Breast and Cervical Cancer Collaboration Helps Women in Kenya and Nepal
Fifty thousand women in Nepal and Kenya will be screened for breast and cervical cancer through a new 3-year AMPATH Global initiative with support from an Eli Lilly and Company Foundation (Lilly Foundation) grant to Indiana University, which leads and coordinates a consortium of universities around the world involved with AMPATH efforts.
The KENON team from Nepal, Kenya and the U.S. recently gathered in Eldoret, Kenya.
The project, AMPATH Breast and Cervical Cancer Screening to Improve Women’s Cancer Outcomes in Kenya and Nepal: Leveraging Advanced Diagnostics and Multi-Site Collaboration (known as KENON), will develop, implement and evaluate strategies to incorporate advanced diagnostics such as mammography, point-of-care ultrasound and HPV testing into screening programs in resource-limited settings in low and middle-income countries.
“Additionally, we will train 500 healthcare workers in these advanced diagnostic techniques to facilitate rapid diagnosis and improve patient adherence to treatment,” said Naftali Busakhala, MBChB, MMed, principal investigator and a specialist physician at Moi Teaching and Referral Hospital and senior lecturer at Moi University in Kenya.
While mammography machines are available in most public facilities in western Kenya and can detect breast cancer much earlier than a clinical breast exam, they are rarely used due to a lack of skilled personnel and resources. In Nepal, there is no national breast cancer screening program and mammography use is extremely limited.
Women in low- and middle-income countries are disproportionately affected by breast cancer and experience much lower overall survival than women in high-income countries. Worldwide, breast cancer is the most common cancer and the leading cause of cancer mortality. Women in sub-Saharan Africa also experience the highest incidence of cervical cancer in the world.
A key strategy to impact cancer among women in resource-limited settings in low- and middle-income countries is offering breast cancer screening along with cervical cancer screening as co-screening.
This is an expansion of the AMPATH Breast and Cervical Cancer Control Program (ABCCCP), utilizing a co-screening strategy from 2017-2023. In total, 715 cases of breast cancer and 416 cases of cervical cancer were diagnosed over the 5-year period.
“Using lessons learned from our ABCCCP experience, AMPATH Kenya is engaging in a knowledge-exchange partnership to help inform a breast and cervical cancer screening program at AMPATH Nepal,” said Patrick Loehrer, MD, principal investigator and director of the Indiana University Melvin and Bren Simon Comprehensive Cancer Center’s Center for Global Oncology and Health Equity.
“While this program has been immensely successful, it has also revealed areas of unmet needs and opportunities to improve outcomes including the use of advanced diagnostics,” added Dr. Busakhala. “We aim to refine our screening strategies in western Kenya as well as collaborate with AMPATH partners in Nepal to develop a locally relevant breast and cervical cancer screening programs as well as determine costs and access to screening services.”
Trainings for healthcare workers will utilize Project ECHO, a tele-education and peer mentoring platform that connects experts at hub sites to healthcare workers at lower-level health facilities in remote areas through Zoom. In the last decade, the Project ECHO model has been used globally to meet health education and care delivery needs where there are low health provider-to-population ratios and limited access to specialty care. In the KENON grant, Project ECHO will also connect partners from AMPATH Kenya and AMPATH Nepal.
Other elements of the collaboration include community engagement events to educate community members about the utility and importance of breast and cervical cancer screening and new modalities being used; site visit to Kenya and Nepal for face-to-face discussions on shared challenges and successful screening strategies currently implemented; continuous assessment of novel screening strategies; and compiling results to document the process of developing and implementing a multi-site collaboration for breast and cervical cancer screening and advanced diagnostics. These results will be shared with relevant academic journals and local policymakers and stakeholders.
“AMPATH is building a comprehensive initiative including universities and academic health centers, including Indiana University, to strengthen health systems and tackle health disparities. This work aligns well with a focus of the Lilly Foundation, which as a tax-exempt organization seeks to support charitable efforts to improve global health for people living in resource-limited communities in low- and middle-income countries,” said Cynthia Cardona, President of the Lilly Foundation. Cynthia added: “This multi-site effort to improve breast and cervical cancer screening strategies in Kenya and Nepal is a model to bring advanced diagnostics to resource-limited communities in low- and middle-income countries.”
