IARC Teams related to WHO Global Initiatives
IARC Global Breast Cancer Initiative (GBCI) Team

Starting date: 2023

Work Programme

The International Agency for Research on Cancer (IARC) and the World Health Organization (WHO) have complementary functions and mandates to advance cancer control globally. WHO launched the Global Breast Cancer Initiative (GBCI) on 8 March 2021, aiming to reduce breast cancer mortality by 2.5% per year. To achieve this goal, three pillars and specific targets were established:

• Pillar 1: Health promotion for early detection
  Target: Achieve diagnosis of at least 60% of invasive cancers at stage I or II

• Pillar 2: Timely diagnosis
  Target: Evaluation, imaging, tissue sampling, and pathology completed within 60 days

• Pillar 3: Comprehensive breast cancer management
  Target: At least 80% of patients with breast cancer undergo a full course of multimodality treatment and successfully return home

The IARC GBCI Team was established with the objective of improving sharing of information and knowledge that relates to the GBCI, and improving dialogue and coordination with the WHO Cancer Team.

The overall objective of the IARC GBCI Team is to share information, knowledge, and updates on the latest developments regarding the ongoing relevant IARC projects, including sharing with WHO, and facilitating dialogue and coordination between the GBCI partners. The current activities, aligned by theme or GBCI Pillar, include:

Development and dissemination of supporting data and tools

• Estimated breast cancer burden via the IARC Global Cancer Observatory, which provides information on incidence, mortality, and prevalence for 185 countries or territories
• Breast cancer mortality trends by age in 70 middle- and high-income countries (via the Cancer Over Time subsite of the Global Cancer Observatory)
• Reported cancer incidence from high-quality cancer registries around the world via the periodic publication Cancer Incidence in Five Continents
• Support to cancer registries in less-developed settings via the Global Initiative for Cancer Registry Development (GICR)
• Breast cancer incidence and survival by stage and age in 70 low- and middle-income countries (SURVCAN-4)
• Breast cancer prevalence according to phase of care (PrevPhase-1)
• Estimated intergenerational impact of premature deaths from breast cancer in terms of maternal orphans
• Cancer Screening in Five Continents (CanScreen5)
• The World Code Against Cancer Framework and related educational materials for health promoters and frontline health-care professionals
• The IARC Learning portal (e.g. self-paced learning programme on Improving the Quality of Cancer Screening)
• Digital atlas on clinical breast examination (CBE), diagnostic mammography and breast ultrasound, and breast pathology (Atlas of Breast Cancer Early Detection)
• Country-specific breast cancer profiles via the GBCI framework (e.g. Namibia)
• Data collection for the GBCI Pillar key performance indicators (KPIs)

Activities related to GBCI Pillar 1: Health promotion for early detection

• Development of standards, recommendations, and studies regarding breast cancer incidence by stage at diagnosis at the population level
• The World Code Against Cancer Framework and related educational materials for health promoters and frontline health-care professionals
• Digital atlas on clinical breast examination (CBE), diagnostic mammography and breast ultrasound, and breast pathology (Atlas of Breast Cancer Early Detection)
• Studies of the patient’s journey to diagnosis, health system barriers to early detection, and breast cancer awareness levels in hospital-based studies in low- and middle-income countries, including across sub-Saharan Africa (ABC-DO: Namibia, Nigeria, South Africa, Uganda, and Zambia) and in eastern Europe and Asia (DEDICA multicountry study: Belarus, Georgia, Kazakhstan, Nepal, the Republic of Moldova, Romania, the Russian Federation, and Uzbekistan)
• Evaluation of clinical breast examination (CBE) in a randomized trial (https://doi.org/10.1002/cncr.34526)
• Implementation of a new multilevel strategy to improve access to the early detection and downstream care continuum for vulnerable rural populations in India (Access Cancer Control India; ACCI)
• Launch of the 1st edition of the Latin America and the Caribbean Code Against Cancer: https://cancer-code-lac.iarc.who.int/en/ and https://www.iarc.who.int/wp-content/uploads/2023/10/pr342_E.pdf

