Breast cancer control is most successful when prevention, early diagnosis, treatment and palliation are integrated and synchronously developed. Comprehensive breast cancer care requires an effective health system with trained community health care personnel, including physicians, nurses, psychologists, social workers and other specialized professionals. This summary covers planning for breast cancer programs and introduces the concepts of knowledge summaries and resource-stratified pathways.
Improving access to care and reducing disparities in outcomes requires identifying, understanding and addressing numerous barriers across the cancer care continuum. Barriers differ by location and population, but can generally be characterized as structural, sociocultural, personal and financial. Reducing barriers to cancer care services can improve patient outcomes, provided appropriate diagnostic and treatment facilities are available, accessible and acceptable. This summary discusses how to improve equitable access to breast cancer care by reducing barriers to breast health services.
Preventive services are often a lower priority in the spectrum of cancer care and thus receive less funding and attention. However, reducing the incidence of breast cancer can affect quality of life for women as well as reduce health care expenditures. This summary covers preventive approaches including prophylactic medications, prophylactic surgery and lifestyle modifications for breast cancer prevention as well as health professional training and individual risk assessments.
Early diagnosis of breast cancer begins with the establishment of programs to improve early detection of symptomatic women. Early recognition of symptoms and accurate diagnosis of breast cancer can result in cancers being diagnosed at earlier stages when treatment is more feasible, affordable and effective. This requires that health systems have trained frontline personnel who are able to recognize the signs and symptoms of breast abnormalities, perform clinical breast examand know the proper referral protocol when diagnostic workup is warranted.
The goal of early detection is to increase the chances of successful treatment by detecting the disease at an early stage, when the available treatments are more effective. This summary discusses how mammography can play an important role in breast cancer control programs when the incidence of breast cancer in the target population is high and resources for providing an accurate diagnosis and effective treatment are universally available and accessible in a timely manner.
Diagnosis requires an efficient referral process and timely coordination of services that include: 1) initial presentation for evaluation of a breast complaint; 2) imaging studies; 3) biopsy of suspicious lesions; 4) pathology (histology/cytology) studies and 5) return visit to review the results of diagnostic studies and to discuss a treatment plan. A lack of coordination of care and poor patient access to care can cause delays in definitive diagnosis and initiation of treatment, with the potential to negatively influence outcomes.
The success of an effective breast health care program is directly related to the availability and quality of breast pathology. Accurate tissue diagnosis is the cornerstone of cancer therapy. All women with a suspected breast mass require an accurate pathologic diagnosis before initiating treatment, even when the clinical findings are strongly suggestive of cancer. This summary expands upon breast cancer biopsy, pathology and subtypes.
Surgical care is one of the primary treatment modalities for locoregional breast cancer; radiotherapy and systemic therapy are the other primary modalities. Surgical care for breast cancer requires expert surgical training and coordination of care. The type of surgery will depend on the disease stage, tumor characteristics, patient preferences and resources available for neoadjuvant (preoperative) and adjuvant (postoperative) treatments. This summary covers surgery as a treatment option for breast cancer.
Radiotherapy is an essential component of the multimodality treatment of breast cancer. Estimates suggest that 60% of all breast cancer patients in the United States would benefit from at least one course of radiotherapy for either curative, definitive treatment or palliation. In LMICs, where most women present with locally advanced breast cancer, the percentage of women who would benefit from radiotherapy is even greater, yet the gap between the demand and available supply continues to grow.
This summary is one of two Systemic Therapy Knowledge Summaries. It covers chemotherapy, which plays a central role in the treatment of breast cancer for the majority of patients at all resource levels. Chemotherapy improves survival, reduces recurrence and has the capacity to improve candidacy for definitive surgery or for breast conservation when used before surgery. It can also be used to palliate painful symptoms of advanced disease.
This summary is one of two Systemic Therapy Knowledge Summaries. It covers hormonal therapy and targeted agents. Targeted therapies have transformed the way cancer is understood and treated, and allow personalization of treatment according to each individual’s tumor characteristics. Targeted cancer therapies are drugs or other substances that block the growth of cancer by interfering with specific molecules (molecular targets or receptors) that are involved in the growth, progression and spread of cancer.
Breast cancer patients require palliative care for the prevention and management of physical as well as psychosocial adverse effects of cancer and its treatments. Emphasis on quality of life is a primary goal of care when considering treatment options and managing treatment-related complications. In low-resource settings, the capacity to manage side effects and toxicities should be a factor in the selection of treatment options for breast cancer. Patient education and counseling are part of treatment planning and should include information about potential treatment-related side effects.
A large percentage of women in low- and middle-income countries (LMICs) who develop breast cancer present with advanced (metastatic) disease. In the majority of these cases, treatment with curative intent is not possible. The survival of patients after a diagnosis of metastatic cancer depends on tumor characteristics and available therapies, but ranges from several months to several years, therefore palliative care represents a substantial contribution to breast cancer programs. This summary expands upon palliative care for metastatic breast cancer.
Breast cancer survivors are patients who have entered the postreatment phase after the successful completion of breast cancer therapy with curative intent; longer-term endocrine therapy and/or targeted therapy may continue during survivorship care. Globally, breast cancer survival rates are increasing, creating a new generation of survivors in need of ongoing care and counseling. Evidence suggests that a significant number of people with a cancer diagnosis have unmet informational, psychosocial and physical needs which can be effectively addressed through survivorship care interventions.
Presented in Tbilisi, Georgia, October 2013 by Jo Anne Zujewski, M.D., Medical Oncologist and Specialist in Breast Cancer, Bethesda, Maryland
A guide on what is needed to establish a national cancer control program incuding resources and collaborations.
An introduction to the origin, evolution and principles of patient navigation in the October 2012 issue of Cancer Epidemiology, Biomarkers & Prevention.
The Community Tool Box is a free, online resource for those working to build healthier communities and bring about social change. It offers thousands of pages of tips and tools for taking action in communities.
The South African Cancer Advocacy Toolkit is based on the Photovoice research outcomes of Dr. Lynn Edwards and Linda Greeff. The Toolkit provides fact sheets, policy briefs and notes on how to meet the challenges, aimed at policy and decision makers.
A toolkit developed by AfrOx, Aortic/OAREC, ESMO and UICC that provides information for developing various an advocacy programs and involving various audiences such a political, education and the media.