HPV) DNA examination by Hybrid Capture Tube test and E6/E7 protein expression detection by western blotting were performed in all samples, as well as histologic diagnosis to determine the stage of CIN. The results revealed that, for the diagnosis of CIN2+, although the sensitivity of E6/E7 protein detection was lower than that of HC2 test (71.3 vs. 96.6%, respectively), the specificity was markedly improved (67.6 vs. 5.9%, respectively). Compared with that of TCT, the sensitivity of E6/E7 protein detection was much higher (36.2 vs. 71.3%, respectively), but the specificity was lower (88.2 vs. 67.6%, respectively). In the present study, HPV E6/E7 protein expression was evaluated as a potential new biomarker for CC, with satisfactory diagnostic values for HPV types 16 and 18. The relative diagnostic value may be further improved by combination of E6/E7 messenger RNA detection.
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Affiliation(s)
- Wen-Jing Shi
- Department of Clinical Laboratory, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Hao Liu
- Department of Health Technology and Informatics, Hong Kong Polytechnic University, Hong Kong, SAR 999077, P.R. China
| | - Dan Wu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Zhen-Hua Tang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Yu-Chen Shen
- Department of Clinical Laboratory, International Peace Maternity and Child Health Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200030, P.R. China
| | - Lin Guo
- Department of Clinical Laboratory, Fudan University Shanghai Cancer Center, Shanghai Medical College of Fudan University, Shanghai 200032, P.R. China
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Abstract
Critical illness in the developing world is a substantial burden for individuals, families, communities and healthcare services. The management of these patients will depend on the resources available. Simple conditions such as a fractured leg or a strangulated hernia can have devastating effects on individuals, families and communities. The recent Lancet Commission on Global Surgery and the World Health Organization promise to strengthen emergency and essential care will increase the focus on surgical services within the developing world. This article provides an overview of nursing the critically ill surgical patient in Zambia, a lower middle income country (LMIC) in sub-Saharan Africa.
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Affiliation(s)
- Chris Carter
- Nurse Tutor, Defence School of Healthcare Education, Department of Healthcare Education, Birmingham City University / Intensive Care Nursing Officer, Queen Alexandra's Royal Army Nursing Corps
| | - David Snell
- Consultant Anaesthetist, Newcastle Upon Tyne Hospitals NHS Foundation Trust
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Polanco Rodríguez ÁG, Inmaculada Riba López M, Angel DelValls Casillas T, León JAA, Anjan Kumar Prusty B, Álvarez Cervera FJ. Levels of persistent organic pollutants in breast milk of Maya women in Yucatan, Mexico. ENVIRONMENTAL MONITORING AND ASSESSMENT 2017; 189:59. [PMID: 28091886 DOI: 10.1007/s10661-017-5768-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/04/2017] [Indexed: 05/09/2023]
Abstract
In this study, 24 breast milk samples, obtained from rural Maya women, from municipalities of Yucatan, Mexico, were analyzed for organochlorine pesticide (OCP) residues by gas chromatography. Recent studies have shown that Maya communities have a poor perception about the proper usage and handling of OCP. The karstic soil in this area has a high vulnerability to groundwater pollution by the use of OCP in agriculture and livestock activities. The impact of the ecosystem on human health is much more critical due to the prevailing poverty and a very low educational level of these communities. About 30% of the Maya population consumes water directly from contaminated wells and sinkholes, resulting in a chronic exposure to OCP. The samples served to identify and quantify high levels of OCP residues (18.43 mg/kg of heptachlor epoxide and 1.92 mg/kg of endrin in the metropolitan zone; 2.10 mg/kg of dieldrin, 0.117 mg/kg of endosulfan II, 0.103 mg/kg of heptachlor, 0.178 mg/kg of endrin, and 0.127 mg/kg of endrin aldehyde in the main agricultural zone and on the west coast). The detected levels of OCP residues are a major concern and represent a potential risk to women and children in the region. This could be associated with the high rates of cervical uterine and breast cancer mortality in Yucatan. Thus, regulations on the usage of OCP and their enforcement are necessary, and it is important to establish a yearly monitoring program for OCP residues in breast milk and groundwater, as well as to implement health promotion programs for women in particular and the general population in general.
