Photo by Susan Hill
Riccardo Masetti, Alexandru Eniu, Robert W. Carlson and Shahla Masood were honored at the 2010 Global Summit on International Breast Health as “founding collaborators” of the Breast Health Global Initiative and Global Summit series. Drs. Carlson, Masetti, Masood and Anderson in photo; missing Dr. Eniu.
By Susan Hill, BHGI communications liaison
The Breast Health Global Initiative (BHGI) was founded on the principle that collaboration will lead to amazing results. Through the international partnerships forged since BHGI’s beginnings, new research, guidelines, programs, and most importantly, hope for breast cancer patients has spread to the far reaches of the globe. The 2010 Global Summit on International Breast Health held in Chicago, June 9-11, included recognition of those partners who helped launch the BHGI and Global Summit series in 2002.
“We owe each of these exceptional individuals a debt of gratitude for their shared vision and tireless work,” said Dr. Benjamin O. Anderson, BHGI Chair and Director, in honoring the founding collaborators. “Each contributed in no small way to BHGI’s tackling of the enormous issue of where to begin to address breast healthcare and cancer treatment for medically underserved women in an overarching fashion,” he added.
Four visionary individuals received a special BHGI “Founding Collaborator Award.” Dr. Anderson began with a quote in presenting the first award to Dr. Riccardo Masetti, by saying “‘A wise man should consider that health is the greatest of human blessings.’” He continued, “This is true when a person has great material wealth, but even more important when a person has little in material resources. Riccardo Masetti has worked tirelessly to optimize healthcare delivery in areas where the need is greatest.” Dr. Masetti is professor of surgery and director of the breast center at Catholic University of Rome and medical director of the Hope Xchange Ghana Health Project.
BHGI has become well known for pioneering its economic stratification approach to clinical guidelines which outlines a step-wise method for integrated resource-based treatment for optimal, sustainable breast healthcare delivery and cancer control in limited resource settings. Dr. Anderson stated his belief that this innovative, logical approach to creating effective healthcare systems ultimately will be adopted throughout the world for other cancers and non-communicable diseases.
In recognizing Dr. Robert W. Carlson and Dr. Alexandru Eniu, two key originators of the guidelines and the economic stratification approach, Dr. Anderson offered Hippocrates’ saying, “‘There are in fact two things: science and opinion: the former begets knowledge, the latter, ignorance.’” He added, “In our quest to bring evidence-based medicine to every part of the globe, we could have no better partners in science than Drs. Carlson and Eniu.” Dr. Carlson is professor of medicine at Stanford University and chairs the breast cancer guidelines committee for the National Comprehensive Cancer Network. Dr. Eniu is a medical oncologist at the Breast Cancer Center of the National Cancer Institute Ion Chiricuta, Cluj-Napoca, Romania, and helped develop that country’s national guidelines for breast cancer patient treatment.
In presenting the final founding collaborator award to Dr. Shahla Masood, Dr. Anderson introduced her by saying, “The practice of medicine calls for an undeniable generosity, but going above and beyond in the spirit of service is what Shahla Masood does in working with the BHGI.” Dr. Anderson told the group that in 2003, Dr. Masood, as editor of The Breast Journal, took a faith-based risk in publishing the first clinical guidelines for developing countries. “Dr. Masood had the faith that this was a right thing to, and I’m sure that she prayed she was right. She was right,” he concluded. In addition to serving as editor of the journal, Dr. Masood is Professor and Chair of the Department of Pathology at the University of Florida College of Medicine at Jacksonville, Florida.
Dr. Luiz Antonio Santini, Director General of INCA, the National Cancer Institute of Brazil, right, engages in a discussion with Dr. Eduardo Cazap, president of SLACOM and UICC, left, at the 2010 Global Summit on International Breast Health
By Susan Hill, BHGI communications liaison
Dr. Luiz Antonio Santini has been an integral part of the improvements in cancer control in South America's largest country for the past decade. He is Director General of INCA, the National Cancer Institute of Brazil, and serves on the board of the International Union against Cancer (UICC). As director of the Fluminense Federal University School of Medicine, he implemented a pioneering project for the integration of health services with the academic field that was widely influential in medical education and health services organizations. Dr. Santini was a presenter at the 2010 Global Summit on International Breast Health on the topic of breast cancer screening strategy, implementation and consensus building in Brazil.
