World Journal of Surgery

, Volume 32, Issue 12, pp 2578–2585 | Cite as

Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative




Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided.


Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery.


The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice.


The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.


  1. 1.
    Parkin DM, Bray F, Ferlay J et al (2005) Global cancer statistics, 2002. CA Cancer J Clin 55(2):74–108PubMedGoogle Scholar
  2. 2.
    Parkin DM, Whelan SI, Ferlay J et al (2005) Cancer Incidence in Five Continents, Vols I-VIII. IARC Cancer Base No. 6. Lyon, France: IARC PressGoogle Scholar
  3. 3.
    Pal SK, Mittal B (2004) Improving cancer care in India: prospects and challenges. Asian Pac J Cancer Prev 5(2):226–228PubMedGoogle Scholar
  4. 4.
    Weir HK, Thun MJ, Hankey BF et al (2003) Annual report to the nation on the status of cancer, 1975–2000, featuring the uses of surveillance data for cancer prevention and control. J Natl Cancer Inst 95(17):1276–1299PubMedGoogle Scholar
  5. 5.
    Sant M, Allemani C, Berrino F et al (2004) Breast carcinoma survival in Europe and the United States. Cancer 100(4):715–722PubMedCrossRefGoogle Scholar
  6. 6.
    Hisham AN, Yip CH (2003) Spectrum of breast cancer in Malaysian women: overview. World J Surg 27(8):921–923PubMedCrossRefGoogle Scholar
  7. 7.
    Chopra R (2001) The Indian scene. J Clin Oncol 19(18 Suppl):106S–111SPubMedGoogle Scholar
  8. 8.
    Greenlee RT, Murray T, Bolden S et al (2000) Cancer statistics, 2000. CA Cancer J Clin 50(1):7–33PubMedCrossRefGoogle Scholar
  9. 9.
    Zotov V, Shyyan R (2003) Introduction of breast cancer screening in Chernihiv Oblast in the Ukraine: report of a PATH Breast Cancer Assistance Program experience. Breast J 9 Suppl 2:S75–S80PubMedCrossRefGoogle Scholar
  10. 10.
    Parkin DM, Fernandez LM (2006) Use of statistics to assess the global burden of breast cancer. Breast J 12 Suppl 1:S70–S80PubMedCrossRefGoogle Scholar
  11. 11.
    Goldhirsch A, Glick JH, Gelber RD et al (2005) Meeting highlights: international expert consensus on the primary therapy of early breast cancer 2005. Ann Oncol 16(10):1569–1583PubMedCrossRefGoogle Scholar
  12. 12.
    Carlson RW, Anderson BO, Burstein HJ et al (2005) Breast cancer. J Natl Compr Canc Netw 3(3):238–289PubMedGoogle Scholar
  13. 13.
    Management of breast cancer. In: Clinical Practice Guidelines. Ministry of Health Malaysia: Academy of Medicine Malaysia, 2002Google Scholar
  14. 14.
    Executive summary of the national cancer control programmes: policies and managerial guidelines. Geneva: World Health Organization, 2002Google Scholar
  15. 15.
    Anderson BO, Braun S, Carlson RW et al (2003) Overview of breast health care guidelines for countries with limited resources. Breast J 9 Suppl 2:S42–S50PubMedCrossRefGoogle Scholar
  16. 16.
    Anderson BO, Braun S, Lim S et al (2003) Early detection of breast cancer in countries with limited resources. Breast J 9 Suppl 2:2:S51–S59PubMedCrossRefGoogle Scholar
  17. 17.
    Vargas HI, Anderson BO, Chopra R et al (2003) Diagnosis of breast cancer in countries with limited resources. Breast J 9 Suppl 2:2:S60–S66PubMedCrossRefGoogle Scholar
  18. 18.
    Carlson RW, Anderson BO, Chopra R et al (2003) Treatment of breast cancer in countries with limited resources. Breast J 9 Suppl 2:S67–S74PubMedCrossRefGoogle Scholar
  19. 19.
    Smith RA, Caleffi M, Albert US et al (2006) Breast cancer in limited-resource countries: early detection and access to care. Breast J 12 Suppl 1:S16–S26PubMedCrossRefGoogle Scholar
  20. 20.
    Shyyan R, Masood S, Badwe RA et al (2006) Breast cancer in limited-resource countries: diagnosis and pathology. Breast J 12 Suppl 1:S27–S37PubMedCrossRefGoogle Scholar
  21. 21.
    Eniu A, Carlson RW, Aziz Z et al (2006) Breast cancer in limited-resource countries: treatment and allocation of resources. Breast J 12 Suppl 1:S38–S53PubMedCrossRefGoogle Scholar
  22. 22.
