PHASE I (1993-1998)

In Phase I of the CBCI, the federal government made a commitment of $25 million over five years to support research, care and treatment, professional education, programs for early detection, and access to information for women. Acting in a collaborative way with its partners, stakeholders, and those affected by breast cancer, the objectives of the CBCI are to reduce the incidence of breast cancer, reduce mortality as a result of breast cancer, and improve the quality of life of those affected by breast cancer and their support networks.

Phase I of the CBCI was made up of five complementary components. These components addressed the recommendations made by women with breast cancer and their families, health care professionals and researchers who participated in the National Forum on Breast Cancer in November, 1993. A brief description of each of these components follows:

1. Research

Canadian Breast Cancer Research Initiative

The Canadian Breast Cancer Research Initiative funds a broad spectrum of breast cancer research related to prevention, early detection, diagnosis, treatment, supportive care and palliation. The initiative is supported by its four founding partners -- Health Canada, the Canadian Institutes for Health Research , the National Cancer Institute of Canada and the Canadian Cancer Society -- along with significant additional support from the corporate and private sectors. Research is overseen by a 15-member Management Committee drawn from the various communities with an interest in promoting breast cancer research of the highest quality. They include breast cancer survivors, members of the public, health care providers, researchers, health policy makers and ethicists. The CBCRI goals are to prevent, cure and eradicate breast cancer and to enhance the lives of women living with the disease.

2.Setting Guidelines for Care

Clinical Practice Guidelines for the Care and Treatment of Breast Cancer

This strategy aims at developing a comprehensive set of clinical practice guidelines for the care and treatment of breast cancer patients. Its goal is to help women, with their physicians, make the best possible treatment choices once breast cancer is suspected or diagnosed. Development and dissemination of the guidelines is overseen by a Steering Committee that includes women with breast cancer, health care professionals, representatives of cancer treatment agencies, educational and licensing bodies, and the Federal/Provincial/Territorial Advisory Committee on Health Services. In February, 1998, a series of 10 guidelines were released simultaneously as a technical document for health care professionals and as a non-technical document for women and their families. The topics covered range from what to do when a mammogram is reported to be abnormal through to the management of chemotherapy, radiotherapy or pain.

3. Meeting women's information needs

Information Exchange Pilot Projects

The Breast Cancer Information Exchange Pilot Projects were established to assist women living with breast cancer and women at risk of developing the disease, their families and caregivers in making informed decisions about breast cancer. The Pilot Projects (based in Halifax, Montreal, Toronto, Calgary and Vancouver) promote access to relevant information by encouraging partnerships among those involved in the collection and dissemination of breast cancer information. An Advisory Panel composed of breast cancer survivors, women affected by breast cancer, family members, health care providers, researchers and educators, oversees the activities of each project.

4. Health Professionals and their continuing medical education

Professional Education Strategy

This strategy, which flowed from a recommendation of the 1993 National Forum on Breast Cancer, aims at developing and implementing communication skills training for practising health professionals. The training focusses on interactions between family physicians, radiologists, surgeons and oncologists and their patients and stresses respect for individual rights and the importance of shared decision-making. A one-hour presentation kit, Talking Tools I, was developed and distributed widely to the Deans, the offices of Continuing Medical Education (CME) and the Departments of Family Medicine of the medical schools and to numerous community-based hospital departments of CME. The kit is designed as an interactive presentation for practising physicians by practising physicians to raise awareness of the importance of communication skills and of the fact that these skills can be taught and learnt.

5. Coordinating screening activities

Canadian Breast Cancer Screening Initiative

The objective of this initiative was to promote the development of organized quality screening programs in Canada, and the development and use of a national database across the country. A National Committee was responsible for review, discussion and action on issues related to the early detection and screening of breast cancer. The Committee was composed of representatives from provincial health ministries, provincial screening programs, national cancer associations, professional associations, breast cancer survivors and women at risk of developing the disease, and Health Canada.

At the end of Phase l, preliminary data suggest these five CBCI strategies have improved the quality of health care delivery for women with breast cancer. Some of the major accomplishments from Phase I include:

• the development of a national database for screening and tools to improve the quality of programs;
• the development of innovative curricula for enhancing communication between health professionals and consumers;
• the development and dissemination of 10 clinical practice guidelines;
• the development of collaboration between community agencies and non-governmental organizations to develop and disseminate information to support decision-making by women;
• the formation of a research partnership amongst the major research funding agencies with leverages additional funds from the corporate sector (the research also gave women a voice by their participation in the research process).