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].
|
#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].
|
#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].
|
#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:
|
#71-88 | ||||
Stage I to IV combined
|
#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].
|
#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.