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 Ø Resource-stratified guidelines Ø Implementation framework Ø Implementation projects
WORLD BANK COUNTRY GROUPS WORLD BANK CLASSIFICATION (ATLAS METHOD) World Bank Country Groups (GNI per capita) Low Income ($995 or less) Lower Middle Income Upper Middle Income ($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% ($996 - $3, 945) High Income 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 Ratio: 4 Mortality Incidence 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 Ø Basic level: Core resources or fundamental services necessary for any breast health care system to function. Ø Limited level: Second-tier resources or services that produce major improvements in outcome such as survival. Ø 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. Ø 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 Ø Resource-stratified guidelines Ø Implementation framework Ø 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 ØLow-Resource Scenarios ØMiddle-Resource Scenarios ØProblem Solving Executive Summary: Lancet Oncology, 12: in press, 2011 Consensus Supplement: The Breast, in press, 2011
GLOBAL SUMMIT 2010 – CHICAGO OPTIMIZING DELIVERY Ø Cancer registries for prevalence , stage, and outcome Ø National cancer plans define cancer care networks Ø Multidisciplinary care to avoid fragmentation Ø issues Lancet Oncology, 12: in press, 2011
OPTIMIZING DELIVERY Ø Training linked to equipment acquisition / quality care Ø Public awareness programs linked to early detection Ø Clinical breast examination (CBE) promotion Ø Coordination of diagnosis and treatment Ø Address pathology, drug acquisition, workforce issues
BREAST HEALTH IN LMCS Ø Resource-stratified guidelines Ø Implementation framework Ø Implementation projects
Public Participation Health Care Delivery Awareness Early Detection Diagnosis Advocacy Survivorship Treatment
BREAST HEALTH IN LMCS Ø Resource-stratified guidelines Ø Implementation framework Ø Implementation projects
LMC IMPLEMENTATION RESEARCH AFRICAN (WHO AFRO) COUNTRIES – LOW RESOURCE Ratio: 22 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 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
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