Cyprien Shyirambere, MMED

Creating healthcare infrastructure and training health care professionals in Rwanda to ensure that previously underserved women receive quality screening and treatment for breast cancer.

Impact

Breast cancer is a major public health concern in low- and middle-income countries such as Rwanda, where women have a much higher risk of dying from their disease. This is due, in part, to delayed and late-stage diagnoses. By focusing on training and infrastructure, Drs. Shyirambere and Shulman have developed effective strategies to integrate early detection services into the health care system in rural Rwanda and reduce time to treatment. They have trained hundreds of Rwandan health care workers in strategies to educate patients about breast cancer, perform high-quality breast exams, utilize ultrasound to identify those who may have cancer, and refer patients for timely diagnosis and treatment. Their program has provided breast exam screening to thousands of patients and expanded into four districts in the country, leading to significant improvement in patient outcomes. The team has developed a tablet-based electronic medical record, an innovative advancement that allows clinicians to share information across facilities and identify patients who have missed visits and re-engage them in care. This mobile platform also helps patients navigate the health care system and obtain timely care and maximize any follow-up care. They are now working to expand these efforts to reach more women with the goal of reducing breast cancer deaths in Rwanda and other low-income countries as well as shaping their national cancer control policy.

Progress Thus Far

Drs. Shyirambere and Shulman developed and implemented a Women’s Cancer Early Detection Program Learning Collaborative in two key districts and 19 health centers in Rwanda. This Collaborative focuses on clinical mentorship, local leadership, and building a culture of data-driven practice improvement. In addition, they are seeking to offer U.S.-driven advancements in diagnostic curriculum to Rwandan radiologists. In partnership with local leaders and radiologists, the team has leveraged their success with virtual mentorship, employing previously trained Rwandan medical staff to implement virtual and in-person ultrasound training as well as to mentor other area radiologists. These efforts will help to decentralize breast ultrasound expertise from cancer hospitals in Rwanda to smaller district hospitals. In the last year, the doctors have refined a tool–a list of items to help assess trainees—that will allow rigorous evaluation of trainees’ skill. To ensure that it is effective in measuring these skills, they continue to assess and refine its performance. By adding details to the tool, they can make sure that trainees are able to accurately describe the characteristics of breast lesions viewed by ultrasound, an important part of judging whether they are benign or cancerous. They have also developed a similar tool to evaluate radiologists’ skill in performing biopsies and are currently testing it.

What’s next

While ultrasound imaging is successfully being decentralized, the team will continue to refine the ultrasound skills metric. These tools will help to judge if trainees have developed adequate skills to be able to perform ultrasounds and biopsies independently at their hospitals. The culmination of their BCRF supported work will not only expand the cadre of Rwandan clinicians with U.S. diagnostic skills, but it will provide scalable and durable strategies to bring these important diagnostic services closer to patients’ homes, facilitating accessible, timely, and high-quality breast cancer care.