Phased Implementation Model of Resource-Stratified Guidelines for Breast Cancer Control

59 Background: Review of breast cancer control efforts in low- and middle-income countries (LMICs) has identified the need for a model to bridge the gap between evidence-based planning and implementation or scale-up of breast cancer diagnosis and treatment programs. We undertook this work to develop an evidence-based framework to guide systematic implementation of resource-stratified, effective, and sustainable systems to improve breast health care delivery in LMICs.Methods: On the basis of survey data and site visits, Breast Cancer Initiative 2.5 (BCI2.5) partners developed a phased implementation model for breast cancer management in LMICs. The model outlines an adaptable framework for step-wise implementation of health system requirements across the continuum of care, with successful and systematic management of clinically detectable (palpable) breast disease being a prerequisite to population-based screening. Prerequisites: Standardized protocols, guidelines, and trained health care workforce. Phase 1: Systematic triage and diagnosis of palpable breast disease; phase 2: adapted stage-appropriate treatment planning; phase 3: scaling-up of clinical breast exam to promote downstaging of clinically detectable disease; and phase 4: upgrading of image-based diagnostic systems and management of nonpalpable disease. Once these systems are in place, mammographic screening can be initiated.Results: Successful implementation of the Breast Health Global Initiative resource-stratified guidelines in northern Peru from 2011 to 2016 followed this phased implementation strategy and demonstrated that this approach can help advance specific aspects of a comprehensive cancer control plan in a systematic fashion, surmounting what may seem to be overwhelming barriers to improving early diagnosis.Conclusion: By using this model, BCI2.5 partners, in collaboration with the Government of Tanzania, are developing recommendations to inform the design, implementation, and scale-up of a breast cancer early diagnosis and treatment platform that can be achieved if adequately resourced and implemented in a phased fashion.AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST Allison Dvaladze Consulting or Advisory Role: Pfizer Travel, Accommodations, Expenses: Roche Catherine Duggan No relationship to disclose Julie R. Gralow Consulting or Advisory Role: Novartis, Genentech, Eli Lilly, Bayer, Pfizer Research Funding: Genentech (Inst), Novartis (Inst), Amgen (Inst) Benjamin O. Anderson Consulting or Advisory Role: Pfizer Research Funding: Pfizer, Roche