Breast cancer is a disease that runs rampant in the United States, but many tend to isolate the incidence of this cancer to the U.S. However, breast cancer affects populations all over the world. The common misconception and ignorance of breast cancer incidence inhibits the treatment of breast cancer in under-developed countries.
Breast cancer seemingly tends to affect developed nations far more than under-developed and developing nations. With incidence rates of 89.7 affected out of 100,000 women in Western Europe compared to 19.3 affected out of 100,000 women in Eastern Africa, it seems plausible that breast cancer would be a western dilemma. However, there are other factors that should be considered when analyzing these statistics. For example, developing countries have lower life expectancies than developed countries; diseases other than breast cancer may have soaring incidence rates in these countries when compared to developed countries. Given that developing countries may not have adequate health care resources, breast cancer may not even be tested for in most women in developing countries – lowering the actual incidence rate. In fact, 50 percent of breast cancer cases and 58 percent of breast cancer deaths take place in developing countries.
Alexandra Berges, a student at Johns Hopkins Medical School and a member of a Johns Hopkins University Design Team, explained the focus of her design team’s endeavors. Her team tackled the issue of breast cancer incidence and mortality rates in developing countries, specifically South Africa. “Breast cancer is extremely deadly in developing countries. There aren’t great treatment options in rural areas and the predominant population goes to small rural clinics” Berges stated. She also explained that breast cancer is often not detected in rural areas until its late stages or until it is metastatic. Because of this, her design team is focusing on alleviating breast cancer fatality from the diagnosis perspective rather than the treatment perspective. This upstream approach allows early detection of breast cancer so that patients will have more time to receive less aggressive treatment.
In their efforts to implement an upstream intervention, Berges’ design team set out to make a low-cost device that would be able to aid in diagnosing women with breast cancer in its early stages. This approach was taken for many reasons. Mammography is known to be the most effective screening test for breast cancer. However, mammography screening is an extremely expensive method that many developing countries cannot afford due to their developing health infrastructure. Since most of the population in developing countries visit small rural clinics, these options are not available to them. “Also, the United States uses one-time use devices that approximately cost anywhere from 50 to 300 US dollars. This practice is not sustainable for developing countries” Berges added. As a result of this, developing countries may turn to utilizing old, multi-use equipment. This increases the risk for internal contamination and infection, which in turn compels these countries to stop performing biopsies altogether.
Therefore, Berges’ design team set up a game plan to create a low-cost, effective biopsy needle device that removes tissue from a suspicious lesion that may indicate breast cancer. The needle was designed to avoid contamination and infection. The prototype was 3-D printed and sent to radiologists to use and rate based on simplicity but also its accuracy. Simplicity was a key factor because in developing countries, the doctor to patient ratio is very low. The design team wanted the biopsy device to be used by nurses as well for maximum utility.
When asked about how the design team attempts to promote the widespread use of the biopsy needle, Berges responded, “Our design team is in contact with the director of breast imaging at Johns Hopkins Hospital and with a doctor in South Africa. We aspire to start a test trial in South Africa with the biopsy needle, but we are still in the early stages of development.” Berges also commented on the difficulty to start trials like this due to the FDA’s strict regulations.
Although Berges’ design team’s efforts to decrease breast cancer incidence in developing countries is still underway, the team is making significant progress in promoting and bring awareness to global health.
Berges, A. (2017, September 19). Breast Cancer Intervention Through Biomedical Engineering Design Team [Telephone interview].
WHO. (n.d.). Breast cancer: prevention and control. Retrieved from http://www.who.int/cancer/detection/breastcancer/en/
Figure 1: Breast cancer awareness ribbon world illustration. Retrieved from https://www.dreamstime.com/royalty-free-stock-image-breast-cancer-awareness-ribbon-world-illustration-global-symbol-planet-earth-concept-eps-vector-file-transparency-image33542716