Breast cancer early detection: A phased approach to implementation

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. Cancer 2020;126:2379-2393.

Situational analysis of breast health care systems: Why context matters

“…As of January 2020, a total of 5 BHGI assessments have been performed in Tanzania, Brazil, Uganda, Panama, and India (Table 3). 39‐47 Assessment reports have included analysis of the questionnaire data as well as data regarding breast cancer mortality and incidence rates (when available), stage distribution from national and regional facilities, and exisiting peer‐reviewed literature concerning breast cancer epidemiology in the country or region. A review of governmental policies, state and private insurance rates versus out‐of‐pocket payments for services, workforce shortages, and health system organization also is included.…”

The Breast Health Global Initiative 2018 Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation: Methods and overview

“…Women with breast cancer in LMICs commonly present or are ultimately diagnosed with late‐stage (locally advanced or metastatic) disease 25 . In such settings, efforts to promote early detection are an absolute prerequisite to improving breast cancer outcomes 26 . A 2019 report from Kenya found that key barriers to early detection and treatment included cost, inadequate knowledge, distance to health facilities, communication with health providers, medicine stock‐outs, long waiting periods, limited or no counseling at diagnosis, patient vulnerability, and limited access to rehabilitation options 27 .…”

“…2). 26 Early diagnosis strategies for symptomatic patients are also necessary for the evaluation and workup of patients under the age of 40‐45 years old who are too young to be appropriate screening candidates (even in high‐income settings) 31 …”

“…The paradigm of breast cancer early detection is illustrated 26 . BSE indicates breast self‐examination.…”

NCCN resource‐stratified and harmonized guidelines: A paradigm for optimizing global cancer care

“…The NCCN Guidelines specify appropriate cancer management in the United States and more specifically within the member institution cancer programs, which represent maximal resource settings. In these settings, there should be little or no resource impediment to obtaining the highest level of recommended care, although significant socioeconomic barriers continue to exist that prohibit access to care among vulnerable sectors of society 6,7 …”