Diagnosis of Breast Cancer in Countries with Limited Resources

Abstract

Accurate diagnosis is a necessary step in the management of breast cancer. In women with breast cancer, diagnosis can confirm the presence of the disease, reduce treatment delays, and clarify the predictive and prognostic features of the cancer, which help in planning treatment and counseling women. In women with benign breast conditions, accurate diagnosis avoids erroneous treatment for breast cancer, which can have devastating consequences for the woman and unnecessarily consumes resources. The panel distinguishes between a "clinical diagnosis" of breast cancer (one based on signs and symptoms and imaging findings) and a "pathologic diagnosis" of breast cancer (one based on microscopic examination of cellular or tissue samples). The panel agrees that all women should have a pathologic diagnosis of breast cancer before they are given definitive treatment for the disease, no matter how strongly their clinical findings suggest cancer. The tools for clinical diagnosis include history, clinical breast examination, ultrasound, and diagnostic mammography; these tools provide valuable information and play important supplemental roles in ascertaining the presence of breast cancer. Mammography and ultrasound also help determine the extent of disease within the breast, which is essential when breast-conserving therapy can be offered to women. The tools for pathologic diagnosis include fine-needle aspiration biopsy, core needle biopsy, and standard surgical biopsy. The panel noted that each of these tools has potential benefits and limitations in the limited-resource setting, and concluded that the choice among them must be based on the available tools and expertise. The triple test-checking for correlation of pathology findings, imaging findings, and clinical findings-was identified as a critical practice in diagnosing breast cancer. Panelists uniformly agreed that mastectomy should not be used to diagnose breast cancer, noting that accurate diagnosis can be made by less invasive means. Expertise in pathology was identified as a key requirement for ensuring reliable diagnostic findings. Several approaches were proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

Breast Cancer in Limited-Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines

“…With extended sponsorship of national and international collaborating organizations, the BHGI guidelines were reexamined, revised, and extended at the second Global Summit, held January [12][13][14][15]2005, and hosted by the Office of International Affairs of the National Cancer Institute in Bethesda, Maryland. Twelve national and international groups joined the BHGI as collaborating organizations (Appendix A).…”

Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology

“…In the morning, summit participants gave presentations on topics related to the diagnosis and pathology of the disease, and current approaches and barriers to delivery of these services in parts of the world where resources are markedly constrained. In the afternoon, the Diagnosis and Pathology Panel, a subgroup of conference participants, reviewed the available evidence, the Breast Health Global Initiative (BHGI) 2003 guidelines on diagnosis (1), and current international guidelines on breast cancer diagnosis; debated approaches to diagnosis and pathology under the constraints of limited resources; and drafted preliminary recommendations. The panel, representing 12 countries with resource levels spanning the spectrum, followed a process similar to that followed in the first BHGI summit (2), based on methods initiated by the World Health Organization (WHO) (3), to address cancer care in countries with low‐ or medium‐level resources.…”

Treatment of Breast Cancer in Countries with Limited Resources

“…The availability of accurate tests for the presence or absence of estrogen (ERs) and progesterone receptors (PRs) in breast cancers is crucial for making decisions about systemic therapy. Accompanying consensus statements offer approaches for the early detection of breast cancer (9) and the diagnosis of breast cancer (10) when resources are limited.…”