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.
Women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit her access to timely, affordable, and effective breast health care services. In this consensus manuscript, phases of an early detection program development are described, beginning with management strategies required for the diagnosis of clinically detectable disease, and core issues are described pertaining to successful planning, implementation, and the iterative process of program improvement needed for a breast cancer early detection program to succeed in any resource setting.
Breast cancer is one of the most common diseases in women worldwide. Many studies have been conducted to predict the survival indicators, however most of these analyses were predominantly performed ...using basic statistical methods. As an alternative, this study used machine learning techniques to build models for detecting and visualising significant prognostic indicators of breast cancer survival rate.
A large hospital-based breast cancer dataset retrieved from the University Malaya Medical Centre, Kuala Lumpur, Malaysia (n = 8066) with diagnosis information between 1993 and 2016 was used in this study. The dataset contained 23 predictor variables and one dependent variable, which referred to the survival status of the patients (alive or dead). In determining the significant prognostic factors of breast cancer survival rate, prediction models were built using decision tree, random forest, neural networks, extreme boost, logistic regression, and support vector machine. Next, the dataset was clustered based on the receptor status of breast cancer patients identified via immunohistochemistry to perform advanced modelling using random forest. Subsequently, the important variables were ranked via variable selection methods in random forest. Finally, decision trees were built and validation was performed using survival analysis.
In terms of both model accuracy and calibration measure, all algorithms produced close outcomes, with the lowest obtained from decision tree (accuracy = 79.8%) and the highest from random forest (accuracy = 82.7%). The important variables identified in this study were cancer stage classification, tumour size, number of total axillary lymph nodes removed, number of positive lymph nodes, types of primary treatment, and methods of diagnosis.
Interestingly the various machine learning algorithms used in this study yielded close accuracy hence these methods could be used as alternative predictive tools in the breast cancer survival studies, particularly in the Asian region. The important prognostic factors influencing survival rate of breast cancer identified in this study, which were validated by survival curves, are useful and could be translated into decision support tools in the medical domain.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background
The Breast Health Global Initiative (BHGI) established a series of resource‐stratified, evidence‐based guidelines to address breast cancer control in the context of available resources. ...Here, the authors describe methodologies and health system prerequisites to support the translation and implementation of these guidelines into practice.
Methods
In October 2018, the BHGI convened the Sixth Global Summit on Improving Breast Healthcare Through Resource‐Stratified Phased Implementation. The purpose of the summit was to define a stepwise methodology (phased implementation) for guiding the translation of resource‐appropriate breast cancer control guidelines into real‐world practice. Three expert consensus panels developed stepwise, resource‐appropriate recommendations for implementing these guidelines in low‐income and middle‐income countries as well as underserved communities in high‐income countries. Each panel focused on 1 of 3 specific aspects of breast cancer care: 1) early detection, 2) treatment, and 3) health system strengthening.
Results
Key findings from the summit and subsequent article preparation included the identification of phased‐implementation prerequisites that were explored during consensus debates. These core issues and concepts are key components for implementing breast health care that consider real‐world resource constraints. Communication and engagement across all levels of care is vital to any effectively operating health care system, including effective communication with ministries of health and of finance, to demonstrate needs, outcomes, and cost benefits.
Conclusions
Underserved communities at all economic levels require effective strategies to deploy scarce resources to ensure access to timely, effective, and affordable health care. Systematically strategic approaches translating guidelines into practice are needed to build health system capacity to meet the current and anticipated global breast cancer burden.
Women in all resource settings continue to face significant obstacles to receiving timely, effective, and high‐quality breast cancer care. Based on a universal, disease‐specific patient pathway for breast cancer management, the Breast Healthcare Global Initiative Sixth Global Summit proposes phased implementation approaches to translate resource‐stratified guidelines into practice, including the identification of health system prerequisites required for effective stepwise implementation and monitoring.
Spectrum of Breast Cancer in Asian Women Agarwal, Gaurav; Pradeep, P. V.; Aggarwal, Vivek ...
World journal of surgery,
20/May , Letnik:
31, Številka:
5
Journal Article
Recenzirano
Introduction
Breast cancer is the leading cause of cancer‐related deaths in Asia, and in recent years is emerging as the commonest female malignancy in the developing Asian countries, overtaking ...cancer of the uterine cervix. There have been no studies objectively comparing data and facts relating to breast cancer in the developed, newly developed, and developing Asian countries thus far.
