Division of Women's Health, Department of Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA02115, United States of America (USA).
Rwanda Biomedical Centre, Kigali, Rwanda.
Bull World Health Organ. 2023 Jul 1;101(7):478-486. doi: 10.2471/BLT.22.289599. Epub 2023 May 26.
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.
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.
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.
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.
评估在卢旺达妇女癌症早期发现计划中整合乳腺癌和宫颈癌筛查是否导致无症状妇女的早期乳腺癌诊断。
该早期发现计划于 2018 年至 2019 年在三个地区启动，为所有接受宫颈癌筛查的妇女提供临床乳房检查筛查，并为有乳腺癌症状的妇女提供诊断性乳房检查。乳房检查异常的妇女被转介到区医院，如果需要，再转介到转诊医院。我们检查了诊所的举办频率、患者人数和转介人数。我们还检查了转介和下一级护理之间的时间间隔，以及在被诊断患有癌症的妇女中，她们最初寻求护理的原因。
保健中心 > 68%的周数都举办了诊所。总体而言，9763 名妇女接受了宫颈癌筛查和临床乳房检查，7616 名妇女仅接受了乳房检查。从保健中心转介的 585 名妇女中，436 名（74.5%）在中位数为 9 天（四分位距，IQR：3-19）后访问了区医院。在转介到转诊医院的 200 名妇女中，179 名（89.5%）在中位数为 11 天（IQR：4-18）后就诊。在 29 名被诊断患有乳腺癌的妇女中，19 名年龄≥50 岁，23 名患有 III 期或 IV 期疾病。所有已知寻求护理原因的乳腺癌妇女（23 名）都有乳腺癌症状。
在短期内，将临床乳房检查与宫颈癌筛查相结合，并未在无症状妇女中发现早期乳腺癌。应优先鼓励妇女及时寻求症状治疗。