What has been the connection and collaboration between BHGI and the Brazilian National Cancer Institute?
Luiz Antonio Santini: I knew Ben Anderson from personal contact during the Second International Cancer Control Congress (ICCC) in Brazil in 2007. He was invited to participate by the steering committee. The ICCC holds biennial meetings to discuss population-based cancer control from the perspectives of governmental and civil society action. The idea is to approach the problem globally. Breast cancer is a big problem for us; we have about 50,000 new cases each year. In the south of Brazil, we have incidence and mortality rates similar to those reported in Europe. The reason isn’t clear, but the aging population is one of the possibilities, and lifestyle, too. This is area has more immigrants from Europe and smaller family size.
Since 2007, we’ve established permanent contact with BHGI and have participated in projects together.
You spoke in your presentation about legislation in Brazil that expanded access to breast cancer screening beginning at age 40. How has this impacted INCA and the medical community?
Luiz Antonio Santini: INCA’s 2004 consensus guidelines were biennial mammograms starting at age 50 and clinical breast exams annually through age 69. The idea was that screening a large population with mammography before age 50 for purposes of early detection wasn’t supported by available evidence. Even before the legislation, however, younger women with a doctor’s order could obtain mammography for early detection; access simply wasn’t guaranteed in law.
The Brazilian Congress passed legislation in 2008 directing the Ministry of Health to make mammography available to women beginning at age 40. The legislation stimulated INCA to revisit its 2004 recommendations by organizing a meeting of international experts in April, 2009. Ben Anderson participated in this conference.
The 2004 INCA recommendations still stand, ages 50-69. Perhaps in Brazil we’ll extend the recommendations to 70-74 because the population is aging, and life expectancy is extending. Even in the US, before 2002, the recommendation was only to age 69. In November, 2009, the United States Preventive Services Task Force issued its recommendations which were quite similar to INCA’s 2004 recommendations.
When the government makes recommendations in our universal health system, the government needs to provide resources. There’s been an effort to expand capacity in Brazil. For 70 percent coverage, we need to do three million mammograms a year to hit the target. We’ll do so by 2011.
You talked in your presentation about the Brazilian campaign to raise awareness and clarify the role of mammography. What was the campaign’s message?
Luiz Antonio Santini: Our idea at INCA was a very clear message of what it means to have a mammogram. Mammography is not a preventative exam. It’s an exam that could extend life, provide a better quality of life – but not prevent breast cancer.
However, the phrase that was used in the government’s campaigns was, “Get your mammogram, and be free of cancer.” It’s not infrequently that you hear that phrase. Independent of the new legislation, women younger than 50 already were flocking to get mammograms, and even women under 40. The campaigns ended up attracting women younger than the intended population.
As the number of mammograms performed has increased, INCA also has implemented initiatives to ensure the quality of the mammograms and readings by radiologists. Right now, screening is opportunistic, generally ordered when women present for a gynecological visit. We are in the process of establishing a pilot program of organized early detection to identify and track women, and, if they don’t show up for their exam, follow up with them. I also want to thank Dr. Ronaldo Corrêa who assisted in the preparation of my presentation. He is involved in the early detection program and will help set up the pilot program.
Another effort already underway is SISMAMA, an information system which enables us to manage the three million mammograms provided annually in the public system. INCA is responsible for the development of the software and its implementation. In order for the providers to be paid, they must enter the data. When you have a system this large and structured, you rapidly accumulate a lot of information you can analyze. In nine months, from July 2009 to March 2010, we accumulated a million cases in the SISMAMA system. We found that 45 percent of the mammograms were in women were under 50. We are now asking whether this is because women want a mammogram to assure themselves or because doctors want to attend to the anxiety of their patients.
What are your plans to increase numbers in the older and higher risk groups of women?
Luiz Antonio Santini: We have a website, and our publications are disseminated every three months, but SISMAMA is so new, we don’t yet have a plan to communicate with the public. We’re working with the Health Ministry on that. We do speak often with the media.