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Affiliation(s)
- Ángel G Polanco Rodríguez
- Social Medicine and Public Health Department, Regional Research Center "Dr. Hideyo Noguchi", Autonomous University of Yucatán, Av. Itzáes No. 490 x 59, 97000, Mérida, Yucatán, Mexico.
| | - M Inmaculada Riba López
- UNESCO/UNITWIN-WiCoP. Physical Chemistry Department. Faculty of Environmental and Marine Sciences, University of Cadiz, Puerto Real, 11510, Cadiz, Spain
| | - T Angel DelValls Casillas
- UNESCO/UNITWIN-WiCoP. Physical Chemistry Department. Faculty of Environmental and Marine Sciences, University of Cadiz, Puerto Real, 11510, Cadiz, Spain
| | - Jesús Alfredo Araujo León
- Laboratory of Chromatography. Faculty of Chemistry, Autonomous University of Yucatán, C. 43 No. 613 x C. 90 Col. Inalámbrica. C.P. 97069, Mérida, Yucatán, Mexico
| | - B Anjan Kumar Prusty
- Environmental Impact Assessment Division, Gujarat Institute of Desert Ecology, Post Box - 83, Mundra Road, Opp. Changleshwar Temple, Bhuj, Gujarat, 370001, India
| | - Fernando J Álvarez Cervera
- Departamento de Neurociencias, Centro de Investigaciones Regionales "Dr. Hideyo Noguchi", Universidad Autónoma de Yucatán, Av. Itzáes No. 490 x 59, 97000, Mérida, Yucatán, Mexico
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Sayed S, Ngugi A, Ochieng P, Mwenda AS, Salam RA. Training health workers in clinical breast examination for early detection of breast cancer in low- and middle-income countries. Hippokratia 2017. [DOI: 10.1002/14651858.cd012515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Shahin Sayed
- Aga Khan University Hospital; Department of Pathology and Laboratory Medicine; 3rd Parklands Avenue P.O. Box 30270 Nairobi Kenya 00100
| | - Anthony Ngugi
- Aga Khan University (East Africa); Centre for Population Health Sciences, Faculty of Health Sciences; P O Box 30270 Nairobi Kenya 00100
| | - Powell Ochieng
- Aga Khan University; Department of Post Graduate Medical Education; 3rd Parklands Avenue Nairobi Kenya
| | - Aruyaru S Mwenda
- Aga Khan University Hospital; Department of Surgery; 3rd Parklands Avenue Nairobi Kenya 00100
| | - Rehana A Salam
- Aga Khan University Hospital; Division of Women and Child Health; Stadium Road PO Box 3500 Karachi Sind Pakistan 74800
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Di Sibio A, Abriata G, Forman D, Sierra MS. Female breast cancer in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S110-S120. [PMID: 27678313 DOI: 10.1016/j.canep.2016.08.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 07/31/2016] [Accepted: 08/05/2016] [Indexed: 12/21/2022]
Abstract
RATIONALE AND OBJECTIVE The burden of breast cancer has increased worldwide. Breast cancer mortality has been increasing in Central and South America (CSA) in the last few decades. We describe the current burden of breast cancer in CSA and review the current status of disease control. METHODS We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change to describe time trends. RESULTS In the most recent 5-year period, Argentina, Brazil, and Uruguay had the highest incidence rates (67.7-71.9) and Bolivia and El Salvador had the lowest (7.9-12.7). For most countries, mortality rates were ≤12.3, except in Uruguay, Argentina and Cuba (14.9-20.5). Age-specific rates increased after the age of 40-50 years and reached a maximum after age 65 years (mean age at diagnosis 56-62 years). Most countries have developed national screening guidelines; however, there is limited capacity for screening. CONCLUSION The geographic variation of breast cancer rates may be explained by differences in the prevalence of reproductive patterns, lifestyle factors, early detection, and healthcare access. Extending early-detection programs is challenging because of inequalities in healthcare access and coverage, limited funding, and inadequate infrastructure, and thus it may not be feasible. Given the current status of breast cancer in CSA, data generated by population-based cancer registries is urgently needed for effective planning for cancer control.