Material and Methods
This multi‐national collaborative study retrospectively compared the demographic, clinical, pathological and outcomes data in breast cancer patients managed at participating breast cancer centers in India, Malaysia and Hong Kong. Data, including those on the availability of breast screening, treatment facilities and outcomes from other major cancer centers and cancer registries of these countries and from other Asian countries were also reviewed.
Results
Despite an increasing trend, the incidence of breast cancer is lower, yet the cause‐specific mortality is significantly higher in developing Asian countries compared with developed countries in Asia and the rest of the world. Patients are about one decade younger in developing countries than their counterparts in developed nations. The proportions of young patients (< 35 years) vary from about 10% in developed to up to 25% in developing Asian countries, which carry a poorer prognosis. In the developing countries, the majority of breast cancer patients continue to be diagnosed at a relatively late stage, and locally advanced cancers constitute over 50% of all patients managed. The stage‐wise distribution of the disease is comparatively favorable in developed Asian countries. Pathology of breast cancers in young Asian women and the clinical picture are different from those of average patients managed elsewhere in the world. Owing to lack of awareness, lack of funding, lack of infrastructure, and low priority in public health schemes, breast cancer screening and early detection have not caught up in these under‐privileged societies.
Conclusions
The inadequacies of health care infrastructures and standards, sociocultural barriers, economic realities, illiteracy, and the differences in the clinical and pathological attributes of this disease in Asian women compared with the rest of the world together result in a different spectrum of the disease. Better socioeconomic conditions, health awareness, and availability of breast cancer screening in developed Asian countries seem to be the major causes of a favorable clinical picture and outcomes in these countries.
Molecular profiling of breast cancer has enabled the development of more robust molecular prognostic signatures and therapeutic options for breast cancer patients. However, non-Caucasian populations ...remain understudied. Here, we present the mutational, transcriptional, and copy number profiles of 560 Malaysian breast tumours and a comparative analysis of breast cancers arising in Asian and Caucasian women. Compared to breast tumours in Caucasian women, we show an increased prevalence of HER2-enriched molecular subtypes and higher prevalence of TP53 somatic mutations in ER+ Asian breast tumours. We also observe elevated immune scores in Asian breast tumours, suggesting potential clinical response to immune checkpoint inhibitors. Whilst HER2-subtype and enriched immune score are associated with improved survival, presence of TP53 somatic mutations is associated with poorer survival in ER+ tumours. Taken together, these population differences unveil opportunities to improve the understanding of this disease and lay the foundation for precision medicine in different populations.
Background
Morbidity and mortality in surgical systems in low- and middle-income countries (LMICs) remain high compared to high-income countries. Quality improvement processes, interventions, and ...structure are essential in the effort to improve peri-operative outcomes.
Methods
A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country surgical systems was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC, occurred in a surgical setting, and measured the effect of an implementation and its impact. The primary outcome was mortality, and secondary outcomes were rates of rates of hospital-acquired infection (HAI) and surgical site infections (SSI). Prospero Registration: CRD42020171542.
Result
Of 38,273 search results, 31 studies were included in a qualitative synthesis, and 28 articles were included in a meta-analysis. Implementation of multimodal bundled interventions reduced the incidence of HAI by a relative risk (RR) of 0.39 (95%CI 0.26 to 0.59), the effect of hand hygiene interventions on HAIs showed a non-significant effect of RR of 0.69 (0.46–1.05). The WHO Safe Surgery Checklist reduced mortality by RR 0.68 (0.49 to 0.95) and SSI by RR 0.50 (0.33 to 0.63) and antimicrobial stewardship interventions reduced SSI by RR 0.67 (0.48–0.93).
Conclusion
There is evidence that a number of quality improvement processes, interventions and structural changes can improve mortality, HAI and SSI outcomes in the peri-operative setting in LMICs.
