Breast cancer is a major public health concern in low and middle income countries (LMCs) such as Rwanda, where women have a much higher risk of dying if they are diagnosed. Without the correct diagnosis, optimal treatment cannot be given, and the chance for successful treatment outcome is greatly diminished. In addition, it is critical that the correct diagnosis is made rapidly so that patients suffering from cancer can have treatment instituted quickly. In the first year of their BCRF funding Drs. Shulman and Mpunga joined forces to address these challenges by implementing strategies to improve the capacity for tumor pathology review at the Butaro Hospital in Rwanda. The project is focused on providing training in standard methods of pathology and includes a low-cost telepathology platform that allows trained pathologists in the US to oversee the interpretation of pathology reports from the physicians in Rwanda.
Delays in accessing diagnostic services and treatment are another major obstacle to reducing breast cancer mortality rates in low and middle income countries. Developing early detection strategies for breast cancer in in these settings is essential to improve survival. The goal of Drs. Shulman’s and Mpunga’s 2014-2015 BCRF project is to assess the impact of a breast cancer educational intervention for rural community health workers and health center nurses. In particular, they will study the impact of this intervention on community health worker and nurse knowledge and skills, patient referrals, breast cancer detection rates, delays in breast cancer diagnoses, and breast cancer stage at diagnosis. This project is part of a larger effort by the investigators to implement robust research and clinical programs at the Butaro Cancer Center in Rwanda.
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.