Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda
PURPOSE: Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan...
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American Society of Clinical Oncology
2019-11-01
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Series: | Journal of Global Oncology |
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doaj-45ffa56e0cf04f0babb7b51354680efb2020-11-25T03:55:58ZengAmerican Society of Clinical OncologyJournal of Global Oncology2378-95062019-11-01511310.1200/JGO.19.002091Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of RwandaLydia E. Pace0Jean Marie Vianney Dusengimana1Lawrence N. Shulman2Lauren E. Schleimer3Cyprien Shyirambere4Christian Rusangwa5Gaspard Muvugabigwi6Paul H. Park7ChuanChin Huang8Jean Bosco Bigirimana9Vedaste Hategekimana10Vestine Rugema11Aline Umwizerwa12Nancy L. Keating13Tharcisse Mpunga14Brigham and Women’s Hospital, Boston, MAPartners in Health, Kigali, RwandaUniversity of Pennsylvania, Philadelphia, PAHarvard Medical School, Boston, MAPartners in Health, Kigali, RwandaPartners in Health, Kigali, RwandaMinistry of Health, Kigali, RwandaBrigham and Women’s Hospital, Boston, MABrigham and Women’s Hospital, Boston, MAPartners in Health, Kigali, RwandaRwanda Biomedical Centre, Kigali, RwandaMinistry of Health, Kigali, RwandaMinistry of Health, Kigali, RwandaBrigham and Women’s Hospital, Boston, MAMinistry of Health, Kigali, RwandaPURPOSE: Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district. METHODS: We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs. RESULTS: From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs (P = .001) and 7.9 visits/month for phase 2 HCs (P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas (P = .048). CONCLUSION: In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers.http://ascopubs.org/doi/10.1200/JGO.19.00209 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lydia E. Pace Jean Marie Vianney Dusengimana Lawrence N. Shulman Lauren E. Schleimer Cyprien Shyirambere Christian Rusangwa Gaspard Muvugabigwi Paul H. Park ChuanChin Huang Jean Bosco Bigirimana Vedaste Hategekimana Vestine Rugema Aline Umwizerwa Nancy L. Keating Tharcisse Mpunga |
spellingShingle |
Lydia E. Pace Jean Marie Vianney Dusengimana Lawrence N. Shulman Lauren E. Schleimer Cyprien Shyirambere Christian Rusangwa Gaspard Muvugabigwi Paul H. Park ChuanChin Huang Jean Bosco Bigirimana Vedaste Hategekimana Vestine Rugema Aline Umwizerwa Nancy L. Keating Tharcisse Mpunga Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda Journal of Global Oncology |
author_facet |
Lydia E. Pace Jean Marie Vianney Dusengimana Lawrence N. Shulman Lauren E. Schleimer Cyprien Shyirambere Christian Rusangwa Gaspard Muvugabigwi Paul H. Park ChuanChin Huang Jean Bosco Bigirimana Vedaste Hategekimana Vestine Rugema Aline Umwizerwa Nancy L. Keating Tharcisse Mpunga |
author_sort |
Lydia E. Pace |
title |
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda |
title_short |
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda |
title_full |
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda |
title_fullStr |
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda |
title_full_unstemmed |
Cluster Randomized Trial to Facilitate Breast Cancer Early Diagnosis in a Rural District of Rwanda |
title_sort |
cluster randomized trial to facilitate breast cancer early diagnosis in a rural district of rwanda |
publisher |
American Society of Clinical Oncology |
series |
Journal of Global Oncology |
issn |
2378-9506 |
publishDate |
2019-11-01 |
description |
PURPOSE: Feasible and effective strategies are needed to facilitate earlier diagnosis of breast cancer in low-income countries. The goal of this study was to examine the impact of health worker breast health training on health care utilization, patient diagnoses, and cancer stage in a rural Rwandan district. METHODS: We conducted a cluster randomized trial of a training intervention at 12 of the 19 health centers (HCs) in Burera District, Rwanda, in 2 phases. We evaluated the trainings’ impact on the volume of patient visits for breast concerns using difference-in-difference models. We used generalized estimating equations to evaluate incidence of HC and hospital visits for breast concerns, biopsies, benign breast diagnoses, breast cancer, and early-stage disease in catchment areas served by intervention versus control HCs. RESULTS: From April 2015 to April 2017, 1,484 patients visited intervention HCs, and 308 visited control HCs for breast concerns. The intervention led to an increase of 4.7 visits/month for phase 1 HCs (P = .001) and 7.9 visits/month for phase 2 HCs (P = .007) compared with control HCs. The population served by intervention HCs had more hospital visits (115.1 v 20.5/100,000 person-years, P < .001) and biopsies (36.6 v 8.9/100,000 person-years, P < .001) and higher breast cancer incidence (6.9 v 3.3/100,000 person-years; P = .28). The incidence of early-stage breast cancer was 3.3 per 100,000 in intervention areas and 0.7 per 100,000 in control areas (P = .048). CONCLUSION: In this cluster randomized trial in rural Rwanda, the training of health workers and establishment of regular breast clinics were associated with increased numbers of patients who presented with breast concerns at health facilities, more breast biopsies, and a higher incidence of benign breast diagnoses and early-stage breast cancers. |
url |
http://ascopubs.org/doi/10.1200/JGO.19.00209 |
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