Should Resource Constraints Guide Global Guidelines?

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Comprehensive efforts to improve global health must address cancer, which kills 4.4 million people each year in low- and medium-income countries (LMCs), more than respiratory infections (3.5 million), respiratory diseases (3 million), HIV/AIDS (2.7 million), diarrheal diseases (1.8 million), and tuberculosis (1.5 million).1 Worsened cancer survival in LMCs is largely due to late stage presentation, which, when coupled with limited diagnosis and treatment capacity, leads to particularly poor outcome.2 In addition, health care experts in LMCs may not have yet identified cancer as a priority health issue, because infectious diseases drive morbidity and mortality in these countries. However, as the control of communicable diseases improves and life expectancy rises, cancer will become an increasingly obvious public health issue in LMCs.3In anticipation, the World Health Organization (WHO) adopted the first Cancer Prevention and Control Resolution (WHA58.22) in May 2005 at the 58th World Health Assembly. The Resolution calls on member states to collaborate in developing comprehensive cancer control programs “aimed at reducing cancer incidence and mortality and improving the quality of life of cancer patients and their families, specifically through the systematic, stepwise, and equitable implementation of evidence-based strategies for prevention, early detection, diagnosis, treatment, rehabilitation, and palliative care.”4Clinicians in LMCs are forced to provide suboptimal patient care when diagnostic and/or treatment resources are lacking. Therefore, knowing which resources most effectively fill health care needs is especially important in limited-resource regions, where patients present with more advanced disease and clinicians must provide guidance on how new resources should be...

Dr. Anderson is Professor of Surgery and director of the Breast Health Center at the University of Washington and the Seattle Cancer Care Alliance, where has devoted his clinical practice to the care of patients with breast cancer and breast health issues. As Joint Member in Public Health Sciences at the Fred Hutchinson Cancer Research Center, Dr. Anderson created and chairs the Breast Health Global Initiative (BHGI), an international project to define and implement guidelines for breast cancer screening, diagnosis, and treatment in low- and middle-income countries. Dr. Anderson has served on the Board of Directors of 3 academic national and international breast cancer societies. He served as president of the American Society of Breast Disease from 2005 to 2007, and also served as private sector advisor on cancer control to U.S. Health and Human Services Secretary Michael O. Leavitt on the U.S. delegation to the WHO World Health Assembly in Geneva, Switzerland.
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