Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study

Publication date: August 2018Source: The Lancet Global Health, Volume 6, Issue 8Author(s): Jeanette K Birnbaum, Catherine Duggan, Benjamin O Anderson, Ruth EtzioniSummaryBackgroundPoor breast cancer survival in low-income and middle-income countries (LMICs) can be attributed to advanced-stage presentation and poor access to systemic therapy. We aimed to estimate the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy in LMICs.MethodsWe adapted a microsimulation model to project outcomes of three early detection strategies alone or in combination with three systemic treatment programmes beyond standard of care (programme A): programme B was endocrine therapy for all oestrogen-receptor (ER)-positive cases; programme C was programme B plus chemotherapy for ER-negative cases; programme D was programme C plus chemotherapy for advanced ER-positive cases. The main outcomes were reductions in breast cancer-related mortality and lives saved per 100 000 women relative to the standard of care for women aged 30–49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumour characteristics from various East African countries) and for women aged 50–69 years in a middle-income setting (Colombia).FindingsIn the East African setting, relative mortality reductions were 8–41%, corresponding to 23 (95% uncertainty interval −12 to 49) to 114 (80 to 138) lives saved per 100 ...
Source: The Lancet Global Health - Category: International Medicine & Public Health Source Type: research