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Action:
Patients, projects, programs, policies
January, 2008
June, 2007
Global Task Force on Expanded
Access to Cancer Care and Control
in Developing Countries
Source: Estimates based on data from Globocan 2012 & IHME, 2015
Breast cancer in LMICs: myths
and realities
33%
Age at
66% 62%
15-39
40-54
>55
Age at
Death
34%
67% 61%
Fuente: Estimaciones de los autores basadas en IARC, Globocan 2012
Breast Cancer affects young women,
in addition to older women
Age of breast cancer detection in LAC,
2012
45- 15-
54 44
50%
25%
0
DOM R.
MEXICO
CHIL
SAL
BEL
PERU
COL
SUR
ECU
BOL
BRA
PAR
VEN
ARG
NIC
CUB
HAI
GUY
URU
HON
GUA
PAN
CR
Fuente: Con base en datos de GLOBOCAN 2002. Source: Own estimates based on data from IARC, GLOBOCAN 2012.
... And 50% of breast cancer deaths occurs in
women under 55 years.
Age of breast cancer mortality in LAC, 2012
15-44 45-54
50%
Mexico
Guatemala
Argentina
Nicaragua
Venezuela
Paraguay
Honduras
Panam
Surinam
Colombia
Uruguay
Guyana
Ecuador
Bolivia
Hait
El Salvador
Belice
Chile
Cuba
CR
Dom. R.
Brazil
Peru
179 177
and mortality
CC deaths (M)
113 115
96
100
43 68 68
37 31 35
19
0
-14 -14
Caribbean Low Middle High income
income income
Source: Knaul, Arreola, Mendez. estimates based on IHME, 2012.
Mortality rank: breast and cervical cancer
Women 15 to 49, countries by income level
1 Breast cancer
Jamaica 2 Diabetes
3 Cervical cancer 11
4 HIV/AIDS other
10 5 Ischemic heart
Number of cause of death
disease
8
in the age group
0
& the Gren
St. Lucia
Suriname
Dominica
Grenade
Jamaica
Guyana
Bolivia
Belice
St. Vicent
Canada
Antigu
Trinida
a&
Barbad
d&
Tobago
Baham
os
as
Barbud
Low Lower- Upper-
High income
incom middle middle
Cancer transition in Mexico
Trends in mortality from breast and cervical
cancer
Mexico
age adjusted mortality rate
16
Rate per 100,000 women
0
1985
1955
2005
2013
Cervical cancer Breast cancer
Source: Estimaciones propias basada en Knaul et al., 2008. Reproductive Health Matters, and updated by Knaul, Arreola-Ornelas and
Mndez based on WHO data, WHOSIS (1955-1978), and Ministry of Health in Mexico (1979-2012)
Source: Data extracted from CI5plus.
Mortality: cervix and breast cancer in
Mexican States (1979-2013)
18 Distrito Federal Nuevo Len
18
16 16
14 14
12 12
Mortality per 100,000 women
10 10
8 8
6 6
4 4
2
2
0
0
1979
1985
1990
1995
2000
2005
2013
2013
20 25
18 Puebla Oaxaca
16
20
14
12
15
10
8
6 10
4
2 5
0
0
1979
1985
2005
2013
1990
1995
2000
2013
Source: Estimaciones propias basadas en datos de DGIS. Base de datos de defunciones 1979-2013. SINAIS. Secretara de Salud.
The Cancer Divide:
Both Health & Equity Imperative
Cancer is a major disease of both rich and poor;
yet it is increasingly the poor who suffer:
1. Exposure to risk factors
2. Preventable cancers (infection)
Facets
Cervix
Children Testis
Prostate
India
Non-
hodkins
China
Hodkins
India
Tyroid
China
Leukaemia Canada
4
Haiti
0
Survival
USA+Cda
Guyana
Jamaica
2
0 Bahamas
Cervical
Breast
0
Low Lower Upper High
Income Middle Middle Income
45
100
Canadia 40
80 Black n
0
19
19
85
90
19
95
20
00
20
05
20
10
20
12
75
80
19
19
10
Ao
20
15
201
201
198
198
199
200
200
201
197
199
5
2
5
0
Ao
Fuente: Breast cancer Facts & figures 2015-2016. ACS, 2016; y Canadian Cancer
Global trends in breast cancer
mortality
30
USA
Age-adjusted mortality rate
Canad
Australi
a
Colombia Mexico
0
1975 1980 1985 1990 1995 2000 2005 2010 2014 2025
?
Source: Data extracted from CI5plus.
Detection + Treatment= Survivorship:
Survivorship in the
Detection by
USA according to
state
ACS
0-1 98%
2-3 84%
4 27%
Mortality
Breast Cervical
in Diabetes
- 35% childbirth
cancer cancer
in 30
years
= 465,000 (2600)
Source: Estimates based on data from WHO: Global Health Observatory, 2008 and Murray et al Lancet 2011.
Applies a diagonal
approach to avoid
the false dilemmas
between disease
silos that
continue to plague
global health
The Diagonal Approach to
Health System Strengthening
Rather than focusing on either disease-specific
vertical or horizontal-systemic programs, harness
synergies that provide opportunities to tackle
disease-specific priorities while addressing
systemic gaps and optimize available resources
Diagonal strategies:
Positive externalities: X = > parts
Compound benefits: increase effectiveness at given cost
Bridge disease divides using a life cycle response
Exploit existing platforms
Diagonal Strategies:
Positive Externalities
Promoting prevention and healthy
lifestyles:
Reduce risk for cancer and other diseases
Reducing stigma for womens cancers:
Contributes to reducing gender
discrimination.
Investing in treatment produces champions
Challenge and disprove the
myths about cancer
M1. Unnecessary NECESSARY
M2. Unaffordable AFFORDABLE
Affiliation:
2004: 6.5 m
2014: 55.6 m
> High
20%
10%
0%
High Medium Low Very Low
br
Engage the primary level of care for early
detection and management of breast cancer
Diagonalizing delivery:
Inclusion of early detection of breast
cancer in Opportunities program
Capacitation and
orientation guide for
beneficiaries of
Oportunidades program
includes information about
breast cancer 2009/10
3 million copies for
promoters and trainers
Reached 5.8 million families
= more than 90% of poor
households
Diagonalizing Delivery: Training primary care
promoters, nurses and doctors in early detection
of breast cancer
Health Promoters
8 Risk Score (0-10)
Significant increase in
7
knowledge, especially among
*
5
health promoters and in clinical
4
breast examination
(Keating, Knaul et al 2014, The Oncologist)
3
Pre Post 3-6 month
ADDITIONAL RESOURCES
The Oncologist,
http://theoncologist.alphamedpress.org/content/early/2014/09/17/theoncologist.2014-0
Challenge: from survival to
survivorship, de la
sobrevivencia a la
Be an
optimist
optimalist
Closing divides:
Health System Responses to the
challenge of breast and cervical cancer
February 23, 2017
Miami Institute of Americas, University of Miami