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      Breast Cancer in Africa: Limitations and Opportunities for Application of Genomic Medicine

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          Abstract

          As genomic medicine gains clinical applicability across a spectrum of diseases, insufficient application in low-income settings stands to increase health disparity. Breast cancer screening, diagnosis, and treatment have benefited greatly from genomic medicine in high-income settings. As breast cancer is a leading cause of both cancer incidence and mortality in Africa, attention and resources must be applied to research and clinical initiatives to integrate genomic medicine into breast cancer care. In terms of research, there is a paucity of investigations into genetic determinants of breast cancer specific to African populations, despite consensus in the literature that predisposition and susceptibility genes vary between populations. Therefore, we need targeted strengthening of existing research efforts and support of new initiatives. Results will improve clinical care through screening and diagnosis with genetic testing specific to breast cancer in African populations. Clinically, genomic medicine can provide information capable of improving resource allocation to the population which most stands to benefit from increased screening or tailored treatment modalities. In situations where mammography or chemotherapy options are limited, this information will allow for the greatest impact. Implementation of genomic medicine will face numerous systemic barriers but is essential to improve breast cancer outcomes and survival.

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          Most cited references32

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          Gene-expression signatures in breast cancer.

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            Expansion of cancer care and control in countries of low and middle income: a call to action.

            Substantial inequalities exist in cancer survival rates across countries. In addition to prevention of new cancers by reduction of risk factors, strategies are needed to close the gap between developed and developing countries in cancer survival and the effects of the disease on human suffering. We challenge the public health community's assumption that cancers will remain untreated in poor countries, and note the analogy to similarly unfounded arguments from more than a decade ago against provision of HIV treatment. In resource-constrained countries without specialised services, experience has shown that much can be done to prevent and treat cancer by deployment of primary and secondary caregivers, use of off-patent drugs, and application of regional and global mechanisms for financing and procurement. Furthermore, several middle-income countries have included cancer treatment in national health insurance coverage with a focus on people living in poverty. These strategies can reduce costs, increase access to health services, and strengthen health systems to meet the challenge of cancer and other diseases. In 2009, we formed the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries, which is composed of leaders from the global health and cancer care communities, and is dedicated to proposal, implementation, and evaluation of strategies to advance this agenda. Copyright © 2010 Elsevier Ltd. All rights reserved.
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              Genomics for the world.

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                Author and article information

                Journal
                Int J Breast Cancer
                Int J Breast Cancer
                IJBC
                International Journal of Breast Cancer
                Hindawi Publishing Corporation
                2090-3170
                2090-3189
                2016
                16 June 2016
                : 2016
                : 4792865
                Affiliations
                1Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA 02115, USA
                2Harvard Medical School, Program in Global Surgery and Social Change, Boston, MA 02115, USA
                3University of Miami Miller School of Medicine, Miami, FL 33136, USA
                4Rwanda Military Hospital, Kigali, Rwanda
                Author notes

                Academic Editor: Lei Shi

                Author information
                http://orcid.org/0000-0003-4188-8424
                http://orcid.org/0000-0002-0943-2892
                Article
                10.1155/2016/4792865
                4927988
                27413551
                0fcd063e-3fd1-4ee1-bec9-fa51ea9eb068
                Copyright © 2016 Allison Silverstein et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 16 April 2016
                : 30 May 2016
                Categories
                Review Article

                Oncology & Radiotherapy
                Oncology & Radiotherapy

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