Management of Breast Cancer 1. "Close the Gap: Equal Access to all

Closing the Care Gap: Breast Cancer" explores the disparities in breast cancer care and outcomes, highlighting the need for equitable access to screening, diagnosis, and treatment. This presentation delves into the causes of the care gap, including socioeconomic factors, cultural barriers, and healthcare system limitations. By addressing these challenges, we can work towards closing the care gap and improving breast cancer outcomes for all individuals.
This presentation examines the intersection of healthcare disparities, cultural competence, and innovative solutions to enhance breast cancer outcomes. Together, we can close the care gap and ensure quality care for all.

1. Close the Care Gap: Breast Cancer Dr. Magarani Balachandar

2. Introduction In the fight against breast cancer, disparities in care remain a significant challenge. The concept of 'Close the Care Gap' focuses on identifying and bridging these inequities, ensuring that every woman, regardless of her background, has access to timely and effective diagnosis, treatment, and support. By addressing these gaps, we can move closer to a world where breast cancer is not only treatable but survivable for all.

3. OBJECTIVES Overview of Breast Cancer Definition of the Care Gap Consequences of the Care Gap Global Strategies for Closing the Care Gap Early Detection and Screening Programs Treatment and Support Systems

4. Breast Cancer Breast Cancer is a malignant tumor that starts in the cells of the breast. The disease occurs almost entirely in women, but men can get it, too. Most commonly from the inner lining of milk ducts or the lobules that supply the ducts with milk .

5. Incidence

6. Survival rate

7. Survival comparison   T he over all 5 year survival for breast cancer has increased from 75% in 1970's to almost 89% in 2005 (According to recent US SEER data, the five year overall survival in US is now more than 95%). This means that, out of every 100 women with breast cancer in the US, 95 women are likely to survive for at least 5 years (And most of them will cross 10 years and 15 years and 20 years as well.   There are barely any similar statistics for India available, but a rough estimate from the PBCR and HBCCR reports is that, the 5 years survival for Breast Cancer in women in India is not even 60%. SEER- Surveillance, Epidemiology, and End Results , PBCR- Population Based Cancer Registry, HBCCR-Hospital based registry Why?

8. Exact causes is not known But some risk factors for breast cancer Etiology Gender Age Genetics related Family related Personal history of breast cancer Menstrual periods Having children Birth control Breast feeding.

9. Types of Breast Cancer Ductal Carcinoma in situ Invasive Ductal Cancer Inflammatory Breast cancer Metastatic Breast cancer

10. Ductal carcinoma in situ … Is a non –invasive cancer where abnormal cells have been found In the lining of the breast milk duct. Does not spread outside of the ducts into surrounding breast tissue. Ductal a Carcinoma in situ is very early cancer that is highly treatable but if it’s left untreated or undetected ,it can spread into the surrounding breast tissue.

11. Invasive Ductal Carcinoma The cancer cells spread beyond the ducts into other parts of the breast tissue. Nearly 70-80 % of all breast cancers IDC. Most commonly affect men . Ex: Mucinous cancer

12. Inflammatory Breast Cancer It is an aggressive and fast growing breast cancer. This infiltrate the skin and lymph vessels of the breast. It produce no distinct tumor or lump that can be isolated but when the lymph vessels become blocked by the breast cancer cells, symptoms begin to appear.

13. Metastatic Breast cancer The cancer spread to other parts of the body This includes the lungs, Liver, bones or brain.

14. Stages of Breast Cancer

15. Sings and Symptoms F ull or partial swelling Thickening of part of a breast A change in the size or shape of a breast Irritation of the skin B reast or  nipple pain S wollen lymph nodes

16. BSE

17. Treatment Surgery Chemotherapy Radiotherapy Hormonal therapy

18. Surgery

19. Control the weight Get plenty of physical activity Breast – feed Healthy Diet Discontinue hormone therapy Avoid exposure to environmental pollution.

20. Why women are more common to have breast cancer than men ? 1.More breast tissue in women 2.Different hormone levels 3.Menstruation 4.lactation

21. Definition of the Care Gap A “gap in care” is defined as  the discrepancy between recommended best practices and the care that's actually provided . Disparities in breast cancer care Race: Black women have a 41 percent higher death rate from breast cancer compared to white women S ocioeconomic status, Geographical location, Access to healthcare , Education, and awareness.

22. Disparities In many regions, international guidelines recommend annual mammograms starting at age 40 for early detection of breast cancer. However, due to factors like limited healthcare resources, socioeconomic barriers, or lack of awareness, many women do not receive timely mammograms, resulting in delayed diagnosis and treatment. This gap between what is advised and what is delivered can significantly affect outcomes, highlighting the need to close the care gap."

23. Care Gap in India Survival percent in US- 95% In INDIA- < 60 % Why is the survival in India so low?  Because, most women come to a doctor in advanced stages, and in cancer, the more advanced the stage, the lesser the survival. Why do they come in advanced stages?  Because, they are not 'aware'. Most women do notice symptoms of breast cancer - for example - a painless lump in the breast. But they do not know that this could be cancerous - they are not 'aware'. So they wait and ignore . Ultimately, the cancerous lump increases a lot in size and also spread , when finally they realize something is wrong, and come to a doctor. By then, it is fairly late.

