Breast Cancer Issues in Developing Countries: An Overview of the Breast Health Global Initiative Benjamin O. Anderson Æ Raimund Jakesz Published online: 19 February 2008 Ó Socie ´te ´ Internationale de Chirurgie 2008 Abstract Background Of the 411,000 breast cancer deaths around the world in 2002, 221,000 (54%) occurred in low- and middle-income countries (LMCs). Guidelines for breast health care (early detection, diagnosis, and treatment) that were developed in high-resource countries cannot be directly applied in LMCs, because these guidelines do not consider real world resource constraints, nor do they pri- oritize which resources are most critically needed in specific countries for care to be most effectively provided. Methods Established in 2002, the Breast Health Global Initiative (BHGI) created an international health alliance to develop evidence-based guidelines for LMCs to improve breast health outcomes. The BHGI held two Global Sum- mits in October 2002 (Seattle) and January 2005 (Bethesda) and using an expert consensus, evidence-based approach developed resource-sensitive guidelines that define comprehensive pathways for step-by-step quality improvement in health care delivery. Results The BHGI guidelines, now published in English and Spanish, stratify resources into four levels (basic, limited, enhanced, and maximal), making the guidelines simultaneously applicable to countries of differing economic capacities. The BHGI guidelines provide a hub for linkage among clinicians and alliance among govern- mental agencies and advocacy groups to translate guidelines into policy and practice. Conclusions The breast cancer problem in LMCs can be improved through practical interventions that are realistic and cost-effective. Early breast cancer detection and comprehensive cancer treatment play synergistic roles in facilitating improved breast cancer outcomes. The most fundamental interventions in early detection, diagnosis, surgery, radiation therapy, and drug therapy can be inte- grated and organized within existing health care schemes in LMCs. Future research will study what implementation strategies can most effectively guide health care system reorganization to assist countries that are motivated to improve breast cancer outcome in their populations. Introduction Breast cancer is the most common cancer of women, comprising 23% of all female cancers around the globe, with an estimated 1.15 million cases diagnosed in 2002 [1]. There is marked geographical variation in incidence rates, being highest in the developed world and lowest in the developing countries in Asia and Africa. The age-stan- dardized incidence in North America is the highest, at 99.4 per 100,000, while the lowest is in central Africa where it is 16.5 per 100,000 [2]. However, in most low- and middle- income countries (LMCs), incidence rates are increasing at a more rapidly than in areas where incidence rates are already high. Global breast cancer incidence rates have increased by about 0.5% annually since 1990, but cancer registries in China are recording annual increases in B. O. Anderson Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA B. O. Anderson (&) Department of Surgery, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA 98195, USA e-mail: banderso@u.washington.edu R. Jakesz Division of General Surgery, Vienna Medical School, Waehringer Guertel 18-20, Vienna A-1090, Austria 123 World J Surg (2008) 32:2578–2585 DOI 10.1007/s00268-007-9454-z