Abstract
Purpose of Review
Breast cancer is the most common cancer and a leading cause of cancer death among women living in low- and middle-income countries (LMIC) despite declining mortality in high-income countries. The rising morbidity and mortality from breast cancer is fueled by a number of factors including late presentation, poor access to medical care, and less than optimal diagnostic and therapeutic capabilities. Reducing the breast cancer burden in LMICs will require improving early detection and overcoming barriers to accessing the health system as well as making diagnosis and treatment more affordable. While North American guidelines advocate for mammography as the most effective screening approach, most developing countries do not have ready access to the technology, nor the trained workforce needed to perform and interpret mammograms.
Recent Findings
In this paper, we present perspectives from Tajikistan, Kenya, and Pakistan and report on efforts to address the burden of breast cancer through screening and early detection programs. Given the significant proportion of women diagnosed with breast cancer in LMICs who present pre-menopausally and with higher grade tumors, widespread screening mammography may not be the most cost-effective approach.
Summary
Based on the current evidence and our experience in LMICs, we suggest an approach which prioritizes population-wide education and self and clinical breast exams as a cost-conscious intervention likely to result in a population-wide shift toward early detection and better survival rates from breast cancer.
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References
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
T. W. B. Group. Low & middle income. 2015;728:2018–9.
•• Ginsburg O, et al. The global burden of women’s cancers: an unmet grand challenge in global health. Lancet. 2018;389(10071):847–60. https://doi.org/10.1016/S0140-6736(16)31392-7 This paper examines trends in incidence, survival, and mortality of breast and cervical cancer in low and middle-income countries. The review highlights the need to identify sustainable interventions and establish cost-effective initiatives in these limited resource settings.
Global Cancer Observatory_Breast Cancer.
Abiltayeva A, et al. Clinical, histopathological and molecular characteristics of metastatic breast cancer in North-Eastern Kazakhstan: a 10 year retrospective study, Asian Pacific J. Cancer Prev. J Cancer Prev. 2016;17(1710):6795–800. https://doi.org/10.22034/APJCP.2016.17.10.4797.
• Pace LE, Shulman LN. Breast cancer in Sub-Saharan Africa: challenges and opportunities to reduce mortality. Oncologist. 2016;21(6):739–44. https://doi.org/10.1634/theoncologist.2015-0429 This study reviews the current knowledge of breast cancer incidence and mortality in Sub-Saharan Africa, specifically the rising number of new cases and breast cancer deaths yearly. It identifies current gaps in the literature and suggests effective strategies for future engagement.
Pace LE, Keating NL. A systematic assessment of benefits and risks to guide breast cancer screening decisions. JAMA. 2014;311(13):1327–35. https://doi.org/10.1001/jama.2014.1398.
Kenya National Cancer Screening Guidelines, pp. 2–122, 2018.
• W. H. O. Position and P. On, WHO Paper on Screening Mammography. The new WHO position paper examines the balance of benefits and harms in offering mammography screening to women after the age of 40 in a variety of settings.
M I, MA K, U R, S Z. Screening & awareness of breast cancer in an urban slum of pakistan: a pilot study. J. Cancer Sci. Clin. Oncol. 2018;5(1):1–5.
CIA World Factbook - Tajikistan. [Online]. Available: https://www.cia.gov/library/publications/the-world-factbook/geos/ti.html.
Ghafur Khodjamurodov BR. Diloram Sodiqova, Baktygul Akkazieva. Health Systems in Transition: Tajikistan. 2016;1:18.
Tajikistan: Institute for Health Metrics and Evaluation Country Profile, pp. 1–9, 2019.
Tediosi F, Aye R, Ibodova S, Thompson R, Wyss K. Access to medicines and out of pocket payments for primary care: evidence from family medicine users in rural Tajikistan. BMC Health Serv Res. 2008;8:1–8. https://doi.org/10.1186/1472-6963-8-109.
World Health Organization - cancer country profiles, 2014. Tajikistan, 2014.
