Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
JCO Glob Oncol. 2024 Feb;10:e2300231. doi: 10.1200/GO.23.00231.
Breast cancer is the most frequent cancer and second most common cause of cancer-related death in Ghana. Early detection and access to diagnostic services are vital for early treatment initiation and improved survival. This study characterizes the geographic access to hospital-based breast cancer diagnostic services in Ghana as a framework for expansion.
A cross-sectional hospital-based survey was completed in Ghana from November 2020 to October 2021. Early diagnostic services, as defined by the National Comprehensive Cancer Network (NCCN) Framework for Resource Stratification, was assessed at each hospital. Services were characterized as available >80% of the time in the previous year, <80%, or not available. ArcGIS was used to identify the proportion of the population within 20 and 45 km of services.
Most hospitals in Ghana participated in this survey (95%; 328 of 346). Of these, 12 met full NCCN Basic criteria >80% of the time, with 43% of the population living within 45 km. Ten of the 12 met full NCCN Core criteria, and none met full NCCN Enhanced criteria. An additional 12 hospitals were identified that provide the majority of NCCN Basic services but lack select services necessary to meet this criterion. Expansion of services in these hospitals could result in an additional 20% of the population having access to NCCN Basic-level early diagnostic services within 45 km.
Hospital-based services for breast cancer early diagnosis in Ghana are available but sparse. Many hospitals offer fragmented aspects of care, but only a limited number of hospitals offer the full NCCN Basic or Core level of care. Understanding current availability and geographical distribution of services provides a framework for potential targeted expansion of services.
乳腺癌是加纳最常见的癌症和第二大癌症相关死亡原因。早期发现和获得诊断服务对于早期治疗开始和提高生存率至关重要。本研究描述了加纳基于医院的乳腺癌诊断服务的地理可及性，作为扩展的框架。
本研究于 2020 年 11 月至 2021 年 10 月在加纳进行了一项基于医院的横断面调查。根据国家综合癌症网络（NCCN）资源分层框架，评估了每家医院的早期诊断服务。服务特征为过去一年中>80%的时间提供、<80%的时间提供或无法提供。ArcGIS 用于确定服务 20 和 45 公里范围内的人口比例。
加纳大多数医院参与了这项调查（95%；328/346）。其中，12 家医院基本满足 NCCN 标准，>80%的时间满足该标准，43%的人口居住在 45 公里范围内。12 家医院中，有 10 家满足 NCCN 核心标准，没有一家满足 NCCN 增强标准。另外还确定了 12 家医院，这些医院提供了大部分 NCCN 基本服务，但缺乏满足这一标准所需的部分服务。在这些医院扩大服务范围，可使另外 20%的人口在 45 公里范围内获得 NCCN 基本水平的早期诊断服务。
加纳基于医院的乳腺癌早期诊断服务虽然存在，但十分有限。许多医院提供了部分方面的护理，但只有少数几家医院提供完整的 NCCN 基本或核心护理水平。了解当前服务的可用性和地理分布情况，为潜在的有针对性的服务扩展提供了框架。
