TY - JOUR
T1 - Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries
T2 - a modelling study
AU - Birnbaum, Jeanette K.
AU - Duggan, Catherine
AU - Anderson, Benjamin O.
AU - Etzioni, Ruth
N1 - Publisher Copyright:
© 2018 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY 4.0 license
PY - 2018/8
Y1 - 2018/8
N2 - Background: Poor 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. Methods: We 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). Findings: In 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 100 000 women over 10 years. In Colombia, mortality reductions were 7–25%, corresponding to 32 (–29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. Interpretation: The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. Funding: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
AB - Background: Poor 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. Methods: We 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). Findings: In 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 100 000 women over 10 years. In Colombia, mortality reductions were 7–25%, corresponding to 32 (–29 to 70) to 105 (61 to 141) lives saved per 100 000 women over 10 years. Interpretation: The best projected outcomes were in settings where access to both early detection and adjuvant therapy is improved. Even in the absence of mammographic screening, improvements in detection can provide substantial benefit in settings where advanced-stage presentation is common. Funding: Fred Hutchinson Cancer Research Center/University of Washington Cancer Consortium Cancer Center Support Grant of the US National Institutes of Health.
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U2 - 10.1016/S2214-109X(18)30257-2
DO - 10.1016/S2214-109X(18)30257-2
M3 - Article
C2 - 30012269
AN - SCOPUS:85049754428
SN - 2214-109X
VL - 6
SP - e885-e893
JO - The Lancet Global Health
JF - The Lancet Global Health
IS - 8
ER -