We want to maintain contact with BHGI. This meeting was very informative and provided the opportunity to share our experiences with important American and international specialists. We need to continue these relationships. With the Global Summit co-sponsorship by SLACOM, INCA wants to promote regular collaboration with our neighbors in Latin America and the Caribbean. I’m now a board member of UICC, and Dr. Eduardo Cazap is the incoming president of UICC, which also will help with communication.
Dr. Riccardo Masetti, medical director of the Hope Xchange Ghana Health Project and Susan G. Komen for the Cure Global Ambassador, and Elizabeth Thompson, senior vice-president, medical and scientific affairs, Susan G. Komen for the Cure, were presenters at the 2010 Global Summit on International Breast Health.
By Susan Hill, BHGI communications liaison
Dr. Riccardo Masetti has a special interest in helping to improve treatment of cancer in countries of limited resources. This commitment led him to become involved in the Breast Health Global Initiative from its beginnings and to serve as medical director of the HopeXchange Ghana Health Project, a collaborative international effort aimed at increasing healthcare capacity in sub-Saharan Africa. The project recently initiated construction of a new hospital in the city of Kumasi, Ghana and has promoted multiple breast cancer educational courses and awareness events in Ghana. Dr. Masetti was one of a group of international specialists who presented in January the first Ghana breast cancer specialty training course, establishing Kumasi as the first breast cancer International Learning Laboratory, a collaboration of BHGI, the Ghana Breast Cancer Alliance, Hope Xchange and Susan G. Komen for the Cure®.
Dr. Masetti is professor of surgery and director of the Breast Center at the Catholic University of Rome, Italy. He is founder and president of Susan G. Komen Italia, the Italian affiliate of Susan G. Komen for the Cure and in 2009 was named a Komen Global Ambassador.
What connected you to breast cancer initiatives in Ghana?
Riccardo Masetti: My connection with Ghana comes with my interest in cancer in countries with limited resources. From my Breast Health Global Initiative work since the beginning, we had planned a site visit to Ghana with Ben Anderson in 2004, but at the last moment, I had to cancel my participation due to commitments at work. I continued to work with BHGI and then, three years ago, a person came to me for a second opinion for his wife. He’d been doing humanitarian work around the world and said he was building a hospital in Ghana. He asked me to help. I thought that this couldn’t be a coincidence; it was the second time that Ghana had called me.
I have a busy life with my work at the University, the Race for the Cure Rome and my wife and children, but this work is so important to me in this time in my life. I thought the hospital was a great connection with BHGI. Hope Xchange is the humanitarian organization, and the HopeXchange Medical Center is an 80-bed hospital in Kumasi under construction now.
What is the vision for the hospital and breast health in Ghana?
Riccardo Masetti: The original idea was a small mission hospital, and I suggested something greater. Now with BHGI and other international programs, it’s grown to an exciting model of intervention to helping healthcare capacity in sub-Saharan Africa. It could be replicated in other countries.
It’s a time of economic crisis, so we’re using a sensible approach. We want people to feel this is their hospital. We’re not competing with what they have, but responding to unmet needs. It’s a very exciting program, but when the doors open, I think it will really fly high!
Dr. Ying Zheng, head of the Department of Cancer Prevention and Control at the Shanghai, China Municipal Center for Disease Prevention and Control, was a presenter at the Global Summit on International Breast Health, June 9-11, 2010.
By Susan Hill, BHGI communications liaison
Dr. Ying Zheng is a researcher who has transcended her role into one of passionate advocacy for breast cancer prevention in China. She is head of the Department of Cancer Prevention and Control at the Shanghai Municipal Center for Disease Prevention and Control (CDC) in Shanghai, China. As a co-investigator of two population-based epidemiology studies, Dr. Zheng and her collaborators work to discern the role of dietary, nutrition and lifestyle determinants in Shanghai breast cancer patients’ survival. The research also aims to define the risk factors related to breast cancer. Dr. Zheng discussed the achievements and challenges in China’s fight against breast cancer at the Global Summit on International Breast Health.
What is the connection between the Shanghai CDC and the Breast Health Global Initiative?
