Breast cancer care in Bangladesh needs radical change
Regular self examination is the best way of early detection of breast cancer
It is estimated that one in fourteen women will be diagnosed with breast cancer at some point in their lives with incidence projected to rise in South-East Asia. Current service provision in our practices lack screening, diagnosis and treatment option delivery to patients in appropriate manner. Outcomes for Bangladeshi Breast cancer patients are worse than India, Thailand, Singapore, Malaysia. Reasons for this include poor communication between professionals in different care settings, and inadequate planning and coordination of care between specialists. The establishment of networks, stressing the importance of multi-disciplinary consultations and management and to recognise the importance of collecting high quality, comprehensive cancer registration data are essential for delivering a quality cancer care. We need to set out a vision to improve cancer services to become and stay comparable with other countries with a programme of investment and service improvement. Significant resources need to be allocated to improving standards. More need to be done to ensure our cancer services become trustworthy in the world. Providing world-class services across the whole of Bangladesh, and to address the existing inequalities between centres to centres and doctors to doctors require radical change with the support from everybody. Over the next 20 years, the cancer burden will increase. Cancer incidence, prevalence and mortality will variably change due to many reasons. The earlier cancer is diagnosed and treated, the greater the likelihood of survival, meaning earlier diagnosis has the potential to save lives. Primary care has limited diagnostic facilities to exclude a diagnosis of cancer and there are no clear protocols for acting on the receipt of abnormal results in secondary care. Screening makes an important contribution to the early diagnosis of breast cancers. For example, over a third of breast cancer cases are detected through the breast screening programme in London. Drivers for changes are enhancement of multidisciplinary work and developments in imaging facilities. Improving cancer treatments will demand increasing sub-speciali-sation in many areas. These include medical and clinical oncology, using new surgical techniques, imaging, histopathology and the use of increasingly sophisticated technologies. This will require hospitals to employ more appropriately highly trained clinical staff. The delivery of world-class cancer care is dependent on factors beyond excellence in clinical service delivery. Evidence from the top cancer centres in the world indicates that research and development, teaching and training need to be embedded in service delivery. The future sustainability of world-class cancer care in Bangladesh depends on harnessing these synergies.
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