• Sub-Saharan Africa
• breast cancer
• determinants
• multilevel
• screening

• Humans
• Breast Neoplasms/diagnosis
• Breast Neoplasms/epidemiology
• Female
• Middle Aged
• Early Detection of Cancer/statistics & numerical data
• Adult
• Africa South of the Sahara/epidemiology
• Prevalence
• Multilevel Analysis
• Health Surveys
• Aged
• Mass Screening/statistics & numerical data
• Young Adult
• Socioeconomic Factors
• Adolescent

Low- and middle-income countries (LMICs) have limited resources compared to high-income countries (HICs). Therefore, it is critical that LMICs implement cost-effective strategies to reduce the burden of breast cancer. This study aimed to answer the question of whether mammography is a cost-effective breast cancer screening method in LMICs.

A systematic article search was conducted through Medline, Embase, Web of Science, and Econlit. Studies were included only if they conducted a full economic evaluation and focused on mammography screening in LMICs. Two reviewers screened through the title and abstract of each article and continued with full-text selection. Data were extracted and synthesized narratively. Quality assessment for each included study was conducted using the Consensus Health Economic Criteria (CHEC) extended checklist.

This review identified 21 studies economically evaluating mammography as a breast cancer screening method in LMICs. Eighteen of these studies concluded that mammography screening was a cost-effective strategy. Most studies (71%) were conducted in upper-middle-income countries (Upper MICs). The quality of the studies varied from low to good. Important factors determining cost-effectiveness are the target age group (eg, 50-59 years), the screening interval (eg, biennial or triennial), as well as any combination with other breast cancer control strategies (eg, combination with treatment strategy for breast cancer patients).

Mammography screening appeared to be a cost-effective strategy in LMICs, particularly in Upper MICs. More studies conducted in lower-middle-income and low-income countries are needed to better understand the cost-effectiveness of mammography screening in these regions.

• breast cancer
• global burden of disease
• health care quality
• quality of care index
• risk factors

• Breast cancer
• Diagnostic interval
• Health system
• Sub-Saharan Africa
• Treatment interval

• Africa South of the Sahara
• Breast Neoplasms/diagnosis
• Breast Neoplasms/therapy
• Female
• Health Facilities
• Health Services Accessibility
• Humans
• Medical Assistance

• 001 World Health Organization

• breast cancer
• diagnostic
• essential medicines list
• national cancer control plans
• national health insurance

• Cancer care pathways
• Dedicated breast cancer clinics
• Diagnosis interval
• Presentation interval
• Timely breast cancer care

• breast cancer
• conflict
• research capacity

• Breast cancer screening
• Decomposition analysis
• Inequality
• Low-resource countries

• Markov decision processes
• cancer screening guidelines
• dynamic programming
• low- and -middle income countries
• mammography screening

We aimed to determine whether the detection-to-treatment interval of non-symptomatic breast cancer is associated with factors that can predict survival outcomes. A retrospective review of the Breast Surgery Department Database at Peking Union Medical College Hospital (PUMCH) was performed, and a total of 1084 non-symptomatic invasive breast cancer patients were included. The findings revealed that detection-to-treatment interval was significantly longer for women who were older (p = 0.001), lived in rural areas (p = 0.024), had lower education (p = 0.024), and had detection in other institutions (p = 0.006). Other sociodemographic and clinicopathological characteristics were not associated to longer interval. A median follow-up of 35 months (range: 6–60 months) was carried out and a long delay at more than 90 days did not significantly decrease the DFS (univariate, P = 0.232; multivariate, P = 0.088). For triple negative breast cancer, there was a worse DFS if the interval was longer than 90 days both in multivariate analysis (hazard ratio [HR] = 3.40; 95% CI, 1.12–10.35; P = 0.031) and univariate analysis (HR = 2.86; 95% CI, 1.03–7.91; P = 0.042). Further studies on care before initial treatment of non-symptomatic breast cancers are warranted.

