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REVIEW ARTICLE
Year : 2020  |  Volume : 152  |  Issue : 4  |  Page : 343-355

A pragmatic approach to tackle the rising burden of breast cancer through prevention & early detection in countries 'in transition'


1 Screening Group, Early Detection & Prevention Section, International Agency for Research on Cancer, Lyon, France
2 Department of Cancer Epidemiology, National Cancer Center/National Clinical Research for Cancer/Cancer Hospital, Chinese Academy of Medical Science & Peking Union Medical College, Beijing, China
3 Division of Clinical Oncology, ICMR-National Institute of Cancer Prevention & Research, Noida, India
4 Faculty of Social Sciences/Health Sciences, Tampere University, Tampere, Finland; N.N. Petrov National Research Medical Center of Oncology, Saint Petersburg, Russia

Correspondence Address:
Dr. Partha Basu
Early Detection & Prevention Section, International Agency for Research on Cancer (WHO), 150 Cours Albert Thomas, 69372 Lyon Cedex 08
France
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijmr.IJMR_1868_19

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Among the emerging economies Brazil, Russia, India, China and South Africa (together known as the BRICS countries) share collectively approximately 40 per cent of the global population and contribute to 25 per cent of the world gross domestic products. All these countries are facing the formidable challenge of rising incidence of breast cancer and significant number of premature deaths from the disease. A multidimensional approach involving prevention, early detection and improved treatment is required to counteract the growing burden of breast cancer. A growing trend in the prevalence of major preventable risk factors of breast cancer such as obesity, western dietary habits, lack of physical activity, consumption of alcohol and smoking is contributing significantly to the rising burden of the disease in BRICS nations. Specific interventions are needed at the individual and population levels to mitigate these risk factors, preferably within the broader framework of non-communicable disease control programme. Population-based quality assured mammography-based screening of the 50-69 yr old women can reduce breast cancer mortality at least by 20 per cent. However, none of the BRICS countries have been able to implement population-based organized screening programme. Large scale opportunistic screening with mammography targeting predominantly the younger women is causing harms to the women and wasting precious healthcare resources. There are recent national recommendations to screen women with mammography in Brazil and Russia and with clinical breast examination in China (along with ultrasound) and India. Given the challenges of implementing systematic screening of the population, the BRICS countries should prioritize the early diagnosis approach and invest in educating the women about the breast cancer symptoms, training the frontline health providers to clinically detect breast cancers and appropriately refer for diagnostic confirmation, and creating improved access to good quality diagnostic and treatment facilities for breast cancer. The early diagnosis approach has been proved to achieve downstaging and improve survival at a fraction of the resources needed for population screening. The countries also need to focus on improving the services and capacity for multidisciplinary treatment of breast cancer, histopathology and immunohistochemistry, safe administration of chemotherapy and palliative care.


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