Ying Zheng: There was a breast self-examination project in Shanghai done by Fred Hutchinson Cancer Research Center with a Shanghai hospital. Several years ago, the Breast Health Global Initiative wanted to use the data for their research. Wenjin Li, who was involved in both the breast self-examination project and BHGI, came to my office in Shanghai and invited me to join the Breast Health Global Initiative. They also invited me to be a panelist at the 2008 Summit in Budapest, but I was unable to attend.
Before then, I was involved in guidelines with BHGI on the internet, working with the early detection panel to give suggestions to them. I also know Dr. Julie Gralow [director of breast medical oncology at Seattle Cancer Care Alliance] from the University of Washington. She contacted some people from the University of Washington, and with support from Komen, a delegation of women from the US visited China to do some breast cancer advocacy activities.
In 2006 and 2008, we had breast cancer prevention, screening and survivors conferences. The delegation was involved in fundraising dinners both years. We introduced Chinese culture and did formal Shanghai opera performances and tai chi demonstrations and raised money for the Yan Kang Salon, a well known breast cancer survivors’ organization. We also invited public health professionals – scientists, researchers, oncologists, surgeons and activists – to talk about delivering public health services to breast cancer survivors.
How has involvement with BHGI assisted you and your organization?
Ying Zheng: BHGI gave me tools and structure for my work. I’m from Shanghai CDC, so I work on cancer control. Our responsibility is to persuade our government to make good use of funds for cancer control and assure activities are effective. BHGI guidelines have helped. We do everything from prevention to palliative care. We tell the government what is good and use the media to spread knowledge about early detection. We provide education to oncologists to help them control pain. In our tradition, we’re taught pain is natural, and people aren’t taught to complain. We’ve had the program 20 years, and now I think it’s better. Now most clinicians follow the basic pain guidelines, and people know they have the right to be free of pain.
BHGI has helped me put these things into a structure and has given me a lot of advice on how to evaluate our work. We translated a lot of guidelines into Chinese with the cooperation of BHGI. The next step is to improve implementation of the guidelines. Next we’ll take the responsibility to monitor the guidelines. I believe the BHGI guidelines are good – they set different resource levels and give resolutions according to what you are facing.
What is your vision for the future of breast cancer control in China?
Ying Zheng: Cancer – especially breast cancer – will be a very big problem in China. We always say America today will be our tomorrow. America has done well with decreasing mortality. China is so big with disparities in places, so it’s hard to see mortality decreasing in the next 10 years. Cancer care is related to technology and specialty care. In the big cities, we follow advanced techniques, but in rural areas, it’s my opinion that the medical system has its own problems. Hospitals should be able to make money to sustain themselves. Cancer treatment is expensive. We should define basic treatment, and it should be affordable to people in rural areas. A lot of Chinese with low incomes will give up treatment. They have the opinion that cancer has no cure. That’s regretful for breast cancer, because it treated early, it’s curable.
A famous Chinese movie star died of breast cancer at only 42. She felt a lump but refused to go to the hospital. Her sister forced her to go, but she refused treatment. She joined a monastery and died there. I think this tragedy will educate women, so when we go out to do breast cancer education, we always tell this story. If she had gone for help early, finished radiotherapy and surgery, she’d be alive today. I always think of our breast cancer advocacy. Why did she have such a wrong conception? Breast cancer advocacy is necessary in China; it’s urgent.
Dr. Eduardo Cazap, president of SLACOM and UICC and co-chair of the 2010 Global Summit on International Breast Health, addressed the Summit and moderated a panel on June 10, 2010 on "Moving from policy to action in early detection program development."
By Susan Hill, BHGI communications liaison
Eduardo Cazap, MD, PhD, truly represents the international effort to improve breast health. He is founder and has served since 2004 as president of the Latin American and Caribbean Society of Medical Oncology (SLACOM) and served as co-convener and co-chair of the 2010 of the Global Summit on International Breast Health, June 9-11, 2010. He also is current president of the International Union against Cancer (UICC) and collaborated with UICC in developing basic and advanced courses in oncology for several Latin American countries. Dr. Cazap answered questions about the breast health efforts in Latin America and the Caribbean at the Global Summit on International Breast Health.
How did you and SLACOM link with the Breast Health Global Initiative?