Breast and cervical cancer are the two most common women’s cancers worldwide. Countries have invested for decades in early detection programs for breast and cervical cancer through screening, community education, and opportunistic case detection by health professionals. However, effectiveness in low- and middle-income countries (LMICs) has been limited due to low coverage, insufficient laboratory capacities for diagnosis, health information systems (HIS) that are not designed to track patients or monitor program performance, barriers that inhibit women’s uptake of services, and inadequate treatment options. Even where some screening activities exist, there has not been sufficient attention to ensuring completion of appropriate diagnosis and treatment after women receive a positive screening test result or report symptoms suggesting cervical or breast cancer. Because of this failure to provide adequate follow-up care, these women miss the potential benefit from early detection and have a higher than average risk to develop cancer or progress to more advanced cancer stages that could have been avoided. There are several critical steps in a woman’s journey from good health to elevated cancer risk, then to cancer prevention or diagnosis, and finally to treatment. There is a window of opportunity that extends from the time a positive finding is identified—by a cervical or breast screening test or recognition of a breast abnormality—to the point when cervical precancer treatment is delivered or a treatment plan for diagnosed breast cancer is initiated. Building on existing health systems and adapting measurable, affordable, and culturally acceptable interventions can achieve a lasting impact. If women can successfully navigate this window of opportunity, they can avoid progression to cervical cancer or greatly reduce the need for invasive treatments for breast cancer and improve their chances for survival and improved quality of life. We propose several actions that can lead us on the path towards reduction of this cancer burden.

• breast cancer
• cervical cancer
• impact
• prevention
• screening
• self-exam

• BI-RADS
• Breast cancer
• Mammography
• Quality assurance
• Screening

• HER2
• breast neoplasm
• drug therapy
• trastuzumab

• Markov processes
• breast cancer modeling
• cancer progression modeling
• cervical cancer modeling
• colorectal cancer modeling
• low income countries
• middle income countries

• Age of Onset
• Aged
• Aged, 80 and over
• Breast Neoplasms/diagnosis
• Breast Neoplasms/epidemiology
• Cross-Sectional Studies
• Female
• Humans
• Middle Aged
• South Africa/epidemiology

• 001 World Health Organization
• R01 CA192627 NCI NIH HHS
• 1R01CA192627 NIH HHS
• National Cancer Institute
• South African Medical Research Council
• Cancer Association of South Africa
• Dept Science and TechnologyT-National ResearchFund SA

Cervical cancer is a major cause of mortality in low- and middle-income countries (LMICs) and the most common cancer diagnosed in women in Botswana. Most women present with locally advanced disease, requiring chemotherapy and radiation. Care co-ordination requires input from a multidisciplinary team (MDT) to deliver appropriate, timely treatment. However, there are limited published examples of MDT implementation in LMICs.

In May 2015, a weekly MDT clinic for gynecologic cancer care was initiated at Botswana’s national referral facility. The MDT clinic served as a forum for discussion and coordination of patients with gynecologic cancer and consisted of a gynecologist, pathologist, medical oncologist, radiation oncologist, palliative care specialist, and nurse coordinator.

Between May 2015 and December 2015, 135 patients were seen in the MDT clinic. The mean age of the patients was 49 years. Most (60%) of the patients were HIV positive. The most common diagnosis was cervical cancer (60%), followed by high-grade cervical intraepithelial neoplastic lesions (12%) and vulvar cancer (11%). Only data up to September 2015 were assessed for treatment delays. It was found that only 38% of patients needed more than one visit for care coordination before treatment initiation. Among patients with cervical cancer, the median delay from date of biopsy to start of radiation treatment was 39 days (interquartile range, 34 to 57 days) for patients treated after MDT initiation, compared with 108 days (interquartile range, 71 to 147 days) for patients treated before MDT initiation (P < .001).

Implementation of MDT clinics in LMICs is feasible and can help reduce delays in treatment initiation, as demonstrated by a gynecologic MDT clinic in Botswana. Streamlining care through MDT clinics can enhance care coordination and improve clinical outcomes. This model can apply to cancer care in other LMICs.

Patient navigation is an internationally utilized, culturally grounded, and multifaceted strategy to optimize patients’ interface with the health-care team and system. The DuPage County Patient Navigation Collaborative (DPNC) is a campus–community partnership designed to improve access to care among uninsured breast and cervical cancer patients in DuPage County, IL. Importantly, the DPNC connects community-based social service delivery with the patient-centered medical home to achieve a community-nested patient-centered medical home model for cancer care. While the patient navigator experience has been qualitatively documented, the literature pertaining to patient navigation has largely focused on efficacy outcomes and program cost effectiveness. Here, we uniquely highlight stories of women enrolled in the DPNC, told from the perspective of patient navigators, to shed light on the myriad barriers that DPNC patients faced and document the strategies DPNC patient navigators implemented.

