Documentos de Académico
Documentos de Profesional
Documentos de Cultura
Harvard Global Equity Initiative, Harvard Medical School; GTF.CCC Tomatelo a Pecho; Fundacin Mexicana para la Salud
From evidence
to anecdote
July, 2007
January, 2008
Harvard, Breast Cancer in Developing Countries Nov 4, 2009; Nobel Laureat Amartya Sen, Cancer survivor
From anecdote
to evidence
OUTLINE:
1. Evidence to anecdote to evidence
Mandate: Design, develop and implement global, regional and local strategies to improve the financing, procurement and delivery of cancer care, control, treatment and palliation in a sustainable 27 members manner applying innovative representing the global health and service delivery models appropriate to health systems cancer in the developing world. communities
LMICS: More than 85% of pediatric cancer cases and 95% of deaths.
For children & adolescents 5-14 cancer is
#2 cause of death in wealthy countries
Children <15
Adults (15+)
0.8
0.8
0.6
0.6
0.4
0.4
0.2
0.2
0 Low income Lower middle income Upper middle income High income Low income Lower middle income Upper middle income High income
Leukaemia
All cancers
Testis
HPV Vaccine
Models:
ACCESS QUALITY
FINANCIAL PROTECTION
Low-income: Rwanda-Malawi-Haiti
Outcomes in MDR-TB patients in Lima, Peru receiving at least four months of therapy
failed therapy died 8% 8%
abandon therapy 2%
cured 83%
98%
0 oncologists
Central Haiti
Status post-CHOP in Central Haiti: Still in remission three years later
Source: Paul Farmer., 2009
OUTLINE:
1. Evidence to anecdote to evidence 2. Cancer in LMICs: so much more can be done
More than half of cases and almost 2/3 of deaths deaths occur in the developing world.
a disease of
large proportion of cases and 60% of deaths in women < 54. More deaths and DALYs lost to breast cancer, in all developing regions other than SEAsia and SSAfrica.
Most frequent cause of cancer-related death in developing and developed regions 2-3rd leading couse 268,000 of the 458,000 deaths per year are in LIMCs: 58% Most common cancer in developed and developing regions 4.4 million women alive (diagnosed): how many in developing regions? 2008: 1.38 million new cases; 50% of which are from LIMCs 10.9% of all incident cancers second to lung
(Globocan, 2010; Boyle y Levin, 2008; Beaulieu, Bloom, y Bloom, 2009).
Africa
APPROX: 210,000
LMICs
APPROX: 360,000
The opportunity to survive should not be an accident of geography or defined by income. Yet it is. But . there is scope for action.
~ case fatality (incidence/mortality)
63% 60 48%
Breast
52%
48% 37%
40
40%
Cervix
38%
24% 20
Low-income countries
Lower middle
Upper middle
High-income countries
Source: Author estimates based on IARC, Globocan, 2008 and 2010. Quote: HRH Princess Dina Mired
15-44
34%
66%
67%
33%
45-54 >55
Age at death
7%
56%
20%
78%
15%
In 2006, women between 30 an 65 years were more likely to die of breast than cervical cancer. In 1980 the risk of dying from cervical cancer was twice as high as breast cancer
Only 5-10% of cases are detected in stage 1 or insitu, compared to approximately 60% in US.
Mortality from breast and cervical cancer in Mexico1955-2008: less death from cervical
16
12
1995
2006: BC>CC.
Por primera vez en ms de 5 dcadas.
Fuente: Lozano, Knaul, Gmez-Dants, Arreola-Ornelas y Mndez, 2008, Tendencias en la mortalidad por cncer de mama en Mxico, 1979-2007.
FUNSALUD, Documento de trabajo. Observatorio de la Salud, con base en datos de la OMS y la Secretara de Salud de Mxico.
2005
1955
1965
1975
1985
As of Feb 2007 all Mexican women diagnosed with breast cancer have the right to financial protection in health for breast cancer treatment
2-3 4
84% 27%
40%
Stage 1
30%
Stage 2 Stage 3
20%
Stage 4
10%
0% Poor (High) N=221 (3.8%) Middle N=1737 (30%) Low N=2877 (49.8%) Very low N=946 (16.4%)
Why?
Health, social and health system barriers
br
28%
20%
21% 22%
16%
24%
10%
0%
+ Poorest Q1 Least poor Q2 Q3 Q4 QV
Fuente: ENSANUT, 2006
Only 1 in 5 women 40-69 report a preventive health visit including mamography 2006
and early detection is unaffordable: mammography, biopsy and pathology - at the most subsidized level in a public hospital costs more than one month of subsistence income.
Fuente: Groot et al, 2006. TheBreastJournal
OUTLINE:
1. Evidence to anecdote to evidence 2. Cancer in LMICs: so much more can be done 3. Breast cancer: global health priority
A diagonal approach to women and health and cancer care and control
Service Platforms
Diagonal approaches
1. Integrating breast and cervical cancer screening into MCH, SRH 2. Integrating disease prevention and management into social welfare and antipoverty programs 3. Catalyzing and employing community health workers and expert patients 4. Financial protection/insurance strategies with horizontal and vertical coverage 5. Reducing non-price barriers to pain control 6. Developing effective health services research and monitoring
History Part 2:
Felt a breast lump 4 years prior fear kept her from saying anything Lump grew last year doctor at local clinic gave anti-b w/out BCE Is entitled to Seguro Popular and free care Cannot travel to Mexico City; seeking care locally; paying out of pock
Mexico: Harnessing the primary level of care for improving BC detection and care
PATH
Harvard Global Equity Initiative, Harvard Medical School; GTF.CCC Tomatelo a Pecho; Fundacin Mexicana para la Salud