1. Jo Anne Zujewski, MD Cancer Therapy Evaluation Program Division of Cancer Diagnosis and Treatment National Cancer Institute January 2011 www.bhgi.info

2. BREAST HEALTH IN LMCS  Resource-stratified guidelines  Implementation framework  Implementation projects

3. © 2011 BHGI. All rights reserved.  WORLD BANK COUNTRY GROUPS WORLD BANK CLASSIFICATION (ATLAS METHOD) World Bank Country Groups (GNI per capita) Low Income ($995 or less) Lower Middle Income ($996 - $3,945) Upper Middle Income ($3,946 - $12,195) High Income ($12,196 or more) Average female life expectancy at birth 57.8 yrs69.3 yrs74.4 yrs82.4 yrs Average GNI per capita (2009 US dollars) $403$1,723$6,314$36,953 Total national health expenditure per capita $22$76$458$4,266 Fraction of GDP spent on health care 5.1%4.3%6.4%11.2% Health expenditure figures 2010 for calendar year 2007; GNI = gross national income http://data.worldbank.org/data-catalog/health-nutrition-and-population-statistics. http://data.worldbank.org/data-catalog/health-nutrition-and-population-statistics

4. © 2011 BHGI. All rights reserved.  BREAST CANCER EPIDEMIOLOGY GLOBAL DISTRIBUTION OF DISEASE 2008: 1,380,000 cases; 458,400 deaths 50% of cases / 60% of deaths in LMCs Ratio: Mortality Incidence Globocan 2008 (IARC)

5. MISSION STATEMENT The Breast Health Global Initiative (BHGI) strives to develop, implement and study evidence-based, economically feasible, and culturally appropriate guidelines for international breast health and cancer control for low and middle income countries to improve breast health outcomes.

6. GLOBAL SUMMIT 2005 – BETHESDA RESOURCE STRATIFICATION  Basic level: Core resources or fundamental services necessary for any breast health care system to function.  Limited level: Second-tier resources or services that produce major improvements in outcome such as survival.  Enhanced level: Third-tier resources or services that are optional but important, because they increase the number and quality of therapeutic options and patient choice.  Maximal level: Highest-level resources or services used in some high resource countries that have lower priority on the basis of extreme cost and/or impracticality.

7. BREAST HEALTH IN LMCS  Resource-stratified guidelines  Implementation framework  Implementation projects

8. BHGI: Health Systems

9. BHGI: Early Detection

10. BHGI: Diagnosis Cancer: 113 (8 suppl), 2008

11. BHGI: Stage 1 Cancer: 113 (8 suppl), 2008

12. BHGI: Stage 2 Cancer: 113 (8 suppl), 2008

13. BHGI: Stage 3; Locally Advanced Cancer: 113 (8 suppl), 2008

14. BHGI: Metastatic

15. Executive Summary: Lancet Oncology, 12: in press, 2011 Consensus Supplement: The Breast, in press, 2011 GLOBAL SUMMIT 2010 – CHICAGO OPTIMIZING DELIVERY  Low-Resource Scenarios  Middle-Resource Scenarios  Problem Solving

16. GLOBAL SUMMIT 2010 – CHICAGO OPTIMIZING DELIVERY  Cancer registries for prevalence, stage, and outcome  National cancer plans define cancer care networks  Multidisciplinary care to avoid fragmentation  issues Lancet Oncology, 12: in press, 2011

17. OPTIMIZING DELIVERY  Training linked to equipment acquisition / quality care  Public awareness programs linked to early detection  Clinical breast examination (CBE) promotion  Coordination of diagnosis and treatment  Address pathology, drug acquisition, workforce issues

18. BREAST HEALTH IN LMCS  Resource-stratified guidelines  Implementation framework  Implementation projects

19. Awareness Survivorship Early Detection Diagnosis Treatment Advocacy Public Participation Health Care Delivery

21. BREAST HEALTH IN LMCS  Resource-stratified guidelines  Implementation framework  Implementation projects

22. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH AFRICAN (WHO AFRO) COUNTRIES – LOW RESOURCE Ratio: Mortality Incidence Globocan 2008 (IARC) AFRO REGIONAL ESTIMATES 2008: 68,000 cases; 37,000 deaths

23. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRY CBE training for nurse midwives Indonesia

24. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH UPPER-MIDDLE INCOME COUNTRY Turkey Mammographic Screening in Istanbul

25. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRY Colombia Readiness Assessment Tools

26. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH LOWER-MIDDLE INCOME COUNTRY Pakistan Locally Advanced Treatment in Lahore

27. © 2011 BHGI. All rights reserved.  LMC IMPLEMENTATION RESEARCH LATIN AMERICAN COUNTRIES – MIDDLE RESOURCE Ratio: Mortality Incidence Globocan 2008 (IARC) SOUTH + CENTRAL AMERICA ESTIMATES 2008: 105,900 cases; 33,600 deaths

28. BHGI GLOBAL ALLIANCE BENEFACTOR / FOUNDATIONAL GRANTS Susan G. Komen for the Cure®Susan G. Komen for the Cure® European School of Oncology (ESO)European School of Oncology (ESO) Pan American Health Organization (PAHO)Pan American Health Organization (PAHO) Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast CancerSheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer American Society of Clinical Oncology (ASCO)American Society of Clinical Oncology (ASCO) LIVESTRONGLIVESTRONG CORPORATE PARTNERS GE HealthcareGE Healthcare Sanofi-AventisSanofi-Aventis