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Lawrence Shulman, MD
Professor of Medicine
Deputy Director for Clinical Services
Director, Center for Global Cancer Medicine
Abramson Cancer Center, Perelman School of Medicine
University of Pennsylvania
Goal: To promote early detection of breast cancer and improve quality of care in low-resource communities in Rwanda.
Impact: Breast cancer outcomes are poor in countries with limited resources such as Rwanda. Drs. Shulman and Shyirambere and their colleagues have trained hundreds of clinicians in breast health care and provided breast exam screening to thousands of patients in four districts of Rwanda. Their efforts have led to a significant improvement in patient outcomes in an area where women have a much higher risk of dying of breast cancer.
What’s next: The doctors will continue to expand their program to other districts in Rwanda. They also plan to develop a mobile platform to help patients navigate the health care system to obtain timely care and to maximize any follow-up care. Lastly, they will continue to expand training in diagnostic breast ultrasound and hope to develop innovative virtual curricula to adapt to current travel restrictions.
In low- to middle-income countries with limited resources such as Rwanda, breast cancer outcomes are poor due to lack of screening and follow-up. As a result, women are more likely to be diagnosed with advanced breast cancer and may not receive quality treatment. By focusing on training and infrastructure, Drs. Shulman and Shyirambere are developing effective strategies to increase early detection and reduce time to treatment.
Full Research Summary
Research area: Creating infrastructure and training health care professionals to ensure that underserved women in Rwanda 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 partly to delayed and late-stage diagnoses. By focusing on training and infrastructure, Drs. Shulman and Shyirambere have developed effective strategies to integrate early detection services into the health care system in rural Rwanda and reduce time to treatment. They are now working to expand these efforts to reach more women and shape national cancer control policy.
Current investigation: The team has been developing a breast cancer early detection program in the remote districts of Rwanda.
What they’ve learned so far: The research team 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. So far, the program has provided clinical breast exam screening to thousands of patients and expanded into four districts in the country.
What’s next: Drs. Shulman and Shyirambere will continue to expand their program to other districts in Rwanda and evaluate the program’s impact on the health system and patients. They also plan to develop a mobile platform to help patients navigate the health care system to obtain timely care and to maximize any follow-up care. Lastly, they will continue to expand training in diagnostic breast ultrasound and hope to develop innovative virtual curricula to adapt to current travel restrictions.
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 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 and ambulatory cancer centers.
Dr. Shulman is currently Chair of the Commission on Cancer and serves on the National Cancer Policy Forum of the National Academy. He is the former Chair of the American Society of Clinical Oncology Quality of Care Committee and the Commission on Cancer’s Quality Integration Committee.
Dr. Shulman serves as Senior Oncology Advisor to the non-profit organization Partners In Health (PIH). The PIH mission includes the establishment of national cancer treatment programs with the Ministries of Health in Rwanda and Haiti, programs for which he plays a seminal leadership role. He sits on the Vice Chancellor’s Advisory Council for Rwanda’s University for Global Health Equity. In addition, he helps to lead the development of the national oncology program in Botswana through the Botswana-UPenn Partnership. Dr. Shulman is a former member of ASCO’s International Affairs Committee and their Task Force on Global Oncology as an Academic Career. He led the World Health Organization’s review and revision of their Essential Medicines for Cancer from 2014-2017.
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