As with many diseases, the burden of cancer falls most heavily on poor, marginalized and rural communities due to their unequal access to screening and treatment. For women living in low and middle income countries, breast and cervical cancers are among the leading causes of morbidity and mortality . It is important to address the significant barriers to quality healthcare that women living in rural or underserved communities may face.
The private sector can complement the substantial work being done by others to address this ongoing NCD challenge by helping to accelerate progress through creative partnerships and collaborations that catalyze innovation and strengthen health infrastructure. Recognizing the unique challenge faced by women, Pfizer, through the Pfizer Foundation1 , has launched a program portfolio with a specific focus on addressing women’s cancers that is aimed specifically at improving equitable access to oncology care and services globally through capacity building and innovative healthcare models.
The Pfizer Foundation grants support a comprehensive and holistic approach toward the prevention and treatment of breast cancer, helping get closer toward the UN Global Goal target to reduce by one-third premature mortality due to NCDs by 2030. They also aim to improve access to quality healthcare for women, in recognition that empowering women is vital to optimal health decision making in families and communities.
In 2016, the Pfizer Foundation is supporting projects to improve breast cancer care in four emerging markets: Peru, Brazil, Rwanda and Kenya. Together, these programs explore opportunities to integrate breast cancer outreach and early screening and diagnosis into existing primary care systems with a link to oncology treatment facilities, thereby expanding access to quality oncology care services to thousands of individuals in Peru, Brazil, Rwanda and Kenya in 2016.
In 2012, Peru had an estimated 3,952 new cases of breast cancer and 1,208 deaths, with an age-standardized incidence rate of 28 per 100,000 women.2 Most of these cases were detected at an advanced stage of disease.
Since 2011, the international nonprofit PATH has collaborated with Peruvian partners to implement a community-based breast cancer program in the northern region of La Libertad. The program has established a feasible, evidence-based approach to early detection at the community level and linked it to triage and diagnostic services at the network level.
With the Pfizer Foundation’s support, PATH plans to scale up this program to reach 115,000 additional women and demonstrate that the model is replicable and sustainable. Specifically, the Foundation’s grant will support building healthcare worker capacity, training doctors and midwives in quality clinical breast exams, training doctors to use ultrasound and fine needle aspiration biopsy to determine management for women with positive clinical exams, and training volunteers as patient navigators.
Brazil (Susan G. Komen)
Breast cancer is the highest cause of cancer mortality and morbidity among women in Brazil.3 With the Pfizer Foundation’s support, Susan G. Komen will implement a program to improve breast cancer care in Brazil by integrating patient support, early detection and timely diagnosis into existing primary care services. The Pfizer Foundation’s grant will also support a multi-phase program that seeks to align Brazil’s national cancer control policies at the city and state levels. This, in turn, will better facilitate the progression of women through the different phases of the continuum of care.
More specifically, the program aims to reduce time between screening, diagnosis and start of treatment by implementing the One Day Clinic approach that has been proven effective in other Brazilian states; improving the quality of screening exams with specialized training for radiologists, physicists and medical technologists on quality of mammography; and providing patient support navigating the system and understanding patient rights, including the access to a help line. Lastly, the program aims to improve quality of screening through multi-disciplinary healthcare worker training and offering patient support and navigation. The program will align with Brazil’s national cancer control policies at the city and state levels.
Rwanda (Partners in Health)
In Rwanda, an estimated 54 out of 100,000 women are diagnosed with breast cancer.4 Despite rising rates of breast cancer diagnosis, women in the country face significant barriers to care. Butaro Cancer Center of Excellence (BCCOE) is one of the only facilities in the country where women with breast cancer can be diagnosed and treated. With this in mind, Partners In Health (PIH) is working with the Rwandan Ministry of Health (MoH) toward the goal of improving accessibility of treatment for breast cancer patients in the country, while also documenting and disseminating lessons learned to inform future efforts to decentralize breast cancer diagnosis and treatment.
The Pfizer Foundation’s grant will allow PIH to implement new national clinical protocols for breast cancer diagnosis and treatment, including a comprehensive social support package. It will also help PIH launch a government certified longitudinal oncology nurse training, which includes nurses from referral hospitals completing a three month curriculum. Together with Rwandan MoH, PIH will produce a report analyzing the impact of providing comprehensive care based on data of breast cancer patient outcomes.
The leading cancers for women in Nairobi, Kenya, are breast cancer, at 51.7 diagnoses per 100,000 individuals, and cervical cancer, at 46.1 diagnoses per 100,000 individuals.5 The Pfizer Foundation’s grant will support a two-year program by Kenya’s AMPATH Oncology Institute to improve services through the continuum of breast cancer care, including cancer prevention, screening, early diagnostics, optimal treatment, palliative and survivorship care.
The program also aims to build capacity through a variety of approaches, including creating tele-medicine and tele-pathology centers, developing a certificate training curriculum for healthcare providers in oncology and multi-disciplinary training, and expanding a mobile screening unit to include breast screening. AMPATH also plans to train community health workers in clinical breast exam techniques and referral protocols and improve data collection and sharing by establishing a cancer registry.
1 The Pfizer Foundation is a charitable organization established by Pfizer Inc. It is a separate legal entity from Pfizer Inc. with distinct legal restrictions.
2 Ferlay J, Soerjomataram I, Ervik M,. et al. GLOBOCAN 2012 v1.0, Cancer Incidence and Mortality Worldwide: IARC CancerBase No. 11 [Internet]. Lyon, France: International Agency for Research on Cancer; 2013. Available from: http://globocan.iarc.fr, accessed on December 13, 2016.
3 Kluthcovsky, Ana Claudia Garabeli Cavalli, Faria, et al. (2014). Female breast cancer mortality in Brazil and its regions. Revista da Associação Médica Brasileira, 60(4), 387-393. https://dx.doi.org/10.1590/1806-9282.60.04.019
5 Korir, A., Okerosi, N., Ronoh, V., et al. (2015), Incidence of cancer in Nairobi, Kenya (2004–2008). Int. J. Cancer, 137: 2053–2059. doi:10.1002/ijc.29674