• community health partnerships
• community-based participatory research
• patient navigation

• Breast cancer
• México
• Public policy

• Argentina
• Brazil
• Breast Neoplasms/mortality
• Breast Neoplasms/therapy
• Colombia
• Early Detection of Cancer
• Health Policy/trends
• Humans
• Mexico
• Policy Making
• Surveys and Questionnaires
• Venezuela

• American Cancer Society

• Breast neoplasms
• Epidemiology
• Healthcare disparities
• Mexico

It is expected that, by 2020, 15 million new cases of cancer will occur every year in the world, one million of them in Africa. Knowledge of cancer trends in African countries is far from adequate, and improvements in cancer prevention efforts are urgently needed. The aim of this study was to characterize breast cancer clinically and pathologically at presentation in Luanda, Angola; we additionally provide quality information that will be useful for breast cancer care planning in the country_.

Data on breast cancer cases were retrieved from the Angolan Institute of Cancer Control, from 2006 to 2014. For women diagnosed in 2009 (5-years of follow-up), demographic, clinical and pathological information, at presentation, was collected, namely age at diagnosis, parity, methods used for pathological diagnoses, tumor pathological characteristics, stage of disease and treatment. Descriptive statistics were performed.

The median age of women diagnosed with breast cancer in 2009 was 47 years old (range 25–89). The most frequent clinical presentation was breast swelling with axillary lymph nodes metastasis (44.9 %), followed by a mass larger than 5 cm (14.2 %) and lump (12.9 %). Invasive ductal carcinoma was the main histologic type (81.8 %). Only 10.1 % of cancer cases had a well differentiated histological grade. Cancers were diagnosed mostly at advanced stages (66.7 % in stage III and 11.1 % in stage IV).

In this study, breast cancer was diagnosed at a very advanced stage. Although it reports data from a single cancer center in Luanda, Angola it reinforces the need for early diagnosis and increasing awareness. According to the main challenges related to breast cancer diagnosis and treatment herein presented, we propose a realistic framework that would allow for the implementation of a breast cancer care program, built under a strong network based on cooperation, teaching, audit, good practices and the organization of health services.

Angola needs urgently a program for early diagnosis of breast cancer.

AIM: To explore lay perceptions of causes, severity, presenting symptoms and treatment of breast cancer.

METHODS: In October-November 2012, we recruited men and women (18 years and older) from households and health facilities in three different parts of Western Kenya, chosen for variations in their documented burdens of breast cancer. A standardized and validated tool, the breast cancer awareness measure (BCAM), was administered in face-to-face interviews. Survey domains covered included socio-demographics, opinions about causes, symptoms, severity, and treatment of breast cancer. Descriptive analyses were done on quantitative data while open-ended answers were coded, and emerging themes were integrated into larger categories in a qualitative analysis. The open-ended questions had been added to the standard BCAM for the purposes of learning as much as the investigators could about underlying lay beliefs and perceptions.

RESULTS: Most respondents were female, middle-aged (mean age 36.9 years), married, and poorly educated. Misconceptions and lack of knowledge about causes of breast cancer were reported. The following (in order of higher to lower prevalence) were cited as potential causes of the condition: Genetic factors or heredity (n = 193, 12.3%); types of food consumed (n = 187, 11.9%); witchcraft and curses (n = 108, 6.9%); some family planning methods (n = 56, 3.6%); and use of alcohol and tobacco (n = 46, 2.9%). When asked what they thought of breast cancer’s severity, the most popular response was “it is a killer disease” (n = 266, 19.7%) a lethal condition about which little or nothing can be done. While opinions about presenting symptoms and signs of breast cancer were able to be elicited, such as an increase in breast size and painful breasts, early-stage symptoms and signs were not widely recognized. Some respondents (14%) were ignorant of available treatment altogether while others felt breast cancer treatment is both dangerous and expensive. A minority reported alternative medicine as providing relief to patients.

CONCLUSION: The impoverished knowledge in these surveys suggests that lay education as well as better screening and treatment should be part of breast cancer control in Kenya.

• Breast cancer
• Health education
• Cancer control
• Lay health beliefs

• awareness
• cancer care
• cancer control plan
• epidemiology
• low- and middle-income countries
• multidisciplinary management
• prevention
• research
• screening
• training

• Breast Neoplasms/economics
• Breast Neoplasms/epidemiology
• Breast Neoplasms/therapy
• Female
• Health Care Costs
• Healthcare Disparities
• Humans
• Long-Term Care/economics
• Long-Term Care/standards
• Patient Care Planning/standards
• Quality Improvement
• Quality of Health Care/economics
• Referral and Consultation
• Survival Rate
• Survivors

• Nigeria
• breast cancer
• non-communicable diseases
• qualitative research
• social barriers to healthcare

