Search

Objective To evaluate whether integrating breast and cervical cancer screening in Rwanda's Women's Cancer Early Detection Program led to early breast cancer diagnoses in asymptomatic women. Methods Launched in three districts in 2018-2019, the early detection programme offered clinical breast examination screening for all women receiving cervical cancer screening, and diagnostic breast examination for women with breast cancer symptoms. Women with abnormal breast examinations were referred to district hospitals and then to referral hospitals if needed. We examined how often clinics were held, patient volumes and number of referrals. We also examined intervals between referrals and visits to the next care level and, among women diagnosed with cancer, their initial reasons for seeking care. Findings Health centres held clinics > 68% of the weeks. Overall, 9763 women received cervical cancer screening and clinical breast examination and 7616 received breast examination alone. Of 585 women referred from health centres, 436 (74.5%) visited the district hospital after a median of 9 days (interquartile range, IQR: 3-19). Of 200 women referred to referral hospitals, 179 (89.5%) attended after a median of 11 days (IQR: 4-18). Of 29 women diagnosed with breast cancer, 19 were > 50 years and 23 had stage III or stage IV disease. All women with breast cancer whose reasons for seeking care were known (23 women) had experienced breast cancer symptoms. Conclusion in the short-term, integrating clinical breast examination with cervical cancer screening was not associated with detection of early-stage breast cancer among asymptomatic women. Priority should be given to encouraging women to seek timely care for symptoms. Recherche sur la mise en reuvre: integration des examens des seins dans le programme de depistage du cancer du col de l'uterus au Rwanda Objectif Evaluer si le fait d'integrer le depistage du cancer du sein et du col de l'uterus dans le Programme de detection precoce du cancer chez les femmes au Rwanda a permis de mieux diagnostiquer les cancers du sein chez les femmes asymptomatiques. Methodes Lance dans trois districts en 2018-2019, le programme de detection precoce proposait un examen clinique des seins a toutes les femmes effectuant un depistage du cancer du col de l'uterus et un examen diagnostique des seins a celles presentant des symptomes de cancer du sein. Les femmes ayant obtenu un resultat anormal lors de cet examen etaient ensuite transferees a des hopitaux de district et, si necessaire, a des hopitaux de reference. Nous nous sommes interesses a la frequence a laquelle les cliniques ont ete mises sur pied, au volume de patients et au nombre de transferts. Nous avons egalement analyse les intervalles entre les transferts et les visites au niveau de soins superieur et, pour les femmes atteintes d'un cancer, les raisons initiales qui les ont incitees a consulter. Resultats Les centres de sante ont organise des cliniques > 68% des semaines. De maniere generale, 9763 femmes ont ete soumises a un depistage du cancer du col de l'uterus et a un examen clinique des seins, tandis que 7616 d'entre elles n'ont fait l'objet que d'un examen des seins. Sur les 585 femmes transferees depuis les centres de sante, 436 (74,5%) se sont rendues dans l'hopital de district apres un delai median de neuf jours (ecart interquartile, EI: 3-19). Sur les 200 femmes renvoyees vers des hopitaux de reference, 179 (89,5%) s'y sont rendues apres un delai median de 11 jours (EI: 4-18). Enfin, sur les 29 femmes ayant recu un diagnostic de cancer du sein, 19 etaient agees de 50 ans et plus, et 23 souffraient d'un cancer de stade III ou IV. Toutes les femmes atteintes d'un cancer du sein ayant partage les raisons qui les ont poussees a consulter (23 femmes) avaient ressenti des symptomes de la maladie. Conclusion A court terme, integrer un examen clinique du sein lors d'un depistage du cancer du col de l'uterus n'a pas donne lieu a une detection precoce du cancer du sein chez les femmes asymptomatiques. La priorite est d'encourager les femmes a consulter rapidement des l'apparition de symptomes. Investigacion sobre la aplicacion: inclusion de las exploraciones mamarias en un programa de deteccion del cancer de cuello uterino, Ruanda Objetivo Evaluar si la integracion de la deteccion del cancer de mama y de cuello uterino en el Programa de Deteccion Temprana del Cancer en Mujeres de Ruanda permitio realizar diagnosticos tempranos de cancer de mama en mujeres asintomaticas. Metodos Lanzado en tres distritos entre 2018 y 2019, el programa de deteccion temprana ofrecia examenes clinicos de mama a todas las mujeres que se sometian al cribado del cancer de cuello uterino y examenes mamarios diagnosticos a las mujeres con sintomas de cancer de mama. Las mujeres con examenes de mama anormales eran derivadas a hospitales de distrito y, posteriormente, a hospitales de referencia si era necesario. Se examino la frecuencia de las consultas, el volumen de pacientes y el numero de derivaciones. Tambien se examinaron los intervalos entre las derivaciones y las visitas al siguiente nivel asistencial y, entre las mujeres diagnosticadas de cancer, sus motivos iniciales para buscar asistencia. Resultados Los centros sanitarios realizaron consultas >68% de las semanas. En total, 9763 mujeres se sometieron a deteccion del cancer de cuello uterino y examen clinico de las mamas, y 7616 solo a examen de las mamas. De 585 mujeres remitidas desde los centros sanitarios, 436 (74,5%) acudieron al hospital de distrito tras una mediana de 9 dias (rango intercuartilico, IQR: 3-19). De 200 mujeres remitidas a hospitales de referencia, 179 (89,5%) acudieron tras una mediana de 11 dias (IQR: 4-18). De 29 mujeres diagnosticadas de cancer de mama, 19 tenian [greater than or equal to] 50 anos y 23 presentaban enfermedad en estadio III o estadio IV. Todas las mujeres con cancer de mama, cuyos motivos de busqueda de atencion eran conocidos (23 mujeres) habian experimentado sintomas de cancer de mama. Conclusion A corto plazo, la integracion del examen clinico de las mamas con la deteccion del cancer de cuello uterino no se asocio con la deteccion temprana del cancer de mama entre las mujeres asintomaticas. Debe darse prioridad a animar a las mujeres a buscar atencion oportuna ante los sintomas., Introduction Breast cancer incidence is increasing rapidly in sub-Saharan Africa. Even though the age-standardized incidence rates of breast cancer in sub-Saharan Africa are still lower than in higher-income regions, women [...]

