All Title Author
Keywords Abstract


Improving Outcomes from Breast Cancer in a Low-Income Country: Lessons from Bangladesh

DOI: 10.1155/2012/423562

Full-Text   Cite this paper   Add to My Lib

Abstract:

Women in low- and middle-income countries (LMICs) have yet to benefit from recent advances in breast cancer diagnosis and treatment now experienced in high-income countries. Their unique sociocultural and health system circumstances warrant a different approach to breast cancer management than that applied to women in high-income countries. Here, we present experience from the last five years working in rural Bangladesh. Case and consecutive series data, focus group and individual interviews, and clinical care experience provide the basis for this paper. These data illustrate a complex web of sociocultural, economic, and health system conditions which affect womens’ choices to seek and accept care and successful treatment. We conclude that health system, human rights, and governance issues underlie high mortality from this relatively rare disease in Bangladesh. 1. Introduction The US-based National Comprehensive Cancer Network guidelines for breast cancer management specifically state that even under the best of circumstances “there is not a single clinical situation in which the treatment of breast cancer has been optimized with respect to either maximizing cure or minimizing toxicity and disfigurement” [1]. In low- and middle-income countries with far fewer resources than the US, the circumstances are compounded by multiple factors associated with increased mortality for this disease [2]. Addressing and remedying these inequities requires an exploration into the unique circumstances surrounding the complex barriers women face in receiving information, accurate and timely diagnosis, and effective treatment critical to reducing breast cancer morbidity and mortality [3]. For the past five years, beginning with work to recruit women to a clinical trial of treatment for metastatic breast cancer, we have been increasing our efforts to understand what is happening to women with breast cancer in the Khulna Division of Bangladesh. Our experience calls into question the application of common high-income country models and strategies in such settings. 2. Bangladesh Understanding barriers to improving outcomes from breast cancer begins with an appreciation of the broader sociocultural context in which women live. We present our experience in Bangladesh as the backdrop for this exploration. Bangladesh is located in Southern Asia, between India and Myanmar, and borders the Bay of Bengal to the south (Figure 1). It is the seventh most populous country in the world; a country of nearly 160 million people (approximately half the population of the US) in an area half

