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, in part because of delayed diagnoses and late-stage presentations. 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. Very little is known, however, about effective ways to promote early detection of breast cancer in settings where mammography screening is not widely available and health care resources are highly limited. With continued funding from BCRF, Drs. Shulman and Mpunga have launched a pilot program to promote early detection of breast cancer in Burera District, a remote rural area of Rwanda where Rwanda’s first national cancer facility, the Butaro Cancer Center of Excellence (BCCOE), is located. In the initial phase of the project, the team trained 66 health center nurses in clinical breast exam and evaluation of breast concerns, and 508 community health workers (CHWs) in the basics of breast awareness and patient education. As a result of these trainings, both health center nurses and CHWs demonstrated significant improvements in knowledge and skills. In the coming year the research team will continue to measure the impact of these trainings on patient volume, diagnostic delays and breast cancer stage, and lay the groundwork for assessment of breast cancer survival. These efforts will further build capacity to efficiently evaluate and care for the growing number of women with breast concerns who come to 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.