There are marked disparities in cancer survival in low‐income countries compared to high‐income countries, yet population‐based data in the first is largely lacking. In this study, data from the national cancer registry of Rwanda were examined for 542 patients diagnosed with eight of the most common cancers of adults stomach (C16), colorectum (C18‐20), liver (C22), breast (female) (C50), cervix (C53), ovary (C56), prostate (C61), and non‐Hodgkin lymphomas (C82‐85) between 2014 and 2017. Subjects were randomly selected for active followed‐up to calculate 1‐, 3‐, and 5‐year observed and relative survival (RS) by cancer type and stage. Overall, 53.7% of cases had died within 5 years of diagnosis. Five‐year RS varied by malignancy and ranged from 17.6% (95% confidence interval [CI]: 6.7%–32.6%) for liver cancer to 68% (CI: 51.6%–79.8%) for cancers of the prostate. Stage was assigned for 71.6% of patients (n = 388 of 542), with over half (58%) having advanced stage (III/IV) at diagnosis. For all except liver and ovary, stage was a strong predictor of survival; for example, three‐year observed survival was 90.9% and 44.8% (p‐value:.002) for early and advanced breast cancer, respectively. This study demonstrates that stage specific survival can be obtained from population based cancer registries in sub Saharan Africa, data that are invaluable for international benchmarking, and for local planning and evaluation of cancer control programs. [ABSTRACT FROM AUTHOR]

Assessing the risk of cancer among people living with HIV (PLHIV) in the current era of antiretroviral therapy (ART) is crucial, given their increased susceptibility to many types of cancer and prolonged survival due to ART exposure. Our study aims to compare the association between HIV infection and specific cancer sites in Rwanda. Population‐based cancer registry data were used to identify cancer cases in both PLHIV and HIV‐negative persons. A probabilistic record linkage approach between the HIV and cancer registries was used to supplement HIV status ascertainment in the cancer registry. Associations between HIV infection and different cancer types were evaluated using unconditional logistic regression models. We performed several sensitivity analyses to assess the robustness of our findings and to evaluate the potential impact of different assumptions on our results. From 2007 to 2018, the cancer registry recorded 17,679 cases, of which 7% were diagnosed among PLHIV. We found significant associations between HIV infection and Kaposi's Sarcoma (KS) (adjusted odds ratio [OR]: 29.1, 95% CI: 23.2–36.6), non‐Hodgkin lymphoma (NHL) (1.6, 1.3–2.0), Hodgkin lymphoma (HL) (1.6, 1.1–2.4), cervical (2.3, 2.0–2.7), vulvar (4.0, 2.5–6.5), penile (3.0, 2.0–4.5), and eye cancers (2.2, 1.6–3.0). Men living with HIV had a higher risk of anal cancer (3.1, 1.0–9.5) than men without HIV, but women living with HIV did not have higher risk than women without HIV (1.0, 0.2–4.3). Our study found that in an era of expanded ART coverage in Rwanda, HIV is associated with a broad range of cancers, particularly those linked to viral infections. [ABSTRACT FROM AUTHOR]

