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. 2013 Dec 10;8(12):e82575. doi: 10.1371/journal.pone.0082575

Table 2. Definition and classification of selected interventions for breast cancer control in Peru.

Treatment of individual stages # Awareness raising † # Screening † # Palliative Care‡ #
Stage I treatment: lumpectomy with axillary dissection and radiotherapy (33 fractions).* Eligible patients receive tamoxifen** [18,60] #4 Basic Awareness Raising (BAR): community nurses training program + opportunistic outreach activities by community nurses to raise breast cancer awareness and educate on breast self examination techniques (BSE) + enhanced media activities [37]. #13 CBE screening: Clinical breast examination (CBE) screening (95% coverage) in asymptomatically women: community nurses training program + active outreach screening by community nurses + limited media and awareness raising activities [53].

  • ages 40-69/40-64/45-64/45-69/50-69/50-64

  • annual/biennial/triennial

 #15-32 Standard Palliative Care (SPC): pain treatment through pain medication and anti-emetics, palliative radiotherapy (8 Gy in 1 boost) for eligible patients. Includes end of life hospitalization. No home based visits[60,61]. All except #11-12, 91-94
Stage II treatment: lumpectomy with axillary dissection (70%), or modified radical mastectomy (30%) followed by adjuvant chemotherapy*** and radiotherapy (33 or 25 fractions)* Eligible patients receive tamoxifen** or chemotherapy. ‡ [18,60] #5 Mass-media awareness raising (MAR): BAR + mass media campaign (weekly emissions) [37] #14 Mammography fixed screening urban only : Mammography screening urban (57% coverage by fixed mammography units) in asymptomatic women + limited media and awareness raising activities [17].

  • ages 40-69/40-64/45-64/45-69/50-69/50-64

  • annual/biennial/triennial

 #33-52 Basic Palliative Care (BPC): SPC + palliative care-volunteers training program + home based visits by volunteers every fortnight. Includes end of life hospitalization [60-62]. #11, 91
Stage III treatment: modified radical mastectomy followed by adjuvant chemotherapy*** and radiotherapy (25 fractions).* Eligible patients receive tamoxifen.** [18,60] #6 Mammography screening fixed (urban) and mobile (rural): Mammography screening fixed (57% coverage by fixed mammography units + 38% coverage by mobile units) in asymptomatic women + limited media and awareness raising activities [17].

  • ages 40-69/40-64/45-64/45-69/50-69/50-64

  • annual/biennial/ triennialages 40

 #53-70 Extended Palliative Care (EPC): SPC+ BPC apart from community nurses instead of palliative care-volunteers, medication strengthened with anti-depressants, and bisphosphonates. Includes end of life hospitalization [60-63]. #12, 92-94
Stage IV treatment: adjuvant chemotherapy*** and radiotherapy (10 whole +3 boost fractions) + Standard Palliative Care. Eligible patients receive tamoxifen **[18,60] #7 Mixed Screening:

  • Urban: Mammography screening urban (57% coverage by fixed mammography units) only in ages >50 / combined with CBE screening in ages <50 urban (57% coverage) in asymptomatic women + limited media and awareness raising activities[17].

  • Rural: CBE screening all ages in non-urban areas (38% coverage) in asymptomatically women: community nurses training program + active outreach screening by community nurses + limited media and awareness raising activities[53].

  • ages 40-69/40-64/45-64/45-69/50-69/50-64

  • annual/biennial/ triennial

 #71-88
Stage I to IV combined

  • without trastuzumab

  • with trastuzumab in all HER2 positives (stage I to IV).with trastuzumab in early stage HER2 positives (stage I and II only)

 #8-10 Upfront FNA (fine needle aspiration) after a positive CBE screen, only in combination with CBE screening: FNA training program for GP/medical officer at district hospitals + training of cytologists (2 per province/year). FNA samples are evaluated at district level, and eligible patients referred to provincial or national hospitals[38].

  • Combined only with the most cost effective biennial and triennial CBE screening intervention

 #33-34, 89-93

* Radiotherapy generally includes a dose of 50 Gy given in 10-33 fractions or boosts on an outpatient basis.

** Endocrine therapy consists of 20 mg. tamoxifen per day for 5 years.

*** The (neo)adjuvant chemotherapy combination regimen consists of AC-Taxol: AC given 3-weekly for 4 cycles followed by paclitaxel given weekly for 12 weeks.

† Down-staging interventions cause a shift in stage distribution and are only modeled in combination with treatment of all stages (I to IV).

‡ Palliative care interventions BPC and EPC are only applied to stage IV patients, and substitutes Standard Palliative Care.

# Scenario number in supplement (Table S2) and Figure 2.