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Breast cancer incidence is increasing in low- and middle-income countries. The challenge is determining whether strategies developed for predominantly white, affluent populations will be effective in lower-income countries, says Peggy Porter.

Writing in the New England Journal of Medicine, she says 45 per cent of the more than one million new cases diagnosed every year and over 55 per cent of related deaths occur in developing countries. Poor data mean the figures are probably an underestimate.

Porter warns that as countries modernise, and more women take deskbound jobs, delay childbearing, control reproduction and eat a more Westernised diet, breast cancer rates will increase.

Developing countries now face the task of detecting and treating a disease that was previously considered too uncommon to be worth funding. Solutions are likely to be country-specific. The Breast Health Global Initiative is developing guidelines that are "evidence-based, economically feasible, and culturally appropriate".

Early detection must be a primary goal worldwide, Porter advises: "Given that we cannot effectively treat metastatic breast cancer in the United States, there is little hope that we'll do so in developing countries."

Link to full article in the New England Journal of Medicine

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