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GLOBAL CANCER POLICY-MAKING

Table 1: Resource level descriptions used for guideline development

Level Description of resource level

Basic Core resources or fundamental services absolutely necessary for any breast health care system to function;

basic-level services are typically applied in a single clinical interaction.

Limited Second-tier resources or services that are intended to produce major improvements in outcome, such as

increased survival, and are attainable with limited financial means and modest infrastructure; limited-level

services may involve single or multiple clinical interactions.

Enhanced Third-tier resources or services that are optional but important; enhanced-level resources should produce

further improvements in outcome and increase the number and quality of therapeutic options and patient choice.

Maximal High-level resources or services that may be used in some high-resource countries, and/or may be recommended

by breast care guidelines that do not adapt to resource constraints but that nonetheless should be considered

lower priority than those resources or services listed in the basic, limited, or enhanced categories on the basis of

extreme cost and/or impracticality for broad use in a resource-limited environment; to be useful, maximal-level

resources typically depend on the existence and functionality of all lower-level resources.

Table 2: BHGI guideline table for early detection resource allocation for breast cancer17

Level of resource Public education and awareness Detection methods Evaluation goal

Basic Development of culturally sensitive, Clinical history and CBE. Breast health

linguistically appropriate local education awareness regarding

programmes for target populations to teach value of early

value of early detection, breast cancer risk detection in improving

factors and breast health awareness breast cancer outcome.

(education + self-examination).

Limited Culturally and linguistically appropriate Diagnostic breast US +/- diagnostic Downsizing of

targeted outreach/education encouraging mammography in women with positive symptomatic disease.

CBE for age groups at higher risk CBE. Mammographic screening of

administered at district/provincial level using target group*.

health care providers in the field.

Enhanced Regional awareness programmes regarding Mammographic screening every 2 years Downsizing and/or

breast health linked to general health and in women ages 50–69*. Consider downstaging of

women’s health programmes. mammographic screening every 12–18 asymptomatic disease

monthsin women ages 40–49*. in women highest yield

target groups.

Maximal National awareness campaigns regarding Consider annual mammographic Downsizing and/or

breast health using media. screening in women aged 40 and older. downstaging of

Other imaging technologies as asymptomatic disease

appropriate for high-risk groups. in women in all risk

groups.

capacity (including appropriate equipment and drug establishment and maintenance of data registries, the

acquisitions, and professional training and accreditation), the coordination of multidisciplinary centres of excellence with

need for qualitative and quantitative research to support broad outreach programmes to provide community access to

decision-making, and strategies to improve patient access and cancer diagnosis and treatment, and the resource-appropriate

compliance as well as public, health care professional, and prioritization of breast cancer control programmes within the

policy-maker awareness that breast cancer is a cost-effective, framework of existing, functional health care systems23 .

treatable disease. The biggest challenges identified for low-

income countries were little community awareness that breast Next steps

cancer is treatable, inadequate advanced pathology services The resource stratified guideline approach appears to be a key

for diagnosis and staging, and fragmented treatment options, first step in determining how cancer care can best be

especially for the administration of radiotherapy and the full administered in the setting of limited resources. In their 2007

range of systemic treatments22. The biggest challenges report, Cancer Control Opportunities in Low- and Middle-

identified for middle-resource countries were the Income Countries, the US Institute of Medicine (IOM)

CANCER CONTROL 2013 39

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