Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Department of Global Health, University of Washington, Seattle, WA, USA.
Lancet Oncol. 2017 Oct;18(10):e607-e617. doi: 10.1016/S1470-2045(17)30592-2.
Breast cancer incidence and mortality rates continue to rise in Peru, with related deaths projected to increase from 1208 in 2012, to 2054 in 2030. Despite improvements in national cancer control plans, various barriers to positive breast cancer outcomes remain. Multiorganisational stakeholder collaboration is needed for the development of functional, sustainable early diagnosis, treatment and supportive care programmes with the potential to achieve measurable outcomes. In 2011, PATH, the Peruvian Ministry of Health, the National Cancer Institute in Lima, and the Regional Cancer Institute in Trujillo collaborated to establish the Community-based Program for Breast Health, the aim of which was to improve breast health-care delivery in Peru. A four-step, resource-stratified implementation strategy was used to establish an effective community-based triage programme and a practical early diagnosis scheme within existing multilevel health-care infrastructure. The phased implementation model was initially developed by the Breast Cancer Initiative 2·5: a group of health and non-governmental organisations who collaborate to improve breast cancer outcomes. To date, the Community-based Program for Breast Health has successfully implemented steps 1, 2, and 3 of the Breast Cancer Initiative 2·5 model in Peru, with reports of increased awareness of breast cancer among women, improved capacity for early diagnosis among health workers, and the creation of stronger and more functional linkages between the primary levels (ie, local or community) and higher levels (ie, district, region, and national) of health care. The Community-based Program for Breast Health is a successful example of stakeholder and collaborator involvement-both internal and external to Peru-in the design and implementation of resource-appropriate interventions to increase breast health-care capacity in a middle-income Latin American country.
乳腺癌在秘鲁的发病率和死亡率持续上升，相关死亡人数预计将从 2012 年的 1208 人增加到 2030 年的 2054 人。尽管国家癌症控制计划有所改善，但仍存在各种阻碍乳腺癌积极结果的因素。需要多组织利益相关者合作，制定具有功能和可持续性的早期诊断、治疗和支持性护理方案，以实现可衡量的结果。2011 年，PATH、秘鲁卫生部、利马国家癌症研究所和特鲁希略地区癌症研究所合作建立了社区乳腺健康计划，旨在改善秘鲁的乳腺保健服务。该计划采用了四步、资源分层的实施策略，在现有的多层次卫生保健基础设施内建立了一个有效的社区分诊计划和一个实用的早期诊断方案。该阶段性实施模式最初是由乳腺癌倡议 2.5 开发的：一组卫生和非政府组织合作以改善乳腺癌的结果。迄今为止，社区乳腺健康计划已在秘鲁成功实施了乳腺癌倡议 2.5 模型的步骤 1、2 和 3，报告称妇女对乳腺癌的认识有所提高，卫生工作者进行早期诊断的能力有所提高，并且在基层（即地方或社区）和较高层次（即区、地区和国家）之间建立了更强、更有效的联系卫生保健。社区乳腺健康计划是利益相关者和合作者参与的成功范例，包括秘鲁国内外的参与，在设计和实施资源适当的干预措施方面取得了成功，以提高中美洲国家的乳腺保健能力。
