Yip C H, Buccimazza I, Hartman M, Deo S V S, Cheung P S Y
Department of Surgery, University of Malaya, Kuala Lumpur, Malaysia,
World J Surg. 2015 Mar;39(3):686-92. doi: 10.1007/s00268-014-2859-6.
Breast cancer is the most common cancer in women world-wide. Incidence rates in low- and middle-income countries (LMICs) are lower than in high income countries; however, the rates are increasing very rapidly in LMICs due to social changes that increase the risk of breast cancer. Breast cancer mortality rates in LMICs remain high due to late presentation and inadequate access to optimal care. Breast Surgery International brought together a group of breast surgeons from different parts of the world to address strategies for improving outcomes in breast cancer for LMICs at a symposium during International Surgical Week in Helsinki, Finland in August 2013. A key strategy for early detection is public health education and breast awareness. Sociocultural barriers to early detection and treatment need to be addressed. Optimal management of breast cancer requires a multidisciplinary team. Surgical treatment is often the only modality of treatment available in low-resource settings where modified radical mastectomy is the most common operation performed. Chemotherapy and radiotherapy require more resources. Endocrine therapy is available but requires accurate assessment of estrogen receptors status. Targeted therapy with trastuzumab is generally unavailable due to cost. The Breast Health Global Initiative guidelines for the early detection and appropriate treatment of breast cancer in LMICs have been specifically designed to improve breast cancer outcomes in these regions. Closing the cancer divide between rich and poor countries is a moral imperative and there is an urgent need to prevent breast cancer deaths with early detection and optimal access to treatment.
乳腺癌是全球女性中最常见的癌症。低收入和中等收入国家（LMICs）的发病率低于高收入国家；然而，由于社会变革增加了患乳腺癌的风险，LMICs的发病率正在迅速上升。由于就诊延迟和无法获得最佳治疗，LMICs的乳腺癌死亡率仍然很高。2013年8月在芬兰赫尔辛基举行的国际外科周期间，国际乳腺外科协会召集了一群来自世界各地的乳腺外科医生，在一次研讨会上探讨改善LMICs乳腺癌治疗效果的策略。早期检测的一项关键策略是公共卫生教育和乳房意识。需要解决早期检测和治疗的社会文化障碍。乳腺癌的最佳管理需要一个多学科团队。在资源匮乏的环境中，手术治疗往往是唯一可用的治疗方式，改良根治性乳房切除术是最常见的手术。化疗和放疗需要更多资源。内分泌治疗是可行的，但需要准确评估雌激素受体状态。由于成本原因，曲妥珠单抗靶向治疗通常无法获得。全球乳腺癌防治倡议针对LMICs乳腺癌早期检测和适当治疗的指南专门设计用于改善这些地区的乳腺癌治疗效果。消除富国和穷国之间的癌症差距是一项道德义务，迫切需要通过早期检测和最佳治疗途径来预防乳腺癌死亡。
