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. 2023 Dec;202(3):541-550.
doi: 10.1007/s10549-023-07076-x. Epub 2023 Aug 30.

Patients' experiences undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program

Lydia E Pace  1 , Amanda M Fata  2 , Vincent K Cubaka  3 , Theophile Nsemgiyumva  4 , Jean de Dieu Uwihaye  3 , Catherine Stauber  5 , Jean-Marie Vianney Dusengimana  3 , Kayleigh Bhangdia  6 , Lawrence N Shulman  7 , Anna Revette  8 , Marc Hagenimana  9 , Francois Uwinkindi  9 , Enock Rwamuza  10
Affiliations

Patients' experiences undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program

Lydia E Pace et al. Breast Cancer Res Treat. 2023 Dec.

Abstract

Purpose: There is urgent need for interventions to facilitate earlier diagnosis of breast cancer in low- and middle-income countries where mammography screening is not widely available. Understanding patients' experiences with early detection efforts, whether they are ultimately diagnosed with cancer or benign disease, is critical to optimize interventions and maximize community engagement. We sought to understand the experiences of patients undergoing breast evaluation in Rwanda's Women's Cancer Early Detection Program (WCEDP).

Methods: We conducted in-person semi-structured interviews with 30 patients in two districts of Rwanda participating in the WCEDP. Patients represented a range of ages and both benign and malignant diagnoses. Interviews were recorded, transcribed, translated, and thematically analyzed.

Results: Participants identified facilitators and barriers of timely care along the breast evaluation pathway. Community awareness initiatives were facilitators to care-seeking, while persistent myths and stigma about cancer were barriers. Participants valued clear clinician-patient communication and emotional support from clinicians and peers. Poverty was a major barrier for participants who described difficulty paying for transport, insurance premiums, and other direct and indirect costs of hospital referrals in particular. COVID-19 lockdowns caused delays for referred patients. Although false-positive clinical breast exams conferred financial and emotional burdens, participants nonetheless voiced appreciation for their experience and felt empowered to monitor their own breast health and share knowledge with others.

Conclusion: Rwandan women experienced both benefits and burdens as they underwent breast evaluation. Enthusiasm for participation was not reduced by the experience of a false-positive result. Reducing financial, logistical and emotional burdens of the breast diagnostic pathway through patient navigation, peer support and decentralization of diagnostic services could improve patients' experience.

Keywords: Breast neoplasms; Early detection of cancer; Health expenditures; Patient satisfaction; Rwanda.

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Conflict of interest statement

Competing interests The authors have no relevant financial or non-financial interests to disclose.

Figures

Figure 1.
Figure 1.
Facilitators and barriers along the patient care pathway in Rwanda’s Women’s Cancer Early Detection Program
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