Clinical Breast Examination and Navigation for Early Cancer Detection in Remote Communities Without an Imaging Screening Option
Authors: Hopkins Melissa , Mkuzi Raphael 
Published: October 2018

Purpose According to Gazette Review report 2018, Malawi is reportedly the lowest-income country in southeastern Africa. It has a population of 19 million people, of which 70% are women and children. A powerful women’s organization was established to support the increased care and status of the women in the community. Methods Malawi’s Catholic Women’s Organization (CWO), with the Diocese of Mangochi, submitted approval for comprehensive breast examination (CBE) and basic patient navigation training, which was completed in May 2018, that targeted remote communities without resources for early breast cancer detection. The rural population-based data are incomplete, though it is commonly held that the high mortality rate from breast cancer is a result of a lack of education and transportation, cultural stigmas, a lack of support, and other barriers to care. Breast cancer is the most common cause of cancer death in women in Mangochi. The CWO routinely brings outside medical experts to address health care disparity and invited a breast care and cancer registered nurse to address these barriers and provide training in viable and sustainable solutions to overcome these obstacles. Results Trusted community members of an existing women’s organization were trained in breast physiology, anomalies, simplified medical reporting, and navigation to existing facilities for diagnostics and treatment. The following challenges were addressed: remote locations of communities without available imaging, early detection of anomalies without the benefit of local mammography or ultrasound, a poor to nonexistent belief that breast cancer can be cured with early diagnosis, poor to nonexistent communication and transportation means, and late presentation of breast cancer once diagnosed. With training, the following was achieved: education of CWO women of Mangochi in breast exams, reporting, and navigation pathways for diagnosis; breast molds (eight), PowerPoint presentations, and reporting tools were developed as educational tools; PowerPoints were created for breast education, breast anomaly education, CBE, self-breast examination, reporting, data collection, workshop start-up, and patient education; and ongoing support for breast cancer program development. Conclusion Collaborative and multidisciplinary work to mitigate the effects of breast cancer will greatly increase survivability among the women of Mangochi. Targeting the communities through the trusted women who live in the same villages allows for a unique outreach for ongoing, routine education through workshops, CBE, and supported efforts to overcome barriers through planned patient flow pathways to diagnostics and treatment as needed. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc . No COIs from the authors.