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Affiliation(s)
| | | | - David Forman
- The International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mónica S Sierra
- The International Agency for Research on Cancer, Section of Cancer Surveillance, France.
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Sierra MS, Soerjomataram I, Antoni S, Laversanne M, Piñeros M, de Vries E, Forman D. Cancer patterns and trends in Central and South America. Cancer Epidemiol 2016; 44 Suppl 1:S23-S42. [PMID: 27678320 DOI: 10.1016/j.canep.2016.07.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 07/15/2016] [Accepted: 07/21/2016] [Indexed: 02/06/2023]
Abstract
RATIONALE AND OBJECTIVE Cancer burden is increasing in Central and South America (CSA). We describe the current burden of cancer in CSA. METHODS We obtained regional and national-level cancer incidence data from 48 population-based registries (13 countries) and nation-wide cancer mortality data from the WHO (18 countries). We estimated world population age-standardized incidence and mortality rates per 100,000 person-years. RESULTS The leading cancers diagnosed were prostate, lung, breast, cervix, colorectal, and stomach, which were also the primary causes of cancer mortality. Countries of high/very high human development index (HDI) in the region experienced a high burden of prostate and breast cancer while medium HDI countries had a high burden of stomach and cervical cancers. Between countries, incidence and mortality from all cancers combined varied by 2-3-fold. French Guyana, Brazil, Uruguay, and Argentina had the highest incidence of all cancers while Uruguay, Cuba, Argentina, and Chile had the highest mortality. Incidence of colorectum, prostate and thyroid cancers increased in Argentina, Brazil, Chile and Costa Rica from 1997 to 2008, while lung, stomach and cervical cancers decreased. CONCLUSION CSA carries a double-burden of cancer, with elevated rates of infection- and lifestyle-related cancers. Encountered variation in cancer rates between countries may reflect differences in registration practices, healthcare access, and public awareness. Resource-dependent interventions to prevent, early diagnose, and treat cancer remain an urgent priority. There is an overwhelming need to improve the quality and coverage of cancer registration to guide and evaluate future cancer control policies and programs.
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Affiliation(s)
- Mónica S Sierra
- International Agency for Research on Cancer, Section of Cancer Surveillance, France.
| | | | - Sébastien Antoni
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Mathieu Laversanne
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Marion Piñeros
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
| | - Esther de Vries
- Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogota, Colombia
| | - David Forman
- International Agency for Research on Cancer, Section of Cancer Surveillance, France
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González-Pier E, Barraza-Lloréns M, Beyeler N, Jamison D, Knaul F, Lozano R, Yamey G, Sepúlveda J. Mexico's path towards the Sustainable Development Goal for health: an assessment of the feasibility of reducing premature mortality by 40% by 2030. LANCET GLOBAL HEALTH 2016; 4:e714-25. [PMID: 27596038 PMCID: PMC5024342 DOI: 10.1016/s2214-109x(16)30181-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/18/2016] [Accepted: 07/18/2016] [Indexed: 01/20/2023]
Abstract
Background The United Nations Sustainable Development Goal for health (SDG3) poses complex challenges for signatory countries that will require clear roadmaps to set priorities over the next 15 years. Building upon the work of the Commission on Investing in Health and published estimates of feasible global mortality SDG3 targets, we analysed Mexico's mortality to assess the feasibility of reducing premature (0–69 years) mortality and propose a path to meet SDG3. Methods We developed a baseline scenario applying 2010 age-specific and cause-specific mortality rates from the Mexican National Institute of Statistics and Geography (INEGI) to the 2030 UN Population Division (UNPD) population projections. In a second scenario, INEGI age-specific and cause-specific trends in death rates from 2000 to 2014 were projected to 2030 and adjusted to match the UNPD 2030 mortality projections. A third scenario assumed a 40% reduction in premature deaths across all ages and causes. By comparing these scenarios we quantified shortfalls in mortality reductions by age group and cause, and forecasted life expectancy pathways for Mexico to converge to better performing countries. Findings UNPD-projected death rates yield a 25·9% reduction of premature mortality for