Introduction

It is an honor and privilege to be the Editors for this third publication of the Breast Health Global Initiative (BHGI) guidelines and associated articles. This publication is a culmination of months of work by a spectacular international group of more than 80 breast cancer and healthcare experts representing 40 countries of all economic strata. The intellectual stamina of this unique group to address detailed but critical issues in healthcare delivery arises from a passionate desire to be agents of change for improved healthcare for women in their own countries and around the world.

The level of enthusiasm, respect, and good will of these contributors is reflected in the final product of 15 well-honed articles that cover the spectrum of breast cancer care issues from prevention, early detection, diagnosis, pathology, treatment, radiotherapy, systemic therapy, healthcare systems, research agendas, and communication strategies. The analytic synthesis of ideas in these articles reflects a spectrum of diverse perspectives concerning healthcare delivery framed in individual but conceptually linked documents. The consensus guideline framework based on multilevel resource stratification provided a mechanism for integrating well-informed, evidence-based, but diverse, viewpoints. This methodology for complex analysis and guideline synthesis could not have worked were it not for the willingness of these experts to listen, contemplate, and adjust to ideas from others with different perspectives.

The simplicity of some consensus statements belies the significant and heartfelt debate regarding topics that have been widely studied and analyzed but for which different conclusions can be reached. For example, the authorship list of the article on early detection consensus includes experts who are widely recognized for having competing and, in some areas, contradictory opinions regarding the role of screening mammography. Despite strong differences of opinion in certain key areas, the BHGI experts were able to find common ground for providing guidance on program implementation that transcends their individual opinions and beliefs. We thank all our panelists for their willingness to remain engaged in several of these difficult dialogues that could have paralyzed the overall process and jeopardized its outcome.

The extraordinary dedication and hard work of these authors, and the people they work with every day to deliver the best possible care, is the often untold story behind technical publications. We hope that you will get a glimpse of the personal efforts that go into creating quality healthcare when you read in this publication about the collaborative effort between Norway and Ghana to re-establish a pathology service. Collaboration between countries with different resource levels is critical to establishing quality global healthcare programs.

This project would not have been possible without the diligent work of several staff members who put countless hours into the development of the Budapest Global Summit and then into the preparation of this publication. We give special thanks to Leslie Sullivan, BHGI Senior Program Manager, for outstanding management of the BHGI alliance, program development, and the global summit series. We would like to acknowledge Global Summit meeting coordinators Carole Fisher and Eric Tobiason of the Office of Continuing Medical Education at the University of Washington for their superb professionalism in the meeting coordination and execution. We also wish to acknowledge global summit volunteers Susan Cranston and Kim Powell, Susan G. Komen for the Cure advocate, both of whom are from Montana, for their many critical, behind-the-scenes efforts. We gratefully thank all the contributors for their efforts toward improving breast cancer care and are honored to have worked with them to create this publication.

The first BHGI publication in 2002 identified a woman's right to healthcare as a core BHGI principle, namely that a successful breast healthcare program is dependent on a woman's ability to access healthcare, and that all women have a right to access and receive healthcare that is equal to that of men. Many of the barriers to breast healthcare access are a reflection of social and economic disparities. This is true for developed countries as well as developing countries. The strategic implementation of breast cancer programs can help identify and mitigate the underlying social and cultural issues that affect women's access to healthcare. We hope that this publication, which represents an end product of all 3 BHGI Global Summits held between 2002 and 2007, can provide a framework for healthcare improvement in all countries and in some small way can contribute to the health and welfare of women in all parts of the world.

FINANCIAL DISCLOSURES

Funding for the BHGI, 2007 Global Summit on International Breast Health-Implementation and Guidelines for International Breast Health and Cancer Control-Implementation publication came from partnering organizations who share a commitment to medically underserved women. We thank and gratefully acknowledge these organizations and agencies for grants and conference support: Fred Hutchinson Cancer Research Center; Susan G. Komen For The Cure; American Society of Clinical Oncology (ASCO); US National Cancer Institute, Office of International Affairs (OIA); 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 (OWH); and US National Institutes of Health, Office of Research on Women's Health (ORWH).

*Funding for the 2007 Global Summit on International Breast Health—Implementation was made possible (in part) by Grant No. 1 R13 HS017218-01 from the Agency for Healthcare Research and Quality (AHRQ). The views expressed in written conference materials or publications and by speakers and moderators do not necessarily reflect the official policies of the Department of Health and Human Services; nor does mention of trade names, commercial practices, or organizations suggest endorsement by the US Government.

Acknowledgements

We thank and gratefully acknowledge the generous support of our corporate partners through unrestricted educational grants: Pfizer Inc.; AstraZeneca; Bristol-Myers Squibb Company; Ethicon Endo Surgery, Inc.; GE Healthcare; F. Hoffmann-La Roche AG; and Novartis Oncology.

BHGI is a global health alliance of organizations and individuals. We are grateful to our collaborators throughout the world who share the BHGI mission and vision. Thank you for your important contributions to this endeavor for medically underserved women.