Background: Rwanda Biomedical Centre, supported by City Cancer Challenge Foundation, launched an interinstitutional, digitally enabled cancer patient navigation DCPN) to improve access to cancer care for cervical and breast cancer patients. The service, including a digital platform, has been implemented across all the regions in 2021. Nurse navigators are in charge of patient navigation and data collection along multidisciplinary pathways. Objective: To assess the value of the DCPN within the first year of its implementation in the 5 main cancer hospitals in Rwanda. Methods: The evaluation adopted a mixed-method approach, using qualitative and quantitative methods of value assessment. It was conducted across 3 dimensions: clinical, economic, and contextual. An assessment of the clinical effectiveness and economic implications, including the cost and cost-effectiveness of the program, as well as an assessment of the organizational, ethical, legal, and regulatory implications of the program were included. The evaluation of the pilot project gathered information from a variety of sources, including primary and secondary data sources within participating health facilities. Contextual analysis data were gathered using a semistructured and flexible data collection tool administered in focus group discussions and key informant interviews conducted with nurse navigators, health providers, and patients. Data to inform the clinical effectiveness assessment were drawn from the Rwanda Cancer Registry and from clinical records of all patients included in the study. Results: Analysis on 1971 patient records (249 DCPN patients; 1722 non-DCPN patients) shows that the DCPN led to a significant decrease in the time to initiate treatment, with a higher proportion of patients commencing treatment within 60 days of diagnosis. The total annual cost of the program was estimated at approximately US $105,000, with personnel costs contributing more than 90% of total costs. With an average program unit cost of approximately US $100 per patient, the DCPN program could be cost-effective. Discussions with hospital managers and clinicians showed that the DCPN filled a critical gap in health service provision and helped facilities to achieve their goals of providing quality patient care. It also increased patient adherence and treatment retention, thus improving patient satisfaction. Conclusion: Interinstitutional patient navigation reduced the time to initiate treatment in women with breast or cervical cancer in Rwanda. A digital supportive solution helps capture more patient data for decision-making and eases the work of nurse navigators. There is potential to expand the program to lower levels of care. [ABSTRACT FROM AUTHOR]

Ministries of Health (MoHs) and health organizations are compelled to work across sectors and build coalitions, strengthening health systems to abate the rise of noncommunicable diseases (NCDs). A critical element of NCD prevention and control involves significant and difficult changes in attitudes, policies and protective behavior at the population level. The population-level impact of NCD interventions depends on the strength of the health system that delivers them. In particular, low-resource settings are exploring efficiencies and linkages to existing systems or partnerships in ways that may alleviate redundancies and high delivery costs. These entail complex operational challenges, and can only be spearheaded by a competent and passionate workforce. There is a critical need to develop and strengthen the management and leadership skills of public health professionals so that they can take on the unique challenges of NCD prevention and control. An added component must include a shift from the traditional clinical approach to a community-based effort, focusing heavily on health education and community norm change. Strengthening the workforce capacity of program managers at MoHs and other implementing institutions is key to capturing, analyzing, advocating and communicating information and will, in turn, reinforce the scale-up of interventions fostering a robust health system. This paper summarizes the best practices and lessons learned from the NCD Program Managers short course conducted by the US Centers for Disease Control and Prevention (CDC) in December, 2016 in Rwanda. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis (TB) is the leading cause of morbidity and mortality among people living with HIV (PLHIV) in sub-Saharan Africa. Early TB detection and treatment is key to saving lives of PLHIV. Rwanda began implementing intensified TB case finding (ICF) in 2005 in line with World Health Organization policy on TB/HIV collaborative activities. We aimed to describe trends of ICF in PLHIV newly enrolled into HIV clinics., Methods: We used routinely collected program data on ICF from facility-based pre-antiretroviral therapy/antiretroviral therapy registers in Rwandan HIV clinics from 2006 to 2011. Semiannual, active data collection for PLHIV newly enrolled into HIV care included proportion screened for TB, proportion screened positive, and percentage with active TB and started anti-TB drugs., Results: The number of health facilities reporting TB screening indicators increased 16-fold, from 20 facilities in the first semester of 2006 to 328 facilities by the end of 2011. The proportion of patients screened increased progressively from 77% of newly enrolled patients in first semester of 2006 to 94% at the end of 2011 (P < 0.001). The proportion of patients who screened positive decreased over time, from 23% in the first semester of 2006 to 10% at the end of 2011 (P < 0.001). The proportion of active TB cases remained relatively constant over time at 2.2%., Conclusions: Rwanda has increased the proportion of newly enrolled PLHIV screened for TB using a simple screening protocol. Countries with limited resources but high HIV and TB disease prevalence should implement ICF as part of their integrated HIV-TB treatment programs.