Implementation of a community-based breast cancer management programme

Important characteristics of the primary care system need to be strengthened to achieve improved and sustainable health outcomes including: improved access to and first contact with professionals trained and able to triage and diagnose effectively; increased longitudinality to support patients and their families to manage diagnosis and follow up; and enhanced comprehensiveness and coordination between health-care levels with good information systems to ensure adequate and appropriate care of patients.2 The Series paper1 repeatedly mentions the decentralised nature of the intervention. Besides the need for primary care, models like the Breast Cancer Initiative 2·5 will not have a major impact if patient values and preferences are not considered,4 or in the absence of a well established, community-organised participation.3 Furthermore, Duggan and colleagues1 do not define measures of success of the programme or any qualitative or quantitative evaluation and its results.