A special supplement of the Oct. 15 journal Cancer for the first time details guidelines for low- and middle-income countries to implement breast cancer programs to detect and treat the most common disease among women worldwide.

“Guidelines for International Breast Health and Cancer Control – Implementation” developed by the Breast Health Global Initiative (BHGI) outlines a tiered system of resource allocation - based on countries’ overall economic status and availability of resources – toward early detection, diagnosis, treatment, and developing an overall breast health program. Other papers contained in the supplement outline how countries implement programs in breast pathology, radiation treatment, surgery and treatment of locally-advanced cancer.

“The breast health guidelines for implementation will be an essential medical reference for low- and middle-income countries to improve breast health outcomes,” said Benjamin O. Anderson, M.D., founder, chair and director of the Seattle-based BHGI organization BHGI, an alliance comprised of a strategic mix of internationally-focused health care organizations, was founded by Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.

“The BHGI guidelines are intended to assist ministers of health, policymakers, administrators and institutions in prioritizing resource allocation as breast cancer treatment programs are implemented and developed in their resource-constrained countries,” the authors note in their overview of the 172-page supplement. The 16 articles by 56 authors from around the world are the culmination of work begun in 2002 when the first of three global summits on breast health took place.

“The development and implementation of these international evidence-based breast health care guidelines, which are oriented to countries or regions of the world with limited financial resources, is a crucial step toward improving breast health care and breast cancer care in these regions,” said Anderson. “Current evidence about the value of earlier detection and cost-effective diagnosis and treatment can be applied to define best practices with limited resources for breast health care. While health care strategies may differ, measurable improvement in breast cancer outcomes can be achieved using the best standard of care that is practical in a given setting.”

Why breast cancer and why low- to middle-income countries? Breast cancer comprises 23% of all female cancers. It’s also the leading cause of cancer mortality. There is a marked geographical variation in case fatality rates, which are highest in developing countries and lowest in developed ones. Further, women in poor- and middle-income nations generally are diagnosed when their cancer has progressed due to lack of resources to detect cancer earlier, resulting in increased morbidity and mortality rates.

BHGI recently launched a five-year plan to achieve guideline implementation. It focuses on three key areas: dissemination & implementation (D&I) research; education and training programs; and technology application and development. The foundation of the plan will be creation of “learning laboratories” – in-country locations in which to test programs that will form the basis for breast health program expansion in low-to-middle-income countries. BHGI is working with partner organizations - Komen for the Cure, HopeXchange, and the Ghana Breast Cancer Alliance - to open the first learning laboratory in Kumasi, Ghana this year, with a second learning laboratory planned for South America in 2009.

About the Breast Health Guidelines Initiative
BHGI is comprised of an alliance of the following healthcare organization: Fred Hutchinson Cancer Research Center, Susan G. Komen for the Cure, American Society of Clinical Oncology, U.S. Office of International Affairs, National Cancer Institute, Pfizer Inc, American Cancer Society, Lance Armstrong Foundation, AstraZeneca, Bristol-Myers Squibb, Ethicon Endo-Surgery, Inc., GE Healthcare, Novartis Oncology, F. Hoffmann-La Roche AG, Oncology Nursing Society, Pan American Health Organization, U.S. Office on Women’s Health, NCI, U.S. Office of Research on Women’s Health, NIH, American Society for Breast Disease, U.S. Centers for Disease Control and Prevention, World Health Organization, Breast Surgery International, International Union Against Cancer, International Atomic Energy Agency of the United Nations, International Network for Cancer Treatment and Research, International Society of Nurses in Cancer Care, International Society of Breast Pathology, Middle East Cancer Consortium, World Society for Breast Health.

Source: Fred Hutchinson Cancer Research Center