Eduardo Cazap: SLACOM is a medical society of cancer specialists which includes many Latin American and Caribbean countries: Argentina, Brazil, Chile, Peru, Venezuela, Uruguay, Colombia and Mexico. Some smaller countries have very small numbers of specialists; Paraguay and Bolivia have only a few members, only a few radiologists and medical oncologists, so the development of specialized doctors is rather limited.
For our current members, one issue is priority: the real need for doctors to have guidelines or norms. We did some research on this and identified two major problems: one is that many countries have official norms or guidelines or recommendations, but they are not truly implemented at the healthcare level. Sometimes the problem is that guidelines are developed by a medical society but they need to be developed by the government, so there’s an important divide between the government and medical society actions. This is one of our improvements: coordination of actions and implementation of strategies between societies and governments.
The second problem identified in previous evaluations and in some publications is the guidelines if they exist sometimes aren’t related to resources or adapted to local needs, or – this is the situation is small localities – they’re using NCCP guidelines which are not appropriate.
Our goal is to have a more useful tool for breast cancer actions. After considering several consensus and international guideless, our experts concluded the Breast Health Global Initiative modality is most useful for our organization, because we have different resource settings, environments and systems, and the BHGI guideless are adaptable to such differences.
What are the greatest challenges facing SLACOM and Latin American and Caribbean countries in achieving breast health improvements?
Eduardo Cazap: Priority one is to have reliable data. Sometimes national cancer registries are difficult to get, so this could be hospital data or a small population registry, or ideally, national population-based data. In essence, reliable data is what further action can be based on.
The second priority, and this was published in the Cancer supplement [October 15, 2008] after the 2008 BHGI Summit in Budapest, the conclusion was that the prevention of breast cancer was considered a priority in most of the countries. The problem of prevention as an objective or goal that could be achieved is the fact that if you want to cover a population, you must have government support. That’s not easy to obtain by a scientific organization. We have some members who are key leaders, but we have different links in different countries.
The third and very important issue in improvement in Latin America is clinical research. This is closely related to a real situation: that current breast cancer research is supported by pharmaceutical companies. Many studies that could be carried out in our region aren’t relevant for our population. The result is some areas follow the needs of other populations in breast cancer care, namely, more developed nations. So it’s necessary to promote independent or publicly funded breast cancer clinical research with objectives that are considered useful and needed for women living in our region.
The main projects ongoing are a series of studies, some already published and some in process, defining characteristics, outcomes, survival and many other areas of information about breast cancer patients in Latin America. Much of this work is supported by the Brest Cancer Research Foundation, the US NGO that supports independent research all over the world. Regulatory support from governments and universities is very limited in our region, around three percent. It is also very important to have a regulatory cooperative group, and SLACOM is working in this direction.
How is SLACOM using BHGI’s guidelines?
Eduardo Cazap: We’ve identified that the problem is not exclusively a problem of guidelines. It’s a problem of implementation. That’s why the 2010 focus is on outcomes. We are focused with BHGI in analyzing the guidelines process and seeing with a deep analysis of the problems whether it would be possible to define a strategy for implementation. If we obtain this information, our next step would be to promote strategies regionally.
I think it’s very important to share some of the very important knowledge and capabilities of high-level organizations in the US with different organizations in Latin America, sharing challenges and objectives. It’s my personal believe that this exchange of information will be for the benefit of all of the participants in the sense that the less developed groups could improve their capabilities, and the more developed group could better understand the real situation outside the US. Finally, this result won’t only benefit breast cancer patients in Latin America, but also similar minorities in the US.
Dr. Samia Al-Amoudi (center), Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, with Leslie Sullivan, BHGI managing director (left), and Dr. Ben Anderson, BHGI founder, chair and director (right), at the 2010 Global Summit on International Breast Health.
By Susan Hill, BHGI communications liaison
Dr. Samia Al-Amoudi has been making history in Saudi Arabian medical circles since she became one of the first women in that country to graduate from medical school. She has become a leading force in opening dialogue and doors for women diagnosed with breast cancer in Saudi Arabia. She is an associate professor at King Abdulaziz University (KAU) in Jeddah, Saudi Arabia, a consulting obstetrician gynecologist and head of the Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, scientific partner in the Breast Health Global Initiative’s global alliance of international organizations. Dr. Al-Amoudi also serves as scientific chair for breast cancer at KAU. Dr. Al-Amoudi answered questions about her passion and involvement in the global breast cancer movement at the Global Summit on International Breast Health.
