Updated Guidelines for International Breast Health and Cancer Control Published

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Specific recommendations for improving breast health care and cancer treatment in countries with limited resources have been published by an international coalition of doctors, scientists and policy makers led by the Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.

Building on guidelines first published in 2003 to help developing nations find ways to make economically feasible and culturally appropriate care available to women, the Breast Health Global Initiative (BHGI) 2005 Guidelines expand and refine the earlier work by proposing a stratified approach to providing breast care based on available healthcare resources. The guidelines offer a stepwise, systematic approach to healthcare improvement using a tiered system of resource allocation on four levels—basic, limited, enhanced and maximal—depending on a country's existing resources.

The BHGI guidelines outline recommendations in four broad areas: breast cancer early detection and access to care; diagnosis and pathology; treatment and resource allocation; and health care systems and public policy. The recommendations are summarized in resource-stratified matrices that recommend, based on the resource level, what level of care and/or service to provide and evaluation goals. Four panels of BHGI experts came up with the recommendations using an evidence-based consensus approach.

For example, in the area of breast cancer early detection and access to care, the guidelines suggest that countries with very basic health systems should educate women about performing breast self-examination to detect lumps. For countries with more but still limited resources, the guidelines recommend targeted outreach and education on clinical breast examination to women in at-risk groups, followed by ultrasound or mammography to confirm the discovery of suspected lumps.

The guidelines are published as a 129-page supplement in the January-February 2006 issue of The Breast Journal. The material is available free of charge on the Internet.

Benjamin O. Anderson, MD, is chairman and director of BHGI, which he founded in 2002 to address the growing rate of breast cancer in developing nations and the need for such nations to provide more services to women.

In an overview of the guidelines published in The Breast Journal, Anderson and colleagues note that breast cancer is the most common cause of cancer-related deaths among women worldwide. Breast cancer is newly diagnosed in more than 1.1 million women annually; these cases represent 10 percent of all new cancer cases. Breast cancer deaths, at more than 410,000 annually, represent about 1.6 percent of all female deaths worldwide.

"Breast cancer is an urgent public health problem in high-resource regions and is becoming an increasingly urgent problem in low-resource regions, where incidence rates have been increasing by up to 5 percent," the authors said.

Low-resource countries generally have not identified cancer as a priority healthcare issue because infectious diseases are the predominant public health threat, the study said. In these situations, cancer is most often treated when it is in its advanced stages, which is when it is most expensive to treat and least successful. Cancer will become a greater healthcare concern in low-resource countries as control of communicable diseases improves and life expectancy rises, the study said.

While evidence-based breast cancer guidelines exist for high-resource countries, they are of little value to poorer countries. "Current evidence about the value of earlier diagnosis and cost-effective diagnosis and treatment can nonetheless be applied to define evidence-based 'best practices with limited resources' for breast healthcare for use in countries where access to healthcare is marginal, breast cancer awareness is marginal and cultural barriers to effective care exist," the study said. Developing guidelines for nations with limited resources "is a crucial step toward improving breast health care and breast cancer in these regions," the study said.