Breast Cancer Priorities in Limited-Resource Environments: The Price-Efficacy Dilemma in Cancer Care

Abstract

Breast cancer has become one of the leading causes of morbidity and mortality in low- and middle-income countries, where 62% of the world’s total new cases are diagnosed. Therefore, the productivity loss because of premature death resulting from female breast cancer is also on the rise. The major challenge in low- and middle-income countries is to reduce the proportion of women presenting with advanced-stage disease, a challenge unlikely to be overcome by adoption of expensive national mammography screening programs. Awareness and education campaigns should focus not only on patients and societies but also on policy makers to address and optimize breast cancer care. Adaptation of existing guidelines and prioritization according to local resources are essential to address the unique needs and overcome the unique barriers of each society to facilitate practical implementation and improve outcomes. Emphasis on the principle of a cancer groundshot in addressing value in cancer care is vital to improving access to therapies that are proven to work rather than chasing after new drugs or innovations of doubtful or marginal clinical benefit. Until we have drug-pricing interventions that take into account the local income of each society, we must acknowledge the fact that the delivery of cancer care will never be the same all around the world.

Effects of Tai Chi Chuan (TCC) Exercise on the Physiological and Psychosocial Wellbeing, and the Quality of Life (QOL) of Breast Cancer Patients on Adjuvant Chemotherapy

“…Table (1) shows that patients' age ranged between 28 and 75, median 49 years, with a great majority of women (94.8%). Around two-fifth of them were either with no (39.1%) or basic/secondary (42.6%) education.…”

Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource–Stratified Guideline

“…The proportion of deaths resulting from BC (72%) in LMICs was higher than their share of incidence (62%), indicating a higher case fatality rate (Tables 2 and 3 ). 8 These statistics illustrate the importance of focusing on BC control as a major contributor to cancer morbidity and mortality in LMICs. Younger age at presentation is a unique aspect of BC diagnosis in LMICs.…”

“…Younger age at presentation is a unique aspect of BC diagnosis in LMICs. 8 , 9 Two thirds of BC cases in Low– and Middle–Human Development Index (HDI) countries are diagnosed in patients younger than 50 years, as compared with one third of BC cases in High-HDI countries, with a median age at presentation being a decade younger than in High-HDI countries. 5 , 9 BC in young women has been associated with unique biology, genetics, and inferior outcomes as compared with BC in older women.…”

“…Lack of access to high-end technology should not be associated with lack of benefit from treatment of patients with cancer. 8 In resource-constrained settings, efficient allocation of resources mandates prioritization. Many cancer medicines included in the WHO Essential Medicines List (EML) are not available or are expensive in LMICs (see Appendix Table A 4 ).…”

Thermal Characterization and Preclinical Feasibility Verification of an Accessible, Carbon Dioxide-Based Cryotherapy System

“…Breast cancer is the most diagnosed cancer, with more than 2.3 million new cases each year, representing nearly a quarter of all cancer diagnoses in women [1]. Over 60% of breast cancer cases occur in low-and-middle-income countries (LMICs) and account for 70% of all breast cancer deaths [1]. Breast cancer has become one of the leading causes of morbidity and mortality in LMICs.…”