Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative
Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative
复制标题
DOI：
10.1007/s00268-007-9454-z
复制
发表时间：
2008-12-01
影响因子：
2.6
通讯作者：
Jakesz, Raimund
中科院分区：
文献类型：
--
作者：
Anderson, Benjamin O.;Jakesz, Raimund
在2002年全球411，000例乳腺癌死亡中，221，000例（54%）发生在低收入和中等收入国家（LMC）。乳房保健指南在资源丰富的国家制定的早期发现、诊断和治疗的指导方针不能直接应用于LMC，因为这些指导方针没有考虑真实的世界资源限制，也没有优先考虑特定国家最迫切需要哪些资源来最有效地提供护理。乳腺健康全球倡议（BHGI）创建了一个国际健康联盟，为LMC制定循证指南，以改善乳腺健康结果。BHGI于2002年10月（西雅图）和2005年1月举行了两次全球峰会（Bethesda），并采用专家共识，循证方法制定了资源敏感的指南，定义了逐步提高医疗服务质量的综合途径。（基本、有限、增强和最大），使准则同时适用于经济能力不同的国家。BHGI指南为临床医生之间的联系以及政府机构和倡导团体之间的联盟提供了一个中心，将指南转化为政策和实践。可以通过现实且具有成本效益的实际干预措施来改善LMC中的乳腺癌问题。早期乳腺癌检测和综合癌症治疗在促进改善乳腺癌预后方面发挥协同作用。早期检测、诊断、手术、放射治疗和药物治疗中最基本的干预措施可以在LMC现有的卫生保健计划中整合和组织起来。未来的研究将研究什么样的实施策略可以最有效地指导卫生保健系统的重组，以帮助那些有动力改善其人口中乳腺癌预后的国家。
Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they prioritize which resources are most critically needed in specific countries for care to be most effectively provided.Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Summits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery.The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among governmental agencies and advocacy groups to translate guidelines into policy and practice.The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be integrated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations.