Intro -- Foreword -- Acknowledgements -- Abbreviations -- Glossary of terms -- Executive summary -- Pillar 1 Health promotion for early detection -- Pillar 2 Timely breast diagnostics -- Pillar 3 Comprehensive breast-cancer management -- Implementation strategies for success -- Breast cancer from the global health perspective -- Key messages from this chapter -- What is breast cancer? -- Epidemiology -- Linked strategies for improving breast-cancer outcomes -- Features of effective breast-cancer control programmes -- Overview of the three GBCI pillars -- Predicted impact of GBCI on the improvement of breast-cancer outcomes -- Investment case for action on breast cancer -- Case study Economic evaluation of breast-cancer control in Kenya, 2022 -- Pillar 1. The pre-diagnostic interval -- Key messages from this chapter -- Who is at risk? -- Breast-cancer risk reduction -- Early-detection programmes -- Monitoring and evaluation of the pre-diagnostic interval -- Pillar 2. The diagnostic interval -- Key messages from this chapter -- Diagnostic imaging and tissue sampling -- Pathology and biomarker testing -- Centralization versus decentralization of diagnostic services -- Cancer staging -- Monitoring and evaluation of the diagnostic interval -- Pillar 3: The treatment interval -- Key messages from this chapter -- Principles of multimodality treatment -- Monitoring and evaluation of the treatment interval -- Management of metastatic breast cancer -- Management of breast cancer during pregnancy -- Supportive services in oncology -- Implementation strategies for success -- Key messages from this chapter -- Implementation planning -- Case study from sub-Saharan Africa -- Evaluation of health-care systems -- Conclusions -- References -- Annex. Anti-cancer medicines for breast cancer and WHO Model List of Essential Medicines 2021 -- Figures.

Fig. 1. Percentage of cancer cases in 2020 worldwide, including both sexes and all ages -- Map 1a. Estimated age-standardized incidence rates for female breast cancer, by country, all ages, -- Map 1b. Ranking of female breast cancer based on estimated age-standardized incidence rates, by cou -- Fig. 2. Age-standardized breast-cancer mortality rates in 10 countries with established cancer-care -- Map 2a. Estimated age-standardized mortality rates for female breast cancer, by country, all ages, -- Map 2b. Ranking of female breast cancer based on estimated age-standardized mortality rates, by cou -- Fig. 3. Modelled breast-cancer death rates with early detection and/or multimodality treatment -- Fig. 4. The three pillars of the GBCI breast-cancer patient-care pathway -- Fig. 5. Projected annual global breast-cancer deaths in females under age 70, 2020-2040 -- Fig. 6A. The Kenya model for early detection and predicted stage shifting over 15 years (2022-2037) -- Fig. 6B. Predicted breast-cancer mortality reductions over 40 years (2022-2062), Kenya -- Fig. 7. The pre-diagnostic interval -- Fig. 8. Hormone- and reproduction-related breast-cancer risk factors -- Fig. 9. Sample BSE technique -- Fig. 10. Distinguishing screening from early diagnosis, according to symptom onset -- Fig. 11. Meta-analysis of breast-cancer mortality after 13 years in breast-cancer screening trials -- Fig. 12. Cumulative breast-cancer mortality during a 20-year study in a prospective, cluster-random -- Fig. 13. The diagnostic interval -- Fig. 14. Centralization versus decentralization of breast-health services -- Fig. 15a. TNM anatomic staging - T stage in breast -- Fig. 15b. TNM anatomic staging - N stage in nodal beds -- Fig. 16. Breast-cancer diagnostic timeline and intervals for monitoring -- Fig. 17. The integrated-care portion of the treatment interval.

Fig. 18. Multimodal treatment use (surgery and systemic therapy) in the ABC-DO cohort study in five -- Fig. 20. Supportive services to help breast-cancer patients manage the negative effects of the dise -- Fig. 21. Psycho-oncology in breast-cancer management -- Fig. 22. Observed and predicted three-year survival from diagnosis (A), and conditional survival to -- Fig. 23. Using a fishbone diagram to identify underlying causes of underperformance -- Boxes -- Box 1. Breast-cancer mortality rates -- Box 2. GBCI recommendations -- Box 3. Elements of successful breast-cancer-control programmes -- Box 4. The three-pillar framework of the breast-cancer patient-care pathway -- Box 5. The generation of a breast-cancer investment case -- Box 6. The Kenya model for early detection -- Box 7. Personalized assessment of risk for breast-cancer -- Box 8. Breast-cancer signs and symptoms -- Box 9. The role of BSE in the early detection of breast cancer -- Box 10. The role of CBE in the early detection of breast cancer -- Box 11. What is the evidence of a stage-shifting threshold in breast cancer? -- Box 12. When should a country set up a mammographic screening programme? -- Box 13. How often are benign breast-cancer diagnostic work-ups conducted in unscreened populations? -- Box 14. Pathology laboratory services -- Box 15. Co-localization of imaging and pathology services -- Box 16. Effective breast-cancer surgical services -- Box 17. Features of a successful radiation-oncology programme -- Box 18. Systemic therapy for breast cancer -- Box 19. Successful systemic-therapy programmes for breast cancer -- Box 20. Why are cancer-management guidelines important? -- Box 21. Factors contributing to patient abandonment of prescribed cancer treatment -- Box 22. Metrics useful in the monitoring and evaluation of metastatic cancer -- Tables.

Table 1. KPIs and targets to evaluate the breast-health-care system -- Table 1A. Predicted breast-cancer-programme and service-delivery costs over 15 years (2022-2037), K -- Table 1B. Projected long-term cost outcomes, (break-even point) and the overall benefit-to-cost ra -- Table 2. Early detection: key elements of early diagnosis and screening -- Table 3. Examples of high-quality evidence-based guidelines for the provision of multimodality-trea -- Table 4. Supportive oncology services: common concerns and required support -- Table 5. Monitoring and evaluation (collecting data, monitoring KPIs, and evaluating programme achi -- Table 6. Examples of responses to deficits in breast-health systems identified by fishbone analysi.