How did you become involved with the Breast Health Global Initiative?
I met Ben Anderson in Jordan and then in Cairo, all with Komen-related activities and the Komen partnerships. I knew he was coming to Riyadh, and he came for a day to the Center. I started looking into BHGI and came into information on how we could be a partner. I thought it would be a big step, honor and achievement for the Center while we still were being established. I’ve been working in breast cancer since my diagnosis in 2006; the Center is just one of the projects I’ve been doing over the last four or five years.
What changes have you seen since you became involved in the breast cancer movement in Saudi Arabia?
When I was diagnosed, the first issue I faced was breaking the silence. Even my family said, “Let’s keep it in the family.” That was the starting point. I’m a doctor, and part of my responsibility is educating the community. Why should I keep it a secret? It should not be a taboo. I have had a regular column in the newspaper for years – I love to write – so I used it to tell my story. I took people with me on my journey, how I broke it to my children, how I faced the questions, fears, all of those things. After that, I was approached by the U.S. Consulate to join the U.S.-Middle East Breast Cancer Partnership. Then came my involvement with Komen. The Partnership involved M.D. Anderson and Susan G. Komen in the U.S. and the Saudi Cancer Society and King Fahad Medical Center in Saudi Arabia.
What has been the impact of all of this work over the past five years?
The biggest change has been in breaking the silence. The word “cancer” wasn’t said before. More and more women now are encouraged to talk about cancer through public campaigns. It’s no longer a taboo. We’re not at the stage of the U.S., but it’s a change in acceptance. Survivors say, “We’re here, and what can we do?”
Medical resources in Saudi Arabia aren’t a problem. We have the best technology and the best qualified doctors; that’s not the problem. It’s awareness, education and cultural issues. There’s under-utilization of mammography, and there’s under-utilization of resources.
What do you see for breast cancer in the next five years?
I think we’ll see big, big changes in the medical aspects. Recognition by the higher authorities is a priority, as are resources that are well directed and well located. Cultural issues are improving. Networking and partnership organizations such as BHGI – all these international parties will save time, money and lives. Although we have resources, we lack the resources of these partners. We can gain from their experience of the last 25 years. We can’t afford to reinvent the wheel. Losing time means losing lives – a mother or a sister. We can’t afford that. We must move our healthcare services to partnership. The best thing I did in establishing the Center of Excellence was to partner with the BHGI, and we’re honored to be with them.
Massoud Samiei, Head of PACT Program Office, and Ben Anderson, BHGI founder, chair and director, forge a new partnership to fight breast cancer worldwide.
By Susan Hill, BHGI communications liaison
This week’s announcement of a new partnership between the International Atomic Energy Association’s Programme of Action for Cancer Therapy (IAEA-PACT) at the Breast Health Global Initiative’s Global Summit on International Breast Health in Chicago came with great excitement and interest. How will the collaboration advance the worldwide fight against breast cancer? Massoud Samiei, head of the PACT Program Office, answered some of the questions about what the partnership could mean to developing countries.
How did PACT select BHGI for this partnership?
Massoud Samiei: For us, it’s important when selecting a partner that they have a plan that fits our goals. BHGI’s focus on low-resource countries was important. They also met our primary goal of cancer control. There was a synergy between our two organizations: BHGI’s focus on breast cancer in developing countries, their reputation and their development of guidelines that are being adopted. Together, we have a better chance of succeeding. I’ve been meeting with Ben Anderson for the past three or four years; this close contact has helped us better understand each other.
At PACT, we need to bring in the right partners to implement complete cancer programs. Since we’re creating base programs in countries, we’re always looking for partners. BHGI is an important example of a partner that can deliver – providing concrete guidelines for planning and then delivering breast cancer control. Guidelines on their own are fine, but at the end of the day, someone must implement them.
As a program manager, I see we have all the theory, but when it comes to designing a program, many areas need much more detail. For example, in pathology, how many lab services are needed? You need to work in real conditions of low-resource countries to decide what works and what needs to wait until later stages.
