June 15, 2024

Breast Cancer Awareness

Breast Cancer is the most common cancer in the world, affecting nearly 12% of all women [1]. Unfortunately, there were 1.7 million new cases of breast cancer diagnosed and 521,000 breast cancer related deaths in 2012 alone [2]. In spite of these facts, a significant amount could be reduced by early detection, via screening mammograms or ultrasounds, and treatment, using various modalities, when available. Such is the case in the United States where breast cancer mortality has decreased by 39% between 1990 and 2015 [3].

If you or a family member ever have the misfortune of being diagnosed with breast cancer, make sure that you have a consult with at least each of the following professionals:

  1. Surgical Oncologist
  2. Radiation Oncologist
  3. Medical Oncologist

Specifically, when you see the radiation oncologist, make sure that you ask about the various radiation therapy schedules such as hypofractionated whole breast irradiation (WBI) and accelerated partial breast irradiation (APBI) as they are now thought to increase survival in resource constrained economies [4].


  1. McGuire A, Brown JA, Malone C, McLaughlin R, Kerin MJ. Effects of age on the detection and management of breast cancer. Cancers (Basel). 2015 May 22;7(2):908-29.
  2. Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA: a cancer journal for clinicians. 2015;65(2):87–108.
  3. Byers T, Wender RC, Jemal A, Baskies AM, Ward EE, Brawley OW. The American Cancer Society challenge goal to reduce US cancer mortality by 50% between 1990 and 2015: Results and reflections. CA Cancer J Clin. 2016 Sep;66(5):359-69.
  4. Khan AJ, Rafique R, Zafar W, Shah C, Haffty BG, Vicini F, Jamshed A, Zhao Y. Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis. Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):287-295.

Nation-Scale Adoption of Shorter Breast Radiation Therapy Schedules Can Increase Survival in Resource Constrained Economies: Results From a Markov Chain Analysis.



Hypofractionated whole breast irradiation and accelerated partial breast irradiation (APBI) offer women options for shorter courses of breast radiation therapy. The impact of these shorter schedules on the breast cancer populations of emerging economies with limited radiation therapy resources is unknown. We hypothesized that adoption of these schedules would improve throughput in the system and, by allowing more women access to life-saving treatments, improve patient survival within the system.


We designed a Markov chain model to simulate the different health states that a postlumpectomy or postmastectomy patient could enter over the course of a 20-year follow-up period. Transition rates between health states were adapted from published data on recurrence rates. We used primary data from a tertiary care hospital in Lahore, Pakistan, to populate the model with proportional use of mastectomy versus breast conservation and to estimate the proportion of patients suitable for APBI. Sensitivity analyses on the use of APBI and relative efficacy of APBI were conducted to study the impact on the population.


The shorter schedule resulted in more women alive and more women remaining without evidence of disease (NED) compared with the conventional schedule, with an absolute difference of about 4% and 7% at 15 years, respectively. Among women who had lumpectomies, the chance of remaining alive and with an intact breast was 62% in the hypofractionation model and 54% in the conventional fractionation model.


Increasing throughput in the system can result in improved survival, improved chances of remaining without evidence of disease, and improved chances of remaining alive with a breast. These findings are significant and suggest that adoption of hypofractionation in emerging economies is not simply a question of efficiency and cost but one of access to care and patient survivorship.



Amir Isbell

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