Coordinated training on early detection and diagnosis of breast cancer across different levels of health workers: An example from Peru

Abstract

As breast cancer rates increase worldwide, many low- and middle-income countries are seeking feasible strategies for providing screening and early detection programs, improving diagnostic imaging and pathology services, and ensuring basic treatment and palliative care. The limited availability of appropriately trained staff is a severe constraint on reaching rural and otherwise disadvantaged populations with essential breast health care. An innovative project in Peru, designed to bring breast cancer screening and early diagnostic services to women in a rural area of the country, illustrates many of the challenges and potential solutions for training various health workers, ensuring that they can acquire and maintain critical competencies and that the health system provides the infrastructure needed to support their performance. This chapter describes an iterative and collaborative process to develop curricula for four key functions: education about screening among women in the target age range, breast screening by clinical breast exam, a first diagnostic step using fine-needle aspiration biopsy, and supervision. Functions were matched with the type of health provider or community volunteer that was already in place in this rural context. Each curriculum defined learning goals and incorporated competency evaluation at the end, and special efforts were made to ensure that messages were consistent throughout the different curricula and followed national guidelines.