The Landscape of Randomised Controlled Trials of Therapies in Breast Cancer in Low and Middle Income Countries.

Katharine Lynch-Kelly,Norman R Williams,Matthew Singer

doi:10.1155/2017/4259704

Katharine Lynch-Kelly, Norman R Williams + Show 1 more

Open Access

https://doi.org/10.1155/2017/4259704

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Abstract

Objectives. The objectives of this study were to identify the randomised controlled trials in breast cancer occurring in low and middle income countries (LMICs) generally and within Sub-Saharan Africa specifically, to describe the current status and identify opportunities for further research in these areas. Materials and Methods. Data for this study were obtained from ClinicalTrials.gov. The search term “Breast Cancer Research” was used, and relevant information extracted and analysed. Results. 2414 trials were identified, of which 1099 were eligible for inclusion. 69 of these trials occurred in LMICs. Of the 52 LMICs globally, 30% were participating in breast cancer research. Of the 17 LMICs in Africa, 77% are situated in Sub-Saharan Africa; 23% were participating in breast cancer research, which accounted for 9% of total Sub-Saharan African studies. Conclusion. This study provides current evidence for the need for breast cancer research in LMICs globally and within Sub-Saharan Africa. Within LMIC regions where research is active, the type and numbers of studies are unevenly distributed. High quality research within such areas should be encouraged as the results may have both local and global applications, particularly in the provision of affordable health care.

Highlights

In 2012, women from less developed countries were less than half as likely to develop breast cancer by the age of 75 compared to those from more developed countries (8% v 3.3%), yet almost just as likely to die from breast cancer (1.6% v 1.2%) [1]
Of the 1099 trials included in the analysis, 70 (6.4%) occurred in an Lower to middle income countries (LMICs), across 104 LMIC sites
Studies are unevenly distributed amongst regions: less than one-third of LMICs are undertaking breast cancer research globally, and in the Middle East, Pacifica, East Asia, and Europe there is no breast cancer research occurring in LMICs, despite Pacifica accounting for 13.5% of the world’s LMICs

Summary

Introduction

In 2012, women from less developed countries were less than half as likely to develop breast cancer by the age of 75 compared to those from more developed countries (8% v 3.3%), yet almost just as likely to die from breast cancer (1.6% v 1.2%) (see Figures 1 and 2) [1]. Lower to middle income countries (LMICs) will be at the epicentre of the eruption that occurs when the high cost of treatment, coupled with increasing incidence rates, collides with a lack of access and ability to pay, unless suitable alternatives can be found. Such alternatives have to provide affordable, simple, and widely accessible solutions. In order to achieve global equality in long term breast cancer incidence and mortality, more evidence-based research addressing particular circumstances in LMICs themselves is required This will generate the highest level of evidence in breast cancer research in LMICs to be produced. Access to treatment, and mortality are to be identified and solutions formulated and scrutinised based upon these constraints, rather than continuing the expensive and evidence-poor culture of implementing effective treatment methods identified in high income countries (HICs) [4]

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