Mexico. Accelerated reductions in adult mortality are necessary to reach a 40% reduction by 2030. Mortality declines aggregated across all age groups mask uneven gains across health disorders. Injuries, particularly road traffic accidents and homicides, are the main health challenge for young adults (aged 20–49 years) whereas unabated diabetes mortality is the single most important health concern for older adults (aged 50–69 years). Interpretation Urgent action is now required to control non-communicable diseases and reduce fatal injuries in Mexico, making a 40% reduction in premature mortality by 2030 feasible and putting Mexico back on a track of substantial life expectancy convergence with better performing countries. Our study provides a roadmap for setting national health priorities. Further analysis of the equity implications of following the suggested pathway remains a subject of future research. Funding Mexico's Ministry of Health, University of California, San Francisco, and Bill & Melinda Gates Foundation.
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Affiliation(s)
| | | | - Naomi Beyeler
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Dean Jamison
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA
| | - Felicia Knaul
- Miami Institute for the Americas, University of Miami, Coral Gables, FL, USA; Mexican Health Foundation, Mexico City, Mexico
| | - Rafael Lozano
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Gavin Yamey
- Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Jaime Sepúlveda
- Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA; National Institute of Public Health, Cuernavaca, Mexico
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Abstract
Cancer is now recognized as one of the four leading causes of morbidity and mortality worldwide, and incidence is expected to rise significantly in the next two decades. Unfortunately, low- and middle-income countries (LMIC) suffer disproportionately from the world's cancer cases. The growing burden of cancer and maldistribution of cancer care resources in LMIC warrant a massive re-evaluation of the structural inequalities that produce global oncological disparities and a worldwide commitment to improve both prevention and treatment strategies. Efforts to improve cancer care capacity should focus on horizontal strengthening of healthcare systems that provide safe, affordable, effective and sustainable care. In response to current deficiencies, many international organizations have started to partner with LMIC to create solutions. Telemedicine and international collaboration are also promising ways to effect change and improve global oncological care.
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Affiliation(s)
- Madeline Pesec
- Brown University 6683, 69 Brown Street, Providence, RI 02912, USA
| | - Tracy Sherertz
- Department of Radiation Oncology, University of California, San Francisco, 1600 Divisadero St, Suite H-1031, San Francisco, CA 94115, USA
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20
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Knaul FM, Langer A, Atun R, Rodin D, Frenk J, Bonita R. Rethinking maternal health. LANCET GLOBAL HEALTH 2016; 4:e227-8. [PMID: 26953968 DOI: 10.1016/s2214-109x(16)00044-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 01/25/2016] [Indexed: 11/26/2022]
Affiliation(s)
| | - Ana Langer
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Rifat Atun
- Department of Global Health and Population, Harvard TH Chan School of Public Health, Boston, MA, USA
| | - Danielle Rodin
- Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | - Julio Frenk
- Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Ruth Bonita
- University of Auckland, Auckland, New Zealand
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21
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Franco-Marina F, López-Carrillo L, Keating NL, Arreola-Ornelas H, Marie Knaul F. Breast cancer age at diagnosis patterns in four Latin American Populations: A comparison with North American countries. Cancer Epidemiol 2015; 39:831-7. [PMID: 26651442 DOI: 10.1016/j.canep.2015.