Soumen Das, Head of Department of Surgical Oncology at Netaji Subhas Chandra Bose Cancer Hospital, CEO and Co-Founder of ArrowsUP LLP, and Co-Founder of Specifixon Healthcare, shared his contribution to the development of a resource-stratified guideline, highlighting the inclusion of insights from low- and middle-income countries in global decision-making:
“An Indian Voice in Global Oncology: Contributing to the NCCN Resource-Stratified Breast Cancer Guidelines
Global cancer guidelines shape not only clinical decisions, but also equity in care. When such guidelines incorporate perspectives from low- and middle-income countries (LMICs), they move closer to real-world applicability for the majority of patients worldwide.
Why Resource-Stratified Guidelines Matter
Breast cancer outcomes vary widely across regions—not because of differences in biology alone, but due to disparities in access to diagnostics, surgery, systemic therapy, radiation, and follow-up care. While high-income settings can adopt guideline recommendations in full, many health systems must make decisions under significant resource constraints.
The NCCN Resource-Stratified Framework addresses this gap by:
- Defining basic, core, and enhanced levels of care
- Prioritizing feasible, evidence-based interventions
- Supporting clinicians and policymakers in LMIC and resource-limited settings
These frameworks are not diluted versions of care, but structured pathways to deliver the best possible outcomes within available resources.
An LMIC Perspective at the Guideline Table
This work reflects extensive on-ground experience in:
- Managing breast cancer across public and resource-constrained health systems
- Designing low-cost, scalable early-detection and treatment models
- Bridging the gap between global evidence and local feasibility
Such perspectives are essential when translating high-level evidence into practice settings where advanced imaging, molecular testing, or newer therapeutics may not be universally available.
Beyond Authorship: Shaping Equity in Care
International guideline development is increasingly recognizing that:
- One-size-fits-all recommendations do not serve global populations
- Equity-driven frameworks require voices from regions bearing the highest cancer burden
- Implementation science is as important as therapeutic innovation
Contributions from clinicians working in LMICs help ensure that guidelines remain ethical, practical, and implementable, rather than aspirational documents limited to select healthcare systems.
A Step Toward Inclusive Global Standards
Breast cancer remains the most commonly diagnosed cancer worldwide, with a disproportionate share of mortality occurring in low- and middle-income countries. Efforts like the NCCN Resource-Stratified Guidelines represent a shift toward inclusive global standards—where excellence in care is defined not only by technological advancement, but by accessibility and impact.”
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