Cyprien Shyirambere, MMED

Creating healthcare infrastructure and training health care professionals in Rwanda to ensure that previously underserved women receive quality screening and treatment for breast cancer.

Impact

Breast cancer is a major public health concern in low- and middle-income countries such as Rwanda, where about three out of four women are diagnosed with advanced stage disease. With colleagues in Rwanda, retired BCRF-investigator Dr. Larry Shulman initiated studies to develop effective strategies for integrating early detection services into the health care system in rural areas and reduce time to treatment. Drs. Shyirambere and Pace joined the effort and together have trained hundreds of Rwandan health care workers in strategies to educate patients about breast cancer, perform high-quality breast exams, utilize ultrasound to identify those who may have cancer, and refer patients for timely diagnosis and treatment. Their program has provided breast exam screening to thousands of patients and expanded into four districts in the country, leading to significant improvement in patient outcomes. The team has developed a tablet-based electronic medical record, an innovative advancement that allows clinicians to share information across facilities and identify patients who have missed visits and re-engage them in care. This mobile platform also helps patients navigate the health care system, obtain timely care, and maximize any follow-up care. Drs. Symirambere, Pace and their colleagues are working to expand these efforts to reach more women with the goal of reducing breast cancer deaths in Rwanda and other low-income countries while shaping their national cancer control policy.

Progress Thus Far

A Women’s Cancer Early Detection Program Learning Collaborative was developed and implemented by the team in two key districts and 19 health centers in Rwanda. It focuses on clinical mentorship, local leadership, and building a culture of data-driven practice improvement. In addition, they are providing U.S.-driven advancements in diagnostic curriculum to Rwandan radiologists, leveraging their success with virtual mentorship, employing previously trained Rwandan medical staff to implement virtual and in-person ultrasound training, and expanding the program to other area radiologists. Assessment in the last year demonstrated improvements in clinicians’ breast assessment skills and increases in early-stage diagnoses as a result of these programs. Their success will help to decentralize breast ultrasound expertise from cancer hospitals in Rwanda to smaller district hospitals.

What’s next

While ultrasound imaging is successfully being decentralized, the team will continue to refine the ultrasound skills metric. In other studies, they will focus on mammography which is a valuable tool for breast cancer screening, diagnosis, and treatment planning. They seek to fill a void since there are no guidelines for how to integrate mammography into diagnostic pathways in low-income settings. To do this, Drs. Pace, Shymirambere, and their Rwandan partners will build clinicians’ skills and health systems’ capacity to provide high-quality diagnostic mammography in Rwanda by training radiologists and radiology technicians in mammography. Further, the team will support the development of mammography protocols, electronic referral and reporting tools, and evaluate the impact of these interventions on mammography proficiency and quality. The culmination of their BCRF supported work will not only expand the cadre of Rwandan clinicians with U.S. diagnostic skills, but it will provide scalable and durable strategies to bring these important diagnostic services closer to patients’ homes, facilitating accessible, timely, and high-quality breast cancer care.