Guideline implementation for breast healthcare in low-income and middle-income countries§

Overview of the Breast Health Global Initiative Global Summit 2007


  • The Breast Health Global Initiative (BHGI) gratefully acknowledges grants and conference support from the following organizations and agencies: Fred Hutchinson Cancer Research Center; Susan G. Komen For The Cure; American Society of Clinical Oncology; US National Cancer Institute, Office of International Affairs; American Cancer Society; Lance Armstrong Foundation; US Agency for Healthcare Research and Quality (*Grant 1 R13 HS017218-01); US Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion; American Society of Breast Disease; Oncology Nursing Society; US National Cancer Institute, Office of Women's Health; US National Institutes of Health, Office of Research on Women's Health. In addition, the BHGI received unrestricted educational grants from AstraZeneca, Bristol-Myers Squibb, Ethicon Endo-Surgery, F. Hoffmann-La Roche, GE Healthcare, Novartis Oncology, and Pfizer Oncology.

  • Complete financial disclosures are presented at the end of this article.

  • §

    This article is a US Government work and, as such, is in the public domain in the United States of America.


Breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion. The Breast Health Global Initiative (BHGI) invited international experts to review and revise previously developed BHGI resource-stratified guideline tables for early detection, diagnosis, treatment, and healthcare systems. Focus groups addressed specific issues in breast pathology, radiation therapy, and management of locally advanced disease. Process metrics were developed based on the priorities established in the guideline stratification. The groups indicated that cancer prevention through health behavior modification could influence breast cancer incidence in LMCs. Diagnosing breast cancer at earlier stages will reduce breast cancer mortality. Programs to promote breast self-awareness and clinical breast examination and resource-adapted mammographic screening are important early detection steps. Breast imaging, initially with ultrasound and, at higher resource levels with diagnostic mammography, improves preoperative diagnostic assessment and permits image-guided needle sampling. Multimodality therapy includes surgery, radiation, and systemic therapies. Government intervention is needed to address drug-delivery problems relating to high cost and poor access. Guideline dissemination and implementation research plays a crucial role in improving care. Adaptation of technology is needed in LMCs, especially for breast imaging, pathology, radiation therapy, and systemic treatment. Curricula for education and training in LMCs should be developed, applied, and studied in LMC-based learning laboratories to aid information transfer of evidence-based BHGI guidelines. Cancer 2008;113(8 suppl):2221–43. Published 2008 by the American Cancer Society.