References

[1]  R. W. Carlson, B. O. Anderson, W. Bensinger et al., “NCCN practice guidelines for breast cancer,” Oncology, vol. 14, no. 11, pp. 33–49, 2000.
[2]  The Lancet, “Breast cancer in developing countries,” The Lancet, vol. 374, no. 9701, p. 1567, 2009.
[3]  L. Remennick, “The challenge of early breast cancer detection among immigrant and minority women in multicultural societies,” The Breast Journal, vol. 12, no. 1, pp. S103–S110, 2006.
[4]  CIA, “The world factbook,” https://www.cia.gov/library/publications/the-world-factbook/geos/bg.html/.
[5]  Bangladesh Bureau of Statistics, “Bangladesh population statistics,” http://www.geohive.com/cntry/bangladesh.aspx/.
[6]  The World Bank, “Country and lending groups,” http://data.worldbank.org/about/country-classifications/country-and-lending-groups/.
[7]  The World Bank, “World development indicators 2011,” http://data.worldbank.org/data-catalog/world-development-indicators/wdi-2011/.
[8]  S. M. Ahmed, M. A. Hossain, and M. R. Chowdhury, “Informal sector providers in Bangladesh: how equipped are they to provide rational health care?” Health Policy and Planning, vol. 24, no. 6, pp. 467–478, 2009.
[9]  P. Claquin, “Private health care providers in rural Bangladesh,” Social Science and Medicine. Part B, vol. 15, no. 2, pp. 153–157, 1981.
[10]  T. Akter and S. Islam, “Dhaka medical college hospital: a diagnostic study,” 2006.
[11]  S. Zaman, “Poverty and violence, frustration and inventiveness: hospital ward life in Bangladesh,” Social Science and Medicine, vol. 59, no. 10, pp. 2025–2036, 2004.
[12]  The World Bank, “Country health system profile—Bangladesh—health resources,” http://www.searo.who.int/en/Section313/Section1515_6124.htm/.
[13]  M. A. Mabud, “Demographic implicatins for helath human resources for Bangladesh,” Centre for Health, Population and Development, Independent University, Bangladesh, 2005.
[14]  M. Brown, S. Goldie, G. Draisma, J. Harford, and J. Lipscomb, “Health service interventions for cancer control in developing countries,” in Disease Control Priorities in Developing Countries, pp. 569–590, Oxford University Press, New York, NY, USA, 2nd edition, 2006.
[15]  Y. Bhurgri, N. Kayani, N. Faridi et al., “Patho-epidemiology of breast cancer in Karachi ‘1995–1997’,” Asian Pacific Journal of Cancer Prevention, vol. 8, no. 2, pp. 215–220, 2007.
[16]  U. Sen, R. Sankaranarayanan, S. Mandal, A. V. Ramanakumar, D. M. Parkin, and M. Siddiqi, “Cancer patterns in Eastern India: the first report of the Kolkata Cancer Registry,” International Journal of Cancer, vol. 100, no. 1, pp. 86–91, 2002.
[17]  C. M. Wilson, S. Tobin, and R. C. Young, “The exploding worldwide cancer burden: the impact of cancer on women,” International Journal of Gynecological Cancer, vol. 14, no. 1, pp. 1–11, 2004.
[18]  P. Porter, “‘Westernizing’ women's risks? Breast cancer in lower-income countries,” The New England Journal of Medicine, vol. 358, no. 3, pp. 213–216, 2008.
[19]  World Cancer Research Fund, “Breast cancer worldwide,” http://www.wcrf.org/cancer_facts/women-breast-cancer.php/.
[20]  R. Sadana, C. D'Souza, A. A. Hyder, and A. M. R. Chowdhury, “Importance of health research in South Asia,” The British Medical Journal, vol. 328, no. 7443, pp. 826–830, 2004.
[21]  World Health Organization, “Primary health care,” http://who.int/topics/primary_health_care/en/.
[22]  J. B. Harford, “Breast-cancer early detection in low-income and middle-income countries: do what you can versus one size fits all,” The Lancet Oncology, vol. 12, no. 3, pp. 306–312, 2011.
[23]  International Breast Cancer Research Foundatio, “Our mission,” 2011, http://www.ibcrf.org/OurMission.cfm/.
[24]  G. Uy, “Immunohistochemical assay of hormone receptors in breast cancer at the Philippine General Hospital: importance of early fixation of specimens,” Philippine Journal of Surgery and Surgical Specialties, vol. 63, no. 3, pp. 123–127, 2007.
[25]  F. Ahmad, S. Mahmood, I. Pietkiewicz, L. McDonald, and O. Ginsburg, “Concept mapping with South Asian immigrant women: barriers to mammography and solutions,” Journal of Immigrant and Minority Health. In press.
[26]  S. Loh, T. Packer, C. H. Yip, and W. Y. Low, “Perceived barriers to self-management in Malaysian women with breast cancer,” Asia-Pacific Journal of Public Health, vol. 19, no. 3, pp. 52–57, 2007.
[27]  P. Parsa, M. Kandiah, H. Abdul Rahman, and N. M. Zulkefli, “Barriers for breast cancer screening among Asian women: a mini literature review,” Asian Pacific journal of cancer prevention, vol. 7, no. 4, pp. 509–514, 2006.
[28]  J. Mitchell, D. R. Lannin, H. F. Mathews, and M. S. Swanson, “Religious beliefs and breast cancer screening,” Journal of Women's Health, vol. 11, no. 10, pp. 907–915, 2002.
[29]  G. X. Ma, S. E. Shive, M. Q. Wang, and Y. Tan, “Cancer screening behaviors and barriers in Asian Americans,” The American Journal of Health Behavior, vol. 33, no. 6, pp. 650–660, 2009.
[30]  L. Uba, “Cultural barriers to health care for Southeast Asian refugees,” Public Health Reports, vol. 107, no. 5, pp. 544–548, 1992.
[31]  T.-Y. Wu, H. F. Hsieh, and B. T. West, “Demographics and perceptions of barriers toward breast cancer screening among Asian-American women,” Women and Health, vol. 48, no. 3, pp. 261–281, 2008.
[32]  N. D. Kristof, Half the Sky: Turning Oppression into Opportunity for Women Worldwide, Vintage Books, New York, NY, USA, 1st edition, 2010.
[33]  M. F. Fathalla, “Human rights aspects of safe motherhood,” Best Practice and Research: Clinical Obstetrics and Gynaecology, vol. 20, no. 3, pp. 409–419, 2006.
[34]  N. Chaudhury and J. S. Hammer, “Ghost doctors: absenteeism in rural Bangladeshi health facilities,” World Bank Economic Review, vol. 18, no. 3, pp. 423–441, 2004.
[35]  M. Lewis, Governance and Corruption in Public Health Care Systems, vol. 78, World Bank, Washington, DC, USA, 2006.

Full-Text

comments powered by Disqus