Return on Investment of a Breast Cancer Screening Program in Tanzania: Opportunity for Patient and Public Education.
Breast cancer
Patient education
Public education
Return on investment
Screening
Tanzania
Journal
Journal of cancer education : the official journal of the American Association for Cancer Education
ISSN: 1543-0154
Titre abrégé: J Cancer Educ
Pays: England
ID NLM: 8610343
Informations de publication
Date de publication:
06 2022
06 2022
Historique:
accepted:
04
09
2020
pubmed:
28
9
2020
medline:
22
6
2022
entrez:
27
9
2020
Statut:
ppublish
Résumé
Breast cancer is the second incident and second cause of cancer mortality among women in Tanzania due to late-stage presentation. The screening clinic at the Ocean Road Cancer Institute (ORCI) can help detect cases early and reduce cost of treatment. We calculated the return on investment (ROI) of the ORCI breast screening clinic. Screening and treatment data of all newly diagnosed breast cancer patients seen at ORCI during 2016-2018 were abstracted from the medical records. Also, data on time, resources, and cost of screening and treatment were obtained. The cost of treating screened patients was compared with cost of treating unscreened patients, and differences in cost of treatment were compared with cost of operating the screening program. Of the 730 total patients, 58 were screened prior to treatment, and 672 were not. There was no significant difference between stage at diagnosis and treatments received by screened and unscreened patients (79.3% late- stage vs 72.2% late-stage diagnosis, respectively (p = .531), or cost of treatment between the two groups (cost, in Tanzanian Shillings, for screened (2,167,155.14 or $954.27) vs unscreened (1,918,592.28 or $844.52), (p = .355). There was also no significant difference in cost of treatment between the screened and unscreened groups and a slightly negative ROI (- 0.05%) from implementing the program. The breast screening clinic in Tanzania has not yet proven its cost-effectiveness in reducing stage with screening. The likelihood that patients have utilized the clinic for treatment rather than early detection is a possible reason for the lack of cost-effectiveness. Future studies should focus on educational initiatives to encourage screening at early disease stage. Public education should increase awareness about the clinic for early detection. The experience of this program is ideal for dissemination to other low-income countries that are initiating cancer early detection and cancer education programs.
Identifiants
pubmed: 32980979
doi: 10.1007/s13187-020-01871-6
pii: 10.1007/s13187-020-01871-6
pmc: PMC7997813
mid: NIHMS1632793
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Langues
eng
Sous-ensembles de citation
IM
Pagination
701-708Subventions
Organisme : NCI NIH HHS
ID : R25 CA112383
Pays : United States
Informations de copyright
© 2020. American Association for Cancer Education.
Références
Global Burden of Disease Cancer Collaboration, Fitzmaurice C, Allen C et al (2017) Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study [published correction appears in JAMA Oncol. 2017;3(3):418]. JAMA Oncol 3(4):524–548. https://doi.org/10.1001/jamaoncol.2016.5688
doi: 10.1001/jamaoncol.2016.5688
pmcid: 6103527
Hu K, Ding P, Wu Y, Tian W, Pan T, Zhang S (2019) Global patterns and trends in the breast cancer incidence and mortality according to sociodemographic indices: an observational study based on the global burden of diseases. BMJ Open 9(10):e028461. Published 2019 Oct 7. https://doi.org/10.1136/bmjopen-2018-028461
doi: 10.1136/bmjopen-2018-028461
pubmed: 31594871
pmcid: 6797270
Tanzania Breast Health Care Assessment 2017: an assessment of breast cancer early detection, diagnosis and treatment in Tanzania. Susan G. Komen on behalf of the Ministry of Health, Community Development, Gender, Elderly and Children of the United Republic of Tanzania; 2017:iii. https://ww5.komen.org/uploadedFiles/_Komen/Content/Grants_Central/International_Grants/Grantee_Resources/Full_Tanzania_Assessment_report.pdf
Yang K, Msami K, Calixte R, Mwaiselage J, Dorn J, Soliman AS (2019) Educational opportunities for down-staging breast cancer in low-income countries: an example from Tanzania. J Cancer Educ 34:1225–1230
doi: 10.1007/s13187-019-01587-2
Caplan L (2014) Delay in breast cancer: implications for stage at diagnosis and survival. Front Public Health 2. https://doi.org/10.3389/fpubh.2014.00087
Breast cancer: prevention and control. World Health Organization. https://www.who.int/cancer/detection/breastcancer/en/index1.html . Updated 2018. Accessed January 1, 2019.
