Research Assistant II
Amanda M. Fata, Jean de Dieu Uwihaye, Vestine Mukandayisenga, Marc Hagenimana, Francois Uwinkindi, Vincent Cubaka, Lydia E. Pace
Lydia E. Pace
OBJECTIVE: Global cancer experts have called for integration of breast and cervical cancer screening in low- and middle-income countries, but there is limited data to inform optimal strategies. Rwanda’s Women’s Cancer Early Detection Program (WCEDP) integrates breast cancer early detection with cervical cancer screening at primary health centers. We examined provision of clinical breast exam in 3 districts implementing this strategy to determine reach of the program for women needing breast evaluation.
METHODS: We extracted pre-intervention paper registry data and post-intervention electronic medical record data on encounters at 15 health centers from July 2019-September 2021.
RESULTS: Of 17,365 encounters for cervical cancer screening, 5,252(30.2%) included clinical breast exam (CBE). Another 1,095 encounters involved CBE only. In 31.7% of all CBE encounters, patients reported breast symptoms. When we compared 12 months before and after the intervention, the average monthly number of encounters including CBE increased from 63 to 299 in Musanze; 10 to 271 in Nyagatare; and 16 to 118 in Gasabo.
CONCLUSIONS: Introduction of the WCEDP at Rwandan health centers increased the monthly average number of encounters involving CBE. Ongoing analyses will determine whether combination of breast and cervical cancer screening services improved efficiency of care delivery or cancer detection.
OBJECTIVE: Combining screening for different cancers is one potential strategy for managing the growing burden of cancer globally. There is limited evidence about the effectiveness of combining cervical cancer screening and breast cancer early detection in low- and middle-income countries. In Rwanda, the Women’s Cancer Early Detection Program (WCEDP) is one example of this approach. We sought to evaluate how this intervention at primary health centers affected the provision of clinical breast exam (CBE).
METHODS: We collected data on cervical and breast cancer encounters from paper registries and electronic medical records (EMR) at 15 health centers in Musanze, Nyagatare, and Gasabo districts, 12 months before and after the introduction of the WCEDP.
RESULTS: Of 17,365 patient visits for cervical cancer screening, 5,252(30.2%) also included CBE. An additional 1,095 patient visits involved CBE only. The average monthly number of patient visits including CBE pre-/post-intervention increased from 63 to 299 in Musanze; 10 to 271 in Nyagatare; and 16 to 118 in Gasabo.
CONCLUSION: The WCEDP was successful in increasing provision of CBE at health centers included in this study. Most patients who received CBE also received cervical cancer screening, suggesting that the combined screening approach led to more patients receiving CBE.