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
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
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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