BHGI's approach to cancer treatment guidelines for low- and moderate-income countries

When the prestigious British medical journal The Lancet Oncology this week published six cancer treatment guideline papers aimed at the resource-diverse nations of Asia, it used as its model the economic template developed by the Breast Health Global Initiative (BHGI) based at Fred Hutchinson Cancer Research Center. It was an important affirmation that the BHGI's unique resource-stratification approach to cancer treatment guidelines for low- and moderate-income countries is a viable model.

"Asia represents a tremendous clinical challenge: Cancer incidence is increasing rapidly; lifestyles are becoming more westernized causing changes in disease etiology; and resources for infrastructure and disease management vary widely from country to country," The Lancet Oncology editors said in their introduction to the papers. "For any clinical guidance to be universally applicable these differences need to be taken into account. The Breast Health Global Initiative provides an excellent economic template on how to achieve this goal."

Founded in 2002, the BHGI strives to develop evidence-based, economically feasible and culturally appropriate guidelines for underdeveloped nations to improve breast-health outcomes. BHGI is co-sponsored by the Hutchinson Center and the Susan G. Komen for the Cure. Benjamin O. Anderson, M.D., is founder, chair and director. He is a member of the Division of Public Health Sciences at Fred Hutchinson Cancer Research Center, director of the Breast Health Clinic at the Seattle Cancer Care Alliance and professor of surgery and global health medicine at the University of Washington.

"The BHGI guidelines are intended to assist ministers of health, policymakers, administrators and institutions in prioritizing resource allocation as breast cancer treatment programs are implemented and developed in their resource-constrained countries," Anderson said. "The guidelines are defined by levels of resources and offer evidence-based pathways for coordinated, step-by-step quality improvements. This systematic approach applies a tiered system of resource allotment: basic, limited, enhanced and maximal, and is based on the contribution of each resource toward improving clinical outcomes."

The papers published by The Lancet Oncology in its November 2009 issue cover management of a variety of malignancies: HER-2 positive breast cancer, neck cancer, T-cell and natural-killer-cell neoplasms, advanced non-small-cell lung cancer, liver cancer and endometrial cancer. The guidelines represent consensus statements from the 2009 Asian Oncology Summit held last April in Singapore. The journal co-hosted the event.

"I was tremendously impressed and pleased with how this worked and how the different key opinion leaders were brought together in the Asian Oncology Summit," Anderson said. "It was a great learning experience for me in addition to the fact that it was a demonstration that this stratified guideline approach is in fact useful and functional."

The first broad dissemination of the BHGI guidelines came in October 2008 when journal Cancer published a special supplement, "Guidelines for International Breast Health and Cancer Control," which detailed guidelines for low- and middle-income countries to implement programs to detect and treat breast cancer, the most common disease among women worldwide.