Activities related to GBCI Pillar 2: Timely diagnosis

• IARC multicentre study to evaluate novel technologies to improve breast cancer early diagnosis in limited-resource settings, in India and Uganda
• Digital atlas on clinical breast examination (CBE), diagnostic mammography and breast ultrasound, and breast pathology (Atlas of Breast Cancer Early Detection)

Activities related to GBCI Pillar 3: Comprehensive breast cancer management

• Patterns-of-care studies for breast cancer in Morocco, in Nepal, across eastern Europe and Asia (DEDICA multicountry study: Belarus, Georgia, Kazakhstan, Nepal, the Republic of Moldova, Romania, the Russian Federation, and Uzbekistan), and across sub-Saharan Africa (ABC-DO); interventions to improve treatment completion

Team Composition

Team Leaders: Dr Nadya Dimitrova, Early Detection, Prevention, and Infections Branch (EPR) and Dr Marion Piñeros, Cancer Surveillance Branch (CSU), IARC
Emails: DimitrovaN@iarc.who.int; PinerosM@iarc.who.int

Team members:
Dr Partha Basu (Branch Head, EPR)
Dr Freddie Bray (Branch Head, CSU)
Dr Pauline Boucheron (Postdoctoral Scientist, ENV)
Dr Andre Carvalho (Scientist, EPR)
Dr Carolina Espina (Scientist, ENV)
Dr Milena Foerster (Scientist, ENV)
Dr Valerie McCormack (Deputy Branch Head, ENV)
Dr Isabel Mosquera (Scientist, EPR)
Dr Farida Selmouni (Scientist, EPR)

Key publications

Supporting data and tools

1. Arnold M, Morgan E, Rumgay H, Mafra A, Singh D, Laversanne M, et al. (2022). Current and future burden of breast cancer: Global statistics for 2020 and 2040. Breast. 66:15–23. https://doi.org/10.1016/j.breast.2022.08.010 PMID:36084384
2. Soerjomataram I, Cabasag C, Bardot A, Fidler-Benaoudia MM, Miranda-Filho A, Ferlay J, et al.; SURVCAN-3 collaborators (2023). Cancer survival in Africa, central and south America, and Asia (SURVCAN-3): a population-based benchmarking study in 32 countries. Lancet Oncol. 24(1):22–32. https://doi.org/10.1016/S1470-2045(22)00704-5 PMID:36603919
3. Piñeros M, Parkin DM, Ward K, Chokunonga E, Ervik M, Farrugia H, et al. (2019). Essential TNM: a registry tool to reduce gaps in cancer staging information. Lancet Oncol. 20(2):e103–11. https://doi.org/10.1016/S1470-2045(18)30897-0 PMID:30712797
4. Soerjomataram I, Ervik M, Fox C, Hawkins S, Yeung K, Napolitano G, et al. (2021). CanStaging⁺: an electronic staging tool for population-based cancer registries. Lancet Oncol. 22(8):1069. https://doi.org/10.1016/S1470-2045(21)00188-1 PMID:34339643
5. Zhang L, Mosquera I, Lucas E, Rol ML, Carvalho AL, Basu P; CanScreen5 collaborators (2023). CanScreen5, a global repository for breast, cervical and colorectal cancer screening programs. Nat Med. 29(5):1135–45. https://doi.org/10.1038/s41591-023-02315-6 PMID:37106168
6. Galukande M, Schüz J, Anderson BO, Zietsman A, Adisa C, Anele A, et al. (2021). Maternally orphaned children and intergenerational concerns associated with breast cancer deaths among women in sub-Saharan Africa. JAMA Oncol. 7(2):285–9. https://doi.org/10.1001/jamaoncol.2020.6583 PMID:33355599
7. Benitez Fuentes JD, Morgan E, de Luna Aguilar A, Mafra A, Shah R, Giusti F, et al. (2024). Global stage distribution of breast cancer at diagnosis: a systematic review and meta-analysis. JAMA Oncol. 10(1):71–8. https://doi.org/10.1001/jamaoncol.2023.4837 PMID:37943547

