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World Cancer Day: BCRF Researcher Shares How He’s Reshaping Breast Health in Rwanda

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Guest blogger Lawrence Shulman, MD, director of the Center for Global Cancer Medicine in the Abramson Cancer Center of the University of Pennsylvania, discusses his work developing innovative approaches to breast cancer care in the developing world. 

In August 2012, Antoinette, a 39-year-old mother of five, sought treatment at her community health center in rural Rwanda for a swollen but painless left breast that she feared might be cancerous. All of the women in her community with breast cancer who went to the clinic had returned home without treatment and ultimately died of the disease. Antoinette was afraid, but resigned to her fate.

However, when she spoke with Gaspard, her community health worker at the clinic, she was surprised to learn about a new option available to her and other women with suspected breast cancer. While Gaspard had not yet received the training needed to diagnose cancer himself, he had recently learned that cancer patients could now receive treatment at Butaro Hospital in the Burera district, 20 miles from the clinic.

Even just one year earlier, Antoinette would not have had access to the treatment that ultimately saved her life. When I first visited in Rwanda in 2011, I walked through hospital wards filled with patients with advanced cancers, who had never had a biopsy or diagnosis, and had no options for treatment.  I knew that many of these patients would survive if they had access to the types of treatments available in the United States and I was determined to help bring these treatment options to patients in Rwanda.

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Thanks to support from Agnes Binagwaho, MD, PhD, the former Rwandan Minister of Health, and Paul Farmer, MD, PhD, co-founder of Partners In Health, we committed to opening a cancer center at Butaro Hospital in just 12 months. In July 2012, former U.S. President Bill Clinton and Dr. Binagwaho dedicated the Butaro Cancer Center of Excellence, supported by the Ministry of Health, Partners In Health and the Dana-Farber Cancer Institute. Since opening its doors, more than 6,000 patients have been diagnosed and treated at Butaro, including more than 1,000 women with breast cancer.  

Antoinette was one of those women. She was able to receive chemotherapy, which dramatically reduced the size of her cancer, making her surgery more feasible. Today she remains cancer-free, raising her children and working on her family farm.

I began my oncology career in the 1970s when our understanding of breast cancer (and most other cancers for that matter) was primitive as were our treatments.  Over the ensuing decades, due in large part to support from the Breast Cancer Research Foundation, our understanding of the biology of breast cancer has grown dramatically, resulting in vastly improved treatments that have translated into higher survival rates, and better quality of life. 

Yet for the millions of women worldwide who will develop breast cancer this year, many will have little or no access to the basics of cancer care that could save their lives, and therefore will die a potentially preventable death. Geography and poverty are greater determinants of cancer outcome than your genetic make-up.

Thanks to support from BCRF, at the Butaro Cancer Center of Excellence we have developed the infrastructure and capacity to offer lifesaving treatments to a growing number of our breast cancer patients. In addition, again with support from BCRF, we have developed innovative approaches to train our colleagues working in community health centers – often the first portal of entry for patients into the healthcare system – to recognize breast cancer at early stages. Data collected over the past year has shown a major shift to earlier stage disease confirming the success of this program. As these women return to their villages they are giving new hope to women who previously viewed cancer as a certain death sentence. 

On World Cancer Day, I’m honored to share Antoinette’s story as a lens into the ongoing work my team is performing to help women around the globe impacted by breast cancer.

This article was originally published on the Breast Cancer Research Foundation’s website.  

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