Breast Cancer in Limited-Resource Countries: Diagnosis and Pathology

Abstract

In 2002 the Breast Health Global Initiative (BHGI) convened a panel of breast cancer experts and patient advocates to develop consensus recommendations for diagnosing breast cancer in countries with limited resources. The panel agreed on the need for a pathologic diagnosis, based on microscopic evaluation of tissue specimens, before initiating breast cancer treatment. The panel discussed options for pathologic diagnosis (fine-needle aspiration biopsy, core needle biopsy, and surgical biopsy) and concluded that the choice among these methods should be based on available tools and expertise. Correlation of pathology, clinical, and imaging findings was emphasized. A 2005 BHGI panel reaffirmed these recommendations and additionally stratified diagnostic and pathology methods into four levels--basic, limited, enhanced, and maximal--from lowest to highest resources. The minimal requirements (basic level) include a history, clinical breast examination, tissue diagnosis, and medical record keeping. Fine-needle aspiration biopsy was recognized as the least expensive reliable method of tissue sampling, and the need for comparing its clinical usefulness with that of core needle biopsy in the limited-resource setting was emphasized. Increasing resources (limited level) may enable diagnostic breast imaging (ultrasound +/- mammography), use of tests to evaluate for metastases, limited image-guided sampling, and hormone receptor testing. With more resources (enhanced level), diagnostic mammography, bone scanning, and an onsite cytologist may be possible. Mass screening mammography is introduced at the maximal-resource level. At all levels, increasing breast cancer awareness, diagnosing breast cancer at an early stage, training individuals to perform and interpret breast biopsies, and collecting statistics about breast cancer, resources, and competing priorities may improve breast cancer outcomes in countries with limited resources. Expertise in pathology was reaffirmed to be a key requirement for ensuring reliable diagnostic findings. Several approaches were again proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.

Strategic health communication across the continuum of breast cancer care in limited-resource countries

“…Constraints may include cultural norms of modesty that may discourage women from seeking breast cancer screening, lack of familiarity with and distrust of the modern healthcare system, and/or socioeconomic factors that may make it difficult for women to travel to clinics where they can access breast cancer screening services. 21,22 Diagnosis Accurate diagnoses of breast cancers depend on effective communication between healthcare providers (eg, primary care physician, pathologist, radiologist, oncologist, nursing staff), as well as between providers and patients. Strategic communication is needed to gather, analyze, and interpret relevant symptom and laboratory test data, as well as to sensitively report diagnostic results to patients.…”

The Challenge of Breast Cancer in Low- and Middle-income Countries— Implementing the Breast Health Global Initiative Guidelines

“…[15][16][17][18] At the 2005 BHGI global summit, the previous BHGI guidelines were updated and expanded into a flexible comprehensive framework for improving the quality of healthcare delivery based on outcomes, cost, cost-effectiveness, and the use of healthcare services. The 2005 guidelines addressed: early detection and access to care; 19 diagnosis and pathology; 20 cancer treatment and allocation of resources; 21 and healthcare systems and public policy. 22 The stepwise, systematic approach to healthcare improvement outlined by the 2005 BGHI panels involved a tiered system of resource allotment defined using four levels-basic, limited, enhanced, and maximal-based on the contribution of each resource toward improving clinical outcomes.…”

“…25 Third, clinical breast examination combined with diagnostic breast imaging (breast sonography with or without diagnostic mammography) can facilitate cost-effective tissue sampling techniques for cytological or histological diagnosis. 20 Fourth, breast cancer treatment with partial mastectomy and radiation requires more healthcare resources and infrastructure than mastectomy, but can be provided in a thoughtfully designed limited-resource setting. 26 Fifth, the availability and administration of systemic therapy are critical to improving the survival of breast cancer patients.…”

Total Excision Accompanied by Roll in Non-Palpable Breast Lesion

“…PEML'nda ameliyat sırasında frozen inceleme, küçük bir invaziv karsinom veya mikroinvaziv hastalık görülemeyebileceğinden önerilme-mektedir. Frozen inceleme sadece yeterli doku varsa ve ayrıca cerrahinin seyrini değiştirecek önemli bir beklenti varsa yapılmalıdır (19)(20)(21)(22).…”