As breast cancer deaths disproportionately affect women in low- and middle-income countries, the time is now to engage global partners to coordinate sustainable efforts and achieve favourable outcomes for these patients. Therefore, the WHO launched the Global Breast Cancer Initiative that focuses on three main aspects of breast cancer care; health promotion, timely diagnosis and comprehensive treatment.
“During the last 10 years we devoted much efforts to our project for a fairer breast cancer care in a globalized world, a project was nominated for the VBHC (Value Based Health Care) Dragon’s Grant 2021. The participation of two world-leading cancer research programs: the CONCORD program and the Breast Health Global Initiative of Benjamin Anderson were of importance in this respect. Recently we accepted to participate to the initiative discussed above, which is being supervised by the WHO Global Breast Cancer Community. The executive summary and consensus were recently published by Prof Anderson in the Lancet Oncology. It is fundamental to make breast cancer care a public health priority for all women worldwide by establishing resource-stratified guidelines (www.bhgi.info). We had the opportunity to work together with Dr Anderson. In April 2021 we published an open access article on this topic entitled “New frontiers for a fairer breast cancer care in a globalized world” in the European Journal of Breast Health (2021).7 An audiogram discussing this paper is freely available at https://research.one.surgery/new-frontiers-for-fairer-breast-cancer-care-in-a-globalized-world/”
To date, breast cancer is the most common incident and prevalent cancer worldwide, as well as the leading cause of cancer-related death in women.1 Unfortunately,breast cancer deaths disproportionately affect women in low- and middle-income countries, where most breast cancer deaths occur prematurely. Moreover, although five-year survival rates for breast cancer patients exceed 90% in high-income countries, rates are reported to be only 66% in India and 40% in South Africa.2 In high-income countries, breast cancer mortality dropped by an impressive 40% between 1989 and 2017. In contrast little progress has been made in low- and middle-income countries, underscoring a painful level of inequality.3 Premature deaths and massive health-care expenditure caused by breast cancer in these countries result in social disruption and generational impoverishment, orphaning children at devastating rates.4 In general, the higher mortality rates in low- and middle-income countries can be attributed to late-stage diagnosis and inadequate access to quality care. This is mainly the result of non-inclusion of breast cancer diagnosis and management into universal health-care commitments.5
Over the past decades, there has been a steady increase in the recognition of breast cancer as a public health priority through multiple political declarations, of which the WHO 2017 Cancer Prevention and Control Resolution is the most recent. Substantial contributions from civil society, professional organisations, and other partners have set the stage for a global response led and coordinated by WHO. The WHO will provide strategic guidance to support governments in prioritising cancer in general, and breast cancer in particular, as part of their national health agendas. This will strengthen health-care systems with breast cancer as an entry point to enable progress across all malignancies and offering broader health, social, and economic benefits. The primary objective of the Global Breast Cancer Initiative is to reduce global breast cancer mortality by increasing access to breast cancer early diagnosis and prompt comprehensive cancer management. Only then, global breast cancer mortality curves can be brought closer to the annual mortality reductions already achieved in high-income countries and millions of breast cancer deaths can be averted.5 The Global Breast Cancer Initiative will be operationalised through three interrelated approaches; I) convening stakeholders and developing a platform for action, II) operational guidance and III) in-country engagement and support.
The Global Breast Cancer Initiative will focus on three important pillars: health promotion and early detection, timely breast cancer diagnosis and comprehensive breast cancer management. For the first pillar, public education on risk-reduction strategies (e.g. promotion of lactation, avoiding obesity), are fundamental steps that must be included alongside early-detection programmes.6 Currently, late-stage presentation of breast cancer is common in low- and middle-income countries as many woman are diagnosed with locally advanced or metastatic disease. At that point, improving survival is not only less likely, it also becomes much more resource-intensive.5 The second pillar of the Global Breast Cancer Initiative focuses on accessible and rapid-diagnosis systems. Therefore, organisational efforts such as the implementation of well-structured referral protocols can facilitate prompt diagnoses and translate to conserved resources and saved lives.5 Finally, comprehensive breast cancer management forms the third pillar and aims at a patient-centred care from the beginning of therapy to multimodality treatment completion and patient rehabilitation. In addition, financial toxicity should be minimised, allowing all women to access the highest possible standard of health care.5
To formulate the Global Breast Cancer Initiative, WHO, in collaboration with the International Atomic Energy Agency and the International Agency for Research in Cancer, convened 100 multisectoral partners and global experts at the first Global Breast Cancer Consultation on World Cancer Day, February 4th, 2021. This technical consultation has set the stage for broader strategic dialogues and technical working groups to rapidly accelerate implementation of the Global Breast Cancer Initiative.5