Breast Cancer in Limited‐Resource Countries: Health Care Systems and Public Policy

Abstract:   As the largest cancer killer of women around the globe, breast cancer adversely impacts countries at all levels of economic development. Despite major advances in the early detection, diagnosis, and treatment of breast cancer, health care ministries face multitiered challenges to create and support health care programs that can improve breast cancer outcomes. In addition to the financial and organizational problems inherent in any health care system, breast health programs are hindered by a lack of recognition of cancer as a public health priority, trained health care personnel shortages and migration, public and health care provider educational deficits, and social barriers that impede patient entry into early detection and cancer treatment programs. No perfect health care system exists, even in the wealthiest countries. Based on inevitable economic and practical constraints, all health care systems are compelled to make trade‐offs among four factors: access to care, scope of service, quality of care, and cost containment. Given these trade‐offs, guidelines can define stratified approaches by which economically realistic incremental improvements can be sequentially implemented within the context of resource constraints to improve breast health care. Disease‐specific “vertical” programs warrant “horizontal” integration with existing health care systems in limited‐resource countries. The Breast Health Global Initiative (BHGI) Health Care Systems and Public Policy Panel defined a stratified framework outlining recommended breast health care interventions for each of four incremental levels of resources (basic, limited, enhanced, and maximal). Reallocation of existing resources and integration of a breast health care program with existing programs and infrastructure can potentially improve outcomes in a cost‐sensitive manner. This adaptable framework can be used as a tool by policymakers for program planning and research design to make best use of available resources to improve breast health care in a given limited‐resource setting.

[1]  Stephen W Duffy,et al.  Breast Cancer in Limited‐Resource Countries: Early Detection and Access to Care , 2006, The breast journal.

[2]  G. Putoto.  The role of Northern NGOs (Non-Governmental Organisations) in rehabilitating the health sector in post-conflict settings: a need for a critical analysis. , 1997, World hospitals and health services : the official journal of the International Hospital Federation.

[3]  J. Aubel,et al.  Health workers' attitudes can create communication barriers. , 1991, World health forum.

[4]  N. Pfeffer.  Screening for breast cancer: candidacy and compliance. , 2004, Social science & medicine.

[5]  C. Varricchio,et al.  Women's health advocacy: its growth and development in oncology. , 1995, Seminars in oncology nursing.

[6]  J. Pfeiffer.  International NGOs and primary health care in Mozambique: the need for a new model of collaboration. , 2003, Social science & medicine.

[7]  L. Reichenbach,et al.  The Politics of Priority Setting for Reproductive Health: Breast and Cervical Cancer in Ghana , 2002, Reproductive health matters.

[8]  S. Cowley,et al.  The development of palliative care in national government policy in England, 1986–2000 , 2003, Palliative medicine.

[9]  A. Haines,et al.  Health financing to promote access in low income settings—how much do we know? , 2004, The Lancet.

[10]  K. Donelan,et al.  Physicians' perspectives on caring for patients in the United States, Canada, and West Germany. , 1993, The New England journal of medicine.

[11]  D. Sahn,et al.  Have structural adjustments led to health sector reform in Africa? , 1995, Health policy.

[12]  Stephen Taplin,et al.  Early Detection of Breast Cancer in Countries with Limited Resources , 2003, The breast journal.

[13]  A. Jemal,et al.  Global cancer statistics , 2011, CA: a cancer journal for clinicians.

[14]  J. Broomberg.  Managing the health care market in developing countries: prospects and problems. , 1994, Health policy and planning.

[15]  D. Radice,et al.  Breast cancer management: quality-of-life and cost considerations. , 2003, PharmacoEconomics.

[16]  R. Sankaranarayanan.  Cancer Survival in Developing Countries , 1998 .

[17]  S. Ramirez,et al.  Paradigms of public-private partnerships in end-stage renal disease care: the National Kidney Foundation Singapore. , 2003, Kidney international. Supplement.

[18]  J. Buchan.  International rescue? The dynamics and policy implications of the international recruitmen of nurses to the UK , 2004, Journal of health services research & policy.

[19]  Anthony Rodgers,et al.  Effectiveness and costs of interventions to lower systolic blood pressure and cholesterol: a global and regional analysis on reduction of cardiovascular-disease risk , 2003, The Lancet.

[20]  Joel W. Cohen,et al.  Spending and service use among people with the fifteen most costly medical conditions, 1997. , 2003, Health affairs.

[21]  R. Carlson,et al.  Breast Cancer in Limited‐Resource Countries: An Overview of the Breast Health Global Initiative 2005 Guidelines , 2006, The breast journal.

[22]  Kathleen M. Errico,et al.  Experiences of Breast Cancer Survivor‐Advocates and Advocates in Countries with Limited Resources: A Shared Journey in Breast Cancer Advocacy , 2006, The breast journal.

[23]  F. Bray,et al.  Cancer burden in the year 2000. The global picture. , 2001, European journal of cancer.

