October is Breast Cancer Awareness Month, which is marked in countries across the world, and helps to increase attention and support for awareness, early diagnosis, and treatment as well as palliative care for women facing this disease.
There are about 1.7 million new cases and 522 000 deaths from breast cancer each year [Globocan 2012 http://gco.iarc.fr/today/home]. Breast cancer is the most common cancer in women worldwide, and is the most common cause of cancer among women in most countries. In low- and middle-income countries the incidence has been rising steadily due to increased life expectancy, changing reproductive patterns (such as later age at first childbirth and less breast-feeding), and the adoption of western lifestyles.
Early diagnosis remains the cornerstone of breast cancer control. When found early, and if adequate diagnosis and treatment are available, there is a good chance that breast cancer can be cured. If detected late, however, curative treatment is often no longer an option. In such cases, treatment may improve quality of life and delay disease progression, while supportive and palliative care should be readily available to relieve suffering for patients and their families.
The majority of women who die from breast cancer (324 000) live in low- and middle-income countries, where most women are diagnosed in late stages due to a variety of factors. These include limited awareness on the part of the public and health care providers, and the lack of access to timely, affordable and effective diagnosis and treatment.
WHO promotes comprehensive breast cancer control programmes as part of national cancer control plans. The recommended early detection strategies for low- and middle-income countries are to increase awareness of early signs and symptoms among health care providers and the public, and to increase capacity for prompt diagnostic evaluation (including imaging, biopsy, and pathology services). Breast screening with mammography screening is very costly and is feasible only in countries with good health infrastructure that can afford a long-term programme. The value of clinical breast examination is an important area of research, particularly in lower resource settings. [WHO position paper 2014].
In November, WHO will release a new document to help countries improve capacity for early diagnosis for breast and other cancers.