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Researchers from the International Agency for Research on Cancer (IARC) and partner institutions in Africa have analysed the feasibility and challenges of measuring the key performance indicators (KPIs) of the three pillars of the World Health Organization (WHO) Global Breast Cancer Initiative (GBCI). The analysis was published in the journal eClinicalMedicine.
The three pillars of the GBCI are (1) health promotion for early detection, (2) timely breast diagnosis, and (3) comprehensive breast cancer management. The corresponding KPIs are (KPI1) diagnosing more than 60% of invasive cancers at stage I or II, (KPI2) completing diagnostic workup within 60 days of first presentation to the health system, and (KPI3) more than 80% of patients undergoing multimodality treatment without abandonment.
The analysis aimed to assess whether it was possible to measure each of the KPIs and, in doing so, document the challenges in obtaining the required data and applying the definitions of the KPIs in practice. The study was conducted within the African Breast Cancer – Disparities in Outcomes (ABC-DO) cohort study, a hospital-based prospective cohort of women who had been newly diagnosed with breast cancer.
The ABC-DO study collected data on stage at diagnosis; thus, the information to assess KPI1 was readily available. However, measurement of both KPI2 (timely completion of diagnostic workup) and KPI3 (completing the recommended treatment) proved more challenging. Measuring KPI2 required some interpretation of the ideal start and end dates of the diagnostic interval and, once these were set, needed to rely on a woman’s recollection of the start of this interval. A useful summary of achievement of KPI2 was made within this study of women diagnosed with breast cancer, but the study design did not allow for the inclusion of women referred for suspected breast cancer. For KPI3, the complex multimodal nature of treatment meant capturing several types of treatment data over an extended period of time.
This analysis within the ABC-DO study is a powerful example of the measurability of the KPIs of the GBCI in hospital-based settings, and thus it provides an example for others attempting to routinely measure these KPIs. The measurability of KPIs is an essential element for the monitoring of the GBCI across countries and over time. Finally, the higher survival of ABC-DO subpopulations in which a higher percentage of women achieved the KPIs attests to the translation of action to improve the KPIs into saved lives.
Boucheron P, Zietsman A, Anele A, Offiah AU, Galukande M, Parham G, et al.
Measuring the WHO Global Breast Cancer Initiative pillars’ key performance indicators in Sub-Saharan Africa: experience in the African Breast Cancer – Disparities in Outcomes hospital-based cohort study
eClinicalMedicine. Published online 13 February 2025;
https://doi.org/10.1016/j.eclinm.2025.103104
Visit the African Breast Cancer – Disparities in Outcomes (ABC-DO) study website
