Download Community-based Program for Breast Health, Peru

Community-based Program for Breast Health, Peru
(Programa Comunitario de Salud Mamaria)
Background
Breast cancer incidence is rising steadily in
low- and middle-income countries as women
live longer and life styles are changing in ways
that increase risk factors for breast cancer. As
with many other diseases, the burden falls more
heavily on poor, marginalized, and rural
women due to their unequal access to screening
and treatment. The importance of early
detection and treatment of breast cancer is well
recognized, since the cost and success of
treatment is directly related to the stage of
disease at the time of diagnosis. Affordable
screening, diagnostic and treatment options,
and resource-appropriate guidelines offer new
opportunities to reach underserved populations
with life-saving screening and treatment
approaches that are effective and sustainable.
Engaging communities in supporting
appropriate-aged women in seeking breast
cancer screening and following through with
early treatment, as well as providing
appropriate psychosocial support for women
both during treatment and afterwards, has been
shown to be critical to treatment success,
survivorship, and quality of life.
The PATH/INEN project
PATH is collaborating with the Peru National
Cancer Institute (INEN), the Regional Cancer
Institute (IREN-Norte), and Ministry of
Health (MINSA), particularly at the regional
level in La Libertad. Together, we are
initiating a collaborative project to introduce
novel approaches to strengthen feasible,
evidence-based strategies to reduce the
growing burden of mortality and morbidity
due to breast cancer—for women in lowresource areas. In addition to providing
technical leadership and support, INEN has
committed its own resources to key inputs,
such as training, for the pilot project.
Map of pilot area in Peru
LA LIBERTAD
LIMA
According to the IARC database (Globocan
2008), Peru had an estimated 4,300 new cases
of breast cancer and 1,365 deaths in 2008, with
an age-standardized annual incidence rate of
34/100,000 women. However, these rates are
rising as elsewhere in the developing world; in
2010 the Peruvian government estimated 5,643
new breast cancer cases.
The project is being implemented in two
phases:
Phase 1 is an 18-month pilot demonstration
of the model of care to improve access and
quality of breast cancer screening, diagnosis,
and treatment services at lower levels of the
health system (February 2011–July 2012). This
is being implemented in one health network
within the region of La Libertad in Peru and is
based on the use of clinical breast exam (CBE)
performed by midwives, followed by referral
of women with suspected masses to the local
hospital for evaluation by trained physicians
using fine-needle aspiration (FNA). In Trujillo,
where a new regional cancer center has been
established for the northern part of the country
(IREN-Norte), women with a confirmed
diagnosis can be referred for appropriate
treatment (surgery, radiotherapy, systemic
therapy). Training will be developed to enable
district-level physicians to provide follow-up
management after treatment, completing the
cycle of offering as much care as possible at
the health level closest to the woman and her
family, while concentrating specialty care at a
level where quality and efficiency can be
assured.
Another component of this phase of the project
is to build long-term capacity by supporting
INEN in their development of a Breast Health
Training Excellence Center. This center will
include validated curricula for three types of
training:
1) Training health promoters to engage
communities in encouraging
appropriate-aged women to seek breast
cancer screening.
2) Training for clinical providers on CBE.
3) Training doctors in the FNA biopsy
procedure.
Phase 2 will be the national scale-up of the
model and the inclusion of new components
of post-treatment support for patients—both
clinical support at the local level for women
who need follow-up care and monitoring, as
well as psychosocial support in the
community.
The project also facilitates the identification
and procurement of essential equipment and
supplies appropriate to local needs and
resources, and will enhance human capacity
in key areas of clinical care, health
promotion, and health care management
related to breast cancer detection, diagnosis,
treatment, palliative care, and survivorship.
The project will support policy and practice
change as needed, through the sharing of
scientific evidence, international guidelines,
and experience from other countries;
designing local studies, as needed; and
providing support to national champions.
Project status
The first training of heath promotion and
clinical providers was completed in July of
2011. Thirteen health promoters have been
trained to encourage appropriate-aged women
to seek CBE annually and if they identify any
unusual changes in their breasts. Eight
midwives and three doctors were trained to
perform CBE, and the three doctors were also
trained to perform the FNA procedure.
IREN
The center will include materials and resources
for providing supportive supervision. Finally, it
will include master trainers who can provide
training to new providers in all of the areas
described above.
Clinical providers practicing clinical breast exam on
breast models during clinical training course.
PATH
Mail: PO Box 900922 │Seattle, WA 98109 USA
Street: 2201 Westlake Avenue, Suite 200 │Seattle, WA 98121 USA
Tel: 206.285.3500 │Fax: 206.285.6619
www.path.org