Supporting Breast Cancer Early Detection and Diagnosis: A Global Metastatic Breast Cancer Policy Analysis and Promising Practice From Brazil
Authors: Thrift-Perry M. , Cardoso F. , Cabanes A. , Hunt K. Moose , Faircloth K. , Cruz T. Araújo 
Published: September 2018

Background and context: Control of metastatic breast cancer (mBC) is an area with high unmet need. Along the patient journey, policy development remains limited and varied across countries, particularly in detection, diagnosis and treatment. Multistakeholder engagements aim to address these policy gaps. Aim: 1. Understand breast cancer (BC)/mBC policy development in 16 countries and identify opportunities for improvement. 2. Illustrate promising practices spearheaded by civil society (NGOs and academia) that demonstrate success addressing identified gaps and exemplify models for replication. 3. Establish the importance of stakeholder collaboration to implement policies that support timely BC/mBC detection and treatment initiation. Strategy/Tactics: An analysis of National Cancer Control Plans (NCCPs), policies and programs was conducted across 16 countries representing different healthcare systems. Key BC diagnosis policy components were identified and evaluated, using standardized criteria on adoption and implementation of NCCP goals, and BC/mBC-specific policies and programs. Promising practices, spearheaded by civil society, that demonstrate success at filling policy gaps were identified. Their objective was to develop an information resource that other organizations can use as practice-based evidence. An example implemented in Brazil is presented. Program/Policy process: Although mBC screening is ineffective, national BC screening programs (NSPs) implementation promotes BC education and encourages prompt symptom reporting. Structured diagnosis guidelines and upskilled healthcare professionals (HCPs) also facilitate timely detection, as evidenced in Brazil, where diagnosis delays are prevalent. Outcomes: Despite policy efforts, gaps persist for timely BC/mBC detection and diagnosis. Implementation of official NSPs, diagnosis guidelines and HCP educational initiatives varied across countries. In Brazil, the Integrated Approach to Improving Oncology Care project brought together various stakeholders. The initiative aimed to use existing community resources as a pivot to address and improve BC diagnosis gaps, including HCP oncology education/training, capacity building in community health centers and increasing patient support. The initiative provided training to over 150 BC HCPs. Upskilled HCPs were supported to improve skills and system capacity to facilitate timely diagnosis. What was learned: Disparities in BC policy development exist across and within countries. Progress in BC policy is skewed toward the early part of the patient journey e.g., awareness, with key gaps remaining in diagnosis. Although national official action is indispensable, collaboration between different stakeholders is critical to address BC/mBC patient unmet needs. As exemplified in Brazil, we see that policy initiatives and promising practices demonstrate successful multistakeholder engagement to inform further advocacy and policy development.