Where do you see PACT being of greatest benefit in the partnership?
Massoud Samiei: As part of IAEA, are door openers at the highest levels, so we’re able to engage at the top levels of government. BHGI is exposed to the realities of countries at the institutional levels, and now also at the highest ministerial levels. We’re global, and BHGI will have exposure to more countries to get feedback from across the globe. In particular, we have eight pilot projects, PACT model demonstration sites: Albania, Ghana, Nicaragua, Tanzania, Sri Lanka, Mongolia, Vietnam and Yemen. The idea is for everyone who comes in to demonstrate what can be feasible and successful, what guidelines will work in our model sites. We’re expanding to another four countries, so the total will be 12 countries.
BHGI will participate as a partner in all of these to the extent that their resources will allow. Breast cancer is the highest priority in some of these sites, including Mongolia, Vietnam and also Nicaragua. BHGI has the chance to bring its guidelines and expertise to all of these countries.
Does PACT provide equipment to these areas?
Massoud Samiei: In these model countries, we include all of the areas. We do an assessment and recommend what is needed in terms of equipment, finances, outreach. Based on these recommendations, the countries develop an action plan. With those having breast cancer as a priority, imaging, pathology, treatment all have to be analyzed. BHGI would be a partner to advise ministries what is needed. Is mammography needed? Should we do mobile mammography? The recommendations are based on research and scientific evidence, not someone’s opinion. That’s a very valuable input to the programs we’re running. It must be scientifically advisable and credible. I need something with support, based on results. That’s what BHGI provides.
What are the next steps for the BHGI-PACT partnership?
Massoud Samiei: Immediate steps are to start joint activities in Ghana. We’d like to support the training course BHGI is doing there. This is a great opportunity to get together and link up. PACT has supported Ghana to raise funding for three cancer centers, a $22 million program, in Kumasi, Accra and Tamale. So far about $14 million has been raised. One component is breast cancer diagnosis and treatment. We could benefit from working with BHGI and with the government to plan expansion of services.
The next step in our collaboration is to engage BHGI in PACT’s virtual network, VUCCnet. The program was launched recently, and the idea is to train and while keeping people at home. It’s designed to provide training, partially distance learning and partially continuing professional development. We need to offer content from providers, adopt curriculum that can be placed on a website and determine how much should be done in person. This can be extended to oncology, pathology, surgery, radiation oncology. We’d like this virtual university to deliver; we have lots of interested parties that the World Health Organization is supporting. BHGI is developing training materials for those delivering cancer care, so this is a valuable partnership.
The virtual network already has been launched in Ghana. The target countries are four now in pilot phase for VUCCnet: Ghana, Tanzania, Uganda and Zambia. The mentor countries used as support are Egypt and South Africa. We’re hoping to link with others and that BHGI will be a link to benefit us with distance learning as they have access to education in the U.S. to help us in our programs in Africa.
Virtual University in its first phase will take three years to implement in four countries. We will analyze capabilities in each of the countries and try to assess their needs. They will expand so they can train their own personnel and decide whether their own hospitals have the resources to do the training. We could have trainings for breast cancer treatment and diagnosis that BHGI could provide for Ghana and then other countries could adopt them for their trainings.
We could expand our collaboration to a regional basis for other countries. We could collaborate in other regions. If there is opportunity, we should join together. We are door openers, and BHGI has an important message: develop clear guidelines for low- and middle-resource countries. It’s a long-term goal, and certainly we should be able to take advantage of this agreement and go forward.
The Programme of Action for Cancer Therapy (PACT) and the Breast Health Global Initiative (BHGI) this week announced a new partnership to join forces in the fight against cancer in the developing world. Previously maintaining an informal relationship, BHGI and PACT recognized in late 2009 that a formal partnership would be beneficial in furthering efforts to advance comprehensive cancer control in low- and middle-resource countries, a goal shared by both organizations.
PACT is a worldwide health outreach organization under the umbrella of the International Atomic Energy Association (IAEA) whose mission is to improve cancer survival in developing countries by integrating radiographic therapy into public health systems.