• attitudes
• evidence-based medicine
• experiences
• medical students
• qualitative study

• global breast cancer control
• implementation science
• national cancer plan
• resource-stratified guideline

• South Africa
• breast neoplasms
• disparities
• early diagnosis
• geographical
• stage at diagnosis

• Adult
• Aged
• Black People/statistics & numerical data
• Breast Neoplasms/diagnosis
• Breast Neoplasms/ethnology
• Breast Neoplasms/prevention & control
• Female
• Follow-Up Studies
• Health Services Accessibility
• Hospitals, Public
• Humans
• Middle Aged
• Neoplasm Staging
• Prognosis
• Socioeconomic Factors
• Travel/statistics & numerical data
• Urban Population
• White People/statistics & numerical data

• 001 World Health Organization
• D43 CA153715 NCI NIH HHS
• R01 CA192627 NCI NIH HHS

This critical review of the literature assembles and compares available data on breast cancer clinical stage, time intervals to care, and access barriers in different countries. It provides evidence that while more than 70% of breast cancer patients in most high-income countries are diagnosed in stages I and II, only 20%-50% patients in the majority of low- and middle-income countries are diagnosed in these earlier stages. Most studies in the developed world show an association between an advanced clinical stage of breast cancer and delays greater than three months between symptom discovery and treatment start. The evidence assembled in this review shows that the median of this interval is 30-48 d in high-income countries but 3-8 mo in low- and middle-income countries. The longest delays occur between the first medical consultation and the beginning of treatment, known as the provider interval. The little available evidence suggests that access barriers and quality deficiencies in cancer care are determinants of provider delay in low- and middle-income countries. Research on specific access barriers and deficiencies in quality of care for the early diagnosis and treatment of breast cancer is practically non-existent in these countries, where it is the most needed for the design of cost-effective public policies that strengthen health systems to tackle this expensive and deadly disease.

• Breast cancer
• Early diagnosis
• Delays
• Time intervals
• Clinical stage
• Access
• Health care delivery

Background: Information on outcome of breast cancer patients treated in the community is scarce. Data on outcome of patients treated in real-life clinical practice may provide useful information for performance improvement.

Methods: Study population is from a single institution practice at the American University of Beirut Medical Center. Demographics, clinical characteristics and survival data on patients diagnosed 1997-2010 in two IRB-approved studies were entered and analyzed on SPSS program. Survival was estimated using Kaplan Meier Method.

Findings: Total was 519 patients. 23.9% had stage I, 39.7% stage II, 30.4% Stage III and 6% stage IV. ER positive in 74.4% of patients. 30.6% of patients <35 had TNBC compared to 12.3% for the whole group. 45.9% of non-metastatic patients had breast-conserving therapy (BCT). BCT rates increased to 64% during the second half of the study, coinciding with increasing awareness and changing cultural mores. 5-year and 10-year overall survivals for stage I were 98.9% and 80.5%, 89.2% and 70.7% for stage II, 67.6% and 35.5% for stage III, and 39.1% and 26.1% for stage IV respectively.

Interpretation: Patients treated outside clinical trials in a multidisciplinary fashion according to guidelines have comparable, and at times better, survival compared to data from trials or population statistics. Locally generated outcome data could be valuable for evaluating results of treatment at individual practices for the purpose of quality assessment and improvement. Our data also provides report of increased rate of breast conserving surgery from Middle East.

• breast cancer
• breast conserving therapy
• general oncology practice
• hormone receptors.
• mastectomy
• outside clinical trials
• screening
• survival
• triple negative

• Education, Nursing/standards
• Honduras
• Humans
• Longitudinal Studies
• Neoplasms/prevention & control
• Oncology Nursing/education
• Palliative Care
• Program Development/methods

• breast cancer control
• economic evaluation
• systematic review
• low- and middle-income countries
• cost-effectiveness
• noncommunicable diseases

• Breast Neoplasms/diagnosis
• Breast Neoplasms/economics
• Breast Neoplasms/therapy
• Cost-Benefit Analysis
• Developed Countries
• Developing Countries
• Female
• Global Health/economics
• Humans
• Mammography
• Mass Screening/economics
• Physical Examination

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Breast Neoplasms/economics
• Breast Neoplasms/prevention & control
• Colorectal Neoplasms/economics
• Colorectal Neoplasms/prevention & control
• Cost-Benefit Analysis
• Female
• Humans
• Male
• Middle Aged
• Models, Theoretical
• Uterine Cervical Neoplasms/economics
• Uterine Cervical Neoplasms/prevention & control
• Young Adult