© Georg Thieme Verlag Stuttgart · New York
International Guideline Development for Breast Health Care: Challenge for the New MillenniumEntwicklung einer Internationalen Richtlinie zur Brustkrebsvorsorge:
Eine Herausforderung für das Neue Jahrtausend
24. Juni 2003 (online)
The International Problem
Among women around the world, breast cancer is the most common cause of cancer related deaths . Breast cancer mortality is the highest among economically disadvantaged countries (Fig. ) . Countries with developed and well-established health care systems have higher breast cancer diagnosis rates, but also have improved breast cancer survival . The reasons for the better survival observed among financially advantaged countries must be multi-factorial. Breast cancer screening combined with comprehensive cancer treatment appears to play synergistic roles in creating better outcomes.
Fig. 1 Breast cancer incidence and 5-year survival in different regions of the world, modified from data provided by Greenlee et al., 2000 .
A key step in improving health care is to establish general guidelines for breast health care. Many guidelines have been developed for breast screening, diagnosis and treatment   . Such guidelines define evidence-based approaches to breast health care. However, guidelines from the United States or Western Europe might have limited applicability in countries of limited resources. Health care resources vary tremendously in different parts of the world based upon differing socioeconomic factors, health care systems and social factors. It is also possible that the fundamental biology of breast cancer varies in different regions of the world based upon environmental factors. As a result, optimal approaches to breast health care may vary in different parts of the world.
General guidelines for basic screening and cancer care can be established. Such guidelines can be used, particularly in developing countries, as a benchmark for growth and improvement. However, some regions of the world do not have organized programs for breast cancer screening, diagnosis and treatment. Since health care systems cannot be transformed at once, the question becomes where initial efforts be placed to best help women cope with the devastating disease.
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Benjamin O. Anderson , M.D.
Department of Surgery · University of Washington
Seattle, Washington 98195
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