Early detection of breast cancer and the WHO Global Breast Cancer Initiative

Dr Benjamin Anderson, Medical Officer, Cancer Control, WHO, gave the opening presentation describing the current landscape of breast cancer globally, the importance of prevention and early detection, and provided an overview of the WHO GBCI.

Currently, breast cancer is the leading cause of cancer deaths among women worldwide. It is to be noted that, at the current rate, by 2040, 60% of the projected three million new breast cancer cases and 70% of the one million new deaths annually will occur in LMICs. However, when necessary measures are taken and sufficient resources are allocated, it can be observed that breast cancer five-year survival rates are over 90% in high-income countries (HICs). Unfortunately, these survival rates are significantly reduced in LMICs, for example, five-year survival rates are 66% in India and 40% in South Africa

In this context, Dr Anderson stressed that prevention and early detection are key to control breast cancer, and early detection programmes must be in adequation with the level of resources of a given country. Early diagnosis, or opportunistic screening (which is providing services to symptomatic women) has proven to be a costeffective and efficient strategy to diagnose breast cancer in limited settings.

The GBCI was designed to address the significant burden of breast cancer and aims at reducing global breast cancer mortality by 2.5% per year, thereby averting 2.5 million breast cancer deaths globally between 2020 and 2040.

The GBCI is comprised of three pillars:

Pillar 1: Health promotion for early detection

TARGET: 60% of invasive cancers are stage I or II at diagnosis

1A: Health Literacy: Breast health education to women ages 30 – 49 (linked to cervical cancer screening and women’s health education programming)

1B: Primary and Secondary Provider Education:

• WHO-PEN breast education modules for primary health care

• Clinical breast assessment (CBA) training for district facilities and providers

Pillar 2: Timely cancer diagnosis

TARGET: Evaluation, imaging, tissue sampling & pathology within 60 days

2A. Rapid Diagnosis Units (RDUs) deployed at secondary level facilities

2B. Tissue Pathology Services using standard and leapfrog methodology

2C. Patient Navigation Systems linking primary, secondary and tertiary care

Pillar 3: Comprehensive breast cancer management

TARGET: 80% undergo multimodality treatment without abandonment

3A. Timely access to quality multidisciplinary cancer treatment (surgery, radiation therapy, systemic treatment) completed with minimal abandonment:

• Multidisciplinary treatment planning based on resource adapted guidelines

• Patient navigation for surgery, radiotherapy and systemic therapy

• Systemic assessment to measure compliance and treatment abadonment

3B. Treated women are reintegrated into community minimizing financial toxicity:

• Follow-up care established at primary level

• Survivorship and palliative care available to women after treatment

Workshop: Advancing early detection of breast cancer in resource-limited settings

Dr Anderson also highlighted the challenges that the breast cancer community faces in achieving this objective and why urgent action is needed:

• Political will has been moving toward NCDs but has not past the ‘tipping point’

• Countries can have multiple parallel delivery systems that tend to lack unity

• Underserved communities are a ‘country within a country’.

He touched on findings that can influence the efforts to address the breast cancer burden in different contexts, highlighting the role that civil society plays as key partners in driving both patient education and political will.

These findings were echoed in the following presentations and table discussions of participants, as they explored steps to achieve the GBCI targets.

“With breast cancer now the most common cancer globally and the most likely reason a woman will die from cancer, countries need to embrace the concept of improving breast cancer outcomes if they are going to address cancer as a health priority.”

Dr Benjamin Anderson, Medical Officer, Cancer Control, WHO