Birnbaum JK, et al. - In low-income and middle-income countries (LMICs), the outcomes of different early detection strategies in combination with systemic chemotherapy and endocrine therapy were determined. Settings with improved access to both early detection and adjuvant therapy showed best-projected outcomes. In settings where advanced-stage presentation is common, enhancing detection could result in a substantial benefit even in the absence of mammographic screening.

Methods

• Adapting a microsimulation model, researchers projected outcomes of three early detection strategies alone or in combination with three systemic treatment programs beyond standard of care (program A): program B was endocrine therapy for all estrogen-receptor (ER)-positive cases; program C was program B plus chemotherapy for ER-negative cases; program D was program C plus chemotherapy for advanced ER-positive cases.
• Reductions in breast cancer-related mortality and lives saved per 100,000 women relative to the standard of care for women aged 30–49 years in a low-income setting (East Africa; using incidence data and life tables from Uganda and data on tumor characteristics from various East African countries) and for women aged 50–69 years in a middle-income setting (Colombia) were assessed as the main outcomes.

Results

• Over 10 years, the East African setting indicated 8–41% reductions in relative mortality, corresponding to 23 (95% uncertainty interval -12 to 49) to 114 (80 to 138) lives saved per 100,000 women.
• Colombia indicated mortality reductions by 7–25% over 10 years, corresponding to 32 (–29 to 70) to 105 (61 to 141) lives saved per 100,000 women.