24. Consequences of the Care Gap Higher mortality rates Reduced quality of life Increased healthcare costs

25. Factors contributing to the care gap : Mortality Rates : When breast cancer care is delayed or inaccessible, the chances of early detection decrease leading to more advanced stages at diagnosis. This significantly increases mortality rates as treatment becomes less effective. Reduced Quality of Life : Gaps in care often result in prolonged suffering due to late diagnosis, inadequate treatment, and lack of support. This not only affects physical health but also takes a toll on mental and emotional well-being. Increased Healthcare Costs : The lack of early det ection and timely intervention leads to more complex and expensive treatments. This not only burdens the healthcare system but also imposes significant financial strain on patients and their families

26. Global Strategies for Closing the Care Gap Enhancing Awareness and Education: Public Health Campaigns: Launching global and regional campaigns to raise awareness about breast cancer, its risks, and the importance of early detection. These campaigns should be culturally sensitive and accessible to all. Community Engagement: Engaging local communities through workshops, seminars, and training sessions to educate women about self-examination, recognizing early symptoms, and seeking timely medical help.

27. Improving Access to Early Detection : Screening Programs: Expanding access to mammography and other screening methods, particularly in low- and middle-income countries. Mobile clinics and telemedicine can be utilized to reach remote areas. Affordable Screening: Implementing subsidies or free screening programs for underprivileged populations to encourage early detection.

28. Strengthening Health Systems: Capacity Building: Training healthcare professionals in early detection and treatment of breast cancer, with a focus on areas with a shortage of specialists. Infrastructure Development: Investing in healthcare infrastructure to ensure that diagnostic and treatment facilities are available and accessible.

29. Policy and Advocacy Government Policies: Advocating for national and international policies that prioritize women's health, including funding for breast cancer research and treatment programs. Global Partnerships: Collaborating with international organizations like WHO and NGOs to implement standardized care protocols and share resources.

30. Reducing Financial Barriers Health Insurance: Expanding health insurance coverage for breast cancer screening, diagnosis, and treatment, ensuring that financial constraints do not prevent access to care. Financial Assistance Programs: Establishing global and local funds to support women who cannot afford treatment, particularly in developing countries.

31. Supporting Survivors: Post-Treatment Care: Developing comprehensive care programs for breast cancer survivors, including psychological support, rehabilitation, and regular follow-up to detect recurrences. Community Support Networks: Encouraging the formation of support groups and networks to help survivors share experiences, provide emotional support, and advocate for better care.

32. Research and Innovation: Global Research Collaborations: Promoting international research partnerships to advance understanding of breast cancer and develop new diagnostic tools and treatments. Innovative Technologies: Investing in new technologies, such as AI and genomic research, to improve early detection and personalize treatment plans.

33. Addressing Social Determinants of Health : Equity in Care: Tackling the social, economic, and environmental factors that contribute to health disparities, such as poverty, education, and access to nutritious food. Cultural Competency: Ensuring that healthcare providers are trained to understand and respect cultural differences in healthcare beliefs and practices.

34. Early Detection and Screening Programs Importance of Early Detection Improved Survival Rates: Less Aggressive Treatment : Better Quality of Life : Lower Healthcare Costs: Increased Treatment Options: Early detection of breast cancer significantly increases the chances of survival. When cancer is found at an early stage, before it has spread to other parts of the body, treatment is often more effective, leading to higher survival rates. Breast cancer detected early may require less aggressive treatment options, such as smaller surgeries, lower doses of radiation, or shorter courses of chemotherapy. This reduces the physical and emotional burden on patients and minimizes side effects. Early diagnosis allows for timely intervention, which can preserve breast tissue and function. Patients are more likely to maintain a good quality of life, with fewer disruptions to their daily routines and less psychological distress. Treating breast cancer at an early stage is generally less costly than treating advanced cancer. Early intervention reduces the need for extensive and expensive treatments, hospital stays, and long-term care, resulting in lower healthcare costs for both patients and healthcare systems. Early-stage breast cancer often presents more treatment options, allowing for personalized care. Patients can choose from a range of therapies, including less invasive surgical options and targeted treatments, leading to better outcomes and more tailored care plans.

35. Nurses role : Innovative Screening Approaches Mobile clinics and telemedicine Community health workers and local partnerships Technological advancements in screening

36. Support Systems Psychological and Emotional support Support groups and P atient Networks Role of NGOs and Community O rganizations

37. Support System Psychological and Emotional Support: Receiving a breast cancer diagnosis can be overwhelming , Making psychological and emotional support. Access to counseling services, stress management resources and therapeutic interventions.

38. Support Groups and Patient Networks: Engagement in support groups and patient networks offers individuals a platform to share experiences, coping strategies, and encouragement. These communities provide a sense of belonging and understanding, reducing feelings of isolation and empowering patients through shared knowledge and mutual support

39. Role of NGOs and Community Organizations: Non-governmental organizations (NGOs) and community groups play a vital role in breast cancer awareness, prevention, and care. They often spearhead educational campaigns, provide screening services, mobilize resources for treatment, and advocate for policy changes, thereby bridging gaps in healthcare systems and reaching underserved populations

40. Key Takeaways Closing the care gap requires a multi-faceted approach involving policy, education, infrastructure, and community engagement. Early detection and screening are crucial in reducing mortality rates and improving outcomes for breast cancer patients. Collaborative efforts at the global, national, and community levels are essential to ensure equitable access to breast cancer care for all women.

41. Questions