Open AccessBreast Cancer in Limited‐Resource Countries: Diagnosis and Pathology
Author(s) -
Shyyan Roman,
Masood Shahla,
Badwe Rajendra A.,
Errico Kathleen M.,
Liberman Laura,
Ozmen Vahit,
Stalsberg Helge,
Vargas Hernan,
Vass László
Publication year - 2006
Publication title -
the breast journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.533
H-Index - 72
eISSN - 1524-4741
pISSN - 1075-122X
DOI - 10.1111/j.1075-122x.2006.00201.x
Subject(s) - medicine , breast cancer , mammography , biopsy , radiology , sampling (signal processing) , fine needle aspiration , cancer , breast cancer screening , breast imaging , medical physics , filter (signal processing) , computer science , computer vision
In 2002 the Breast Health Global Initiative (BHGI) convened a panel of breast cancer experts and patient advocates to develop consensus recommendations for diagnosing breast cancer in countries with limited resources. The panel agreed on the need for a pathologic diagnosis, based on microscopic evaluation of tissue specimens, before initiating breast cancer treatment. The panel discussed options for pathologic diagnosis (fine‐needle aspiration biopsy, core needle biopsy, and surgical biopsy) and concluded that the choice among these methods should be based on available tools and expertise. Correlation of pathology, clinical, and imaging findings was emphasized. A 2005 BHGI panel reaffirmed these recommendations and additionally stratified diagnostic and pathology methods into four levels—basic, limited, enhanced, and maximal—from lowest to highest resources. The minimal requirements (basic level) include a history, clinical breast examination, tissue diagnosis, and medical record keeping. Fine‐needle aspiration biopsy was recognized as the least expensive reliable method of tissue sampling, and the need for comparing its clinical usefulness with that of core needle biopsy in the limited‐resource setting was emphasized. Increasing resources (limited level) may enable diagnostic breast imaging (ultrasound ± mammography), use of tests to evaluate for metastases, limited image‐guided sampling, and hormone receptor testing. With more resources (enhanced level), diagnostic mammography, bone scanning, and an onsite cytologist may be possible. Mass screening mammography is introduced at the maximal‐resource level. At all levels, increasing breast cancer awareness, diagnosing breast cancer at an early stage, training individuals to perform and interpret breast biopsies, and collecting statistics about breast cancer, resources, and competing priorities may improve breast cancer outcomes in countries with limited resources. Expertise in pathology was reaffirmed to be a key requirement for ensuring reliable diagnostic findings. Several approaches were again proposed for improving breast pathology, including training pathologists, establishing pathology services in centralized facilities, and organizing international pathology services.