Comprehensive Overview of How to Start or Improve a Breast Cancer Unit on the Global Stage

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Breast cancer is the leading cause of cancer death among women worldwide. As populations age, the incidence of cancer inevitably increases—the World Health Organization has predicted a dramatic increase in global breast cancer cases during the next 15 years. Moreover, breast cancer is increasing in low- and middle-income countries compared with high-income countries, where presentation at later stages coupled with suboptimal treatment leads to a high mortality rate.

Title: Breast Cancer: Global Quality Care
Editors: Drs. Didier Verhoeven, Cary S. Kaufman, Robert Mansel, and Sabine Siesling
Publisher: Oxford University Press
Publication date: January 2020
Price: $52.95, paperback, 432 pages

Although the global breast cancer burden presents unique region-specific challenges—some of which seem insurmountable due to poverty and government dysfunction—there is consensus among leaders in the international oncology community, which was enunciated 10 years ago at a meeting in Paris: “All women across the world should have access to fully equipped, quality-assured, dedicated breast centers/units that provide competent and comprehensive care.” The initiative to create access to high-quality breast health across all spectrums of societies received much-needed clarity of mission with the publication of Breast Cancer: Global Quality Care, edited by noted oncologists Drs. Didier Verhoeven, Cary Kaufman, Robert Mansel, and Sabine Siesling.

Monumental International Effort

This fine book is the result of a project addressing a global approach to the quality of breast cancer care that began 10 years ago in Paris. Since then, meetings have been organized in other cities as well as during several international breast conferences devoted to quality management, organization of breast cancer care, breast center quality, guidelines, and the influence of local economies and resources in breast care. It was a monumental 3-year effort, involving a faculty of 115 experts from 5 continents and 25 different countries who communicated during expert meetings via mail, Skype conferences, and conference calls. The result is a book for a wide audience of just about everyone working in the field of integrated breast cancer care.

Breast Cancer: Global Quality Care is organized into 10 parts. Although there’s a lot of heavy lifting within the pages, the editors were wise in choosing the book’s interior structure, making it reader-friendly and easy to annotate. Part one, not surprisingly, is “Epidemiology,” which gives a concise overview of global cancer. The use of easy-to-view figures and bulleted lists helps the reader digest the avalanche of data. Moreover, each part ends with a Key Messages section, which neatly summarizes the content.

Technology’s Potential to Reach Challenged Populations

Part six, “Health Information Technology,” is especially interesting and timely, given the challenges the oncology community is experiencing during the COVID-19 pandemic. The field of “connected health” has emerged in response to access-to-care issues, largely in economically challenged communities around the world.

“One of telehealth’s newly evolved disciplines is teleoncology, defined as the delivery of clinical oncology services from a distance for diagnosis, treatment, and patient follow-up using communications technologies,” the editors noted. “Its fundamental aim is the reduction of inequities in cancer care and the development of health professionals…. To reach its full transformational potential, teleoncology must become applicable in areas where its impact is most needed—the developing world and underserved areas in the developed world.”

The editors of this informative section then lay out the technical requirements needed to accomplish wide acceptance of teleoncology services. They offer a terrific example of a successful telepathology program in a low-income country, launched by the North Carolina Project Malawi Telepathology Program. Briefly, here is the scope of the problem: Across much of Africa, there is a critical shortage of pathology services. A survey from 2016 estimated there are more than 500,000 people per pathologist in much of the continent, with this ratio exceeding 5 million to 1 in some countries. When reading this book, one becomes aware of the enormous challenge these intrepid leaders in global oncology undertake; balancing success and failure is an inevitable reality they face.

Triaging Resources

Part 8 is a sobering chapter titled, “The Economics of Breast Cancer Care,” which details the reasons why the increasing health-care expenses are not sustainable. The editors discuss various innovations that might help to curtail expenses, such as the potential of precision oncology to reduce unneeded treatments and optimize needed ones. However, this particular option, when filtered through crushing poverty and soaring drug prices, seems like a drop in the bucket. The only viable answer on the table is a form of resource triage, in which decision-makers determine the optimal use of the limited resources available. It all comes back to value-based care on a macro level.

Information Overload and the Role of Governments

The book’s last two parts deal with the importance of correct messaging in our new world of information overload. Here, the editors offer several pointed examples of incorrect medical information and how it impacted certain populations. It is particularly relevant today, stressing the primary roles of physicians are to be patients’ source of accurate education and support.

In the last chapter, the role of governments is explored, although it is one of the drier sections of the book. Discussion about bringing stakeholders together and harmonizing national polices is the perfect way to end the book. This section offers more sobering content, and many readers might not know, for instance, breast surgery is not a recognized subspecialty in India. Moreover, until 2011, there was no dedicated surgical society in India focused exclusively upon issues surrounding breast disease. Since 2016, three trainees from India completed subspecialty training in the United Kingdom. They have since returned to India and are practicing the art and science of breast surgery in a country of nearly 1.5 billion people.

The challenges outlined in this excellent guide to advancing the quality of global breast cancer treatment are staggering. However, efforts like this one will help to ease the burden and suffering of women with breast cancer across the globe. This book is important and highly recommended for readers of The ASCO Post