Breast cancer in Latin America: Experts perceptions compared with medical care standards
ABSTRACT The BCRF II study presents a systematic review of the norms, recommendations and guidelines that are considered medical care standards (MCS) for breast cancer in 12 Latin American and Caribbean countries. Three key questions from the BCRF I survey data on early detection and diagnosis are presented to identify implementation practice patterns related to MCS.
Information related to MCS was requested from governmental health authorities, cancer institutes, and national scientific and professional societies in 12 Latin American and Caribbean countries. Documents received were reviewed by breast cancer experts from each respective country. Three key survey questions from the BCRF I survey on early detection and diagnosis were reprocessed to provide information related to implementation practice of existing MCS. Results: All countries included in the BCRF II study had medical care standards (MCS) whether published by governmental authorities, national professional or scientific associations, cancer institutes, or adoption of international MCS. Experts reported different practice patterns at a Country level versus a Center level. Overall, 85% of the experts reported that less than 50% of the women with no symptoms undergo a mammography at the Country level compared to 43% at the Center level. For diagnostic suspicion of breast cancer, 80% of experts considered the diagnostic suspicion at a Country level to come from the patient compared to 50% at a Center level. About 30% of patients waited for more than 3 months for a diagnosis at the Country level compared to 7% at the Center level.
All the Latin America and Caribbean countries in the study reported the use of similar MCS for breast cancer care. The reported difference between care practiced at a Country level versus a Center level suggests the challenge is not in generating new MCS, but in implementing policies and control mechanisms for compliance with existing MCS, guaranteeing their applicability to all populations.
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ABSTRACT: The benefit of early breast cancer detection is the foundation for programs around the globe to reduce morbidity and mortality related to breast cancer. These programs range from educational programs targeted to women and health professionals to organized or opportunistic screening programs that target specific age groups of women. Modern mammography programs tend to follow the protocols from the randomized clinical trials, but there is variation in key program elements such as the age groups invited to screening, the screening interval, performance indicators, and the uptake rate. Until recently, the emphasis on early breast cancer detection was limited to mammography, but the steady rise in incidence and mortality in low and medium resource countries, where mammography may be unaffordable, has led to a renewal in emphasizing the incremental value of downsizing palpable tumors through physical exams. There is consensus that programs should be designed based on disease burden and available resources, but that even in low resource countries there are opportunities to reduce breast deaths through earlier diagnosis and effective treatment. Screening programs are most effective when they are organized, and program planners should consider WHO criteria and local input data as a basis for tailoring screening programs to the needs of their population.Salud publica de Mexico 10/2011; 53(5):394-404. · 0.94 Impact Factor
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ABSTRACT: Breast cancer is the most common cancer in women worldwide and 70% of breast cancer deaths occur in women from low-income and middle-income countries. Latin America has about 115,000 new cases of disease every year, with about 50,000 arising in Brazil. We examined the present status of breast cancer in Brazil as an example of the health effects of geographical, ethnic, and socioeconomic diversities on delivery of care. Our goal was to identify deficiencies that could be responsible for disparities in survival from breast cancer. We searched the English and Portuguese published work and reviewed national databases and Brazilian publications. Although the availability of publications specific to Brazil is low in general, we identified several factors that could account for disparities: delays in diagnosis due to low cancer awareness and implementation of mammography screening, unknown quality of surgery, and restricted access to radiotherapy and modern systemic therapies.The Lancet Oncology 03/2012; 13(3):e95-e102. DOI:10.1016/S1470-2045(11)70323-0 · 25.12 Impact Factor
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ABSTRACT: We compared the relationships among percentage of body fat (%BF) and physical activity with breast cancer (BC) and benign breast diseases (BBD) in low-income Brazilian women. A case-control study including 106 incident BC cases, 178 incident BBD cases, and 181 control women recruited from a public hospital-based screening center was conducted. Logistic regression models showed that sedentary women have a higher odds of developing BC in the age adjusted model [odds ratio (OR) = 2.39, 95% confidence interval (CI) 1.43-3.99]. After adjusting for hormonal-related risk factors and family history of breast cancer (OR = 2.94, 95%CI 1.50-5.79) and also for the %BF (OR = 2.71, 95%CI 1.36-5.37) the odds remained high. Independent of the adjustments made, %BF did not affect the odds for developing BC. When the same models were tested for women with BBD, we found a significant association with sedentary lifestyle in all models tested, with an OR = 3.03 (95%CI 1.69-5.42) in the fully adjusted model. In the same way, in the fully adjusted model %BF was significantly associated to risk for BBD (OR = 0.54, 95%CI 0.30-0.98). Similar to results found in other populations, our data suggest that physical activity is an important, independent protective factor for the risk of developing BC and BBD in low-income women from an admixed population.Nutrition and Cancer 09/2013; DOI:10.1080/01635581.2013.801997 · 2.70 Impact Factor