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 08/03/2015] [Accepted: 10/01/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the Latin America countries (LAC), one in five breast cancer (BC) cases occur in women younger than 45 years, almost twice the frequency seen in developed countries. Most BC cases in younger women are premenopausal and are generally more difficult to detect at early stages and to treat than postmenopausal cancers. We employ data from four high quality population-based registries located in LAC and assess the extent to which the higher frequency of BC occurring in younger women is due to a younger population structure, compared to that of developed countries. Next, we analyze secular and generational trends of incidence rates in search for additional explanations. METHODS Using data from the International Agency for Research on cancer, between 1988 and 2007, the age distribution of BC incident cases for registries located in Brazil, Colombia, Costa Rica, Ecuador is compared to that of USA and Canadian registries, both before and after removing differences in population age structure. An age-period-cohort modelling of incidence rates is also conducted in all compared registries to identify secular and generational effects. RESULTS BC incident cases in the LAC registries present, on average, at an earlier age than in the USA and Canadian registries and for 2003-2007, between 20 and 27% of cases occur in women aged 20-44. About two thirds of the difference in age distribution between LAC and USA registries is attributable to the younger age distribution in the LAC base populations. The USA registries show the highest age-specific BC incidence rates of all compared aggregated registries, at all ages. However, in all the LAC registries incidence rates are rapidly increasing, fueled by a strong birth cohort effect. This cohort effect may be explained by important reduction in fertility rates occurring during the second half of the 20th century, but also by a greater exposure to other risk factors for BC related to the adoption of life styles more prevalent in developed countries. CONCLUSION The younger age at presentation of BC incident cases seen in the analyzed LAC registries, and possibly in many Latin American countries, is not only attributable to their relatively young population age structure but also to the low incidence rates in older women. As more recently born cohorts, with greater exposure to risk factors for postmenopausal BC, reach older age, incidence rates will be more similar to the rates seen in the USA and Canadian registries. There is a need for additional research to identify determinants of the higher BC rate among younger women in these countries.
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Affiliation(s)
- Francisco Franco-Marina
- Instituto Nacional de Enfermedades Respiratorias (INER), Calzada Tlalpan No. 4502, Col. Sección XVI, Delegación Tlalpan, C.P. 14080, México D.F., Mexico.
| | - Lizbeth López-Carrillo
- National Institute of Public Health, Universidad No. 655, Col. Santa María Ahuacatitlán, C.P. 62100 Cuernavaca, Morelos, Mexico; Cáncer de mama: Tómatelo a Pecho A.C., Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, C.P. 14610 México, D.F., Mexico.
| | - Nancy L Keating
- Division of General Internal Medicine, Brigham and Women's Hospital and Department of Health Care Policy, Harvard Medical School. 180 Longwood Avenue, Boston, MA 02115-5899, United States.
| | - Hector Arreola-Ornelas
- Competitiveness and Health, Mexican Health Foundation, Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, C.P. 14610 México D.F., Mexico; Cáncer de mama: Tómatelo a Pecho A.C., Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, C.P. 14610 México, D.F., Mexico.
| | - Felicia Marie Knaul
- Harvard Medical School. Harvard Global Equity Initiative. Harvard University. François-Xavier Bagnoud Building, Room 632, 651Huntington Ave., Boston, MA 02115, United States; Cáncer de mama: Tómatelo a Pecho A.C., Periférico Sur No. 4809, Col. El Arenal Tepepan, Delegación Tlalpan, C.P. 14610 México, D.F., Mexico.
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22
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Vodonaivalu L, Bullen C. Trends in cervical cancer in Fiji, 2000-2010. Public Health Action 2015; 3:68-71. [PMID: 26392999 DOI: 10.5588/pha.12.0066] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Accepted: 01/02/2013] [Indexed: 11/10/2022] Open
Abstract
SETTING Cancer patients recorded in Fiji's National Patient Information System (PATIS) from 2000 to 2010. OBJECTIVE To identify trends in cervical cancer using case numbers, incidence rates and case fatality in Fiji over the decade 2000-2010. DESIGN Retrospective descriptive and analytical study. RESULTS Between 2000 and 2010, 1234 patients were registered with cervical cancer, of whom 845 (68%) were indigenous Fijians and 357 (29%) were Indians; only 32 (3%) were of other ethnic groups. Mortality rates were much higher among Fijian women, and were far higher in women aged ≥45 years. CONCLUSION The high incidence rates of cervical cancer in Fijian women between the ages of 35 and 45 years reflect ethnic differences in social norms. The higher case fatality and mortality rates in these groups indicate that more work is needed to improve access to and quality of screening and treatment services.
