In this study, we investigated the barriers to the delivery of internationally accepted breast cancer care in low resource settings (LRS) as compared to well-endowed resource settings (WRS) via an online survey. The survey was completed by 199 surgeons from eleven countries: 51 from WRS and 148 from LRS, based on our definition. The two most common facilities lacking in LRS were sentinel lymph node biopsy and immune-histochemistry (67% and 60% respectively). Only 22% respondents from LRS confirmed that all their eligible patients received hormonal therapy and only 8% radiotherapy as compared to 98% and 75% from WRS. Widespread limitations exist in most LRS, making internationally accepted breast cancer treatment guidelines impossible to follow, and thus resulting in suboptimal cancer care.
SungHFerlayJSiegelRL, et al.Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin2021; 71: 209–249.
2.
AlthuisMDDozierJMAndersonWF, et al.Global trends in breast cancer incidence and mortality 1973-1997. Int J Epidemiol2005; 34: 405–412.
3.
GoutsouliakKVeeraraghavanJSethunathV, et al.Towards personalized treatment for early stage HER2-positive breast cancer. Nat Rev Clin Oncol2020; 17: 233–250.
4.
GradisharWJAndersonBOAbrahamJ, et al.Breast cancer, version 3.2020, NCCN clinical practice guidelines in oncology. J Natl Compr Canc Netw 2020; 18: 452–478. Retrieved Sept 9, 2021, from https://jnccn.org/view/journals/jnccn/18/4/article-p452.xml.
5.
Paluch-ShimonSCardosoFPartridgeAH, et al.ESO-ESMO 4th international consensus guidelines for breast cancer in young women (BCY4). Ann Oncol2020; 31: 674–696.
6.
KropIIsmailaNStearnsV. Use of biomarkers to guide decisions on adjuvant systemic therapy for women with early-stage invasive breast cancer: american society of clinical oncology clinical practice focused update guideline summary. J Oncol Pract2017; 13: 763–766.
7.
BrandNRQuLGChaoA, et al.Delays and barriers to cancer care in low- and middle-income countries: a systematic review. Oncologist2019; 24: e1371–e1380.
8.
ShahSCKayambaVPeekRM,et al.Cancer control in low- and middle-income countries: is it time to consider screening?J Glob Oncol2019; 5: –8.
9.
MutebiMAndersonBODugganC, et al.Breast cancer treatment: a phased approach to implementation. Cancer2020; 126: 2365–2378.
10.
AngladeFMilnerDABrockJE. Can pathology diagnostic services for cancer be stratified and serve global health?Cancer2020; 126: 2431–2438.
11.
AndersonBOYipCHSmithRA, et al.Guideline implementation for breast healthcare in low-income and middle-income countries: overview of the breast health global initiative global summit 2007. Cancer2008 Oct 15; 113: 2221–2243.
12.
CarlsonRWScavoneJKohW-J, et al.NCCN Framework for resource stratification: a framework for providing and improving global quality oncology care. J Natl Compr Canc Netw2016; 14: 961–969.
13.
ShingdeRSalinderaSAherneNJ, et al.Survival outcomes for breast cancer patients who decline recommended treatment: a propensity score-matched analysis. ANZ J Surg2021; 91: 1766–1771.
14.
HillDAFriendSLomoL, et al.Breast cancer survival, survival disparities, and guideline-based treatment. Breast Cancer Res Treat2018; 170: 405–414.
15.
WöckelAWoltersRWiegelT, et al.The impact of adjuvant radiotherapy on the survival of primary breast cancer patients: a retrospective multicenter cohort study of 8935 subjects. Ann Oncol2014; 25: 628–632.
16.
HoPJOwSGWSimY, et al.Impact of deviation from guideline recommended treatment on breast cancer survival in Asia. Sci Rep2020; 10: 1330.
17.
HershmanDLShaoTKushiLH, et al.Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat2011; 126: 529–537.
18.
Yadav SK, Carpenter A, Rai R, Jha CK, Sharma D. Low-Cost Vacuum Assisted Core Needle Biopsy Technique for Breast Lumps. World J Surg. 2022 Feb 15. doi: 10.1007/s00268-022-06475-3. Epub ahead of print.
19.
Chavda J, Mishra A, Silodia A, Yadav SK, Sharma DB, Sharma D, Khandare M. Validation sentinel lymph node biopsy study in cN0 axilla using low-cost dual dye technique: potential solution for resource poor settings. Breast Cancer Res Treat. 2022 Mar 5. doi: 10.1007/s10549-022-06556-w. Epub ahead of print.
20.
Kumar S, Usmanova G, Nair TS, et al. Implementation of a large-scale breast cancer early detection program in a resource-constrained setting: real-world experiences from 2 large states in India. Cancer. 2022 Feb 8. doi: 10.1002/cncr.34114. Epub ahead of print.
21.
EspinaCMcKenzieFDos-Santos-SilvaI. Delayed presentation and diagnosis of breast cancer in African women: a systematic review. Ann Epidemiol2017; 27: 659–671.e7.
22.
ForoozaniEGhiasvandRMohammadianpanahM, et al.Determinants of delay in diagnosis and end stage at presentation among breast cancer patients in Iran: a multi-center study. Sci Rep2020; 10: 21477.
23.
PoumAPromthetSDuffySW,et al.Factors associated with delayed diagnosis of breast cancer in northeast Thailand. J Epidemiol2014; 24: 102–108.
24.
YadavHShahDSayedS, et al.Availability of essential diagnostics in ten low-income and middle-income countries: results from national health facility surveys. Lancet Glob Health2021 Oct 5; S2214–109X(21)00442-3. Epub ahead of print.
25.
KnightSRShawCAPiusR, et al.Global variation in postoperative mortality and complications after cancer surgery: a multicentre, prospective cohort study in 82 countries. Lancet2021; 397: 387–397.
