Breast cancer is the most frequently diagnosed cancer and the leading cause of cancer-related death among women worldwide. Herein, we examine global trends in female breast cancer rates using the ...most up-to-date data available.
Breast cancer incidence and mortality estimates were obtained from GLOBOCAN 2012 (globocan.iarc.fr). We analyzed trends from 1993 onward using incidence data from 39 countries from the International Agency for Research on Cancer and mortality data from 57 countries from the World Health Organization.
Of 32 countries with incidence and mortality data, rates in the recent period diverged-with incidence increasing and mortality decreasing-in nine countries mainly in Northern/Western Europe. Both incidence and mortality decreased in France, Israel, Italy, Norway, and Spain. In contrast, incidence and death rates both increased in Colombia, Ecuador, and Japan. Death rates also increased in Brazil, Egypt, Guatemala, Kuwait, Mauritius, Mexico, and Moldova.
Breast cancer mortality rates are decreasing in most high-income countries, despite increasing or stable incidence rates. In contrast and of concern are the increasing incidence and mortality rates in a number of countries, particularly those undergoing rapid changes in human development. Wide variations in breast cancer rates and trends reflect differences in patterns of risk factors and access to and availability of early detection and timely treatment.
Increased awareness about breast cancer and the benefits of early detection and improved access to treatment must be prioritized to successfully implement breast cancer control programs, particularly in transitioning countries.
In some countries, breast cancer age-standardised mortality rates have decreased by 2–4% per year since the 1990s, but others have yet to achieve this outcome. In this study, we aimed to characterise ...the associations between national health system characteristics and breast cancer age-standardised mortality rate, and the degree of breast cancer downstaging correlating with national age-standardised mortality rate reductions.
In this population-based study, national age-standardised mortality rate estimates for women aged 69 years or younger obtained from GLOBOCAN 2020 were correlated with a broad panel of standardised national health system data as reported in the WHO Cancer Country Profiles 2020. These health system characteristics include health expenditure, the Universal Health Coverage Service Coverage Index (UHC Index), dedicated funding for early detection programmes, breast cancer early detection guidelines, referral systems, cancer plans, number of dedicated public and private cancer centres per 10 000 patients with cancer, and pathology services. We tested for differences between continuous variables using the non-parametric Kruskal-Wallis test, and for categorical variables using the Pearson χ2 test. Simple and multiple linear regression analyses were fitted to identify associations between health system characteristics and age-standardised breast cancer mortality rates. Data on TNM stage at diagnosis were obtained from national or subnational cancer registries, supplemented by a literature review of PubMed from 2010 to 2020. Mortality trends from 1950 to 2016 were assessed using the WHO Cancer Mortality Database. The threshold for significance was set at a p value of 0·05 or less.
148 countries had complete health system data. The following variables were significantly higher in high-income countries than in low-income countries in unadjusted analyses: health expenditure (p=0·0002), UHC Index (p<0·0001), dedicated funding for early detection programmes (p=0·0020), breast cancer early detection guidelines (p<0·0001), breast cancer referral systems (p=0·0030), national cancer plans (p=0·014), cervical cancer early detection programmes (p=0·0010), number of dedicated public (p<0·0001) and private (p=0·027) cancer centres per 10 000 patients with cancer, and pathology services (p<0·0001). In adjusted multivariable regression analyses in 141 countries, two health system characteristics were significantly associated with lower age-standardised mortality rates: higher UHC Index levels (β=–0·12, 95% CI −0·16 to −0·08) and increasing numbers of public cancer centres (β=–0·23, −0·36 to −0·10). These findings indicate that each unit increase in the UHC Index was associated with a 0·12-unit decline in age-standardised mortality rates, and each additional public cancer centre per 10 000 patients with cancer was associated with a 0·23-unit decline in age-standardised mortality rate. Among 35 countries with available breast cancer TNM staging data, all 20 that achieved sustained mean reductions in age-standardised mortality rate of 2% or more per year for at least 3 consecutive years since 1990 had at least 60% of patients with invasive breast cancer presenting as stage I or II disease. Some countries achieved this reduction without most women having access to population-based mammographic screening.
Countries with low breast cancer mortality rates are characterised by increased levels of coverage of essential health services and higher numbers of public cancer centres. Among countries achieving sustained mortality reductions, the majority of breast cancers are diagnosed at an early stage, reinforcing the value of clinical early diagnosis programmes for improving breast cancer outcomes.
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Because most breast cancers cannot be attributed to modifiable risk factors, global breast cancer control efforts cannot rely solely on risk factor reduction,2 and will require systematic ...improvements in access to resource-appropriate, quality services to meet the Sustainable Development Goals for non-communicable diseases (target 3.4) and universal health coverage (target 3.8). For decades, there has been a steady escalation in the recognition of breast cancer as a public health priority through multiple political declarations, the most recent of which is the WHO 2017 Cancer Prevention and Control Resolution calling for broader investments in cancer, among other non-communicable diseases, as leading efforts to improve women's health. Breast cancer prevention through public education about risk-reduction strategies (eg, encouraging lactation, avoiding obesity, and limiting alcohol intake) is a foundational step for cancer control, but must be implemented alongside early-detection programmes.2 Late-stage presentation is unfortunately common throughout low-income and middle-income countries, where women are first diagnosed when their malignancy is already locally advanced (stage III) or metastatic (stage IV), at which point improving survival is both less likely and resource-intensive.
