As the burden of breast cancer remains disproportionately high in under-resourced countries, multisectoral partners commit to advance the WHO’s global initiative to end inequities in diagnosis and treatment.
Breast cancer is the most commonly diagnosed cancer in women worldwide, with an estimated 2.3 million new cases in 2020 alone. Despite significant advances in diagnosis and treatment over the past few decades, the burden of breast cancer remains disproportionately high in low- and middle-income countries (LMICs), primarily due to late diagnosis, inadequate services and low coverage. To address this issue, on May 22, 2023, during the World Health Assembly in Geneva, the World Health Organization (WHO) and City Cancer Challenge (C/Can) announced a partnership for the in-country implementation of the WHO Global Breast Cancer Initiative (GBCI) Framework.
The GBCI is one of WHO’s three global cancer initiatives to address childhood, cervical and breast cancer, respectively. The first two initiatives have already impacted many countries, providing governments and multisectoral actors tools to strengthen and scale up childhood and cervical cancer control.
While the GBCI is the newest initiative – the framework for implementation was officially launched on International Women’s Day on March 8, 2023 – its foundation is built on more than 20 years of collaborative work by 250 leading experts and 50 organisations. The GBCI framework uses evidence-based approaches to health system strengthening to illustrate how countries can build capacity, increase access and empower women. It relies on three pillars of action for national cancer control programmes:
1. health promotion and early detection
2. timely and accurate cancer diagnosis
3. comprehensive breast cancer management to completion
To implement the GBCI framework, WHO will join forces with C/Can to leverage cities as cancer care hubs. C/Can is a non-profit foundation that works with cities in LMICs to improve access to cancer care. It will support the WHO through its multisectoral city network to translate GBCI recommendations and national dialogues into actionable work plans and generate best practices to support more cities. The collaboration will initially focus on capacity development and patient journey improvements to ensure timely breast cancer diagnosis and reduce treatment abandonment.
"The GBCI framework will help our city stakeholders make the right decision on system optimisation, processes, and investments. This will ultimately improve access to quality cancer care for all cancer types.”
At the launch event, I highlighted the importance of the GBCI framework for our city partners in the implementation of breast cancer care:
“While C/Can addresses all cancer types, breast cancer has been a priority across all our cities. The GBCI framework will help our city stakeholders make the right decision on system optimisation, processes, and investments. This will ultimately improve access to quality cancer care for all cancer types.”
Enabling greater access to oncology diagnostics, treatments, and quality cancer care globally requires a coordinated effort by every actor of the healthcare ecosystem. GBCI has a clear evidence-based goal to reduce breast cancer mortality by 2.5% per year, potentially saving 2.5 million lives between now and 2040. Several high-income countries have shown uniform declines in breast cancer mortality rates, year-on-year, in the past twenty years. The 40% reduction in breast cancer mortality seen in high-income countries since the 1980s has yet to be achieved in most under-resourced countries, and the GBCI seeks to close that gap.
“Inadequate access to breast cancer care has exacerbated health inequities and undermines progress towards Universal Health Coverage and the realisation of the Sustainable Development Goals.”
The burden of breast cancer is expected to continue to rise in LMICs in the coming decades due to population growth, ageing, and lifestyle changes. If access to breast cancer care in LMICs remains limited, it could have important social consequences. Global breast cancer control is also an important gender-equity issue, as approximately 99% of breast cancers occur in women.
As Dr Ben Anderson, lead for GBCI at the WHO, noted during his intervention at the launch, “Inadequate access to breast cancer care has exacerbated health inequities and undermines progress towards Universal Health Coverage and the realisation of the Sustainable Development Goals.”
Moreover, improving cancer care in under-resourced countries can help build resilience in health systems towards future health crises, including pandemics and other emerging infectious diseases. The GBCI framework will help prioritise new process and infrastructure investments, leading to quality care for all types of cancers. This investment can yield significant economic returns, including improved productivity, reduced healthcare costs, and increased economic growth.
The collaboration will combine the convening power and global reach of WHO with C/Can’s experience of working with local stakeholders, now operating in 13 cities around the world. C/Can brings its know-how on coordinating implementation on the ground. Among our partners, we have civil society, professional associations, United Nations agencies, health institutes and private sector organisations that support cities to accelerate the progress of breast cancer management in LMICs.
The partnership for the implementation of the GBCI framework will leverage the resources and expertise of partners from the pharmaceutical industry, thanks to the convening role of the International Federation of Pharmaceutical Manufacturers & Associations (IFPMA). Amgen, AstraZeneca, Bristol Myers Squibb and MSD expressed their intent to support the initiative financially and in kind.
The social, economic and health burden of breast cancer in LMICs must be a priority for health ministries, governments, and the global health community. The GBCI framework provides the tools and the know-how for earlier detection, diagnosis and treatment, and help spread the advances made in breast cancer management in high-income countries to lower-resource settings. It is only with the collaboration and shared responsibility of all sectors that we can contribute to reducing breast cancer mortality worldwide. We look forward to partnering with the WHO, the implementing countries and other partner institutions to contribute to the goal of downstaging breast cancer and improving health outcomes of women around the world.
The opinions expressed are those of the authors and do not necessarily reflect the position of Re:solve Global Health.
Isabel Mestres is the Chief Executive Officer of City Cancer Challenge.
Dr Benjamin O. Anderson is Technical Lead for Global Breast Cancer Initiative (GBCI) at the World Health Organization. His input to this article is greatly appreciated.
The writing of this article was supported with input from Sean Lybrand, Executive Director and Strategic Lead, Access to Healthcare at Amgen.