Abstract P1-11-14: Evidence-based programs to reduce breast cancer mortality in Panama City
Authors: Cabanes Anna , Roquebert Maria , Cruz Tauane , Benaglio Blanca , Royer Becky 
Published: May 2015

Abstract
In Panama, as in other Latin American countries, breast cancer is the most common cause of cancer-related deaths among women, and is becoming a major public health problem. Breast cancer mortality rates have steadily risen since 2002 and reflect not only breast cancer incidence and risk factors, but also late-stage diagnosis, quality of cancer care and reduced access to health care.
Susan G. Komen® developed an evidence-based strategic plan for reducing breast cancer mortality focused on increasing access to breast cancer screening and care. Komen’s approach resulted from an analysis of the breast cancer continuum of care in Panama City, aimed at understanding the factors that determine whether women enter the breast cancer continuum of care, and the barriers that prevent women from completing the continuum. Komen utilized the results of the study to drive programs and develop evaluation plans.
We conducted four focus groups and individual interviews with 35 breast cancer survivors living in Panama City to assess the factors that determine access to the breast cancer continuum of care, as well as personal perceptions of breast cancer treatment and follow up. In addition, we held 69 in-depth interviews to capture the community’s perceived barriers in accessing cancer care from three stakeholder groups: public and private medical professionals, non-profits, and private insurers. Interviews and focus groups were audio taped, transcribed and the content analyzed for emergent themes and patterns.
Based on the data, we drafted three different paths of breast cancer care depending on the type of health insurance: Seguro Social (Social security system), private insurance, or no insurance. In all scenarios we identified health care system deficiencies within the primary, secondary and tertiary care levels, in particular low medical breast cancer training and lack of delineated referral guidelines. Community level gaps identified include lack of information, awareness, and social support networks.
To address these gaps, Komen implemented strategic activities that included a program to fund interventions to conduct awareness campaigns, train primary care medical professionals, and reduce barriers to access breast health and cancer care that in Panama is mostly localized in the capital. Impact was measured using an impact chart based on evidence-based and best practice interventions in the areas of public awareness, community and professional education, and continuum of care services.
With an investment of $500,000 over two years we were able to reach 2 million people with breast health and breast cancer messaging through 92 television and 268 radio events, and 2,500 views through social media. We funded a total of 36 medical trainings on standard breast health care guidelines by level of care, protocols and referral processes reaching a total of 1,328 medical providers and 65 community leaders, some from indigenous communities (caciques). Finally, we provided housing assistance to 130 women from rural areas that had traveled to receive breast health and breast cancer services, including treatment and follow-up if needed.
Our results show that evidence-based programs provide the opportunity to improve service in areas of most need.
Citation Format: Anna Cabanes, Maria Roquebert, Tauane Cruz, Blanca Benaglio, Becky Royer. Evidence-based programs to reduce breast cancer mortality in Panama City [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-14.