[24]  P. Born,et al.  Health Maintenance Organization (HMO) Performance and Consumer Complaints: An Empirical Study of Frustrating HMO Activities , 2004, Hospital topics.

[25]  Dominic Montagu,et al.  Franchising of health services in low-income countries. , 2002, Health policy and planning.

[26]  R. Nadišauskienė,et al.  Women’s Health, Changes and Challenges in Health Policy Development in Lithuania , 2002, Reproductive health matters.

[27]  A. Rothberg.  Making Choices in Health: WHO Guide to Cost Effectiveness Analysis , 2008 .

[28]  Christopher J L Murray,et al.  WHO Framework Convention on Tobacco Control: development of an evidence based global public health treaty , 2003, BMJ : British Medical Journal.

[29]  J. Msuya,et al.  Does preventive health care have a chance in the changing health sector in Tanzania? , 2004, East African medical journal.

[30]  N. Dubrawsky.  Cancer statistics , 1989, CA: a cancer journal for clinicians.

[31]  Patrick C. Walsh,et al.  American Cancer Society Guidelines for the Early Detection of Cancer , 2002, CA: a cancer journal for clinicians.

[32]  David A. Leon,et al.  Health policy-making in central and eastern Europe: lessons from the inaction on injuries? , 2000, Health policy and planning.

[33]  David W. Bates,et al.  A Consensus Action Agenda for Achieving the National Health Information Infrastructure , 2004, Journal of the American Medical Informatics Association.

[34]  M. González-Block,et al.  Health policy and systems research agendas in developing countries , 2004, Health research policy and systems.

[35]  S. Obenauer,et al.  Computer‐Aided Detection in Full‐Field Digital Mammography: Detection in Dependence of the BI‐RADS Categories , 2006, The breast journal.

[36]  S R Hernandez,et al.  Horizontal and vertical healthcare integration: lessons learned from the United States. , 2000, HealthcarePapers.

[37]  J. Bailes.  Use and coverage of novel cancer agents in managed care. , 1994, Seminars in oncology.

[38]  A. Jemal,et al.  Cancer Statistics, 2005 , 2005, CA: a cancer journal for clinicians.

[39]  L. Remennick.  Breast screening practices among Russian immigrant women in Israel. , 1999, Women & health.

[40]  Roman Shyyan,et al.  Introduction of Breast Cancer Screening in Chernihiv Oblast in the Ukraine: Report of a PATH Breast Cancer Assistance Program Experience , 2003, The breast journal.

[41]  S. S. Sule.  Community participation in health and development. , 2004, Nigerian journal of medicine : journal of the National Association of Resident Doctors of Nigeria.

[42]  R. Carlson,et al.  Treatment of Breast Cancer in Countries with Limited Resources , 2003, The breast journal.

[43]  J W Cullen,et al.  Cancer prevention and control. , 1994, Seminars in oncology.

[44]  Kate Macintyre,et al.  Mapping capacity in the health sector: a conceptual framework. , 2002, The International journal of health planning and management.

[45]  G. Omenn.  Prevention policy: perspectives on the critical interaction between research and policy. , 1994, Preventive Medicine.

[46]  A. Reath.  Intelligible character and the reciprocity thesis 1 , 1993 .

[47]  G. Hortobagyi,et al.  Costs and Health Effects of Breast Cancer Interventions in Epidemiologically Different Regions of Africa, North America, and Asia , 2006, The breast journal.

[48]  A. David.  Women's health. Community input into health. , 1995, Nursing times.

[49]  D. M. Parkin,et al.  Corrigendum to “Cancer burden in the year 2000. The global picture” [European Journal of Cancer,37(Suppl. 8) (2001) S4–S66] , 2003 .

[50]  R. Baltussen,et al.  Cost-effectiveness analysis of cataract surgery: a global and regional analysis. , 2004, Bulletin of the World Health Organization.

[51]  I. Gram,et al.  Cancer anxiety and attitudes toward mammography among screening attenders, nonattenders, and women never invited. , 1992, American journal of public health.

[52]  B. Mittal,et al.  Fight against cancer in countries with limited resources: the post-genomic era scenario. , 2004, Asian Pacific journal of cancer prevention : APJCP.

[53]  Lynn Calman,et al.  The global shortage of registered nurses: An overview of issues and actions , 2004 .

[54]  S. Braun.  The History of Breast Cancer Advocacy , 2003, The breast journal.

[55]  B. McPake,et al.  How to bridge the gap in human resources for health , 2004, The Lancet.

[56]  D. Fell,et al.  Impact and inequity of inpatient waiting times for advanced cardiovascular services in community hospitals across the greater Toronto area. , 1999, Canadian Journal of Cardiology.

[57]  C. Victora,et al.  Making health systems more equitable , 2022 .

[58]  A. David.  Community input into health. , 1995 .

[59]  Robert A Smith,et al.  American Cancer Society Guidelines for the Early Detection of Cancer, 2005 , 2005, CA: a cancer journal for clinicians.

