Breast Cancer in Limited-Resource Countries: Health Care Systems and Public Policy

Abstract

As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade-offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade-offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease-specific "vertical" programs warrant "horizontal" integration with existing health care systems in limited-resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost-sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited-resource setting.

"Knowledge into action" – Exploration of an appropriate approach for constructing evidence-based clinical practice guidelines for hepatocellular carcinoma

“…Of the current 17 guidelines, only the AOS Guideline (13) and the WGO Guideline (14) suggested providing different recommendations for countries with minimal resources, moderate resources, or extensive resources. It has been shown that although evidence-based CPGs constructed in resource-affluent countries define optimal goals and care, many measures could not be directly implemented in resource-constrained countries due to the lack of required fundamental infrastructure and resources (15). For example, many studies have proved that the combined testing of DCP and AFP or AFP-L3 could increase the sensitivity of HCC diagnosis, but DCP is currently approved just in Japan, Korea, and Indonesia (9).…”

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

“…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.…”

A national cancer control program: the ‘Down Under’ experience with breast cancer

“…A number of the above approaches have been recently identified by the Breast Health Global Initiative as being feasible for use globally by non-government organizations including those in limited-resource countries, where interventions promoting improved outcomes can be introduced in an incremental manner [25].…”