Abstract ES7-1: Global patterns of breast cancer
Authors: Anderson Benjamin O. 
Published: May 2015

Globally, breast cancer is most common cancer among women and the most likely reason that a woman will die from cancer. High-income countries (HICs) with established health care systems report the highest incidence rates, but have also made the most progress in improving outcomes. From 1990 to 2014, breast cancer death rates dropped by 34% in the US, an impressive advance attributable to the combination of improved earlier detection and effective adjuvant therapies. By contrast, breast cancer is an increasingly urgent problem in low and middle-income countries (LMICs), where historically low incidence rates have been rising by as much as 5% per year. In 2010, the majority of the 425,000 global breast cancer deaths occurred in LMICs and that percentage is expected to grow. The number of young lives lost is even more disproportionate that the total number: in 2010, breast cancer killed 68,000 women ages 15 to 49 years in LMICs, compared to 26,000 in this age range in HICs. Of the 19.7 million cases projected to occur in the coming decade, 10.6 million will be in LMICs. By 2020, over 1 million cases per year will occur in LMICs alone, where the majority of breast cancer deaths already occur. A large fraction of women with breast cancer in LMICs are anticipated to be diagnosed with advanced stage disease with no access to treatment or even basic palliative care.

The huge strides seen primarily in economically developed countries have not been mirrored in LMICs. Optimal management strategies from wealthy countries cannot be fully implemented in LMICs due to significant resource constraints. The greatest global challenge today is transforming existing knowledge about early detection, diagnosis and treatment into clinical practice. Countries at all economic levels, and particularly LMICs, need stronger health systems to support essential cancer control efforts. In LMICs, adaptations are necessary to span the gap of inadequate healthcare capacity related to limited personal resources, underdeveloped health care infrastructure, lack of pharmaceuticals and cultural barriers. Advanced stage cancers require aggressive, expensive, and resource intensive treatment protocols, differences which are not minor to the systems that must provide them or to the patients who must undergo them. Therefore, a priority in LMICs should be to improve early detection, which has its own set of economic, cultural and political barriers to implementation.

The Breast Health Global Initiative (BHGI) was formed in 2002 to devise evidence-based strategies for breast cancer early detection, diagnosis and treatment. A diverse global group of clinicians, public health scientists, international health experts, health policy makers, social scientists, and economists used systematic analyses of resource-utilization and projected outcome improvements to create a set of resource-stratified guidelines (RSGs) as a comprehensive tool set whereby health care systems can be evaluated for their capacity to deliver breast cancer care with existing resources. BHGIs RSGs define a prioritization scheme for resource allocation that illustrates a framework for gap analysis to identify when critical resources are missing in a given system. Used effectively, RSGs can provide a platform for policy makers to prepare for breast cancer's rising tide.

Citation Format: Benjamin O. Anderson. Global patterns of breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr ES7-1.