To Address Breast Cancer Globally, Three Things Are Essential

In In The News by Barbara Jacoby

By: Elaine Schattner


At one of the opening sessions of the 37th annual San Antonio Breast Cancer Symposium, Dr. Benjamin Anderson of the University of Washington spoke on breast cancer as a worldwide health problem. He, a surgeon and breast cancer specialist, leads the Breast Health Global Initiative (BHGI).

He considered the disease’s toll. “It is the most likely reason a woman will die of cancer around the globe,” he stated.

In 2012, the World Health Organization’s IARC estimated 1.67 million breast cancer cases worldwide, and 522,000 deaths from the disease per year. Deaths from breast cancer occur disproportionately in less developed world regions. In impoverished countries, women tend to present with more advanced tumors and, if they have breast cancer, are more likely to die from the disease.

Anderson spoke to the difficulty of detecting and managing breast cancer in developing countries. He gave an example of a resource-adjusted protocol for evaluating a breast lump.

At a facility In Peru, if a woman has a suspicious breast lump, she may undergo a fine needle aspirate (FNA). That simple procedure, which costs around $4 (approximately, he indicated), is rarely done in the United States. In advanced health care systems, core needle biopsies are preferred because those offer more accurate and detailed information. In the system he described in Peru, if the FNA results are suspicious for cancer, then woman is referred to a cancer center for further evaluation.

Anderson showed pictures of a hospital in Vietnam where breast cancer patients having surgery or radiation stay in wards with four beds in each room. “There are often two or three patients in each bed,” he said.

“In the global community, the discussion is very different,” he emphasized. “People don’t have access to the most basic supplies and medications.” Apart from constraints affecting diagnosis, surgery and access to cancer drugs, there are additional barriers. For instance, doctors may be limited in their capacity to relieve pain. “In many places there is no palliative care,” he said.

Not uncommonly, people with malignant diagnoses don’t return for care, based on problems of stigma and fear. “Even if you find cancer, the patients don’t come back,” Anderson said. “If you say you’re going to give radiation, they get scared.”

A lack of insurance programs is another sort of obstacle. Anderson referred to an example of a patient in Ghana. “If you have to pay for each step of treatment, you’re going to have a lot of people who stop treatment before they’re done,” he said.

Anderson reviewed the concept of resource-stratified guidelines. “Early detection is unusual in poor countries,” he said. “Diagnosis is more of an issue, if treatment might be given.”

Three things are essential to advance the well-being of breast cancer patients around the world, Anderson said. He attributed the “triad” to his colleague, David. B. Thomas, an epidemiologist who has studied breast cancer in China and elsewhere.

“First, you need awareness. Women need to be educated about the disease, so they know that treatment can help,” he said. In many regions, fatalism is still an obstacle.”

Second, there needs to be an infrastructure. “You need a system to provide care,” he considered. Implementing a delivery system takes more than just funds, but the cooperation of local authorities as well.

“Third, women need to be empowered to get care,” he said. “In many places, women need a man’s permission to go see a doctor,” he said. “We need to address that.”