www.bhgi.info
Jo Anne Zujewski, MD
Cancer Therapy Evaluation Program
Division of Cancer Diagnosis and Treatment
National Cancer Institute
January 2011
BREAST HEALTH IN LMCS
 Resource-stratified guidelines
 Implementation framework
 Implementation projects
WORLD BANK COUNTRY GROUPS
WORLD BANK CLASSIFICATION (ATLAS METHOD)
World Bank
Country Groups
Low
Income
Lower
Middle Income
Upper
Middle Income
High
Income
(GNI per capita)
($995 or less)
($996 - $3,945)
($3,946 - $12,195)
($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.
3
© 2011 BHGI. All rights reserved.
BREAST CANCER EPIDEMIOLOGY
GLOBAL DISTRIBUTION OF DISEASE
0.21
0.19
0.36
0.37
0.37
0.20
0.22
0.54
0.25
0.43
0.59
0.62
0.44
0.50
0.30
Ratio:
4
Mortality
Incidence
0.51
0.18
0.33
Globocan 2008 (IARC)
2008: 1,380,000 cases; 458,400 deaths
50% of cases / 60% of deaths in LMCs
© 2011 BHGI. All rights reserved.
MISSION STATEMENT
The Breast Health Global Initiative (BHGI) strives to
develop, implement and study evidence-based,
economically feasible, and culturally appropriate
guidelines for international breast health and cancer
control for low and middle income countries to
improve breast health outcomes.
GLOBAL SUMMIT 2005 –
BETHESDA
RESOURCE STRATIFICATION
 Basic level: Core resources or fundamental services
necessary for any breast health care system to function.
 Limited level: Second-tier resources or services that produce
major improvements in outcome such as survival.
 Enhanced level: Third-tier resources or services that are
optional but important, because they increase the number
and quality of therapeutic options and patient choice.
 Maximal level: Highest-level resources or services used in
some high resource countries that have lower priority on the
basis of extreme cost and/or impracticality.
BREAST HEALTH IN
LMCS
 Resource-stratified guidelines
 Implementation framework
 Implementation projects
BHGI: Health Systems
BHGI: Early Detection
BHGI: Diagnosis
Cancer: 113 (8 suppl), 2008
BHGI: Stage 1
Cancer: 113 (8 suppl), 2008
BHGI: Stage 2
Cancer: 113 (8 suppl), 2008
BHGI: Stage 3; Locally
Advanced
Cancer: 113 (8 suppl), 2008
BHGI: Metastatic
GLOBAL SUMMIT 2010 –
CHICAGO
OPTIMIZING DELIVERY
Low-Resource Scenarios
Middle-Resource Scenarios
Problem Solving
Executive Summary: Lancet Oncology, 12: in press, 2011
Consensus Supplement: The Breast, in press, 2011
GLOBAL SUMMIT 2010 –
CHICAGO
OPTIMIZING DELIVERY
 Cancer registries for prevalence , stage, and
outcome
 National cancer plans define cancer care networks
 Multidisciplinary care to avoid fragmentation
 issues
Lancet Oncology, 12: in press, 2011
OPTIMIZING DELIVERY
Training linked to equipment
acquisition / quality care
Public awareness programs linked
to early detection
Clinical breast examination (CBE)
promotion
Coordination of diagnosis and
treatment
Address pathology, drug
acquisition, workforce issues
BREAST HEALTH IN
LMCS
 Resource-stratified guidelines
 Implementation framework
 Implementation projects
Public Participation
Health Care Delivery
Awareness
Early Detection
Diagnosis
Advocacy
Survivorship
Treatment
BREAST HEALTH IN
LMCS
 Resource-stratified guidelines
 Implementation framework
 Implementation projects
LMC IMPLEMENTATION RESEARCH
AFRICAN (WHO AFRO) COUNTRIES – LOW
RESOURCE
0.54
0.59
0.62
0.51
Ratio:
22
0.33
Mortality
Incidence
AFRO REGIONAL ESTIMATES 2008:
68,000 cases; 37,000 deaths
Globocan 2008 (IARC)
© 2011 BHGI. All rights reserved.
LMC IMPLEMENTATION RESEARCH
LOWER-MIDDLE INCOME COUNTRY
Indonesia
23
CBE training for nurse midwives
© 2011 BHGI. All rights reserved.
LMC IMPLEMENTATION RESEARCH
UPPER-MIDDLE INCOME COUNTRY
Turkey
24
Mammographic Screening in Istanbul
© 2011 BHGI. All rights reserved.
LMC IMPLEMENTATION RESEARCH
LOWER-MIDDLE INCOME COUNTRY
Colombia
25
Readiness Assessment Tools
© 2011 BHGI. All rights reserved.
LMC IMPLEMENTATION RESEARCH
LOWER-MIDDLE INCOME COUNTRY
Pakistan
Locally Advanced Treatment in Lahore
26
© 2011 BHGI. All rights reserved.
LMC IMPLEMENTATION RESEARCH
LATIN AMERICAN COUNTRIES – MIDDLE
RESOURCE
0.36
0.37
0.30
Ratio:
27
Mortality
Incidence
Globocan 2008 (IARC)
SOUTH + CENTRAL AMERICA ESTIMATES 2008:
105,900 cases; 33,600 deaths
© 2011 BHGI. All rights reserved.
BHGI GLOBAL ALLIANCE
BENEFACTOR / FOUNDATIONAL GRANTS
•
•
•
•
Susan G. Komen for the Cure®
European School of Oncology (ESO)
Pan American Health Organization (PAHO)
Sheikh Mohammed Hussein Al-Amoudi Center of
Excellence in Breast Cancer
• American Society of Clinical Oncology (ASCO)
• LIVESTRONG
CORPORATE PARTNERS
• GE Healthcare
• Sanofi-Aventis