Cancer kills more people globally than tuberculosis, AIDS and malaria combined. According to the World Health Organization, 7.1 million people died of cancer in 2005. Of these, 4.5 million deaths (63%) occurred in low- and middle- income countries. By 2012, cancer will overtake heart disease as the world’s top killer, part of a trend that is projected to more than double the number of cancer deaths worldwide by 2030.
The PACT/BHGI partnership announcement coincides with BHGI’s annual Global Summit on International Breast Health, June 9-11 in Chicago, where PACT’s Director, Massoud Samiei, will be presenting current cancer-related efforts of PACT and the IAEA. Samiei joins more than 30 speakers at the summit, which will base its content around the optimization of healthcare delivery, an area of critical emphasis for both the IAEA and BHGI.
“By working together, the BHGI and PACT can effectively integrate overlapping programs to achieve our common goals of building capacity through stronger regional and national healthcare systems, beginning in Ghana," said Benjamin O. Anderson, MD, founder, chair and director of the BHGI. “Together, our organizations will be able to maximize results through targeted programs to extend our reach, progress and, ultimately, achieve concrete outcomes, while leveraging dollars invested by all parties,” he added.
BHGI began work in Ghana through a collaboration with HopeXchange, a nonprofit international humanitarian organization which has initiated the well received Ghana Health project and organized the Ghana Breast Cancer Alliance (GBCA). Under the direction of Dr. Riccardo Masetti, professor of surgery at the Catholic University in Rome, the GBCA is working in a joint venture with BHGI and HopeXchange to develop the first international Learning Laboratory in Kumasi, Ghana.
PACT and BHGI will be working together in the partnership to curb the number of breast cancer deaths in Africa through collaboration on several projects, including PACT’s new VUCCnet. This distance-learning apparatus was developed by PACT and now will incorporate a breast cancer curriculum jointly created by BHGI, HopeXchange and GBCA, which provides detailed training on the applications of breast cancer medicine. This curriculum currently is in use on a pilot basis in Ghana, but, with its incorporation into the VUCCnet, soon will be accessible in three additional African countries.
“The Learning Lab example in Ghana illustrates the successful initiation of classroom, operating room and online learning resources that we hope to replicate elsewhere in Africa and in Asia with the essential partnership of IAEA,” said Dr. Anderson. “We are very excited about the innovative frontiers of breast cancer control and reduction in mortality that this partnership represents," he added.
Dr. Samia Al-Amoudi, Sheikh Mohammed Hussein Al-Amoudi Scientific Chair for Breast Cancer at King Abdulaziz University, Jeddah, Saudi Arabia, led an historic gathering of medical providers, medical students and public health officials at the first Multidisciplinary Approach to Breast Cancer Course, May 2-3, in Jeddah, Saudi Arabia.
The course was co-sponsored by Breast Health Global Initiative Alliance scientific partner, Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, and the Johns Hopkins School of Medicine. The program offered healthcare providers from Saudia Arabia, Egypt and surrounding areas the opportunity to enhance knowledge and hands-on skills. Course objectives included:
· Appreciation of the importance of the role of the gynecologist and primary care doctors in early detection
· Knowledge of how to use various modalities to work up a breast cancer diagnosis
· Familiarization with the epidemiology of breast cancer
· Appreciation of the impact of mammography on breast cancer mortality
· Understanding of the indications and contributions of breast ultrasound and breast MRI
· Understanding of the issues affecting surgical options for breast cancer
· Discussion of the prognosis of breast cancer in young women and new approaches to its management
· Familiarization with issues related to the navigation and care of breast cancer patients
“Breast cancer is a multidisciplinary area where each healthcare provider has a certain and important role,” said Dr. Al-Amoudi. “Together we could be one hand in the face of this dreadful disease that from my personal experience as a doctor, a survivor and an advocate has a great impact on our lives,” she added.
The Sheikh Mohammed Hussein Al-Amoudi Center of Excellence is the first of its kind in the Middle East. “The Center promises to advance breast health for all women and their families and is destined to become a national and regional treasure,” said Dr. Theadore Tsangaris, course presenter and chief of breast surgery, division of surgical oncology, Johns Hopkins, and director, Johns Hopkins Comprehensive Breast Center.