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BCRF Investigator Since

2013

Donor Recognition

The Estée Lauder Companies’ North America Manufacturing
Distribution and Research and Development Centers Award

Area(s) of Focus

Lawrence N. Shulman, MD

Deputy Director for Clinical Services
Director, Center for Global Cancer Medicine
University of Pennsylvania, Abramson Cancer Center
Philadelphia, Pennsylvania

Current Research

  • Seeking to improve diagnosis and quality care for women in the Burera District of Rwanda, a remote and low resource community.

  • International efforts are ongoing to create infrastructure and train health care professionals to ensure that women receive quality breast cancer for early diagnosis and treatment of breast cancer.

  • "If we could use the tools we have in the US in low resource settings around the world, we could prevent or cure most breast cancers" - Dr. Shulman. This project is an important step to achieving this goal.

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, in part because of delayed diagnoses and late-stage diagnoses. Without the correct diagnosis, optimal treatment cannot be given, and the chance for a successful outcome is greatly diminished. In addition, the correct diagnosis must be made rapidly so that patients can begin treatment quickly.

With continued funding from BCRF, Drs. Shulman and Mpunga have launched a pilot program to promote early detection of breast cancer in the remote Burera District of Rwanda. The team has now trained 127 rural health center nurses in clinical breast exam and evaluation of breast concerns, 1076 community health workers (CHWs) in the basics of breast awareness and patient education, and seven district hospital clinicians in breast ultrasound.

As a result of these trainings, both health center nurses and CHWs demonstrated significant improvements in knowledge and skills. The team noted an increase in women with breast concerns and numbers of breast cancer diagnoses, an indication that the intervention is working. Many of the breast cancers are being found at earlier stage, when treatments are more effective.

This year, the international team will complete follow-up assessments and analyze clinical outcomes from the first 2 years of the project, as well as expand the intervention to the remaining health centers in the district. They will expand training in breast ultrasound and ultrasound-guided biopsy, and will perform a comprehensive analysis of the distribution of breast cancer stages diagnosed at Butaro Hospital to evaluate the impact of the intervention on breast cancer stage.

These efforts will further improve diagnosis and care for the women served at the Butaro Hospital. The researchers envision this program as a model for early detection efforts throughout Rwanda and the region.

Bio

Lawrence N. Shulman, M.D., is the Deputy Director for Clinical Services of the Abramson Cancer Center at the University of Pennsylvania, and Director of their newly formed Center for Global Cancer Medicine.  He has a leadership role in the strategic development of cancer services for the Cancer Center and its affiliated hospitals.

Dr. Shulman is the former Chair of American Society of Clinical Oncology’s Quality of Care Committee. He is a member of the Commission on Cancer of the American College of Surgeons, and Chair of their Quality Integration Committee. 

Dr. Shulman serves as Senior Oncology Advisor to Partners In Health (PIH), a non-profit organization co-founded by Dr. Paul Farmer, Dr. Jim Yong Kim, and Ophelia Dahl in 1987. Over the past five years, PIH has expanded its mission to include supporting the establishment of national cancer treatment programs with the Ministries of Health in Rwanda and Haiti. In addition he works with the cancer program in Botswana.  Dr. Shulman is a member of ASCO’s Global Oncology Leadership Task Force and International Affairs Committee.

A specialist in the treatment of patients with breast cancer, his research includes development of new cancer therapies, and implementation of cancer treatment programs in low-resource settings.

He received his MD from Harvard Medical School, and trained in Hematology and Oncology at the Beth Israel Hospital in Boston, MA.

Co-Investigators