[60]  Paola Pisani,et al.  Outcome of screening by clinical examination of the breast in a trial in the Philippines , 2006, International journal of cancer.

[61]  R. Bitrán.  Efficiency and quality in the public and private sectors in Senegal. , 1995, Health policy and planning.

[62]  D. M. Parkin,et al.  Use of Statistics to Assess the Global Burden of Breast Cancer , 2006, The breast journal.

[63]  E. Winer,et al.  NCCN Practice Guidelines for Breast Cancer. , 2000, Oncology.

[64]  Steven Russell,et al.  The economic burden of illness for households in developing countries: a review of studies focusing on malaria, tuberculosis, and human immunodeficiency virus/acquired immunodeficiency syndrome. , 2004, The American journal of tropical medicine and hygiene.

[65]  J. Ferlay,et al.  Global Cancer Statistics, 2002 , 2005, CA: a cancer journal for clinicians.

[66]  S. Love,et al.  Breast Cancer from a Public Health Perspective , 2004, The breast journal.

[67]  B. Vikram,et al.  Breast Cancer in Limited‐Resource Countries: Treatment and Allocation of Resources , 2006, The breast journal.

[68]  Taylor Murray,et al.  Cancer statistics, 2000 , 2000, CA: a cancer journal for clinicians.

[69]  C. Lehman,et al.  Diagnosis of Breast Cancer in Countries with Limited Resources , 2003, The breast journal.

[70]  Eusoma.  The requirements of a specialist breast unit. , 2000, European journal of cancer.

[71]  M. Reich,et al.  Political analysis of health reform in the Dominican Republic. , 1999, Health policy and planning.

[72]  Constance Lehman,et al.  Overview of Breast Health Care Guidelines for Countries with Limited Resources , 2003, The breast journal.

[73]  B. Trock,et al.  Psychological and behavioral implications of abnormal mammograms. , 1991, Annals of internal medicine.

[74]  Sanjay Kumar.  Non-governmental report spells out failings in India's health care , 1998, The Lancet.

[75]  Pradeep Ray,et al.  CSCW-based system development methodology for health-care information systems. , 2003, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[76]  J. Bryce,et al.  Achieving universal coverage with health interventions , 2004, The Lancet.

[77]  Rajendra A Badwe,et al.  Breast Cancer in Limited‐Resource Countries: Diagnosis and Pathology , 2006, The breast journal.

[78]  L. Remennick.  Preventive behavior among recent immigrants: Russian-speaking women and cancer screening in Israel. , 1999, Social science & medicine.

[79]  Kate Macintyre,et al.  Understanding referral from primary care clinics in rural Kenya: using health information systems to prioritize health services. , 2003, The International journal of health planning and management.

[80]  W George,et al.  Prospects and Problems , 1975 .

[81]  A. Ezzat,et al.  Book review: National cancer control programmes, policies and managerial guidelines. , 1996, Annals of Saudi medicine.

[82]  I. Magrath,et al.  Cancer in developing countries: opportunity and challenge. , 1993, Journal of the National Cancer Institute.

[83]  D. Parkin,et al.  An overview of cancer survival in developing countries. , 1998, IARC scientific publications.

[84]  A. Maynard,et al.  Universal coverage and cost control: the United Kingdom National Health Service. , 1998, Journal of health and human services administration.

[85]  L. Gilson,et al.  The potential of health sector non-governmental organizations: policy options. , 1994, Health policy and planning.

[86]  G. Lim,et al.  Overview of cancer in Malaysia. , 2002, Japanese journal of clinical oncology.

[87]  L. Remennick,et al.  The Challenge of Early Breast Cancer Detection among Immigrant and Minority Women in Multicultural Societies , 2006, The breast journal.

[88]  Sule Ss.  Community participation in health and development. , 2004 .

[89]  S. Moss,et al.  Psychiatric morbidity associated with screening for breast cancer. , 1989, British Journal of Cancer.

[90]  W. Lawrence,et al.  Costs and benefits of different strategies to screen for cervical cancer in less-developed countries. , 2002, Journal of the National Cancer Institute.

[91]  Marita Schlesser,et al.  Assessing Community Health Among Indigenous Populations in Ecuador with a Participatory Approach: Implications for Health Reform , 2001, Journal of Community Health.

[92]  Sidney Ruth Schuler,et al.  Paying for reproductive health services in Bangladesh: intersections between cost, quality and culture. , 2002, Health policy and planning.

[93]  Bailes Js.  Use and coverage of novel cancer agents in managed care. , 1994 .

[94]  G. Dziekan,et al.  The cost-effectiveness of policies for the safe and appropriate use of injection in healthcare settings. , 2003, Bulletin of the World Health Organization.

[95]  O. Razum,et al.  Self-help: What future role in health care for low and middle-income countries? , 2004, International journal for equity in health.

[96]  J. Reschovsky,et al.  Do HMOs make a difference? Summary and implications. , 1999, Inquiry : a journal of medical care organization, provision and financing.