Last Saturday, 4 February 2023, marked World Cancer Day and, in advance of this annual event, the World Health Organization (WHO) released its new Global Breast Cancer Initiative that provided a roadmap to save 2.5 million women’s lives by 2040. There are more that 2.3 million new cases of breast cancers that occur globally each year, making it the most common cancer among adults. Sadly, survival from breast cancer is extremely inequitable, with nearly 80% of deaths occurring in low- and middle-income countries.
Dr Tedros Ghebreyseus, director-general of WHO, said: “Countries with weaker health systems are least able to manage the increasing burden of breast cancer. It places a tremendous strain on individuals, families, communities, health systems, and economies, so it must be a priority for ministries of health and governments everywhere.” As seen in the illustration below left (© WHO), the 5-year breast cancer survival rate exceeds 90% in high-income countries, compared to 66% in India and 40% in South Africa.
In sub-Saharan Africa, half of all deaths from breast cancer occur in women younger than 50 years of age so that, on average, each death leads to two maternal orphans. The social and financial disruption of the disease will therefore continue to have a negative impact on families in low- and middle-income countries for years to come. There is hope, however, given what has been learned from the success achieved in high-income countries that have lowered breast cancer mortality over the past four decades. The WHO framework is built on three pillars.
Pillar 1: Health promotion for early detection [pre-diagnostic interval], where a key performance indicator (KPI) of > 60% is the target for diagnosis of invasive cancers at stages I or II. Pillar 2: Timely breast diagnostics [diagnostic interval], where the KPI set is the diagnostic evaluation, imaging, tissue sampling, and pathology within 60 days. Pillar 3: Comprehensive breast cancer management [treatment interval], where a KPI of > 80% is set for patients to undergo multi-modality treatment without abandonment.
The WHO director for non-communicable diseases, Dr Bente Mikkelsen (seen right), said: “Countries need to ensure this framework engages and integrates into primary health care. This effort would not only support health promotion, but also empower women to seek and receive health care throughout the life cycle.” The challenge now is for companies to bring to market novel diagnostic tools that can be efficiently and successfully deployed on a wde scale, and for government healthcare departments to have comprehensive treatment programmes in place.