Are mammograms the only way to detect breast cancer?

January 15, 2018 by PATH

Angela and family

Angela Gonzalez (pictured with her mom and two of her children) has become a vocal advocate for the community-based program for breast health after being diagnosed with breast cancer. Photo: PATH/Daniel San Martin

Our partnerships with the Peruvian government and local cancer organization bring early breast cancer detection to women in their communities.

When she first noticed the change in her breast, Angela Gonzalez thought she had pulled a muscle working as a fare collector on her husband’s colectivo, or shared taxi. When she mentioned it to friends, they shrugged it off as “normal fat,” she says.

It wasn’t until the lump grew that Angela visited the public hospital near her home in Trujillo, in the La Libertad region of northwest Peru.

There, she met Dr. Wilfredo Larios, a primary care physician who had been trained by PATH to screen for breast cancer using simple techniques instead of costly gold-standard tools, like mammograms. What Dr. Larios saw concerned him, so he sent Angela to a cancer specialist to make a definitive diagnosis of breast cancer—or rule it out.

Survival depends on early detection

In wealthy countries, deaths from breast cancer have been dropping since 2000; today, the vast majority of women diagnosed with the disease in the United States survive. But the story is different in low- and middle-income countries, where the incidence of breast cancer is on the rise and the standard tools to detect it are rarely available to most women.

PATH is committed to making breast cancer services accessible—so more women survive to be there for their families, friends, and communities.

Peru, with its population of 30 million people, has nearly 4,000 new breast cancer cases each year and more than 1,200 deaths. More than 75 percent of women with breast cancer are diagnosed after the disease has progressed to stage 3 or beyond—when treatment is more expensive and less effective. It’s no wonder that for many women, a breast cancer diagnosis is often perceived as a death sentence.

PATH has made remarkable strides in bringing prevention, screening, and treatment for cervical cancer to the most vulnerable women around the world. Now we’re committed to making breast cancer services accessible—so more women survive to be there for their families, friends, and communities.

Providers learn to look for red flags

Clinical breast exam training in Peru

Doctors learn to conduct clinical breast exams using a curriculum PATH created. Photo: PATH/Daniel San Martin

Since early detection is the cornerstone of breast cancer survival, PATH partnered with Peru’s government and its national cancer hospital, Instituto Nacional de Enfermedades Neoplasticas (INEN), to create a model for early breast cancer detection, diagnosis, and treatment to benefit women like Angela.

The community-based program for breast health trains volunteers and providers throughout the health care system to catch breast cancer early:

  • Women learn about breast health from volunteers, who are trained to share information and encourage women to see midwives, who are trained to conduct clinical breast examinations.
  • If a midwife finds a palpable breast mass, she refers the woman to a community hospital, where gynecologists and primary care physicians like Dr. Larios are trained to conduct clinical breast exams, and to use ultrasound imaging and fine-needle aspiration biopsy, to assess breast abnormalities.
  • When these examinations don’t allay concerns, community physicians refer women to the national cancer hospital or a regional cancer center for definitive diagnosis from breast cancer specialists.
  • Women who are diagnosed with breast cancer are paired with PATH-trained patient navigators, who help them overcome financial concerns, communication and information gaps, medical system challenges, and emotional or other personal barriers to care.

Private donors play a critical role

Efforts to address breast cancer and other noncommunicable diseases receive a tiny fraction of the world’s health and development funds.

Thanks to support from private donors, we were able to pilot the Community-Based Program for Breast Health in La Libertad; develop a training curriculum for volunteers, providers, and patient navigators; and partner with INEN to establish a national center for excellence for breast cancer—crucial steps toward advancing our ultimate goal of replicating the program throughout Peru and adapting it for other countries.

This work paved the way for a larger grant from the Pfizer Foundation to roll the model out to nine additional health districts and train hundreds of midwives, doctors, health promoters, and patient navigators. Trainers include some of Peru’s top breast cancer experts from INEN and experienced local providers—including Dr. Larios.

As the model takes hold and spreads in Peru, PATH is adapting it for different cultural settings, starting with Uganda.

Planning for life after cancer

Clinical breast exam midwife/patient interaction.

Midwives, like the woman on the right, are the first stop for breast cancer screening. Photo: PATH/Daniel San Martin

When Angela went to the regional cancer center, a specialist confirmed Dr. Larios’s suspicion: Angela had breast cancer.

The diagnosis was a blow for the 40-year-old mother of three. But it came with a silver lining: because her cancer was detected at stage 2, she has a good chance of beating it.

Like most breast cancer patients, Angela’s journey has had its ups and downs. She has the support of a loving family, including her husband, who shaved his head in solidarity when Angela lost her hair. Her doctors at the regional cancer center in Trujillo oversee her care. PATH-trained patient navigators support her as she makes her way through the health care system.

Angela’s plans for the future have been shaped by her experience as a patient. When she recovers, she wants to be part of the support system that has helped her. “I’ve met wonderful people since my cancer diagnosis,” she says.

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