Feasibility of monitoring Global Breast Cancer Initiative Framework key performance indicators in 21 Asian National Cancer Centers Alliance member countries

Sok King Ong, Rei Haruyama, Cheng Har Yip, Tran Thu Ngan, Jingmei Li, Daphne Lai, Yawei Zhang, Siyan Yi, Abhishek Shankar, Evlina Suzanna, So-Youn Jung, Peh Joo Ho, Aasim Yusuf, Ashrafun Nessa, Kyu-Won Jung, Eshani Fernando, Shweta Baral, Maryam Bagherian, Prabhat Pradhan, Uranbolor JugderChampadeng Vongdala, Siti Norbayah Yusof, Khin Thiri, Patumrat Sripan, Clarito Cairo, Tomohiro Matsuda, Suleeporn Sangrajran, Veronique Kiak-Mien Tan, Ravi Mehrotra, Benjamin O. Anderson

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Abstract

Background
The Global Breast Cancer Initiative (GBCI) Framework, launched by the World Health Organisation (WHO) in 2023, emphasises assessing, strengthening, and scaling up services for the early detection and management of breast cancer. This study aims to determine the feasibility of monitoring the status of breast cancer control in the 21 Asian National Cancer Centers Alliance (ANCCA) countries based on the three GBCI Framework key performance indicators (KPIs): stage at diagnosis, time to diagnosis, and treatment completion.

Methods
We reviewed published literature on breast cancer control among 21 ANCCA countries from May to July 2023 to establish data availability and compiled the latest descriptive statistics and sources of the indicators using a standardised data collection form. We performed bivariate Pearson's correlation analysis to measure the strength of correlation between stage at diagnosis, mortality and survival rates, and universal health coverage.

Findings
Only 12 (57%) ANCCA member countries published national cancer registry reports on breast cancer age-standardised incidence rate (ASIR) and age-standardised mortality rate (ASMR). Indonesia, Myanmar, and Nepal had provincial data and others relied on WHO's Global Cancer Observatory (GLOBOCAN) estimates. GLOBOCAN data differed from the reported national statistics by 5–10% in Bhutan, Indonesia, Iran, the Republic of Korea, Singapore, and Thailand and >10% in China, India, Malaysia, Mongolia, and Sri Lanka. The proportion of patients diagnosed in stages I and II strongly correlated with the five-year survival rate and with the universal health coverage (UHC) index. Three countries (14%) reported national data with >60% of invasive breast cancer patients diagnosed at stages I and II, and a five-year survival rate of >80%. Over 60% of the ANCCA countries had no published national data on breast cancer staging, the time interval from presentation to diagnosis, and diagnosis to treatment. Five (24%) countries reported data on treatment completion. The definition of delayed diagnosis and treatment completion varied across countries.

Interpretation
GBCI's Pillar 1 KPI correlates strongly with five-year survival rate and with the UHC index. Most ANCCA countries lacked national data on cancer staging, timely diagnosis, and treatment completion KPIs. While institutional-level data were available in some countries, they may not represent the nationwide status. Strengthening cancer surveillance is crucial for effective breast cancer control. The GBCI Framework indicators warrant more detailed definitions for standardised data collection. Surrogate indicators which are measurable and manageable in country-specific settings, could be considered for monitoring GBCI indicators. Ensuring UHC and addressing health inequalities are essential to early diagnosis and treatment of breast cancer.
Original languageEnglish
Article number102365
Number of pages14
JournaleClinicalMedicine
Volume67
Early online date16 Dec 2023
DOIs
Publication statusPublished - 16 Jan 2024

Keywords

  • Breast Cancer
  • WHO GBCI Framework
  • Survival
  • Cancer Screening
  • Early Diagnosis
  • ANCCA
  • Asia

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