Implementation of a large-scale breast cancer early detection program in a resource-constrained setting: real-world experiences from 2 large states in India

Abstract

Background: The Breast Health Initiative (BHI) was launched to demonstrate a scalable model to improve access to early diagnosis and treatment of breast cancer.

Methods: A package of evidence-based interventions was codesigned and implemented with the stakeholders, as part of the national noncommunicable disease program, through the existing primary health care system. Data from the first 18 months of the BHI are presented.

Results: A total of 108,112 women received breast health education; 48% visited the health facilities for clinical breast examination (CBE), 3% had a positive CBE result, and 41% were referred to a diagnostic facility. The concordance of CBE findings between health care providers and adherence to follow-up care improved considerably, with more women visiting the diagnostic facilities and completing diagnostic evaluation within 1 month from initial screening, and with only 9% lost to follow-up. The authors observed a clinically meaningful decrease in time to complete diagnostic evaluation with biopsy, from 37 to 9 days.

Conclusions: The results demonstrate the feasibility and effectiveness of implementing a large-scale, decentralized breast cancer early detection program delivered through the existing primary health care system in India.

Keywords: India; breast cancer; diagnosis; early detection; implementation.

Figure 1

Operational framework and resource‐stratified care pathways for breast health services. ANM indicates auxiliary nurse midwife; ASHA, accredited social health activist; FNAB, fine‐needle aspiration biopsy; USG, ultrasonography.

Figure 2

The intervention states.