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Affiliation(s)
- L Vodonaivalu
- Ministry of Health, Public Health Division, Suva, Fiji
| | - C Bullen
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
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Knaul FM, Bhadelia A, Atun R, Frenk J. Achieving Effective Universal Health Coverage And Diagonal Approaches To Care For Chronic Illnesses. Health Aff (Millwood) 2015; 34:1514-22. [DOI: 10.1377/hlthaff.2015.0514] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Felicia Marie Knaul
- Felicia Marie Knaul ( ) is director of the Miami Institute for the Americas and professor at the Miller School of Medicine, University of Miami, in Florida. At the time this research was conducted, she was director of the Harvard Global Equity Initiative, in Boston, Massachusetts
| | - Afsan Bhadelia
- Afsan Bhadelia is a research associate at the Harvard Global Equity Initiative
| | - Rifat Atun
- Rifat Atun is a professor of global health systems in the Department of Global Health and Population at the Harvard School of Public Health
| | - Julio Frenk
- Julio Frenk is president of the University of Miami, in Florida. At the time this research was conducted, he was dean of the Harvard School of Public Health
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24
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Financial catastrophe, treatment discontinuation and death associated with surgically operable cancer in South-East Asia: Results from the ACTION Study. Surgery 2015; 157:971-82. [DOI: 10.1016/j.surg.2015.02.012] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/28/2015] [Accepted: 02/28/2015] [Indexed: 11/26/2022]
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25
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Pu Z, Zhang X, Chen Q, Yuan X, Xie H. Establishment of an expression platform of OATP1B1 388GG and 521CC genetic polymorphism and the therapeutic effect of tamoxifen in MCF-7 cells. Oncol Rep 2015; 33:2420-8. [PMID: 25812934 DOI: 10.3892/or.2015.3864] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 02/10/2015] [Indexed: 11/05/2022] Open
Abstract
The present study was designed to evaluate the gene polymorphisms of organic anion transporting polypeptide 1B1 (OATP1B1) in predicting the therapeutic efficacy of tamoxifen (TAM) for MCF-7. Established plasmids OATP1Bl wild-type 388GG and 521CC were transfected into MCF-7 cells and used to determine whether the gene polymorphisms affected the therapeutic efficacy of TAM for MCF-7. The established plasmids pcDNA3.1(-)-OATP1B1 wild-type 388GG and 521CC were digested by restriction enzymes and analyzed by gene sequencing. The gene polymorphisms of OATP1Bl in MCF-7 breast cancer cells were examined by RT-PCR and western blot analysis. The results showed that the mutations of OATP1B1 388GG and 521CC led to a decrease of the inhibition and apoptotic rates of MCF-7 cells, albeit not significantly compared to the OATP1B1 group. The G₀/G₁ phase length ratio was reduced, and the S and G₂M phases were increased in the OATP1B1 388GG and 521CC groups, although not significantly compared to the OATP1B1 group. The mutations of OATP1B1 388GG and 521CC inhibited the activity of OATP1B1 protein, restrained the turnover capacity of OATP1B1 and reduced the entrance of TAM into MCF-7 cells, resulting in weakened efficacy of TAM in the treatment of breast cancer.
