Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, and University of Washington, Seattle, WA 98195, USA.
Lancet Oncol. 2011 Apr;12(4):387-98. doi: 10.1016/S1470-2045(11)70031-6.
The purpose of the Breast Health Global Initiative (BHGI) 2010 summit was to provide a consensus analysis of breast cancer control issues and implementation strategies for low-income and middle-income countries (LMCs), where advanced stages at presentation and poor diagnostic and treatment capacities contribute to lower breast cancer survival rates than in high-income countries. Health system and patient-related barriers were identified that create common clinical scenarios in which women do not present for diagnosis until their cancer has progressed to locally advanced or metastatic stages. As countries progress to higher economic status, the rate of late presentation is expected to decrease, and diagnostic and treatment resources are expected to improve. Health-care systems in LMCs share many challenges including national or regional data collection, programme infrastructure and capacity (including appropriate equipment and drug acquisitions, and professional training and accreditation), the need for qualitative and quantitative research to support decision making, and strategies to improve patient access and compliance as well as public, health-care professional, and policy-maker awareness that breast cancer is a cost-effective, treatable disease. The biggest challenges identified for low-income countries were little community awareness that breast cancer is treatable, inadequate advanced pathology services for diagnosis and staging, and fragmented treatment options, especially for the administration of radiotherapy and the full range of systemic treatments. The biggest challenges identified for middle-resource countries were the establishment and maintenance of data registries, the coordination of multidisciplinary centres of excellence with broad outreach programmes to provide community access to cancer diagnosis and treatment, and the resource-appropriate prioritisation of breast cancer control programmes within the framework of existing, functional health-care systems.
乳腺健康全球倡议（BHGI）2010 峰会的目的是对乳腺癌控制问题和中低收入国家（LMCs）实施策略进行共识分析，这些国家在就诊时多为晚期，诊断和治疗能力较差，导致乳腺癌生存率低于高收入国家。确定了与卫生系统和患者相关的障碍，这些障碍导致了常见的临床情况，即妇女在癌症进展到局部晚期或转移性阶段之前不会进行诊断。随着国家向更高的经济地位发展，晚期就诊率预计会下降，诊断和治疗资源预计会得到改善。LMCs 的医疗保健系统面临许多挑战，包括国家或地区数据收集、方案基础设施和能力（包括适当的设备和药物采购，以及专业培训和认证）、支持决策的定性和定量研究的需求，以及改善患者获得和遵医行为的策略，以及提高公众、医疗保健专业人员和决策者对乳腺癌是一种具有成本效益、可治疗疾病的认识。低收入国家面临的最大挑战是社区对乳腺癌可治疗的认识不足，诊断和分期的高级病理学服务不足，以及治疗方案支离破碎，特别是在放疗和各种系统治疗的应用方面。中等资源国家面临的最大挑战是建立和维护数据登记处，协调具有广泛外联计划的多学科卓越中心，为社区提供癌症诊断和治疗，以及在现有功能卫生保健系统框架内对乳腺癌控制方案进行资源适当的优先排序。