De-escalating therapy in breast cancer means doing less to achieve the same outcomes. Surgery to the breast de-escalated from the Halsted radical mastectomy to the modified radical mastectomy, and ...then to breast-conserving surgery (BCS), which is the current standard of care for early breast cancer. BCS includes a course of radiotherapy, which was de-escalated from a 6-week course to a 3-week course, with a boost to the tumour bed. As the majority of local recurrences occur in the quadrant where the primary tumour was located, a single intraoperative dose of radiotherapy to the cavity at the time of surgery in selected patients was equivalent to whole breast irradiation with a boost to the tumour bed. In tandem with de-escalating surgery to the breast, a full axillary dissection was de-escalated to sentinel lymph node biopsy (SLNB) in clinically node-negative patients. In patients with large tumours where breast conservation is not possible, neoadjuvant systemic therapy (NAST) can safely de-escalate a mastectomy to BCS. NAST can also downstage an axillary node-positive cancer to a node-negative one, so that SLNB can be performed. Lesser surgery will lead to less complications and thus a better quality of life. Current research is focused on treating breast cancer with systemic therapy alone, and selecting out a group of patients where breast or axillary surgery is not required. A major concern of de-escalating surgery is that some women may be undertreated and hence have poorer outcomes. A discussion on the pros and cons of de-escalating surgery is important when offering the choice to women.
Background
Trauma mortality in low- and middle-income countries (LMICs) remains high compared to high-income countries. Quality improvement processes, interventions, and structure are essential in ...the effort to decrease trauma mortality.
Methods
A systematic review and meta-analysis of interventional studies assessing quality improvement processes, interventions, and structure in developing country trauma systems was conducted from November 1989 to August 2020 according to the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were included if they were conducted in an LMIC population according to World Bank Income Classification, occurred in a trauma setting, and measured the effect of implementation and its impact. The primary outcome was trauma mortality.
Results
Of 37,575 search results, 30 studies were included from 15 LMICs covering five WHO regions in a qualitative synthesis. Twenty-seven articles were included in a meta-analysis. Implementing a pre-hospital trauma system reduced overall trauma mortality by 45% (risk ratio (RR) 0.55, 95% CI 0.4 to 0.75). Training first responders resulted in an overall decrease in mortality (RR 0.47, 95% CI 0.28 to 0.78). In-hospital trauma training with certified courses resulted in a reduction of mortality (RR 0.71, 95% CI 0.62 to 0.78). Trauma audits and trauma protocols resulted in varying improvements in trauma mortality.
Conclusion
There is evidence that quality improvement processes, interventions, and structure can improve mortality in the trauma systems in LMICs.
Managing menopause after cancer Hickey, Martha; Basu, Partha; Sassarini, Jenifer ...
The Lancet (British edition),
03/2024, Letnik:
403, Številka:
10430
Journal Article
Recenzirano
Globally, 9 million women are diagnosed with cancer each year. Breast cancer is the most commonly diagnosed cancer worldwide, followed by colorectal cancer in high-income countries and cervical ...cancer in low-income countries. Survival from cancer is improving and more women are experiencing long-term effects of cancer treatment, such as premature ovarian insufficiency or early menopause. Managing menopausal symptoms after cancer can be challenging, and more severe than at natural menopause. Menopausal symptoms can extend beyond hot flushes and night sweats (vasomotor symptoms). Treatment-induced symptoms might include sexual dysfunction and impairment of sleep, mood, and quality of life. In the long term, premature ovarian insufficiency might increase the risk of chronic conditions such as osteoporosis and cardiovascular disease. Diagnosing menopause after cancer can be challenging as menopausal symptoms can overlap with other common symptoms in patients with cancer, such as fatigue and sexual dysfunction. Menopausal hormone therapy is an effective treatment for vasomotor symptoms and seems to be safe for many patients with cancer. When hormone therapy is contraindicated or avoided, emerging evidence supports the efficacy of non-pharmacological and non-hormonal treatments, although most evidence is based on women older than 50 years with breast cancer. Vaginal oestrogen seems safe for most patients with genitourinary symptoms, but there are few non-hormonal options. Many patients have inadequate centralised care for managing menopausal symptoms after cancer treatment, and more information is needed about cost-effective and patient-focused models of care for this growing population.
Palliation and breast cancer Yip, Cheng‐Har
Journal of surgical oncology,
April 1, 2017, 2017-Apr, 2017-04-00, 20170401, Letnik:
115, Številka:
5
Journal Article
Recenzirano
Metastatic breast cancer is an incurable disease. With improvement in systemic therapy, survival has improved over the past few years. Removing the primary tumor has shown improved survival in ...retrospective studies, but this may be due to selection bias. The first reported randomized controlled trial (RCT) from India showed no difference in survival with surgery. However another RCT from Turkey showed that a select group of patient with bone‐only metastases have a survival benefit.
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