Different Routes, Similar Destination: Building Breast Care Models in Tanzania, Zambia, and Colombia
Authors: Cabanes Anna , Giattas Mary Rose , Orozco-Urdaneta Mavalynne , Parham Groesbeck , Pinder Leeya , Sardi Armando , Yuma Safina 
Published: October 2018

Purpose Cancer is becoming an urgent problem in low- and middle-income countries as the global burden of disease shifts from infectious to noncommunicable diseases. Whereas cervical cancer and breast cancer are preventable and treatable, these diseases are the leading causes of women’s cancer deaths in low-resource settings, mostly because of late-stage presentation and limited diagnostic and treatment capacities. Methods Using the Breast Health Global Initiative resource-stratified guidelines and a phased implementation approach, countries with resource constraints have designed and implemented breast cancer interventions that allow for a balanced, efficient, and equitable use of limited resources. Results Tanzania, Zambia, and a rural area of Colombia serve as examples of evidence-based approaches to the implementation of breast cancer control programs, leveraging the successes and experiences of existing care platforms—mostly cervical cancer and HIV—while creating a solid foundation for country ownership and sustainability. Tanzania used a top-down approach, investing in understanding the needs through a breast health care assessment to inform policy and practice, as well as building a national policy framework. Zambia analyzed the successes and experiences of their public Cervical Cancer Prevention Program to introduce breast cancer education, detection, and surgical treatment, and to improve the time of diagnosis for breast cancer using the single-visit approach recommended by WHO for cervical cancer. A rural community in Colombia has focused on mitigating some of the most common barriers that women face during their cancer journey by improving the cancer education of medical personnel, providing technology for early diagnosis, and implementing an outreach and navigation program that has significantly reduced waiting times from screening through diagnosis and treatment. Conclusion What are key characteristics that guarantee success? Country ownership is crucial, with political, institutional, and community ownership; capabilities; and accountability. Under these four dimensions and a phased implementation framework, we explain the approach that civil society, ministries of health, and stakeholders have taken to implement these programs. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . Anna Cabanes Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mary Rose Giattas Research Funding: Pfizer, Genentech, Merk (Inst) Travel, Accommodations, Expenses: Pfizer, Astra Zeneca Mavalynne Orozco Urdaneta Stock or Other Ownership: Celgene, Johnson and Johnson Armando Sardi Stock or Other Ownership: Celgene, Johnson and Johnson