World Health Organization - noncommunicable diseases country profiles, 2018, p. 2018, 2018.
Buribekova R, et al. Promoting clinical breast evaluations in a lower middle–income country setting: an approach toward achieving a sustainable breast health program. J Glob Oncol. 2018;(4):1–8. https://doi.org/10.1200/JGO.17.00103.
Talib Z, et al. A community-oriented approach to breast cancer in a low-resource setting: improving awareness, early detection and treatment of breast cancer in Tajikistan. Breast J. 2016;22(3). https://doi.org/10.1111/tbj.12618.
WHO. Primary Health Care Systems - case study from Kenya (Primasys ). World Heal Organ. 2017:1–16.
C. M. Profile, A. C. M. Trends, and C. Incidence, Kenya, pp. 3–4, 2014.
Sayed S, et al. Breast camps for awareness and early diagnosis of breast cancer in countries with limited resources: a multidisciplinary model from Kenya. Oncologist. 2016;21(9):1138–48. https://doi.org/10.1634/theoncologist.2016-0004.
Kisiangani J, et al. Determinants of breast cancer early detection for cues to expanded control and care: the lived experiences among women from Western Kenya. BMC Womens. Health. 2018;18(1):81. https://doi.org/10.1186/s12905-018-0571-7.
CIA World Factbook - Pakistan.
R. S., S. S.Z., and S. C.C. Breast cancer in Pakistan: identifying local beliefs and knowledge. J Am Coll Radiol. 2012;9(8):571–7. https://doi.org/10.1016/j.jacr.2012.02.020.
Jalal S. The lady health worker program in Pakistan - a commentary. Eur. J. Public Health. 2011;21(2):143–4. https://doi.org/10.1093/eurpub/ckq199.
C. M. Profile, A. C. M. Trends, and C. Incidence, Pakistan, 2014.
Kim Y, Yoo KY, Goodman MT. Differences in incidence, mortality and survival of breast cancer by regions and countries in Asia and contributing factors. Asian Pac J Cancer Prev. 2015;16(7):2857–70. https://doi.org/10.7314/apjcp.2015.16.7.2857.
Zeeshan S, Ali B, Ahmad K, Chagpar AB, Sattar AK. Clinicopathological features of young versus older patients with breast cancer at a single Pakistani institution and a comparison with a national US database. J Glob Oncol. 2019;(5):1–6. https://doi.org/10.1200/JGO.18.00208
Menhas R, Umer S. Breast cancer among Pakistani women. Iran J Public Health. 2015;44(4):586–7.
Khan A, Khan K, Raza A, Qureshi D, Sultan B, Khan FA. Patient self delay among women with breast cancer. J Ayub Med Coll Abbotabad. 2018;30(4):558–61.
G. S.I, et al. Knowledge, attitude and practice of a Pakistani female cohort towards breast cancer. J Pak Med Assoc. 2010;60(3):205–8.
Pink Ribbon Campaign.
Gutnik LA, et al. Breast cancer screening in low- and middle-income countries: a perspective from Malawi. J Glob Oncol. 2015;2(1):4–8. https://doi.org/10.1200/JGO.2015.000430.
Hashmi AA, Edhi MM, Naqvi H, Faridi N, Khurshid A, Khan M. Clinicopathologic features of triple negative breast cancers: an experience from Pakistan. Diagn Pathol. 2014;9(1):1–9. https://doi.org/10.1186/1746-1596-9-43.
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Zohray Talib, Farin Amersi, Attiya Harit, and Mansoor Saleh declare no conflicts of interest relevant to this manuscript.
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Talib, Z., Amersi, F., Harit, A. et al. Promoting Breast Cancer Awareness and Clinical Breast Examination in the LMIC: Experiences from Tajikistan, Pakistan and Kenya. Curr Breast Cancer Rep 11, 152–157 (2019). https://doi.org/10.1007/s12609-019-00321-7
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DOI: https://doi.org/10.1007/s12609-019-00321-7