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).
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.
Study Type
OBSERVATIONAL
Enrollment
17,379
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
Rwanda Biomedical Centre
Kigali, Rwanda
Cancer detection rate
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
Time frame: 2 years
Loss to follow-up
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
Time frame: one year
Patient volume and services received
Number of patients presenting at the health centers, district hospital and referral hospitals
Time frame: two years
Breast cancer stage
Among women diagnosed with breast cancer, distribution of cancer stage among women who participated in the WCEDP.
Time frame: 2 years
Patients' costs
out-of-pocket costs borne by patients while undergoing evaluation for an abnormal clinical breast exam
Time frame: 6 months
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