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Lawrence Shulman, MD
Deputy Director for Clinical Services
Director, Center for Global Cancer Medicine
University of Pennsylvania, Abramson Cancer Center
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.
Access to standard of care is the first step in improving breast cancer outcomes in low-resource settings around the world. This project is an important step to achieving this goal.
Breast cancer is the leading cause of cancer deaths in women worldwide. Low-income and low-resource communities bearing a significant burden of deaths. Lack of screening and follow-up increase the chance that a woman will be diagnosed with advanced breast cancer and may not get quality treatment. Drs. Shulman and Mpunga are changing this statistic in rural area hospitals in Rwanda with emphasis on training and infrastructure to increase early detection and reduce time to treatment. With early successes reported, they are expanding these efforts to more sites.
Full Research Summary
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. This is due, 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 nearly 200 rural health center nurses in clinical breast exams and evaluation of breast concerns. In addition, they trained nearly 2000 community health workers (CHWs) in the basics of breast awareness and patient education, as well as seven district hospital clinicians in breast ultrasound. As a result of these efforts, there has been significant improvement in clinicians' knowledge and skills, as well as patient outcomes. Based on these successes, they are now scaling up the project to other districts in Rwanda to broaden its impact.
In response to a request from Rwanda’s Ministry of Health, the international team will scale up the intervention to two other districts this year and two more next year. They will work to integrate the program into existing health services and ensure appropriate follow-up and referrals for patients. Few rigorous evaluations of breast cancer early detection programs exist in rural low-income settings, and this work will have significant impact for Rwanda and sub-Saharan Africa as a whole.
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.