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Affiliation(s)
- Zhichen Pu
- Department of Clinical Pharmacy, Yijishan Hospital of Wannan Medical College, Anhui Province Center for Drug Clinical Evaluation, Wuhu, Anhui 241001, P.R. China
| | - Xuefeng Zhang
- Department of Clinical Pharmacy, Yijishan Hospital of Wannan Medical College, Anhui Province Center for Drug Clinical Evaluation, Wuhu, Anhui 241001, P.R. China
| | - Qun Chen
- Department of Pharmacy, Wuhu Chinese Medicine Hospital, Wuhu, Anhui 241001, P.R. China
| | - Xiaolong Yuan
- Department of Clinical Pharmacy, Yijishan Hospital of Wannan Medical College, Anhui Province Center for Drug Clinical Evaluation, Wuhu, Anhui 241001, P.R. China
| | - Haitang Xie
- Department of Clinical Pharmacy, Yijishan Hospital of Wannan Medical College, Anhui Province Center for Drug Clinical Evaluation, Wuhu, Anhui 241001, P.R. China
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26
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Kruk ME, Nigenda G, Knaul FM. Redesigning primary care to tackle the global epidemic of noncommunicable disease. Am J Public Health 2015; 105:431-7. [PMID: 25602898 PMCID: PMC4330840 DOI: 10.2105/ajph.2014.302392] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/19/2023]
Abstract
Noncommunicable diseases (NCDs) have become the major contributors to death and disability worldwide. Nearly 80% of the deaths in 2010 occurred in low- and middle-income countries, which have experienced rapid population aging, urbanization, rise in smoking, and changes in diet and activity. Yet the health systems of low- and middle-income countries, historically oriented to infectious disease and often severely underfunded, are poorly prepared for the challenge of caring for people with cardiovascular disease, diabetes, cancer, and chronic respiratory disease. We have discussed how primary care can be redesigned to tackle the challenge of NCDs in resource-constrained countries. We suggest that four changes will be required: integration of services, innovative service delivery, a focus on patients and communities, and adoption of new technologies for communication.
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Affiliation(s)
- Margaret E Kruk
- At the time of the study, Margaret E. Kruk was with the Department of Health Policy and Management and Better Health Systems Initiative, Mailman School of Public Health, Columbia University, New York, NY. At the time of the study, Gustavo Nigenda was with the Harvard Global Equity Initiative, Harvard University, Boston, MA. Felicia Marie Knaul is with the Department of Global Health and Social Medicine, Harvard Medical School, Boston, and the Harvard Global Equity Initiative, Boston
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27
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Sivaram S, Sanchez MA, Rimer BK, Samet JM, Glasgow RE. Implementation science in cancer prevention and control: a framework for research and programs in low- and middle-income countries. Cancer Epidemiol Biomarkers Prev 2014; 23:2273-84. [PMID: 25178984 PMCID: PMC4221499 DOI: 10.1158/1055-9965.epi-14-0472] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Implementation science is a set of tools, principles, and methodologies that can be used to bring scientific evidence into action, improve health care quality and delivery, and improve public health. As the burden of cancer increases in low- and middle-income countries, it is important to plan cancer control programs that are both evidence based and delivered in ways that are feasible, cost-effective, contextually appropriate, and sustainable. This review presents a framework for using implementation science for cancer control planning and implementation and discusses potential areas of focus for research and programs in low- and middle-income countries interested in integrating research into practice and policy.
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Affiliation(s)
- Sudha Sivaram
- Center for Global Health, National Cancer Institute, , Phone: 2402765804
| | - Michael A. Sanchez
- Division of Cancer Control and Population Sciences, National Cancer Institute,
| | | | - Jonathan M. Samet
- Department of Preventive Medicine, Keck School of Medicine, Director, Institute for Global Health, University of Southern California,
| | - Russell E. Glasgow
- Colorado Health Outcomes Program, Department of Family Medicine, University of Colorado School of Medicine,
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28
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Tsu VD, Jeronimo J, Anderson BO. Why the time is right to tackle breast and cervical cancer in low-resource settings. Bull World Health Organ 2014; 91:683-90. [PMID: 24101784 DOI: 10.2471/blt.12.116020] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2012] [Revised: 05/29/2013] [Accepted: 05/30/2013] [Indexed: 01/04/2023] Open
Abstract
The health concerns of women in their mid-adult years - when the prime age of reproduction has passed - have been traditionally given little or no attention by health systems and donors, despite the heavy burden that diseases such as breast and cervical cancer impose on women and their families. The risk of sexually transmitted infections that accompanies sexual relations and the risk of death and morbidity associated with pregnancy have long been recognized and have stimulated major control efforts that are finally yielding positive results. Much less attention has been focused, however, on how experiences in early life can affect women's health in adulthood. Breast and cervical cancers kill more women than any other types of cancer in all parts of the developing world. In most of Asia and Latin America and some African countries, deaths from these two forms of cancer now outnumber pregnancy-related deaths. There are five compelling reasons for focusing on these cancers now to try to reverse these epidemiologic trends: (i) the burden of breast and cervical cancer is large and is growing; (ii) effective screening and treatment are available; (iii) research is generating new knowledge; (iv) there are opportunities for synergy with other health programmes; and (v) noncommunicable diseases are the focus of much current interest.
