Implementation research: including breast examinations in a cervical cancer screening programme, Rwanda

Area of Science:

• Oncology
• Public Health
• Health Services Research

Background:

• Rwanda's Women's Cancer Early Detection Program integrated breast and cervical cancer screening starting in 2018-2019.
• The program aimed to improve early cancer detection rates among women.

Purpose of the Study:

• To determine if integrating clinical breast examination with cervical cancer screening facilitated early breast cancer diagnosis in asymptomatic women.
• To evaluate the effectiveness of the integrated screening program in Rwanda.

Main Methods:

• The study involved offering clinical breast examination alongside cervical cancer screening to women in three Rwandan districts.
• Women with symptoms received diagnostic breast examinations, and those with abnormal findings were referred to higher care levels.
• Data collected included clinic frequency, patient volumes, referral rates, and time intervals between referrals.

Main Results:

• Clinics were held over 68% of the weeks, with thousands of women screened for both cancers.
• Referral follow-up rates were high (74.5% to district hospitals, 89.5% to referral hospitals).
• Of 29 breast cancer diagnoses, most were in women over 50, and 23 had advanced stage III or IV disease; all known cases had presented with symptoms.

Conclusions:

• Short-term integration of clinical breast examination with cervical cancer screening did not result in earlier breast cancer detection among asymptomatic women.
• The findings highlight the importance of encouraging women to seek prompt medical attention for any experienced symptoms.