The COVID-19 pandemic presents clinicians a unique set of challenges in managing breast cancer (BC) patients. As hospital resources and staff become more limited during the COVID-19 pandemic, it ...becomes critically important to define which BC patients require more urgent care and which patients can wait for treatment until the pandemic is over. In this Special Communication, we use expert opinion of representatives from multiple cancer care organizations to categorize BC patients into priority levels (A, B, C) for urgency of care across all specialties. Additionally, we provide treatment recommendations for each of these patient scenarios. Priority A patients have conditions that are immediately life threatening or symptomatic requiring urgent treatment. Priority B patients have conditions that do not require immediate treatment but should start treatment before the pandemic is over. Priority C patients have conditions that can be safely deferred until the pandemic is over. The implementation of these recommendations for patient triage, which are based on the highest level available evidence, must be adapted to current availability of hospital resources and severity of the COVID-19 pandemic in each region of the country. Additionally, the risk of disease progression and worse outcomes for patients need to be weighed against the risk of patient and staff exposure to SARS CoV-2 (virus associated with the COVID-19 pandemic). Physicians should use these recommendations to prioritize care for their BC patients and adapt treatment recommendations to the local context at their hospital.
•Breast cancer is a major cause of morbidity, disability and mortality among women.•Epidemiological trends describe global disparities in breast cancer-related mortality.•Disparities in breast cancer ...result from variable access to early detection, treatment and palliative care.•Investing in breast cancer control generate broad population impact, particularly in countries with high/increasing burden.•WHO-led Global Breast Cancer Initiative (GCBI) is a programmatic platform to tackle global disparities in cancer care.•GBCI aims to improve the capacity for breast cancer care to result in population health and broader socio-economic impact.
Breast cancer is the leading cause of cancer morbidity, disability and mortality in women, worldwide. Overall, in 2020, it was the most diagnosed malignancy. Differences in breast cancer mortality have been historically evidenced, as a result of disparities in access to diagnosis, treatment and palliative care. Epidemiologic trends in the last decades display three main patterns of breast cancer mortality: some high-income countries report continuous substantial improvements exceeding 2% annual mortality reduction; however, many low- and middle-income countries (LMICs) have stagnant or even increasing mortality rates. Population-based studies show that investing in breast cancer control, based on a primary health care approach, and expanding the cancer treatment capacity can portend population health benefits, with positive changes of the epidemiological adverse trajectories. Framed as part of the political commitment to the Sustainable Development Goals Agenda, World Health Organization (WHO) has recently launched a global initiative to tackle disparities in breast cancer mortality. The WHO-led Global Breast Cancer Initiative (GBCI) is framed across 3 pillars, to address key determinants of the cancer-related outcomes: health promotion and early detection, timely access to diagnosis and treatment, comprehensive breast cancer treatment, palliative and survivorship care. GBCI is a systematized approach, with the goal to (i) increase the fraction of newly diagnosed invasive cancers being stage 1 or 2 at diagnosis (60% or more), (ii) ensure diagnostic work-up to be completed within 60 days from the first connection with the primary healthcare providers to avoid delays in diagnosis and treatment and (iii) assure 80% or more women with breast cancer to undergo and complete multimodal treatments. GBCI will pursue a comprehensive and multisectoral approach, to deliver population health, social and economic benefits, ultimately intended as an entry point for health system strengthening and for the broader cancer control.
Summary Investments in cancer control—prevention, detection, diagnosis, surgery, other treatment, and palliative care—are increasingly needed in low-income and particularly in middle-income ...countries, where most of the world's cancer deaths occur without treatment or palliation. To help countries expand locally appropriate services, Cancer (the third volume of nine in Disease Control Priorities , 3rd edition) developed an essential package of potentially cost-effective measures for countries to consider and adapt. Interventions included in the package are: prevention of tobacco-related cancer and virus-related liver and cervical cancers; diagnosis and treatment of early breast cancer, cervical cancer, and selected childhood cancers; and widespread availability of palliative care, including opioids. These interventions would cost an additional US$20 billion per year worldwide, constituting 3% of total public spending on health in low-income and middle-income countries. With implementation of an appropriately tailored package, most countries could substantially reduce suffering and premature death from cancer before 2030, with even greater improvements in later decades.
Summary Breast and cervical cancers are the commonest cancers diagnosed in women living in low-income and middle-income countries (LMICs), where opportunities for prevention, early detection, or ...both, are few. Yet several cost-effective interventions could be used to reduce the burden of these two cancers in resource-limited environments. Population- wide vaccination against human papillomavirus (HPV) linked to cervical screening, at least once, for adult women has the potential to reduce the incidence of cervical cancer substantially. Strategies such as visual inspection with acetic acid and testing for oncogenic HPV types could make prevention of cervical cancer programmatically feasible. These two cancers need not be viewed as inevitably fatal, and can be cured, particularly if detected and treated at an early stage. Investing in the health of girls and women is an investment in the development of nations and their futures. Here we explore ways to lessen the divide between LMICs and high-income countries for breast and cervical cancers.
Breast cancer--thinking globally Anderson, Benjamin O
Science (American Association for the Advancement of Science),
03/2014, Letnik:
343, Številka:
6178
Journal Article
Recenzirano
Few diseases have seen more rapid scientific progress over the past three decades than breast cancer. Beginning in the 1980s, screening mammography led to sweeping improvements in early cancer ...detection. At the same time, endocrine treatment and systemic chemotherapy proved life-saving. The development of drugs that target hormone receptor and
HER2/neu
oncogene signaling pathways, coupled with biomarker-based subclassification of the disease, have helped make breast cancer therapy a more precise science. Cloning of the
BRCA
genes provided insight into inherited predisposition and the opportunity for genetic testing. As a result of these advances, breast cancer death rates in the United States dropped by 34% between 1990 and 2014.
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.
Women around the world continue to face obstacles to receiving timely, effective, and high‐quality breast cancer care. The sixth global summit of the Breast Health Global Initiative has published a ...supplement in Cancer proposing phased implementation as an evidence‐based methodology with which to translate resource‐stratified guidelines into practice.
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