Insights Into a Phased Approach to Breast Cancer Early Detection Programs (original) (raw)

Oncology Times

Abstract

15 Oncology Times B reast cancer is the second most diagnosed cancer worldwide, with approximately 2.3 million new diagnoses and almost 685,000 breast cancer-related deaths (CA Cancer J Clin 2021; https://doi.org/10.3322/caac.21660). In the United States, approximately 1 in 8 women will develop breast cancer over the course of their lifetime. Finding breast cancer early is one of the most important strategies to prevent deaths from breast cancer. According to the American Cancer Society, when breast cancer is detected early and is in the localized stage, the 5-year relative survival rate is 99 percent. In order to promote the early detection of cancer, the World Health Organization (WHO) has defined two distinct but related strategies: 1) screening, which refers to the tests and exams used to identify asymptomatic disease in a target population of apparently healthy individuals, and 2) early diagnosis, which refers to finding and recognizing symptomatic cancer at an early stage. Studies have shown that lowand middle-income countries bear a growing and lopsided share of the disease burden (Am J Cancer Res 2020;10(5):1568-1591). Country case examples have highlighted the opportunities and obstacles of employing effective breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings. In all case studies, the indispensable obstacle is the same: the main cause of poor survival is a late-stage diagnosis. In these settings, multifaceted challenges to early detection, such as economic, social, geographic, and other interconnected issues, can hinder a woman’s access to early detection as well as judicious, effective, and affordable care. Efforts to overcome these challenges need to be multipronged to significantly decrease breast cancer mortality globally. In a recent consensus article from the sixth Breast Health Global Initiative Global Summit, “Breast cancer early detection: A phased approach to implementation,” Ophira Ginsburg, MD, and colleagues describe phases of early detection programs in order to ensure that critical components for improving breast cancer outcomes are established in a rational manner (Cancer 2020; https://doi.org/10.1002/ cncr.32887). Essential components of breast cancer early detection programs include recognizing the target population, defining the diagnostic tools, explaining the program strategies, and determining the rollout and scale-up process. Of course, for each element, different alternatives may be implemented, thereby ensuing in varied strategies. The phased implementation approach can be applied sequentially or in parallel, contingent on the specific environment in which implementation is taking place to advance high-quality breast health care. Overall, each phase necessitates continuous assessment and improvement to establish and sustain quality. Addressing any one of these phases in isolation will not improve breast cancer outcomes.

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