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Jo Anne Zujewski, MDJo Anne Zujewski, MDCancer Therapy Evaluation ProgramCancer Therapy Evaluation Program
Division of Cancer Diagnosis and TreatmentDivision of Cancer Diagnosis and TreatmentNational Cancer InstituteNational Cancer Institute
January 2011January 2011
www.bhgi.info
BREAST HEALTH IN BREAST HEALTH IN
LMCSLMCS
Resource-stratified guidelinesResource-stratified guidelines
Implementation frameworkImplementation framework
Implementation projectsImplementation projects
© 2011 BHGI. All rights reserved.3
WORLD BANK COUNTRY GROUPS WORLD BANK COUNTRY GROUPS WORLD BANK CLASSIFICATION (ATLAS METHOD)WORLD BANK CLASSIFICATION (ATLAS METHOD)
World Bank Country Groups(GNI per capita)
Low Income
($995 or less)
LowerMiddle Income
($996 - $3,945)
UpperMiddle Income($3,946 - $12,195)
High Income
($12,196 or more)
Average female life expectancy at birth 57.8 yrs 69.3 yrs 74.4 yrs 82.4 yrs
Average GNI per capita (2009 US dollars) $403 $1,723 $6,314 $36,953
Total national health expenditure per capita $22 $76 $458 $4,266
Fraction of GDP spent on health care 5.1% 4.3% 6.4% 11.2%
Health expenditure figures 2010 for calendar year 2007; GNI = gross national income http://data.worldbank.org/data-catalog/health-nutrition-and-population-statistics.
© 2011 BHGI. All rights reserved.4
0.19
0.37 0.36
0.30
0.43
0.18
0.37
0.25
0.21
0.20
0.62 0.440.50
0.22
0.51
0.54
0.59
0.33
BREAST CANCER EPIDEMIOLOGYBREAST CANCER EPIDEMIOLOGYGLOBAL DISTRIBUTION OF DISEASEGLOBAL DISTRIBUTION OF DISEASE
2008: 1,380,000 cases; 458,400 deaths2008: 1,380,000 cases; 458,400 deaths50% of cases / 60% of deaths in LMCs50% of cases / 60% of deaths in LMCs
Ratio:MortalityIncidence Globocan 2008 (IARC)Globocan 2008 (IARC)
MISSION STATEMENTMISSION STATEMENT
The The Breast Health Global Initiative (BHGI)Breast Health Global Initiative (BHGI) strives to strives to develop, implement and study evidence-based, develop, implement and study evidence-based,
economically feasible, and culturally appropriate economically feasible, and culturally appropriate guidelines for international breast health and cancer guidelines for international breast health and cancer
control for low and middle income countries to control for low and middle income countries to improve breast health outcomes.improve breast health outcomes.
The The Breast Health Global Initiative (BHGI)Breast Health Global Initiative (BHGI) strives to strives to develop, implement and study evidence-based, develop, implement and study evidence-based,
economically feasible, and culturally appropriate economically feasible, and culturally appropriate guidelines for international breast health and cancer guidelines for international breast health and cancer
control for low and middle income countries to control for low and middle income countries to improve breast health outcomes.improve breast health outcomes.
GLOBAL SUMMIT 2005 – GLOBAL SUMMIT 2005 – BETHESDABETHESDA
RESOURCE STRATIFICATIONRESOURCE STRATIFICATION
Basic level: Basic level: Core resourcesCore resources or fundamental services or fundamental services necessary for any breast health care system to function. necessary for any breast health care system to function.
Limited level: Limited level: Second-tier resourcesSecond-tier resources or services that produce or services that produce major improvements in outcome such as survival.major improvements in outcome such as survival.
Enhanced level: Enhanced level: Third-tier resourcesThird-tier resources or services that are or services that are optional but important, because they increase the number optional but important, because they increase the number and quality of therapeutic options and patient choice. and quality of therapeutic options and patient choice.
Maximal level: Maximal level: Highest-level resourcesHighest-level resources or services used in or services used in some high resource countries that have some high resource countries that have lower priority lower priority on the on the basis of extreme cost and/or impracticality.basis of extreme cost and/or impracticality.
