Abstract 4226: Challenges to breast cancer early detection in the developing, high income country of Trinidad and Tobago
Authors: Badal Kimberly , Rampersad Fidel , Mohammed Hamish , Moosoodeen Murrie , Konduru Siva , Maharaj Nalini Kokaram , Russel Adaila , Nathan Melissa , Nimrod Marisa , Warner Wayne A. , Haraksingh Rajini , Toriola Adetunji 
Published: July 2017

Abstract
Trinidad and Tobago (T&T) has one of the highest breast cancer (BC) mortality rates in the Americas. For the period 1995-2007, 5-year BC survival rates in T&T were approximately 30%. One possible explanation for T&T’s low BC survival rates could be late presentation and detection. Currently, opportunistic BC screening programs exist in the public and private sectors and some advocate for an organized national BC screening program. However, the World Health Organization (WHO) only recommends the implementation of organized BC screening in high resource settings. Thus, the purpose of this study was to conduct a situational analysis of breast cancer early detection services in the public and private sector to identify gaps in service and determine if a national organized screening program is warranted. The quality, availability, affordability and accessibility of BC screening services in the public and private sector was assessed with an online survey using the Cancer Control WHO Guide for Effective Programs framework. The inter-rater reliability and validity was assessed during a pilot phase at two public institutions. All public and private facilities and NGOs with BC early detection services were invited to participate in the survey. A focus group with key radiologists in T&T was held to review the results of the study, identify unaddressed challenges and make recommendations for improvement. Significant challenges exist in service availability and access, physical and human resources, program monitoring and evaluation, quality control mechanisms, follow-up diagnostics and care. Specifically, services are largely monopolized by the private sector at a cost to nationals. Public services which are free, are restricted to major hospitals where wait times extend to 3-6 months, thus contributing to a disparity in access. Both sectors cite a lack of trained staff such as specialist breast radiographers and radiologists. There is also a lack of preventative maintenance and investment in new machinery. No quality control guidelines or manuals for machinery use exist in the public sector. Across both sectors, 70% of institutions have no program evaluation. Other systemic problems such as long wait times for pathology reports also undermine the efficacy of current BC early detection efforts. An organized national breast cancer screening program is not recommended for T&T at this time. More pressing concerns across the cancer care continuum need to be first addressed particularly in strengthening human and physical resource capacity and service quality for detection, diagnosis, and follow-up care. Also, research into factors such as time-to-treat, frequency of late stage presentation and misdiagnosis warrant further attention if T&T is to improve its BC survival rate.
Note: This abstract was not presented at the meeting.
Citation Format: Kimberly Badal, Fidel Rampersad, Hamish Mohammed, Murrie Moosoodeen, Siva Konduru, Nalini Kokaram Maharaj, Adaila Russel, Melissa Nathan, Marisa Nimrod, Wayne A. Warner, Rajini Haraksingh, Adetunji Toriola. Challenges to breast cancer early detection in the developing, high income country of Trinidad and Tobago [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 4226. doi:10.1158/1538-7445.AM2017-4226