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Cyprien Shyirambere, MMED

Butaro Cancer Center of Excellence
Butaro, Rwanda

Titles and Affiliations

Director of Oncology
Partners in Health/Inshuti Mu Buzima
Administrative Director, Oncology Program

Research area

Creating 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 women have a much higher risk of dying from their disease. This is due, in part, to delayed and late-stage diagnoses. By focusing on training and infrastructure, Drs. Shyirambere and Shulman have developed effective strategies to integrate early detection services into the health care system in rural Rwanda and reduce time to treatment. To date, the team has trained hundreds of Rwandan health care workers in ways 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. They are now working to expand these efforts to reach more women with the goal of reducing breast cancer deaths in Rwanda and other low-income countries and shaping national cancer control policy.

Progress Thus Far

One of their major innovations has been the development of a tablet-based electronic medical record 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 and obtain timely care and maximize any follow-up care. Drs. Shyirambere and Shulman have developed and implemented a Women’s Cancer Early Detection Program Learning Collaborative in two key districts and 19 health centers in Rwanda. This Collaborative focuses on clinical mentorship, local leadership, and building a culture of data-driven practice improvement. In addition, Drs. Shymirambere, Shulman, and their colleagues are seeking to offer U.S.-driven advancements in diagnostic curriculum to Rwandan radiologists. To accomplish this, they have engaged a local leader and radiologist as a trainer to serve as a liaison. The team has leveraged their success with virtual mentorship and employed previously trained Rwandan medical staff to implement virtual and in-person ultrasound training and mentorship to other radiologists. These efforts will help to decentralize breast ultrasound expertise from cancer hospitals in Rwanda to smaller district hospitals.

What’s next

The team will continue to expand their clinical trials program to other districts in Rwanda and evaluate the program’s impact on the health system and patients. Refinement of their patient navigation model to improve its delivery, address barriers to care, and facilitate patient re-engagement is ongoing. While ultrasound imaging is successfully being decentralized, the team will develop an ultrasound skills metric that can be used to determine which non-radiologist clinicians possess the necessary skills to perform breast ultrasound. Simultaneously, Drs. Shulman and Shymirambere will develop and implement a training program for non-radiologist clinicians at district hospitals to perform ultrasound-guided core needle biopsy. These studies will expand the cadre of Rwandan clinicians with U.S. diagnostic skills and bring these important diagnostic services closer to patients’ homes and facilitate accessible, timely, and high-quality breast cancer care.

Biography

Cyprien Shyirambere, MD is a pediatrician and currently serves as the Director of Oncology at Partners In Health Rwanda. He received a BS degree in General Medicine and Surgery and a MMed degree in Pediatrics at the National University of Rwanda, Butaro, Rwanda. He has provided clinical care as well as administrative leadership at Butaro Cancer Center of Excellence (BCCOE) and in the Partner’s In Health national oncology program since 2013.

Dr. Shyirambere has been a key leader in the breast cancer early detection program, overseeing program implementation in Butaro and beyond. As a clinician focused on cancer care in Rwanda, he also has profound insights into cancer diagnosis and care in Rwanda. His research focus has been in examining the success and challenges facing a cancer program in rural, resource-limited areas. He has been working closely with Drs. Shulman and Pace and the Rwanda Biomedical Center since 2013 in a collaborative effort to increase breast cancer early detection in under-resourced areas of Rwanda.

BCRF Investigator Since

2020

Donor Recognition

The Estée Lauder Companies’ North American Research & Development and Supply Chain Award

The Estée Lauder Companies' Award in honor of employees

Areas of Focus

Treatment

Co-Investigator

Lawrence Shulman, MMED

University of Pennsylvania
Philadelphia, Pennsylvania