1. Breast Cancer: Take it to heart February 24, 08 Mexico, D.F. Felicia M. Knaul

2. Breast Cancer: “Tómatelo a pecho” A cross-cutting strategy of ICS 1. I nformation 2. I nvestigation and research 3. I nnovation 4. I nstitutional strengthening

3. Carried out by Observatorio de la Salud a regional, joint initiative between: a regional, joint initiative between: 1. Information A)Systematic review and prospective analysis Literature review: promotion, prevention, detection, epidemiology, treatment, evaluation, trends, and cost-effectiveness of interventions. Prospective analysis: cost of the disease, social and economic. Projection of needs under different scenarios. Mapping of key actors: civil society organizations, service providers, and researchers. Identification and analysis of public policy options and strategic projects. and

4. Mexico As of 2006, second cause of death among women aged 30-54 2000: 3,726 reportes cases; 2006: 6,043 Breast cancer mortality is increasing while mortality from cervical cancer has been on the decline since 1990. The average age at death among women with breast cancer is 2 years younger than that of women with cervical cancer. As of 2006, women under 65 presented a greater risk of dying from breast cancer than from cervical cancer, while 27 years ago the risk of dying from cervical cancer at any age was twice as great as the risk of dying from breast cancer. Stylized facts

5. Breast cancer motality has been steadily increasing since at least the 1950´s. By contrast, and likely due to public health interventions, cervical cancer mortality has been declining since about 1990. As of 2006, breast cancer mortality rates exceed C-U cancer. Age-adjusted rate x 100,000 women 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 19551960196519701975198019851990199520002005 BreastCervix Mortality from malignant tumors of the breast and cervix in Mexico 1955-2006 Fuente: R.Lozano, J. Frenk. F.Knaul. Estimaciones propias.

6. Rank 30 – 59 /1 3rd 30 – 54 /2 2nd 30 – 49 /2 2nd 30 – 44 /2 2nd 30 – 39 /2 2nd IMSS /2 2nd ISSSTE /2 2nd Uninsured6th Jalisco /2 2nd N. León /2 2nd D.F. /2 2nd Age group Rank Source: R. Lozano, J Frenk, F Knaul. Author’s own estimations with database of mortality statistics from 2005. /1 The 1st is diabetes mellitus and the 2nd is ischemic heart disease. /2 The 1st is diabetes mellitus. Institution State Breast Cancer Mortality, by age group, Mexico, 2005

7. 1. Information B)Education and communication: materials and campaign Aimed at health professionals, patients and families. Focus: early detection, improved treatment practices, non-discrimination, partner/companion support. Wide range of products aimed at different audiences: book for patients and their families; manuals for health professionals and patients; web page at the ICS site; multimedia messages through television and cellular phones; video.

8. 2. Investigation and research A)Qualitative study, perceptions: knowledge of breast cancer among the Mexican population and barriers to early detection and treatment With the National Institute of Public Health and EngenderHealth. B)Breast cancer genomics in the Latin American population With the National Institute for Genomic Medicine.

9. 3. Innovation A) Develop and finance connectivity for regional, digital-imaging centres B) Installation of digital mammography C) Innovate on the existing models of early detection at the clinic-level Solutions for barriers to early detection

10. 4. I nstitutional strengthening A)Endowed chair B) Short courses to train radiologists C) Scholarships for fellows, including international exchanges Within Mexico as program participants. International exchanges with leading institutions. Human resource development