Page 21 - ACCF Essentia | Vol. III | Issue 3 | June 2024

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lack of awareness, led to the majority of patients presentin g at adva nced
lack of awareness, led to the majority of patients presenting at advanced
stages (as depicted in the gure) often too late for effective intervent t ion.
stages (as depicted in the gure) often too late for effective intervention.
Of the 40-50 cases seen at our institute, about half were already
Of the 40-50 cases seen at our institute, about half were already

in metastatic or signi cant ly advanced st ag e. A considerable
in metastatic or signi cantly advanced stage. A considerable
pp
ortuni
number, due to various constraints, lost the o
number, due to various constraints, lost the opportunity for further
for further
ty
investigations or treatment after initially presenting with symptoms.
investigations or treatment after initiall y pr esenti ng with sy mp toms.
This retrospective analysis underlines the critical issue of patients
This retrospective analysis underlines the critical issue of patients
presenting at advanced stages, primarily due to lack of
presenting at advanced stages, primarily due to lack of
knowledge and early detection, compounded by nancial
knowledge and early detection, compounded by nancial
limitations. It emphasises the need for LMICs to adopt more
limitations. It emphasises the need for LMICs to adopt more
practical, cost-effective early detection strategies.
practical, cost-effective early detection strategies.
Screening strategies in developed nations, heavily reliant on
Screening strategies in developed nations, heavily reliant on
cant challenges in LMICs due to high
mammography face signi

mammography face signi cant challenges in LMICs due to high
costs and infrastructural de cits. Additionally, the high incidence
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costs and infrastructural de
cits. Additionally, the high incidence g

of breast cancer occurring in younger women (aged 40–49), where
of breast cancer occurring in younger women (aged 40–49), where
e
mammography has no signi cant bene t, highlights the need for adaptable
a
mammography has no signi cant bene t, highlights the need for adaptable
strategies.
strategies.
4. Recognising these barriers, the Breast Health Global Initiative( BHGI)
4. Recognising these barriers, the Breast Health Global Initiative( BHGI)
B
proposes a tiered approach to breast health, adaptable to varying
proposes a tiered approach to breast health, adaptable to varyying
resource levels.
resource levels.
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5. This model ranges from basic awareness and self-examination
5. This model ranges from basic awareness and self-examination
to clinical breast exams (CBE) and diagnostic ultrasound,
to clinical breast exams (CBE) and diagnostic ultrasound,
progressing to mammography as resources allow. Such
progressing to mammography as resources allow. Such
a stepwise approach promises a practical route towards
a stepwise approach promises a practical route towards
improving breast cancer outcomes in resource - constrained
improving breast cancer outcomes in resource - constrained
settings.
settings.
R e f e r e n c e:
Reference:
“Breast cancer in developing countries.” The Lancet, 2009; 374 (9701):
1. 1. “Breast cancer in developing countries.” The Lancet, 2009; 374 (9701):
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egel RL, et al. “Global Cancer Stat
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2. Sung H, Ferlay J, Siegel RL, et al. “Global Cancer Statistics 2020: GLOBOCAN
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O
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cs 2020: GL
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Sung H, Ferlay J, S
rs in 185
estimates of incidence and mortality worldwide for 36 canc
e
e
estimates of incidence and mortality worldwide for 36 cancers in 185
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n 2021
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71:209-24
es”. CA Cancer J Cl
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countries”. CA Cancer J Clin 2021; 71:209-249
;
countr
3. Bedwinek JM, Lee J, Fineberg B, et al. “Prognostic indicators in patients with
3. Bedwinek JM, Lee J, Fineberg B, et al. “Prognostic indicators in patients with
isolated local-regional recurrence of breast cancer.” Cancer 1981; 47:2232-2235.
isolated local-regional recurrence of breast cancer.” Cancer 1981; 47:2232-2235.
4. Arslan AA, Formenti SC. “Mammography in developing countries: the risks
4. Arslan AA, Formenti SC. “Mammography in developing countries: the risks
associated with globalizing the experiences of the Western world.” Nature Clinical Practice
associated with globalizing the experiences of the Western world.” Nature Clinical Practice
g
g
g
Oncology,2009;6(3): 136–137.
Oncology,2009;6(3): 136–137.
5. Anderson BO, Yip CH, Smith RA, et al. “Guideline implementation for breast healthcare in low-
5. Anderson BO, Yip CH, Smith RA, et al. “Guideline implementation for breast healthcare in low-
income and middle-income countries: overview of the Breast Health Global Initiative Global
income and middle-income countries: overview of the Breast Health Global Initiative Global
Summit 2007.” Cancer. 2008;113(8):2221–2243
Summit 2007.” Cancer. 2008;113(8):2221–2243
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Our greatest weakness lies in giving up. The most certain
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Our greatest weakness lies in giving up. The most certain
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way to succeed is always to try just one more time.
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way to succeed is always to try just one more time .
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y