BREAST HEALTH IN BREAST HEALTH IN LMCSLMCS
Resource-stratified guidelinesResource-stratified guidelines
Implementation frameworkImplementation framework
Implementation projectsImplementation projects
BHGI: Health SystemsBHGI: Health Systems
BHGI: Early DetectionBHGI: Early Detection
BHGI: DiagnosisBHGI: Diagnosis
Cancer: 113 (8 suppl), 2008Cancer: 113 (8 suppl), 2008
BHGI: Stage 1BHGI: Stage 1
Cancer: 113 (8 suppl), 2008Cancer: 113 (8 suppl), 2008
BHGI: Stage 2BHGI: Stage 2
Cancer: 113 (8 suppl), 2008Cancer: 113 (8 suppl), 2008
BHGI: Stage 3; Locally BHGI: Stage 3; Locally AdvancedAdvanced
Cancer: 113 (8 suppl), 2008Cancer: 113 (8 suppl), 2008
BHGI: MetastaticBHGI: Metastatic
Executive Summary: Lancet Oncology, 12: in press, 2011Executive Summary: Lancet Oncology, 12: in press, 2011Consensus Supplement: The Breast, in press, 2011Consensus Supplement: The Breast, in press, 2011
GLOBAL SUMMIT 2010 – GLOBAL SUMMIT 2010 – CHICAGOCHICAGO
OPTIMIZING DELIVERYOPTIMIZING DELIVERY
Low-Resource ScenariosLow-Resource Scenarios
Middle-Resource ScenariosMiddle-Resource Scenarios
Problem SolvingProblem Solving
GLOBAL SUMMIT 2010 – GLOBAL SUMMIT 2010 – CHICAGOCHICAGO
OPTIMIZING DELIVERYOPTIMIZING DELIVERY Cancer registries Cancer registries for prevalence , stage, and for prevalence , stage, and
outcomeoutcome National cancer plans define National cancer plans define cancer care networkscancer care networks Multidisciplinary care Multidisciplinary care to avoid fragmentationto avoid fragmentation issuesissues
Lancet Oncology, 12: in press, 2011Lancet Oncology, 12: in press, 2011
OPTIMIZING DELIVERYOPTIMIZING DELIVERY
TrainingTraining linked to equipment linked to equipment acquisition / quality careacquisition / quality care
Public awareness programsPublic awareness programs linked to linked to early detectionearly detection
Clinical breast examination Clinical breast examination (CBE) (CBE) promotionpromotion
CoordinationCoordination of diagnosis and of diagnosis and treatmenttreatment
Address Address pathologypathology, , drug acquisitiondrug acquisition, , workforce issuesworkforce issues
BREAST HEALTH IN BREAST HEALTH IN LMCSLMCS
Resource-stratified guidelinesResource-stratified guidelines
Implementation frameworkImplementation framework
Implementation projectsImplementation projects
AwarenessAwareness
SurvivorshipSurvivorship
Early DetectionEarly Detection
DiagnosisDiagnosis
TreatmentTreatment
AdvocacyAdvocacy
Public ParticipationPublic Participation Health Care DeliveryHealth Care Delivery
BREAST HEALTH IN BREAST HEALTH IN LMCSLMCS
Resource-stratified guidelinesResource-stratified guidelines
Implementation frameworkImplementation framework
Implementation projectsImplementation projects
© 2011 BHGI. All rights reserved.22
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH AFRICAN (WHO AFRO) COUNTRIES – LOW AFRICAN (WHO AFRO) COUNTRIES – LOW
RESOURCERESOURCE
Ratio:MortalityIncidence Globocan 2008 (IARC)Globocan 2008 (IARC)
AFRO REGIONAL ESTIMATES 2008: AFRO REGIONAL ESTIMATES 2008: 68,000 cases; 37,000 deaths68,000 cases; 37,000 deaths
0.62
0.51
0.54
0.59
0.33
© 2011 BHGI. All rights reserved.23
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRYLOWER-MIDDLE INCOME COUNTRY
CBE training for nurse CBE training for nurse
midwivesmidwives
IndonesiaIndonesia
© 2011 BHGI. All rights reserved.24
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH UPPER-MIDDLE INCOME COUNTRYUPPER-MIDDLE INCOME COUNTRY
TurkeyTurkeyMammographic Screening in Mammographic Screening in
IstanbulIstanbul
© 2011 BHGI. All rights reserved.25
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRYLOWER-MIDDLE INCOME COUNTRY
ColombiaColombiaReadiness Assessment ToolsReadiness Assessment Tools
© 2011 BHGI. All rights reserved.26
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRYLOWER-MIDDLE INCOME COUNTRY
PakistanPakistanLocally Advanced Treatment in Locally Advanced Treatment in
LahoreLahore
© 2011 BHGI. All rights reserved.27
LMC IMPLEMENTATION RESEARCH LMC IMPLEMENTATION RESEARCH LATIN AMERICAN COUNTRIES – MIDDLE LATIN AMERICAN COUNTRIES – MIDDLE
RESOURCERESOURCE
Ratio:MortalityIncidence Globocan 2008 (IARC)Globocan 2008 (IARC)
SOUTH + CENTRAL AMERICA ESTIMATES 2008: SOUTH + CENTRAL AMERICA ESTIMATES 2008: 105,900 cases; 33,600 deaths105,900 cases; 33,600 deaths
0.37 0.36
0.30
BHGI GLOBAL ALLIANCEBHGI GLOBAL ALLIANCEBENEFACTOR / FOUNDATIONAL GRANTSBENEFACTOR / FOUNDATIONAL GRANTS• Susan G. Komen for the Cure® Susan G. Komen for the Cure® • European School of Oncology (ESO) European School of Oncology (ESO) • Pan American Health Organization (PAHO)Pan American Health Organization (PAHO)• Sheikh Mohammed Hussein Al-Amoudi Center of Sheikh Mohammed Hussein Al-Amoudi Center of
Excellence in Breast CancerExcellence in Breast Cancer• American Society of Clinical Oncology (ASCO)American Society of Clinical Oncology (ASCO)• LIVESTRONGLIVESTRONG
CORPORATE PARTNERSCORPORATE PARTNERS• GE HealthcareGE Healthcare• Sanofi-AventisSanofi-Aventis