Titles and Affiliations
Clinician researcher, Division of Women’s Health
Interim Clinical and Research Director
Lead, Global Women’s Health Fellowship
Associate Professor of Medicine, Harvard Medical School
Research area
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. Pace and Shyirambere 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. Pace, Shymirambere, 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.
Biography
Lydia Pace, MD, MPH, is a primary care physician and researcher in the Division of Women’s Health at Brigham and Women’s Hospital (BWH) and Associate Professor of Medicine at Harvard Medical School. Dr. Pace is also Interim Clinical and Research Director of the BWH Division of Women’s Health and leads BWH’s Global Women’s Health Fellowship. She received her medical degree from the University of California, San Francisco, completed her residency in internal medicine at Brigham and Women’s Hospital, and obtained a master’s in public health from the Harvard T.H. Chan School of Public Health in Boston, MA.
Dr. Pace’s work combines clinical practice in primary care and women’s health with research on access to and utilization of breast cancer early detection and other women’s health services. Specifically, her research has focused on breast cancer early diagnosis, screening, shared decision-making and care, with a particular focus on using implementation science methodology to understand and address disparities in breast cancer diagnosis, treatment, and outcomes in the United States and sub-Saharan Africa.
From 2011 through 2014, Dr. Pace lived in Rwanda where she worked as an internist in the Departments of Internal Medicine and Oncology at Butaro Hospital. She also served as District Clinical Advisor for Partners in Health/Inshuti Mu Buzima in Rwanda from 2011-2012 and as Deputy Director of the PIH/IMB Women’s Health Program from 2013-2014. Since that time, Dr. Pace has collaborated with Drs. Lawrence Shulman, Cyprien Shyirambere, and other Rwandan clinical and policy leaders to develop clinical programs, infrastructure, and policies to facilitate earlier diagnosis of breast cancer in Rwanda. She has also collaborated with researchers in other low- and middle-income countries addressing these issues and served as co-lead of the World Health Organization’s Global Breast Cancer Initiative’s Early Diagnosis Working Group.
She returned to the U.S. where she completed a postdoctoral fellowship at the NIH Training Institute for Dissemination and Implementation Research in Health in Bethesda, MD. Dr. Pace has received several awards including the Extraordinary Women Advancing Healthcare Award from The Women’s Edge (2022), BWH’s Internal Medicine Residency Research Mentor Award (2020), SGIM Northeast Regional Award for Excellence in Clinician Investigation (2019), and a Young Leader award from the Breast Health Global Initiative (2018).