    Anderson BO, Yip CH, Ramsey SD et al (2006) Breast cancer in limited-resource countries: health care systems and public policy. Breast J 12 Suppl 1:S54–S69PubMedCrossRefGoogle Scholar
  23. 23.
    Anderson BO, Shyyan R, Eniu A et al (2006) Breast cancer in limited-resource countries: an overview of the Breast Health Global Initiative 2005 guidelines. Breast J 12 Suppl 1:S3–S15PubMedCrossRefGoogle Scholar
  24. 24.
    Groot MT, Baltussen R, Uly-de Groot CA et al (2006) Cost and health effects of breast cancer interventions in epidemiologically different regions of Africa, North America, and Asia. Breast J 12 Suppl 1:S81-S90PubMedCrossRefGoogle Scholar
  25. 25.
    Remennick L (2006) The challenge of early breast cancer detection among immigrant and minority women in multicultural societies. Breast J 12 Suppl 1:S103–S110PubMedCrossRefGoogle Scholar
  26. 26.
    Bese NS, Kiel K, El-Gueddari Bel K et al (2006) Radiotherapy for breast cancer in countries with limited resources: program implementation and evidence-based recommendations. Breast J 12 Suppl 1:S96–S102PubMedCrossRefGoogle Scholar
  27. 27.
    Smith RA, Cokkinides V, Eyre HJ (2003) American Cancer Society guidelines for the early detection of cancer, 2003. CA Cancer J Clin 53(1):27–43PubMedGoogle Scholar
  28. 28.
    [No authors listed] (2002) Screening for breast cancer: recommendations and rationale. Ann Intern Med 137(5 Part 1):344–346Google Scholar
  29. 29.
    Nystrom L, Rutqvist LE, Wall S et al (1993) Breast cancer screening with mammography: overview of Swedish randomised trials. Lancet 341(8851):973–978PubMedCrossRefGoogle Scholar
  30. 30.
    Roberts MM, Alexander FE, Anderson TJ et al (1990) Edinburgh trial of screening for breast cancer: mortality at seven years. Lancet 335(8684):241–246PubMedCrossRefGoogle Scholar
  31. 31.
    Andersson I, Aspegren K, Janzon L et al (1988) Mammographic screening and mortality from breast cancer: the Malmo mammographic screening trial. BMJ 297(6654):943–948PubMedCrossRefGoogle Scholar
  32. 32.
    Smith RA, Duffy SW, Gabe R et al (2004) The randomized trials of breast cancer screening: what have we learned? Radiol Clin North Am 42(5):793–806, vPubMedCrossRefGoogle Scholar
  33. 33.
    Parsa P, Kandiah M, Abdul Rahman H et al (2006) Barriers for breast cancer screening among Asian women: a mini literature review. Asian Pac J Cancer Prev 7(4):509–514PubMedGoogle Scholar
  34. 34.
    Smith I, Procter M, Gelber RD et al (2007) 2-year follow-up of trastuzumab after adjuvant chemotherapy in HER2-positive breast cancer: a randomised controlled trial. Lancet 369(9555):29–36PubMedCrossRefGoogle Scholar
  35. 35.
    Weerakkody G, Ray P (2003) CSCW-based system development methodology for health-care information systems. Telemed J E Health 9(3):273–282PubMedCrossRefGoogle Scholar
  36. 36.
    Montagu D (2002) Franchising of health services in low-income countries. Health Policy Plan 17(2):121–130PubMedCrossRefGoogle Scholar
  37. 37.
    Victora CG, Hanson K, Bryce J et al (2004) Achieving universal coverage with health interventions. Lancet 364(9444):1541–1548PubMedCrossRefGoogle Scholar
  38. 38.
    Hernandez SR (2000) Horizontal and vertical healthcare integration: lessons learned from the United States. Healthc Pap 1(2):59–66; discussion 104–107PubMedGoogle Scholar
  39. 39.
    Anderson BO, Eniu AE, Sullivan L et al (2007) Defining resource-level-appropriate cancer control. In: Sloan FA, Gelband H (eds). Cancer Control Opportunities in Low- and Middle-Income Countries. Washington, DC: The National Academies Press, chap 4, pp 106–137Google Scholar
  40. 40.
    The Breast Health Global Initiative (BHGI) resource-stratified matrix guidelines. Breast J 2006;12 Suppl 1:S117–S120Google Scholar

Copyright information

© Société Internationale de Chirurgie 2008

Authors and Affiliations

  1. 1.Breast Health Global InitiativeFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of SurgeryUniversity of WashingtonSeattleUSA
  3. 3.Division of General SurgeryVienna Medical SchoolViennaAustria

Personalised recommendations