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