Related to GBCI Pillar 1: Health promotion for early detection

1. Piñeros M, Ginsburg O, Bendahhou K, Eser S, Shelpai WA, Fouad H, et al.; Staging Survey Group (2022). Staging practices and breast cancer stage among population-based registries in the MENA region. Cancer Epidemiol. 81:102250. https://doi.org/10.1016/j.canep.2022.102250 PMID:36115143
2. Ryzhov A, Corbex M, Piñeros M, Barchuk A, Andreasyan D, Djanklich S, et al. (2021). Comparison of breast cancer and cervical cancer stage distributions in ten newly independent states of the former Soviet Union: a population-based study. Lancet Oncol. 22(3):361–9. https://doi.org/10.1016/S1470-2045(20)30674-4 PMID:33556324
3. Mosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, et al. (2023). Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: a systematic review. Cancer Med. cam4.6050. https://doi.org/10.1002/cam4.6050 PMID:37245225
4. McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, et al. (2018). Drivers of advanced stage at breast cancer diagnosis in the multicountry African Breast Cancer – Disparities in Outcomes (ABC-DO) study. Int J Cancer. 142(8):1568–79. https://doi.org/10.1002/ijc.31187 PMID:29197068
5. McKenzie F, Zietsman A, Galukande M, Anele A, Adisa C, Parham G, et al. (2018). Breast cancer awareness in the sub-Saharan African ABC-DO cohort: African Breast Cancer-Disparities in Outcomes study. Cancer Causes Control. 29(8):721–30. https://doi.org/10.1007/s10552-018-1047-7 PMID:29980984
6. Mosquera I, Barajas CB, Zhang L, Lucas E, Benitez Majano S, Maza M, et al. (2023). Assessment of organization of cervical and breast cancer screening programmes in the Latin American and the Caribbean states: the CanScreen5 framework. Cancer Med. 12(19):19935–48. https://doi.org/10.1002/cam4.6492 PMID:37768035
7. Espina C, Feliu A, Maza M, Almonte M, Ferreccio C, Finck C, et al.; Working Groups of Scientific Experts (2023). Latin America and the Caribbean Code Against Cancer 1st Edition: 17 cancer prevention recommendations to the public and to policy-makers (World Code Against Cancer Framework). Cancer Epidemiol. 86(Suppl 1):102402. https://doi.org/10.1016/j.canep.2023.102402 PMID:37852725
8. Baena A, Paolino M, Villarreal-Garza C, Torres G, Delgado L, Ruiz R, et al. (2023). Latin America and the Caribbean Code Against Cancer 1st Edition: medical interventions including hormone replacement therapy and cancer screening. Cancer Epidemiol. 86(Suppl 1):102446. https://doi.org/10.1016/j.canep.2023.102446 PMID:37852728

Related to GBCI Pillar 3: Comprehensive breast cancer management

1. Foerster M, McCormack V, Anderson BO, Boucheron P, Zietsman A, Cubasch H, et al. (2022). Treatment guideline concordance, initiation, and abandonment in patients with non-metastatic breast cancer from the African Breast Cancer-Disparities in Outcomes (ABC-DO) cohort in sub-Saharan Africa: a prospective cohort study. Lancet Oncol. 23(6):729–38. https://doi.org/10.1016/S1470-2045(22)00198-X PMID:35550274
2. McCormack V, McKenzie F, Foerster M, Zietsman A, Galukande M, Adisa C, et al. (2020). Breast cancer survival and survival gap apportionment in sub-Saharan Africa (ABC-DO): a prospective cohort study. Lancet Glob Health. 8(9):e1203–12. https://doi.org/10.1016/S2214-109X(20)30261-8 PMID:32827482