A key determinant of
breast cancer outcome is the degree to which newly diagnosed
cancers are treated correctly in a timely fashion. Available resources must be applied in a rational manner to optimize population-based outcomes. A multidisciplinary international panel of experts addressed the implementation of treatment guidelines and developed process checklists for breast surgery,
radiation treatment, and systemic
therapy. The needed resources for stage I, stage II, locally advanced, and metastatic
breast cancer were outlined, and process metrics were developed. The ability to perform
modified radical mastectomy is the mainstay of locoregional treatment at the basic level of breast healthcare.
Radiation therapy allows for consideration of breast-conserving
therapy, postmastectomy chest wall irradiation, and palliation of painful or symptomatic
metastases. Systemic
therapy with cytotoxic
chemotherapy is effective in the treatment of all
biologic subtypes of
breast cancer, but its provision is resource intensive. Although endocrine
therapy requires few specialized resources, it requires knowledge of
hormone receptor status. Targeted
therapy against
human epidermal growth factor receptor 2 (anti-HER-2) is very effective in
tumors that overexpress HER-2/neu receptors, but cost largely prevents its use in resource-limited environments. Incremental allocation of resources can help address economic disparities and ensure equity in access to care. Checklists and allocation tables can support the objective of offering optimal care for all patients. The use of process metrics can facilitate the development of multidisciplinary, integrated, fiscally responsible, continuously improving, and flexible approaches to the global enhancement of
breast cancer treatment.