Breast Cancer in Limited-Resource Countries: Treatment and Allocation of Resources

摘要: Treating breast cancer under the constraints of significantly limited health care resources poses unique challenges that are not well addressed by existing guidelines. We present evidence-based guidelines for systematically prioritizing therapies across entire spectrum resource levels. After consideration factors affecting value a given therapy (contribution to overall survival, disease-free quality life, and cost), we assigned each one four incremental levels--basic, limited, enhanced, or maximal--that together map out sequential flexible approach planning, establishing, expanding treatment services. For stage I disease, basic-level modified radical mastectomy endocrine with ovarian ablation tamoxifen; added at level breast-conserving therapy, radiation standard-efficacy chemotherapy (cyclophosphamide, methotrexate, 5-fluorouracil [CMF], doxorubicin cyclophosphamide [AC], epirubicin [EC], 5-fluorouracil, doxorubicin, [FAC]); enhanced level, taxane aromatase inhibitors luteinizing hormone-releasing hormone (LH-RH) agonists; maximal reconstructive surgery, dose-dense chemotherapy, growth factors. II allocation is same, exception therapy. locally advanced cancer, mastectomy, neoadjuvant (CMF, AC, FAC), postmastectomy therapy; whole-breast LH-RH surgery metastatic recurrent total ipsilateral in-breast recurrence, tamoxifen, analgesics; CMF anthracycline chemotherapy; taxanes, capecitabine, trastuzumab, inhibitors, bisphosphonates; vinorelbine, gemcitabine, carboplatin, factors, fulvestrant. Compared early more intensive generally has poorer outcomes, highlighting potential benefit earlier detection diagnosis, both in terms conserving scarce reducing morbidity mortality. Use scheme outlined here should help ministers health, policymakers, administrators, institutions limited-resource settings plan, establish, gradually expand services their populations.