Benign Breast Disease, Breast Cancer
Conditions
Keywords
Rwanda, breast cancer, screening, early detection
Brief summary
This observational study evaluates scale-up of a breast cancer early detection program in Rwanda that was initially piloted in a single district. Specifically investigators will examine patient volume, service delivery, loss-to-follow-up rates, and cancer detection rates noted following implementation of scale-up to 3 additional districts. For scaleup, breast cancer screening with CBE was added to a cervical cancer screening initiative, in a combined Women's Cancer Early Detection Program (WCEDP).
Detailed description
Investigators previously conducted a cluster randomized controlled trial of a clinician training program to facilitate prompt evaluation of women with breast symptoms in one rural district of Rwanda. Subsequently, Rwanda Biomedical Centre (RBC) has scaled up the curriculum in 3 districts, adapting the program to integrate CBE screening into a cervical cancer screening initiative. In this study, we will evaluate implementation of this combined screening initiative. Investigators will assess patient volume, services, diagnoses, and loss to follow up.
Interventions
OTHEREarly diagnosis program combined with electronic medical record
Implementation of early diagnosis approach targeting symptomatic women, combined with use of electronic medical record to facilitate documentation, patient tracking across levels of the health care system, and patient contact
Sponsors
Rwanda Biomedical Centre
Partners in Health
Breast Cancer Research Foundation
Brigham and Women's Hospital
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Healthy volunteers
No
Inclusion criteria
* All women and men who are evaluated for a breast concern or receive breast cancer screening through implementation of the nationally-led early detection programs
Exclusion criteria
* None
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Cancer detection rate | 2 years | Proportion of patients presenting to health centers who are ultimately diagnosed with cancer; proportion of patients who receive biopsy who are ultimately diagnosed with cancer; proportion of individuals diagnosed with cancer who initially presented with versus without breast symptoms |
| Loss to follow-up | one year | Rates of loss-to-follow up before and after implementation of electronic medical record in districts utilizing breast cancer screening approach; and loss to follow up in districts implementing early diagnosis approach and EMR |
| Patient volume and services received | two years | Number of patients presenting at the health centers, district hospital and referral hospitals |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Breast cancer stage | 2 years | Among women diagnosed with breast cancer, distribution of cancer stage among women who participated in the WCEDP. |
| Patients' costs | 6 months | out-of-pocket costs borne by patients while undergoing evaluation for an abnormal clinical breast exam |
Countries
Rwanda
Outcome results
None listed