Open Access Open Badges Research article

Identifying important breast cancer control strategies in Asia, Latin America and the Middle East/North Africa

John FP Bridges1*, Benjamin O Anderson2, Antonio C Buzaid3, Abdul R Jazieh4, Louis W Niessen56, Barri M Blauvelt7 and David R Buchanan7

Author Affiliations

1 Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA

2 Department of Surgery, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA

3 Hospital São Jose, Centro Avançado de Oncologia, Rua Martiniano de Carvalho, 951 - Bela Vista, 01321-001, Sao Paulo, Brazil

4 Department of Oncology, King Abdulaziz Medical City Riyadh, P.O. Box 14691, Riyadh, 11426, Saudi Arabia

5 Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA

6 Health Policy and Practice, Faculty of Medicine and Health Sciences, University of East Anglia, University Drive, Norwich NR4 7TJ, UK

7 Institute for Global Health, University of Massachusetts, 715 North Pleasant Street, Amherst, MA 01003, USA

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BMC Health Services Research 2011, 11:227  doi:10.1186/1472-6963-11-227

Published: 20 September 2011



Breast cancer is the most frequent cause of cancer death in women worldwide, but global disparities in breast cancer control persist, due to a lack of a comprehensive breast cancer control strategy in many countries.


To identify and compare the need for breast cancer control strategies in Asia, Latin America and the Middle East/North Africa and to develop a common framework to guide the development of national breast cancer control strategies.


Data were derived from open-ended, semi-structured interviews conducted in 2007 with 221 clinicians, policy makers, and patient advocates; stratified across Asia (n = 97), Latin America (n = 46), the Middle East/North Africa (ME/NA) (n = 39) and Australia and Canada (n = 39). Respondents were identified using purposive and snowballing sampling. Interpretation of the data utilized interpretive phenomenological analysis where transcripts and field notes were coded and analyzed and common themes were identified. Analysis of regional variation was conducted based on the frequency of discussion and the writing of the manuscript followed the RATS guidelines.


Analysis revealed four major themes that form the foundation for developing national breast cancer control strategies: 1) building capacity; 2) developing evidence; 3) removing barriers; and 4) promoting advocacy - each specified across five sub-ordinate dimensions. The propensity to discuss most dimensions was similar across regions, but managing advocacy was discussed more frequently (p = 0.004) and organized advocacy was discussed less frequently (p < 0.001) in Australia and Canada.


This unique research identified common themes for the development of breast cancer control strategies, grounded in the experience of local practitioners, policy makers and advocacy leaders across diverse regions. Future research should be aimed at gathering a wider array of experiences, including those of patients.