article · Reports of Practical Oncology & Radiotherapy
Standard Western guidelines for locally advanced breast cancer are often impractical to implement in low- and middle-income countries due to constraints on human resources, diagnostic equipment, and healthcare funding. Effective breast cancer management in these settings requires guidelines that reflect regional development, cost-effectiveness, and socio-cultural contexts. This work evaluates the applicability of Western clinical guidelines in resource-limited environments by defining two distinct treatment tiers: minimal requirements for settings with severe resource constraints, and realistic optimal care achievable as resources expand. Validated by clinical experts, the framework spans adjuvant and neoadjuvant settings across various breast cancer molecular subtypes. Specific clinical protocols addressed include axillary management during the sentinel lymph node biopsy era, regional nodal irradiation guided by response to primary systemic therapy, and subtype-specific neoadjuvant systemic treatments.
In low- and middle-income countries, healthcare providers frequently struggle to apply cancer guidelines designed for well-funded systems. By establishing baseline clinical requirements alongside realistic targets for optimal care, this framework helps healthcare systems deliver safe, structured breast cancer treatment that fits local infrastructure, ensuring more patients receive appropriate care despite resource constraints.
The work provides clinical and policy guidance rather than a commercial technology. Healthcare administrators, hospital networks, and health ministries in low- and middle-income countries can use these recommendations to standardise oncology protocols and allocate resources cost-effectively. Because the framework consists of validated clinical practices, it is ready for immediate adoption in policy and clinical management.
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Locally advanced breast cancer (LABC) is still a concern in low- and middle-income countries (LMICs) where the limited availability of human resources and means do not allow implementation of the guidelines that are elaborated in high-income countries (HICs). Thus, guidelines for BC care must take into account the differences in regional development, the availability of diagnostic tools, the cost-effectiveness of the treatment methods, and the socio-cultural context for BC management. In this report, we aimed to focus on the applicability of the Western guidelines in LMICs for LABC, including the identification of “minimal requirements” that should be offered to patients in the context of lack of means and the “optimal care” which should be the realistic goal to reach according to human resources and means availability. The conclusions regarding locoregional and systemic treatments for the different LABC molecular subtypes have been validated by all experts for all adjuvant and neoadjuvant settings. “Minimal requirements and optimal care” will be discussed for axillary management in the sentinel node biopsy era, for regional nodal irradiation after primary systemic therapy according to the response, and for neoadjuvant systemic therapies according to the BC subtypes.
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DOI: 10.5603/rpor.114286
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