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Affiliation(s)
- Vivien Davis Tsu
- PATH, PO Box 900922, Seattle, WA 98109, United States of America (USA)
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29
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Luciani S, Cabanes A, Prieto-Lara E, Gawryszewski V. Cervical and female breast cancers in the Americas: current situation and opportunities for action. Bull World Health Organ 2014; 91:640-9. [PMID: 24101780 DOI: 10.2471/blt.12.116699] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 05/21/2013] [Accepted: 05/27/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE To understand better the current regional situation and public health response to cervical cancer and female breast cancer in the Americas. METHODS Data on cervical cancer and female breast cancers in 33 countries, for the period from 2000 to the last year with available data, were extracted from the Pan American Health Organization (PAHO) Regional Mortality Database and analysed. Changes in mortality rates over the study period - in all countries except those with small populations and large fluctuations in time-series mortality data - were calculated using Poisson regression models. Information from the PAHO Country Capacity Survey on noncommunicable diseases was also analysed. FINDINGS The Bahamas, Trinidad and Tobago and Uruguay showed relatively high rates of death from breast cancer, whereas the three highest rates of death from cervical cancer were observed in El Salvador, Nicaragua and Paraguay. Several countries - particularly Paraguay and Venezuela - have high rates of death from both types of cancer. Although mortality from cervical cancer has generally been decreasing in the Americas, decreases in mortality from breast cancer have only been observed in a few countries in the Region of the Americas. All but one of the 25 countries in the Americas included in the PAHO Country Capacity Survey reported having public health services for the screening and treatment of breast and cervical cancers. CONCLUSION Most countries in the Americas have the public health capacity needed to screen for - and treat - breast and cervical cancers and, therefore, the potential to reduce the burden posed by these cancers.
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Affiliation(s)
- Silvana Luciani
- Pan American Health Organization, 525 23rd Street NW, Washington, DC 20037, United States of America
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30
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Ali MK, Rabadán-Diehl C, Flanigan J, Blanchard C, Narayan KMV, Engelgau M. Systems and capacity to address noncommunicable diseases in low- and middle-income countries. Sci Transl Med 2013; 5:181cm4. [PMID: 23596201 DOI: 10.1126/scitranslmed.3005121] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Noncommunicable diseases (NCDs) are increasingly getting attention from different forums, including media outlets, health agencies, and the public and private sectors. Progress is being made in addressing NCDs, though more slowly in low- and middle-income countries (LMICs) as compared with high-income settings. Here, we offer an analysis of the challenges faced in LMICs. We discuss realistic strategies to understand and develop capacity needs (workforce, finances, and infrastructure) and systems (institutions and processes) to sustainably optimize NCD prevention and care in LMICs.
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Affiliation(s)
- Mohammed K Ali
- Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA.
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31
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Bustreo F, Knaul FM, Bhadelia A, Beard J, Araujo de Carvalho I. Women's health beyond reproduction: meeting the challenges. Bull World Health Organ 2012; 90:478-478A. [PMID: 22807588 DOI: 10.2471/blt.12.103549] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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