Global registry data on care patterns in breast, cervical, and ovarian cancers

Evidence before this study

Cancers of the breast, cervix, and ovary are a major public health problem worldwide. Global differences in survival from these cancers, shown by the CONCORD programme, are striking, and inequalities in survival also exist between and within high-income countries (HICs). We searched PubMed for articles published in English between Jan 1, 1990, and May 1, 2018, using the following search terms: (“breast neoplasms” OR “ovarian neoplasms” OR “uterine cervical neoplasms”) OR (“breast cancer” OR “ovarian cancer” OR “cervical cancer”) AND (“global high-resolution” OR “international high-resolution” OR “EUROCARE high-resolution” OR “CONCORD high-resolution” OR “patterns of care” OR “standard care”). To our knowledge, the largest comparison of indicators of consistency with clinical guidelines to date, derived from population-based high-resolution data, was between representative samples of around 20 000 women diagnosed with breast cancer during 1996–98 in 12 countries across Europe and seven US states. Several high-resolution studies of breast cancer have been conducted between or within European countries. Population-based studies on cervical cancer have mainly described trends in incidence or mortality, or the effect of a screening programme on the cure proportion. The largest study on ovarian cancer is a trial focused on the effect of screening on mortality from ovarian cancer, whereas the largest population-based study focused on risk factors. Other studies include only a meta-analysis of indicators for ovarian cancer, produced by various centres in four HICs, as well as a study of adherence to guidelines for the treatment of breast cancer in sub-Saharan Africa based on samples from hospital-based registries only.

Added value of this study

In this worldwide secondary analysis of data from 103 population-based cancer registries, we have examined indicators of treatment consistency with clinical guidelines derived from over 250 000 anonymised individual records of women diagnosed with breast, cervical, or ovarian cancer between 2015 and 2018 in 39 countries, including 15 low-income and middle-income countries (LMICs). We have created the largest population-based, high-resolution database for the three most common cancers in women, including detailed information on stage at diagnosis, staging procedures, treatment, and biomarkers. Ten times larger than any previous high-resolution study, the VENUSCANCER project—embedded in the CONCORD programme—offers the first real-world picture of global patterns of care and consistency with clinical treatment guidelines for breast, cervical, and ovarian cancer.

Implications of all the available evidence

Population-based indicators of consistency of initial treatment with the main international clinical guidelines (ESMO, ASCO, and NCCN) and time from diagnosis to initial treatment will both be useful tools to help interpret the persistent disparities in survival for women with breast, cervical, or ovarian cancers. Global variability in the deployment of international clinical guidelines for treatment indicates the need for simplified guidelines, tailored to local needs and resources, and made available in local languages. Availability of optimal treatment for early-stage breast, cervical, and ovarian cancers in most countries worldwide highlights the importance of early detection in LMICs, where the proportion of women with cancer who are diagnosed at an early stage is still far too low. An increased number of radiotherapy facilities and trained surgeons could also help ensure the availability of breast-conserving surgery plus radiotherapy in LMICs. In these countries, wide use of chemotherapy for all three cancers might indicate availability of old drugs, which are more affordable, but might not be the optimal choice for patients.

Data on stage at diagnosis and treatment should be routinely collected by all population-based cancer registries, even in HICs. To guarantee timeliness and completeness of these data, any cancer control plan should include the provision of stable financial support from governments to population-based cancer registries as a permanent goal. As shown by this project, even limited financial support to cancer registries can improve the quality and completeness of data in most LMICs. Financial support would also be beneficial in several HICs. WHO's Global Breast Cancer Initiative and Cervical Cancer Elimination Initiative, as well as the Women, Power and Cancer Commission, should consider using the results from VENUSCANCER as baseline real-world evidence to support the implementation and monitoring of their goals and recommendations.

Source: The Lancet