通过筛查和/或早期检测在低收入和中等收入国家预防乳腺癌:现实与超现实。
Preventing breast cancer in LMICs via screening and/or early detection: The real and the surreal.
作者信息
Dey Subhojit
机构信息
Subhojit Dey, Indian Institute of Public Health-Delhi, Gurgaon 122002, Haryana, India.
出版信息
World J Clin Oncol. 2014 Aug 10;5(3):509-19. doi: 10.5306/wjco.v5.i3.509.
To review the present status of breast cancer (BC) screening/early detection in low- and middle-income countries (LMICs) and identify the way forward, an open focused search for articles was undertaken in PubMed, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on ResearchGate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer (BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. Notably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of mHealth for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
为了回顾低收入和中等收入国家(LMICs)乳腺癌(BC)筛查/早期检测的现状并确定未来方向,我们在PubMed、谷歌学术和谷歌上进行了公开的针对性文章搜索,并采用滚雪球技术从初始搜索结果的参考文献列表中获取了更多文章。此外,我们在ResearchGate上发布了一个查询,以获取更多参考文献并了解专家对该主题的总体看法。我们还亲自联系了专家征求他们的意见。乳腺癌(BC)是全球女性中最常见的癌症。发病率上升幅度在低收入和中等收入国家最高,这些国家的发病率通常远低于高收入国家。尽管在低收入和中等收入国家,死于癌症的女性比死于与怀孕或分娩相关原因的女性更多,但大多数关注和资源都用于孕产妇健康。此外,低收入和中等收入国家的大多数女性在晚期才到医院开始治疗。在不同的低收入和中等收入国家已经进行了一些试验,研究临床乳腺检查和乳房X线摄影的各种组合使用情况,以了解实施人群水平的乳腺癌筛查/早期检测的最佳方法;然而,针对不同低收入和中等收入国家的具体情况,该领域还急需更多研究。值得注意的是,很少有低收入和中等收入国家制定通过筛查/早期检测预防乳腺癌的国家级计划,甚至降低分期也未列入公共卫生议程。除此之外,还存在其他障碍,如女性对乳腺癌缺乏认识、存在耻辱感、态度不当以及缺乏正确的筛查行为,如进行乳房自我检查。上述情况还伴随着政策制定者的冷漠和缺乏认识,即预防乳腺癌比治疗乳腺癌更具成本效益和人道。实施人群水平的乳腺癌筛查/早期检测计划,以及采用提高女性对乳腺癌认识的方法,对于遏制低收入和中等收入国家日益增加的乳腺癌负担可能至关重要。使用更适合低收入和中等收入国家人群的超声等更新的检查手段,以及利用移动健康技术提高认识和增加筛查依从性,是低收入和中等收入国家预防乳腺癌总体议程中急需的额外补充。