Burson A, Soliman A, Ngoma T et al (2010) Clinical and epidemiologic profile of breast cancer in Tanzania. Breast Dis 31(1):33–41. https://doi.org/10.3233/bd-2009-0296
doi: 10.3233/bd-2009-0296
pubmed: 21109721
pmcid: 4276128
Stapleton JM, Mullan PB, Dey S et al (2011) Patient-mediated factors predicting early- and late-stage presentation of breast cancer in Egypt. Psychooncology. 20(5):532–537. https://doi.org/10.1002/pon.1767
doi: 10.1002/pon.1767
pubmed: 21456061
pmcid: 4511958
Blumen H, Fitch K (2016) Polkus, v. Comparison of treatment costs for breast cancer, by tumor stage and type of service. Am Health Drug Benefits 9(1):23–32
pubmed: 27066193
pmcid: 4822976
Mushlin A, Fintor L (1992) Is screening for breast cancer cost-effective? Cancer 69(S7):1957–1962. https://doi.org/10.1002/1097-0142(19920401)69:7+<1957::AID-CNCR2820691716>3.0.CO;2-T
van der Maas PJ, de Koning HJ, van Ineveld BM et al (1989) The cost-effectiveness of breast cancer screening. Int J Cancer 43(6):1055–1060
doi: 10.1002/ijc.2910430617
Nelson S, Kim J, Wilson F et al (2016) Cost-effectiveness of screening and treatment for cervical cancer in Tanzania: implications for other sub-Saharan African countries. Value Health Reg Issues 10:1–6. https://doi.org/10.1016/j.vhri.2016.03.002
doi: 10.1016/j.vhri.2016.03.002
pubmed: 27881270
pmcid: 5123439
Gard AC, Soliman AS, Ngoma T et al (2014) Most women diagnosed with cervical cancer by a visual screening program in Tanzania completed treatment: evidence from a retrospective cohort study. BMC Public Health 14:910. Published 2014 Sep 3. https://doi.org/10.1186/1471-2458-14-910
doi: 10.1186/1471-2458-14-910
pubmed: 25187329
pmcid: 4162936
Gross CP, Long JB, Ross JS et al (2013) The cost of breast cancer screening in the Medicare population. JAMA Intern Med 173(3):220–226. https://doi.org/10.1001/jamainternmed.2013.1397
doi: 10.1001/jamainternmed.2013.1397
pubmed: 23303200
pmcid: 3638736
Skrundevskiy AN, Omar OS, Kim J, Soliman AS, Korolchuk TA, Wilson FA (2018) Return on investment analysis of breast cancer screening and downstaging in Egypt: implications for developing countries. Value Health Reg Issues 16:22–27. https://doi.org/10.1016/j.vhri.2018.01.006
doi: 10.1016/j.vhri.2018.01.006
pubmed: 29626738
pmcid: 7770629
Pace LE, Shulman LN (2016) Breast cancer in sub-Saharan Africa: challenges and opportunities to reduce mortality. Oncologist. 21(6):739–744. https://doi.org/10.1634/theoncologist.2015-0429
doi: 10.1634/theoncologist.2015-0429
pubmed: 27091419
pmcid: 4912363
Zelle S, Nyarko K, Bosu W et al (2012) Costs, effects and cost-effectiveness of breast cancer control in Ghana. Tropical Med Int Health 17(8):1031–1043. https://doi.org/10.1111/j.1365-3156.2012.03021.x
doi: 10.1111/j.1365-3156.2012.03021.x
Okonkwo Q, Draisma G, der Kinderen A, Brown M, de Koning H (2008) Breast cancer screening policies in developing countries: a cost-effectiveness analysis for India. J Natl Cancer Inst 100(18):1290–1300. https://doi.org/10.1093/jnci/djn292
doi: 10.1093/jnci/djn292
pubmed: 18780864
Brinton LA, Figueroa JD, Awuah B et al (2014) Breast cancer in sub-Saharan Africa: opportunities for prevention. Breast Cancer Res Treat 144:467–478. https://doi.org/10.1007/s10549-014-2868-z
doi: 10.1007/s10549-014-2868-z
pubmed: 24604092
pmcid: 4023680
Ng’ida FD, Kotoroi GL, Mwangi R, Mabelele MM, Kitau J, Mahande MJ (2019) Knowledge and practices on breast cancer detection and associated challenges among women aged 35 years and above in Tanzania: a case in Morogoro Rural District. Breast Cancer (Dove Med Press) 11:191–197. Published 2019 May 28. https://doi.org/10.2147/BCTT.S199889
doi: 10.2147/BCTT.S199889
Peters LM, Soliman AS, Bukori P, Mkuchu J, Ngoma T (2010) Evidence for the need of educational programs for cervical screening in rural Tanzania. J Cancer Educ 25(2):153–159. https://doi.org/10.1007/s13187-009-0018-9
doi: 10.1007/s13187-009-0018-9
pubmed: 20204578
pmcid: 3223858
Black E, Richmond R (2019) Improving early detection of breast cancer in sub-Saharan Africa: why mammography may not be the way forward. Glob Health 15:3. https://doi.org/10.1186/s12992-018-0446-6
doi: 10.1186/s12992-018-0446-6
Abuidris D, Elsheikh A, Ali M et al (2013) Breast-cancer screening with trained volunteers in a rural area of Sudan: a pilot study. Lancet Oncol 14(4):363–370. https://doi.org/10.1016/s1470-2045(12)70583-1
doi: 10.1016/s1470-2045(12)70583-1
pubmed: 23375833
Ngoma T, Mandeli J, Holland J (2014) Downstaging cancer in rural Africa. Int J Cancer 136(12):2875–2879. https://doi.org/10.1002/ijc.29348
doi: 10.1002/ijc.29348
pubmed: 25408458
Chiarelli A, Muradali D, Blackmore K et al (2017) Evaluating wait times from screening to breast cancer diagnosis among women undergoing organised assessment vs usual care. Br J Cancer 116(10):1254–1263. https://doi.org/10.1038/bjc.2017.87
doi: 10.1038/bjc.2017.87
pubmed: 28359079
pmcid: 5482732