Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative

Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
World Journal of Surgery (Impact Factor: 2.64). 03/2008; 32(12):2578-85. DOI: 10.1007/s00268-007-9454-z
Source: PubMed


Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided.
Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery.
The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice.
The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.

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Available from: Benjamin Olney Anderson, May 05, 2014
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    • "Breast cancer is the most common malignancy among women worldwide (Anderson et al., 2008) which has been considered as the fifth cause of cancer related death both in the less developed (LDCs) and more developed (MDCs) countries (Ghiasvand et al., 2014). Out of LDCs countries, the breast cancer problem seems more serious in Iran because it affects Iranian women at least one decade younger than their counterparts in MDCs countries (Naderimagham et al., 2014) therefore there is an urgent need for detecting the underlying risk factors of premenopausal breast cancer and making appropriate policies to prevent this cancer in Iran and neighboring countries with similar etiologies. "
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    ABSTRACT: Background: Kermanshahi oil is one the most favorable oils in Iran especially in Kermanshah province. We aimed to evaluate the role of usual intake of Kermanshahi oil and other kinds of dietary fats as well as different meats, vegetables and fruits, carbohydrates, cereals, grains, sweets, candy and lifestyle habits in risk of breast cancer. Materials and methods: A case-control study with 47 consecutive, newly diagnosed premenopausal breast- cancer patients and 105 age and socioeconomic matched healthy women was conducted from 2013-2014 in Imam Reza hospital of Kermanshah using a standardized, validated questionnaire assessing various anthropometric, socio-demographic, lifestyle and dietary characteristics. Results: Kermanshahi oil intake was associated with a 2.1-fold (OR= 2.123, 95% CI 1.332- 3.38) (p= 0.002) higher likelihood of having breast cancer, while daily intake of other solid animal fats also increased the likelihood by 2.8-fold (OR = 2.754, 95% CI 1.43- 5.273) (p < 0.001), after various adjustments made. Lack of fish oil, white meat, vegetables, soy products, nuts and dairy products (especially during adolescence) in daily regimens and lack of sun exposure were significantly associated with premenopausal breast cancer risk in this region. Conclusions: This study suggested that animal fat increases the risk of premenopausal breast cancer but many other dietary and non-dietary factors including calcium and vitamin D deficiency are consistently associated with increased odds of breast cancer in this region.
    Full-text · Article · Dec 2015 · Asian Pacific journal of cancer prevention: APJCP
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    • "Increasing awareness of early signs and symptoms and screening by clinical and self breast examinations are the only viable options in these countries (Anderson et al 2008). With the challenge of breast cancer being global and with increasing prevalence in the developing world, various nations have come up with strategies to attenuate its effects. "

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    • "of cancer deaths and this malignancy has been remained as a major health problem worldwide (Anderson and Jakesz, 2008). One recent study in Iran showed that severe vitamin D deficiency causes a three-fold increase in the risk of breast cancer while it is not the case for moderate and mild deficiency (Alipour et al., 2014). "
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    ABSTRACT: Background: Vitamin D has been suggested as one of the critical factors for female reproductive health with protective activities against different cancers but there are conflicting facts regarding its role on breast cancer without any clear data on premenopausal cases. This study aimed to evaluate the role of vitamin D from dietary sources and sunlight exposure on the incidence of premenopausal breast cancer. Materials and methods: We conducted a case control study on 60 newly diagnosed premenopausal breast cancer patients and 116 normal women who lived in Sabzevar and surrounding villages in Razavi, Khorasan, a rural and conservative area of Iran. Results: The mean concentrations of 25-OH vitamin D in cases and controls were 15.2 ± 8.15 vs 15.5 ± 7/45 ng/ml, both well below normal values elsewhere. In fact 50% of analyzed individuals showed very severe or severe vitamin D deficiency and the rest (25%) were detected in suboptimal levels. Although the lack of vitamin D and calcium supplementation increased slightly the risk of premenopausal breast cancer (p=0.009, OR=1.115, CI 95%=1.049-1.187), higher prevalence of weekly egg consumption (86.66% vs 96.55%, p=0.023, OR=0.232, CI 95% 0.065-0.806) showed a slight protective role. The last but the most important risk factor was lack of sunlight exposure because the breast cancer patients had total body coverage from sun (p=0.007, OR=10.131, CI 98% 0.314-78.102). Conclusion: This study pointed out the role of vitamin D and other possible risk factors on the development and growth of breast tumors in this special geographical region. Although this study has revealed the interactions between hormonal and environmental factors in this province of Iran, understanding the deficiency pattern and its contribution to other lifestyle factors elsewhere is also necessary.
    Full-text · Article · Apr 2014 · Asian Pacific journal of cancer prevention: APJCP
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