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21.10.2013

For the first time ever, the Russian clinical practice guidelines for breast cancer treatment were discussed with representatives of the WHO, the Union for International Cancer Control (UICC) and leading world experts.

By December 1, 2013, the Ministry of Healthcare of the Russian Federation will be provided with the clinical practice guidelines for the most widespread and socially significant diseases approved by professional healthcare associations. This process is governed by Federal Law No. 323 “On the Fundamentals of Public Health Protection in the Russian Federation”.

The Association of Oncologists of Russia held the first meeting of the Expert Council for the preparation of clinical practical guidelines with representatives of WHO, UICC and opinion leaders from West European countries. The meeting was arranged and held by “Equal Right to Life” Non-Profit Making Partnership that has a special consultative status with the UN Economic and Social Council. Officers of the Permanent Mission of the Russian Federation to the UN were also invited to participate in the meeting.
The clinical practical guidelines are the basic document for the development of the national healthcare system, development of economic standards, budgeting and providing access to healthcare. In her presentation Julie Torode, Deputy CEO at Union for International Cancer Control (UICC), told about their experience on development and implementation of Guidelines for International Breast Health and Cancer Control for low- and middle-income countries (LMCs) aimed at improvement of breast health outcomes and access to breast cancer screening, detection and treatment for women. Improvements in early detection, diagnosis and treatment of breast cancer require organized, sequentially implemented steps to achieve improved outcome. The development of evidence-based, economically feasible, and culturally appropriate breast health care guidelines is a crucial step toward improving breast health care and cancer treatment in these countries.
In all developed countries, the clinical practice guidelines represent the most advanced approaches to disease treatment. Providing access to such disease treatment approaches and technologies is a task for economists and healthcare professionals. “Since the strategy for providing universal access to healthcare underlies the activities of the WHO and implementation of such a strategy ensures attainment of the goals set out in the Political Declaration of the High-Level Meeting of the General Assembly on the Prevention and Control of Non-communicable Diseases, the experience in development and implementation of Russian clinical practice guidelines for providing access to medical technologies can be actively used by WHO experts”- Oleg Chestnov, Assistant Director-General for Noncommunicable Diseases and Mental Health, noted in his speech. Russia will take the chair at the next year G8 Summit where healthcare will be one of the key political dominants. Therefore, Russian experience and approaches in providing access to treatment of non-communicable diseases, especially cancer and cardiovascular diseases, can form the basis for economic integration and healthcare development processes. 
Russian leaders in oncology will do their best to ensure that the Clinical Practice Guidelines for Diagnosis and Treatment of Breast Cancer are adopted as soon as possible. This document would logically continue and expand legislative initiatives that already exist in Russia, such as the Federal Law No. 323 “On the Fundamentals of Public Health Protection in the Russian Federation” and the Russian Presidential Decree No.598 “On Improvement of Public Health Policy” concerning the need to reduce mortality from socially significant diseases, including cancer (2012). 
In his welcoming address to the meeting participants, Academician Mikhail Davydov, Director of N.N. Blokhin Cancer Research Center of Russia, said: “The clinical practice guidelines will improve the quality of clinical decisions made by professionals, and provide them with information to facilitate selection of diagnosis and treatment strategies. The clinical practice guidelines are the basic document for any practitioner in oncology. It must contain the principles and algorithms for the application of the most advanced cancer treatment technologies. The economic standards of treatment will be further developed on the basis of these guidelines."
Professor Irina Poddubnaya, a correspondent member of the Russian Academy of Medical Sciences, also stressed the need to adopt the Guidelines. She noted that 2% of the population in Russia, i.e. about 3 million people, face cancer problems. Malignant neoplasms are detected in 505 thousand people every year; more than 29% out of them die during the first year after the disease is diagnosed. The main reason is late diagnosis and late initiation of treatment due to the absence of national screening programs. Today, there are several published versions of clinical practice guidelines developed by various scientific and professional societies in Russia. They have significant differences due to the fact that the authors tried to take account of the existing financing system, thus limiting the use of advanced approaches to cancer diagnosis and treatment. This situation should be changed, and the guidelines must be uniform and contain, first and foremost, all advanced approaches to cancer treatment. 
In addition, the situation across the country differs from region to region. This was cited by Anatoly Makhson, Chief Medical Officer and Oncologist of Moscow. Particularly, he noted that the Russian capital had managed to achieve a significant progress in diagnosis and screening of non-communicable diseases. According to him, “The situation in Moscow is close to ideal because the city Healthcare Department regularly discusses the principle of expanded clinical practice guidelines that should be used in actual practice of patient treatment. We managed to ensure that budgeting is based on the needs of patients rather than on the restrictive budget capabilities."
Working on clinical guidelines and further practical steps in implementing the economic standards for management of patients with non-communicable diseases are intended to provide universal access to the required medical technologies for the implementation of public and private partnership, first and foremost, from the voluntary insurance sector. This is important to secure the rights of Russian citizens to access to advanced healthcare. Dmitry Borisov, CEO of “Equal Right to Life” Non-Profit Making Partnership, commented on this at the meeting as follows: “We will provide comprehensive support to this work and we plan to present the first results at a special event within the framework of the UN General Assembly and meetings of the UN Economic and Social Council. The clinical practice guidelines and economic standards for treatment are the basic documents for the development of principles for intersectoral collaboration in healthcare and securing the rights of patients to treatment they need." 
The meeting participants focused on the problem of breast cancer, the most widespread type of malignant neoplasms in women, making 16% of all diagnosed tumors. More than 1 million new breast cancer cases are detected every year in the world. In 2011, 57,500 new patients with diagnosed breast cancer were registered in Russia. The statistics are further worsened by the fact that Russian women with breast cancer have a low five-year survival rate – 43%, half as high as in the developed countries (the USA – 90%, Finland – 86%, Sweden – 85%, etc.). Such a situation with the disease that responds to treatment if detected early cannot be recognized as satisfactory.
At the same time, fast adoption and implementation of the clinical practice guidelines for control of breast cancer, and implementation of new methods and more effective medicines could significantly improve the outcomes.