Addressing breast cancer mortality in low-income and middle-income countries: if you can't measure it, it doesn't exist.

Abstract

Disparities in cancer outcomes within and between countries have become increasingly more visible in the past two decades; some regions have achieved reductions both cancer incidence and mortality, whereas others are falling dramatically behind. In The Lancet Oncology, Catherine Duggan and colleagues 1 Duggan C Trapani D Ilbawi AM et al. National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysis. Lancet Oncol. 2021; (published online Oct 12.)https://doi.org/10.1016/S1470-2045(21)00462-9 Summary Full Text Full Text PDF PubMed Scopus (12) Google Scholar report that 20 countries have achieved sustained mean reductions in breast cancer mortality of at least 2% for 3 consecutive years since 1990, all of which are either high-income or upper-middle-income countries. All 20 of these countries with sustained mortality reductions had at least 60% of patients with breast cancer diagnosed at early stages (stage I or II) of disease. In the multivariable analysis, the Universal Health Care Service Coverage Index score and number of public cancer centres per 10 000 patients with cancer were significantly and independently negatively associated with age-standardised mortality rates (β=–0·12, 95% CI −0·16 to −0·08, and β=–0·23, −0·36 to −0·10, respectively). These results provide useful additional information on which future research might be based. National health system characteristics, breast cancer stage at diagnosis, and breast cancer mortality: a population-based analysisCountries with low breast cancer mortality rates are characterised by increased levels of coverage of essential health services and higher numbers of public cancer centres. Among countries achieving sustained mortality reductions, the majority of breast cancers are diagnosed at an early stage, reinforcing the value of clinical early diagnosis programmes for improving breast cancer outcomes. Full-Text PDF