Breast cancer kills more than half a million women a year worldwide—with most of those deaths occurring in resource-limited countries.

Alicia Cerrato Grande, MD, a surgery postdoctoral associate from Honduras, is on a quest to change that, and a new initiative from the University of Minnesota Medical School’s Global Surgery and Disparities Program (UMGSD) is key to her efforts.

“This is one of the most outstanding opportunities I’ve had,” Grande says.

She’s one of two international physicians—along with Batsukh Pushkin, MD, of Mongolia—enrolled in a pilot version of the UMGSD’s new Global Breast Cancer Fellowship. The program revolves around the idea of bringing doctors from all parts of the globe to Minnesota to learn the ins and outs of assembling a comprehensive breast cancer care program. 

UMGSD, which is funded entirely by philanthropy, was established in 2020 and aims toimprove surgical and anesthesia care through local, national, and international collaborations.

Todd Tuttle, MD, MS, an M Health Fairview surgical oncologist and UMGSD vice chair, says this effort is different from global health programs of the past.

“For decades, global health has been dominated by infectious disease—malaria, tuberculosis, HIV,” Tuttle explains. “And a lot of it is treating one patient at a time. … Our goal here is to change the treatment for this one disease—for the [entire] country. These doctors are going to move the needle for their countries.”

Grande and Pushkin have been learning how to diagnose and treat breast cancer as part of a coordinated, multidisciplinary team, an approach they’ll work to adapt in their respective home countries.

“Through teamwork, with our collective expertise, we will be able to provide a more holistic approach,” Grande says. 

The two came to Minnesota in late December 2023. They went back to their home countries this summer where they completed a research project, and they’ll return to Minnesota to finish the program at year’s end. A second cohort will begin the fellowship in July 2025. 

Same disease, very different outcomes

Tuttle, who holds the Regis Chair for Breast Cancer Research, traces the program’s inception to a 2015 Lancet article about the unmet need for lifesaving surgical and anesthesia care in many low- and middle-income countries.

“Five billion people around the planet have no access to surgical care,” he says.

While he’d been involved in medical mission trips—particularly to Honduras—for more than a decade, that report made him consider what a systemic response might look like.

Around the world, breast cancer is the second most common kind of cancer (for women, it’s the No. 1 type). And while the five-year breast cancer survival rate tops 90% in the U.S., that’s far from typical globally—primarily because of delayed diagnoses, Grande says.

“In Honduras, we don’t have population screening programs,” she explains. “In the U.S., for example, people over 40 will have a mammogram every year. ... We don’t have enough cancer awareness, enough education for the population; women might have a concern, but they don’t seek [medical attention] quickly. So we are pushing for policy development also.”

Other factors include lack of access to specialized breast cancer centers and costliness of state-of-the art therapies, Tuttle says.

 “We have better drugs here. We have better equipment here. And that’s a part of it—but it’s mostly that if we were dealing with the cases they are at diagnosis, we would have bad outcomes, too,” he says.

After the fellowship experience, Tuttle says, doctors like Grande and Pushkin will be equipped with the know-how to not only treat people diagnosed with breast cancer, but to assemble the teams needed to make a comprehensive, long-term impact for communities in their countries.

“Breast cancer is a team sport that involves cancer surgeons, plastic surgeons, pathologists, radiologists, medical oncologists, radiation oncologists,” Tuttle explains. “The physicians coming here from other countries get to see how we do a multidisciplinary tumor board. And they have a personal relationship with people in each of these disciplines—so when they go back home, they have all these mentors [in the U.S.] who are easy to contact. It’s a lifetime thing.”

Embracing personalized medicine

Not every aspect of Minnesota-style breast cancer care can be replicated in every country, Pushkin says. In Mongolia, for example, medical resources are limited, and the nomadic lifestyle of many residents makes accessing cancer care clinics difficult. “But we are figuring out how we can [enhance] care based on our own countries’ situations,” he says.

Grande says networking is key. “That’s why these long-lasting relationships are important,” she says. “We can actually ask our mentors: ‘What would you do in this scenario if you have [limited resources]? What might be an alternative?’” 

She’s hopeful that, in addition to reducing breast cancer mortality rates, the multidisciplinary management approach could lead to fewer radical mastectomies—an extensive surgery that used to be the standard of care for breast cancer but is far less common today.

One lesson that’s stuck with her is that every breast cancer case is different. And providing tailored, personalized care for each individual requires collaboration.

“I’ve really learned the importance of teamwork; we need complementary disciplines to properly treat breast cancer,” Grande continues. “And not just teamwork, but good communication between team members. That [allows] us to properly tailor the treatment to each patient. It’s not like a recipe, where the care you deliver to everyone is the same.”

Pushkin is invigorated by the experience and hopeful about its potential to ripple throughout his country. “With these experts, we are now sharing experience, sharing research studies,” he says. “That’s really important for our countries.”