Abstract P1-10-05: The Impact of Resource Setting and Guidelines on Global Early Breast Cancer Practice
Authors: Gandhi S , Alibhai S , Victor JC , Simmons C , Verma S. 
Published: April 2011

Abstract
Background: We developed an international physician survey to identify variations in early breast cancer practice, use of guidelines, and key challenges facing clinicians (MDs) globally in implementing guideline-based care. Methods: The survey was administered at an international breast oncology meeting, and also online using a secure platform. Results were analyzed using descriptive statistics and the chi-squared test was used for bivariate analysis. Results: 691 respondents from 70 countries completed the survey. 38% of respondents were from low income (LIC) or middle income (MIC) countries. More respondents in LICs (89%) and MICs (74%) practice in academic centres; 34% of MDs in high income countries (HICs) practice in community settings (P&lt;0.001). More LIC physicians (74%) rely on clinical breast exam for diagnosis versus in MICs (58%) and HICs (55%) (P&lt;0.001). 87% of LIC physicians say that hormone receptor status is routinely reported on pathology, versus in MICs (91%) and HICs (95%) (p=0.011). The reporting of HER2 status also varies by income setting: 83% in LICs, 89% in MICs, and 95% in HICs (P&lt;0.001). Reporting seems to be the lowest in African nations (78% for hormone and 74% for HER2 status, p &lt;0.001 for each). 46% of LIC and 61% of MIC physicians offer sentinel lymph node dissection, versus 94% in HICs (P&lt;0.001). Adjuvant radiation is available in 93% of all surveyed practices. 99% of respondents give eligible patients endocrine treatment; tamoxifen is prescribed almost universally (&gt;96% of respondents). Aromatase inhibitors are given by 87% of LIC, 93% of MIC, and 94% of HIC physicians (p=0.042). 75% of MDs in LICs give chemotherapy to high risk patients; 81% of those in MICs and HICs do the same (NS). More LIC oncologists give classical CMF (21%, p=0.006), and 77% give anthracycline-taxane combinations, compared to 84% of MIC and 88% of HIC physicians (p=0.017). Trastuzumab is given to a majority (&gt;75%) of eligible patients by only 11% of LIC and 36% of MIC physicians, compared to 80% of HIC clinicians (P&lt;0.001). Trastuzumab use is most prominent in North America (85%) and Europe (75%), and lowest in Africa (19%) and Asia (32%) (P&lt;0.001). 94% of LIC and 63% of MIC physicians said trastuzumab use is limited by drug cost (P&lt;0.001); lack of HER2 testing was cited as an issue by only 8-9% of all respondents. 63% of LIC and 76% of MIC physicians say international guidelines impact their clinical practice, compared to 56% of HIC physicians (P&lt;0.001), who are more likely to rely on local/regional guidelines (33%, P&lt;0.001). Conclusions: Global practice patterns in early breast cancer care vary by resource setting but also by continent. More costly therapies such as trastuzumab are used less often in LICs and MICs. Surveyed physicians from LICs and MICs also rely on international guidelines to direct their practice more than HIC physicians. This may reflect that many guidelines with international influence are created in HICs. In order to improve breast cancer outcomes worldwide, global collaboration is required to create guidelines which not only recommend best practice, but are applicable in various resource and cultural settings, and are followed by implementation research efforts.
Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-05.