How did PACT select BHGI for this partnership?
Dr. Samiei: For us, it’s important when selecting a partner that they have a plan that fits our goals. BHGI’s focus on low-resource countries was important. They also met our primary goal of cancer control. There was a synergy between our two organizations: BHGI’s focus on breast cancer in developing countries, their reputation and their development of guidelines that are being adopted. Together, we have a better chance of succeeding. I’ve been meeting with Ben Anderson for the past three or four years; this close contact has helped us better understand each other.

At PACT, we need to bring in the right partners to implement complete cancer programs. Since we’re creating base programs in countries, we’re always looking for partners. BHGI is an important example of a partner that can deliver – providing concrete guidelines for planning and then delivering breast cancer control. Guidelines on their own are fine, but at the end of the day, someone must implement them.

As a program manager, I see we have all the theory, but when it comes to designing a program, many areas need much more detail. For example, in pathology, how many lab services are needed? You need to work in real conditions of low-resource countries to decide what works and what needs to wait until later stages.

Where do you see PACT being of greatest benefit in the partnership?
Dr. Samiei: As part of IAEA, are door openers at the highest levels, so we’re able to engage at the top levels of government. BHGI is exposed to the realities of countries at the institutional levels, and now also at the highest ministerial levels. We’re global, and BHGI will have exposure to more countries to get feedback from across the globe. In particular, we have eight pilot projects, PACT model demonstration sites: Albania, Ghana, Nicaragua, Tanzania, Sri Lanka, Mongolia, Vietnam and Yemen. The idea is for everyone who comes in to demonstrate what can be feasible and successful, what guidelines will work in our model sites. We’re expanding to another four countries, so the total will be 12 countries.

BHGI will participate as a partner in all of these to the extent that their resources will allow. Breast cancer is the highest priority in some of these sites, including Mongolia, Vietnam and also Nicaragua. BHGI has the chance to bring its guidelines and expertise to all of these countries.

Does PACT provide equipment to these areas?
Dr. Samiei: In these model countries, we include all of the areas. We do an assessment and recommend what is needed in terms of equipment, finances, outreach. Based on these recommendations, the countries develop an action plan. With those having breast cancer as a priority, imaging, pathology, treatment all have to be analyzed. BHGI would be a partner to advise ministries what is needed. Is mammography needed? Should we do mobile mammography? The recommendations are based on research and scientific evidence, not someone’s opinion. That’s a very valuable input to the programs we’re running. It must be scientifically advisable and credible. I need something with support, based on results. That’s what BHGI provides.

What are the next steps for the BHGI-PACT partnership?
Dr. Samiei: Immediate steps are to start joint activities in Ghana. We’d like to support the training course BHGI is doing there. This is a great opportunity to get together and link up. PACT has three cancer centers in Ghana, a $22 million program, in Kumasi, Accra and Tamale. One component is breast cancer diagnosis and treatment. We could benefit from working with BHGI and with the government to plan expansion of services.

The next step in our collaboration is to engage BHGI in PACT’s virtual network, VUCCnet. The program was launched recently, and the idea is to train and while keeping people at home. It’s designed to provide training, partially distance learning and partially continuing professional development. We need to offer content from providers, adopt curriculum that can be placed on a website and determine how much should be done in person. This can be extended to oncology, pathology, surgery, radiation oncology. We’d like this virtual university to deliver; we have lots of interested parties that the World Health Organization is supporting. BHGI is developing training materials for those delivering cancer care, so this is a valuable partnership.

The virtual network already has been launched in Ghana. The target countries are four now in pilot phase for VUCCnet: Ghana, Tanzania, Uganda and Zambia. The mentor countries used as support are Egypt and South Africa. We’re hoping to link with others and that BHGI will be a link to benefit us with distance learning as they have access to education in the U.S. to help us in our programs in Africa.

Virtual University in its first phase will take three years to implement in four countries. We will analyze capabilities in each of the countries and try to assess their needs. They will expand so they can train their own personnel and decide whether their own hospitals have the resources to do the training. We could have trainings for breast cancer treatment and diagnosis that BHGI could provide for Ghana and then other countries could adopt them for their trainings.

We could expand our collaboration to a regional basis for other countries. We could collaborate in other regions. If there is opportunity, we should join together. We are door openers, and BHGI has an important message: develop clear guidelines for low- and middle-resource countries. It’s a long-term goal, and certainly we should be able to take advantage of this agreement and go forward.

Participants in the Ghana breast cancer training course, January 2010, co-sponsored by the Breast Health Global Initiative and Ghana Breast Cancer Alliance.

Worldwide, breast cancer is a growing epidemic as women are living longer and communication and awareness of the disease increases. An estimated 1.5 million new cases will be diagnosed this year. Depending on where the woman lives, that may or may not be tantamount to a death sentence.

Founded almost a decade ago by breast cancer surgeon and University of Washington School of Medicine professor Dr. Ben Anderson and medical school program manager Leslie Sullivan, the Breast Health Global Initiative (BHGI) seeks to bring a higher standard of breast healthcare to the world using an innovative model of collaboration with the best minds in breast cancer across the globe.

Communicating with clinicians in far-flung countries in Africa, Asia, South America and Europe, they have developed workable guidelines that match resources on the ground – however limited those resources may be.

The Breast Health Global Initiative is achieving groundbreaking goals in developing realistic guidelines matched to countries’ specific existing resources – from low- to mid-levels of services that might be accessible in developing countries. Much of the work of the Breast Health Global Initiative also involves education: overcoming stereotypes and dismissive attitudes about women’s health that keep a woman with a lump silenced in fear of losing her husband and children. Changing cultural stereotypes and introducing breast self-examination to low-income countries are just the beginning.

The Global Summit on International Breast Health, June 9-11, will bring together in Chicago doctors, nurses, public health educators and administrators from 40 countries and six continents. Co-sponsored by BHGI and the Latin American and Caribbean Society of Clinical Oncology, led by Dr. Eduardo Cazap, the Summit will assess best practices and surgical techniques for low-resourced locations and diagnostic tools where mammography and ultrasound may be far-fetched fantasies for the near future.

Dozens of scientific poster presentations at the Summit will allow clinical providers from around the world to show their research and outcomes – ideas that have worked in their corners of the globe and which may inspire others to try something new that may save more women’s lives. The Summit will bring together national and international organizations from around the world to address a central theme: to produce scientific and clinical publications that will serve as medical tools for low- and middle-resource countries in perpetuity, freely available via the internet.

The spirit of ingenuity and generosity that is at work in the Global Summit is exemplified in leaders such as Dr. Ben Anderson, Dr. Eduardo Cazap, Leslie Sullivan and others around the world who see a problem, overcome barriers and engage with counterparts across borders to work on real solutions.