Breast cancer early detection and diagnostic capacity in Uganda.
Uganda
breast cancer
detection
diagnosis
health care capacity
low-resource country
Journal
Cancer
ISSN: 1097-0142
Titre abrégé: Cancer
Pays: United States
ID NLM: 0374236
Informations de publication
Date de publication:
15 05 2020
15 05 2020
Historique:
received:
24
01
2020
revised:
24
02
2020
accepted:
25
02
2020
entrez:
30
4
2020
pubmed:
30
4
2020
medline:
22
5
2021
Statut:
ppublish
Résumé
Greater than 80% of women presenting for breast cancer treatment in Uganda have late-stage disease, which is attributable to a dysfunctional referral system and a lack of recognition of the early signs and symptoms among primary health care providers, and compounded by the poor infrastructure and inadequate human capacity. Improving the breast health care system requires a systemic approach beginning with situational analysis to identify systematic gaps that prevent sustainable improvements in outcome. The authors performed a situational analysis of the breast health care system using methods developed by the Breast Health Global Initiative. Based on their findings, they developed a series of recommendations for strengthening the health system for the early diagnosis of breast cancer based on clinical detection, referral, tissue sampling, and diagnosis. Deficits in the recognition of breast cancer signs and symptoms, the underuse of clinical breast examination as a diagnostic and/or screening tool, the centralization of diagnostic tests (radiology and pathology), reliance on excisional biopsies rather than needle biopsies, and a lack of trained professionals and knowledge of the referral system all contribute to significant health system delays. To strengthen referral networks and improve the early diagnosis of breast cancer in Uganda, national referral hospitals should provide educational programs to primary health care providers in community health centers (CHCs), at which the majority of women first present with symptoms. At secondary district-level facilities in which imaging and tissue sampling can be performed, the capacity for diagnostic testing could be increased through task shifting of basic interpretation (abnormal vs normal) from specialists to nonspecialists using networking technology to facilitate remote oversight from specialists at the national referral hospitals.
Sections du résumé
BACKGROUND
Greater than 80% of women presenting for breast cancer treatment in Uganda have late-stage disease, which is attributable to a dysfunctional referral system and a lack of recognition of the early signs and symptoms among primary health care providers, and compounded by the poor infrastructure and inadequate human capacity. Improving the breast health care system requires a systemic approach beginning with situational analysis to identify systematic gaps that prevent sustainable improvements in outcome.
METHODS
The authors performed a situational analysis of the breast health care system using methods developed by the Breast Health Global Initiative. Based on their findings, they developed a series of recommendations for strengthening the health system for the early diagnosis of breast cancer based on clinical detection, referral, tissue sampling, and diagnosis.
RESULTS
Deficits in the recognition of breast cancer signs and symptoms, the underuse of clinical breast examination as a diagnostic and/or screening tool, the centralization of diagnostic tests (radiology and pathology), reliance on excisional biopsies rather than needle biopsies, and a lack of trained professionals and knowledge of the referral system all contribute to significant health system delays.
CONCLUSIONS
To strengthen referral networks and improve the early diagnosis of breast cancer in Uganda, national referral hospitals should provide educational programs to primary health care providers in community health centers (CHCs), at which the majority of women first present with symptoms. At secondary district-level facilities in which imaging and tissue sampling can be performed, the capacity for diagnostic testing could be increased through task shifting of basic interpretation (abnormal vs normal) from specialists to nonspecialists using networking technology to facilitate remote oversight from specialists at the national referral hospitals.
Identifiants
pubmed: 32348563
doi: 10.1002/cncr.32890
pmc: PMC7219536
mid: NIHMS1584213
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2469-2480Subventions
Organisme : Radiological Society of North America
Organisme : Susan G. Komen
ID : SAC170082
Pays : United States
Organisme : National Comprehensive Cancer Network
Organisme : NCI NIH HHS
ID : P30 CA015704
Pays : United States
Organisme : Novartis
Organisme : NCI NIH HHS
ID : 1R13CA224776-01A1
Pays : United States
Organisme : American Society of Clinical Oncology
Organisme : General Electric
Organisme : pH Trust
Organisme : Journal of Global Oncology
Organisme : Pfizer
Organisme : Union for International Cancer Control
Organisme : American Society of Clinical Pathology
Organisme : NCI NIH HHS
ID : R13 CA224776
Pays : United States
Organisme : Seattle Cancer Care Alliance
Organisme : Cepheid
Organisme : University of Washington
Organisme : GE Healthcare
Organisme : UE LifeSciences
Organisme : Fred Hutchinson Cancer Research Center
Organisme : National Breast Cancer Foundation
Organisme : Susan G. Komen
ID : GSP18BHGI001
Pays : United States
Informations de copyright
© 2020 American Cancer Society.
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