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. 2018 Aug;6(8):e885-e893.
doi: 10.1016/S2214-109X(18)30257-2.

Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study

Jeanette K Birnbaum  1 , Catherine Duggan  1 , Benjamin O Anderson  2 , Ruth Etzioni  3
Affiliations

Early detection and treatment strategies for breast cancer in low-income and upper middle-income countries: a modelling study

Jeanette K Birnbaum et al. Lancet Glob Health. 2018 Aug.

Abstract

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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Conflict of interest statement

Declaration of interests

We declare no competing interests.

Figures

Figure 1:
Figure 1:. Schematic of the state-transition microsimulation model
Dashed arrow shows that early detection interventions decrease advanced-stage incidence. ER=oestrogen-receptor.
Figure 2:
Figure 2:. Absolute risk reduction for each intervention compared with the standard of care in (A) the East African region and (B) Colombia
Error bars are 95% uncertainty intervals. Percentages in brackets are the proportions of women who present with advanced-stage disease. ER=oestrogen-receptor. B=endocrine therapy for ER-positive cases. C=B plus chemotherapy for ER-negative cases. D=C plus chemotherapy for advanced ER-positive cases.
See this image and copyright information in PMC

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