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Newly Available Guidelines Promise Better Results in Breast Cancer Care

PAHO partners with the Breast Health Global Initiative to promote "best practices" in developing countries

Washington, D.C., July 26, 2007 (PAHO)—International guidelines for the detection, care and management of breast cancer are now available in Spanish thanks to a partnership between the Pan American Health Organization (PAHO) and the Breast Health Global Initiative (BHGI).

The Guidelines for International Breast Health and Cancer Control, published in English in an updated form last year, are intended to help policymakers and health care providers in low- and middle-income countries improve breast cancer outcomes through evidence-based, economically feasible, and culturally appropriate practices. The guidelines address a full range of issues including early detection and access to care, diagnosis and pathology, treatment and resource allocation, and health care systems and public policy.

Breast cancer is newly diagnosed in more than 1 million women each year and is the most common cause of cancer-related deaths among women worldwide. Women in low- and middle-income countries are more likely to die of the disease than those in richer countries, in part because their cancers are commonly detected and treated in advanced stages, when treatment is more expensive and least successful.

"Breast cancer is a growing problem in Latin America, with some 90,000 cases reported every year, many of them at advanced stages because of poor access to preventive and curative services," said PAHO Director Dr. Mirta Roses. "The availability of these guidelines in Spanish will be an important contribution for those interested in expanding health services to reach Latin American women early and to improve their quality of life."

Major scientific advances in detection and management of breast cancer have improved outcomes in developed countries, but health care providers in lower income countries face resource constraints that limit their ability to apply these advances to improve breast cancer care. The Guidelines for International Breast Health and Cancer Control address this problem by recommending the most appropriate and applicable "best practices" for countries with limited resources.

The guidelines recommend a stepwise, tiered system of resource allocation on four levels—basic, limited, enhanced and maximal—depending on the availability of resources. In the areas of detection and access to care, for example, they recommend that countries with very basic health systems educate women about performing breast self-examination to detect lumps. For countries with more but still limited resources, they recommend targeted outreach and education on clinical breast examination to women in at-risk groups, followed by ultrasound or mammography to confirm the discovery of suspected lumps.

In the area of detection and diagnostics, the guidelines recommend both ultrasound and mammography as cost-effective. However, ultrasound, which can be used to diagnose other conditions, may be implemented before mammography if resources do not allow for both.

In terms of treatment, breast-conserving procedures require more health care resources and infrastructure than mastectomy but can be provided in a carefully designed limited-resource setting. Systemic treatments are critical for improved survival, the guidelines note. The selection of appropriate hormonal treatments for individual patients requires estrogen receptor testing. Chemotherapy requires adequate resources and infrastructure and should be used to treat node-positive locally advanced breast cancers, the most common clinical presentation of the disease in low-resource countries. If chemotherapy is not available, patients with locally advanced, hormone receptor–negative cancers can only receive palliative care.

The guidelines call for additional research to assess how these recommendations can be best implemented in limited-resource settings.

Translation of the Guidelines for International Breast Health and Cancer Control into the world's major languages is a long-standing goal of BHGI, and future plans include translation into Russian, Chinese, and Arabic. The partnership with PAHO to produce a Spanish translation grew out of discussions at the International Union Against Cancer Conference in Washington in July 2006.

"The availability of these guidelines in Spanish is a major leap forward in reaching ministries of health, health care providers, and policymakers in Spanish-speaking countries," said Dr. Benjamin O. Anderson, chairman and director of BHGI. "With this and future translations, we hope to lessen the global burden of this devastating disease."

The Spanish version of Guidelines for International Breast Health and Cancer Control (Normas internacionales para la salud de mama y el control del cáncer de mama) may be downloaded in Spanish through the websites of PAHO and BHGI.

The Breast Health Global Initiative, an extensive international alliance of organizations and individuals around the world devoted to medically underserved women, is sponsored by the Fred Hutchinson Cancer Research Center and Susan G. Komen for the Cure.

The Pan American Health Organization, founded in 1902, works with all the countries of the Americas to improve the health and quality of life of their peoples. It serves as the Regional Office of the World Health Organization (WHO).

For more information please contact , PAHO, Public Information, 202-974-3122.