There are new guidelines published by the USPSTF to start screening women (at average risk) for breast cancer at the age of 50 (not 40 as is currently done). If we were to establish a set of screening guidelines for developing countries would we start at age 40 because the disease appears to be aggressive in this context or would we use data on cost effectiveness from the developed world and create a more conservative program that started screening at age 50?
The Lancet recently published an editorial on Breast Cancer in Developing Countries which describes the increasing burden of this disease on people in resource-poor settings. The article states that currently only 5% of global spending on cancer is aimed at developing countries. This is worrisome given that “an estimated 1·7 million women will be diagnosed with breast cancer in 2020—a 26% increase from current levels—mostly in the developing world.” Yet the article explains that the WHO Commission has determined that most current strategies for breast cancer treatment and prevention in the developed world are not cost effective in the developing world.
In contrast, an article by the Breast Health Global Initiative states that “breast cancer outcomes in low- and middle-income countries (LMCs) correlate with the degree to which 1) cancers are detected at early stages, 2) newly detected cancers can be diagnosed correctly, and 3) appropriately selected multimodality treatment can be provided properly in a timely fashion.
There is clearly a major challenge that lies ahead – we have a growing problem in resource-poor setting and we won’t be able to export our solutions from the developed world to solve these issues. We will need to dig deep by chanelling research dollars to understand the nature of the disease in this context and develop a customized set of guidelines for the developing world.