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, Dr. Mpunga with BCRF co-investigator Dr. Lawrence Shulman 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.
Tharcisse Mpunga, MD, MSc, has been the Medical Director of Butaro Hospital in Rwanda since 2009. He led the development of Butaro's acclaimed new hospital facility that opened in 2011, serving a predominantly poor, rural population of about 350,000 people in Northern Rwanda. In 2012 Dr. Mpunga oversaw the opening of Butaro Center of Excellence in Cancer Care, the first rural cancer referral center in Africa and the only cancer-focused facility in Rwanda. Dr. Mpunga also leads numerous research efforts at Butaro in partnership with the Ministry of Health, Dana-Farber Cancer Institute, and Partners in Health, including implementation and evaluation of the center's unique telepathology program and a cohort study of breast cancer patients.